Rheumatology Flashcards
Lupus serology
ANA
Ds DNA (antismith) Nephritis
Anti-histone drug Induced
RA Serology
RF
Anti-ccp
Scleroderma, CREST antibody
Anti-centromere
Scleroderma, Systemic Antibody
Topoisomerase, Scl70
SLE Presentation
4 of 11 for the diagnosis Malar rash Discoid rash Serositis Oral Ulcers Arthritis Photosensitivity blood Renal Failure ANA pos Immunologic Neuro
SLE Dx Tests
Serology- ds-DNA (anti-smith) nephritis Anti-histone-Drug induced U/A-ESR, CRP C3,C4
SLE Tx
Everyone-Hydroxychloroquine
Steroids (flare)
Nephritis-
IV cyclophosphamide
Oral Mycophenolate
drugs that induce lupus
Hydralazine
Isoniazid
Procainimide
methlydopa
Rheumatoid Arthritis Presentation
Morning Stiffness >60 min
Hands/feet affected symmetrical >3 joints spares DIP
RA Treatment
NSAIDs for Sx Control
EVERYONE-Methotrexate
Severe (TNF-a Inhibitors)
Steroids for flares
CREST Scleroderma presentation, Dx
Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangiectasias Dx: Anti-centromere Pulmonary Artery HTN
Diffuse Scleroderma Presentation, Dx
CREST + Visceral Involvement Lung=Interstitial lung disease Heart=constrictive pericarditis Kidney=renal scleroderma (ACEi) Dx: ANTI-SCL-70 (topoisomerase)
Scleroderma Treatment
Sclerodactyly=Penacillamine
Esophageal=PPI
Raynauds/Calcinosis=CCB
Sjogrens Presentation, Dx, Tx
Dry eyes, Dry Mouth, Parotid Swelling Dx: ANA, RF serology RO and La Schirmer test Tx: Artifical tears, saliva
Idiopathic Inflammatory Myopathy Presentation, Dx, Tx
Proximal muscle weakness, Painless, Subacute, malignancy heliotrope rash Grottens papules-symmetrical Shawl Sign Dx: Increased CK EMG Anti Mu, Jo Tx: Steroids
Arthrocentesis
>50 K WBCs
+ Organism
- Crystal
Infection Gonorrhea Hematogenous, STD Cervicitis, Urethritis Dx: Gram stain (-) NAAT Tx: Ceftriaxone 7-14 days IV Doxycycline or azithromycin
Non-gonorrhea monoarticular arthropathy
Dx, Tx
Dx: Gram stain (+)
Tx: Nafcillin
Arthrocentesis
Shows Crystals
Gout or pseudo gout
Gout Presentation
Crystals Negatively Bifringent
Patient history=CKD, EtOH, Thiazide use
presents with podogra
Tumor Lysis syndrome Causes, ppx, tx
Chemo, leukemia, Renal Failure
ppx: IVF
Allopurinol
Tx: Rasburicase
Gout Acute Flare Tx
Colchicine
NSAIDs
Steroids
Gout Tx >2 attacks/year
Lifestyle modifications-alcohol, red meat, fructose
>2 attacks/year - Allopurinol
Febuxostat
gout PPX
colchicine
Repeated Gout Attacks Dx, Tx
Uric Acid level, >6 goal <6 Tx: Lifestyle Allopurinol Febuxostat
Gout PPx
Colchicine
What are the seronegative Arthritides PAIR
Psoriatic Ankylosing IBD related Reactive all are HLA-B27 positive
Ankylosing Spondylitis Presentation, Dx, Tx
Sacroilieitis - low back pain better with use Dx: X-ray=Bamboo Spine Tx: NSAIDs Localized Steroids Anti-TNFa F/u back pain-CT
Psoriatic Arthritis Presentation, Dx, Tx
Psoriasis and arthritis Nail pitting Dx: Clx Tx: NSAIDs Local steroids DMARDs ANTI-TNFa
IBD Related (Enteropathic) Presentation, Dx, Tx
IBD and arthritis
Dx: Clx
Tx-Treat the IBD
No NSAIDs/steroids
Reactive Arthritis Presentation, Dx, Tx
Urethritis and arthritis (conjunctivitis->Reiters) Dx: Arthrocentesis negative Find Infxn Tx: Arthritis=NSAIDs + time treat GC/NG
Giant Cell Arthritis Presentation, Dx, Tx (Large)
Jaw Claudication, Vision Changes, Temporal Tenderness
Dx: Bx
Tx: Steroids
Takeyasu Presentation Dx, Tx (Large)
<40 Aorta and branches
Pulselessness
Dx: Angiogram
Tx: Steroids
Wegners Granulomatosis Presentation, Dx, Tx
small vessel
Hemoptysis, Hematuria, something with the nose
Dx: C-ANCA
Bx ( BEST)
Tx: Steroids and cyclophosphamide
Polyarteritis Nodosum Presentation, Dx, Tx
Associated with Hep B Gut, Renal, Skin Mesenteric Ischemia Renal Failure Purpura Mono neuritis Multiplex Dx: angiogram Tx: Steroids and cyclophosphamide
Cryoglobulinemia Presentation, Dx, Tx
associated with HepC Palpable Purpura + HepC Tx: Severe-Plasmapheresis Underlying Dz Steroids and cyclophosphamide
Henoch Scholnein Purpura Presentation, Dx, Tx
Palpable Purpura
GI Sx- Pain of bleeding
Dx: Bx-IgA immunofluorescence
Tx: Steroids
