Step studying 2 Flashcards
Describe presentation of Guillain Barre
♣ Ascending symmetrical paralysis over days to weeks
♣ Absent/depressed deep tendon reflexes
♣ Respiratory compromise if paralysis reaches the diaphragm
Diagnosis of Guillain Barre
♣ Lumbar puncture
• High protein with few cells
Tx of Guillan Barre
♣ IV immunoglobulin or plasmapheresis
♣ Intubation if ascending paralysis has extended to the diaphragm
Describe presentation of myasthenia gravis
• Ptosis, diplopia, weakness
• Worsens with muscle use (fatiguability)
o Most prominent in eyes, swallowing, and fine movements of distal extremities
Diagnosis of MG
- Antibodies (anti-Ach)
- EMG (will show waning muscle activity)
- CT scan to look for thymoma
Tx of MG
- Cholinesterase inhibitors
- Steroids to decrease autoimmune component
- IVIG = plasmaphoresis for myasthenic crisis
- Thymectomy
Presentation of lambert eaton
• Proximal muscle weakness that improves with use
Diagnosis of lambert eaton
- Antibodies (anti-Ca)
- EMG (will show increasing amplitude with prolonged muscle use)
- CT to look for small cell lung cancer
How many WBCs do you expect to see in a normal joint, OA, RA, and septic joint
- Normal = <200
- OA = 200-2,000
- RA = 2,000-50,000
- Septic = >50,000
How many PMNs do you expect to see in a normal joint, OA, RA, and septic
- Normal = <25%
- OA = 25%
- RA = often >50%
- Septic = 80-90%
Symptoms of lupus
RASH OR PAIN R = rash A = arthritis S = serositis H = hematologic (anemia, thrombocytopenia) O = oral ulcers R = renal disease P = photosensitivity A = ANA I = immunologic (anti-dsDNA) N = neuro (psychosis, seizures)
What antibody is more specific for lupus
Anti-dsDNA
ANA is sensitive but not specific
What antibody is specific for drug-induced lupus
Anti-histone antibody
What drugs are associated with drug-induced lupus
SHIPP-E
- Sulfa drugs
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
- Etanercept
Tx of lupus nephritis
- Cyclophosphamide
- Mycophenylate
Will RA be symmetric or asymmetric, and what joints does it involve
Symmetric, usually involving smaller joints
- PIP with sparing of DIP
What part of the spine is involved in RA
Cervical spine
Tx of RA
NSAIDs + DMARDs
- NSAIDs as monotherapy do not prevent disease progression
What DMARDs should you use in RA
o Methotrexate*, Leflunomide, Hydroxychloroquine, Sulfasalazine
o REMEMBER: MTX for RA and Hydroxychloroquine for SLE
What about steroids in RA
o Only for acute flares
o Do not use long term due to side effects/morbidity/mortality
Describe presentation of limited type scleroderma
CREST syndrome
- C = calcinonis
- R = raynoud
- E = esophageal dysmotility
- S = sclerodactyly
- T = telangiectasias
Describe presentation of diffuse type scleroderma
Same as limited type PLUS heart, lungs, kidney. . .
- Myocardial ischemia and fibrosis
- Interstitial lung disease
- Renal crisis
What antibody is associated with limited vs. diffuse scleroderma
Limited = anti-centromere (THINK: the C in CREST also stands for centromere)
Diffuse = anti-scl-70 aka anti-topoisomerase
What antibodies are associated with Sjogrens
Anti-SSA (Anti-Ro) and Anti-SSB (Anti-La)
What antibodies are associated with polymyositis and dermatomyositis
Anti-Jo-1
Describe difference between polymyositis and polymyalgia rheumatica
Polymyositis will have elevated CK and polymyalgia rheumatica will not
Tx of acute gout attack
o NSAIDs (indomethacin)
o Colchicine – stabilizes tubulin to impair leukocyte chemotaxis
o Glucocorticoids
Tx of chronic gout
o Allopurinol – inhibits xanthine oxidase, thus inhibiting uric acid synthesis
—- Do not start Allopurinol in an acute flare – will worsen the attack
o Febuxostat – also xanthine oxidase inhibitor
o Probenecid – inhibits reabsorption of uric acid in PCT
What are the seronegative spondyloarthropathies
PAIR: P = psoriatic arthritis A = ankylosing spondylitis I = IBD R = reactive arthritis
Tx of prolactinoma
Dopamine agonists (e.g. Cabergoline or Bromocriptine)
MOA of Hydroxychloroquine
TNF and IL-1 suppressor
Used in lupus
Adverse effect of Hydroxychloroquine
Retinopathy
Describe complete abortion:
- Intrauterine products remaining
- Cervical os (closed/open)
- Vaginal bleeding
o Complete passage of all products of conception
o Vaginal bleeding
o Closed cervical os
Describe incomplete abortion:
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding
o Occurs when some, but not all, of the products of conception have passed
o Associated with cramping, vaginal bleeding, an open cervical os
Describe missed abortion
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding
o An embryo larger than 5 mm without cardiac activity, often “missed” term is used for nonviable pregnancy in which patient has no symptoms of pain or bleeding
o Pregnancy <20 weeks with embryonic or fetal demise but no sx such as bleeding or cramping
o No vaginal bleeding
o Closed cervical os
Describe threatened abortion
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding
o Vaginal bleeding <20 weeks in the presence of an embryo with cardiac activity and closed cervix
Describe inevitable abortion
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding
o Bleeding and cramping in the presence of a dilated cervix
o Products of conception may be seen or felts at or above the cervical os
o Indicates that passage of the conceptus is unavoidable
At what gestational age is external cephalic version appropriate
> /= 37 weeks
Most common cause of anemia in chronic alcoholics
Folate deficiency
What are antibodies against in pemphigous vulgaris
♣ Autoimmune destruction of desmosomes (connection between cells of the stratum spinosum)
Presentation of pemphigous vulgaris
- Flaccid bullae and ulcers
- (+) Nikolsky sign (separation of epidermis upon manual stroking of skin) thin-walled bullae that rupture easily
- Oral mucosa involved
What are antibodies against in bullous pemphigoid
♣ Autoimmune (IgG) destruction of hemidesmosomes (connection between basal cell layer and basement membrane)
Presentation of bullous pemphigoid
♣ Tense bullae do not rupture easily (- Nikolsky sign)
♣ Oral mucosa NOT involved
Tx of psoriasis
(1) phototherapy
(2) topical steroids
Describe pityriasis rosea
o Initial lesion (“herald patch”) followed by scaly erythematous plaques in a “Christmas tree” distribution on trunk
♣ Spares palms and soles (if it does not, consider syphilis)
Tx of pityriasis rosea
None - self limiting
Describe lichen planus
- Pruritic, purple, polygonal, planar, papules and plaques
- Wickham striae (reticular white lines) = mucosal involvement
Tx of tinea capitis
Oral griseofulvin
Tx of onychomycosis
Oral terbinafine
Tx of tinea corporis
Topical antifungal
