Rheum/Derm Flashcards
Uricosuric agents and allopurinol toxicity
Hypersensitivity- rash, hemolysis, allergic interstitial nephritis
SJS, toxic epidermal necrolysis
Colchicine toxicity
Diarrhea
Supression of WBC production
Older, slow worse with use
DIP, PIP, hip, and knee joints affected
Osteoarthritis
Dx:
<200 WBC in synovial fluic
X-ray: osteophytes and narrowing of joint space
Men, acute, associated with over-eating and binge drinking
1st big toe affected
Gout
Dx:
2000-50000 WBC
Negatively biofringent needles
Hemachromatosis
Hyperparathyroidism
Wrist and knees
CPPD
Dx:
2000-50000 WBC
Positively biofringent rhomboids
Young female with morning stiffness that improves with use
Multiple joints of hands and feet
RA
Anti-cyclic citrulinated peptide (anti-CCP)
High fever, very acute
single joint affected
Septic arthritis
Dx:»_space;50000 neutrophils, culture fluid
Back pain
History of cancer
PE: vertebral tenderness, sensory level, hyperreflexia
Cord compression
Back pain
Fever
High EST
PE: vertebral tenderness, sensory level, hyperreflexia
Epidural abscess
Back pain
Bowel/bladder incontience
Erectile dysfunction
PE: bilateral leg weakness, saddle area anesthesia
Cauda equina syndrome
Back pain
Male under 40yo, pain worsens with rest and improves with activity
PE: decreased mobility in chest
Ankylosing spondylitis
Back pain
Pain and numbness of medial calf or foot
PE: loss of knee and ankle reflex, positive straight leg raise
Disk herniation
Anti-TNF AE
Reactiviation of tuberculosis
Hydroxychoroquine AE
Ocular
Sulfasalazine AE
Rash and hemoptysis
Rituximab AE
Infection
Gold Salt AE
Nephrotic syndrome
Methotrexate AE
Liver, lung, BM
Young person
High spiking fevers (104)
Rash-salmon colored on chest and abdomen
Splenomegaly
+/- pericardial effusion
+/- mild joint symptoms
JRA
Dx: anemia hypoalbuminemia leukocytosis Ferritin markedly elevated
Tx: NSAID - steroids- anti-TNF
Cancers associated to with dermatomyositis
Ovary
Lung
GI
Lymphoma
Diagnosis of Poymyositis or dermatomyositis
Initial tests: CPK and aldolase
Accurate test: Lung bx
Anti-Jo associated with lung fibrosis
Diagnosis of Sjogren
Initial- Schrimer test (filter paper)
Accurate- lip or parotid gland biopsy
Initial blood test- SS-A (Ro) and SS-B (La)
Evaluate for lymphoma
Glomerulonephritis Foot drop Stroke in a young person Abdominal pain worse with eating Lower extremity ulcers
Polyarteritis nodosa
Dx:
Most accurate- bx of symptomatic site
Angiography of renal, mesenteric, hepatic artery- beading
p-ANCA <20% (anti-myeloperoxidase Ab)
Tx: prednisone and cyclophosphamide
URI: sinusitis, otitis media, mastoiditis, oral or gingival involvment
Lower respiratory tract infections
Renal insufficiency
Wegner’s (granulomatosis with polyangitis)
Dx:
Best initial - c-ANCA (anti-proteinase 3 Ab)
Accurate: Bx Lung>Renal>Sinus
Tx: prednisone and cyclophosphamide
Lung disease
Renal disease
Asthama
Eosinophilia
Churg-Strauss
DX: p-ANCA, bx
Treat: prednisone and cyclophosphamide
Kiddo GI- pain bleeding intususseption purpura arthralgias hematuria
Henoch-Schnolein
Clinical dx, bx most accurate- leukoclastic vasculitis
Resolve spontaneously, steroids if severe
Hepatitis C: Joint pain Glomerulonephritis Purpuric skin lesions Neuropathy
Cryoglobulinemia- IgM Ab
Dx: positive RF factor and cold precipitable immune complexes
No use in steroids, treat underlying cause- HCV
Septic arthritis etiology
- Staph
- Strep
- Gram -ve rods
Empiricially treat with ceftriaxone and vancomycin
Prosthetic joint infection
Lucency around implantation of joint on imaging
Joint is physically loose
Treat: remove the joint, treat with abx for 6-8 weeks, replace joint
Recently placed joint with infection = s. epi
