Rheuma

Question 1

pain over the tibial tubercle in a growing child
It occurs during late childhood or adolescence, especially in athletes, and is likely due to repetitive tensile microtrauma. It occurs between the ages of 10 and 15yr; the onset in girls is about 2yr before that in boys. It is more common in boys.

Answer 1

Osgood-Schlatter disease

self-limited in most patients and resolves with skeletal maturity.

Question 2

a hip disorder of unknown etiology that results from temporary interruption of the blood supply to the proximal femoral epiphysis, leading to osteonecrosis and femoral head deformity.

Answer 2

Legg-Calve-Perthes disease (LCPD)

• The most common presenting symptom is a limp of varying duration. Pain, if present, is usually activity related and may be localized in the groin or referred to the anteromedial thigh or knee region.
• Children who develop signs and symptoms before the age of 5yr tend to recover without residual problems. Patients older than 9yr of age at presentation usually have a poor prognosis.
• goal of treatment in LCPD is preservation of a spherical, well-covered femoral head and maintenance of hip range of motion that is close to normal

Question 3

A hip disorder that affects adolescents, most often between 11 and 16yr of age, and involves failure of the physis and displacement of the femoral head relative to the neck.

Answer 3

Slipped capital femoral epiphysis (SCFE)

• The classic patient presenting with a SCFE is an obese, African-American boy between the ages of 11 and 16yr. Girls present earlier, usually between 10 and 14yr of age. Patients with chronic and stable SCFEs tend to present after weeks to months of symptoms. Patients usually limp to some degree and have an externally rotated lower extremity
• the examiner notes that as the affected hip is flexed, the thigh tends to rotate into progressively more external rotation
• Once the diagnosis is made, the patient should be admitted to the hospital immediately and placed on bed rest. Allowing the child to go home without definitive treatment increases the risk that a stable SCFE will become an unstable SCFE and that further displacement will occur.
• the current gold standard for the treatment of SCFE is in situ pinning with a single, large screw

Question 4

an autoinflammatory, multisystem disorder originally described as recurrent oral and genital ulceration associated with relapsing iritis or uveitis and is often characterized by cutaneous, arthritic, neurologic, vascular, and gastrointestinal manifestations.

Answer 4

Behcet disease

• most consistent symptom is painful, shallow oral ulcers, usually 2-10mm in diameter with surrounding erythema, that develop on the buccal mucosa, gingiva, lips, and tongue, persist for days to weeks, and then heal without scarring in 1-3wk
• Arthritis is common and is usually acute, recurrent, asymmetric, and polyarticular, involving the large joint
• dx: oral aphthae that recur at least 3 times within 12mo accompanied by 2 of the following: recurrent genital ulcerations, eye lesions (anterior or posterior uveitis, or retinal vasculitis), skin lesions (erythema nodosum, pseudofolliculitis, or acneiforme nodules), and a positive pathergy test result

Question 5

hallmark of HSP

Answer 5

characteristic rash: palpable purpura starting as pink macules or wheals and developing into petechiae, raised purpura, or larger ecchymoses

• symmetric
• on gravity-dependent areas (lower extremities) or on pressure points