Paeds Rheum Flashcards
(111 cards)
1
Q
What are the three key causes of limping child that you mustn’t miss?
A
- infection / infl (esp osteomyelitis/septic arthritis)
- trauma (esp NAI)
- tumour
2
Q
Osteomyelitis is most commonly caused by which bacterium?
A
Staph aureus
3
Q
Osteomyelitis is infection of metaphysis of long bones. It usually happens by haematogeneous spread, or direct from soft tissue.
What bacterium commonly causes osteomyelitis in children with sickle cell anaemia?
A
salmonella in sick cell
4
Q
What bacterium can cause osteomyelitis in immunocompromised children?
A
TB
5
Q
X ray in osteomyelitis is initially normal. What would MRI show?
A
subperioesteal pus
6
Q
What is the treatment for osteomyelitis?
A
Immediate IV Abx
then oral Abx for wks after
may need surgical drainage
7
Q
What blood tests would you do if suspect osteomyelitis?
A
Blood cultures
WCC, CRP/ESR
8
Q
What bacterium usually causes septic arthritis in older children?
A
Staph aureus
also consider Neisseria gonorrhoea in sexually active
9
Q
In babies, what bacteria cause septic arthritis?
A
Kingella kingi
Group B strep
(group B strep also causes osteomyelitis in neonates)
10
Q
What is the treatment for septic arthritis?
A
Immediate IV Abx
may need washout / surgical drainage
11
Q
What is the medical name for “irritable hip” in 2-10 yr olds?
A
Transient synovitis
12
Q
What is commonest cause of acute hip in 2-10 yr olds?
A
Transient synovitis
13
Q
What is the treatment for transient synovitis?
A
self-limiting! Rest and analgesia! resolves in <1wk
14
Q
What percentage of children with transient synovitis go on to develop Perthe’s disease?
A
3%
15
Q
In transient synovitis, does the child usually have pain at rest?
A
no
16
Q
Which criteria distinguish Septic arthritis from transient synovitis?
A
Kocher’s criteria
17
Q
Kocher’s criteria indicating septic arthritis are…..(x4)
A
fever >38.5
non-weight bearing
raised ESR
raised WCC
18
Q
3 key risk factors for developmental dysplasia of the hip?
A
female
breech birth
positive FHx
19
Q
What are the clinical examinations for DDH?
A
Barlow
Ortolani
20
Q
what investigation confirms diagnosis of DDH
A
ultrasound
21
Q
what is treatment for DDH?
A
Pavlik harness (flexed abducted) older - surgery
22
Q
idiopathic avascular necrosis of the femoral head. whats this?
A
Perthes disease
23
Q
What would Bart Simpson get?
A
Perthe’s disease (short schoolboys age 5-10, low socioeconomic)
24
Q
In Perthe’s disease they get hip pain which develops over a few weeks, limp, and reduced range of movement in which directions?
A
all ROMs!
25
What is the treatment for Perthe's disease?
physio, rest in cast/braces
< 6yrs - observation
>6 yrs - surgery for deformities
26
What does SCFE stand for?
"slipped capital femoral epiphysis" - epiphysis of femoral head SLIPS off the back!
27
Which age group does SCFE affect?
adolescents
28
What kind of pain does SCFE cause?
hip pain referred to knee.
| limp
29
SCFE affects adolescents with what body types?
obese
| or just had a growth spurt
30
what is osgood-sclater disease?
osteochondritis of the patellar tendon where inserts at the knee
31
Sporty adolescent male Charlie Knox has knee pain after exercise, localized tenderness on knee cap, and swelling over tibial tuberosity. What treatment do you recommend?
decrease activity :(
| physio (quads strengthening and hamstring stretching)
32
softening of articular cartilage of patella = ?
chrondromalacia patellae
33
Adolescent female with knee pain standing up and walking upstairs ?
chrondromalacia patellae (Ailsa Bell)
34
what is the treatment for chondromalacia patellae?
phsyio (Paul) - quads strengthening
35
what is the most common form of arthritis in childhood?
reactive arthritis
36
which joints does reactive arthritis often affect in kids?
ankles and knees
37
in reactive arthritis, how long do they usuallly take until complete recovery?
UNDER 6 wks
38
name three common bacteria than lead to reactive arthritis is KIDS?
what about in teenagers?
kids: salmonella, shigella, campylobacter
teens: chlamydia, gonorrhoea
39
what causes reactive arthritis in low-income countries?
rheumatic fever (strep)
40
what is the treatment for reactive arthritis?
NSAIDs! complete recovery <6wks!
41
what would CSR/ERP and Xray of joint show in reactive arthritis?
CSR/ERP normal/raised
| X ray normal!!
42
malignancy in children can cause leg pain. name two NON-BONE cancers that can cause leg pain
acute lymphoblastic leukaemia
| neuroblastoma
43
what BENIGN bone tumour can cause leg pain?
```
osteiod osteoma
(affects adolescent boys, pain at NIGHT, improves w NSAIDs)
```
44
what is the treatment for osteoid osteoma? (benign bone tumour)
surgical removal. (good prognosis)
45
name two malingant bone tumours which can cause leg pain in children
Osteosarcoma
| Ewing sarcoma
46
adolescent male with persistent localized bone pain and mass. otherwise well. what are you thinking?
osteosarcoma or Ewing sarcoma
47
adolescent male with persistent localized bone pain and mass. you suspect osteosarcoma or ewing. what investigations?
```
X ray
MRI
bone scan
(CT chest for lung mets)
(bone marrow sampling)
```
48
what does X ray/MRI/bone scan show in osteosarcoma/ewing?
destruction + new bone formation
| ewing - soft tissue mass
49
what is treatment for osteosarcoma/ewing?
| what extra for ewing?
combination chemo
.. then surgery
ewing - radio for local
50
a 6 yr old with episodes of generalized pain in legs. wakes from sleep. symmetrical. never at start of day. no limp. Physical examination normal. What do you suspect?
growing pains!
51
What are the 5 rules for growing pains!
1. 3-12 yrs
2. symmetrical
3. never at start of day / after walking
4. no limp
5. physical examination normal
52
what other problem is hypermobility associated with?
flat feet!
| like me! I'm lucky I didn't get chrondromalacia patellae!
53
symmetrical hyperextension of thumbs, fingers, elbows, knees. they can put their palms flat on floor with knees straight! Can cause MSK pain, often worse after exertion. What is this?
hypermobility
54
Hypermobility can be a normal finding especially in young girls. It can also be a feature of which 3 diseases?
1. Down's
2. Marfan's
3. Ehlers Danlos
55
what is allodynia??
pain from a stimulus that doesnt usually cause pain
56
severe pain, hyperaesthesia and allodynia. worse with psychological stress. otherwise well and physical Ex normal. What is this?
"complex regional pain syndromes"
| treat with physio & MDT
57
RIGHT KATE. Give me the 6 key causes of back pain in children. You can do it.
1. Mechanical
2. Tumour (benign)/Malignancy
3. Discitis / osteomyelitis
4. Compression of spinal cord/nerve root
5. Spondylo-lysis!
6. Schuermann disease
58
What is Schuermann disease?
osteochondrosis of vertebral body (hunchback + back pain)
| dodgy ossification near the cartilage
59
What are the 2 key complications of Perthe's disease?
osteoarthritis
| premature fusion of growth plates
60
BackPainRedFlag - focal neuro defecit. What could this be?
4. Compression of spinal cord/nerve root
61
BackPainRedFlag - high fever. What could this be?
3. Discitis / osteomyelitis
62
BackPainRedFlag - night waking / persistent pain. What could this be?
2. Malignancy
63
Name some back pain red flags. Don't have to get them all just try hun
```
young age
high fever
night waking / persistent pain
scoliosis which is painful
focal neuro
weight loss / systemic malaise
```
64
BackPainRedFlag - weight loss / systemic malaise. What could this be?
2. Malignancy
65
BackPainRedFlag - scoliosis which is painful. What could this be? (x2)
2. Maligancy
| 3. Discitis / osteomyelitis
66
Fixed thoracic kyphosis (hunchback) + back pain. Suspect?
Shuermann disease
67
Heavy schoolbag on one shoulder. Back pain. Likely cause?
Mechanical back pain
68
Which bone tumour is often found in spine?
osteoid osteoma (benign)
69
What is the treatment for discitis / osteomyelitis in spine?
IV Abx immediately!
70
How are you gonna do in these exams Kate?
FINE! :)
71
Define Juvenile Idiopathic Arthritis
umbrella term for ...
persistent joint inflammation in under 16s,
lasting for 6wks,
with no identified cause.
72
Please name the 5 types of Juvenile Idiopathic Arthritis.
1. Oligoarticular
2. Polyarticular
3. Psoriatic
4. Enthesitis-related
5. Systemic
73
How many joints does oligoarticular JIA affect?
<4
74
How many joints does polyarticular JIA affect?
>4
75
Asymmetric. Mostly knee or ankle. Associated with chronic anterior uveitis. What kind of JIA is this?
Oligoarticular
76
Why do you arrange a 3 monthly eye screening for any child with JIA?
To check for UVEITIS
77
Which joints does polyarticular JIA tend to affect, and in what distribution?
symmetrical large and small joints, often fingers! can also be asymmetrical tho
78
This type of JIA can be Rheumatoid Factor positive or Rheumatoid Factor negative. Often with nodules and low-grade fever. Affects joints symmetrically.
Polyarticular (>4 joints)
79
What is prognosis of polyarticular JIA ?
Bad. Destroys joints. Causes overgrowth of bone on affected side. Can cause scoliosis.
80
Which type of JIA is also known as Still's Disease?
Systemic JIA
81
Name some features of Systemic JIA.
```
arthralgia / myalgia
salmon pink macular rash
hepatosplenomegaly
lymphadenopathy
quotidian spiking temps
```
82
Which type of JIA has the highest mortality?
Systemic JIA (Still's Disease)
83
Which type of JIA causes salmon pink macular rash?
Systemic JIA
84
Diagnosis of psoriatic JIA if:
- arthritis + actual psoriasis
or athritis plus (x3).... ?
1. Dactylitis
2. Nail pitting
3. First degree relly with PSORIASIS
85
Which JIA is like ANKYLOSING SPONDYLITIS, in that it inflames lumbar spine and sacroiliac joints?
enthesitis-related JIA (HLA-B27)
86
What is an enthesis?
the connective tissue between tendon/ligament and bone
87
Which joints does enthesitis-related JIA affect?
| HLA-B27
lumbar spine
sacroiliac
also Achilles!
88
Name 4 risk factors for JIA.
female sex
age <6yrs
HLA polymorphism
FHx autoimmunity
89
JIA is a clinical diagnosis. But what bloods might be helpful?
```
FBC (normocytic anaemia)
ESR/CRP
ANA
HLA-B27
RF
```
90
What percent of oligoarticular JIA are ANA positive?
70%
91
Most JIAs affect females more often than males. Except WHICH?
Enthesisitis-related JIA - males
92
If ANA is positive, this is associated with increased risk of what?
UVEITIS
93
HLA-B27 is positive in what 90% of which JIA?
enthesitis-related JIA
94
What imaging might you consider in JIA?
X-ray
ultrasound
MRI
95
Give me some non-pharma management of JIA.
MDT - OT and physio
try to do lots of sports, dance :)
support for family
96
Give me 5 types of medications which can be used in JIA.
```
NSAIDs / analgesics
Corticiosteroids
Methotrexate
DMARDs
Biologics
```
97
Give me 2 examples of DMARDs that may be used for JIA
sulfasalazine , leflunomide
98
This Biologic is used to treat patients with POLYARTICULAR JIA for whom methotrexate has failed. It is the only TNF blocker licensed for JIA.
Etanercept
99
Etanercept is a Biologic, the only TNF blocker licensed for treating JIA. When can it be used?
polyarticular, when methotrexate has failed
100
Give me two examples of Biologics used in JIA
etanercept (TNF blocker)
| tocilizumab (IL-6 blocker)
101
Tocilizumab is a Biologic, an IL-6 blocker used for treating which kind of JIA?
Systemic JIA
| when steroids + methotrexate have failed
102
Corticosteroids are used to treat JIA. In what forms are steroids used?
Intra-articular injections
Systemic steroids for quick symptom relief/systemic disease
Topical steroids for uveitis
103
Methotrexate is first line treatment for JIA (if multiple joints are affected or steroid injections not enough in a particular joint). How is it given? What should you monitor?
weekly methotrexate injections.
| blood monitoring for liver & bone marrow
104
Name 6 complications of JIA
- chronic anterior uveitis.
- joint deformities
- growth failure
- anaemia of chronic disease
- delayed puberty
- osteoporosis
105
Why would osteoporosis be a complication of JIA?
corticosteroids + reduced weight bearing
106
Uveitis can lead to....
cataracts, glaucoma, possibly blindness
107
Which has polyarticular JIA has a worse prognosis, RF+ve or RF-ve ?
RF positive has worse prognosis
108
Who should be involved in the care of a child with JIA?
```
paediatricians
rheumatology MDT
opthalmologist
arthritis nurse
physio
OT
```
109
What are the two types of oligoarticular JIA?
persistent
| extended
110
Which type of JIA is tocilizumab used for?
systemic JIA
111
Why might a child with JIA have growth failure?
cortciosteroids + chronic disease
