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USMLE Step 2 CK > Rheumatology & Vascular Disease > Flashcards

Rheumatology & Vascular Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

DIAGNOSIS-PAIN (KNEE>HIP>ANKLE>DIP»>PIP/MCP), STIFFNESS (<15MIN) ,CREPITATIONS,LITTLE TO NO INFLAMMATION

INITIAL TEST=
INITIAL TREAT=

A

OSTEOARTRITIS (DJD)

EXCLUTION TESTS: ESR,CBC,ANA,RH FACTOR= NORMAL XRAY:JOINT SPACE NARROWING,OSTEOPHYTES, DENSE SUBC. BONE,BONE CYSTS

WEIGHT LOSS (SWIMMING), ACETAMINOPHEN(MAY ADD NSAIDS THEN IJ-STEROIDS, CAPSAICIN CREAM FOR PAIN), IJ-HYALURONAN, SURGERY

TIP- GLUCOSAMINE AND CHONDROITIN SULFATE ARE NO MORE EFFECTIVE THAN PLACEBO

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2
Q

TIP- DIP=HEBERDEN NODES ; PIP= BOUCHARD NODES

A

TRUE

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3
Q

DIAGNOSIS- ACUTE EXRUCIATING PAIN AND REDNESS IN TOE, AFTER HEAVY DRINKING + FEVER

A

ACUTE GOUT/GOUTY ARTHRITIS

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4
Q

TIP- HOW TO DISTINGUISH FROM INFECTION?

TIP- GOUT MY ALSO PRESENT IN ANKLE, FEET AND KNEES?

A

ARTHROCENTESIS

TRUE

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5
Q

DIAGNOSIS- MTP JOINT PAIN, TOPHI, URIC ACID KIDNEY STONES, SAME AS 6 MONTHS AGO?

INITIAL TEST-
INITIAL TREAT- ACUTE
INITIAL TREAT- CHRONIC STEP 1 OF 2
INITIAL TREAT- CHRONIC STEP 2 OF 2

A

CHRONIC GOUT

JOINT ASPIRATION: NEEDLE SHPED CRYSTALS WITH NEG. BIREFRINGENCE ON POLAR LIGHT; WBC=2000-50000;INC:URIC ACID(95%),ESR,WBC

ACUTE:NSAID,CORTICOSTEROIDS(IJ-FOR SINGLE JOINT AND ORAL FOR MULT. [TRIAMCINOLONE]), COLCHICINE(ONLY WHEN OTHERS DON’T WORK)

DIET:DECREASE ALCOHOL/BEER,WIEGHT, HIGH PURINE FOODS,STOP THIAZIDES,COLCHICINE(PREVENTS AT.)

ALLOPURINOL/FEBUXOSTAT(DEC. URATE),PEGLOTICASE(DISOLVES URATE), PROBENECID AND SULFINPYRAZONE INCREASE THE EXCRETION.

TIP- ALWAYS TAP THE JOINT TO RULE INFECTION OUT IN GOUT
TIP- XRAY IN CHRONIC GOUT MAY SHOW EROSIONS

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6
Q

TIP- RENAL PROBLEMS CHANGE WHAT IN GOUT TREATMENT
TIP- GOUT + HIGH BLOOD PRESURE USE?
TIP- URICOSURIC AGENTS AND ALLOPURINOL SIDE EFFECTS
TIP-CHOLCHICINE SIDE EFFECTS
TIP-ALLOPURINOL SIDE EFFECTS

A

PROBENECID/SULFINPYRAZONE AND NSAIDS

LOSARTAN: LOWERS URIC ACID LEVELS

HYPERSENSITIVITY(RASH, HEMOLYSIS,ALLERGIC INTERSTITIAL NEPHRITIS)

BONE MARROW SUPPRESSION AND DIARRHEA

STEVEN JOHNSON SYNDROME (TOXIC EPIDERMAL NECROLYSIS)

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7
Q

DIAGNOSIS- LARGE JOINT(WRIST AND KNEE) PAIN BUT NOT MCP NOR DIP/PIP, HX:HEMOCHROMATOSIS,HYPERPARATHYROIDISM

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

CPPD (CALCIUM PYROPHOSPHATE DEPOSITE DISEASE) OR PSEUDOGOUT

XRAY (SHOWS CALCIFICATION AND DJD),
ARTHROCENTESIS

ARTHROCENTESIS (“+”BIREFRINGENT RHOMBOIDS)=CELL COUNT,CULTURE/GM STAIN, E. CRYSTALS,LDH,GLUCOSE,PROTIEN

NSAIDS, IJ-STEROIDS THEN COLCHICINE (PROPHYLAXIS)

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8
Q

TIP- WHAT DISEASES TO LOOK FOR IN JOINT PAIN?

A

DJD,GOUT,CPPD, RA (ANTI-CCP), SEPTIC (WBC >50000), AND SYSTEMIC (6 PATHOLOGY)

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9
Q

DIAGNOSIS- BACK PAIN, EXCLUDED:CORD COMPRESSION, EPIDURAL ABSCESS,CAUDA EQ.,ANK.SPON.,DISK HERNIA

INITIAL TREAT-

A

LUMBOSACRAL STRAIN/FACETITIS

NSAIDS

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10
Q

DIAGNOSIS-BACK PAIN,HX. OF CANCER,FOCAL NEUROLOGICAL DEFICITS (SENSORY:T4=NIPPLES,T10=UMBIL),SPINAL POINT TENDERNESS,HYPERREFLEX

A

CORD COMPRESSION (MALIGNANCY)

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11
Q

DIAGNOSIS-BACK PAIN,FEVER, INC. ESR,FOCAL NEUROLOGICAL DEFICITS (SENSORY:T4=NIPPLES,T10=UMBIL),SPINAL POINT TENDERNESS,HYPERREFLEX

A

CORD COMPRESSION (INFECTION)/EPIDURAL ABSCESS

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12
Q

DIAGNOSIS-BACK PAIN, INCONTINENCE,ED,BILATERAL LEG WEAKNESS,SADDLE AREA ANESTHESIA

A

CAUDA EQUINA

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13
Q

DIAGNOSIS- BACK PAIN,UNDER 40YRS, WORSE WITH REST AND BETTER WITH ACTIVITY, DECREASED CHEST MOBILITY

A

ANKYLOSING SPONDYLITIS

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14
Q

DIAGNOSIS- BACK PAIN, POSITIVE STRAIGHT LEG RAISE (SLR), NUMBNESS OF MEDIAL CALF, LOSS OF KNEE REFLEX, LOSS OF DORSIFLEXION OF FOOT

A

DISK HERNIATION (SCIATICA) OF L4

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15
Q

DIAGNOSIS- BACK PAIN, POSITIVE STRAIGHT LEG RAISE (SLR), NUMBNESS INNER FOREFOOT, LOSS OF DORSIFLEXION OF TOE

A

DISK HERNIATION (SCIATICA) OF L5

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16
Q

DIAGNOSIS- BACK PAIN, POSITIVE STRAIGHT LEG RAISE (SLR), NUMBNESS OF OUTERFOOT,LOSS ANKLE JERK, LOSS OF FOOT EVERSION

A

DISK HERNIATION (SCIATICA) OF S1

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17
Q

TIP- LOW BACK PAIN LOOK FOR 5 POSSIBLE IF SLR IS NEGATIVE

A

GOOD SENSITIVITY (EXLCUDES SCIATICA)

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18
Q

TIP-LOW BACK PAIN LOOKS FOR WHEN IMAGE IS NEEDED ON TEST

TIP- LOW BACK PAIN OVER 50 LOOK FOR DJD ALSO

A

TRUE

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19
Q

INITIAL TEST- FRACTURES,COMPRESSION,EPIDURAL ABSCESS,ANK. SPON.,CAUDA EQUINA SYND.

ACC. TEST- FRACTURES,COMPRESSION,EPIDURAL ABSCESS,ANK. SPON.,CAUDA EQUINA SYND.

INITIAL TEST- ONLY IN SEVERE PROGRESSIVE HERNIATION

INITIAL TREAT- CORD COMPRESSION

INITIAL TREAT- EPIDURAL ABSCESS

A

CXR THEN MRI (CT WITH CONTRAST IF MRI IS CONTRAINDICATED)

MRI (CT WITH CONTRAST IF MRI IS CONTRAINDICATED)

MRI (CT WITH CONTRAST IF MRI IS CONTRAINDICATED)

SYSTEMIC STEROIDS, CHEMO(LYMPHOMA), RADIATION(SOLID TUMORS) THEN SURGERY IF THEY DON’T WORK

STEROIDS, ANTISTAPH ANTIBIOTIC(VANC,LINEZOLID IF SENSITIVITY IS NOT KNOWN; AFTER SWITCH BACK)

TIP- TREAT EPIDURAL ABSCESS LIKE ENDOCARDITIS

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20
Q

INITIAL TREAT- CAUDA EQUINA

INITIAL TREAT- DISK HERNIATION (SIATICA)

A

SURGERY DECOMPRESSION

NSAIDS, CONSERVATIVE:BETTER THAN BED REST/YOGA/PT THEN STEROID INJECTION:EPIDURAL THEN SURGERY IF PROGRESSIVE

TIP- NO IMAGE IN LOW BACK PAIN WITH FOCAL NEUROLOGICAL SYMPTOMS AND BACK STRAIN

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21
Q

DIAGNOSIS- >60YRS, BACK PAIN(WALKING DOWNHILL WORSE), RAIDIATES TO BUTT AND THIGHS BILATERAL, NORMAL PULSES ANK/BRA INDEX

P.ASS.- 25% DEMINISHED LOWER EXTERMITY REFLEX, FLEX SPIN=BETTER, EXTEND SPIN=WORSE

INITIAL TEST-
INITIAL TREAT-

A

LUMBAR SPINAL STENOSIS

LUMBAR SPINAL STENOSIS

MRI

WEIGHT LOSS, PAIN MANAGEMENT, STEROID INJECTION:EPIDURAL, PT/LIGHT EXERCISE THEN SURGERY

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22
Q

DIAGNOSIS- YOUNG WOMAN,CHRONIC PAIN IN TRIGGER POINTS:TRAPEZIUS,KNEE,L. EPICONDYLE,NECK SHOULDER, BACK,HIPS, HEADACHE,FATIGUE,STIFF,SLEEP

INITIAL TEST-
INITIAL TREAT-

A

FIBROMYALGIA

HX. CRITERIA; ALL LAB NORMAL:ESR,C-REACTIVE, RF,CPK LEVELS.

AMITRIPTYLINE, MILNACIPRAN (REUPTAKE INH OF 5HT AND NOREPI), PREGABALIN

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23
Q

DIAGNOSIS- HX. JOB USE OF HANDS, WRIST PAIN TO HAND:PALM,THUMB,INDEX FINGER WORES AT NIGHT, “+”TINEL AND PHALEN SIGN

INITIAL TEST-
INITIAL TREAT-

A

CARPAL TUNNEL SYNDROME (PERIPHERAL NEUROPATHY FROM COMPRESSION UNDER FLEXOR RETINACULUM)

HX. PE, THEN ELECTROMYOGRAPHY AND NERVE CONDUCTION TESTING TO CONFIRM

WRIST SPLINTS, AVOID MANUAL ACTIVITY AND NSAIDS THEN STEROID INJECTION THEN SURGERY

TIP- SENSORY SYMPTOMS OCCUR FIRST THEN MOTOR

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24
Q

DIAGNOSIS- NODULE FORMATION ON HAND, CONTRACTURE OF 4TH AND 5TH FINGERS, CANNOT EXTEND

INITIAL TREAT-

A

DUPUYTREN CONTRACTURE

TRIMCINOLONE, LIDOCAINE, OR COLLAGENASE INJECTION THEN SURGERY

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25
Q

DIAGNOSIS- YOUNG AGE, WRIST NODULE; DISCONFORT VERY LITTLE PAIN WHEN TOUCHED

INITIAL TREAT-

A

GANGLIONIC CYST (BIBLE CYST)

NOTHING SELF LIMITED OR SURGERY/DRAIN FOR COSMETIC OR UNCOMFORT

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26
Q

DIAGNOSIS-INABILITY TO FLEX OR ABDUCT SHOULDER AND PAIN WORSE AT NIGHT WHILE LYING, TENDERNESS AT SUPRASPINATUS INSERTION

INITIAL TEST/AND ACC. TEST-
INITIAL TREAT-

A

ROTATOR CUFF INJURY

MRI

NSAIDS, REST, PT THEN STEROID INJECTION THEN SURGERY

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27
Q

DIAGNOSIS- KNEE PAIN AFTER TRAUMA/IMBALANCE QUAD/MENISCAL TEAR, LOCAL UNDER PATELLA/FRONT, WORSE IF START WALKING&GETS BETTER

INITIAL TEST-
INITIAL TREAT-

A

PATELLOFEMORAL SYNDROME

NORMAL XRAY AND PE: CREPITUS, LOCK, INSTABILITY

PT: STRENGTH TRAINING WITH CYCLING

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28
Q

TIP- TUNNEL SYNDROMES WORSE WITH USE

A

TRUE

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29
Q

DIAGNOSIS- PLANTAR PAIN IN MORNING, IMPROVES WITH WALKING,POINT TENDERNESS

INITIAL TREAT-

A

PLANTAR FASCIITIS

PT: STRETCHING AND NSAIDS THEN STEROID INJECTION THEN RARE SURGERY

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30
Q

DIAGNOSIS- BILATERAL, JOINT PAIN:(PIP,MCP,WRISTS,NKEES AND ANKLES,CERVICAL),MORING WORSE,NODULES,OCULAR SYMPTOMS,LUNG EFFUSION,VASCULITIS

P.ASS. CHRONIC SYNOVITIS:OVERGROWTH PANNUS FORMATION WHICH DAMAGE STRUCTURES SURROUNDING STRUCTURES

P.ASS. BAKER CYST RUPTURE (MIMIC DVT), PERICARDITIS AND PLEURAL DIASEASE (NODULES), VASCULITIS:SKIN,BOWEL, PERIPHERAL NERVES

P.ASS. CARPAL TUNNEL, C1 AND 2 SUBLAXATION( IMAGE PRE-SURGERY ALWAYS)

INITIAL TEST- RA STEP 1 OF 4
INITIAL TEST- RA STEP 2 OF 4
INITIAL TEST- RA STEP 3 OF 4

TIP- DIP INVOLVMENT ONLY IN
TIP- SICCA

INITIAL TREAT- 1/2

INITIAL TREAT- 2/2

A

RA

RA

RA

RA

LAB: ANEMIA,RF (70-80% POS.), ANTI-CYCLIC CITRULINATED PEPTIDE(ANTI-CCP SENSITIVE AND SPEC.), INCR.:ESR,CRP

RADIOGRAPH: EROSION OF JOINTS, OSTEOPENIA

CRITERIA(6PTS OR MORE)=RA; JOINT INVOLVEMENT XRAY/HX(UP TO 5PTS),ESR/CRP(1PT),6WK DURATION(1PT),RF OR ANTI-CCP(1)

DJD

DRY EYES, MOUTH AND MUCOUS NO JOINT PAIN

RA EROSIVE(JOINT SPACE NARROW,DEFORMITY OF JOINTS, XRAY ABNORMALITIES):= DMARD:MTX,TNF-INH,RITUXIMAB(CD20 REMOVE),HYDROXYCHLOROQUINE;THEN (SULFASALAZINE,LEFLUNOMIDE, ABATACEPT)

RA EROSIVE(JOINT SPACE NARROW,DEFORMITY OF JOINTS, XRAY ABNORMALITIES):= RA SYMPTOM:NSAIDS THEN STEROIDS(OR WHILE WAITING FOR DMARDS TO WORK)

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31
Q

DIAGNOSIS- RA+SPLENOMEGALY, NEUTROPENIA
DIAGNOSIS- RA+ PNEUMOCONIOSIS, LUNG NODULES
TIP- MOST IMPORTANT IN RA STOP PROGRESSION
TIP- RA CAUSE OF DEATH

A

FELTY SYNDROME
CAPLAN SYNDROME
TRUE
CAD

32
Q

TIP-IN RA KNOW DRUG ADVERSE EFFECTS
TIP- RA SIDE EFFECTS: 1/3- ANTI TNF, HYDROXYCHLOROQUINE
TIP- RA SIDE EFFECTS: 2/3- SULFASALAZINE, RITUXIMAB
TIP- RA SIDE EFFECTS: 3/3- GOLD SALTS, MTX

A

TRUE
TB REACTIVATION, OCULAR (CHECK RETINA)
RASH/HEMOLYSIS, INFECTION
NEPHROTIC SYNDROME, LIVER/LUNG/MARROW PROBLEMS

33
Q

DIAGNOSIS-KID WITH SPIKE FEVER(104), SALMON COLOR RASH ON CHEST AND ABDOMEN, MILD JOINT PAIN

P.ASS. SPLENOMEGALY, PERICARDIAL EFFUSION

INITIAL TEST-
INITIAL TREAT-

A

JRA

JRA

LAB: ANEMIA, HYPOALBUMINEMIA,LEUKOCYTOSIS, FERRITIN LEVEL ELEVATED (ANA- IS NORMAL)

NSAIDS THEN STEROIDS THEN ANTI TNF DRUGS

34
Q

DIAGNOSIS- 4 OF 11= SKIN:MALAR RASH,DISCOID RASH,PHOTOSENS,ORAL ULCERS/JOINT: ARTHRITIS NON-EROSION*/SEROSITIS:PLEURAL,PERICARDIAL

A

SLE

35
Q

DIAGNOSIS- 4 OF 11= RENAL:ANY,MEMRANOUS,HEMATURIA,RBC/NEUROLOGIC:PSYCHOSIS,SEIZURES,STROKE VASCULITIS

A

SLE

36
Q

DIAGNOSIS- 4 OF 11= HEME:ANEMIA,LYMPHOPENIA,LEUKOPENIA,THROMBOCYTOPENIA/IMMUN:”+”ANA,ANTI-DSDNA,ANTI-SM,FALSE-VDRL,LE CELL

A

SLE

37
Q

P.ASS.-ALOPECIA,PNEUMNIA,ALVEOLAR HEMORRHAGE AND RESTRICTIVE LUNG,PHOTOPHOBIA,RETINAL LESION(COTTON),BLINDNESS

A

SLE

38
Q

P.ASS.-MESENTERIC VASCULITIS, RAYNAUD PHENOMENON, ANTIPHOSPHOLIPID SYNDROMES

A

SLE

39
Q

INITIAL TEST- SLE
INTIAL TREAT- SLE
INTIAL TREAT- SLE

A

LAB: ANA(SEN.)+ANTI-DS-DNA AND ANTI-SM(SP.) THEN CONTROL:COMPLEMENT LEVELS(DISEASE ACTIVITY)

FLARE: HIGH-DOSE STEROIDS/SKIN AND
JOINT:HYDROXYCHLOROQUINE/PROGRESSION:BELIMUMAB

RENAL: STEROIDS+ CYCLOPHOSPHAMIDE OR MYCOPHENOLATE

TIP- MORTALITY OF SLE ATHEROSCLEROSIS(MI)/INFECTION(PNEUMONIA)/RENAL FAILURE AND ELS**

40
Q

DIAGNOSIS- THROMBOSES OF ARTERIES AND VEINS RECURRENT SPONTANEUOUS ABORTIONS, NORMAL INR

INITIAL TEST-
ACC. TEST-
INTIAL TREAT-

A

APL ANTIPHOSPHOLIPID SYNDROME

MIXING STUDY:ELEVATED PTT(ANTICOAGULANT TYPE) NORMAL PT AND INR, FALSE-VDRL OR RPR; SPONTANEOUS ABORTION: ANTICARDIOLIPIN ANTIBODIES

RUSSELL VIPER VENOM TEST RVVT( MIX WITH NORMAL PLASMA AND STILL HIGH APTT

LIKE DVT OR PE /HEPARIN THEN WARFRIN 6 MONTHS OR MORE

41
Q

P.ASS. SPONTANEOUS ABORTION:WHAT AND WHEN TO CHECK AND HOW TO TREAT NEXT PREGNANCY?

A

ANTI-CARDIOLIPIN/TWO OR MORE 1ST TRIMESTER ABORTIONS OR A SINGLE 2ND TRIMESTER EVENT/TX. HEPARIN AND ASPIRIN

42
Q

DIAGNOSIS- 20-40YR OLD WOMEN,FIBROSIS OF SKIN AND INTERNAL ORGANS(LUNGS,KIDNEY, GI)

A

SCLERODERMA 20% DIFFUSE

43
Q

DIAGNOSIS-20-40YR OLD WOMEN,CALCINOSIS,RAYNAUD,ESOPHAGEAL DYSMOTILITY, SCLERODACTYLTY, TELANGICTASIA

A

CREST/LIMITED SCLERODERMA

44
Q

DIAGNOSIS- FIGNER PAIN/BLUE-WHITE THEN RED WHEN COLD OR STRESS

A

RAYNAUD:CREST

45
Q

DIAGNOSIS-FIBROSIS OF HANDS,FACE,NECK,TELANGIECTASIA AND ABNORMALITIES OF PIGNEMTATION

A

SKIN SCLEROSIS:CREST

46
Q

DIAGNOSIS-ESOPHAGEAL DYSMOTILITY, GERD,LARGE MOUTHED DIVERTICULI OF SMALL AND LARGE BOWEL

A

GI:CREST

47
Q

DIAGNOSIS-HYPERTENSIVE CRISIS SUDDEN/ 20-40 YR OLD WOMEN

A

RENAL:CREST

48
Q

DIAGNOSIS-RESTRICTIVE LUNG DISEASE AND PULMONARY HYPERTENSION

A

LUNG FIBROSIS: CREST

49
Q

DIAGNOSIS-MYOCARDIAL FIBROSIS, PERICARDITIS,AND HEART BLOCK,LUNG PROBLEMS=RVHYPERTROPHY

A

CARDIAC:CREST

50
Q

INITIAL TEST- SCLERODERMA (SYSTEMIC SCLEROSIS)

INTIAL TREAT- SCLERODERMA

A

ANA (“-“EXLCUDES), ESR(NORMAL), SCL-70 (20 CREST-30%DIFFUSE), ANTICENTROMERE (50% IN CREST)

MTX, RENAL CRISIS:ACE INH, ESOPHAGUS:PPI’S, RAYNAUD:CCB, PULMONARY FIBROSIS: CYCLOPHOSPHAMIDE, BOSANTAN/SILDENAFIL/PROSTACYCLIN

51
Q

DIAGNOSIS-PROXIMAL MUSCLE WEAKNESS LEADING TO DIFFICULTY GETTING UP, PAIN(25%)

A

POLYMYOSITIS

52
Q

INITIAL TEST- DERMATOMYOSITIS/POLYMYOSITIS
ACC TEST- DERMATOMYOSITIS/POLYMYOSITIS
INITIAL TREAT-DERMATOMYOSITIS/POYMYOSITIS

A

CPK AND ALDOLASE,ANA,ANTI-JO(LUNG FIBROSIS), MRI(PATCHY INVOLVMENT): OTHER NON SPECIFIC ALSO

MUSCLE BIOPSY

STEROIDS, MTX/AZATHIOPRINE/IV-IMMUNOGLOBULIN/MYCOPHENOLATE, HYDROXYCHLOROQUINE(SKIN)

53
Q

DIAGNOSIS- DRYNESS ON MOUTH AND EYES, FEELING OF SAND IN EYE (KERATOCONJUNCTIVITIS SICCA), NEED WATER FOR DRY MOUTH,CARIES,DYSPAREUNIA

P.ASS.-RA,SLE,PRIMARY BILIARY CIRRHOSIS,POLYMYOSITIS,HASHIMOTO THYROIDITIS,VASCULITIS,LUNG,PANCREATITIS,RTA,LYMPHOMA

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

SJORGREN (SCHORGREN) SYNDROME

SJORGREN SYNDROME

SCHIRMER TEST (HOW MUCH DOES A STRIP OF PAPER WET) LAB: SS-A(RO), SS-B(LA) [MAYBE ALSO IN SLE]; OTHERS NON SPECIFIC

LIP OR PAROTID GLAND BIOPYS

WATER MOUTH:SIPS,GUM,FLUORIDE TREATMENT, ARTIFICIAL TEARS, PILOCARPINE AND CEVIMELINE; EVALUATE LYMPHOMA (10% OCCUR)

54
Q

DIAGNOSIS- FEVER WEIGHT LOSS, MALAISE/FATIGUE, HEP B AND C, GLOMERULONEPHRITIS NO LUNG INVOLVED, STROKE,GI PAIN,FORELEG PURPURA,YOUNG AGE

INITIAL TEST-
INITIAL TREAT-

A

POLYMYOSITIS NODOSA (PAN)

BIOPSY OF A SYMPTOMATIC SITE, ANGIOGRAPHY:RENAL,MESENTERIC OR HEPATIC=DILATION OR BEADING; LAB:ESR,ANEMIA,WBC,CRP,P-ANCA(20%)

PREDNISONE AND CYCLOPHOSPHAMIDE; HEPATIS IF PRESENT

TIP-ANTI-MYELOPERSOXIDASE ANTIBODIES=P-ANCA

55
Q

DIAGNOSIS-FEVER WEIGHT LOSS,FATIGUE,PAIN IN SHOULDERS, AND PELVIC GIRDLE,CANT COMB HAIR,INC.ESR,NN.ANEMIA

INITIAL TEST-
INITIAL TREAT-

A

PMR POLYMYALGIA RHEUMATICA

NORMAL CPK AND ALDOLASE

STEROIDS EVEN AT LOW DOSE

56
Q

DIAGNOSIS- FEVER,WEIGHT LOSS, FATIGUE, VISUAL SYMPTOMS,JAW CLAUDICATION,SCALP TENDERNESS,HEADACHE,DECR. ARM PULSE,AR

P.ASS. PMR
TIP- PAN

A

GAIN CELL ARTERITIS (TEMPORAL)

EXTENDS TO TEMPORAL ARTERITIS

SCREEN FOR HEP B AND C

57
Q

DIAGNOSIS-FEVER WEIGHT LOSS,FATIGUE,PAN-RESPIRATORY FINDING(SINUSITIS,OM,MASTOIDITIS,ORAL PBL.),SKIN,JOINT AND EYE AND RENAL INSUFFICIENCY

INTIAL TEST-
ACC. TEST-
INTIAL TREAT-

P.ASS.- PNEUMONIA DOES NOT RESOLVE WITH ANTIBIOTICS

A

WEGNER GRANULOMATOSIS

C-ANCA (CYTOPLASMIC ANTIBODIES/ANTI-PROTEINASE3)

LUNG>RENAL>SINUS BIOPSY

PREDNISONE AND CYCLOPHOSPHAMIDE

WEGNER GRANULOMATOSIS

58
Q

DIAGNOSIS-FEVER,WEIGHT LOSS FATIGUE, A PULMONARY-RENAL SYNDROME ASTHMA EOSINOPHILIA

INITIAL TEST-
ACC. TEST-

A

CHURG-STRAUSS SYNDROME

C-ANCA (CYTOPLASMIC ANTIBODIES/ANTI-PROTEINASE3)

BIOPSY

59
Q

DIAGNOSIS- FEVER,WEIGHT LOSS, FATIGUE, GI (ABDOMIN),JOINT AND LOWER EXTREMITY PURPURA + HEMATURIA

INITIAL TEST-
ACC. TEST-
INTIAL TREAT-

A

HENCOK-SCHONLEIN PURPURA (HSP)

HX

BIOPSY (LEUKOCYTOCLASTIC VASCULITIS)

SPONTANEOULY SELF LIMIT OR STEROIDS FOR GI AND RENAL

TIP- SERUM IGA LEVELS IS THE WRONG ANSWER FOR HSP

60
Q

DIAGNOSIS- FEVER,WEIGHT LOSS, FATIGUE,HEPC,ENDOCARDITIS AND SJOGREN,JOINT PAIN,NEPHRITIS,PUPUIC SKIN LESIONS,NEUROPATHY

INITIAL TEST-
INTIAL TREAT-

A

CRYOGLOBULINEMIA

RA(POS.),COLD PRECIP. IMMUNE COMPLESES, LOW C4 COMPLEMENT

TREAT HEP C:INF,RIBAVIRIN AND TELAPREVIR OR BOCEPREVIR

61
Q

TIP- DIFFERENTIAL CRYOGLOBULINEMIA

TIP- SLE LABS SHOW LOW COMPLEMENT #?

A

COLD AGGLUTININ: EBV,MYCOPLASMA, LYMPHOMA[HEMOLYSIS AND TX:STAY WARM,TITUXIMAB, CYCLOSPORIN,C.PHOS.

3

62
Q

DIAGNOSIS-FATIGUE,ASIAN/M.EAST PERSON, PAINFUL ORAL AND GENITAL ULCERS, ERYTHEMA NODOSUM-LIKE LESIONS,BLINDNESS,ARTHRITIS,CNS LESIONS(MS-LIKE)

INTIAL TEST-
INTIAL TREAT-

A

BEHCET SYNDROME

HX.

STEROIDS/ AZATHIOPRINE,C.PHOS,COLCHICINE,THALIDOMIDE

63
Q

TIP- PATHERGY:STERILE SKIN PUSTULES FROM MINOR TRAUMA

A

BEHCET SYNDROME

64
Q

DIAGNOSIS- JOINT PAIN, AGE <40YRS,SPINE AND LARGE JOINTS,(-)RA,ENTHESOPATHY,UVEITIS,HLA-B27

A

SERONEGATIVE SPONDYLOARTHROPATHIES (ANK.SP.,PSORIATIC ARTHRITIS,REACTIVE ART. [REITER])

65
Q

DIAGNOSIS- YOUNG MAN BACKACHE, STIFFNESS, PAIN RADIATES TO BUTT, FLAT LUMBAR CURV,DECR. CHEST EXPANSION; RELIVED W/ACTIVITY
P.ASS.- UVEITIS,ARTHRITIS:KNEES,HIPS AND SHOULDERS (50%); CARDIAC AV BLOCK(5%)

INTIAL TEST-
ACC. TEST-
INTIAL TREAT-

A

ANKYLOSING SPONDYLITIS

ANKYLOSING SPONDYLITIS

XRAY OF SACROILIAC(SI) JOINT[NARROWING] THEN BAMBOO SPINE (LATER); LAB:ESR IS ELEVATED

MRI

EXERCISE PROGRAM AND NSAIDS THEN ANTI-TNF DRUGS

66
Q

DIAGNOSIS- PSORIASIS(80% PROCEDING), PAIN RADIATES TO BUTT, SAUSAGE DIGITS, NAIL PITTING(10%)

INITIAL TEST-
INITIAL TREAT-

A

PSORIATIC ARTHRITIS

XRAY OF JOINT: PENCIL IN A CUP DEFORMITY; LAB:ESR,URIC ACID

NSAID THEN MTX(SEVERE CASES) THEN ANTI-TNF ANGENTS (IF MTX DOES NOT WORK)

67
Q

DIAGNOSIS- INFLAMMATORY BOWEL DISEASE(M/W); SEXUALLY TRANSMITTED INFECTION(M),GI-INFECTION(YERSINIA,ALMONELLA,CAMPYLOBACTER)

INITIAL TEST-
INITIAL TREAT-

A

REACTIVE ARTHRITIS (REITER)

TAP TO EXCLUD SEPTIC ARTH., HX.

NSAID, CORRECT CAUSE; THEN SULFASALAZINE OR IJ-STEROID

68
Q

P.ASS.- KERTODERMA BLENNORHAGICUM(SKIN LESION)

A

PUSTULAR PSORIASIS

69
Q

DIAGNOSIS-OLDER PERSON WOMEN,VERTEBRAL FRACTURES LEADING FRACTURES

INTIAL TEST-
INTIAL TREAT-

A

OSTEOPOROSIS

DEXA SCANNING (DENSITOMETRY) T-SCORE: 1-2.5=OSTEOPENIA;>2.5=OSTEOPOROSIS; LAB:NORMAL

OSTEOPENIA THEN OSTEOPOSOSIS= VIT-D&CALC.; THEN BISPH, ESTROGEN/RALOXIFENE(DEC.LDL AND CANCER), TERIPARATIDE (PTH),CALCITONIN(DEC. VERT FRACT)

70
Q

TIP-OSTEONECROSIS OF JAW:? CONTRACT ESOPHAGITIS:? SIDE EFFECTS
TIP- TERIPARATIDE (PTH) SIDE EFFECT

A

BISPHOSPHANATES

OSTEOSARCOMA AND HYPERCALCEMIA

71
Q

DIAGNOSIS- HX. ARTHRITIS(e.g. RA,DJD) OR PROSTHETIC JOINT+ NEW INFECTION, (STAPH(IV USE)>STREP>(-)RODS),WARM,RED,IMMOBILE,PALPABLE EFFUSION JOINT,FEVER

INITIAL TEST-
ACCT TEST-
INITIAL TREAT-

A

SEPTIC ARTHRITIS

ASPIRATION OF JOINT (LEUK:>50,000WBC; GRAM STAIN; CULURE), BLOOD CULTURE

ASPIRATION OF JOINT

CEFTRIAXONE AND VANCOMYCIN/GN:QUINOLONES,AZTREONAM,CEFOTAXIME,PIPERA,AMINOGLY; GP:OX,NAF,CEF,PIPER; GP-RES:LINEZOLID

TIP- SEPTIC ARTHRITIS ADJUST ANTIBIOTIC AFTER RESULTS

72
Q

INITIAL TEST- SEPTIC ARTHRITIS PROSTHETIC JOINT

INITIAL TREAT-TX PROSTHETIC JOINT INFECTION

A

HARD TO VISUALIZE; LOOK FOR LOOSE JOINT OR LUCENCY AROUND JOINT; FOR BONE SPREAD

REMOVE JOINT, ANTIBIOTICS 6-8 WEEKS THEN REPLACE THE JOINT

73
Q

DIAGNOSIS-STD’S, PERMISCUES,,POLYARTICULAR INVOLVED,TENOSYNOVITIS(FINGER MOV. PAINFUL),PETECHIAL RASH

INITIAL TEST-
INITIAL TREAT-

A

GONOCOCCAL SEPT. ARTHRITIS

SYNOVIAL FLUID:WBC 30,000-50,000 CULTURE EVERYWHERE(PHARYNX,RECTUM,URETHRA,CERVIX): IF RASH,TNOSYNOVITIS, POLYART. INV

CEFTRIOXONE,CEFOTAXIME OR CEFTIZOXIME (QUINOLONES ONLY IF SENSITIVE)

TIP- GONOCOCCAL SEPT. ARTHRITIS FREQUENT DURING MENSES

74
Q

DIAGNOSIS- NEARBY INFECTION IN ADULTS, HEMATOGENOUS SPREAD IN KIDS; DIABETIC PATIENT WITH ULCER, P. NEUROPATHY,IMFLAMATION:PURULENT SINUS TRACT

INITIAL TEST-
ACC TEST-
INTIAL TREAT-

A

OSTEOMYELITIS

XRAY IF NORMAL DO AN MRI (BONE SCAN IF CONTRAINDICATED); CONTROL: ESR

BIOPSY

BIOPSY: SHOULD INDICATE ORGANISM AND ANTIBIOTIC SENSITIVITY= QUINOLONES (CIPRO)/OXICILLIN’S DEPENDING ON SENS.

75
Q

TIP-NEVER TEST IN OSTEOMYELITIS

TIP- QUINOLONES: SIDE EFFECTS

TIP- CIPROFLOXACIN IS THE ONLY ORAL THERAPY FOR OSTEOMYELITIS, BUT ONLY USE IF?

A

CULTURE AND DRAINAGE

ACHILLES TENDON RUPTURE

CONFIRMED SENSITIVE IN BIOPSY

USMLE Step 2 CK (9 decks)

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