Rheum Flashcards
(125 cards)
1
Q
Paucitarticular JIA
A
MC!!!!!
```
4 or less joints
ANA +
RF -
Young females
Uveitis- slit lamp
No other systemic
~~~
2
Q
Poly arthritis JIA
A
5+ joints
+ RF= RARE= SEVERE
+ ANA = MILDER- younger
3
Q
Systemic onset stills disease
A
Recurrent high fever
HSM
salmon macular rash
- ANA
- RF
4
Q
Tx JIA
A
NSAIDS= #1
STEROIDS
IMMUNOSUPPRESSIVE
5
Q
Definition JIA
A
Autoimmune arthritis with morning stiffness
Gradual LOM
for at least 6 weeks
6
Q
Bow legs genu varum associated with
A
Rickets
OI
Blount disease
7
Q
Age genu varus
A
1-3 years
8
Q
XR genu varum
A
Beaking of medial tibial epiphysis
9
Q
Blount disease
A
SEVERE GENU VARUM
(Tibia vara)
UNILATERAL
BLACKS
10
Q
Knock knees genu valgum associated with
A
JIA
11
Q
Age genu valgum
A
2-7 years old
12
Q
Tx genu valgum
A
Resolves spon
13
Q
Pes planus associated with
A
Hyper mobility
Congenital tarsal fusion
14
Q
When is flat feet normal and why?
A
Toddlers
Since fat pad covering the medial longitudinal arch
15
Q
AGE of pets planus
A
1-2 years old
16
Q
Tx of pets planus
A
arch support and footwear
17
Q
AGE of in toeing
A
1-2 years old
18
Q
in toeing associated with
A
- metatarsus varus
- medial tibial torsion
- persistent anteversion femoral neck
19
Q
Metatarsus varus
A
Adduction highly mobile forefoot
20
Q
age of metatarsus varus
A
infants;
21
Q
tx metatarsus varus
A
since heel held in normal position…
- passively correctable
- no treatment unless > 5 yo and symptomatic
22
Q
medial tibial torsion
A
tibia laterally rotated LESS than normal wrt femur
23
Q
AGE medial tibial torsion
A
TODDLERS
24
Q
Medial tibial torsion associated with
A
bowing of the tibia
25
Tx of medial tibial torsion
self corrected within 5 years
26
Persistent anteversion femoral neck
at hip when femoral neck twisted forward MORE than normal
27
AGE of persistent ante version of femoral neck
childhood
28
persistent anteversion femoral neck a/w
hypermobile joints
29
tx persistent anteversion femoral neck
self corrects by 8 years old
30
W sitting
persistent ante version of femoral neck
31
OUT-toeing age
6-12 months
32
OUT-toeing a/w
- ED
- Marfans
- hypermobile joints
33
AGE toe walking
1-3 years
34
toe walking a/w
- spastic diplegia
- muscular dystrophy
- JIA
35
EXCLUDE toe walking
- mild CP
- tight achilles
- arthritis of foot and ankle
- OLDER--- DUCHENNES
36
VARIATION of NORMAL POSTURE PC: 6-12 months
out toeing
37
VARIATION of nORMAL POSTURE PC: 1-2 yo
pes planus
in-toeing
38
VARIATION of NORMAL POSTURE PC: 1-3 yo
bow legs genu varum
| toe walking
39
VARIATION OF NORMAL POSTURE PC: 2-7 yo
knock knees
40
TALIPES EQUINOVARUS=
club foot
41
types of talipes equinovarus
positional talipes
| talipes equinovarus
42
talipes equinovarus a/w
BOYS (2:1)
olgiohydramnios, spina bifida
DDH
43
tx talipes equinovarus
PONSETTI METHOD-- plaster casting and brace
| ...... if unsuccessful= sx
44
ROCKER BOTTOM FEET=
VERTICAL TALUS
45
Talipes calcaneovalgus
dorsiflexes and everted
46
Talipes equinovarus
- think calf
- short foot
- heel plantarflexed
- supination
- inversion
47
Talipes calcaneovalgus associated with
DDH
48
what two abnormal postures are a/w DDH
talipes calcaneovalgus
| talipes equinovarus
49
FLAT FEET= PATHO-- OLDER KIDS.... A/W
TJT
- tendon achilles contraction
- JIA
- tarsal coalition
50
Tarsal coalition
symptomatic once ossifies-- PRE-ADOLESCENT
51
PES CAVUS A/W
- friederich's ataxia
| - peroneal muscular atrophy (type 1 hereditary motor sensory neuropathy)
52
which leg more common for DDH
LEFT
53
Risk factors for DDH
7
- breech
- oligohydramnios
- females 4:1
- first born
- race [chinese protected]
- fam hx
- a/w: NTD/NM/foot deformities: talipes calcaneovalgus, and talipes equinovarus
54
PC DDH > 8 weeks
Limited AB
Limp
Length leg discrepancy
Asymmetric leg folds
55
Tx DDH
```
newborn- pavlik- 6 weeks
6weeks-pavlik- 8 weeks
4 months- spica cast
18 months- triple acetabular osteotomy
teen- Ganz procedure= periacetabular osteotomy
```
56
Ganz procedure
periacetabular osteotomy
57
Scoliosis mild
painfree
58
Scoliosis severe
cardioresp compromise
59
Causes of scoliosis
1. Idiopathic
| -
60
Tx-- surgery for scoliosis when...
neuromuscular disorder
| respiratory disease
61
MCC TORTICOLLIS
SCM TUMOR= congenital muscular torticollis
62
PC congenital muscular torticollis
first few weeks of life, resolves spontaneously by 2-6 months
63
LATER CHILDHOOD CAUSES TORTICOLLIS
- muscular spasm
- ENT infection spread
- C- spine arthritis/ deformity
- Spinal tumor= osteoid osteoma
- Posterior fossa tumor
64
Nocturnal idiopathic pain=
GROWING PAINS
65
PC GROWING PAINS
- at night
- 3-12yo
- LL pain, symmetric [may be other]
NO- pain with walking/ activity
NO- limp
WELL OTHERWISE :)
66
MSK pain (generalised or local) WORSE after exercise
hypermobility
67
AGE hypermobility
older kids/ adolescents
68
Hyper mobility foot deformities
- pes planus
- anteversion femoral neck
- out-toeing
69
Hyper mobility associated pathology
Downs
ED
Marfans
70
Idiopathic pain syndrome=
CRPS:
| congenital reigonal pain syndrome
71
Age of CRPS
adolescent females
72
Local CRPS
```
foot and ankle
hyperesthesia
allodynia
cool to touch
distract--> normal
```
73
Diffuse CRPS
SEVERE PAIN
| night disturbance--day time fatigue
74
MCC ACUTE LIMB PAIN
TRAUMA!
75
Causes of OM
1. S.aureus
2. Strep pneumo (multi)
3. Haemophilus (multi)
4. Salmonella-- SICKLE CELL
5. TB
76
INSIDIOUS PC OM INFANT
decrease limb movement or swelling (harder to appreciate)
77
Dx OM:
- blood cultures
- increase ESR/CRP
- imaging:
XR: normal at first, soft tissue swelling
US: periosteal elevation
MRI: subperiosteal pus and debris
RAI/Bone scan
78
Tx OM:
- IV antibiotics
- aspiration
- Sx decompression of subperiosteal space
- Sx drainage
79
Malignancies presenting with acute limb pain
1. ALL
2. Neuroblastoma
3. Bone tumors
- osteosarcoma
- ewing's sarcoma
- osteoid osteoma
80
PC ALL
- night pain
| - arthritis
81
PC Neuroblastoma
INFANT
- bone mets
- septic arthritis
82
PC Osteoid osteoma
NIGHT pain-- resolves with NSAID's
- joint swelling
- joint tenderness
- joint effusions
- scoliosis -- SPINE INVOLVED
83
Dx osteoid osteooma
XR: radiolucent core, sclerotic rim
84
Ddx acute limb pain
1. TRAUMA
2. OM
3. Malignancy
85
Ddx knee pain
1. osgood schlatter
2. chondromalacia patellae
3. Subluxation and dislocation patella
4. osteochondritis dissecans
5. injuries
86
PC: male adolescent active, with knee pain after exercise
Osgood schlatter
87
Defn osgood
osteochondritis of the patella tendon as inserts into the tibia
88
Knee pain adolescent male
osgood
89
knee pain adolescent female
osteonchondromalacia patellae
90
PC osgood
knee pain AFTER exercise
+ hamstring tightness
+ local tenderness
_ SWELLING over tibial tuberosity
91
Tx osgood
- decrease activity
- physio- quads
- hamstring stretching
- orthotics
- knee immobiliser
92
Defn chondromalacia patellae
softening of the cartilage of patella
93
PC: female adolescent, pain with sitting-->standing, and going up the stairs
Chondromalacia patellae PC
94
chondromalacia patellae a/w
- hypermobility
| - flat feet
95
PC: subluxation patella
instability, giving way
96
PC: dislocation patella
SUDDEN SEVERE PAIN,
| LATERAL DISLOCATION
97
Tx: patella
quads exercises
| sx-- realign pull of quads on patellar tendon
98
Osteochondritis dissecans defn
= segmental AVN subchondral bone
| -----> thus get separation of bone and cartilage from medial epicondyle
99
PC: active adolescent with persistent knee pain
osteochondritis dissecans PC
[can also get loose bodies: thus locking and giving way]
100
younger kids: bone or ligaments stronger?
ligaments stronger-- thus fracture more often
101
RED FLAG SIGNS BACK PAIN
- weight loss/malaise
- night pain
- fever
- scoliosis
- neuro symptoms
- YOUNGER
102
Ddx back pain
1. mechanical
2. tumors
3. vertebral OM or discitis
4. spinal cord/ nerve entrapment
5. scheuermann disease
6. spondylosis/ spondylosthisesis
103
Scheuermann disease
= osteochondrosis of vertebral body
PC: fixed thoracic KYPHOSIS-- +/- pain
often asymptomatic
104
Spondylosis/ spondylosthesis
stress fracture of pars interarticularis of vertebra
increased risk
- gymnastics
- cricket bowlers
105
Transient synovitis
```
ACUTE pain, non wt bearing
no/mild fever
normal child
comfy at rest; mov't--> limited IR, and pain
WCC= normal
ESR= normal/ ^
US: fluid in joint
XR= normal
mgmt:
- rest
- analgesia
```
lasts perthes
106
MCC acute hip pain kids 2-12 years old
transient synovitis; post viral or a/w viral
107
Septic arthritis
```
ACUTE pain, non weight bearing
fever
sick looking child
pain at rest; mov't--> SEVERE pain; d: FABER
WCC= ^^^/normal
ESR= ^^^^
US: fluid in joint
XR: normal----> WIDE joint space
```
mgmt:
- joint aspirate with US
- prolonged antibiotics
- rest
- analgesia
- wash out
- immobliize
108
AGE OM
109
CAUSES OF OM:
1. S.aureus (1 joint)
| 2. H influ (1+ joints)
110
5-10 year old with hip/knee pain and limp
PERTHES DISEASE
111
Tx perthes
1. bed rest and analgesia
2. maintain AB
- plasters
- calipers
- femoral or pelvic osteotomy
112
Direction of displacement SUFE
posteroinferior
113
PC SUFE
10-15yo
OBESE
HYPOgonadism
HYPOthyroidism
+ LIMP OR HIP PAIN--> KNEE
- acute post minor trauma
- chronic
114
RESTRICTIONS IN SUFE
AB
| IR
115
Tx SUFE
pin fixation in situ
116
CAUSES OF REACTIVE ARTHRITIS....post extra-articular infection
1. enteric bacteria: salmonella/ camp/ shigella/ yersinia
2. viral
3. STI's
4. mycoplasma
5. borrelia burdorferi
+ rheumatic fever
+ post-strep RA
117
Tx reactive arthritis
NONE,
| NSAID's
118
PC HSP:
```
palpable purpura butt and legs
arthritis: knees and ankles
abdo pain
haematuria
proteinuria
```
MCC VASCULITIS KIDS
119
HOW OFTEN DO SLE AND DERMATOMYOSITIS OCCUR IN KIDS?
RARE!!!!!!!!!!!!
120
death in juvenile dermatomyositis
resp F
asp pneumonia
121
still birth
large head
very short limbs
small chest
Than-ato-phoric dysplasia
XR: DX
Antenatal US
122
ABSENCE of all or part of clavicles
DELAYED closure fontanelles/ ossification of skull
can bring shoulders in front of chest to touch
Cleido-cranial dys-os-to-sis
123
Arthro-gry-posis
STIFFNESS and CONTRACTORS of joints
124
Arthro-gry-posis a/w
- oligohydramnios
- widespread congenital anomalies
- chromosomal disorders
skin= thin, decrease sc, muscle atrophy around joints
125
Tx arthrogryposis
1. physio
| 2. correct deformities: splints/plaster/ sx
