Rheumatology & Vascular Disease Flashcards by lionel varela

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

INITIAL TEST=
INITIAL TREAT=

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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TIP- DIP=HEBERDEN NODES ; PIP= BOUCHARD NODES

TRUE

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

ACUTE GOUT/GOUTY ARTHRITIS

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TIP- HOW TO DISTINGUISH FROM INFECTION?

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

ARTHROCENTESIS

TRUE

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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

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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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

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

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

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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TIP- WHAT DISEASES TO LOOK FOR IN JOINT PAIN?

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

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

INITIAL TREAT-

LUMBOSACRAL STRAIN/FACETITIS

NSAIDS

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

CORD COMPRESSION (MALIGNANCY)

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

CORD COMPRESSION (INFECTION)/EPIDURAL ABSCESS

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

CAUDA EQUINA

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

ANKYLOSING SPONDYLITIS

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

DISK HERNIATION (SCIATICA) OF L4

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

DISK HERNIATION (SCIATICA) OF L5

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

DISK HERNIATION (SCIATICA) OF S1

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

GOOD SENSITIVITY (EXLCUDES SCIATICA)

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

TIP- LOW BACK PAIN OVER 50 LOOK FOR DJD ALSO

TRUE

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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

CXR THEN 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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INITIAL TREAT- CAUDA EQUINA

INITIAL TREAT- DISK HERNIATION (SIATICA)

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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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-

LUMBAR SPINAL STENOSIS

MRI

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

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

INITIAL TEST-
INITIAL TREAT-

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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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-

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

INITIAL TREAT-

DUPUYTREN CONTRACTURE

TRIMCINOLONE, LIDOCAINE, OR COLLAGENASE INJECTION THEN SURGERY

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

GANGLIONIC CYST (BIBLE CYST) NOTHING SELF LIMITED OR SURGERY/DRAIN FOR COSMETIC OR UNCOMFORT

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-

ROTATOR CUFF INJURY MRI NSAIDS, REST, PT THEN STEROID INJECTION THEN SURGERY

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

PATELLOFEMORAL SYNDROME NORMAL XRAY AND PE: CREPITUS, LOCK, INSTABILITY PT: STRENGTH TRAINING WITH CYCLING

TIP- TUNNEL SYNDROMES WORSE WITH USE

TRUE

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

PLANTAR FASCIITIS PT: STRETCHING AND NSAIDS THEN STEROID INJECTION THEN RARE SURGERY

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

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)

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

FELTY SYNDROME CAPLAN SYNDROME TRUE CAD

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

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

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-

JRA JRA LAB: ANEMIA, HYPOALBUMINEMIA,LEUKOCYTOSIS, FERRITIN LEVEL ELEVATED (ANA- IS NORMAL) NSAIDS THEN STEROIDS THEN ANTI TNF DRUGS

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

SLE

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

SLE

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

SLE

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

SLE

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

SLE

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

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**

DIAGNOSIS- THROMBOSES OF ARTERIES AND VEINS RECURRENT SPONTANEUOUS ABORTIONS, NORMAL INR INITIAL TEST- ACC. TEST- INTIAL TREAT-

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

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

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

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

SCLERODERMA 20% DIFFUSE

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

CREST/LIMITED SCLERODERMA

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

RAYNAUD:CREST

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

SKIN SCLEROSIS:CREST

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

GI:CREST

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

RENAL:CREST

DIAGNOSIS-RESTRICTIVE LUNG DISEASE AND PULMONARY HYPERTENSION

LUNG FIBROSIS: CREST

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

CARDIAC:CREST

INITIAL TEST- SCLERODERMA (SYSTEMIC SCLEROSIS) | INTIAL TREAT- SCLERODERMA

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

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

POLYMYOSITIS

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

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)

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-

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)

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-

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

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

PMR POLYMYALGIA RHEUMATICA NORMAL CPK AND ALDOLASE STEROIDS EVEN AT LOW DOSE

DIAGNOSIS- FEVER,WEIGHT LOSS, FATIGUE, VISUAL SYMPTOMS,JAW CLAUDICATION,SCALP TENDERNESS,HEADACHE,DECR. ARM PULSE,AR P.ASS. PMR TIP- PAN

GAIN CELL ARTERITIS (TEMPORAL) EXTENDS TO TEMPORAL ARTERITIS SCREEN FOR HEP B AND C

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

WEGNER GRANULOMATOSIS C-ANCA (CYTOPLASMIC ANTIBODIES/ANTI-PROTEINASE3) LUNG>RENAL>SINUS BIOPSY PREDNISONE AND CYCLOPHOSPHAMIDE WEGNER GRANULOMATOSIS

DIAGNOSIS-FEVER,WEIGHT LOSS FATIGUE, A PULMONARY-RENAL SYNDROME ASTHMA EOSINOPHILIA INITIAL TEST- ACC. TEST-

CHURG-STRAUSS SYNDROME C-ANCA (CYTOPLASMIC ANTIBODIES/ANTI-PROTEINASE3) BIOPSY

DIAGNOSIS- FEVER,WEIGHT LOSS, FATIGUE, GI (ABDOMIN),JOINT AND LOWER EXTREMITY PURPURA + HEMATURIA INITIAL TEST- ACC. TEST- INTIAL TREAT-

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

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

CRYOGLOBULINEMIA RA(POS.),COLD PRECIP. IMMUNE COMPLESES, LOW C4 COMPLEMENT TREAT HEP C:INF,RIBAVIRIN AND TELAPREVIR OR BOCEPREVIR

TIP- DIFFERENTIAL CRYOGLOBULINEMIA | TIP- SLE LABS SHOW LOW COMPLEMENT #?

COLD AGGLUTININ: EBV,MYCOPLASMA, LYMPHOMA[HEMOLYSIS AND TX:STAY WARM,TITUXIMAB, CYCLOSPORIN,C.PHOS. 3

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-

BEHCET SYNDROME HX. STEROIDS/ AZATHIOPRINE,C.PHOS,COLCHICINE,THALIDOMIDE

TIP- PATHERGY:STERILE SKIN PUSTULES FROM MINOR TRAUMA

BEHCET SYNDROME

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

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

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-

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

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

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)

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

REACTIVE ARTHRITIS (REITER) TAP TO EXCLUD SEPTIC ARTH., HX. NSAID, CORRECT CAUSE; THEN SULFASALAZINE OR IJ-STEROID

P.ASS.- KERTODERMA BLENNORHAGICUM(SKIN LESION)

PUSTULAR PSORIASIS

DIAGNOSIS-OLDER PERSON WOMEN,VERTEBRAL FRACTURES LEADING FRACTURES INTIAL TEST- INTIAL TREAT-

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)

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

BISPHOSPHANATES | OSTEOSARCOMA AND HYPERCALCEMIA

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-

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

INITIAL TEST- SEPTIC ARTHRITIS PROSTHETIC JOINT | INITIAL TREAT-TX PROSTHETIC JOINT INFECTION

HARD TO VISUALIZE; LOOK FOR LOOSE JOINT OR LUCENCY AROUND JOINT; FOR BONE SPREAD REMOVE JOINT, ANTIBIOTICS 6-8 WEEKS THEN REPLACE THE JOINT

DIAGNOSIS-STD'S, PERMISCUES,,POLYARTICULAR INVOLVED,TENOSYNOVITIS(FINGER MOV. PAINFUL),PETECHIAL RASH INITIAL TEST- INITIAL TREAT-

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

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-

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.

TIP-NEVER TEST IN OSTEOMYELITIS TIP- QUINOLONES: SIDE EFFECTS TIP- CIPROFLOXACIN IS THE ONLY ORAL THERAPY FOR OSTEOMYELITIS, BUT ONLY USE IF?

CULTURE AND DRAINAGE ACHILLES TENDON RUPTURE CONFIRMED SENSITIVE IN BIOPSY