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59 Cards in this Set
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Granulomatosis with Polyangitis
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the term they use to trick you out of Wegener's Dz
Wegener's: systemic vaculitis + Upper + Lower Airway granulomatous inflammation + flomerulonephritis. Onset 40 yo C-ANCA positive vs protease-3 tx: cyclophosphamide |
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ankylosing spondylitis pt w/ minimal trauma
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--> vertebral fx; high index of suspicion
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Immune thrombocytopenia
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pre-schooler antibovies vs platelets
self limited, spontaneous recovery observe & corticosterois if <30k more platelets --> more destrx, do not unless active bleeding/ intracranial bleeding life saving heroic measure: splenectomy |
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Methotrexate side effects
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side effects can be alleviated by folate supplementation without changing the efficacy (crazy)
MTX: macrocytic anemai, nausea, stomatitis, rash, hepatoticity, itnerstitial lung disease, alopecia, fever |
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Hydroxychloroquin
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Gi distress, visual distrubances, hemolysis in G6DP deficient
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Cyclosporin main toxicities
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virla infx, lymphoma, nephrotoxic
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Azathirprine
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pancreatitis, liver toxicity dose dpt BM suppression
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Cyclophosphamide main toxicities:
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hemorrhagic cystitis, bladder carcinoma, sterility, meylosuppression
In SLE reserved for pts with renal or CNS problems |
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best test to confirm dermatitis herpetiformis:
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anti-endomysial IgA antibodies assay
also sometimes they'll try to trick you by asking you to confirm celiac with this and not offering anti-gliadin |
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Initial therapy for rosacea
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topical metronidazole to prevent papules & pustules
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painless blisters /skin fragility on hand dorsum + hyperpigmentation or hypertrichosis on face
dz, tx |
porphyrea cutanea tardis, exacerbated by alcohol & estrogens so stop those
tx: phlebotomy, hydroxychloroquin |
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Mouth Ulcers + MCP/PIP Pain
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SLE
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3 classic signs of psoriatic arthritis:
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DIP involvement
dactylitis "sausage digits" onycholysis - pitting/separation of nailbed |
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DIP involvement
dactylitis "sausage digits" onycholysis - pitting/separation of nailbed |
3 classic signs of psoriatic arthritis:
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Diagonostic testing of Ankylosing Spondylitis
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AP XR of SI Joint
Fusion/Bamboo spine is diagnostic --> equivocal --> MRI NB: 90% of AS pts have HLA B27, but only 5% of HLAB27 pts have AS --> not a diagnostic test. |
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SLE & blood
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warm iGG antibodies against everythihng
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hydroxychloroquine & SLE
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hydroxychloroquine is good for SLE with only eye and skin manifestations, but it can cause eye damage, need eye exam q6mo
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SLE with eye & skin manifestations
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hydroxychloroquine is good for SLE with only eye and skin manifestations, but it can cause eye damage, need eye exam q6mo
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Eosinophiluria with Drug use
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Drug Induced Interstitial nephritis
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Tx: Seborrheic dermatitis
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moiturizers, topical antifungals, antidandruff shampoo, topical steroids
severe cases suggest immunodeficiency |
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pain and stiffness in neck, shoulders, & hips
pain is not in joint, no limitation of passive/active motion Dz, Dx, Tx |
Polymyalgia Rheumatica:
pain and stiffness in neck, shoulders, & hips pain is not in joint, no limitation of passive/active motion Req for Dx: pain as above ESR >40, age >50, morning stiffness >1h, no other dzs causing Tx: low dose prednisone Do not order ANA /Rh titers |
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symmetrical muscle weak with pain.
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Polymyositis: symmetrical muscle weak with pain. From inflammed muscle fibers, CK is elevated. Dx: Bx,
NB: polymyalgia rheumatica = PAIN and weakness, DErmatomyositis: skin manifestations |
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Myopathy with sluggish achilles DTR:
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think hypothyroid
hypothyroidism can be coordinated with proximal myopathy, rhabdo; |
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6 Diagnostic features of osteoarthritis:
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>50yo
minimal/no morning stiffness boney tenderness boney enlargement creiptus on motion no warmth 3 make the dx |
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Dematomyositis
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is a muscle/skin paraneopalstic ondition
looks like eaton lambert but with cutaneous manifestations |
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Fibromyalgia txs
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amytriptaline & cyclobenzaprine
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Pt dxd with aSx giant cell arteritis fu:
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serial CXR's for known complixn: Aortic Anuerysm
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Complixn from well controlled RA
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pts with RA get osteoporosis from meds & the fact that pts are usually women & 2/2 arthritis do not perform weight bearing
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osteitis deformans
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is from pagets loss of lamellar bone
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Erythema Nodosum Acronym
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SORE SHINS - not fully inclusive
Streptococci, OCP, Rickettsia, Eponymous (Bechet), Sulfonamides, Hansen's Leporsy, IBD, NHL, Sarcoid always fu with CXR |
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ANA
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anti-ncuelar sensative for SLE anti-smith is specific
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anti-smith
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anti-ncuelar sensative for SLE anti-smith is specific
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MCP + PIP
no joint swelling, no systemic sx, stiffness <30d even s tx |
"Viral arthritis"
Parvovirus B19: |
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child:
rash, arthralgia, abdominal pain/vomiting, renal dz |
= HS purpura IgA vasculitis
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Strawberry vs Cherry Hemangiomas:
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Strawberry: infantile, common & benign grow rapidly until age 2, regress by age 8
Cherry: adults, small, do nt regress |
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Rheumatic Fever:
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antibody cross reactivity
heart, joints, skin, brain (carditis, polyarthritis, erythema marginatum (central clearing/pink border)/subcu nodules, chorea |
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DDX: Widened Gamma Gap:
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MM, Amyloidosis, Waldenstrom's macroglobulinemia, MGUS
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Definitive Dx of Amyloidosis is
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Abdominal Fat Pad Bx
Consider when M spike + some organ failure (heart, liver, kidney) |
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Toxic Epidermal Necrolysis vs SJS
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SJS <10% of body surface
TEN >30% same spectrum |
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pt with temporal arteritis later complains of muscle pains
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could be polymyalgia rheumatica, ESR would be elevated
could also be treatment induced steroid --> muscle degredation, dc steroids |
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hypercalcemia, elevated ACE levels in middle aged African American women
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Sarcoidosis usually causes--> hypercalcemia, elevated ACE levels
typical pt: middle aged African American women progressive dry cough, interstitial infiltrates --> pulmonary fibrosis --> dry rales. uveitis, acute polyarthritis, or erythema nodosum non caseatin ggranulomas asx --> no tx, follow often remits sx dz --> glucocorticoids hypercalcemia is from increased conversion of 25OHVitD to 1,25OHVitD |
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Most Common Organ involved in Graft vs Host Disease
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: Skin; Skin rash is almost always seen.
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achalasia vs scleroderma
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achalasia: lost esophageal tone + increased LES tone
scleroderma: lost ET + decreased LES tone |
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cyclosprin toxicities
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nephrotoxicity, hyperkalemia, hypertension, gum hertertophy, hirsutism, tremor
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Pt with RA controlled the pain with indomethacin
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still use Methotrexate; pain isn't the only problem;
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DOC for relapsing-remitting MS:
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Interferon Beta
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pseudogout crystals
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= calcium pyrophosphate dihydrate cyrstals = rhomboid with postive birefringence
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Pt has persistent nasal congestion & postnasal drip, no eye sx, no triggers, no help from loratidine
course of action |
Non-Allergic Rhinitis
some help from 1st gen antihistamines, no help from 2nd gen (no anticholinergic properties) Tx: topical antihistamine or topical glucocorticoid intranasallly, both if necessary |
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Inflammatory Arthritis <2 mo
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: likely infectious
weakly postiive ANA normal in 5% of adults Tx: NSAIDs |
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azithropine
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diarhrhea, leukopenia, hepatotoxicity
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Mycophenolate
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Marrow suppression
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Diagnostic Test for Ankylosing Spondylitis
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plain film demonstrating sacroilitis
NB: 1/2 dvlp anterior uveitis: monocular pain, blurring photophobia |
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herberden vs Bouchard nodes
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distal & proximal IPJs respectively, boht arte osteoarthritis
Not the Middle |
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sausage digits
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psoriatic arthritis =
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which chronic hepatitis has arthralgias
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C
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DOC's for RA:
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Infliximab (Remicade) - TNF inhibitor
Etanercept (Enbrel) - TNF inhibitor MTX Hydroxychloroquine |
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Celiac Sprue --> Dermatitis Herpetiformis
DOC |
DOC: Dapsone; improvement with dapsone is considered diagnostic feature of condition.
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bullous pemphigoid vs pemphigus vulgaris
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bullous: tense blisters not in mouth; IgG & C3; benign, pruritic
pemphigus vulgaris: flaccid bullae, happen first in mouth; IgG deposidts; autoantibodies vs desmoglein; tx: steroids, immunosuppressants; |
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Late Middle Aged Female w/ Dry mouth & Dry Eyes
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--> Sjogren
Dx: Anti-Ro/SSA Abs or SSB (La) |