Paeds MSK + Onc Flashcards
(28 cards)
What is JIA?
Juvenile idiopathic arthritis-condition affecting children and adolescents where autoimmune inflammation occurs in the joints
What are the 3 main features of JIA?
Joint pain
Swelling
Stiffness
What is the criteria for diagnosing JIA?
6+wks of arthritis in an under 16 without any other cause
Name the 5 subtypes of JIA
Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis
Name 4 Mx options for JIA
NSAIDs
Steroids
DMARDs
Biologics e.g. tumour necrosis factor inhibitors etanercept, infliximab and adalimumab
What condition do you think of if dactylitis in a Afro-Caribbean child?
Sickle cell
What is systemic JIA?
AKA Still’s disease - idiopathic inflammatory condition
Key feature: Subtle salmon-pink rash
What are the symptoms of systemic JIA/Still’s disease?
Subtle salmon-pink rash
High swinging fevers
Enlarged lymph nodes
Weight loss
Joint inflammation and pain
Splenomegaly
Muscle pain
Pleuritis and pericarditis
What is a key complication of systemic JIA?
Macrophage activation syndrome (MAS) = severe activation of the immune system with a massive inflammatory response.
Presents with an acutely unwell child with disseminated intravascular coagulation (DIC), anaemia, thrombocytopenia, bleeding and a non-blanching rash. It is life threatening
What is polyarticular JIA?
Idiopathic inflammatory arthritis in 5 joints or more, often symmetrical. Equivalent to rheumatoid arthritis in adults
What is oligoarticular JIA?
Paediatric arthritis in 4 joints/less. Tends to affect larger joints
What is a key complication with JIA?
Anterior uveitis
What is juvenile psoriatic arthritis?
Seronegative inflammatory arthritis associated with psoriasis
What is HEADSSS?
Tool used to structure the assessment of an adolescent patient, encompassing
Home,
Education/Employment,
Activities,
Drugs,
Sex and relationships,
Self harm and depression,
Safety and abuse
What practical exam would you use in paediatrics for joint assessment?
pGALS
What is leukaemia?
Cancer of a particular line of the stem cells in the bone marrow.
Name the 3 most common types of paediatric leukaemia
Acute lymphoblastic leukaemia (ALL) is the most common in children
Acute myeloid leukaemia (AML) is the next most common
Chronic myeloid leukaemia (CML) is rare
What is pancytopenia?
Combination of low:
Red blood cells (anaemia),
White blood cells (leukopenia)
Platelets (thrombocytopenia)
Name 4 RF for paediatric leukaemia
Radiation exposure in pregnancy
Higher risk with:
Down’s syndrome
Kleinfelter syndrome
Noonan syndrome
Fanconi’s anaemia
How do paediatric leukaemias present?
Lymphadenopathy
Localised mass
(categorise into effects on RBC, WBC, platelets e.g. anaemia, immune suppression, clotting issues)
Persistent fatigue
Unexplained fever
Failure to thrive
Night sweats
Pallor
Abnormal bruising
What investigations would you order for suspected leukaemia?
FBC, which can show anaemia, leukopenia, thrombocytopenia and high numbers of the abnormal WBCs
Blood film, which can show blast cells
Bone marrow biopsy
Lymph node biopsy
CXR/CT for staging
How do you manage leukaemia?
Chemo-5 phases
radiotherapy
Bone marrow transplant
What is the prognosis for ALL?
Overall cure rate of 80%, less positive prognosis for AML
How do CNS tumours present?
Headaches
Vomiting
Papilloedema
Ataxia (loss of skills in toddlers=red flag)
Squint
