Rheumatology & Vascular Disease Flashcards
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
TIP- DIP=HEBERDEN NODES ; PIP= BOUCHARD NODES
TRUE
DIAGNOSIS- ACUTE EXRUCIATING PAIN AND REDNESS IN TOE, AFTER HEAVY DRINKING + FEVER
ACUTE GOUT/GOUTY ARTHRITIS
TIP- HOW TO DISTINGUISH FROM INFECTION?
TIP- GOUT MY ALSO PRESENT IN ANKLE, FEET AND KNEES?
ARTHROCENTESIS
TRUE
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
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)
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)
TIP- WHAT DISEASES TO LOOK FOR IN JOINT PAIN?
DJD,GOUT,CPPD, RA (ANTI-CCP), SEPTIC (WBC >50000), AND SYSTEMIC (6 PATHOLOGY)
DIAGNOSIS- BACK PAIN, EXCLUDED:CORD COMPRESSION, EPIDURAL ABSCESS,CAUDA EQ.,ANK.SPON.,DISK HERNIA
INITIAL TREAT-
LUMBOSACRAL STRAIN/FACETITIS
NSAIDS
DIAGNOSIS-BACK PAIN,HX. OF CANCER,FOCAL NEUROLOGICAL DEFICITS (SENSORY:T4=NIPPLES,T10=UMBIL),SPINAL POINT TENDERNESS,HYPERREFLEX
CORD COMPRESSION (MALIGNANCY)
DIAGNOSIS-BACK PAIN,FEVER, INC. ESR,FOCAL NEUROLOGICAL DEFICITS (SENSORY:T4=NIPPLES,T10=UMBIL),SPINAL POINT TENDERNESS,HYPERREFLEX
CORD COMPRESSION (INFECTION)/EPIDURAL ABSCESS
DIAGNOSIS-BACK PAIN, INCONTINENCE,ED,BILATERAL LEG WEAKNESS,SADDLE AREA ANESTHESIA
CAUDA EQUINA
DIAGNOSIS- BACK PAIN,UNDER 40YRS, WORSE WITH REST AND BETTER WITH ACTIVITY, DECREASED CHEST MOBILITY
ANKYLOSING SPONDYLITIS
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
DIAGNOSIS- BACK PAIN, POSITIVE STRAIGHT LEG RAISE (SLR), NUMBNESS INNER FOREFOOT, LOSS OF DORSIFLEXION OF TOE
DISK HERNIATION (SCIATICA) OF L5
DIAGNOSIS- BACK PAIN, POSITIVE STRAIGHT LEG RAISE (SLR), NUMBNESS OF OUTERFOOT,LOSS ANKLE JERK, LOSS OF FOOT EVERSION
DISK HERNIATION (SCIATICA) OF S1
TIP- LOW BACK PAIN LOOK FOR 5 POSSIBLE IF SLR IS NEGATIVE
GOOD SENSITIVITY (EXLCUDES SCIATICA)
TIP-LOW BACK PAIN LOOKS FOR WHEN IMAGE IS NEEDED ON TEST
TIP- LOW BACK PAIN OVER 50 LOOK FOR DJD ALSO
TRUE
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)
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
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
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
LUMBAR SPINAL STENOSIS
MRI
WEIGHT LOSS, PAIN MANAGEMENT, STEROID INJECTION:EPIDURAL, PT/LIGHT EXERCISE THEN SURGERY
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
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
DIAGNOSIS- NODULE FORMATION ON HAND, CONTRACTURE OF 4TH AND 5TH FINGERS, CANNOT EXTEND
INITIAL TREAT-
DUPUYTREN CONTRACTURE
TRIMCINOLONE, LIDOCAINE, OR COLLAGENASE INJECTION THEN SURGERY
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
