Step 3- Rheumatology

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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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	Erstellt von Jaimie Shah vor etwa 11 Jahre