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21 Cards in this Set
- Front
- Back
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What is the clinical difference between primary and secondary Raynaud's?
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primary does not cause ischemia
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What are the main categories of cause for secondary Raynaud's?
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1. rheumatic: RA, SLE, Scl, PM-DM, vasculitis, Sjogren's; also primary pulmonary HTN and active hepatitis
2. traumatic: vibrating machinery 3. drugs: BB, clonidine, ergots, bromocriptine, many chemo meds 4. occlusive arterial: embolic/thrombotic, carpal tunnel, atherosclerotic 5. hyperviscosity: polycythemia, cryoglobulinemia, leukemia 6. infections: ENDOCARDITIS, HEPATITIS, mono, Lyme 7. Other: RSD, fibro, AVM, cancer |
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T/F: Raynaud's can be diagnosed by putting patient's hands in ice water.
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False--this may work, but it is unreliable and dangerous.
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What tests should be performed on exam and labs for suspected Raynaud's?
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Nailfold capillary exam with ophthalmoscope set at 40 diopters: if abnormal, then rheumatologic cause is suspected
--Adson's test for thoracic outlet syndrome --look for scleroderma signs --check pulses for vasculitis, obstruction ---heart exam for cx that throws clots LABS: primary may have ANA coag studies TSH anti-centromere, anti-topoisomerase cryoglobulins |
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What are red flags for secondary Raynaud's symptoms?
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RP in a man
onset after 30 ulcerations abnormal nailfold serologic or clinical evidence of rheumatic condition |
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What is the main medication to look for and discontinue for Raynaud's?
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beta blockers
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What are the main medication steps to treat Raynaud's?
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dx and tx underlying conditions
1. warm digits, aspirin 2. CCBs, especially nefidipine XL 30 mg/day, amlodipine 5 mg/day, diltiazem 3. Add prazosin, or topical nitrate gel 4. severe, try IV prostaglanding |
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Tx for heavily ischemic Raynaud's
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hospitalize
chemical sympathectomy for pain (?) IV prostaglandins for vasodilation aspirin for antiplatelet heparin for anticoag |
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Amyloidosis must be distinguished from ?
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multiple myeloma
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What are some clinical syndromes that might be associated with amyloidosis?
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NEPHROTIC SYNDROME (most common; dx with UPEP or SPEP + immunofluoresis)
CARPAL TUNNEL peripheral or autonomic neuropathy CHF (amyloid cardiomyopathy) Hepatic disease |
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Most common sx of primary amyloidosis
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fatigue
SEVERE WEIGHT LOSS EDEMA hepatomegaly macroglossia (enlarged and FIRM tongue, dental impressions) MUSCLE HYPERTROPHY purpura |
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What rheumatic diseases are most commonly complicated by amyloidosis?
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RA, JRA, ankylosing spondylitis
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How is amyloidosis dx and tx?
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UPEP, SPEP, amyloidosis
biopsy (abdominal fat pat, rectal mucosa, bone marrow), Congo red stain, apple-greem birefringence tx: primary amyloidosis: cytotoxic agents: melphalan > colchicine stem cell transplants secondary amyloidosis: control underlying inflammatory dz DMSO, colchicine chlorambucil for JRA cytotoxics are controversial for secondary form |
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Do you treat anklyosing spondlyitis with methotrexate?
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No, MTX is ineffective.
Anti-TNF agents are main treatment. |
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What kind of syndesmophytes are seen in Reiter's?
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"jug-handle"
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[Hypo, hyper] thyroidism can cause Raynaud's.
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hypo
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[Hypo, hyper] thyroidism can cause osteoporosis.
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hyper
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Besides PM-DM or muscular dystrophy, what should you think consider in a patient with proximal muscle weakness?
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hypo/hyperthyroid
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Bechet's: oral, genital and ? lesions
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skin (erythema nodosum, pseudofolliculitis)
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Main concern in relapsing polychondritis
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tracheal cartilage erosion, respiration obstruction
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Spiking fever, highly elevated ferritin, rash, arthralgias
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Still's disease
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