R2 Flashcards
dermatomyositis myopathy?
Proximal myopathy
UE=LE
Elevated CK >10x
Elevated LDH
Skin finding in DM?
1-Gottron papules: flat-topped, erythematous to violaceous papules and plaques found over bony prominences, particularly the MPJ,PIP and DIP
2- Photo distributed facial erythema
3-heliotrope [violaceous] edema of the eyelids
4–darkening and thickening of fingertips and sides resulting in irregular, “dirty”-appearing marks.
Extramuscular finding?
ILD
Dysphagia
Myocarditis
Diagnosis?
Nonspecific: ⊕ ANA,
Specific: ⊕ anti-Jo-1 (histidyl-tRNA synthetase), ⊕ anti-SRP (signal recognition particle), ⊕ anti-Mi-2 (helicase).
EMG?Biopsy in uncertain condition
TX?
High dose GC and GC sparing agent
Screen for malignanacy
Joint inflamation cause differentiation?
BSE
Apearance
WBC
PMN
Apearance?
Normal and Non Inf.(OA)–Clear
Inflam(Ra,Crystal.)–Translucent/opaque
Septic:Opaque
WBC?
N:<200
NI:200-2000
I:2000-100,000
S:50,000-150,000
PMN:
N:<25%
Ni-25%
I>50%
S>80-90%
OA x-ray feauture?
Narowing of joint space
Joint space osteophyte
subchondral sclrosis/cyst
Complication of temporal artheritis?
Proximal myophaty
Acute visual loss
Aortic anurythm
Pain CXS in Carpal tunell syndrome?
Pain along latteral 3 fingers
not relieved by rest
shaking may inprove it
rep.hand movt can exacerbate it
diagosis?
Tinel test
Phalen test
Nerve conduction test if above non conclusive
Drug induced lupus CM?
Cons.Sx(fever,myalase)
Artheralgia
Serositis(pluritis,pericarditis)
les rash
Risk?
High dose
Prolonged use
slow acetytlator
LAB?
Antihistone
ANA
MC implicated drugs?
Procainamide Penicillamine Hydralazine TNF inhibitors Minocycline Isoniazid
Managment?
stope causative drug
NSAID
IBD and arthritis?
Occur in 45% of patients Spondyloarthritis feature MC sacroiliac but rare knee involvement Using NSAID may worse diarrhea Sulfasalazine treat both
Achilles tendinophaty cause?
Floroquinolol
Age >60,Femmale,CS use and organ transplant
Managment
stop drug
avoid exercise use that tendon
if continue use–can cause tendone rapture
Complex regional pain syndrome?
sever/burning/regional(not dermatomal pain) allodynia edema and abnormal sweating vasomotor change:alterd Temprature tropic skin, nail, and hair change
Triggers?
Trauma
#
Sprain
Surgery
Diagnosis?
Primary clinical
X-Ray–patchy demineralization
Bone scintigraphy: Increase uptake in the affected limb
Managment?
Physical and occupational therapy
exercise
NSAID
TCA/Pregabaline
Polymyositis CM?
Similar to dermatomyositis w/o skin finding
Pharyngeal muscle involvement can lead to dysphagia
Endomysial infn.unlike dermatomyositis (periimycial)
Mixed CT disease triads?
SLE
Systemic sclerosis
Polymyositis
Lab finding?
Anti-U1 ribonucleoprotein ANA RF,anti-CCP Elevated CK Anemia/Cytopinia
Lumbosacral strain cause?
The strain of paraspinal tendon, muscle, and IV ligament
Sudden unbalanced muscle contraction
RF:Obesity,S.deformity/degeneration,muscle weakness
CM?
Back pain that may radiate to thighs, hip, or buttock
Paraspinal tenderness
No neurologic deficit and negative straight leg test
managment?
M.activity
NSAID
Non benzodiazepine muscle relaxant
wrist splinting used for?
carpal tunnel syndrome
Diabetic foot deformity Pathogenesis?
Atrophy of intrinsic foot muscle
Nerve degeneration
Dec.Pain and Prop.
Concurrent orthopedic and vasculr formation
Manifestation?
Hammertoe(MTJ dorsiflexed, PITJ plantarflexed, and DIT joint dorsiflexion).
Clawfoot (Dorsiflexion at MTJ and plantar flexion at P & DIJ.
Psoriatic arthritis clinical features?
Asymmetric oligoartherophaty
DIP involvement
Symmetric arthropathy
Arthritis mutilans (deforming and destructive arthritis)
Spondyloartherophaty(sacroiliitis and spondylitis)
Soft tissue and nail involvement?
Ententhitis
Dactylitis
Onychomycosis
Swelling of hand and feet(pitting)
Skin finding?
Absent in 15%
Can be preceded by arthritis
Managment?
NSAID
Methotrexate
TNF alpha inhibitor
Etiology for avascular necrosis?
Steroid Alcohol SLE Anti-Phospholipid syndrome Hemoglinophaty(SCD) Infection(osteomyelitis,HIV) Renal transplantation Decompression sickness
CM?
Groin pain on standing
Pain on abduction and IR
No erythema,tendernes,s or swelling
Lab?
Normal ESR and CRP
Normal WBC
Radiographic sign?
Cresent sign(subchondral) and deformity in X-Ray MRI is most sensitive--determine zone of ischemia
Cause of gout?
Increase production(Primary,MPD,TLS and HGPRT deficiency) Decreae clerance(Renal disease,Tiazide diuretic)
Exocrine feature of Sjogren syndrome?
Keratoconjunctivitis sicca
Dry mouth
Xerosis
Salivary hypertrophy
Extragladular feature?
Raynaud's phenomena Cutaneous vasculitis arteritis/arthralgia ILD NHL
Diagnosis?
Schirmer test (Dec.lacrimation)
anti-ro(SSA) and Anti-La(SSB)
Focal lymphocytic siaalinoadinitis in SG biopsy
Disease-associated with psoriasis?
ILD
Raynauds
Esophagial dysmotility
D/T gonococcal from non-gonococcal septic arthritis?
GA: Usually in young sexually active/may be migratory
NGA: Usually one joint inv. and non-migratory, occur patient with risk for SA
DMARD used in patients with CNS or renal disease?
Cyclophosphamide
S/E?
Hemorrhagic cystitis
Bladder Ca
Sterility
Myelosuppression
Fibromyalgia?
Widespread pain Tenderness at the trigger point Impaired concentration Normal Lab. Pain exacerbated by vigrous exercise
Cause of lumbar spinal stenosis?
Osteoarthritis
Spondylosis
Degenerative disk disease
Thickening of ligamentum flavum
CM?
Back pain Exacerbated by a back extension(walking) Relived by leaning forward LE tingling and numbness LE weakness
What triads are associated with female stress #?
Oligomenorrhea
low-calorie intake(low BMI)
Osteoporosis
CM of stress #
Forefoot pain
Localized pain to surface of bone usually 2nd,3rd & 4th MT
Area palpation increase pain
Common in athletes
A sudden increase in exercise intensity increases the risk
Forefoot pain other cause?
Arthritis(MT-P joint tenderness) Bursitis--Tenderness b/n metatarsal head(the poor fitting shoe is a risk) Morton Neuroma(Pain in 3rd and 4th toe), clicking sensation while palpating the space and simultaneous MTP joint squeezing)
MTX toxicity?
Cytopinia Hepatitis Stomatitis Fever Alopecia ILD Rash
CNS Sx of SLE?
Cognitive dysfunction Seizure TE disease(IS,TIA) Transverse mylitis Vasculitis
DEXA scan score interpration?
1) -1 and above — normal once over 50.
2) -1 and -2.5 —-osteopenia
3) lower than -2.5 —- osteoporosis.
Osteoporosis risk factor?
Age > 65
Menopausal status
Smoking history
Family history
Managment of osteoporosis?
Weight-bearing exercise
Alcohol and smoking sesassion
Adequate Ca And Vit D intake(supplemental)
Drugs
Drug indication?
indication
1) -1 and -2.5 (osteopenia) with high ostoporetic # risk
2) TS, lower than -2.5
3) Osteoporetic #
1st line drug and C/I?
first-line are Biposphonate (alendronate, risedronate)
Not recommended in RF patient
Prolonged use is a risk for atypical #
alternative?
Denozimab
Anabolic agent(teripartide)
Nasal calcitonin
SERM(raloxifine)
Unexplained only elevated ALP in an asymptomatic old patient?
Paget disease
Viral arteritis feature?
Polyarticular symmetric Wrist, hand, knee, and foot inv. Usually self-limited resolve with 1-2 month commonly due to parvovirus Tx with NSAID
Screening for bladder ca?
Not recommended b/c
No sensitive test
False survival prediction
Scleroderma renal crisis pathophysiology?
Collagen deposition in renal vessel–RAAS activation
CM?
Hypertensive emergency Renal failure Maybe early symptom Proteinuria(MC:normal ) Thrombocytopenia Microangiphatic HA Manage with ACE inhibitor irrespective of RFT(captopril more preferd due to rapid onset)
The first test to do in SLE suspects?
ANA
scleroderma Ab?
Anti topoisomerase—diffuse
Anti centromere–loccalize
Morton neuroma?
Misnomer
Due to interdigital nerve injury
Common in athletes
Diagnose clinically by (Mulder sign)–lateral compression of 3rd and 4th MT then touching middle case reproduce pain)
For foot pain may radiate to the plantar surface
The pain worsened by walking hard surface, high heel, and tight shoo.
Managment?
Make pad/slap in the metatarsal head
Surgery for failed conservative Tx
Drug cause complication in scleroderma?
BB_increase Rynauds risk
CS–Increase SRC risk
Plantar fasciitis?
pain in plantar area of rearfoot
pin worse in the morning then decrease after first activity and worsen back at end of day
Point tenderness at the plantar heel area
DEXA scan indication?
women Age >65
Age < 65 with ostoporesis equivalent risk(FRAX calculation)
Non BZD muscle relaxant usage?
Acute back pain due to benign cause I.e muscle strain does not respond to NSAID
Cyclopenzaprine and tinazidine(may have anti cholinergic S/E)
an avascular disease that can cause asymmetric UE claudcation?
Takayasu arteritis
Toxicity of hydroxychloroquine?
Retinal toxicity
Irreversible blindness
Commonly occur after 5-7 years of there[y
Anual and baseline test
Factor decrease gout?
Dairy product
High Vit C level
Increase coffee intake
Acute gout attack onset?
Develop to high-intensity pain within 12-24 Hr
A drug used for gout that can cause rhabdomyolysis
Cholchicine
A chronic complication of Enthesitis?
Fibrosis
calcification
End up in the difficulty of joint movt
Initial managment of fibromyalgia?
Pt education(about its benign and good prognosis)
Exercise(aerobic, stretching, and strength training)
Sleep hygiene
Behcet syndrome CM?
Young adult Recurrent painful oral ulcer Genital Ulcer Eye lesion(uveitis) Skin (erythema nodusum,achneiform lesion) Thrombosis
Evaluation of BS?
Pathergy
Non-specific vasculitis in d/t vessel
A complication of AS?
Osteoporosis/osteopenia Vertebral # AR Cauda equina Kyphosis Extrinsic restrictive lung disease
ANA and systemic sclerosis?
almost all patients will have positive result
MRI indication in Lumbosacral radiculopathy?
sever/progressive bilateral neuropathy
Malignancy sucpection
Epidural abscess sucpection
pesanserinous pain syndrome?
due to bursa of pesanserinous tendons(formed by conjoint tendons of sartorius,grasilious and semitendinosus)
Not have thru bursitis
CM?
Localize pain on AM tibia
No inflammation sign
Minimal tenderness on medial tibia
Managment?
X-ray to r/o other cause
NSAID
Quadriceps strengthening exercise
What about patellofemoral syndrome?
pain occurs in the medial tibia
