Rheumatology & Ortho q-bank Flashcards
(54 cards)
What is the most common primary malignancy of bones in kids? #2?
Osteosarcoma
Ewing’s sarcoma
M:F 1.5:1
How does osteosarcoma present and where?
Bone pain, limp, swelling. Rarely B-symptoms.
Located at epiphyses / metaphyses of maximum growth sites (distal femur, proximal tibia, humerus)
How to work up bone tumour?
X-ray CBC, chem (usually normal) LDH and AlkP (elevated) MRI mets work-up: CT chest + bone scan Ewing's requires BM bx x2
Osteosarcoma management?
Local resection VERY important + chemotherapy (doxo, MTX, ofosfamide, cisplatinum)
NO radiation.
5 year survival 75%
negative prognostic factors: pelvic tumours, widespread lung mets, bone mets (<20% survival)
Ewing’s presentation?
Systemic symptoms.
Pain, swelling, decreased ROM.
Femur and pelvis most common sites, equal distribution among extremities and central axis.
*primarily white people
Ewing’s treatment?
Radiation therapy
Chemo
Resection
Chemo
75% cure in small, nonmets, local tumours
<30% with mets to bone or bone marrow at dx
Syndromes / conditions predisposing to osteosarcoma?
Retinoblastoma
Li-Fraumeni
Paget disease
Radiotherapy
Presents with gradually increasing bone pain at femur or tibia, worse at night and relieved by aspirin/NSAIDs.
Osteoid osteoma.
25% not on xray, CT required
Treat by resection, some spontaneously resolve.
List 7 causes of intoeing gait
1) metatarsus adductus (types: flexible, bone, heel-cord)
2) talipes equinovarus (serial casting)
3) internal tibial torsion (reassure)
4) femoral anteversion (most common, clinical dx, no W sit)
5) spasticity
6) paralysis
7) maldirected acetabulum
Progression of treatment for JIA?
- NSAIDs (4-6wks)
- intra-articular steroid injection
- Methotrexate
- biologic DMARD ie: TNF-alpa antagonist (etanercept, adalimumab/humera, infliximab/remicaide)
- systemic steroids for severe systemic illness, bridge therapy awaiting DMARD response, uvveitis control *may not prevent joint destruction in addition to many s/e’s
Who is at greatest risk of severe JIA uveitis and how to manage?
ANA + disease, < 6yo, oligoarticular
initial: mydriatics and steroids
then MTX or anti-TNF-alpha
Juvenile dermatomyositis diagnosis?
- primarily clinical diagnosis based on characteristic rash (heliotrope, Gottron’s) with three signs of symmetric, proximal muscle weakness
- supported by elevated muscle enzymes (CK, AST, ALT, LDH) and EMG (denervation & myopathy)
- if in doubt or to grade disease: muscle biopsy (necrosis & inflammation)
*photosensitive, bulbar weakness= VFSS, PFTs
Which auto-antibodies are associated with dermatomyositis?
ANA +ve in 80%
anti-Jo1 and anti-Mi2 may indicate severe disease
Dermatomyositis treatment progression?
Corticosteroids Methotrexate Hydroxychloroquine for rash MMF IVIG cyclophosphamide PT OT sun avoidance
HSP organs involved?
Palpable purpura… 15-60% develop recurrences! milder each time
MSK: arthritis/arthralgias (75%)
GI: pain, intussusception, bleeding
GU: HTN, hematuria, proteinuria (50%) with renal disease as long-term complication in 1-2%, ESRD in 8% of HSP nephritis. Can develop up to 6 months after diagnosis
CNS: ICH, sz, headache
rarely: orchitis, carditis, eye, testes torsion, pulmonary hemorrhage r
Lab evaluation for HSP?
leukocytosis, thrombocytosis, anemia
increased ESR, CRP
high IgA
LOOK CLOSELY AT:
blood pressure
urinanalysis
serum creatinine
Name examples of enthesitis-related arthritis
The spondyloarthritides except psoriasis:
ankylosing spondylitis
IBD-associated arthritis
reactive arthritis
If an older boy develops LE joint pain and back of the heel pain, what is his most likely diagnosis?
Spondyloarthritis
HLA-B27
oligoarthritis +/- enthesitis
What are features of inflammatory back pain?
nighttime pain morning stiffness improved by activity worsened by rest insiduous onset
Presentation of juvenile ankylosing spondylitis?
oligoarthritis + enthesitis (mainly LEs and hips)
rarely axial involvement before adulthood
uncommonly with fever and weight loss –> don’t miss IBD!
SCFE risk factors?
OBESITY
black, polynesian, male
hypothyroidism, hypopituitary, osteodystrophy
if thin patient, <10 presents with SCFE: screen for endocrinopathy (ie GH, cortisol)
SCFE or LCPD physical exam?
limp
shortened & externally rotated lower extremity
limited internal rotation, adduction and flexion
SCFE vs LCPD treatment
SCFE: pin it
LCPD: cast it
When to screen for scoliosis?
Examine AP & lateral, Adam’s forward bend test, superficial abdominal reflex
girls: at 10 and 12 years of age
boys: once at 13 or 14
