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2023 RC Blue's Clues > Rheum and MSK > Flashcards

Rheum and MSK Flashcards

1
Q

Diagnosis of JIA

A

Onset before age 16
Presence of inflammatory arthritis in at least one joint for >= 6 weeks

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2
Q

Risk factor for uveitis

A

Female
oligo articular
age < 7
ANA +ve

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3
Q

Systemic onset JIA presenting symptoms

A

Fevers (often predictable timing)
Rashes
Serositis
Lymphadenopathy
HSM
joints

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4
Q

Common complications JIA

A

Uveitis
Tmj complications
Macrophage activation syndrome

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5
Q

How to assess uveitis

A

Refer to optho for slit lamp
Screen every 3 months in high risk children

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6
Q

Symptoms of acute uveitis

A

Conjunctival erythema
Photophobia
Eye pain

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7
Q

Macrophage activation syndrome signs and symptoms

A

Rapid development
Constant fevers
HSM
lymphadenopathy
Hepatic dysfunction
Encephalopathy
Easy bruising/ bleeding

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8
Q

Macrophage activation syndrome lab findings

A

Hyperferritinemia (thousands)
Cytopenias
Hypertriglycerides
Coagulopathy
Elevated LDH and liver enzymes
Sharp drop in ESR with higher CRP
Bone marrow: hemophagocytosis

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9
Q

Macrophage activation syndrome treatment

A

Hugh dose steroids
Interleukin inhibitor (anakinra)

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10
Q

genu varum vs. valgus

A

valgum/valgus - goes in - knees in
varum/vargus - air - knees out

varus <2 can be normal

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11
Q

Blount Disease

A

tibia rotates
+ lateral thrust sign (sharp angulation outwards at the knee)
on differential for bowing of the legs before age 2

think about this if sharp bowing at the knee

usually asymmetric

widening of growth plates on XR

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12
Q

leg bowing referral to ortho

A

age over 2
sharp angle
lateral thrust
methaphyseal/diaphyseal angle >11

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13
Q

Elbow ossification centers

A

CRITOE (2,4,6,8,10,12)
- capitellum
- radial
- internal
- trochlea
- olecranon
- external

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14
Q

Nursemaid’s elbow (radial head subluxation)

A

radial head normally anchored to ulna by annular ligament
in nursemaid’s, the proximal annular ligament subluxes off of the radial head

exam: cannot supinate (hand up)

reduction: supination with pushing onto radial head

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15
Q

posterior elbow dislocation

A

mechanism: falling backwards onto arm with elbow extended

look for olecranon fractures

treatment: immediate reduction with longitudinal traction to forearm with upward pressure on distal humerus

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16
Q

olecranon fracture

A

mechanism: falling ont o flexed ot extended elbow

treatment
- non-displaced = non-operative in long arm splint or cast
- displaced = ORIF

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17
Q

condylar fracture

A

need AP, lateral and oblique views of elbow

high risk for nonunion and AVN

treatment
- non-operative if <2mm displaced
- operative if >2mm

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18
Q

avascular necrosis

A

Management
- bisphosphonates (unless associated with LCP)

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19
Q

12 yo F with pain in her right leg with running and squatting. X ray shows soft tissue swelling over right tibia tubercle, and the tubercle appears fragmented. What is this? Management?

A

Osgood Schlatter Disease (OSD)
- microavulsion fracture of patellar tendon onto tibial tuberosity
- M>F, bilateral in 30%
- localized pain with running, jumping, kneeling and focal tenderness at tibial turberosity

Treatment:
- activity modification
- stretching
- PT to strengthen surround muscles
- DONT CAST

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20
Q

Sinding-Larsen-Johansson Disease

A

Sinding-Larsen-Johansson Disease (SLJD) is like osgood sclatter but patellar tendon insertion to inferior patellar pole

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21
Q

Complex regional pain syndrome diagnostic criteria

A

Need 2/4:
1. Presence of initiating noxious event or cause of immobilization
2. Continuing pain, allodynia, or hyperalgesia with which pain is disproportionate to inciting event
3. Evidence of edema, changes in skin blood flow abnormal motor activity in the region of the pain.
4. Exclusion of alternative diagnosis

more common in teen females
do CBC, CRP, ESR - should be normal

treatment: pain goals, CBT, PT/OT

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22
Q

CPS NAT Fracture pearls

A

high risk fractures
- rib
- metaphyseal
- humerus <18 mo
- femur non ambulatory
- spiral/oblique

Imaging
- skeletal survey in all children < 2yo with fracture. If initial negative, repeat in 2 weeks

Labs
- add ca, po4, alp, urine
- consider pth, vit d, serum copper, ceruloplasmin

23
Q

Calcaneal apophysitis

A

AKA Sever disease

  • common in kids (more common than Achilles tendonitis)
  • common in active kids
  • often bilateral

presentation
- heel pain with running and jumping
- tenderness over posterior heel
- pain with squeeze test

Tx: NSAIDs, ice, PT, activity modification

24
Q

Lupus common antibodies

A

ANA + (sensitive)
dsDNA (Specific)
anti-smith (specific)
anti-Histone (drug induced lupus)

25
Q

multi system involvement in lupus (MD SOAP BRAIN)

A

Malar rash
Discoid rash
Serositis
oral ulcers
arthritis
photosensitivity
blood (hemolysis, low WBC, low plt)
renal (proteniuria, casts, hematuria)
ANA +
immunologic (dsDNA, smith, lupus anticoagulant)
neurologic (psychosis, seizures)

26
Q

Labs to follow in lupus

A
  • low C3/C4, complement (lower in worse disease)
  • anti ds DNA
  • anti phospholipid ab
27
Q

Classic rash in lupus

A

cheeks
sparing nasolabial folds
photosensitive

28
Q

what is an important test to do in new lupus?

A

urinalysis (if urine involvement, admit them)

29
Q

Investigations in lupus

A
  • CBCd
  • CRP/ESR
  • ferritin
  • ANA (must be positive to be lupus)
  • Anti dsDNA
  • extractable nuclear ab (anti-sm, anti-rnp, anti-ro, anti-la)
  • antiphospholipid antibodies (increased risk for clotting)
  • C3/C4 (low)
  • urinalysis

once diagnosied:
- echo
- PFT
- bone density
- TSH, anti TPO

-consider macrophage activation syndrome labs
(ferritin, trigs, fibrinogen, d-dimer)

30
Q

Meds for lupus treatment

A

plaquinil for everyone
- aka hydroxychloroquine
- check eye exam annual

steroids when unwell

31
Q

lupus emergency complications

A

DIC/clotthing
- pulm hemorrhage, stroke, PE
- due to antiphospholipid antibody syndrome

MAS
- type of HLH
- excessive inflammation and cytokine storm
- fever, rash, HSM
- high CRP, ESR (may be lower than baseline)

32
Q

Catastrophic Antiphospholipid Syndrome

A
  1. Evidence of involvement of three or more organs, systems, or tissues
  2. Development of manifestations simultaneously or within 1 week
  3. Confirmation by histopathology of small-vessel occlusion in at least 1 tissue
  4. Lab confirmation of presence of APLs
33
Q

Systemic JIA (aka Still’s disease)

A
  • daily spiking fever (quotidian) x 2 weeks
  • erythematous, salmon colored rash (during fever)
  • lymphadenopathy
  • HSM
  • serositis
  • arthritis (may appear months later)
34
Q

Vacterl features

A

Diagnostic: > 3 ___ anomalies
Vertebral defects (hemivertebrae, butterfly, rib anomalies, sacral agenesis, scoliosis, tethered cord)

Anal atresia (others: imperforate anus, fistula)

Cardiac anomalies (VSD, ASD, TOF)

TEF

Esophageal atresia

Renal anomalies (renal agenesis/dysplasia, horseshoe kidney, ureteral anomalies)

Limb (radial defects): underdevelopment/agenesis of thumb, radial bone

35
Q

Legg Calves Perthes

A
  • idiopathic AVN of femoral head in young kids age 3-10 yr

Presentation
- Trendelenburg gait
- Pain, if present, is usually activity related and may be localized to the groin or referred to thigh/knee region
- Decreased internal rotation
- Decreased abduction
- Thigh and buttock atrophy

Imaging
- Pelvic X-ray (AP + frog-leg): morphologic changes (“crumbled”) of the proximal femoral epiphysis
- MRI is the best test for early Perthes
- Bone scan can show decreased perfusion to femoral head early on
MR is most sensitive
XR is first line

36
Q

Anti TNF side effects (ex. infliximab)

A
  • Injection or infusion side effects
  • Infections
  • Reactivation of TB (disseminated)
  • Pancytopenia
  • Neurological (MS like syndrome)
  • Autoimmunity
  • Malignancy
  • Don’t give live vaccines to kids on immunosuppressants !!!
37
Q

PFAPA

A

Onset <5yrs
Fever (recurrent, at least 5 days, regular occurence q3-6 weeks)
Aphthous stomatitis and/or pharyngitis (with or without cervical adenitis)
High inflamm markers during episodes
Well between episodes
Resolves at 5-8yrs

Treatment: Prednisone single dose 1-2mg/kg and tonsillectomy (cureable)
No genetic associations

38
Q

Familial mediterranean fever

A

Onset <20yrs
Short duration of fever 1-3days
Irregular occurrences
Present with erysipeloid erythema rash, monoarthritis, polyarthritis or sterile peritonitis

HIGHEST RISK OF AMYLOIDOSIS (use colchicine to help reduce amyloids and avoid this risk)

Genetic testing - familial

39
Q

TRAPS - TNF associated periodic fever syndrome

A

recurrent long fevers (1 week to 1 month long)

40
Q

salmon or evanescent rash

A

systemic JIA

41
Q

Atypical KD criteria

A

Fever >5d but <4 features AND CRP >30 or ESR >40

WITH + echo findings OR 3 or more lab features
Anemia
Elevated plts
Low albumin
Elevated ALT
Sterile pyuria
Elevated WBC

42
Q

risk factors for coronary artery aneurysm in KD

A

Prolonged fever
<1yr and >9yr
Male
Hypoalbuminemia
Thrombocytopenia
Prominent infllam markers

43
Q

Child with recurrent 3-4d episodes of fever, abdominal pain, arthritis and erysipeloid rash, family history of renal disease. What is this? What do you treat with?

A
  • FMF
  • colchicine (prevent amyloidosis)
44
Q

CAP - Cryopyrin-Associated Periodic Fever

A

periodic fever syndrome assocaited with hearing loss

45
Q

Ewing sarcoma classic findings

A

EEWWW - moths
EEWWW - onions (periosteal rxn with new bone formation)
EEWWW - axial

46
Q

osteosarcoma common findings

A

sunburst sign on Xray (radiating calcifications around the bone) - think O the Sun!

47
Q

methotrexate side effects

A

Immunosuppression
Transaminitis
GI upset
Oral ulcers
Pulmonary toxicity (rare and usually only upon initiation of methotrexate)
Teratogenic
Avoid alcohol (exacerbates transaminitis)
No live vaccines
Pulmonary toxicity

48
Q

Tricky lab test consistent with lupus

A

positive RPR suggestive of lupus

49
Q

What is the most clinically significant complication of neonatal lupus?!?!

A

HEART BLOCK!! Can also get cardiomyopathy and valve regurg and effusions - Screen with serial echos from weeks 18-30, treat with dexamethasone from time of diagnosis to delivery

50
Q

Spondylosis

A

Defect in the pars interarticularis, the segment of bone connecting the superior and inferior articular facets in the vertebra

Mechanism: repetitive hyper-extension stresses (think gymnast, football, wrestlers)
most commonly at L5

most common cause of back pain in adolescents

Discomfort with spinal extension

51
Q

JIA criteria

A

JIA = chronic arthritis (single joint >/= 6 weeks) with onset before age 16

52
Q

Lyme disease

A

Presentation:
Erythema migrans - 89%
Rash that appears at the site of the tick bite, usually within 7-14 days after bite
Can be accompanied by fever, fatigue, headache, neck pain, arthralgia, myalgia
Arthritis - 7%
Most common clinical manifestation of systemic untreated lyme
Typically a knee that is ++ swollen but not that painful
Facial nerve palsy (typically bilateral)- 3%
Aseptic meningitis - 1%
Carditis - 0.5%

Diagnosis:
Clinical - Serum antibody testing is highly sensitive AFTER 4 weeks

Treatment:
Early localized - Doxycycline x 10 days for children > 8 yo
Alternate children < 8 yo - Amoxicillin or cefuroxime x 14 days
Neuro Lyme: IV ceftriaxone, IV penicillin, or PO doxy 2-3 weeks

53
Q

juvenile dermatomyositis terrible D’s

A

Always ask about the dangerous Ds - dysphagia, dyspnea (ILD or Resp wall weakness), dysphonia - need to be admitted and kept NPO

54
Q
A

2023 RC Blue's Clues (20 decks)

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