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47 Cards in this Set
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- Back
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Henoch-Schonlein purpura
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-IgA mediated vasculitis involving the skin, joints, GI tracts, kidneys
- A viral syndrome or URT precedes (mostly GABH strep) |
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Henoch-Schonlein purpura
Clinical features |
- Skin: maculopapular lesions progress to petechiae and palpable purpuric lesions concentrated on the buttocks and lower extremities, edma
- Joints: mostly arthralgia and arthritis -BI: Colicky abd pain, GI bleeding, and increased risk for intussusception - Renal: mild hematuria and trace proteins (nephritic syndrome) *Platelet counts are normal |
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Kawasaki Disease
- management |
Intravenous immune globulin
Aspirin Steroids |
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Dermatomyositis
Clinical features |
Periorbital violaceous heliotrope rash
Gottrons papules Proximal muscle weakness (positive gower sign) Tx: cortiosteroids |
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Rheumatic fever
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delayed autoimmune complication of URT infection with group A beta hemolytic
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Jones Criteria for Rheumatic fever
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recent strep infection
Migratory polyarthritis Carditis (endo,myocarditis, pericarditis) Sydenham chorea Erythema marginatum Subcutaneous nodules |
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Laboratory findings with Rheumatic fever
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Antistreptolysin O
Anti-Dna Anti-hyaluronidase Tx: penicillin |
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Reiters Diease
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arthritis
urethritis conjunctivitis -Chlamydia trachomatis |
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Nursemaid elbow
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subluxation of the radius head
-a sudden on set of pain -elbow is heald flexed and not using the arm - managment is to reduce it |
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Torticollis
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tilting of the head to one side towards the side affected
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Atlantoaxial instability
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unstable joint between the occiput and the first cervical vertebrae
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Klippel feil syndrome
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failure of normal vertebral segmentation that results in fusion of the involved vertebrae
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Scoliosis
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lateral curvature of the spine
- asymmetry of the shoulders -Cobbs angle measrue the degree of scoliosis Management: braching prevents progression |
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Kyphosis
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AP curvature of the thhoracic spine
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Spondylolysis
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-stress fracture of the pars interarticularis
- caused by repetitive hyperextension of the spine - pain is localized and increased with hyperextension |
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Spondylolisthesis
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when the body of the vertebra involving the spondylolysis slips ant.
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Diskitis
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infection (mostly Stap aureus) of the intervertebral disk
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Developmental Dysplasia of the Hip
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occurs when the acetabulum is abnormally flat
- increased risk with breech presentation -Clinical features positive barlow and ortolani Dx: ultrasound (<6 month) plan films Complications: avasular necrosis, limb lenth discrepancy, abn gait |
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Ddx of painful limp
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STARTSS HOTT
S: Septic arthritis T: Transient synovitis A: Acute Rhematic fever R: Rheumatoid artheritis T: trauma S: Sickle cell (pain crisis), S: Slipped capital femoral epiphysis H: Henoch schonlein purpura O: Osteomyelitis T: Tuberculosis T: Tumor |
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Septic Arthritis
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bacterial infection of the joint
- hip most common in younger children Etiology: Staph aureus and Strep pyogenes |
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Septic Arthritis
Clinical features |
-Fever and irritablity
-Limp, refusal to walk and pain with movment - Erythema, swelling and asymmetry of soft tissue folds - held in a flexion, abduction and external rotaiton -Lab: elevated WBC, ESR and C reactive protien synovial fluid of > 50-100,000 - can use both ultrasound or plain films |
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Transient Synovitis
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self limited postinfectious
- most common cause of limp in toddlers Clinical features: low grade fever, limp, unilateral hip pain (most common complant) (similar position as septic arthritis ) Lab: WBC and ESR are normal Tx: first R/O septic arthritis then tx with NSAIDS |
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Legg Calve Perthes
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-avascular necrosis of the femoral head
-clinical: painful limp with ecreased internal rotation and abd of the hip Dx: AP and frog leg xrays increased density in the femoral head Tx: Pt and surgery |
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Slipped capital femoral epiphysis
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- slipping of the femoral head off the femoral neck
- typical pt is obese adolescent boy SS: painful limp with pain in the groin Klein line: do not cross the epiphysis -those with hypothyroidism may have bilateral |
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Osteomyelitis
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cause: Staph aureus, S pyogenes, salmonella (sickle cell) and Pseudomonas (step on nail w sneaker)
Clinical featues Fever bone pain, erthema, swelling painful limp Lab: elevated WBC, ESR and C reactive protein Imaging: bone scan or MRI |
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What are the bugs that cause osteomyelitis?
Infants 1 year - 15 years |
Infants: Group B strep, S. aureus, E. coli
Older: S. aureus, Group A Strep, S. pneumoni, Pseudomonas * Salmonella in sickle cell disease -mostly seen at the end of long bones |
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What are the signs of Osteomyelitis?
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Fever and irritablity
Refusal to walk or bear weight PE: Painful local swelling Point tenderness Local warmth Erythema |
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What are sensitive lab markers for Osteomyelitis?
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Increased ESR is a sensitive marker
Increased CRP Leukocytosis **NOTE X rays will be normal 7-10 days!!** but late will show lucent areas |
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What is the treatment for osteomyelitis?
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Antibotics pending blood cultures
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A Previously ambulatory 18 month old girl refuses to walk. She has marked tenderness over the distal left femur. Her mother says she fell several times the previous day while playing. The child has a temp of 101.6, ESR of 72, WBC 18.5. Radiographys reveal no bony abnormalities.
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Osteomyelitis
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A 14 year old boy presents to the emergency department bc of right knee pain for the past 2 days. 3 days prior to the onset of the pain he hit his knee on a pool table. Vitals Temp 100.6, pulse 100, respirations 24, PE the knee is slightly swollen and tender and is held in flexion. Now what?
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The most important diagnostic procedure is aspiration of the knee for smear and culture
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What are the organisms that cause septic arthritis?
Neonates Older children |
Neonates: Group B Strep, S. aureus,
Older: S. aureus, Strep pyogenes |
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A 5 year old boy who has a definite history of penicillin allergy develops osteomyelitis. Smear of the aspirate shows gram positive cocci in clusters. What is the treatment?
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Vancomycin
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T or F fever is not necessary for the diagnosis of septic arthritis?
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T
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What is the most common cause of POLYarticular septic arthritis
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Neisseria gonorrhoeae
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What are the SS of septic arthritis?
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Pain
joint stiffness Erythema, swelling, and asymmetry of soft tissue Edema Limp and unable to bear weight Lab: elevated WBC (sometimes), elevated ESR, Blood culture Synovial fluid > 50,000 WBC |
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An 18 month infant develops a temperature of 105 and refuse to bear weight on her right leg. Physical exam reveals a swollen and warm right knee that the infant will not allow to be flexed or extended. The infant was diagnosed with varicella 3 weeks prior to the onset of this illness. Now what? What ya think?
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most appropriate diagnositic test would be a synovial fluid analysis
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A 11 year old boy comes to the office because he has had pain in the lower part of his knee. The pain is reproducible by extending the knee against resisitance. However the knee exam is normal. What is the Dx?
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Osgood Schlatter Disease
Caused by chronic microtrauma to the tibial tuberosity secondary to the overuse of the quads. -SS Tibial tubersoity swelling, absence of effusion of condylar tenderness. |
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A 16 year old boy complains of right knee pain. On examination there is significant tenderness and swelling over the tibial tuberosity. The is other wise healthy.
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Osgood Schlatter disease
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Two weeks later this same kid comes in with a limp that cause him no pain after a minor trauma. He he has limited hip motion mainly with abduction and medial rotation with some knee pain.
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Legg Calve Perthes
-avascular necrosis of the femoral head |
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A 6 year old boy presents with hip and knee pain. He has been limping. On exam heis unable to abduct or interally rotate his hip>
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legg calve perthes
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An obese 14 year old boy has pain in the left anterior thigh for 2 months. On physical exam there is limited passive flexion and ineranl rotation of hip.
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Slipped capital femoral epipysis
-this is a salter I fracture -loss of internal rotation. flexion and abduction -on AP view the Klein lines show less femoral head |
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Toddler Fracture
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nondisplaced spiral fracture of the tibia
Age: 9 months- 3 years Symptoms: pain, refusal to walk and minor swelling, erythema. mild point tenderness found on the distal tibia -no history of trauma or history fo twisitng motion of the tibia |
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A 2 year old boy complains of left arm pain. He olds his arm in a flexed pronated position and refused to supinate his forearm during examination. His mother remembers pulling him by the arm yesterday.
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Subluxation of the radial head
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While doing a physical exam on a 3 month old female infant the physician notice that her left knee is lower when her hips are flexed. The infant was born via a breech vaginal delivery
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Developmental Dysplasia of the hip
Newborns: positive ortolani and barlow with asymmetric skin folds 12 months: positive Trendelenburg sign (painless limp and lurch to the affected side with ambulation. |
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A 2 year old child is brought in witha right radical fracture after lightly bumping his arm. An x-ray shows multiple healing fractures. On examination the child has blue sclera thin skin, and hypoplastic teeth.
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Osteogenesis imperfecta
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A pt comes to the office that is tall, has long thin digis, hyperextensible joints and has had a dislocation of lenses in the past
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Marfans syndrome
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