1. Systemic symptoms seen with Rheumatoid arthritis?
    • Fever, Malaise
    • Subcutaneous nodules
    • Pericarditis or Pleural effusion
    • Uveitis
  2. Characteristics of juvenile rheumatoid arthritis?
    • Rheum factor negative
    • Uveitis is often presenting symptom
    • Can present as pauciarticular form (few joints affected)
  3. Name 4 characterisitics of RA.
    • Systemic symptoms
    • Morning stiffness
    • swan neck deformity
    • Pannus (cartilage looks like granulation tissue from chronic inflammation)
  4. Rx for RA?
    • NSAIDs
    • Methotrexate
    • Hydroxychloroquine
    • Etanercept
    • Infliximab
  5. 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
  6. Rx for acute attack of Gout?
    NSAIDs or Cholchicine
  7. Maintenance treatments for Gout?
    • No EtOH
    • Lots of fluid
    • Alkalinize urine
    • Probenicid or allopurinol (not for acute attacks)
  8. Signs and symptoms of pseudogout?
    • Pain in knee or elbow
    • rhomboid-shaped crystals with weak positive birefringence
    • Older man or woman
  9. What causes pseudogout?
    Ca pyrophosphate crystal deposition
  10. 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
  11. 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
  12. Treatment for Ankylosing Spondylitis?
    • Exercise
    • NSAIDs
    • Methotrexate, Etanercept, Infliximab
  13. With what gene group is Ankylosing Spondylitis associated?
  14. 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
  15. Rx for Reiters syndrome?
    • NSAIDs for arthritis
    • methotrexate or sulfasalazine for more serious joint symptoms
  16. 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
  17. 20 something female with fever, microcytic anemia, fatigue, weight loss, + ESR, painful oral and genital ulcers, uveitis, arthritis, erythema nodosum.
    Behcets syndrome
  18. 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
  19. 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
  20. 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
  21. 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
  22. Patient with dry eyes, dry mouth, and other possible autoimmune disease.
  23. Lab tests + in SLE?
    • ANA (screen)
    • anti-Smith antibody (confirm)
    • VDRL
    • rapid plasma reagin test for syphillis
    • thrombo, leuko, and pan - cytopenia.
  24. Rx for SLE?
    • NSAIDs
    • hydroxychloroquine
    • Corticosteroids
    • azathioprine
  25. 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
  26. Pt with nose bleeds, hemoptysis / dyspnea, hematuria / ARF; + ANCA. Dx? Rx?
    • Wegeners granulomatosis
    • Rx with Cyclophosphamide
  27. Pt with raynauds phenomenon, skin thickening, esophageal dysmotility, sclerodactyly, intestinal hypomotility, dyspnea, heart arrhythmias or CHF, arthralgias / myalgias. Dx?
  28. Pt with Calcinosis, raynauds phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias; skin thickening on distal extremities and face. Dx?
    CREST syndrome
  29. Lab differences between CREST syndrome and Scleroderma?
    • CREST: + anticentromere antibodies
    • Scleroderma: + anti-scl-70 ANA or antitopoisomerase-1
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