reumato Flashcards
disease modifying antirheumatic drugs
methotrexate; folate antimetabolite, hepatotoxicity, stomatitis, cytopenias = folate supplements
leflunomide; pyridine synthesis inhibitor. hepatotoxicity cytopenia
hydroxychloroquine ; TNF and IL1 suppressor , retinopathy
sulfasalazine, TNF and IL1 suppressor, hepatotoxicity stomatitis, hemolytic anemia
TNF inhibitors ( adali, certo, etanercept, goli, infliximab); Infection, demyelination, CFF, malignancy interfron gamma release assay
conditions associated with ankylosing spondylitis
one of them is restrictive lung disease due to limited costovertebral joint motion ,…acute anterior uveitis, aortic regurgitation, apical pulmonary fibrosis, IgA nephropathy
these patients normally have the same life expectancy linked normal population
transplant and gout
transplant patients take cyclosporine which decreases uric acid excretion
systemic sclerosis clinical manifestation autoantibodies and comlications
(skin , extremities: arthralgia and myalgia and contracture)gastrointestinal; esophageal dysmotility, dysphagia, acid reflux, lung; dyspnea, dry cough, vascular raynaud )
ANA, anti- topoisomerase type 1 (anti- scl70)
anticentromere( limited SSc)
lungs ( interstitial lung disease, pulmonary arterial HTN, kidneys: HTN( treatment : ace and nitroproside, scleroderma renal crisis, heart; myocardial fibrosis, pericarditis , pericardial effusion
Ace inhibitors are not in the treatment of AKI only one exception and that is it
infection susceptibility of hemochromatosis
vibrio vulnificus and yersinia entrocolitica
scaphoid fracture
if suspected even without pain : one week later another x ray or MRI or Radioscintigraphy
autoantibodies for myositis
ana anti jo 1
sjogren syndrome
anto ro LA (SS,A- AA,B)
scleroderma renal crisi ( hypertention)
clinical manifestations of hereditaty hemochromatosis
skin; hyperpgmintation
musculo: arthralgia (second and third metacarpophalangeal) and arthropathy, chondrocalcinosis joint asprations can identify calcium pyrophosphate dihydrate
gastro; elevated hepatic enzymes with hepatomegaly, cirrhosis, hepatocellular carcinoma,
endocrin; DM , secondary hypogonadism and hypothyroidism
cardiac; restrictive nad dilated
infections Listeria , vibriovulnificus, yersinia entrocloitica
how can we see scaphoid fracture
MRI or repeat the XRAY in 1- 2 weeks or radioscintography bone scan in 3-5 days
NSAIDS contra
peptic ulcer , acute or chronic kidney diseases, CHF, anticoagulation meds
clinical manfistation od dermatomyositis
proximal symmetric, weakness in UE=LE, gottron sign papuls, heliotope rash,
INTERSTITIAL lung disease, dysphagia, myocarditis, anti jo anti Mi2,
high dose corton= glucocorticoids sparing agents,
screening for malignancy( adenocarcinomas, lung stomach bladder and cervix ovaries)
lupus management
hydoxychloroquine , prevents further kidney and central nervous system damage, low dose cotton for short term to improve patients symptome until the hydroxy takes full effect,
combination of cotton and cyclophosphamide; reserved for the patients with more serious manifestations ( lupus nephritis and CNS involvement and vasculitis,
femoral < tidal and fibular nerve sensory regions
ace inhibitors and arbs on acid uric
decrease ( good in patients with gout for HTN)
patella pain
patellofemoral sundrome ( younge female athlete SUBACUTE pain to chronic squatting, sitting and running with positive patellofemoral test ( extension with holding the atella)
patellar tendnitis primary athlete jimpers knoee < episodic pain and tenderness at INFERIOR atella
osgood schlatter preadolecents and adolescents athlete recent growth spur
bursitis acute housemaids knee localized and visible swelling anterior to patella secondary infection with aureus,
anserine bursitis medial to knee acute and episodic
complex regional pain syndrome
pain swelling and skin changes vasomotor changes after recent injury
sympathetic nerve block
reactive arthritis
GI , and genitourinary : chlamydia trachomatis
musculoskeletal ; asymmetric , peripheral oligoarthrtis , enthestis , dactylitis
uveitis and cnjuctivitis , uretgrutus cervicitis anf prostitis , dermal keratoderma blennorhagicum , and circinate balanitis, oral ulcers
AB (chlamydia) NSAID if fails cotton and …
circinate balanitis
painless shallow ulcers of the glans of penis is an extraarticular manifestation of reactive arthritis
it may be for several month , without lymphadenopathy
by contrast : lymphogranuloma vereum LVG resolve within few days with lymphadenopathy
cobb angle
under 10 normal
10 to 40 nonsurgical
40 and up surgical after puberty
management of vertebral compression fracture
avoid muscle relaxant
resume normal activity
avoid excessive bed rest and order PT
vertebroplasty in selected patients ( refractory ppain)
fall prevention and osteoporosis
acute back pain
normal activity and NSAID (not bed rest)
myotonic dystrophy
AD, CT , myotinia and weakness
childhood; cognitive behavioral difficulties
infantile: hypotonia respiratory and V shaped lips,
arrhythmia and cardiomyopathy
dysphagia and constiapation , pharyngeal weakness and hypoventilation , INSULIN resistant< CATARACT, FRONTAL BALDING EXCESSIVE DAYTIME SLEEPINESS
