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Old 08-01-2013
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Help Peds Questions #2

A 4 year old girl comes to the office with her grandmother because the latter noticed her grand-daughter was limping and had a swollen left knee. The parents report that the patient complains of occasional pain in that knee. On physical examination you notice a normal left and right knee, with the left showing pain on both passive and active motion and a temperature of 37.9 C. The girl also complains of moderate left eye pain with photophobia and blurred vision. The rest of the physical examination is non-contributory. CBC shows anemia, thrombocytosis and leukocytosis, ESR and C-reactive protein are elevated
Which of the following conditions is most likely to be associated with these findings?
A. Rheumatoid Arthritis.
B. Polyarteritis Nodosum.
C. Septic Arthritis.
D. Juvenile Idiopathic Arthritis (Still disease)
E. Osgood-Schlatter disease.
F. Viral Arthritis.

I tweaked the question and made it harder so that my pal Kais_MD has some challenge before his exam!
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Old 08-01-2013
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I would have to go with D (Still Disease) just because of the extra articular signs and Sx like the photophobia and blurred vision which is called iridocyclitis. Viral Arthritis would have a history of viral infection. THe anemia also points more towards still disease as oppose to viral arthritis. The main course of treatment is Nsaids and sometimes intraarticular steriod injections. Methrotrexate is used as a last resort in this age group.

TOo young for RA and Osgood schlatter disease (usually more active kids) NO temp for septic or any effusions or other cardinal sings associated with septic arthritis
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Old 08-01-2013
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Originally Posted by Kais_MD View Post
I would have to go with D (Still Disease) just because of the extra articular signs and Sx like the photophobia and blurred vision which is called iridocyclitis. Viral Arthritis would have a history of viral infection. THe anemia also points more towards still disease as oppose to viral arthritis. The main course of treatment is Nsaids and sometimes intraarticular steriod injections. Methrotrexate is used as a last resort in this age group.

TOo young for RA and Osgood schlatter disease (usually more active kids) NO temp for septic or any effusions or other cardinal sings associated with septic arthritis
You are correct and your explanation is perfect, so I wont put the explanation of my source because it sucks compared to yours lol good job, this is JIA.
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