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Peds Exam 2 > Lecture 6: Rheum & MSK > Flashcards

Lecture 6: Rheum & MSK Flashcards

1
Q

3 Requirements for Dx of Juvenile Arthritis (JIA)?

A
  1. Evid of joint inflammation
  2. CHRONIC arthritis (> 6 wks)
  3. Sxs must have been present at < 16 yrs old
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2
Q

4 signs on PE indicating chronicity of Juvenile Arthritis

A
  1. Synovial thickening
  2. Contracture
  3. Bony proliferation
  4. Limb length discrepancy
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3
Q

Definition of Systemic Juvenile Arthritis/Still’s Dz
(subset of JIA)

What is the typical fever pattern in this dz?

A

Systemic inflammation BEFORE onset of arthritis

daily fever spike of > 39 C –> quickly goes below baseline
- feel fine b/t spikes

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4
Q

4 characteristics of the rash a/w Systemic Juvenile Arthritis/Still’s Dz?

A
  1. at peak of fever
  2. Erythematous maculopapular rash on trunk/extremities
  3. Migrates + fades quickly
  4. Dermatographia
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5
Q
  1. Main thing seen on labs a/w Juvenile Arthritis?
  2. What other lab results a/w JIA?
  3. What is NOT seen in kids in JIA labs?
A
  1. ANA (anti-nuclear Abs)
  2. Evid of systemic inflam (C reactive protein, WBCs, etc)
  3. Rheumatoid factor NOT seen in kids w/JIA
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6
Q

Which type of JIA has the highest prevalence of ANAs
- what is only prob w/ANAs for Dx?

When is Rheumatoid factor positive?

A

Oligoarticular JIA = most ANAs

Rheumatoid factor is positive in adol + adults w/ RA

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7
Q

What is lst line Tx for JIA?

  • when should you switch pts to something else?
  • what are the other 3 Tx options?
A

1st line = NSAIDs
- switch if not working in 1-2 wks

other Tx options

  1. Hydroxychloroquine
  2. Methotrexate
  3. Biologics (-mabs, etc)
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8
Q

What is the main complication of JIA?

Therefore kids w/what dz are required to be screen for this?

A

Uveitis
- note: MC cause of blindness in kids and often Asx

screening required for ALL kids w/chronic arthritis

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9
Q

3 cutaneous manif a/w Juvenile Dermatomyositis (JDM)?

A
  1. Heliotrope rash –> rash around eyes
  2. Gattron’s papules (fingers)
  3. Periungual erythema
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10
Q

Main sign a/w Juvenile Dermatomyositis?
What it is/what is it d/t?

Other signs

  1. Calcinosis/calcif of muscles
  2. Lipotrophy
A

Gower’s sign = child must must hands to “walk own body up from lying prone position to stand
- d/t lack of strength of in hips/thighs (proximal muscle weakness)

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11
Q

What 3 things provide evid of inflammatory myositis in JDM?

A
  1. Muscle enzymes elevated
  2. Muscle Bx
  3. MRI
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12
Q

What is the initial Tx for JDM?

- other tx options?

A

start w/prednisone

  • other: Methotrexate, Cyclophosamide
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13
Q

2 Cutaneous manifestations of Henoch-Schonlein Purpura (HSP)?

note: dz peaks in winter

A
  1. Palpable purpura = MC

2. Edema (hands, feet, face, scrotum)

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14
Q

MC areas and appearance of Palpable Purpura in HSP?

A

MC in dependent areas –> bac of legs/butt

appearance = petechia/macules/urticaria –> ecchymosis

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15
Q

4 things a/w Arthralgia/arthritis see in Henoch-Schonlein Purpura?

A
  1. in large LE joints
  2. v. painful–> refuse to bear wt
  3. joint swelling but usu no erythema
  4. Transient
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16
Q

3 signs a/w GI involvement in Henoch-Schonlein Purpura?

Note: onset = w/in 1wk -1 mo of rash

A
  1. colicky abd pain
  2. heme (+) stools
  3. intestinal perforation
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17
Q

What is the renal involvement in Henoch-Schonlein Purpura (HSP) d/t? 3 things seen w/it?

Note: onset = w/in 1-3 mo of rash

A

d/t acute glomerular nephritis

  1. hematuria/proteinuria
  2. HTN
  3. +/- renal failure
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18
Q

2 things seen on labs a/w Henoch-Schonlein Purpura
- what cannot be present?

Results on pathology?

A
  1. Elevated inflam markers
  2. Normocytic, normochromic anemia
    - CANT HAVE THROMBOCYTOPENIA

Pathology –> IgA deposition w/Leukocytoclastic vasculitis

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19
Q

Classic palpable, non-thrombocytopenic purpuric rash + 1 of following:

  • arthritis or arthralgia
  • abd pain and/or GI blood loss
  • Bx w/IgA deposition

What name of this/dz a/w?

A

EULAR consensus criteria for HSP

20
Q

What is given for Tx of arthritis in HSP?

Tx for severe GI dz or active renal dz?

A

Tx for arthritis = NSAIDs

Tx for severe GI dz or active renal dz = CCS

21
Q

1 y/o pt in February present w/fever for last 5 days, non-exudative bilateral conjuctivitis, swollen/red/cracked lips and tongue and LAD of single cervical node. What is Dx?\

What is name for lip/tongue sign?
Peak months?

A

Dx = Kawasaki Dz

Strawberry lips + tongue

Peak = February - May

22
Q

Nemonic for Dx criteria for Kawasaki Dz and what each stands for?

What if pts present w/4+ ?

A

“FEBRILE”

  1. Fever
  2. Exanthem
  3. Bulbar conjunctivitis
  4. Rash
  5. Internal organ involvement (not part of it)
  6. LAD
  7. Extremity changes

4+ present –> can Dx on day 4 of fever

23
Q

What is the mainstay of Tx for Kawasaki Dz?
- when given and why?

Other medication given in this dz?

A

IVIG
- given w/ 7-10 days of onset of rash –> prevent cardiac complications (HIGH RISK OF CORONARY ARTERY ANEURYSM)

ASA –> once instance where given in kids
(Reye’s Syn)

24
Q

5 y/o comes in complaining of deep aching pain for 6 months that occurs MC in her legs. Her mother said the pain usu occurs after playing or later in day/night. PE was normal. What is Dx and how to Tx?

A

Dx = growing pains
Note: MC in 3-7 y/o & legs, chronic pain

Tx = stretching and reassurance

25
Q

5 y/o pt comes in non-articular bone pain, back pain, bone tenderness, severe wt loss + fever, night sweats and bruising… What is most likely cause?

A

Cancer

26
Q

What in newborns put them at risk for developing Developmental Dyplasia of Hip (DDH)?

Other RFs: female, breech, FHx

What are the 2 main presentations of baby w/DDH?

A

newborns = ligamentous laxity –> spontaneous hip dislocation

  1. Asymmetrial Creases
  2. Galeazzi’s Sign –> asymmetric knee heights
27
Q

Name of the two screening tests for Developmental Dyplasia of Hip/what they are for?

A
  1. Barlow Test = dislocation

2. Orotolani Test = reduction

28
Q

Tx of DDH for younger kids < 6 mo vs older kids?

A

young kids < 6 mo –> Pavlik harness –> put hip back in place (usu in 2 wks)

older kids –> surgery

29
Q

Why does Avascular Necrosis of the Femoral Head occur?

what is it a common complication of?

Note: aka Legg-Calve-Perthes Dz

A

Femoral Head lacks collateral blood supply

complication of SCD

30
Q

3 common S/s of Avascular Necrosis of the Femoral Head?

What is late sign of dz seen on XR?

Tx for kids > 6 y/o?

A
  1. painless limp
  2. +/- intermittent LE pain
  3. decr internal rotation + abduction of hip

Late sign on XR = flattening of femoral head

Tx = braces/surgery

31
Q

What d/o is an orthopedic emergency, mainly occurring in adolescents?

A

Slipped Capital Femoral Epiphysis

32
Q

12 y/o pt presents w/limp, decr ROM and atalgic gait. You notice she is holding her R leg externally rotated position. When you hip her R hip her leg externally rotates and there is limited internal rotation + loss of flexion/extension.
Dx?
Tx?

A

Dx = Slipped Capital Femoral Epiphysis
- note: if unstable pts cant ambulate at all

Tx: NWB status, ortho referral for surgery

33
Q

2 complcations of Slipped Capital Femoral Epiphysis?

A
  1. Chondrolysis

2. Avascular necrosis

34
Q

What is Osgood-Schlatter Dz?

When does it typically occur and boys vs girls?

A

Microfracture or partial avulsion involving tibial tubercle (TT)

Typically after growth spurt
- earlier in girls than guys

35
Q

3 s/s of Osgood-Schlatter Dz?

Tx = rest, modify activity, ICE, NSAIDs, stretch/exercises

A
  1. knee pain (during/after activ)
  2. tender + local swelling (TT)
  3. bony enlargement (TT)
36
Q

How to distinguish in-toeing vs out-toeing? How position the child?

A

Thigh-Foot-Angle Measurements w/child lying prone

- look at angle of foot compared to thigh

37
Q

Other names for Bowleg and Knock Knees

only 2 reasons surgery needed?

A

Bowleg = Genu Varum
Knock Knees = Genu Valgum

surgery if severe disformities or gait dysfxn

38
Q

What is torticollis?

2 common findings in infants?

A

shortening of sternocleidomastoid muscle

  1. tilt ear towards affected side
  2. look up toward contralateral side
39
Q

How does Polydactyly affect Af Am vs Caucasians?

A

Af Am –> pinky affected (AD inheritance)

Caucasians –> thumb affects

40
Q

3 types of Polydactyly?

What type is the only one that doesnt need surg? what is Tx?

A

Type 1 = soft tissue only –> dont need surg
- Tx = ligation or electrocautery

Type 2 = duplicate finger +bone/joints

Type 3 = duplicate finger + metacarpal

41
Q

What is scoliosis? How detect?

When is least likely idiopathic?

2 non-idiopathic causes?

How to measure angle of curve?

Who more likely to have bigger curve?

A

Lateral curvature of spine (truncal asymmetry)
- w/”forward bend test”

Least likely idiopathic in infants (birth - 3 yrs)

Non-idiopathic causes:

  1. Cerebral Palsy
  2. Muscular Dystrophy

Cobb angle on Xray

bigger curve more likely in females

42
Q

When is bracing considered for scoliosis? Other option/considered when?

A

bracing: curve 20-40 degrees

Other option = surgery
- curve > 40 degrees

43
Q

Mechanism for Nursemaid’s Elbow

why common in < 5

A
  1. Axial traction on pronated forearm + extended elbow –> annular ligament –>trapped in radiohumeral joint

“Swinging kids by arm”

at age 5 annular ligament strengthened

44
Q

3 y/o boy presents w/arm pain w/active supination. He is holding his arm close to his w/elbow fully extended and forearm protonated. What should you do to Tx his condition?

A

Tx = Radial Head Subluxation

for Nursemaid’s Elbow

45
Q

Steps of Radial Head Subluxation for Tx of Nursemaid’s Elbow

A
  1. thumb on radial head
  2. apply longitudinal traction
  3. supinate forearm
  4. flex elbow

Peds Exam 2 (9 decks)

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