Rheum

Question 1

Back Pain that improves with activity and gets worse with rest should make you think of

Answer 1

Ankylosis spondylitis

Question 2

Presentation for dermatomyositis

Answer 2

Younger than 10
Heliotrope rash on the face
Grottons sign (shiny skin on extensor surfaces of IPJ)
Proximal muscle weakness (difficulty getting dressed or climbing stairs)

Question 3

Lab finding in dermatomyositis

Answer 3

Elevated CK level

Question 4

Lab findings in HSP

Answer 4

Elevated BUN and Cr, heme positive stools, UA with hematuria and proteinuria

Normal platelet count

Question 5

HSP UA findings

Answer 5

Hematuria and proteinuria which is transient and resolves in a few months

Question 6

What is the most common etiology to the abdominal pain in HSP

Answer 6

Intussusception

Question 7

Presentation of JIA (6)

Answer 7

Morning stiffness, gradual loss of motion, rash

Less than 16 yrs old

Symptoms present for at least 6 wks in at least 1 joint

Large joint involvement

More common in females

ANA often positive and rheumatoid factor neg

Question 8

Polyarthrisits knows:

Answer 8

5 or more joints in first 6 months

Systemic disease is uncommon

Question 9

Oligoarthritis/pauciaethritis to know

Answer 9

4 or fewer joints in first 6 months

Main morbidity is chronic uveitis

If Rheumatoid factor positive disease is worse

Boys are usually HLA B27 positive

Question 10

Systemic onset JIA to know

Answer 10

Male = female

Extraarticular involvement common

Systemic manifestations -
High fever with shaking chills, leukocytosis, rash, hepatosplenomegaly, lymphadenopathy, pleuritis/pericarditis/serositis

ANA and RF are negative

Question 11

Hat are some long term consequences of JIA

Answer 11

Leg-length discrepancy
Joint contractures
Permanent joint destruction
Blindness from chronic uveitis (not with systemic JIA)

Question 12

How do you distinguish JIA from leukemia

Answer 12

JIA will have morning stiffness and symptoms wax and wane

Leukemia - pain awakens child at night with bone pain that doesn’t involve a joint. Symptoms are persistent and worsening.

Question 13

Causes of arthritis in children

Answer 13

Glove*

Gonorrhea, Genetic syndromes 
lyme
Osteomyelitis 
Viral
Evasive infection (septic arthritis)

Question 14

Causes of monoarticular disease

Answer 14

Lyme, legg calve perthes, leukemia

Question 15

What causes polyarticular disease

Answer 15

Fabry and farber disease, infections, reactive arthritis, lupus, connective tissue disease, malignancy