Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

545 > Week 8: neuro, MSK, rheum, pain > Flashcards

Week 8: neuro, MSK, rheum, pain Flashcards

1
Q

JIA

  • must be diagnosed before ____ (age)?
  • subtype is assigned after how many months of symptoms?
A
  • must be diagnosed before age 16

- subtype assigned after 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Psoriatic arthritis

bimodal age distribution - what is the peak age of presentation?

A

age 3 and age 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which type of JIA is associated with HLA-B27?

most common age and sex?

where is the pain?

A

enthesitis JIA

  • boys 8 and older
  • lower extremity at insertion of tendons/ligaments, fascia, joint capsule to bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the criteria for diagnosis of psoriatic arthritis?

A 
Chronic arthritis and psoriasis 
OR 
meets 2 of following:
-dactylitis (sausage-like digit)
-nail pitting
-onycholysis
-first degree relative with psoriasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the most common form of JIA?

where is the arthritis?

A

50% of JIA is oligoarticular

4 or fewer joints

large joints (knee/hip), may be just one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what form of JIA is often + for ANA?

where is the arthritis?

A 
Often +ANA
• increased risk anterior uveitis (compared to oligoarticular)
• Mix of large and small joints
• Asymmetric or symmetric
Usually early childhoo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which form of JIA commonly affects small joints and teenage girls?

A

Polyarticular RF positive JIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

General characteristics of joint pain with JIA?

A
  • persistent
  • daily
  • worse in AM
  • not severe
  • improves with activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the difference between oligoarticular and polyarticular JIA?

A

oligo: 4 or less joints (usually large joints)
slow onset

RF neg
polyarticular: 5+ joints in first 6 months, mix of large and small, symmetric/asymmetric, slow onset

RF positive
polyarticular: 5+ joints in first 6 months, symmetric, nodules, RAPID onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some features of systemic JIA?

A

• Fever, rash, lymphadenopathy, hepatosplenomegaly, serositis
• Fever (39+) daily with migratory rash: salmon colored macules to trunk and proximal limbs
• Pain worse during febrile period
• Arthritis may be mild or not present initially
Polyarticular arthritis within first 6 months of symptoms: large and small joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common complication of JIA

-what increases risk?

A

anterior uveitis

highest risk of +ANA and young age (<6)

higher risk in oligo, polyarticular RF neg, psoriatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is unique feature of anterior uveitis associated with enthesitis related JIA?

A

painful and acute

oligo and polyarticular often asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Physical exam of JIA

A
  • full MSK including TMJ
  • C-spine and L-spine
  • leg length discrepancy
  • joint hypermobility
  • flexion contractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Workup of JIA

most important test?

A
  • usually normal ESR/CRP
  • if marked elevation in ESR/CRP –> workup for malignancy/infection

RF, anti-CCP Ab, ANA, HLA-B27

most important is ANA (helps stratify development of uveitis)

XR, US, MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

management of JIA

A
  • refer to rheum and ophtho
  • calcium and vit D
  • PT and OT
  • NSAIDs first line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SNOOPPPY mnemonic for headache red flags for peds

A 
Systemic
Neurological symptoms/signs
Onset: sudden (thunderclap)
Occipital 
Pattern: precipitated by Valsalva (coughing, sneezing)
Pattern: positional (worse in recumbent)
Pattern: progressive
Parents: no family history
Younger than 6

also: wakes up from sleep and <6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Chronic progressive headaches

Features

A

brain tumour/abscess

  • crescendo hx
  • <6 months duration
  • increasing severity and frequency
  • wakes up from sleep
  • persistent vomiting without headache
  • neuro and development change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cluster headaches

Features

A 
short unilateral ice pick pain
tearing
nasal stuffiness
Horner syndrome
pacing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some common side effects with triptan?

A

tingling, chest pressure, warming sensation, flushing, dizziness

*combined with naproxen is increased effectiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Medication overuse headache

definition

A

occurs 15+ days in a month as a result of:

  • using simple analgesics (NSAIDs, tylenol) for 15+ days/month for >3 months
  • using triptans/ergotamine/opioids/combo for 10+ days/month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

GENU VARUM vs GENU VALGUM

what’s the diff?

A

genu varum: bow legs
-deformity distal to knee angled toward midline

genu valgum: knock knees
-deformity distal to knee angled away from knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Common causes of genu varum

A
  • physiologic
  • rickets (vit D deficiency - nutrition vs genetic)
  • achondroplasia
  • trauma, infection, tumour of PROXIMAL TIBIA
  • excess prenatal fluoride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Common causes of genu valgum

A
  • physiologic
  • rickets (renal)
  • trauma, infection, tumour of DISTAL FEMUR or PROXIMAL TIBIA
  • paralytic conditions (polio, CP)
  • osteogenesis imperfecta
  • RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how to measure limb length? intercondylar distance?

how often to measure?

A

limb length:
superior iliac spine to medial malleolus

intercondylar distance:
-lie on side with medial malleoli touching

measure intercondylar and intermalleolar distance q6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When would you expect physiologic varus to correct naturally?

A

18-24 months old

consider pathological process if not starting to correct or angulation is progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Risk factors for in-toeing

A
  • intrauterine positioning
  • club foot (bony abnormality)
  • metatarsus adductus
  • sleeping prone with legs internally rotated
  • internal tibial torsion
  • metatarsus primus varus
  • internal femoral anteversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Internal tibial torsion

  • features?
  • management?
A
  • feet turn inward during walking, knees are straight
  • deformity is distal to knee
  • watch and wait
  • usually corrects once walking
  • refer if no improvement at 18 months or walking x 1 year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Medial femoral torsion

  • features?
  • management?
A
  • sit in W position
  • both knees and feet turn inward
  • deformity is proximal to knee
  • run in egg beater position

Resolves by age 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

most common cause of out-toeing?

A
  • physiologic
  • seen in infants
  • resolves when child learns to walk
  • usually by 18 months

normal to have 5 degrees toe-out in kids >3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Definitions

sprain

strain

tendinitis

A

sprain: ligament/connective attaching bone –> bone
strain: muscle/tendon attaching muscle –> bone
tendinitis: tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Examples of overuse syndromes

A

repetitive microtrauma

eg Osgood-Schlatter, shin splints (medial tibial stress)
patellofemoral syndrome (chondromalacia patellae)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Sprains:
-based on assessment of?

Strains:
-based on assessment of?

A

SPRAINS:
-assessment of joint instability (ROM, weight bearing)

STRAINS
-assessment of strength

33
Q

Management of sports injuries in acute phase:

A

relative rest (as long as painfree)

ice limit to 20 min

compression

NSAIDs

34
Q

Prevention of sports injuries

specifically what is AAP recommendation on weight training?

A

flexibility (stretching), hydration, warmup
training and conditioning
rehab

weight training: wait until tanner stage 5

35
Q

Osgood-Schlatter disease

features?
diagnosis?

A
  • most common in adolescent athletes (running and jumping)
    • partial avulsion of patellar tendon at its insertion on the tibia
    • pain, swelling, bony prominence and tenderness over the tibial tubercle at the insertion of the patellar tendon
    • symptoms tend to resolve at approximately 14-15 yrs
  • clinical dx, may use XR to rule out pathology
36
Q

Patellofemoral syndrome

features?
diagnosis?

A
  • pain around or behind the patella that is aggravated by load bearing activities on a flexed knee (eg climbing stairs, running, squatting)
    • anterior patellar pain after sitting for long time
    • runner’s knee, jumper’s knee
    • clinical diagnosis, plain films not helpful
    • physio to focus on strength of knee, hip, and core
    • avoid prolonged NSAID use
    • no evidence for surgical intervention
  • rest!
37
Q

Growing pains

  • location?
  • timing?
  • common age?
A
  • intermittent poorly localized pain b/l lower extremities
  • at night, resolves in minutes and in the morning
  • common to calves and anterior thighs
  • NEVER to joints

common age 4-14

38
Q

Growing pains

  • diagnosis?
  • management?
A

Physical exam

  • generally normal
  • CBC and ESR if symptoms don’t resolve and presentation not typical
  • requires normal blood results (dx of exclusion)
  • reassure
  • heat, massage, stretch
39
Q

Nursemaid Elbow

  • aka?
  • signs and symptoms?
  • common age
A

radial head subluxation

sudden onset elbow pain, refusal to use arm

  • arm held in slight flexion, forearm pronated
  • refusal to SUPINATE
  • NO gross deformity
  • NO swelling

common age 1-4

40
Q

Nursemaid Elbow

suspect fracture if?

A
  • obvious deformity
  • lack of spontaneous movement
  • swelling
  • tenderness
41
Q

Salter Harris fracture

What part is involved in:

type 1 and 2:

type 3 and 4:

type 5:

A

1 and 2: involve growth plate

3 and 4: involve epiphysis (intra-articular)

type 5: crush injury to growth plate
**growth arrest common because physis is injured

42
Q

If toddler is refusing to bear weight, what type of fracture do you suspect?

A

toddler’s fracture:
spiral fracture of distal tibia

typically 9 months to 3 months

43
Q

What type of fractures raise concerns re: physical abuse?

A
  • long bone in pre-ambulatory kids
  • ribs
  • metaphyseal lesions
  • multiple and old fractures
44
Q

Transient synovitis

  • common age
  • features
  • diagnosis
  • management
A 
Transient synovitis
	• Typical age 4-10 (can be younger or older)
	• M>F (2:1)
	• Acute unilateral hip pain
		○ Referred pain to anterior thigh or knee
	• Diagnosis of exclusion
		○ CBC, CRP/ESR: WNL or mild elevation
		○ XR: normal or effusion
		○ US: effusion
		○ Arthrocentesis: N WBC and neg gram stain
	• Supportive care
		○ F/U in 24-48 hours
		○ Rest and NSAIDs
		○ Recover in 3-10 days
69% recurrence rate
45
Q

Septic arthritis

  • common organism?
  • features
  • diagnosis
  • complications
A

Septic arthritis
• Staph aureus most common
-gonorrhea if sexually active
• Fever, decreased use of affected leg, limp/refusal to walk or weight bear
• Hip most commonly affected: held in FABER
• Pain with passive ROM, diaper changes
• Diagnosis: hard to differentiate from transient synovitis
○ Temp >38.5
○ Elevated ESR/CRP and WBC
○ XR: effusion
○ US: effusion
○ Synovial aspirate: WBC and bacteria on gram stain
• Complications in 10-25%
Joint damage can occur within 6-8 hours

46
Q

Osteomyelitis

  • common age
  • patho
  • location
  • organism
  • features
  • diagnostics
A 
Osteomyelitis
-50% in kids <5
	• Staph aureus most common
	• Bacteremia deposits bacteria into bone marrow
	• Femur, tibia, pelvis
	• 50% fever. Pain, limp, reduced ROM, refusal to weight bear
		○ If sub-periosteal spread: erythema, warmth, swelling
	• Labwork may be non-specific
		○ CRP elevated in 90%
		○ Blood cultures positive in 40-55%
	• Imaging
		○ XR: normal, only soft tissue changes
MRI gold standard
47
Q

DISKITIS

  • common age
  • features
  • workup
A

• Kids under 5
• Lumbar back pain, progressive limp, refusal to walk. Afebrile
• Labwork nonspecific
• Imaging
○ XR: abnormal in 75%: decreased vertebral disc space, erosion of end plate
○ CT: not helpful
MRI: r/o vertebral osteomyelitis

48
Q

Legge-Calve-Perthes disease

  • definition
  • common age
  • symptoms
  • workup
A

Legg-Calve-Perthe
• Avascular necrosis of femoral head
• 3-12 years old
• M>F
• Chronic intermittent limp, painful or painless
• Worse with internal rotation and abduction
• Labwork: normal
• XR: negative if early, widening of joint space
Later: increased density and decreased size of femoral head

REFER TO ORTHO

49
Q

Slipped capital femoral epiphysis

  • definition
  • common age group
  • features
  • imaging
A

Slipped capital femoral epiphysis (SCFE)
-most common hip disorder in age group
-displacement of femoral epiphysis from femoral neck through growth plate
• Teens 9-16
• M>F
• Overweight, knee pain
• Knee exam normal despite report of knee pain
○ Passive hip flexion causes obligate external rotation
○ Pain with internal rotation
• Imaging: both hips (20% SCFE bilateral)
US or MRI

REFER TO ORTHO

50
Q

Osgood Schlatter disease

  • definition
  • commonly seen in?
  • symptoms
  • imaging
A
  • overuse injury
  • commonly seen in adolescent athletes especially with jumping or running
  • repetitive microtrauma causes avulsion of patellar tendon
  • bony prominence, swelling, tenderness over tibial tubercle
  • clinical diagnosis
  • imaging to r/o other pathology

symptoms resolve at 14-15 years of age

51
Q

Physical exam of a child with a limp should include:

A
  • all joints and spine
  • hips for all kids with knee pain
  • supine and standing
  • muscle strength
  • leg length measurements
52
Q

Henoch Schonlein Purpura (HSP)

  • what type of vasculitis?
  • symptoms
  • workup
  • management
A
  • small vessel
  • IgA vasculitis

lower extremity purpura/petechiae to legs and buttocks

  • abdo pain
  • arthritis of knees/ankles (50% of kids)
  • renal: proteinuria and hematuria

Workup:
-U/A, CRP

Self limiting 1-3 months
supportive, NSAIDs

53
Q

Kawasaki Disease

symptoms
CRASH and BURN

A 
conjunctivitis
rash (any)
adenopathy (cervical, unilateral, >1.5 cm)
strawberry tongue
hands and feet (erythema and peeling)

Burn: fever x 5 days

54
Q

Kawasaki Disease

  • what type of vasculitis?
  • what are some GI, MSK and CNS symptoms
  • lab workup
  • treatment
  • complications
A

medium vessel arteritis

  • abdo pain, vomiting
  • arthritis
  • irritable, headache

CBC (elevated WBC and platelets), elevated CRP and LFTs urinalysis
Echo and ECG
CXR

need high dose ASA and IVIG within first 10 days

complications: coronary artery aneurysm

55
Q

juvenile dermatomyositis

  • patho
  • symptoms
A

autoimmune vasculopathy of muscles and skin
-necrosis of muscles causing inflammation and proximal muscle weakness

symptoms:

  • symmetric proximal muscle weakness
  • neck abdo muscles, limb girdle
  • fever, malaise, fatigue
56
Q

juvile dermatomyositis

skin manifestations

cardiac manifestations

A
  • heliotrope discoloration (violaceous over eyelids)
  • grotton papules (shiny red plaques ro flexural surfaces of fingers, elbows, knees)
  • ulcerations

CVS: HTN in 25-50%

57
Q

Absence (petit mal) seizures are type of ______ seizures

features

A

generalized

lasts 5-10 seconds
-looks like daydreaming (cannot be interrupted)
ABSENCE of aura and postictal confusion
-COMPLETE loss of consciousness
-clusters >20/day
-provoked by hyperventilation
58
Q

Complex partial seizures are type of _______ seizures

features

A

focal

-lasts 1-2 min
-sudden onset
daydreaming
-automatism (lip smacking, rubbing hands)
-PARTIAL loss of consciousness
-frequent aura
-brief post-ictal
-not provoked by hyperventilation

59
Q

Head injury

symptoms of basilar fracture

A
  • racoon eyes (b/l periorbital ecchymosis)
  • hemotympanum
  • battle sign (post-auricular ecchymosis)
60
Q

Majority of concussion symptoms resolve by ______ weeks

A

four weeks

if prolonged: refer to interdisciplinary concussion team

61
Q

CT head required for any kid with minor head injury and any of these findings:

A
  • GCS <15 at 2 hours after injury
  • suspected open/depressed scalp fracture
  • worsening h/a
  • irritable
  • basal skull fracture
  • large boggy hematoma of scalp
  • dangerous MoI
  • 4+ episodes of vomiting
62
Q

Concussion

initial rest is recommended for ______ (time)

A

first 24-48 hours

  • limited physical and cognitive activity
  • sleep (encourage)
  • screen time (limit)
  • drugs (avoid)
  • driving (avoid)
63
Q

Concussion

when should return to sport occur?

A
  • when back to school FT at full academic load without accommodations
  • seek care immediately if new concussion symptoms or new suspected consussion
64
Q

Guillane Barre

-common triggers?

A

-viral infection
(URTI or gastro) 10-14 days before onset
EBV, CMV

65
Q

Guillane Barre

symptoms

A

-ascending weakness and paresthesia

progressive weakness/tingling in legs
-crawling skin sensation in feet and hands

progresses to acute flaccid paralysis

66
Q

Guillane Barre

prognosis and dtreatment

A

-remits spontaneously
can takes weeks to months to years
-can have lasting residual weakness

67
Q

Myasthenia Gravis

symptoms

A

-variable

classic triad:

  • droopy eyelids
  • blurry vision
  • sense of choking

also:
-slurred speech
worse in evening

68
Q

Multiple sclerosis

early symptoms
triggers

A

MSK: paresthesia and weakness (face, trunk, limbs)
impaired gait
eyes: blurred vision, diplopia

fatigue, depression

triggers: exercise, heat, weather

69
Q

Bells palsy

  • patho
  • symptoms
A

facial nerve (CN 7) neuritis
LOWER motor neuron
peripheral neuropathy

-viral vs autoimmune vs idiopathic trigger –> neural inflammation

unilateral facial weakness, inability to close one eye

  • mouth drooping
  • unilateral ptosis
  • loss of nasolabial fold
  • SMOOTH forehead
  • sensitivity to sound
  • facial paresthesia
70
Q

Scoliosis

signs and symptoms

A
  • shoulder height asymmetry
  • scapular prominence
  • rib prominence/hump
  • leg length discrepancy
71
Q

SLE

-patho

A

genetic predisposition activated by environmental factors
-self-antigens, autoimmune

  • environmental trigger: UV radiation, viral infection (EBV)
  • estrogen
72
Q

SLE

symptoms

A

systemic: fever, fatigue, weight loss, lymphadenopathy, HSM

photosensitive butterfly malar rash

  • discoid rash
  • arthritis (symmetric)
  • kidneys: lupus nephritis
  • headache
  • antiphospholipid antibody syndrome (prothrombotic) –> increased risk DVT
  • pericarditis
  • pleurisy, pulmonaryHTN
73
Q

SLE

what to know about ANA testing?

A

90% of SLE cases will show ANA antibodies

20% of general population will have positive ANA with no SLE

74
Q

Acute rheumatic fever

organism?
JONES criteria

A

GAS

2 major manifestations OR 1 major and 2 minor manifestations AND evidence of GAS

JONES criteria: (imagine heart shape in the place of O)
J = migratory polyarthritis (J for joints): 60-80%
O = carditis (O shaped like heart): 50-80%
N = subcutaneous nodules (N for nodules): 0-10%
E = erythema marginatum (E = erythema rash): <6%
S = Sydenham chorea (S = sydenham): 10-30%

Minor manifestations: fever, arthralgia, elevated ESR/CRP, prolonged PR interval

75
Q

Acute rheumatic fever

timeline after GAS infection

A

2-3 weeks between GAS infection and manifestation of arthritis and carditis

chorea 1-8 months after GAS

**high rate of recurrence in first 5 years

76
Q

Acute rheumatic fever

diagnostic test?

A

throat culture

ASO antibody titres

77
Q

Acute rheumatic fever

describe the arthritis and carditis symptoms

A

arthritis: occurs in 70%

large joints (knees, ankles, wrists, elbows)

  • migratory
  • lasts 1-2 days to a week

carditis:
mitral and aortic murmur

78
Q

Acute rheumatic fever

treatment

A

-penicillin to prevent recurrent ARF

for YEARS (if carditis present then will be on PCN until age 21 or 10 years after initial dx)

NSAIDs for arthritis

high dose ASA for carditis

545 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions