Mehl. Peds MSK arthritides/joint (sacroilitis, scolio, psoriasis, JIA) 04-04 (1)

Question 1

2CK Peds forms love JIA (Juvenile idiopathic arthritis). It will sound like regular RA but just in a kid.

Answer 1

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Question 2

JIA. USMLE will structure these Qs where they want you to pick between JRA and septic arthritis (SA) as answer choices.

Answer 2

This can be confusing since SA can occur in patients with JRA. They might say a kid has a low-grade fever and a warm, red, painful knee (sounds like SA), but then they say he’s had similar episodes in the past (i.e., they want JRA over SA). This is because SA is usually a one-off event; for JRA, however, the vignette will say “intermittent” or “episodic.” Low-grade fever can occur in autoimmune flares (not limited to JRA; HY for sarcoidosis as well).

Question 3

JIA. ….maculopapular rash only in ~50% of JRA Qs???

Answer 3

“Salmon-pink”

Question 4

“Salmon-pink” maculopapular rash only in ~50% of JRA Qs. Often described as a buzzy finding, but I’d say about half of JRA vignettes don’t even mention rash.

Answer 4

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Question 5

2CK forms are obsessed with ……… in JRA. ???

Answer 5

anemia of chronic disease.

Question 6

JIA. HY point is that MCV can absolutely be low. Resources push normal MCV for AoCD. This is absolute nonsense. Plenty of 2CK NBME Qs give MCV as 70s in AoCD.

Answer 6

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Question 7

JIA. Can be associated with ???????

Answer 7

Serous pericarditis.

Question 8

JIA. If the Q asks what arthrocentesis will show in JRA, the answer is ??

Answer 8

Leukocytes

Question 9

Both should be ordered for JIA (and RA in adults).????????????

Answer 9

For antibodies, anti-cyclic citrullinated peptide (anti-CCP) is more specific than rheumatoid factor.

Question 10

JIA. Tx plan?

Answer 10

Tx for JRA has arms of management: 1) symptoms; 2) disease progression.

Question 11

JIA. Tx - symptoms?

Answer 11

For symptoms, give NSAIDs first, followed by steroids. These do not slow disease progression. NSAIDs and steroids are for symptoms only.

Question 12

JIA. Tx - disease progression?

Answer 12

For disease progression, we use disease-modifying anti-rheumatic drugs (DMARDs), which slow disease progression.

Methotrexate is given first, followed by adding an anti-TNF-a agent (i.e., infliximab, adalimumab, or etanercept).

Question 13

Scoliosis. Sideways curvature of spine, creating an S- or C-shaped curve. Usually idiopathic; affects 3% of population; girls 4:1.

Answer 13

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Question 14

Scoliosis. Most common type is ?

Answer 14

idiopathic adolescent thoracic scoliosis.

Question 15

Scoliosis. Can be associated with ? 3

Answer 15

Marfan syndrome, Friedreich ataxia, NF1

Question 16

Scoliosis. what used to Dx?

Answer 16

Adams forward bend test used to diagnose.

Question 17

Scoliosis. Tx?

Answer 17

USMLE wants you to know most children do not need treatment, but that curvatures will remain throughout life.

Question 18

Scoliosis. when Tx with bracing?

Answer 18

Answer = bracing if curvature is >25 degrees and child is still growing.

Question 19

Scoliosis. I’ve never seen surgery as answer for scoliosis on NBME; literature says recommended only when curvature >40 degrees

Answer 19

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Question 20

Psoriasis. Can occur in children and teens.
15% of patients with psoriasis will get arthritis before any skin findings.

Answer 20

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Question 21

Psoriasis. Plaques are described as ?

Answer 21

silvery and scaly and over extensor regions (elbows); plaques can also show up on the face (i.e., forehead and lip).

Question 22

Plaques are described as silvery and scaly and over extensor regions (elbows); plaques can also show up on the face (i.e., forehead and lip). Dx?

Answer 22

Psoriasis

Question 23

Psoriasis. What sign when plaque is removed?

Answer 23

Auspitz sign is bleeding of the scales if removed.

Question 24

Psoriasis. HY point for USMLE is that psoriasis is part of the ????

Answer 24

HLA-B27 constellation (PAIRà Psoriasis, Ankylosing spondylitis, IBD, Reactive arthritis).

Question 25

For example, if 17M has silvery plaque on elbow and forehead + bloody stool ->???

Answer 25

the latter is most likely IBD due to HLA-B27 association. Plaque = psoriasis

Question 26

Psoriasis. Don’t confuse psoriasis + IBD combo with dermatitis herpetiformis + Celiac disease combo!!!!!!!!!!

Answer 26

.

Question 27

Psoriasis. Tx?

Answer 27

Treatment for plaque psoriasis is topicals first: USMLE wants calcipotriene (vitamin D derivative), triamcinolone or hydrocortisone (both corticosteroids), and coal tar. Choose in that order if you are forced. Chronic application of topical steroids causes dermal collagen thinning, so they are not preferred prior to topical vitamin D.

Question 28

Psoriasis. when oral meds for Tx?

Answer 28

Oral meds are given if patient fails topicals, OR if patient has systemic psoriasis (i.e., arthritis). Oral methotrexate is HY on new NBME material as the first-line oral agent used. An old NBME has oral acitretin (a vitamin A derivative) as an answer, where methotrexate is not listed.

Question 29

Sacroiliitis. Sacroiliitis is broad term that refers to arthritis of lower back; ankylosing spondylitis (AS) is most severe form.

Answer 29

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Question 30

Vignette will almost always be male 20s-40s who has lower back pain worse in the morning that improves throughout the day. Dx? However, there is Q on 2CK Peds form where AS is diagnosis in an 8-year-old, so you need to know it’s possible in peds.

Answer 30

Sacroiliitis/ankylosing spondylitis (AS) nebuvo tiksliai nurodyta kuris pries to pirmo case kur adult

Question 31

Lower back pain in patient with IBD, psoriasis, or reactive arthritis points toward ??

Answer 31

sacroiliitis (HLA-B27 PAIR).

Question 32

Sacroiliitis. Hemato?

Answer 32

High ESR and anemia of chronic disease high-yield.

Question 33

Sacroiliitis. Dx?

Answer 33

x-rays of the lumbosacral spine and sacroiliac joints.

Question 34

USMLE wants “slit-lamp examination” to look for anterior uveitis in ankylosing spondylitis. Any autoimmune disease can theoretically increase risk of this eye finding, but for whatever reason USMLE likes it for AS.

Answer 34

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Question 35

Sacroiliitis. Treat same as JRA.

Answer 35

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