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MS3 > Step studying 2 > Flashcards

Step studying 2 Flashcards

1
Q

Describe presentation of Guillain Barre

A

♣ Ascending symmetrical paralysis over days to weeks
♣ Absent/depressed deep tendon reflexes
♣ Respiratory compromise if paralysis reaches the diaphragm

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2
Q

Diagnosis of Guillain Barre

A

♣ Lumbar puncture

• High protein with few cells

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3
Q

Tx of Guillan Barre

A

♣ IV immunoglobulin or plasmapheresis

♣ Intubation if ascending paralysis has extended to the diaphragm

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4
Q

Describe presentation of myasthenia gravis

A

• Ptosis, diplopia, weakness
• Worsens with muscle use (fatiguability)
o Most prominent in eyes, swallowing, and fine movements of distal extremities

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5
Q

Diagnosis of MG

A
  • Antibodies (anti-Ach)
  • EMG (will show waning muscle activity)
  • CT scan to look for thymoma
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6
Q

Tx of MG

A
  • Cholinesterase inhibitors
  • Steroids to decrease autoimmune component
  • IVIG = plasmaphoresis for myasthenic crisis
  • Thymectomy
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7
Q

Presentation of lambert eaton

A

• Proximal muscle weakness that improves with use

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8
Q

Diagnosis of lambert eaton

A
  • Antibodies (anti-Ca)
  • EMG (will show increasing amplitude with prolonged muscle use)
  • CT to look for small cell lung cancer
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9
Q

How many WBCs do you expect to see in a normal joint, OA, RA, and septic joint

A
  • Normal = <200
  • OA = 200-2,000
  • RA = 2,000-50,000
  • Septic = >50,000
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10
Q

How many PMNs do you expect to see in a normal joint, OA, RA, and septic

A
  • Normal = <25%
  • OA = 25%
  • RA = often >50%
  • Septic = 80-90%
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11
Q

Symptoms of lupus

A 
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)
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12
Q

What antibody is more specific for lupus

A

Anti-dsDNA

ANA is sensitive but not specific

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13
Q

What antibody is specific for drug-induced lupus

A

Anti-histone antibody

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14
Q

What drugs are associated with drug-induced lupus

A

SHIPP-E

  • Sulfa drugs
  • Hydralazine
  • Isoniazid
  • Procainamide
  • Phenytoin
  • Etanercept
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15
Q

Tx of lupus nephritis

A
  • Cyclophosphamide

- Mycophenylate

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16
Q

Will RA be symmetric or asymmetric, and what joints does it involve

A

Symmetric, usually involving smaller joints

  • PIP with sparing of DIP
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17
Q

What part of the spine is involved in RA

A

Cervical spine

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18
Q

Tx of RA

A

NSAIDs + DMARDs

  • NSAIDs as monotherapy do not prevent disease progression
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19
Q

What DMARDs should you use in RA

A

o Methotrexate*, Leflunomide, Hydroxychloroquine, Sulfasalazine

o REMEMBER: MTX for RA and Hydroxychloroquine for SLE

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20
Q

What about steroids in RA

A

o Only for acute flares

o Do not use long term due to side effects/morbidity/mortality

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21
Q

Describe presentation of limited type scleroderma

A

CREST syndrome

  • C = calcinonis
  • R = raynoud
  • E = esophageal dysmotility
  • S = sclerodactyly
  • T = telangiectasias
22
Q

Describe presentation of diffuse type scleroderma

A

Same as limited type PLUS heart, lungs, kidney. . .

  • Myocardial ischemia and fibrosis
  • Interstitial lung disease
  • Renal crisis
23
Q

What antibody is associated with limited vs. diffuse scleroderma

A

Limited = anti-centromere (THINK: the C in CREST also stands for centromere)

Diffuse = anti-scl-70 aka anti-topoisomerase

24
Q

What antibodies are associated with Sjogrens

A

Anti-SSA (Anti-Ro) and Anti-SSB (Anti-La)

25
Q

What antibodies are associated with polymyositis and dermatomyositis

A

Anti-Jo-1

26
Q

Describe difference between polymyositis and polymyalgia rheumatica

A

Polymyositis will have elevated CK and polymyalgia rheumatica will not

27
Q

Tx of acute gout attack

A

o NSAIDs (indomethacin)
o Colchicine – stabilizes tubulin to impair leukocyte chemotaxis
o Glucocorticoids

28
Q

Tx of chronic gout

A

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

29
Q

What are the seronegative spondyloarthropathies

A 
PAIR:
P = psoriatic arthritis
A = ankylosing spondylitis
I = IBD
R = reactive arthritis
30
Q

Tx of prolactinoma

A

Dopamine agonists (e.g. Cabergoline or Bromocriptine)

31
Q

MOA of Hydroxychloroquine

A

TNF and IL-1 suppressor

Used in lupus

32
Q

Adverse effect of Hydroxychloroquine

A

Retinopathy

33
Q

Describe complete abortion:

  • Intrauterine products remaining
  • Cervical os (closed/open)
  • Vaginal bleeding
A

o Complete passage of all products of conception
o Vaginal bleeding
o Closed cervical os

34
Q

Describe incomplete abortion:
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding

A

o Occurs when some, but not all, of the products of conception have passed
o Associated with cramping, vaginal bleeding, an open cervical os

35
Q

Describe missed abortion
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding

A

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

36
Q

Describe threatened abortion
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding

A

o Vaginal bleeding <20 weeks in the presence of an embryo with cardiac activity and closed cervix

37
Q

Describe inevitable abortion
♣ - Intrauterine products remaining
♣ - Cervical os (closed/open)
♣ - Vaginal bleeding

A

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

38
Q

At what gestational age is external cephalic version appropriate

A

> /= 37 weeks

39
Q

Most common cause of anemia in chronic alcoholics

A

Folate deficiency

40
Q

What are antibodies against in pemphigous vulgaris

A

♣ Autoimmune destruction of desmosomes (connection between cells of the stratum spinosum)

41
Q

Presentation of pemphigous vulgaris

A
  • Flaccid bullae and ulcers
  • (+) Nikolsky sign (separation of epidermis upon manual stroking of skin) thin-walled bullae that rupture easily
  • Oral mucosa involved
42
Q

What are antibodies against in bullous pemphigoid

A

♣ Autoimmune (IgG) destruction of hemidesmosomes (connection between basal cell layer and basement membrane)

43
Q

Presentation of bullous pemphigoid

A

♣ Tense bullae do not rupture easily (- Nikolsky sign)

♣ Oral mucosa NOT involved

44
Q

Tx of psoriasis

A

(1) phototherapy

(2) topical steroids

45
Q

Describe pityriasis rosea

A

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)

46
Q

Tx of pityriasis rosea

A

None - self limiting

47
Q

Describe lichen planus

A
  • Pruritic, purple, polygonal, planar, papules and plaques

- Wickham striae (reticular white lines) = mucosal involvement

48
Q

Tx of tinea capitis

A

Oral griseofulvin

49
Q

Tx of onychomycosis

A

Oral terbinafine

50
Q

Tx of tinea corporis

A

Topical antifungal

MS3 (88 decks)

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