Can present as pauciarticular form (few joints affected)
Name 4 characterisitics of RA.
swan neck deformity
Pannus (cartilage looks like granulation tissue from chronic inflammation)
Rx for RA?
Signs and symptoms of Gout?
Podagra (Big toe)
Tophi (uric acid crystals in skin)
Punched out lesions on bone xray
Needle shaped crystals with negative birefringence
Rx for acute attack of Gout?
NSAIDs or Cholchicine
Maintenance treatments for Gout?
Lots of fluid
Probenicid or allopurinol (not for acute attacks)
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
Differential Dx for arthritis?
Sickle cell disease
Childhood ortho problem
Signs and symptoms of Ankylosing Spondylitis?
20-40 yo male
Back pain and morning stiffness
Possible bamboo spine on xray
Often fever, +ESR, anemia, some have uveitis
Treatment for Ankylosing Spondylitis?
Methotrexate, Etanercept, Infliximab
With what gene group is Ankylosing Spondylitis associated?
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
Rx for Reiters syndrome?
NSAIDs for arthritis
methotrexate or sulfasalazine for more serious joint symptoms
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.
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?
Do muscle biopsy to confirm
Rx is steroids
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?
Muscle biopsy to confirm
Rx with steroids
Child under 5, truncal rash, high fever, conjuctivits, cervical lymphadenopathy, strawberry tongue, late skin desquamations of palms and soles, and/or arthritis. Dx? Rx?
Aspirin and IV immunoglobulin
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?
Biopsy or angiography may show multiple aneurysms
Rx with steroids or immunosuppressants
Patient with dry eyes, dry mouth, and other possible autoimmune disease.
Lab tests + in SLE?
anti-Smith antibody (confirm)
rapid plasma reagin test for syphillis
thrombo, leuko, and pan - cytopenia.
Rx for SLE?
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?
CT or MRI arteriogram shows vessel wall abnormalities and stenosis
Corticosteroids / Cyclophosphamide
Pt with nose bleeds, hemoptysis / dyspnea, hematuria / ARF; + ANCA. Dx? Rx?
Rx with Cyclophosphamide
Pt with raynauds phenomenon, skin thickening, esophageal dysmotility, sclerodactyly, intestinal hypomotility, dyspnea, heart arrhythmias or CHF, arthralgias / myalgias. Dx?
Pt with Calcinosis, raynauds phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias; skin thickening on distal extremities and face. Dx?
Lab differences between CREST syndrome and Scleroderma?
CREST: + anticentromere antibodies
Scleroderma: + anti-scl-70 ANA or antitopoisomerase-1