1. March 22, 2011

8.  Most common organism?  Staph Aureus  Presentation?  Acute  Monoarthritis  Erythema  Warmth  Swelling  Intense pain on movement  Fever – 70%

9.  Definitive Diagnostic Test?  Joint fluid analysis and culture  Other labs or studies?  CBC  ESR/CRP  US  CT/MRI

10.  Emergency?  Outcome depends of timing of diagnosis, initiation of antibiotics, adequacy of drainage, virulence and host factors

11.  Presentation  Fever  Localized pain  Erythema  Swelling  Pinpoint tenderness  Decreased ROM

12.  Diagnosis?  Bone scan  MRI  Bone Culture  Other labs?  WBC  ESR/CRP  Blood culture – 60%  Bone culture – 80%  Plain films

13.  Emergency?  Benign, self-limited  Causes?  Acute or post infection  Trauma  30% of all nontraumatic limps

14.  Presentation?  Limp  Painful hip  Afebrile or low-grade  Otherwise appears well  Mild restriction of ROM

15.  Diagnosis?  Exclude septic arthritis and osteo  Four predictors associated with septic arthritis  History of fever  Inability to bear weight  ESR >40  WBC >12

16.  Treatment?  Rest  Anti-inflammatory  Most children do very well

17.  Definition of arthritis  Joint effusion + 2 of the following  Stress pain  Limited ROM  Increased warmth  JIA  One joint for at least 6 weeks  Cause  Host  Enviromental

19.  Oligo  Most common  Girls 1-3y  Large joints  Knee, ankle, wrist elbow  Morning stiffness  ANA +  Anterior uveitis

20.  Poly  Symmetric involvement  Small and large joints  Most RF –  RF+ are typically adolescent females and behave like adult RA  Systemic  Fevers  Evanescent rash  Salmon pink macules  Other  HSM, pericarditis, serositis, LAD

21.  Psoriatic  Knees and small joints of hands and feet  Look for the rash  Other  Nail changes or dactylitis  Enthesitis  More common in boys  Asymmetric lower limbs  Tendons of heel, plantar fascia or patella  May develop ankylosing spondylitis or other HLA-B27 diseases

22.  Diagnosis?  History and exam  Testing?  CBC  ESR/CRP  ANA  RF  Radiographs

23.  Treatment  Anti-inflammatories  Rheumatologist  Intra-articular corticosteroids  Disease modifying agents  MTX  Sulfasalazine  Biologics  PT

24.  Name of infective agent  Borrelia burgdorferi  Transmission  Ticks  Presentation  Erythema migrans  Arthritis  May occur months to years after infection  Other  Meningitis, cranial nerve palsies, carditis, ocular involvement

25.  Diagnosis  History and PE  Lab testing  Culture  Stain  PCR  Blood, synovial fluid or synovial tissue  Serologic testing  IgG may remain positive for years

26.  Treatment  Antibiotics  Ceftriaxone or  Amoxicillin or  Doxycycline  Anti-inflammatories  Prognosis for children  Good

27.  Definition  Intermittent  Nonarticular  Diagnosis  History and normal PE  Benign  Age range  3-10y

28.  Pain  At night  Limited to calf, thigh or shin  Short-lived  Alleviated by  Heat  Massage  Mild analgesics

29.  Definition  Femoral head is displaced from the femoral neck  Typical patient  Overweight  Boy  10-14y

30.  History and PE  Trauma  Acute  Pain  Inability to walk  Subacute or Chronic  Pain  Limb held flexed and externally rotated  Passive internal rotation is painful

31.  Diagnosis  Radiographs  Bilateral 30%  Treatment  Referral to ortho for repair  No weight bearing  Close follow up

32.  Definition  Avascular necrosis of the capital femoral epiphysis  Typical patient  Boy  4-10y

33.  Presentation  Limp  Pain  Reduced hip ROM  Diagnosis  Radiographs  MRI  Early disease  Treatment  Refer to ortho  Splints  Casts  surgery