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PPC3 Exam 2 > Rheumatology: Kawasaki, Henoch-Schonlein Purpura, Chronic Pain > Flashcards

Rheumatology: Kawasaki, Henoch-Schonlein Purpura, Chronic Pain Flashcards

1
Q

Kawasaki Syndrome: Diagnostic Criteria of CDC (5)

A
  1. Fever > 5 days
  2. Presence of 4 of 5 following:
    a. Bilateral conjunctiva injection
    b. Changes in mucous membranes of upper respiratory tract
    c. changes of peripheral extremities
  3. Rash: primarily truncal, polymorphic
  4. Cervical Lymphadenopathy
  5. Illness that cannot be explained by other known disease processes
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2
Q

Kawasaki Mucutaneous Lymph Node Syndrome (4)

A

a. Asians highest % affected
b. Risk to blacks> whites
c. Males> females
d. Peak age 6 months - 2 years (75% before age 5 years)

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3
Q

Kawasaki Phases (3)

A
  1. Acute: up to 11 days
  2. Sub-acute: 11-21 days
  3. Convalescent: 21-60 days
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4
Q

Acute Kawasaki Clinical Picture (6)

A
  1. Erythema./edema hands/feet
  2. Irritable, conjunctivitis
  3. Fever, oral findings, rash
  4. Early form of arthritis/ arthralgia- small and large joints
  5. Lethargy, diarrhea, abdominal pain,
  6. Pericarditis, pericardial effusion, myocarditis
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5
Q

Sub-Acute Kawasaki Clinical Picture (4)

A
  1. Desquamantion of hands/toes abdominal pain, hepatitis
  2. Oral findings may persist edema
  3. Joint pain may persist
  4. Arterial aneurysms form now- Now is when are at risk for MI or rupture
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6
Q

Kawasaki: Worrisome signs of probability of Cardiac involvement (7)

A
  1. Males
  2. Age < 12 months
  3. Recurrent fevers after defervesence
  4. Recurrence of rash
  5. Exaggerated leukocytosis
  6. > ESR
  7. Cardiac dysrhythmias
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7
Q

Kawasaki Convalescent stage (3)

A
  1. Symptomatology should start to resolve
  2. Must keep watch on those with aneurysms - followed by cardiology as needed
  3. Recurrence is rare but can happen
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8
Q

Kawasaki Labs (6)

A
  1. CBC, ESR, Platelet
  2. Chemistries
  3. Blood Cultures
  4. Urine Cultures
  5. CSF
  6. ANA, ASLO, RF
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9
Q

Kawasaki Differentials (8)

A
  1. Scarlet fever
  2. Staph, scalded skin syndrome
  3. Toxic shock
  4. Rocky mountain Spotted fever
  5. Rubeola
  6. JRA
  7. SLE
  8. Polyarthteritis nordosa
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10
Q

Kawasaki Treatment (4)

A

a. IV IGG
b. Aspirin
c. Cardiac Echo
d. Close follow-up

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11
Q

Henoch-Schonlein Purpura (4)

A
  1. Most common vasculitis of childhood
  2. 75% of cases occur b/w ages 2-11 yrs
  3. Etiology unknown
  4. Some have been associated with post EBV, adenovirus, enteric bacteria, streptococcus, s/p URI
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12
Q

Henoch-Schonlein Purpura: Signs and Symptoms (7)

A
  1. Purpuric rash
  2. Abdominal pain
  3. Arthritis
  4. Nephritis
  5. Intussusception (2-3%)
  6. Scrotal swelling
  7. Renal involvement (20-50%)
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13
Q

Henoch-Schonlein Purpura: Treatment (2)

A
  1. Supportive care
  2. Role of corticosteroids controversial:
    * May improve rash, arthritis and abdominal pain
    * Unclear if reduce progression of renal disease
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14
Q

Systemic JRA with joint pain lab results (8)

A

WBC: ++ elevated

Hg/Hct: anemia

Plt: elevated

ESR: ++ elevated

CRP: ++ elevated

ANA: Negative

RF: Negative

ASO: Negative

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15
Q

Polyarticular with joint pain lab results (8)

A

WBC: elevated

Hg/Hct: normal

Plt: decreased/normal

ESR: ++ elevated

CRP: +++++++ elevated

ANA: negative

RF: ++ elevated

ASO: negative

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16
Q

Pauciarticular with joint pain lab results (8)

A

WBC: normal

Hg/Hct: normal

Plt: normal

ESR: elevated

CRP: elevated

ANA: positive

RF: negative

ASO: negative

17
Q

RF with joint pain lab results (8)

A

WBC: +/-

Hg/Hct: Anemia

Plt: normal

ESR: elevated

CRP: elevated

ANA: negative

RF: negative

ASO: rising over 3 weeks

18
Q

SLE with joint pain lab results (8)

A

WBC: low

Hg/Hct: anemia

Plt: elevated

ESR: elevated

CRP: low

ANA: positive

RF: negative

ASO: negative

19
Q

Kawasaki with joint pain lab results (8)

A

WBC: elevated

Hg/Hct: mild anemia

Plt: elevated 2nd week

ESR: elevated

CRP: elevated

ANA: negative

RF: negative

ASO: negative

20
Q

Chronic Pain Syndromes: Fibromyalgia (6)

A
  1. More common white females
  2. Disorder of diffuse ms pain/fatigue
  3. Headaches, abd pain
  4. DX: clinical
  5. Labs: normal
  6. Treatment:
    a. NSAIDS
    b. Low dose tricyclics
    c. Physical therapy
    d. Cognitive behavioral therapy
21
Q

Lyme overview including treatment length (7)

A
  1. Usually large joints
  2. ANA, RF negative
  3. Lyme Elisa positive
  4. Sed rate/CRP- may be elevated

Treatment

  1. Amox x 28 days
  2. Doxycycline x 28 days
  3. If Fails: 2nd months or with Ceftriaxone IV x 28 days

PPC3 Exam 2 (11 decks)

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