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Systemic symptoms seen with Rheumatoid arthritis?
- Fever, Malaise
- Subcutaneous nodules
- Pericarditis or Pleural effusion
- Uveitis
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Characteristics of juvenile rheumatoid arthritis?
- Rheum factor negative
- Uveitis is often presenting symptom
- Can present as pauciarticular form (few joints affected)
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Name 4 characterisitics of RA.
- Systemic symptoms
- Morning stiffness
- swan neck deformity
- Pannus (cartilage looks like granulation tissue from chronic inflammation)
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Rx for RA?
- NSAIDs
- Methotrexate
- Hydroxychloroquine
- Etanercept
- Infliximab
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Signs and symptoms of Gout?
- Older Man
- Podagra (Big toe)
- Tophi (uric acid crystals in skin)
- Punched out lesions on bone xray
- Needle shaped crystals with negative birefringence
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Rx for acute attack of Gout?
NSAIDs or Cholchicine
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Maintenance treatments for Gout?
- No EtOH
- Lots of fluid
- Alkalinize urine
- Probenicid or allopurinol (not for acute attacks)
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Signs and symptoms of pseudogout?
- Pain in knee or elbow
- rhomboid-shaped crystals with weak positive birefringence
- Older man or woman
-
What causes pseudogout?
Ca pyrophosphate crystal deposition
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Differential Dx for arthritis?
- Osteo
- RA
- Gout
- Pseudogout
- Septic
- Psoriasis
- SLE
- IBD
- Ankylosing Spondylitis
- Reiters Syndrome
- Hemophilia
- Lyme disease
- Rheumatic Fever
- Sickle cell disease
- Previous Trauma
- Childhood ortho problem
- Charcot Joint
- Hemochromatosis
- Wilsons disease
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Signs and symptoms of Ankylosing Spondylitis?
- 20-40 yo male
- Family hx
- Back pain and morning stiffness
- Possible bamboo spine on xray
- Often fever, +ESR, anemia, some have uveitis
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Treatment for Ankylosing Spondylitis?
- Exercise
- NSAIDs
- Methotrexate, Etanercept, Infliximab
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With what gene group is Ankylosing Spondylitis associated?
HLA-B27
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What are the signs and symptoms of Reiters syndrome?
- Hx of recent Chlam or enteric bacterial infection
- Urethritis, Conjunctivits, and Arthritis (Cant pee, see, bend the knee)
- Superficial oral or penile ulcers
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Rx for Reiters syndrome?
- NSAIDs for arthritis
- methotrexate or sulfasalazine for more serious joint symptoms
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Describe the presentation and progress of Lyme disease.
- Stage 1: (3-30 days post infx) Erythema Migrans
- Stage 2: (days to weeks later) Rash at other locations; migrating pain in muscles, joints, and tendons; heart palpitations c associated dizziness. Less common neuro signs include bells palsy, meningismus, encephalitis (mood change, sleep changes, memory loss) and shooting neurologic pain.
- Stage 3: (later) polyneuropathy, encephalopathy, arthritis
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20 something female with fever, microcytic anemia, fatigue, weight loss, + ESR, painful oral and genital ulcers, uveitis, arthritis, erythema nodosum.
Behcets syndrome
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40-60 yo female with fever, microcytic anemia, fatigue, weight loss, + ESR, +CPK; trouble rising from chair or climbing stairs (proximal muscle weakness); abnormal EMG. Diagnosis? Next step? Rx?
- Polymyositis
- Do muscle biopsy to confirm
- Rx is steroids
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40-60 yo female with fever, microcytic anemia, fatigue, weight loss, + ESR, +CPK; trouble rising from chair or climbing stairs (proximal muscle weakness); abnormal EMG. Heliotrope rash around eyes with periorbital edema (or other rash). Diagnosis? Next step? Rx?
- Dermatomyositis
- Muscle biopsy to confirm
- Rx with steroids
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Child under 5, truncal rash, high fever, conjuctivits, cervical lymphadenopathy, strawberry tongue, late skin desquamations of palms and soles, and/or arthritis. Dx? Rx?
- Kawasakis syndrome
- Aspirin and IV immunoglobulin
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Male < 40 yo pt with chronic hep B/C presents with fever, abdominal pin, weight loss, renal disturbances and/or peripheral neuropathies, skin lesions; +ESR, +WBC, -RBC, hematuria and proteinuria, +p-ANCA.
Dx? Confirmation? Rx?
- Polyarteritis Nodosa
- Biopsy or angiography may show multiple aneurysms
- Rx with steroids or immunosuppressants
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Patient with dry eyes, dry mouth, and other possible autoimmune disease.
Sjogrens
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Lab tests + in SLE?
- ANA (screen)
- anti-Smith antibody (confirm)
- VDRL
- rapid plasma reagin test for syphillis
- thrombo, leuko, and pan - cytopenia.
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Rx for SLE?
- NSAIDs
- hydroxychloroquine
- Corticosteroids
- azathioprine
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15 - 30 woman from east asia with malaise, vertigo / syncope with no pulses and difficult to get BP with hx of stroke / TIA and CHF. Dx, confirm, and Rx?
- Takayasus arteritis
- CT or MRI arteriogram shows vessel wall abnormalities and stenosis
- Corticosteroids / Cyclophosphamide
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Pt with nose bleeds, hemoptysis / dyspnea, hematuria / ARF; + ANCA. Dx? Rx?
- Wegeners granulomatosis
- Rx with Cyclophosphamide
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Pt with raynauds phenomenon, skin thickening, esophageal dysmotility, sclerodactyly, intestinal hypomotility, dyspnea, heart arrhythmias or CHF, arthralgias / myalgias. Dx?
Scleroderma
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Pt with Calcinosis, raynauds phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias; skin thickening on distal extremities and face. Dx?
CREST syndrome
-
Lab differences between CREST syndrome and Scleroderma?
- CREST: + anticentromere antibodies
- Scleroderma: + anti-scl-70 ANA or antitopoisomerase-1
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