211907
Description
Flashcards by Jaimie Shah, updated more than 1 year ago
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Created by Jaimie Shah
over 10 years ago
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| Question | Answer |
| RA is defined as having 4 of more of the following present for diagnosis... | Morning stiffness more than an hour, MCP and PIP involved, swelling in a least 3 joints, symmetric involvement, Rheumatoid nodules, X ray showing erosions, positive RF or CCP, elevated CRP and ESR |
| Single most accurate test for RA | Anti CCP (95% spp) |
| felty's syndrome | RA, splenomegaly, Neutropenia |
| type of anemia common to RA | normocytic normochromic |
| joint findings in RA | MCP swellingn and Pain, boutonniere deformity, swan neck deformity, Backer's cyst, C1/C2 subluxation, Knee involvement |
| what gives the lowest glucose level in Pleural effusions | RA |
| Tx of RA | NSAID with DMARD; can use steroids to bridge accutely to DMARDs |
| DMARDs in RA | MTX, Biologics, Hydroxychloroquine (need eye exams for retinopathy), Sulfasalazine, Rituximab, Anakinara, Tocilizumab, Leflunomide, Abatacept, gold salts |
| what are the seronegative spondyloarthropathies | AS, Reactive arthritis, Psoriatic arthritis, Juvenille RA (adult onset still's disease) |
| what all seronegative spondyloarthropathies have in common | negative RF, prediliction for spine, SI joint involved often, assoc with HLA B27 |
| AS presentation | young patient, spine and back stiffness, worse at night and relieved by leaning forward, kyphosis and diminished chest expansion, uveitis, aortitis, restrictive lung disease |
| Dx AS | initally start with XR and do most sensitive test MRI |
| Tx AS | NSAIDs, Biologics, Sulfasalazine (do not use steroids-they dont work) |
| reactive arthritis tx | NSAIDs |
| Psoriatic arthritis features | Nail pitting, DIP involved no like in RA, sausage digits, Enthesitis |
| Psoriatic Arthritis Dx and Tx | no test spp for it don't mistake with nail fungus; NSAIDs, MTX, biologics |
| Juvenille RA presentation (adult onset still's) | Fever, salmon colored rash, polyarthrits, LAD, Myalgias, +/- hepatosplenomegaly and increased LFTs |
| Juvenille RA Dx | no spp test but high ferritin, elevated WBC, negative RF and negative ANA |
| tx juenille RA | NSAIDS add steroids if needed, and if dont respond start MTX andd biologics |
| Whipple basics | presents with diarrhea, malabsorption, and weight loss and JOINT PAIN; need bX gut that is PAS +; tx is Bactirm |
| OA nodules | Heberden's (DIP) and Bouchard's (PIP) |
| order all of this in CCS for OA | Xray, ANA, ESR, RF, CCP, joint tap |
| Tx of OA | tylenol and NSAIDs, intra joint steroid injection, surgery |
| Need 4/11 criteria to dx SLE | Malar rash, photosensitive rash, oral ulcers rash, discoid rash, arthralgias, either low WBC/Hemolysis/low Plts, benign proteinuria too ESRD, behavior change/stroke/seizure/ menegitis, Perecardits/pleural CP/pulm HTN/PNA/Myocarditis; ANA +, DS DNA+ |
| Dx test of SLE | best inital test is ANA, most spp is anti DS DNA or anti Smith |
| best serology to follow in flare up of SLE | Complements drop in flare and anti-DS DNA increase in flare |
| Anti Ro/SSA put baby at risk for what in the uterus | heart block |
| ACD is more common than hemolysis in SLE (t/f) | true |
| tx of SLE | Steroids acutely, NSAIDs for joint pain--if no response hydroxychloroquine; relapse after stopping steroids--Belimumab, Azathioprine, Cyclophosphamide; Nephritis--steroids and mycophenalate mofetil |
| Drug induced lupus basics | due to Hydralazine, procainamide, and INH; always anti histone positive; never has renal or CNS involvement ; complement and anti DS DNA are normal |
| Presentation of Sjogren's syndrome | dry eyes and dry mouth, sensation of sand under the eyes, loss of taste and smell, loss of teeth at an early age |
| Sjogren's syndrome dx | most accurate test lip bx; schirmer test; ANA positive 95% of time, RF pos 70% of time, Anti Ro (SSA), anti La (SSB) |
| Sjogren's syndrome tx | keep mouth and eyes moist, Pilocarpine and cevimeline to increase ach so increases oscular secretions |
| Dx of scleroderma | ANA and anti Scl-70 |
| tx of scleroderma | renal involvement with HTN: use ACE; pulm HTN: bosentan, epoprostenol, sildenafil; Raynaud's: CCB; GERD: PPI; Lung Fibrosis: cyclophosphamide |
| CREST antibodies | Anticentromere only; doesn't present with primary HTN |
| Eosinophilic fasciitis looks like scleroderma but is not... | thickened skin, but no hand involvment, no raynaud's, no heart/lung/kidney involvement. it has marked eosinophilia and orange peel appearance and tx is corticosteroids. |
| weakness + elevated CK + elevated aldolase + bx is what? | Polymyositis |
| weakness, increased CK, increased aldolase, biopsy, skin rash | Dermatomyositis |
| Dx workup for PM and DM | CPK, aldolase, EMG, LFT, ANA, muscle biopsy (most accurate) |
| where is positive anti Jo seen? | ILD |
| threat of malig in DM>PM (T/F) | true |
| tx of PM/DM | steroids |
| tx of fibromyalgia | Exercise, Initial tx: milnacipran, duloxetine or pregabalin; TCAs effective but more SE; NSAIDs not the first line therapy |
| presentation of PMR | person>50yo, profound pain and stiffness of prox muscles, stiffness worse in AM and is localized to muscles not joints, ESR elevated and responds to steroids |
| nonspp features of PMR | fever, weight loss, malaise, normocytic anemia, normal CPK/EMG/Aldolase/muscle biopsy, no muscle atrophy |
| PAN defining features | abd pain, renal involvment, testicular involvement, Pericarditis, HTN, no lung involvement |
| PAN dx and tx | angiography of abd vessels (initial), most accurate test biopsy of skin, muscle or sural nerve; tx prednisone or cyclophosphamide |
| Wegners basics | similar presentation to PAN but upper and lower lung involvement and C-ANCA positive; tx also same as PAN |
| vasculitis + eosinophilia + asthma | Churg- Strauss (P-anca and anti MPO positive)--Bx most accurate test and great response to steroids |
| what disease is associated with PMR | temporal arteritis (tx with steroids and don't delay to get bx the changes in it wont pass quickly) |
| Takayasu's arterits | most have usual vasculitis findings before they go pulseless; special features TIA and stroke; dx with Aortic aortography and MRA; tx with steroids |
| Cryoglobulinemia tx | associated with Hep C and renal involvement and you treat Hep C with interferon and ribavirin first |
| Behcet disease basics | oral and genital ulcers, ocular involvment that can cause blindness, skin lesions (hyperactivity to needle sticks result to sterile skin abscesses); no spp dx test and tx prednisones and colchicines |
| best inital test of a tapped joint to tell it is septic joint | not culture, it is cell count usu>50,000 but can be as low as 20,000 |
| cell count of joint fluid--inflammatory (gout/pseudogout) | 2000-50000 |
| normal joint fluid cell count< | <2000 |
| following precipitate gout | binge on ETOH, Thiazides, Nicotinic acids |
| tx of gout (acute) | NSAIDs, steroids, Colchicine (good in first 24 hrs, if NSAIDs cant be used)--but can cause N/D/bone marrow suppression |
| tx of gout (prevention) | Allopurinol (SE-rash, allergic interstial nephritis and hemolysis), probenecid, sulfinpyrazone; weight loss and avoid ETOH; febuxostat if cant tolerate allopurinol; if other meds not enough use Uricases |
| Dont use allopurinol if an acute gout attack (T/F) | true |
| Associated diseases with pseudogout | hemochromatosis, HPTH, acromegaly, hypothyroid |
| pseudogout dx and tx | positive bireringent crystals that are rhomboid shaped; tx NSAIDs and steroids acutely |
| Dx and emperic tx of septic joint | tap joint, gram stain and culture; use ceftriaxone and vanc |
| staph and strep septic arthritis | Oxacillin, Nacillin, Cefazolin; if PCN allergic--vanc, linezolid, Dapto, Clinda |
| Gram negative septic arthritis tx | ceftriaxone, ceftazidime, gentamicin; if PCN allergic: Aztreonam, Fluoroquinolone |
| Gram negative septic arthritis tx | ceftriaxone, ceftazidime, gentamicin; if PCN allergic: Aztreonam, Fluoroquinolone |
| Gram negative septic arthritis tx | ceftriaxone, ceftazidime, gentamicin; if PCN allergic: Aztreonam, Fluoroquinolone |
| paget's disease presentation | pain, stiffness, aching, bowing of tibias and sarcoma in 1% of patients. |
| Dx tests for Paget's | initially is ALK, most accurate is X-ray, on CCS also order urinary hydroxyproline, serum Ca, serum Phos both will be normal, and bone scan. |
| Paget's tx | bisphosphonates and calcitonin |
| what do you need to exclude even if you think the patient has a baker's cyst | DVT (can both present with painful and swollen ext) |
| Backer's cyst tx | NSAIDs and steroids injections sometimes. |
| difference between plantar fascitis and tarsal tunnel syndrome | tarsal tunnel has more pain with use and can cause numbness of bottom of foot, also in this avoid high heels and boots and may need steroid injection and surgery |
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