Rheumatology Flashcards
Calcium Pyrophosphate Dihydrate
Prism shaped crystals
Positive birefringence
Hint : all have Ps.
Pseudogout
Pseudogout With a P.
Gout has no P. Has negative birefringence.
Gout treatment
Pseudogout treatment
NSAIDs and colchicine
Dietary
Allopurinol
Pseudogout usually not painful so not treated
Rheumatoid arthritis
20-40 yo F with sudden onset of morning stiffness for 2 hrs with symmetric joint swelling in wrist, MCP, and PIP. Ulnar deviation at MCP.
spares the PIP
Swan neck and Boutonnière deformity
Juxta-articular dimineralization
Rheumatoid arthritis
What labs will indicate diagnosis?
80% positive RF
Positive CCP
Positive ANA
Rheumatoid arthritis treatment
Methotrexate
Hydrochloroquine
Azothioprine
Systemic Lupus Erythematosis
90% young female with family hx
Malar rash Discoid rash Oral ulcers Renal disease Positive ANA More-- see list
Mainstay of treatment for lupus
Prednisone
Then hydroxychloroquin
Hallmark of Sjogrens
Dry eyes and dry mouth
CREST
Calsinosis Raynaud's phenomenon Esophageal dysmotility - GERD Sclerodactyly Tangelectasias
Bamboo spine
Ankylosing spondylitis
Commonly presents in 20-40 yo M that has pain stiffness with *uveitis
Ankylosing spondylitis
Psoriasis followed by arthritis
Psoriatic arthritis
Positive HLA-B27
Can’t see, can’t pee, can’t climb a tree
Reactive arthritis or reiters syndrome
60 yo F with acute vision loss or diplopia and tender temple
May have history of polymyalgia rheumatica
Temporal arteritis
Upper extremity clarification in young girl with absent pulses
Takayasu’s arteritis
Abdominal pain and livedo reticularis
Polyarteritis Nodosa
Kawasaki Disease
Wegeners granulomatosis
40 yo M with shortness of breath, bloody urine, and necrotizing vasculitis
Polymyalgia Rheumatica
70 yo F with Pain and stiffness in neck (doesn’t want to comb hair) with fever and fatigue, hx of temporal arteritis
High ESR and CRP
Hypospadius
Urethral meatus is at the Ventral aspect of penis or scrotum or perineum
Epispadius
Urethral meatus on dorsal aspect of penis –
Usually doesn’t connect all the way around
Peyronie’s disease
curvature of penis that is painful when erect!!!
Phimosis
Chronic infection where can’t retract foreskin
Typically uncircumcised
Paraphimosis
Iatrogenic reason that Can’t retract foreskin – due to catheter placement
Can’t use PDE-5 inhibitor with which drugs ?
Nitro -duh
Alpha blocker for BPH!!
Baby with large testicle
Hydrocele – effusion of the scrotum
Transilluminate at the bedside
Watchful waiting, Refer
African American Male with priapism should be evaluated for what condition?
Sickle cell disease
Varicocele
Enlargement of internal spermatic veins Bag of worms If lay flat, should go away Can lead to infertility Left side and slow - reassure Right side, abrupt, doesn't go flat-RCC
Bell clapper deformity
Testicular torsion
Testicular pain that awakens or at night
Testicular torsion
All infants / toddlers with abdominal pain should be evaluated for what?
Testicular torsion
Minimally symptomatic in kids
Testicular torsion suspected. What next?
US or surgery?
Surgery .
Medical emergency. No time for US
Urge Incontinence
Uninhibited bladder contractions
have to go. Already went before standing up to go.
Tx: anti-spasmodic. Oxybutinen
Stress incontinence
Loss of small amounts with cough and sneezing etc
Tx: oxybutinen
Overflow incontinence
Detrusor underactivity
Chronic urinary retention
Continual leaking
Tx:
Double void
Catheter
BPH
Size of prostate does NOT equal symptoms
Symmetrical, large, rubbery
Surgery if: retention, recurrent UTI, hematuria, stones, renal insuff
Acute cystitis
E.coli
Positive LE, blood, bacteruria, pyuria
Cystitis treatment
Cephalexin 250-500 po QID 1-3 days
Nitrofurantoin 100mg PO bid 7days
Cipro 500 bid 1-3 days
TMP-SMX 160/800 x 2 tabs one dose
Prostatitis
Less than 40: STD
Older than 40: e.coli, pseudomonas
NO parastatic massage
73 yo M with Painless hematuria in a smoker
Bladder cancer
Should always be concerned if bloody urine in plavix pts – rule out cancer
How diagnose bladder cancer?
UA
Urine cytology
Cystoscopy and biopsy is gold standard
High alk phos or high calcium
Hx of prostate cancer
Think bony metastasis from prostate cancer
Urethritis
Inflammation of urethra
Usually have STI
Note : recall that May have reactive arthritis if have this !
Tx: ceftriaxone 250mg iM x 1 + doxycycline 100mg po bid x 10 days
Epididymitis
Painful enlargement of epididymis
Usually STI
Scrotal US
Tx: scrotal elevation
Treat STI : ceftriaxone + doxy
Orchitis
Inflammation of
Uric acid
Needle shaped crystal
Negative birefringence
Gout
