peds rheum

Question 1

JIA

Answer 1

prolonged fever, salmon patch rash, arthritis, visceral involvement

Question 2

scarlet fever

Answer 2

strawberry tongue, bilateral cervical LAD, fever, rash

Question 3

rheumatic fever

Answer 3

Rash, subcutaneous nodules, fever, polyarthralgia, chorea

Question 4

viral syndrome (enterovirus)

Answer 4

Fever 3-5 days, non-descript non-painful rash, can walk

Question 5

kawasaki

Answer 5

fever > 5days, nonpurulent conjunctivitis, erythematous rash, swelling and erythema of extremities, unilateral LAD

Question 6

osteomyelitis/septic joint

Answer 6

Low grade fever, painful walking

Question 7

RMSF

Answer 7

Fever

Question 8

Steven johnson

Answer 8

Severe pruritic rash, fever

Question 9

measles

Answer 9

conjunctivitis, fever, rash, non-immunized

Question 10

kawasaki

Answer 10

Mucocutaneous lymph node syndrome

Acute Febrile Vasculitic syndrome of early childhood

Question 11

kawasaki symps list

Answer 11

Supporting Sx: Non-remitting High grade Fever > 5 days PLUS 4/5 of the following:
red macpap rash
unilat cerv adeno>1.5 cm
strawberry tongue, red fissurd lips, injected pharynx
non-pur. conjunc, bilat, painless
redness/swell of hands/feet
desquamations of tips, transfers grooves across nails -beau lines)

Question 12

kawasaki labs

Answer 12

No specific diagnostic test; Elevated ESR/CRP, Anemia, Elevated WBC, Thrombocytosis, Hypoalbuminemia, Elevated AST/ALT
Case: Echocardiogram with coronary artery aneurysms

Question 13

kawasaki complications

Answer 13

coronary artery aneurysm
CNS manifest (mening.)
liver dysfunc
arthritis
hydrops of gall bladder

Question 14

kawasaki pathoma

Answer 14

Kawasaki Motorcycle
Hold on with Palms and Soles:
Edema
Erythema
Desquamation
Heart Racing: CAA

Question 15

kawasaki tx

Answer 15

Usually self-limiting ~12 days
BUT leads to significant morbidity and mortality
IV IG (dec. CAA)
Aspirin
(Anti-inflammatory, anti-pyretic, anti-platelet)
Possible Reye syndrome- recommend influenza vaccine
Echocardiogram- evaluate for CAA

Question 16

kawasaki buzz words

Answer 16

High-grade Fever for multiple days
Strawberry Tongue
Conjunctivitis
Thrombocytosis and peeling of fingers
Erythematous Maculopapular Rash
Coronary Artery Aneurysms
Treated with Aspirin in Childhood

Question 17

“gelling phenomenon”

Answer 17

joint pain is worse in the morning and after periods of sitting and watching television

Question 18

ESR vs CRP

Answer 18

ESR: concentration of fibrinogen and other inflammatory modulators that have half-lives of days to weeks.
CRP: made exclusively in the liver and can rise and fall within hours of an acute inflammatory stimulus

Question 19

JIA (Juvenile Idiopathic Arthritis)

Question 20

JIA types

Answer 20

polyarthritis
oligoarthritis
systemic: characteristic arthritis that develops with fever and rash; and exclusion of other juvenile arthritis

Question 21

JIA comps

Answer 21

Chronic iridocyclitis in pauciarticular JRA (other ocular disease includes iritis, and uveitis)

Joint deformities in polyarticular JRA
(can have positive or negative rheumatoid factor)

Question 22

common tests for GAS (rheumatic fever)

Answer 22

throat cx

anti–streptolysin O (ASO) and anti–deoxyribonuclease B (anti–DNAase B)

Question 23

ASO titers

Answer 23

peak 3 to 6 weeks after GAS infection.
They are elevated in 80% of patients with typical rheumatic fever (and GABHS pharyngitis)
less than 50% of kicks w/ rec. GABHS skin inf.
less than 70% of patients with chorea

Question 24

Anti–DNAase B titers

Answer 24

more reliable, in both pharyn. and skin GABHSpts

peak 6 to 8 weeks after GABHS infection. The elevated titers may persist for several months after infection

Question 25

elevation of ??? in 95% rheumatic fever pts

Answer 25

anti–DNAase B, antistreptokinase, or antihyaluronidase

Question 26

Jones Criteria for rheumatic fever

Answer 26

2 major criteria or 1 major + 2 minor + evidence of recent GAS infection (+ throat cx/RADT, rising ASO titers) MAJOR: carditis, polyarthritis, chorea, erythema marginatum MINOR: fever, arthralgia, elevated APPs, prol. PR interval

Question 27

JIA tx

Answer 27

Hospitalization Cardiology consult PCN or Erythromycin (if patient is allergic to PCN) arthritis and carditis tx: ASA 90 to 120mg/kg/day until symptoms resolve chorea tx: Haloperidol, phenobarbital, or valproic acid

Question 28

JIA ppx

Answer 28

Start prophylactic antibiotics immediately after the therapeutic antibiotic course is completed. Continue until child is an adult and is recurrence free for 10 years (longer if they have residual heart disease) Options for lower risk of recurrent ARF: PCN V K, Sulfadiazine, Macrolides Higher risk of recurrent ARF: Benzathine PCN G intramuscularly, every 4 weeks

Question 29

RF summary

Answer 29

``` Age range: 5-15yo Seasonality: Winter Preceding URI Strep Pharyngitis Jones criteria ```

Question 30

RF: carditis

Answer 30

``` Prolonged PR interval Varying degrees of heart block Cardiomegaly may be noted on CXR Inflammation of valves and endocardium valvular regurgitation/stenosis Mitral valve most common (rheuMATic: Valves affected Mitral>Aortic>Tricuspid) ```

Question 31

RF: skin/ST

Answer 31

(typically only in carditis patients) Subcutaneous nodules over bony prominences present up to a month Erythema marginatum annular erythema, usually present on the trunk and proximal portions of the extremities, sparing the face

Question 32

RF: CNS

Answer 32

Sydenham Chorea abrupt, purposeless, nonrhythmic, involuntary movements that cease during sleep muscular weakness emotional disturbances; ranges from outbursts of inappropriate behavior to transient psychosis Occur 3-8 months after GAS infection

Question 33

RF labs

Answer 33

``` elev. ESR, CRP CXR: mild effusion EKG: prol. PR interval Echo: mitral valve regurg +ASO ```

Question 34

erythema nodosum

Answer 34

type of panniculitis, inflammation of subcutaneous fat in the skin, usually first evident as an outcropping of erythematous nodules that are highly sensitive to touch Most located symmetrically on the ventral aspect of the lower extremities tests: CBC, ESR, ASO titers, Excisional biopsy (when clinical diagnosis is in doubt)

Question 35

Henoch Schonlein Purpura

Answer 35

Small-vessel vasculitis associated with abrupt onset of a rash, palpable purpura most common; GI manifestation, arthritis and arthralgia, and late renal manifestations, commonly after exposure to triggering antigen (eg infectious agent) tests: CBC, ESR, abdominal US, urinalysis, ASO titers, Excisional biopsy (when clinical diagnosis is in doubt)

Question 36

Immune thrombocytopenic purpura

Answer 36

Thrombocytopenia associated with petechia or purpura; bleeding (e.g., gingival, gastrointestinal, mucocutaneous); symptoms of end-organ ischemia (in patients with thrombotic disease) tests: CBC with peripheral smear, coagulation studies, platelet-associated antibody (immunoglobulin G), electrolytes, BUN, creatinine, LDH, urinalysis

Question 37

leukemia

Answer 37

Nonspecific symptoms of fever, easy bleeding, skin findings (e.g., petechiae, purpura), bone pain, fatigue, hepatosplenomegaly, lymphadenopathy tests: CBC, ESR, coagulation profile, bone marrow biopsy

Question 38

meningococcemia

Answer 38

Malaise, fever, rash (e.g., maculopapular rash, petechiae, ecchymosis), and hypotension with possible associated symptoms of meningitis or tenosynovitis tests: CBC, PT/aPTT, fibrinogen, fibrin degradation productions, blood culture, CSF analysis and culture

Question 39

polyarteritis nodosa

Answer 39

Multisystem involvement from segmental inflammatory, necrotizing vasculitis of the small- and medium-sized muscular arteries leading to general symptoms of fever, weakness, weight loss, malaise, myalgia, rash (e.g., livedo reticularis, purpura), headache, and abdominal pain tests: Biopsy of involved organ, urinalysis, CBC, ESR, CRP, angiography

Question 40

RMSF

Answer 40

Headache; fever associated with a centripetal rash (involving palms and soles, spreading to arms, legs, and trunk) that is often petechial; report of recent tick bite or outdoor activity in endemic area tests: Immunofluorescence staining of tissue specimen or serologic analysis for Rickettsia rickettsii, CBC, electrolytes

Question 41

HSP (Henoch Schonlein Purpura/IgA vasculitis)

Answer 41

most common vasculitis in children (about 50% of cases). S/S Hallmark: non-thrombocytopenic palpable purpura. LE and buttocks Colicky abdominal pain (50%) Occult blood (50%) Arthritis(50-67% kiddos) Mainly in knees and ankles ]renal involvement (hematuria) (1/3rd kiddos) screen monthly with UA for 6 months, nephritis is a late finding recent URI (2/3 cases) elevated ASO (50%)

Question 42

HSP dx

Answer 42

triad of purpura, abdominal pain, and arthritis Non-blanching palpable purpura of LE and butt absence of thrombocytopenia Skin biopsy(rare): characteristic IgA deposits in vessel walls Renal biopsy (only indicated if nephritis develops): membranoproliferative glomerulonephritis similar to IgA nephropathy

Question 43

HSP comps

Answer 43

considered benign hosp. if abd pain, GI bleed, intussusception, renal involve - 5% kids-->renal failure - 2-3% intussusception (60% ileoileal) - 33% recurrence rate

Question 44

HSP tx

Answer 44

min: supportive mild: acetomin/NSAIDs mod: corticosteroids sev: cortsters + adj. immunsuppr (cyclophosphamide, IVIG) or plasmapheresis

Question 45

HSP labs

Answer 45

Abdominal CT:marked bowel wall thickening from the vasculitis Abdominal US: identify constipation, intussusception, or other GI involvement ASO titers – Previous strep inf BMP (electrolytes, BUN, Cr) – monitor for renal insufficiency Blood culture – Evaluate for bacteremia or sepsis as possible cause CBC – identify WBC, HCT, Hgb, platelets Anemia could indicate GI bleed Identify thrombocytopenia CRP, ESR – indicate inflammatory reaction IgA levels – typically elevated in HSP, but nonspecific PT/PTT – Elevated levels make bleeding diathesis more probable UA – Assess for renal involvement Serology – Evaluate for cause of infection