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31 Cards in this Set

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1. Best diagnostic test for Juvenile RA?
a. No lab studies are diagnostic for JA, but a hx + a CBC, blood cultures, ESR, RF, ANA, and synovial fluid assessment can aid in establishing or eliminating the diagnosis.
2. Tx of JRA?
a. NSAIDS, methotrexate, and glucocorticoids can be used to control symptoms.
b. Physical and occupational therapy are important for preserving function and preventing deformity.
3. When you have Fever of Unknown Origin (FUO) in a child, what should make you suspect JRA?
a. Daily, high-spiking fevers associated w/a characteristic rash!!!
b. Organomegaly and lymphadenopathy are also characteristics of systemic JRA.
c. Arthritis may develop after other symptoms begin, sometimes appearing months or even years into the disease course.
4. Arthritis
a. Swelling or effusion or the presence of two or more of the following signs:
1. Limited ROM
2. Tenders or pain on motion
3. Increased heat in one or more joints.
5. 3 types of Juvenile Rheumatoid Arthritis?
1. Systemic-onset JRA
2. Pauciarticular JRA (oligoarthritis)
3. Polyarticular JRA (polyarthritis)
6. Systemic-onset JRA?
a. Characterized by arthritis w/prominent visceral involvement, including:
1. Visceromegaly
2. Serositis
3. Lymphadenopathy
7. Pauciarticular JRA?
a. JRA w/involvement of 1-4 joints
8. Polyarticular JRA?
a. JRA w/involvement of 5 or more joints
9. Note: JRA is the most common rheumatologic disorder in children.
9. Note: JRA is the most common rheumatologic disorder in children.
10. Diagnosis of JRA?
a. Onset Prior to 16.
b. Symptoms duration ≥6 weeks
c. Other causes or arthritis in children must be excluded
11. Common cause of arthritis in sexually active adolescents that must be considered?
a. Gonococcal arthritis.
12. Systemic-onset JRA?
a. Systemic symptoms dominate the clinical presentation in system-onset JRA, making the diagnosis difficult.
b. Daily high-spiking fevers
c. Rash and arthralgias that wax and wane with the fever
d. Lymphadenopathy and organomegaly
13. 4 Complications of Systemic JRA?
1. Pericarditis
2. Hepatitis
3. Pleural effusion
4. Encephalopathy
14. Diagnosis of Polyarticular JRA?
a. Diagnosed when 5 or more joints are involved
b. And
c. Systemic s/s are mild or absent
d. More common in girls and usually occurs in the teen years, but it may appear as early as 8 yrs of age.
15. Prognosis of Polyarticular JRA?
a. Pts are stratified by RF:
1. RF-negative pts generally have a better prognosis, although 5-10% progress to severe
16. Pauciarticular JRA?
a. Involves <5 joints
b. Divided into early and late-onset.
17. In who does Pauciarticular JRA, early-onset primarily occur and how is it manifested?
a. Predominantly in females
b. Serum ANA is often positive.
c. Half of the children w/early-onset disease develop iridocyclitis (iris and ciliary body inflammation; also called anterior uveitis) that is often asymptomatic.
d. Eye disease does NOT parallel the arthritis activity.
18. In who does Pauciarticular JRA, late-onset primarily occur and significant complication?
a. Primarily affects boys >8 yrs old
b. Late-onset can progress to lumbar and sacral joint involvement (ankylosing spondylitis)
19. What lab results support the diagnosis of systemic JRA?
1. Leukocytosis
2. Thrombocytosis
3. Anaemia
b. The ESR is elevated and blood cultures are negative.
20. What may be necessary to r/u septic arthritis?
a. Evaluation of synovial fluid, particularly in the presence of a significantly tender joint or when only a single joint is involved.
21. RF and ANA in systemic JRA?!?!
a. Usually negative!
22. In addition to medical, physical, and occupational therapy, what should be part of the treatment plan for pts w/JRA?
a. Routine slit-lamp ophthalmic exam to monitor for uveitis.
23. Prognosis of systemic JRA?
a. Approximately 50% of systemic JRA pts eventually recover completely, but 25% develop chronic and destructive arthritis.
b. Death can occur, usually from overwhelming infection!
24. S/S of rubella?
a. Lymphadenopathy (posterior auricular and suboccipital
b. Diffuse salmon-coloured rash.
c. Hx of recent sore throat and cough w/low-grade fever prior to rash.
d. Swelling of multiple large and small joints
25. Most common cause of uveitis in children?
a. JRA
26. What do you always need to make sure you evaluate when someone (esp a child) presents w/knee pain?
a. Hips! Pain from hip problem can be referred to knee.
b. Need to be vigilant of Slipped Capital femoral epiphysis.
27. In who does Slipped capital femoral epiphysis most commonly occur?
a. Obese African American boys.
b. JRA rarely affects the hip in the initial disease course.
28. Where are friction rubs (pericarditis) best heard?
a. “grating” or “creaking” sound best heard along the left sternal border.
29. Presentation of Pericarditis w/JRA?
a. Rarely, pericarditis may preceded the development of arthritis by months or even years.
b. Pts typically complain of chest pain that is relieved when leaning forward and worsened by deep inspiration or coughing.
c. Pain is not always present.
d. Can occur w/JRA.
e. Low voltage QRS complexes and ST-segment elevations may be seen.
30. Tx of pericarditis?
a. Aspirin or NSAIDs
31. Note: No single lab test confirms the dx of JRA.
31. Note: No single lab test confirms the dx of JRA.