R1 Flashcards
Systemic-Sclerosis pathogenesis?
Progressive tissue fibrosis
Vascular dysfunction
Clinical features?
Fatigue and weakness
Telangiectasia, Sclerodactyly, digital ulcer ,calcinosis cutis,pruritis and edema
Arthralgia, myalgia, and contracture
Esophageal dysmotility, dysphagia, and dyspepsia
Raynaud’s Phenomena
Serology?
Antinuclear
Anti-topoisomerase I
Anti- centromere
Complication?
Lung: ILD, PAHTN
Kidney: HTN, Scleroderma renal crisis
Heart: Myocardial fibrosis, pericarditis, and pericardial effusion
Scleroderma renal crisis?
Oligouria,MAHA,thrombocytopnia
Manometry?
Hypomotility with defective lower esophageal sphincter relaxation
Triads of disseminated gonococcus?
Disseminated arthralgia
Tenosynovitis
Painless pustular
Suprascapular nerve entrapment?
Compression of SSN at SS foramen(formed by TSS ligament and SS noch, found on superior mid scapular)
Cause?
Heavy backpack
Direct blow
Heavy weight lifting(ex.shoulder movt_)
Sx and Sign?
shoulder pain
defect in shoulder abduction(supraspinatus)
defect in shoulder ex.rotation(infraspinatus)
No other neurologic finding
Clinical features of RA?
Pain, Swelling, and morning stiffness in multiple joint
Small Joint(MCP,PIP, and MTP)
Spares DIP
Fever, weight loss, and anemia
Cervical S.(Subluxation & Cord compression)
Lab?
Positive RF & anti–CCP Ab.
C-RP and ESR(correlate with activity)
X-Ray: Soft tissue swelling, Joint space narrowing, and boney erosion
CM of Paget disease?
Asymptomatic(MC)
Headache, hearing loss
Spinal stenosis and radiculopathy
Laboratory?
Elevate ALP
Elevated B.Turnover marker(PINP, urine hydroxyproline)
Normal Ca, P and PTH
Pathogenesis?
osteolytic/mixed lytic/sclerotic lesion
B.Scan: Focal increase in uptake
Tx?
Biphosphonate
Pathogenesis?
Osteoclast dysfunction
High bone turnover
CM of SLE?
fever, fatigue, and wt loss symmetric migratory arthritis butterfly rash and photosensitivity pleuritis, pericarditis and peritonitis thromboembolic sign(due to vasculitis and APA) cognitive dysfunction and seizures DMP and M nep
Laboratory?
HA, thrombocytopenia and leukopenia Low C3 & C4 ANA(sensitive) Anti DNASE and ANTI smith(specific) elevated proteinuria and creatinin
Arthritis Cxs in SLE?
Polyarticular Migratory Symmetric Morning stiffness(shorter than RA) Normal joint X-ray Pain exceeds the PE Oral ulcer
antiphospholipid syndrome?
MC: occurs in SLE patient
Venous or Arterial TE(DVT/PE/IS/TIA)
Unexplained Px loss(abortion)
Preterm birth due to PI and PE
Laboratory?
LA(Paradoxical PTT elevation does not respond to plasma mixing)
Presence of SAb(Anti-cardiolipin and anti-B2G-1-Ab)
Risk factors for septic arthritis?
OA,RA,Gout,Prostetic joint Frequent IA GC injection Age >80 DM IV drug abuse Alcoholism
CM?
Monoartheritis
Hot, painful, and tender joint
ROM decrement
Elevated ESR and CRP
Diagnosis?
SFA(WBC>50,000,culture and GS)
Blood culture
Initial treatment?
G+ Cocci–Vancomycin
G_ve–3rd gen.C
Negativ–Vanco +(3rdGC,if Immunocompromised)
Managment of RA?
Acute Sx.relief(NSAID & Predisolon)
DMARD–As soon as posible
DMARD?
MTX(the first line, determine LFT before starting) Leflunomide Hydroxychloroquine Sulfasalazine TNF alpha inhibitors
MTX S/E?
Hepatitis–ALF/Cirrhosis: MC
Pancytopnia
Mucosal ulcers(stomatitis)
Avoid alcohol and give concomitant leucovorin
Leflunomide?
Pyrimidine Sx inhibitor
Hepatotoxicity
Cytopenias
Hydroxy chloroquine?
TNF and IL-1 inhibitor
Retinopathy
Sulfasalazine
TNF and IL-1 inhibitor
Hepatotoxicity
Stomatitis
H.Anemia
TNF inhibitor?
Adalizumab,intracept... Infection(TB) Demyelination CHF Malignancy
Acute back pain < 4 weeks managment?
Moderate activity
NSAID & acetaminophen
Muscle relaxant and spinal manipulation
Subacute and chronic(>4 weeks)?
Intermitent NSAID & acetaminophen
Exercise (stretching, aerobic and strengthing)
Consider: TCA and Deloxitine
Secondary prevention?
Exercise
Education
case of vertebral compresion #?
Trauma Osteoporosis.Osteomylaisa Bone metastasis Metabolic(HPT) Paget disease osteomylitis
CM?
Acute sudden Low Back pain & dec. spinal mobility after heavy lifting, coughing, and sudden bending Pain inc. In standing, walking, and lie back tenderness at affected level Chronic Painless Progressive kyphosis Loss of stature
Comp.
Increase future # risk
Hyperkyphosis: Protuberant Abd, early satiety, weight loss, and decrease respiratory capacity
Ankle reflex and aging?
May be absent finding in Pt age > 70
Mechanical cause of back pain and their caracter?
Muscle strain and disk degeneration
Tenderness on paraspinal area
Inflammatory cause of back pain and cx?
MCC: Spondyloartherophaty(AP, SNA)
Worse at rest and better by activity
Sacroiliitis
Tenden site insertion Infn–cartilage destruction
Osteoarthritis pathogenesis?
Non-inflamatory articular cartilage distraction
idiopathic but may Ass with joint injury and SD(hemochromatosis)
CM?
Joint pain and stiffness
Herben(DIP) and Bouchard(PIP) joint area node-due to osteophyte
Wight being joint mainly affected
Pul.A Complication of RA?
Fibrotic lung disease
Plural effusion
Lung nodule
Pul.HTN
CVS?
Atherosclerosis and vasculitis
MSK?
Osteopenia and osteoporosis
Dermatology?
RA nodule(firm, SC non-tender nodule occur in pressure area)
Hematology?
anemia
CNS?
Neuropathy and Depression
other?
Sjorgen
Raynaud’s
Scleritis
episcleritis
X-Ray indication in Back pain?
Osteoporosis
Compression #
Suspected malignancy
Ankylosing spondilitis
MRI–indication for back pain?
Sensory deficit
Motor deficit
Cauda equina syndrome
Suspected epidural abscess/infection
Red flag sign in back pain requires imaging?
Sudden onset back pain with spine tenderness
History of cancer
constitutional symptoms(fever ,weight loss)
Trauma
Significant/Progressive neurologic deficit
Elevated infection risk(Recent inf,Imunocompromization,IV drug usage)
Felty syndrome pathogenesis?
Long-standing Erossive RA complication
Marked by the formation of Ab against neutrophil and GCSF
Clinical feature?
1) Rheumatoid arthritis(S.erosive Joint disease & deformity, R.Nodule, and vasculitis(mononeuritis multiplex, necrotizing skin lesion)
2) Netrophinia(ANC<2000)–Due to destruction by A.Ab–a recurrent bacterial infection
3) Splenomegaly(B/C traped Ab bound neutrophil)
Diagnosis?
Ant-CCP and RF
Elevated ESR
Pheripherial smear and BM biopsy to r/o other causes
Treatment?
Managing The RA will treat it
Managment Raynaud’s phenomena?
Primary: Avoid aggravating factors(smoking,Cold T and emotional stress) & CCB for persistent symptoms
Secondary: Treat the underlying disease, CCB for persistent symptoms, and aspirin for patients at risk of hand ulcer
Primary and secondary Raynaud’s phenomena D/C?
PR:start at young age15-30),symetric
SR:Start age >40.asymetric,hand ischemia sign
Tests should do in patients with RP?
CBC Metabolic panel ANA/RF Urinalysis ESR Complement level
adhesive capsulitis pathogenesis?
Loss of GH distensibility due to C.Inflamation, fibrosis, and contracture.
manifestation?
Gradual onset shoulder pain
Shoulder stiffness
Defective both passive and active movement
Normal X-Ray
Risk increase in DM, Hypothyroid, and immobile patients
RA treatment If symptoms persist for more than 6 months of treatment?
ADD TNF inhibitors
Tophaceous gout?
Multiple white nodule A common location is an area where tendon meet joints(finger) Common in advanced gout Due to UA crystal deposition in tissue Can drain whitish choky discharge
How to d/t from osteoarthritis (B & H) nodule and R.Nodule/
OAN: Bonny AT area of PIP and DIP
R.N: Occurs at pressure areas like wrist and post. ulna.
G.T: Occur in multiple joint areas
Reactive arthritis triads?
Non-Gonococcal uretritis
Asymmetric oligoarthritis
Conjunctivitis
Other Cxs?
Mucosal ulcer Seronegative Sterile SFA NSAID is the first line TX. Knee and sacroiliac joint MC involved
Sicca syndrome CXS?
Dry eye
Con..erosion–D.vision
Dry mouth
Common in women
Cause?
Age-related: Usually, start age >75
Sjorgen S: Usually start at young age, ANA positive and systemic A.I disease sx. mainly SS
Age-related SS managment?
due to gland atrophy
artificial tear
topical cyclosporine
polymyalgia rheumatic symptoms?
age > 50 bilateral joint pain mainly around tissue not joint morning stiffness 2 joint involvement(with decrease AOM) 1)neck or torso 2)Shoulder or PUE 3)Pelvis or proximal Le 4)Constitutional symptoms(F,WL and fatigability) May have associated TA No tenderness
LAB?
Elevated ESR and CRP 15 15 15% may have normal lab Normocytic anemia Symptoms respond to steroid Normal CK(22-198)
Whipple disease CM?
Chronic diarrhea
Non-deforming arthritis
LDP
May damage eye, cardiac, and CNS tissue
Diagnosis?
PAS-positive macrophage in SI lamina porphyria
+PCR for G-ve T.whipli
Disease-associated with pseudogout?
Primary HPT with chronic Ca elevation
Hypothyroidism
Hemochromatosis
Cxs?
Due to CPP deposition
Commonly affect knee
SFA:rhomboid-shaped + birefringence cristal
X-Ray: Chondrocalcinosis
CXS of back pain associated with malignancy?
Progressive
Worse at night
Unrelieved by rest
Focal vertebral tenderness
Inflammatory back pain(AS) feature??
Insidious onset age <40 Sx more than 3 month Relived y exercise Worse at night Lumbosacral tenderness Decrease range of motion
Ankylosing spondylitis CM?
MCC of inflammatory BP Arthritis (sacroiliitis) Reduced CE and spinal mobility Enthesitis Dactylitis(swelling of hand and finger) Uveities
complication?
osteoporesis
cauda equina
AR
Vertebral #
Diagnosis?
Elevated ESR and CRP
HLAB-27
X-Ray(sacroiliac joint infn, vertebral bodies fusion)
If negative do MRI
Goaty arteritis SFA?
Inflammatory
MSU cristal
Needle shaped % NBR(yellow to parallel light)
Lateral epicondilitis CM?
Subacute or chronic Lateral elbow pain
Hx repetitive/forceful wrist extension
Peak incidence age 45-54
Diagnosis?
Tenderness at Lat. epicondyle & P.E.Muscle
pain with resisted wrist extension/supination
Pain with passive wrist flexion
Managment?
Modified activity Inelastic counterforce brace NSAID Stretching and progressive ex. resistance Physical therapy
Pathogenesis?
Non-inflammatory extensor tendinosis due to EX.Extensor muscle usage like tennis
chondrocalcinosis in CPP arthritis?
Calcification of articular cartilage
Acute goit atack treatment?
NSAID
Colchicine
Glucocorticoids
Urate lowering medication(Alllopirinol and febuxostat) indication?
Recurrent gout
Gout complicated by topi and uric acid stone
Does practice doing reduce future got attacks?
Wight reduction BMI<25
Low-fat diet
Lower seafood and red meat intake
Protein intake preferably from vegetable and low-fat dairy product
Avoidance of organ rich food(liver and sweat bread)
Avoidance of beer & distilled sprint
Avoid diuretic if posible
Managment of ostoarteritis?
exercise and wt loss–If the symptom persists–Topical NSAID—If still persist—Surgery, Chronic pain managment
