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aaaaazzzzz 2 c06 Rheu

Aaaaazzzzz 2 C06 Rheu

by jimarzi9, May 2012

Subjects: aaaaazzzzz c06

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230 Cards in this Set

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	What is Arthritis?	What is Arthritis? Acute or Chronic Inflammation of a Joint.
	What is Osteoarthritis?	What is Osteoarthritis? Osteoarthritis is DJD. It is a Chronic slow progressive Erosive damage to Joint Surfaces This Loss of Articular Cartilage causes Increasing pain with Minimal or Absent Inflammation.
	What is DJD? Cause?	What is DJD? DJD is Osteoarthritis. 1 Chronic, 2 Loss of Articular Cartilage, 3 Absent Inflammation. Cause? 1 Increasing Age, and 2 Trauma. 3 Obesity increases DJD.
	Most common cause of Joint disease?	Most common cause of Joint disease? DJD
	DJD Definition? Etiology? Px? Lx? Tx?	DJD Definition? DJD is Osteoarthritis. 1 Chronic, 2 Loss of Articular Cartilage, 3 Absent Inflammation. Etiology? 1 Increasing Age, and 2 Trauma. 3 Obesity increases DJD. Px? Symptomatic in 1 Weight Bearing Joints (Knee, Hip, Ankle). Distal Interphalangeal joints are affected in hand. 2 Crepitations in involved joints. 3 Stiffness is short (under 15 minutes). Lx? Normal 1 ESR, CBC, ANA, Rheuatoid factor. Most Accurate Lx? X-rays shows 1 Joint Space Narrowing, 2 Osteophytes, 3 Dense Subchondral bone, 4 Bone Cysts. Tx? 1 Weight Loss and Moderate Exercise (Hydrotherapy - Swimming, Tai Chi, Yoga), 2 Acetaminophen, 3 NSAIDS, 4 Capsaicin cream, 5 Intraarticular Steroids, 6 Joint Replacement.
	Contrast DJD and Rheumatoid Arthritis.	Contrast DJD and Rheumatoid Arthritis. DJD - 1 Absence of Inflammation, 2 Normal Lx, 3 Short duration of Stiffness.
	Glucosamine for DJD Tx?	Glucosamine for DJD Tx? 1 Glucoasmine and 2 Chondroitin Sulfate are Not effective.
	Chondroitin sulfate for DJD Tx?	Chondroitin sulfate for DJD Tx? Glucoasmine and Chondroitin Sulfate are Not effective.
	What medication is Not useful in DJD Tx?	What medication is Not useful in DJD Tx? Glucoasmine and Chondroitin Sulfate are Not effective.
	What disease is Defect in Urate Metabolism?	What disease is Defect in Urate Metabolism? Gout
	Gout Etiology? Px? Lx? Tx?	Gout Etiology? Gouty arthritis is a Defect in Urate Metabolism. Overproduction or Underexcretion. 90 perc in Men. Overproduction - 1 Idiopathic, 2 Increased Turnover of Cells (aaa Cancer, bbb Hemolysis, ccc Psoriasis, ddd Chemotherapy), 3 Enzyme Deficiency (aaa Lesch-Nyhan Syndrome, bbb Glycogen Storage Disease). Underexcretion - 1 Renal Insufficiency, 2 Ketoacidosis or Lactic Acidosis, 3 Thiazides and Aspirin. Px? 1 Man, 2 Big toe has Sudden, 3 Excruciating Pain, 4 Redness, and 5 Tenderness at night after 6 Binge Drinking. 7 Fever is common (hard to differentiate from infection). Chronic Gout - 1 Tophi, 2 Uric Acid kidney Stones, 3 Long Asymptomatic Periods between attacks. Lx? Most Accurate - 1 Aspirating shows Needle-Shaped Crystals with Negative Birefringence on Polarized light. 2 WBC between 2000 and 50000 with mostly Neutrophil. Joint - 1 Red, 2 Warm, 3 Tender - Tap the joint to exclude infection. 3 Uric Acid levels - elevated in 75 perc in attack. 4 Xrays normal (early), Cortical Erosion (later). Tx? Acute Attack - 1 NSAIDS better than Colchicine, 2 Corticosteroids is effective (Triamcinolone if No response to NSAIDs, or Contraindication to NSAIDS - Renal Insufficiency). Chronic Management - 1 Diet (Decrease Alcohol, Lose Weight, Decrease High-Purine food like meat and seafood), 2 Stop Thiaides, Aspirine, and Niacin, 3 Colchicine, 4 Probenecid and Sulfinpyrazone - Increase excretion in kidney (Uricosuric), 5 Alloprinol - Decrease production of uric acid. AE of Chronic Tx - 1 Hypersensitivity (Rash, Hemolysis, Allergic Interstitial Nephritis) occurs wtih Uricosuric agents and Allopurinol, 2 Neutropenia - Colchicine, 3 Toxic Epidermal Necrolysis or Stevens-Johnson syndrome from Allopurinol.
	What is AE of Colchicine?	What is AE of Colchicine? Diarrhea and Bone Marrow Suppression (Neutropenia)
	What Gout medications are contraindicated in renal insufficiency?	What Gout medications are contraindicated in renal insufficiency? 1 Probenecid, 2 NSAIDS, 3 Sulfinpyrazone. Allopurinol is safe in Renal insuffiency.
	In acute gout, what medication should not be given?	In acute gout, what medication should not be given? Do Not start Uricosuric agents or Allopurinol during acute gout. Can continue Allopurinol.
	What cause Overproduction of Uric Acid?	What cause Overproduction of Uric Acid? Overproduction - 1 Idiopathic, 2 Increased Turnover of Cells (aaa Cancer, bbb Hemolysis, ccc Psoriasis, ddd Chemotherapy), 3 Enzyme Deficiency (aaa Lesch-Nyhan Syndrome, bbb Glycogen Storage Disease). Underexcretion - 1 Renal Insufficiency, 2 Ketoacidosis or Lactic Acidosis, 3 Thiazides and Aspirin.
	What cause Underexcretion of Uric Acid?	What cause Underexcretion of Uric Acid? Overproduction - 1 Idiopathic, 2 Increased Turnover of Cells (aaa Cancer, bbb Hemolysis, ccc Psoriasis, ddd Chemotherapy), 3 Enzyme Deficiency (aaa Lesch-Nyhan Syndrome, bbb Glycogen Storage Disease). Underexcretion - 1 Renal Insufficiency, 2 Ketoacidosis or Lactic Acidosis, 3 Thiazides and Aspirin.
	What is Calcium Pyrophosphate Deposition Disease?	What is Calcium Pyrophosphate Deposition Disease? Calcium-containing salts depositing in articular cartilage is same as Pseudo-Gout.
	What is Pseudogout?	What is Pseudogout? Pseudogout is Calcium Pyrophosphate Deposition Disease.
	What is Calcium Pyrophosphate Deposition Disease? Risk factors? Px? Lx? Tx?	What is Calcium Pyrophosphate Deposition Disease? Calcium-containing salts depositing in articular cartilage is same as Pseudo-Gout. Risk factors? Most common Risk factors are 1 Hemochromatosis, 2 Hyperparathyroidism. Also associated with 3 Diabetes, 4 Hypothyroidism, 5 Wilson disease. Px? CPPD affects 1 Knee, and 2 Wrist (Differs from Gout. Do Not affect DIP and PIP - differs from DJD). Lx? 1 Uric Acid - Normal, 2 X-ray shows Calcification of Cartilaginous structures of joint and DJD. Most Accurate -- 3 Arthrocentesis - shows Positively Birefringent Rhomboid-shaped crystals. Synovial Fluid shows Elevated level of WBC between 2000 and 50000 (Similar to Gout and other inflammatory disorders, such as Rheumatoid Arthritis). Tx? Initial - 1 NSAIDs. If unresponse to NSAIDs, give 2 Intrarticular Steroids (Triamcinolone). 3 Colchicine - helps prevent subsequent attacks - prophylaxis between attacks.
	Positively Birefringent Rhomboid-shaped crystals. Dx?	Positively Birefringent Rhomboid-shaped crystals. Dx? Pseudogout (Calcium Pyrophosphate Deposition Disease)
	Hx, Px, Lx - Older, slow, worse with use. DIP, PIP, hip, and knees. Less than 200 WBC, Osteophytes and joint space narrowing. . Dx?	Hx, Px, Lx - Older, slow, worse with use. DIP, PIP, hip, and knees. Less than 200 WBC, Osteophytes and joint space narrowing. . Dx? DJD
	Hx, Px, Lx - Men, acute, binge drinking. First big toe. 2000 to 50000 WBC, negatively birefringent needles . Dx?	Hx, Px, Lx - Men, acute, binge drinking. First big toe. 2000 to 50000 WBC, negatively birefringent needles . Dx? Gout
	Hx, Px, Lx - Hemochromatosis. Wrist and knees. 2000 to 50000 WBC, positively birefringent rhomboids . Dx?	Hx, Px, Lx - Hemochromatosis. Wrist and knees. 2000 to 50000 WBC, positively birefringent rhomboids . Dx? CPPD
	Hx, Px, Lx - Hyperparathyroidism. Wrist and knees. 2000 to 50000 WBC, positively birefringent rhomboids . Dx?	Hx, Px, Lx - Hyperparathyroidism. Wrist and knees. 2000 to 50000 WBC, positively birefringent rhomboids . Dx? CPPD
	Hx, Px, Lx - Young, female, morning stiffness better with use. Multiple joints of hands and feet. Anti-cyclic citrulinated pepetide (anti-CCP) . Dx?	Hx, Px, Lx - Young, female, morning stiffness better with use. Multiple joints of hands and feet. Anti-cyclic citrulinated pepetide (anti-CCP) . Dx? Rheumatoid Arthritis
	Hx, Px, Lx - High fever, very acute. Single hot joint. More than 50000 neutrophils, culture of fluid . Dx?	Hx, Px, Lx - High fever, very acute. Single hot joint. More than 50000 neutrophils, culture of fluid . Dx? Septic Arthritis
	Dx -DJD. Hx, Px, Lx?	Dx -DJD. Hx, Px, Lx? Older, slow, worse with use. DIP, PIP, hip, and knees. Less than 200 WBC, Osteophytes and joint space narrowing.
	Dx -Gout. Hx, Px, Lx?	Dx -Gout. Hx, Px, Lx? Men, acute, binge drinking. First big toe. 2000 to 50000 WBC, negatively birefringent needles
	Dx -CPPD. Hx, Px, Lx?	Dx -CPPD. Hx, Px, Lx? Hemochromatosis, Hyperparathyroidism. Wrist and knees. 2000 to 50000 WBC, positively birefringent rhomboids
	Dx -Rheumatoid Arthritis. Hx, Px, Lx?	Dx -Rheumatoid Arthritis. Hx, Px, Lx? Young, female, morning stiffness better with use. Multiple joints of hands and feet. Anti-cyclic citrulinated pepetide (anti-CCP)
	Dx -Septic Arthritis. Hx, Px, Lx?	Dx -Septic Arthritis. Hx, Px, Lx? High fever, very acute. Single hot joint. More than 50000 neutrophils, culture of fluid
	Lx - 2000 to 50000 WBC in Joint tap. Dx?	Lx - 2000 to 50000 WBC . Dx? Gout, CPPD, Rheumatoid Arthritis
	Lx - Less than 200 WBC in Joint tap. Dx?	Lx - Less than 200 WBC . Dx? DJD
	Lx - More than 50000 WBC in Joint tap. Dx?	Lx - More than 50000 WBC . Dx? Septic Arthritis
	Lx - Anti-cyclic citrulinated peptide . Dx?	Lx - Anti-cyclic citrulinated peptide . Dx? Rheumatoid Arthritis
	Px - Big toe pain. Dx?	Px - Big toe . Dx? Gout
	How to Dx lumbosacral strain? Lx? Tx?	How to Dx lumbosacral strain? Dx lumbosacral strain by excluding 1 Spinal Cord Compression, 2 Epidural Abscess, 3 Cauda Equina Syndrome, and 4 Disk Herniation (Sciatica). Lx? none. Tx? Only NSAIDs
	What are lower back pain Dx?	What are lower back pain Dx? Lower back pain has 0 Ankylosing Spondylitis, 1 Spinal Cord Compression, 2 Epidural Abscess, 3 Cauda Equina Syndrome, 4 Disk Herniation (Sciatica), and 5 Lumbosacral Strain (by excluding others)
	Sensory level for T4?	Sensory level for T4? Nipple
	Sensory level for Nipple?	Sensory level for Nipple? T4
	Sensory level for T10?	Sensory level for T10? Umbilicus
	Sensory level for Umbilicus?	Sensory level for Umbilicus? T10
	Px - Hx of Cancer with sudden onset of Focal Neurological Deficits. Point tenderness at spine. Hyperreflexia. Dx?	Px - Hx of Cancer with sudden onset of Focal Neurological Deficits (sensory level). Point tenderness at spine. Hyperreflexia. Dx? Spinal Cord Compression. It is a Neurological Emergency. Epidural Abscess is most often from Staph Aureus (high Fever, markedly Elevated ESR.)
	Spinal Cord Compression. Px? Etiology?	Spinal Cord Compression. Px? Px - Hx of 1 Cancer or 2 Infection with sudden onset of 3Focal Neurological Deficits (sensory level - T4 is Nipple, T10 is Umbilicus). 4 Point tenderness at spine. 5 Hyperreflexia. Dx? Spinal Cord Compression. It is a Neurological Emergency. Etiology? Cancer and Epidural Abscess is most often from Staph Aureus (high Fever, markedly Elevated ESR. )
	Motor Deficit, Reflex Affected, Sensory Area - Dorsiflexion of foot. Knee Jerk. Inner Calf . Dx?	Motor Deficit, Reflex Affected, Sensory Area - Dorsiflexion of foot. Knee Jerk. Inner Calf . Dx? L4
	Motor Deficit, Reflex Affected, Sensory Area - Dorsiflexion of toe. Inner forefoot . Dx?	Motor Deficit, Reflex Affected, Sensory Area - Dorsiflexion of toe. Inner forefoot . Dx? L5
	Motor Deficit, Reflex Affected, Sensory Area - Eversion of foot. Ankle Jerk. Outer foot . Dx?	Motor Deficit, Reflex Affected, Sensory Area - Eversion of foot. Ankle Jerk. Outer foot . Dx? S1
	Spinal cord level affected - L4 .Motor Deficit, Reflex Affected, Sensory Area?	Spinal cord level affected - L4 .Motor Deficit, Reflex Affected, Sensory Area? Dorsiflexion of foot. Knee Jerk. Inner Calf
	Spinal cord level affected - L5 .Motor Deficit, Reflex Affected, Sensory Area?	Spinal cord level affected - L5 .Motor Deficit, Reflex Affected, Sensory Area? Dorsiflexion of toe. Inner forefoot
	Spinal cord level affected - S1 .Motor Deficit, Reflex Affected, Sensory Area?	Spinal cord level affected - S1 .Motor Deficit, Reflex Affected, Sensory Area? Eversion of foot. Ankle Jerk. Outer foot
	Affected - Dorsiflexion of foot. . Dx?	Affected - Dorsiflexion of foot. . Dx? L4
	Affected - Knee Jerk. . Dx?	Affected - Knee Jerk. . Dx? L4
	Affected - Inner Calf . Dx?	Affected - Inner Calf . Dx? L4
	Affected - Dorsiflexion of toe. . Dx?	Affected - Dorsiflexion of toe. . Dx? L5
	Affected - Inner forefoot . Dx?	Affected - Inner forefoot . Dx? L5
	Affected - Eversion of foot. . Dx?	Affected - Eversion of foot. . Dx? S1
	Affected - Ankle Jerk. . Dx?	Affected - Ankle Jerk. . Dx? S1
	Affected - Outer foot . Dx?	Affected - Outer foot . Dx? S1
	What is Sciatica?	What is Sciatica? Sciatica is Disk Herniation. Herniations at L4_5 and L5_S1 account of 95 perc of cases. Px? Straight Leg Raise (SLR) test is Pain going into the Buttock and Below the Knee when the leg is Raised above 60 degrees. Negative SLR excludes herniation with 95 perc Sensitivity.
	What is Disk Herniation?	What is Disk Herniation? Disk Herniation is Sciatica.
	What are lower back pain Dx? Lx? Tx?	What are lower back pain Dx? Lower back pain has 0 Ankylosing Spondylitis, 1 Spinal Cord Compression, 2 Epidural Abscess, 3 Cauda Equina Syndrome, 4 Disk Herniation (Sciatica), and 5 Lumbosacral Strain (by excluding others). Lx? 0 Ankylosing Spondylitis, 1 Spinal Cord Compression, 2 Epidural Abscess, 3 Cauda Equina Syndrome require imaging. Lx Initial (for Compression, Infection, and Fracture) - 1 X-ray. Most Accurate is 2 MRI. 3 CT is used as most accurate if contraindication to MRI (Such as Pacemaker. CT require Intrathecal Contrast increase accuracy of CT Myelogram). No MRI for LBP and Positive SLR alone. IF severe or progressive neurological deficits (Paralysis, weakness), then MRI should done. Tx? Cord Compression Tx - Systemic Glucocorticoids, Chemotherapy for Lymphoma, Radiation for Solid Tumors. Surgical decompression if Steroids and Radiation are Not effective. Epidural Abscess Tx - Steroid controls acute neurological deficit, use Antistaph antibiotic (Vancomycin or Linezolid until sensitivity is known. Sensitive Staph - Oxacillin, Nafcillin, or Cefazolin). Gentamicin is added for synergy with Staph (Same in Endocarditis). Surgical Drainage for large collection. Cauda Equina Syndrome Tx - Surgical decompression. Disk Herniation (Sciatica) Tx - NSAIDs with ambulation, Steroid injection into Epidural space if unimproved.
	Lower back pain. When to do imaging study?	Lower back pain. When to do imaging study? If there is focal neurological abnormality.
	LBP. Px - Hx of cancer. Vertebral tenderness, Sensory level, hyperreflexia . Dx?	LBP. Px - Hx of cancer. Vertebral tenderness, Sensory level, hyperreflexia . Dx? Cord Compression
	LBP. Px - Fever, High ESR. Vertebral tenderness, Sensory level, hyperreflexia . Dx?	LBP. Px - Fever, High ESR. Vertebral tenderness, Sensory level, hyperreflexia . Dx? Epidural Abscess
	LBP. Px - Bowel and Bladder incontinence, erectile dysfunction. Bilateral leg weakness, saddle area anesthesia . Dx?	LBP. Px - Bowel and Bladder incontinence, erectile dysfunction. Bilateral leg weakness, saddle area anesthesia . Dx? Cauda Equina
	LBP. Px - Under age 40, pain worsens with rest and improves with activity. Decreased chest mobility . Dx?	LBP. Px - Under age 40, pain worsens with rest and improves with activity. Decreased chest mobility . Dx? Ankylosing Spondylitis
	LBP. Px - Pain_Numbness of medial calf or foot. Loss of knee and ankle reflexes, positive straight leg raise . Dx?	LBP. Px - Pain_Numbness of medial calf or foot. Loss of knee and ankle reflexes, positive straight leg raise . Dx? Disk Herniation
	Dx - Cord Compression . Px?	Dx - Cord Compression . Px? Hx of cancer. Vertebral tenderness, Sensory level, hyperreflexia
	Dx - Epidural Abscess . Px?	Dx - Epidural Abscess . Px? Fever, High ESR. Vertebral tenderness, Sensory level, hyperreflexia
	Dx - Cauda Equina . Px?	Dx - Cauda Equina . Px? Bowel and Bladder incontinence, erectile dysfunction. Bilateral leg weakness, saddle area anesthesia
	Dx - Ankylosing Spondylitis . Px?	Dx - Ankylosing Spondylitis . Px? Under age 40, pain worsens with rest and improves with activity. Decreased chest mobility
	Dx - Disk Herniation . Px?	Dx - Disk Herniation . Px? Pain_Numbness of medial calf or foot. Loss of knee and ankle reflexes, positive straight leg raise
	Dx - Erectile dysfunction . Dx?	Dx - Erectile dysfunction . Dx? Cauda Equina
	Dx - Bilateral leg weakness . Dx?	Dx - Bilateral leg weakness . Dx? Cauda Equina
	Dx - Saddle area anesthesia . Dx?	Dx - Saddle area anesthesia . Dx? Cauda Equina
	LBP. Px - Under age 40. . Dx?	LBP. Px - Under age 40. . Dx? Ankylosing Spondylitis
	LBP. Px - Pain worsens with rest and improves with activity. . Dx?	LBP. Px - Pain worsens with rest and improves with activity. . Dx? Ankylosing Spondylitis
	LBP. Px - Decreased chest mobility . Dx?	LBP. Px - Decreased chest mobility . Dx? Ankylosing Spondylitis
	LBP. Px - Pain_Numbness of medial calf or foot. . Dx?	LBP. Px - Pain_Numbness of medial calf or foot. . Dx? Disk Herniation
	LBP. Px - Loss of knee and ankle reflexes . Dx?	LBP. Px - Loss of knee and ankle reflexes . Dx? Disk Herniation
	LBP. Px - Positive straight leg raise . Dx?	LBP. Px - Positive straight leg raise . Dx? Disk Herniation
	What is lumbar spinal stenosis? Etiology? Px? Lx? Tx?	What is lumbar spinal stenosis? Narrowing of spinal canal leading ot pressure on the cord - Idiopathic. Pain occurs when the back is in extension and cord presses backwads against ligamentum flavum. Etiology? Idiopathic. Px? Age over 60 with Back pain while walking, Radiating into Buttocks and Thighs bilaterally. Worse when walking Downhill (Ankle_Brachial index are normal - In contrast to Peripheral Artery Disease), Pain is much less with activities that have Patient Leaning Forward. Lx? MRI. Tx? Weight Loss and Steroid injection into lumbar epidural space improve 25 to 50 perc of cases. Surgical Correction - dilate spinal canal is needed in 75 perc.
	Back pain worse when walking downhill. Ankle_Brachial index is normal. Dx?	Back pain worse when walking downhill. Ankle_Brachial index is normal. Dx? Lumbar spinal stenosis
	What is Fibromyalgia Px? Lx? Tx?	What is Fibromyalgia Px? Young Woman with Chronic Musculoskeletal pain and Tenderness with Trigger Points - Trapezius, Medial Fat pad of knee, and Lateral Epicondyle. Pain at many sites (Neck, Shoulders, Back, and Hips). Associated with Stiffness, Numbness, Fatigue, Headaches, Sleep Disorder. Lx? None. All Lx tests are normal (ESR, CRP, RF, CPK). Tx? Initial - 1 Amitriptyline. 2 Milnacipran and 3 Pregabalin (SNRI specifically for Fibromyalgia). 4 Trigger Point injections with local anesthetic used sometimes.
	Young woman. Tenderness with trigger point. Dx?	Young woman. Tenderness with trigger point. Dx? Fibromyalgia
	What is Babinski sign?	What is Babinski sign? Dorsiflexion of Big toe and fanning out of all the toes. There is Upper Motor Neuron lesion. The test is AKA plantar response.
	What is Carpal Tunnel Syndrome? Etiology? Px? Lx? Tx?	What is Carpal Tunnel Syndrome? Periheral neuropathy from compression of Median Nerve as it passes under Flexor Retinaculum. Etiology? 1 Overuse of hand_Wrist, 2 Pregnancy, 3 Diabetes, 4 Rheumatoid Arthritis, 5 Acromegaly, 6 Amyloidosis, 7 Hypothyroidism. Px? 1 Pain in Hand affecting Palm, Thumb, Index finger, and Radial Half of Ring finger with 2 Muscle Atrophy of Thenar Eminence. 3 Pain Worse at Night. 4 Tinel sign (Tapping or Percussion), 5 Phalen sign (Flexion of wrists to 90 degrees). Lx? Most accurate - ElectroMyoGraphy and Nerve Conduction testing. Tx? Initial - 1 Wrist Splints, (Avoid manual activity). 2 Steroid injection, 3 Surgery can be curative.
	What is Dupuytren Contracture? Association? Tx?	What is Dupuytren Contracture? Hyperplasia of palmar fascia - nodule formation and contracture of fourth and fifth fingers. Association? Genetic predispoistion and asso with Alcoholism and Cirrhosis. Tx? 1 Triamcinolone injection, 2 Surgical release.
	What is Rotator cuff injury? Px? Lx? Tx?	What is Rotator cuff injury? Damage to rotator cuff of muscles, tendons, and bursae around shoulder - Inability to flex or Abduct the shoulder. Severe Tenderness at insertion of Supraspinatus (near Acromium). Px? Inability to flex or Abduct the shoulder. Severe Tenderness at insertion of Supraspinatus (near Acromium). Lx? Most accurate - MRI. Tx? 1 NSAIDs, Rest, Physical Therapy, 2 Steroids injection, 3 Surgery for complete tears.
	Inability to flex or Abduct the shoulder. Severe Tenderness at insertion of Supraspinatus. Dx?	Inability to flex or Abduct the shoulder. Severe Tenderness at insertion of Supraspinatus. Dx? Rotator Cuff Tear
	What is Patellofemoral syndrome? Px? Lx? Tx?	What is Patellofemoral syndrome? Cause of Anterior Knee Pain secondary to Trauma, Imbalance of quadriceps strength, or Meniscal Tear. Px? Pain is Infront of knee or Underneath the Patella. Pain is Bad when 1 Walking Up or Down Stairs. Symptoms Worse just 2 After Starting to Walk after having been seated for a Prolonged period. 3 Improves after walking. 4 Crepitus, Joint Locking, Instability. Lx? X-rays is normal. Tx? 1 Physical Therapy and 2 Strength Training with Cycling. Nothing to fix surgically.
	Pain is Infront of knee or Underneath the Patella. Pain is Bad when Walking Up or Down Stairs. Symptoms Worse just 2 After Starting to Walk after having been seated for a Prolonged period. Dx?	Pain is Infront of knee or Underneath the Patella. Pain is Bad when Walking Up or Down Stairs. Symptoms Worse just 2 After Starting to Walk after having been seated for a Prolonged period. Dx? Patellofemoral Syndrome.
	What is Plantar Fasciitis? Px? Tx?	What is Plantar Fasciitis? Px? 1 Very severe pain in bottom of foot near Calcaneus, 2 Worse in the morning, 3 Improves with Walking a few steps, 4 Point tenderness. In contrast, Tarsal Tunnel Syndrome worsens with use. Tx? 1 Stretching Exercises, 2 Arch Supports, and 3 NSAIDs, 4 Steroid injection, 5 Surgical release of Plantar Fascia
	Very severe pain in bottom of foot near Calcaneus, Worse in the morning, Improves with Walking a few steps. Dx?	Very severe pain in bottom of foot near Calcaneus, Worse in the morning, Improves with Walking a few steps. Dx? Plantar Faciitis.
	Xray in plantar faciitis?	Xray in plantar faciitis? Not useful
	Morning stiffness of multiple small, inflamed joints. Dx?	Morning stiffness of multiple small, inflamed joints. Dx? Rheumatoid Arthritis.
	Rheumatoid Arthritis Definition? Etiology? Px? Lx? Tx?	Rheumatoid Arthritis Definition? RA 1 Autoimmune disorder of 2 Joint but with many 3 Systemic manfiestation of 4 Chronic Inflammation. Associated with HLA type. Most common in Women. Chronic Synovitis leads to Overgrowth or Pannus formation which damages all structures Surrounding the joint (Bone, Ligaments, Tendons, and Cartilage). Etiology? Chronic inflmmation of Unknown cause. Px? 1 Women, 2 Symmetrical_Bilateral joint involvement (PIP, MCP of hands, wrists, knees, and ankles. 3 Morning Stiffness (More than 30 minutes), 4 Nodules or Bony prominence. 5 Ocular symptoms - Episcleritis. 6 Lung involvement (Pleural effusion and nodules of lung parenchyma). 7 Vasculitis (Skin, Bowel, and Peripheral nerves). 8 Cervical joint involvement (esp C1 and C2. Can lead to Subluxation or partial Dislocation). 9 Baker cyst rupture may mimic a DVT. 10 Pericarditis and Pleural disease. 11 Carpal Tunnel Syndrome. Lx? 1 Rheumatoid factor in 70 to 80 perc. (asso with many autoimmune and chronic infectious diseases). 2 Anti-cyclic Citrulinated Peptide (Anti-CCP) - more than 80 perc sensitive and 95 perc specific. 3 Radiographs (Erosion of joints, Osteopenia). 4 Elevated ESR and C-Reactive Protein. 5 Anemia (Normocytic). 6 Arthrocentesis (exclude Crystal disease and infection). Tx? Disease Modifying Antirheumatic Drugs (DMARD) - 1 Methotrexate, 2 Tumor Necrosis Factor Inhibitor - TNF inhibitors (Infliximab, Adalimumab, Etanercept), 3 Rituximab, 4 Hydroxychloroquine, 5 Sulfasalazine, Leflunomide, and Abatacept (Alternative DMARD to add to Methotrexate if anti-TNF is not effective. ). Symptomatic Control of RA - 6 NSAIDs - best initial for pain and improve inflammation. 7 Sterods
	What is DMARD? What are different DMARD? What Dz Tx?	What is DMARD? Disease Modifying Antirheumatic Drugs (DMARD). What are different DMARD? - 1 Methotrexate, 2 Tumor Necrosis Factor Inhibitor - TNF inhibitors (Infliximab, Adalimumab, Etanercept), 3 Rituximab, 4 Hydroxychloroquine, 5 Sulfasalazine, Leflunomide, and Abatacept (Alternative DMARD to add to Methotrexate if anti-TNF is not effective. ). What Dz Tx? Rheumatoid Arthritis.
	Disease Modifying Antirheumatic Drugs (DMARD) - 1 Methotrexate, 2 Tumor Necrosis Factor Inhibitor - TNF inhibitors (Infliximab, Adalimumab, Etanercept), 3 Rituximab, 4 Hydroxychloroquine, 5 Sulfasalazine, Leflunomide, and Abatacept (Alternative DMARD to add to Methotrexate if anti-TNF is not effective. ). Symptomatic Control of RA - 6 NSAIDs - best initial for pain and improve inflammation. 7 Sterods	Disease Modifying Antirheumatic Drugs (DMARD) - 1 Methotrexate, 2 Tumor Necrosis Factor Inhibitor - TNF inhibitors (Infliximab, Adalimumab, Etanercept), 3 Rituximab, 4 Hydroxychloroquine, 5 Sulfasalazine, Leflunomide, and Abatacept (Alternative DMARD to add to Methotrexate if anti-TNF is not effective. ). Symptomatic Control of RA - 6 NSAIDs - best initial for pain and improve inflammation. 7 Sterods
	Infliximab . What type of drug? Tx for what Dx?	Infliximab . What type of drug? Tx for what Dx? Tumor Necrosis Factor Inhibitor. Rheumatoid Arthritis DMARD.
	Adalimumab . What type of drug? Tx for what Dx?	Adalimumab . What type of drug? Tx for what Dx? Tumor Necrosis Factor Inhibitor. Rheumatoid Arthritis DMARD.
	Etanercept . What type of drug? Tx for what Dx?	Etanercept . What type of drug? Tx for what Dx? Tumor Necrosis Factor Inhibitor. Rheumatoid Arthritis DMARD.
	Sulfasalazine . What type of drug? Tx for what Dx?	Sulfasalazine . What type of drug? Tx for what Dx? For Rheumatoid Arthritis, Alternative DMARD to add to Methotrexate if anti-TNF is not effective.
	Leflunomide . What type of drug? Tx for what Dx?	Leflunomide . What type of drug? Tx for what Dx? For Rheumatoid Arthritis, Alternative DMARD to add to Methotrexate if anti-TNF is not effective.
	Abatacept . What type of drug? Tx for what Dx?	Abatacept . What type of drug? Tx for what Dx? For Rheumatoid Arthritis, Alternative DMARD to add to Methotrexate if anti-TNF is not effective.
	What is Sicca syndrome?	What is Sicca syndrome? Dry Eyes, Mouth, and Other Mucous Membranes.
	What is most common cause of death in Rheumatoid Arthritis?	What is most common cause of death in Rheumatoid Arthritis? CAD
	What is Felty Syndrome?	What is Felty Syndrome? (RAiSN) 1 RA, 2 Splenomegaly, 3 Neutropenia.
	What is Caplan Syndrome?	What is Caplan Syndrome? (RALP) 1 RA, 2 Lung Nodule, 3 Pneumoconiosis
	RA, Splenomegaly, Neutropenia. Syndrome?	What is Felty Syndrome? (RAiSN) 1 RA, 2 Splenomegaly, 3 Neutropenia.
	RA, Pneumoconiosis, Lung Nodule. Syndrome?	What is Caplan Syndrome? (RALP) 1 RA, 2 Lung Nodule, 3 Pneumoconiosis
	What is the most important issue in Rheumatoid Arthritis?	What is the most important issue in Rheumatoid Arthritis? Stopping the progression of disease. Any patient with 1 Erosive Disease, or 2 X-ray Abnormalities needs at least Methotrexate to slow disease progression.
	What is Erosive disease in Rheumatoid Arthritis?	What is Erosive disease in Rheumatoid Arthritis? 1 Joint Space Narrowing, 2 Physical Deformity of Joints, 3 X-ray Abnormalities
	What is the AE of Hydroxychloroquine? What dz treatment?	What is the AE of Hydroxychloroquine? Retinal Toxicity. Do a Dilated Eye exam. Hydroxychloroquine is a DMARD for Rheumatoid Arthritis.
	Drug - Anti-TNF . AE? What Dz Tx?	Drug - Anti-TNF . AE? What Dz Tx? Reactivation of Tuberculosis. DMARD for Rheumatoid Arthritis.
	Drug - Hydroxychloroquine . AE? What Dz Tx?	Drug - Hydroxychloroquine . AE? What Dz Tx? Ocular. DMARD for Rheumatoid Arthritis.
	Drug - Sulfasalazine . AE? What Dz Tx?	Drug - Sulfasalazine . AE? What Dz Tx? Rash, Hemolysis, Oligospermia. DMARD for Rheumatoid Arthritis.
	Drug - Rituximab . AE? What Dz Tx?	Drug - Rituximab . AE? What Dz Tx? Infection. DMARD for Rheumatoid Arthritis.
	Drug - Gold salts . AE? What Dz Tx?	Drug - Gold salts . AE? What Dz Tx? Nephrotic syndrome. DMARD for Rheumatoid Arthritis.
	Drug - Methotrexate . AE? What Dz Tx?	Drug - Methotrexate . AE? What Dz Tx? Liver, lung, marrow. DMARD for Rheumatoid Arthritis.
	Drug AE- Reactivation of Tuberculosis. DMARD for Rheumatoid Arthritis. . Medication?	Drug AE- Reactivation of Tuberculosis. DMARD for Rheumatoid Arthritis. . Medication? Anti-TNF
	Drug AE- Ocular. DMARD for Rheumatoid Arthritis. . Medication?	Drug AE- Ocular. DMARD for Rheumatoid Arthritis. . Medication? Hydroxychloroquine
	Drug AE- Rash, Hemolysis, Oligospermia. DMARD for Rheumatoid Arthritis. . Medication?	Drug AE- Rash, Hemolysis, Oligospermia. DMARD for Rheumatoid Arthritis. . Medication? Sulfasalazine
	Drug AE- Infection. DMARD for Rheumatoid Arthritis. . Medication?	Drug AE- Infection. DMARD for Rheumatoid Arthritis. . Medication? Rituximab
	Drug AE- Nephrotic syndrome. DMARD for Rheumatoid Arthritis. . Medication?	Drug AE- Nephrotic syndrome. DMARD for Rheumatoid Arthritis. . Medication? Gold salts
	Drug AE- Liver, lung, marrow. DMARD for Rheumatoid Arthritis. . Medication?	Drug AE- Liver, lung, marrow. DMARD for Rheumatoid Arthritis. . Medication? Methotrexate
	What is Adult Still Disease?	What is Adult Still Disease? It is Juvenile Rheumatoid Arthritis.
	What is Adult Still Disease Px? Lx? Tx?	What is Adult Still Disease Px? AKA Juvenile Rheumatoid Arthritis. Most important feature is 1 High Spiking Fever (Often Above 104) in a 2 Young Person, 3 No Clear Etiology, 4 associated with a Rash. Lx? No Clear Dx. May have Anemia and Leukocytosis. Tx? Half of cases Improve with 1 Aspirin or NSAIDs, unresponsive to NSAIDs, then use 2 Steroids.
	What is SLE? Etiology? Px? Lx? Tx?	What is SLE? Autoimmune disorder with autoantibodies (ANA, DS DNA). Causes Inflammation diffusely through the body (Skin, Brain Kidney, Joint) and Blood.Abnormal blood tests asso (Anemia, Anti-Sm, AntiPhospholipid antibodies). Etiology? Unknown. Px? Diagnosis of SLE is based on presence of at least 4 of 11 known Manifestations of disease. AAA Skin (1 Malar Rash, 2 Discoid Rash, 3 Photosensitivity, 4 Oral Ulcers), BBB Joint (Arthritis is first symptom for coming to office. No Deformation or Erosion - Xray normal). CCC Serositis (Inflammation of Pleura and Pericardium gives Chest Pain - may have Pericardial and Pleural Effusion). DDD Renal (Mild Proteinuria to ESRD requiring Dialysis. Most Common Glomerulonephritis is Membranous. RBC Casts and Hematuria occur). EEE Neurologic (Psychosis, Seizure, or Stroke from Vasculitis). FFF Hematologic (Hemolytic Anemia is diagnostic criteria. But, Anemia of Chronic Disease is More commonly found. Lymphopenia, Leukopenia, and Thrombocytopenia also seen). GGG Immunologic (Lab) Abnormalities (ANA, Anti DS DNA, Anti-Sm, False Positive test for Syphilis, Positive LE cell preparation). Additional Findings (Mesenteric Vasculitis, Raynaud Phenomenon, AntiPhospholipid Syndromes). Ocular fingers are Not part of formal diagnostic criteria (Photophobia, Retinal lesions - Cotton wool spots, Blindness). Lx? 1 ANA in 95 perc. (Negative is Sensitive). 2 Anti-Double-Stranded DNA and Anti-Sm (they are only found in SLE. Extremely Specific). 3 decreased Complement Levels (correlate with disease Activity. Drop further with Acute Disease Exacerbations). 4 Anti-SSA and Anti-SSB (only found in 10-20 perc. Add little to diagnosis. Most often found in Sjogren Syndrome - 65 perc). Tx? Acute Lupus Flare - 1 High-dose Boluses of Steroids. 2 Hydroxychloroquine - control mildly Chronic disease limited to Skin and Joint manifestations. Lupus Nephritis - 3 Steroids Alone, or 4 Steroid with Cyclophosphamide or Mycophenolate. Severity of Lupus Nephritis determination - Kidney Biopsy (GlomeruloSclerosis - scarring - Not responsive to Tx.)
	What SLE symptoms is not part of diagnostic criteria?	What SLE symptoms is not part of diagnostic criteria? Eye and some lung. Ocular findings - 1 Photophobia, 2 Retinal lesions (Cotton Wool spots), 3 Blindness. Lung findings not diagnostic - Pneumonia, Alveolar hemorrhage, and Restrictive lung disease.
	What Lx is specific for SLE?	What Lx is specific for SLE? 1 Anti-DS DNA, 2 Anti-Sm.
	What is Anti-DS DNA specific for?	What is Anti-DS DNA specific for? SLE.
	What is Anti-Sm specific for?	What is Anti-Sm specific for? SLE
	What is Anti-SSA and anti-SSB found in?	What is Anti-SSA and anti-SSB found in? SLE (10-20 perc). Sjogren syndrome (65 perc)
	34 yo woman with hx of SLE admitted with Pneumonia and Confusion. As you are wrestling with decison over a bolus of high-dose steroids in a person with an infection, you need to determine if this is a flare of lupus, or simply an infection with sepsis causing confusion. What Lx?	34 yo woman with hx of SLE admitted with Pneumonia and Confusion. As you are wrestling with decison over a bolus of high-dose steroids in a person with an infection, you need to determine if this is a flare of lupus, or simply an infection with sepsis causing confusion. What Lx? 1 Decrease in Complement and 2 Rise in Anti-DS DNA.
	What is the cause of death in SLE patients?	What is the cause of death in SLE patients? Young - die of Infection. Older - Accelerated Atherosclerosis makes MI most common Death.
	What is Antiphospholipid Syndrome? Px? Lx? Tx?	What is Antiphospholipid Syndrome? Majority not asso with SLE. Idiopathic disorder with 1 IgG or IgM Antibodies against Negatively charged Phospholipids. Types - 1 Lupus Anticoagulant (High PTT), 2 AntiCardiolipin Antibodies (causes Abortion). Px? APL presents with 1 Thromboses of both 2 Arteries and Veins as well as 3 Recurrent Spontaneous Abortions. Unlike other thrombophilia, APL asso with 4 Elevation of aPTT with Normal PT and normal INR. 5 False Positive VDRL or RPR with a normal FTA occurs because antibody reacts with reagent in lab, which is Cardiolipin. Anticardiolipin antibodies more often give spontaneous abortion and Lupus anticoagulant is more often asso with Elevated aPTT. Lx? Best initial - Mixing Study (APL - aPTT Remains Elevated. Clotting factor deficiency get corrected.) Most specific Lx - Lupus anticoagulant is Russel Viper Venom test (RVVT) - prolonged and not correct. Tx? Asymptomatic APL Antibody Does Not Need Tx. Thromboses (DVT or PE) Tx - 1 Heparin and 2 Warfarin with an 3 INR of 2-3. Single episode of thromboses - 6 month tx. Recurrent episodes - Life long Tx. Spontaneous Abortion occurring - No Tx. Two or more First-Trimester Abortion, or One Second-Trimester event needs Anticardiolipid antibody investigation. Prevent recurrence of abortion - 1 Heparin, and 2 Aspirin. Warfarin contranindicated in pregnancy.
	Clotting, Elevated aPTT, Normal PT. Dx?	Clotting, Elevated aPTT, Normal PT. Dx? APL - Antiphospholipid syndrome.
	Regarding Spontaneous Abortion, when to investigate? What Lx? What Dz?	Regarding Spontaneous Abortion, when to investigate? What Lx? What Dz? APL - Antiphopholipid syndrome. Spontaneous Abortion occurring - No Tx. Two or more First-Trimester Abortion, or One Second-Trimester event needs Anticardiolipid antibody investigation. Prevent recurrence of abortion - 1 Heparin, and 2 Aspirin. Warfarin contranindicated in pregnancy.
	What is the wrong answer in preventing spontaneous abortion?	What is the wrong answer in preventing spontaneous abortion? Warfarin is contraindicated in Pregnancy. Steroids does Not work.
	What is scleroderma?	What is scleroderma? Systemic sclerosis
	What is systemic sclerosis?	What is systemic sclerosis? Scleroderma
	What is Scleroderma? Px? Lx? Tx?	What is Scleroderma? Scleroderma is Diffuse (20 perc) and Limited (80 perc. Aka CREST). Limited_CREST (Calcinosis, Raynaud, Esophageal Dysmotility, Sclerodactyly, Telangiectasia). Px? 1 Young (20s to 40s), 2 Woman, 3 Fibrosis of Skin and Internal Organs (Lung, Kidney, and GIT). AAA Raynaud Syndrome (Increased Vascular Reactivity of Fingers beginning with Pain and Pallor or Cyanosis followed by Reactive Hyperemia (red). Precipitated by Cold and Emotional stress. Some cases lead to Ulceration and Gangrene.) BBB Skin Manifestations (Fibrosis of hands, face, neck, and extremitites. Telangiectasia and abnormalities of pigmentation occur.) CCC Gastrointestinal (Esophageal dysmotility with GERD, large-mouthed diverticuli of small and large bowel). DDD Renal (sudden Hypertensive Crisis). EEE Lung (Fibrosis leading to Restrictive lung disease and Pulmonary Hypertension). FFF Cardiac (Myocardial fibrosis, pericarditis, and heart block. Lung disease gives right ventricular hypertrophy). Lx? 1 ANA (85 to 90 perc), 2 ESR (usually normal), 3 SCL-70 (Most specific - SCL-70, aka Anti-Topoisomerase - only in 30 perc with Diffuse dz and 20 perc of limited disease), 4 AntiCentromere (50 perc of CREST syndrome - Extremeley Specific). Tx? No Tx stop process. 1 Penicillamine is Not effective. Renal Crisis - 1 ACE inhibitors (even if Creatinine is Elevated). Esophageal Dysmotility - 2 PPI for GERD. Raynaud - 3 CCB. Pulmonary Fibrosis - 4 Cyclophosphamide - improves Dyspnea and PFT. (Pulmonary Hypertension is Tx like Primary Pulmonary Hypertension with - 5 Bosentan - Endothelin Antagonist).
	What is CREST?	What is CREST? Limited Scleroderma. Calcinois, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia.
	What is SCL70 for? Dz?	What is SCL70 for? SCL70 is Anti-Topoisomerase. Dz? SCL70 elevated in Scleroderma (30 perc Diffuse dz and 20 perc Limited_CREST).
	What is AntiCentromere Antibodies for? Dz?	What is AntiCentromere Antibodies for? Dz? AntiCentromere Antibodies are Extremely Specific for CREST syndrome..
	What is specific for CREST?	What is specific for CREST? AntiCentromere Antibodies are Extremely Specific for CREST syndrome..
	What type of medication is Bosentan?	What type of medication is Bosentan? Endothelin Antagonist to Tx Primary Pulmonary Hypertension.
	Compare and Contrast Polymyositis and Dermatomyositis.	Compare and Contrast Polymyositis and Dermatomyositis. They both have Proximal muscle weakness. Do Not affect Facial or Ocular muscles (like in Myasthenia Gravis). Dermatomyositis has Skin involvement (Malar - cheek, Shawl sign - edema of Face_Neck_Shoulders_Upper chest and back, Heliotrope rash - edema and purplish discoloration of eyelids, Gottron papules - scaly atches over back of hands esp PIP and MCP)
	What is Shawl sign? Tx?	What is Shawl sign? Edema of Face_Neck_Shoulders_Upper chest and back. Seen in Dermatomyositis. Tx? Hydroxychloroquine - helps skin lesion.
	What is Heliotrope rash? Tx?	What is Heliotrope rash? Edema and Purplish discoloration of eyelids. Seen in Dermatomyositis. Tx? Hydroxychloroquine - helps skin lesion.
	What is Gottron papules? Tx?	What is Gottron papules? Scaly atches over back of hands esp PIP and MCP. Tx? Hydroxychloroquine - helps skin lesion.
	Dermatomyositis Px? Lx? Tx?	Dermatomyositis Px? Polymyositis is similar, but it does Not have skin finding. They are Inflammatory myopathies with Proximal Muscle Weakness (Difficulty getting up from seat). Dysphagia occurs with striated muscle of pharynx involvement. Dermatomyosistis has Skin findings (Malar - cheek, Shawl sign - edema of Face_Neck_Shoulders_Upper chest and back, Heliotrope rash - edema and purplish discoloration of eyelids, Gottron papules - scaly atches over back of hands esp PIP and MCP). Dermatomyositis asso with cancer (1 Ovary, 2 Lung, 3 Gastrointestinal, 4 Lymphoma). Lx? Initial - 1CPK and 2 Aldolase. Most Accurate - 3 Muscle Biopsy. 4 ANA often positive (not specific), 5 Anti-Jo Antibodies are Asso with Lung Fibrosis. 6 MRI detects Patchy muscle involvement, 7 ElectroMyoGraphy is often Abnormal. 8 other labs abnormal - ESR_CReactiveProtein_RheumatoidFactor_Anemia. Tx? 1 Sterods usually sufficient. Unresponseive or intolerant of steroids, 2 Methotrexate, 3 Azathioprine, 4 Intravenous Immunoglobulin, 5 Mycophenolate. 6 Hydroxychloroquine - helps skin lesion.
	What disease is Dermatomyositis often asso with?	What disease is Dermatomyositis often asso with? Dermatomyositis asso with cancer (1 Ovary, 2 Lung, 3 Gastrointestinal, 4 Lymphoma).
	What is the most dangerous complication of Sjogren?	What is the most dangerous complication of Sjogren? Lymphoma.
	What disease is Sjogren asso?	What disease is Sjogren asso? 1 Rheumatoid Arthritis, 2 SLE, 3 Primary Biliary Cirrhosis, 4 Polymyositis, 5 Hashimoto Thyroiditis.
	What is Sjogren Syndrome? Px? Lx? Tx?	What is Sjogren Syndrome? Idiopathic Autoimmune disorder secondary to Antibodies predominantly against 1 Lacrimal and 2 Salivary glands. Mainly Women. Asso with 1 Rheumatoid Arthritis, 2 SLE, 3 Primary Biliary Cirrhosis, 4 Polymyositis, 5 Hashimoto Thyroiditis. Px? Dryness of 1 Mouth (Constantly Drink water, Rampant Dental Caries and loss of teeth) and 2 Eyes (Sand in the eyes, Burning and Itching called KeratoConjunctivitis Sicca.) Dyspareunia - Loss of vaginal secretions. Less common manifestations - Vasculitis, Lung Disease, Pancretitis, Renal Tubular Acidosis. Lx? Initial - 1 Schirmer test - filter paper placed against eye to measure amount of tears produced. Most Accurate - 2 Lip or Parotid Gland Biopsy (Lymphoid Infiltration in Salivary glands). Best initial test on Blood - 3 SS-A and SS-B (Ro and La. SLE is asso with both). 4 Other abnormalities - ANA_RF_Anemia_Leukopenia_Eosinophilia. Tx? Initial - 1 Water the mouth. 2 Sugar-free gums, 3 Fluoride. 4 Artificial Tears (Prevent corneal ulcers). 5 Pilocarpine and 6 Cevimeline Increase Acetylcholine (main stimulant to making saliva. Cevimeline is single use for saliva making). 7 Evaluate for Lymphoma (10 perc).
	What medication increase Acetylcholine?	What medication increase Acetylcholine? Pilocarpine and Cevimeline. They increase Acetylcholine (stimulate making saliva). Cevimeline increases saliva making. They Tx Sjogren syndrome.
	What is KeratoConjunctivitis Sicca?	What is KeratoConjunctivitis Sicca? Sand in the eyes, Burning, and Itching. It occur in Sjogren syndrome.
	Dry mouth and eyes. Dx?	Dry mouth and eyes. Dx? Sjogren syndrome.
	What is Cevimeline? Tx for?	What is Cevimeline? Increase Acetylcholine for Increase Saliva production. Tx for? The single use is for Sjogren syndrome.
	What do all vasculitis Px?	What do all vasculitis Px? 1 Fever, 2 Malaise_Fatigue, 3 Weight Loss, 4 Arthralgia_Myalgia
	What is PAN? Px? Lx? Tx?	What is PAN? Vasculitis - Polyarteritis Nodosa is a disease of 1 Small- and Medium-sized Arteries. 2 Spares the Lungs. 3 Asso with Chronic Hepatitis B. Px? Difficult to Identify due to No Single Pathognomonic feature. Common Features - 1 Renal (glomerulonephritis needs biopsy), 2 Neurological (Any large peripheral nerve. Peroneal Neuropathy leads to Foot Drop. Stroke in a Young person), 3 GastroIntestinal (Abdominal Pain worsened by Eating - Mesenteric vessels. Bleeding, Nausea, Vomiting), 4 Skin (Lower Extremity Ulcers - most common. Livedo Reticularis, Purpura, Nodule, and Rarely Gangrene also occur), 5 MonoNeuritis Multiplex (Multiple Peripheral Neuropathies of Nerves Large Enough to have a name. Ex - Radial and Peroneal nerve, or Ulnar nerve and Lateral Femoral cutaneous). Lx? Most Accurate - 1 Biopsy of Symptomatic site. 2 Angiography (Renal, Mesenteric, or Hepatic Artery - Abnormal Dilation or Beading.) 3 Other abnormalities - Anemia_Leukocytosis_ESR_CRP. 4 P-ANCA present in less than 20 perc. 5 Evaluate for Hepatitis B. Tx? 1 Prednisone, and 2 Cyclophosphamide. Tx Hepatitis B when found.
	What is Polymyalgia Rheumatica? Px? Lx? Tx?	What is Polymyalgia Rheumatica? Vasculitis. Polymyalgia Rheumatica occurs in 1 Age Over 50 with Px. Px? 1 Pain and Stiffness in Shoulder and Pelvic Girdle muscles, 2 Difficulty Combing Hair and Rising from Chair. Lx? 1 ESR Elevated. 2 Normochromic, Normocytic Anemia. 3 CPK and Aldolase - Normal. Tx? 1 Steroids - very responsive at Low dose.
	Over 50 years old. Pain and Stiffness in Shoulder and Pelvic Girdle muscles. Difficulty Combing Hair and Rising from Chair. Dx?	Over 50 years old. Pain and Stiffness in Shoulder and Pelvic Girdle muscles. Difficulty Combing Hair and Rising from Chair. Dx? Vasculitis - Polymyalgia Rheumatica occurs in 1 Age Over 50 with Px. Px? 1 Pain and Stiffness in Shoulder and Pelvic Girdle muscles, 2 Difficulty Combing Hair and Rising from Chair. Lx? 1 ESR Elevated. 2 Normochromic, Normocytic Anemia. 3 CPK and Aldolase - Normal. Tx? 1 Steroids - very responsive at Low dose.
	What should PAN be test for additionally?	What should PAN be test for additionally? Hepatitis B
	What is Giant Cell Arteritis? Px? Lx? Tx?	What is Giant Cell Arteritis? aka Temporal Arteritis. Seems to be in a spectrum with PMR (PolyMyalgia Rheumatica). Px? 1 Visual symptoms, 2 Jaw Cladication (Pain in jaw when Chewing), 3 Scalp Tenderness, 4 Headache, 5 Symptoms in other arteries - Arm pulses decreased, Bruits near clavicles, or Aortic Regurgitation. Lx? 1 ESR, 2 C-Reactive Protein are Elevated. Most Accurate - 3 Biopsy of Affected artery - Temporal artery. Tx? 1 Prednisone (Starting High-dose quickly is more important than waiting for Biopsy.) Blindness is Not reversible.
	What disease has C-ANCA? P-ANCA?	What disease has C-ANCA? 1 Wegner. P-ANCA? 1 Churg-Strauss, and 2 Microscopic PolyAngiitis.
	What is AntiProteinase-3 Antibodies? What disease has it?	What is AntiProteinase-3 Antibodies? aka C-ANCA. What disease has it? Wegener.
	What is AntiMyeloPeroxidase Antibodies? What disease has it?	What is AntiMyeloPeroxidase Antibodies? aka P-ANCA. What disease has it? 1 Churg-Strauss, and 2 Microscopic PolyAngiitis.
	What is ANCA?	What is ANCA? ANCA is AntiNeutrophil Cytoplasmic Antibody.
	What is Wegener Granulomatosis? Px? Lx? Tx?	What is Wegener Granulomatosis? Vasculitis. Unresolving Pneumonia Not Better with Antibiotics. Px? Both 1 Upper and 2 Lower Respiratory Tract findings in asso with 3 Renal Insufficiency. Upper Respiratory Tract (Sinusitis, Otitis Media, Mastoiditis, Oral and Gingival involvement). Also Asso - 4 Skin, 5 Joint, and 6 Eye lesions. Lx? Best Initial - AntiNeutrophil Cytoplasmic Antibody (ANCA). Most Accurate - Biopsy (Lung is best. Renal is better than Sinus biopsy). Tx? 1 Prednisone, and 2 Cyclophosphamide.
	What is Churg-Strauss Syndrome? Px? Lx? Tx?	What is Churg-Strauss Syndrome? Vasculitis. Pulmonary-Renal Syndrome. Px? 1 Asthma, 2 Eosinophilia. Lx? 1 Biopsy - most accurate. Tx? 1 Prednisone, and 2 Cyclophosphamide.
	What is Henoch-Schonlein Purpura? Px? Lx? Tx?	What is Henoch-Schonlein Purpura? Vasculitis. Px? 1 Children, 2 GastroIntestinal Tract (Pain, Bleeding), 3 Skin (Purpura), 4 Joint (Arthralgia), 5 Renal (Hematuria). Most often a clinical diagnosis. Lx? 1 Biopsy (LeukoCytoClastic Vasculitis) - most accurate. Tx? Most resolve spontaneously. 1 Steroids - Severe ExtraRenal Manifestations asso with Progressive Renal Insufficiency (Steroid do not reverse renal insufficiency)
	Biopsy shows LeukoCytoclastic Vasculitis. Dx?	Biopsy shows LeukoCytoclastic Vasculitis. Dx? Henoch-Schonlein Purpura.
	Pulmonary-Renal syndrome. Asthma. Eosinophilia. Dx?	Pulmonary-Renal syndrome. Asthma. Eosinophilia. Dx? Churg-Strauss Syndrome.
	What is SLE and Hepatitis C effect on complement level?	What is SLE and Hepatitis C effect on complement level? SLE decreased C3 (3 letters). Hep C decreased C4 (4 letters)
	Child. Abdominal pain. Purpura. Arthralgia. Hematuria. Dx?	Child. Abdominal pain. Purpura. Arthralgia. Hematuria. Dx? Henoch-Schonlein Purpura.
	Compare and Contrast Henoch Scholine Purpura and Cryoglobulinemia.	Compare and Contrast Henoch Scholine Purpura and Cryoglobulinemia. They both have Joint Pain and Purpura. Henoch Scholine Purpura (Children, GI problem - pain or bleeding). Cryoglobulinemia (Middle age Adult, Hepatitis C, No GI problem)
	What is Cryoglobulinemia? Px? Lx? Tx?	What is Cryoglobulinemia? Asso with 1 Chronic Hepatitis B and C, 2 Endocarditis, 3 Connective tissue disorder - Sjogren syndrome. IgM antibodies. Px? 1 Joint Pain, 2 Glomerulonephritis, 3 Purpuric skin lesions, 4 Neuropathy. Lx? 1 Rheumatoid Factor - positive, 2 Cold Precipitable Immune Complexes. Tx? Tx underlying cause - Hep C (1 Interferon, and 2 Ribavirin).
	Compare and Contrast Cryoglobulins and Cod Agglutinin.	Compare and Contrast Cryoglobulins and Cod Agglutinin. They are both IgM antibodies. They both do Not respond to Steroids. Cryoglobulins (Asso Hep C, Px - 1 Joint Pain, 2 Glomerulonephritis, 3 Purpuric skin lesions, 4 Neuropathy. Tx - Interferon and Ribavirin). Cold Agglutinin (Asso EBV, Mycoplasma, Lymphoma. Px - Hemolysis. Tx - 1 Stay Warm, 2 Rituximab, 3 Cyclophosphamide, 4 Cyclosporine)
	Asso - Hepatitis C . Cryoglobulins or Cold Agglutinins?	Asso - Hepatitis C . Cryoglobulins or Cold Agglutinins? Cryoglobulins.
	Asso - EBV . Cryoglobulins or Cold Agglutinins?	Asso - EBV . Cryoglobulins or Cold Agglutinins? Cold Agglutinin
	Asso - Mycoplasma . Cryoglobulins or Cold Agglutinins?	Asso - Mycoplasma . Cryoglobulins or Cold Agglutinins? Cold Agglutinin
	Asso - Lymphoma . Cryoglobulins or Cold Agglutinins?	Asso - Lymphoma . Cryoglobulins or Cold Agglutinins? Cold Agglutinin
	Px - Joint Pain . Cryoglobulins or Cold Agglutinins?	Px - Joint Pain . Cryoglobulins or Cold Agglutinins? Cryoglobulins.
	Px - Glomerulonephritis . Cryoglobulins or Cold Agglutinins?	Px - Glomerulonephritis . Cryoglobulins or Cold Agglutinins? Cryoglobulins.
	Px - Purpuric Skin Lesions . Cryoglobulins or Cold Agglutinins?	Px - Purpuric Skin Lesions . Cryoglobulins or Cold Agglutinins? Cryoglobulins.
	Px - Neuropathy . Cryoglobulins or Cold Agglutinins?	Px - Neuropathy . Cryoglobulins or Cold Agglutinins? Cryoglobulins.
	Px - Hemolysis . Cryoglobulins or Cold Agglutinins?	Px - Hemolysis . Cryoglobulins or Cold Agglutinins? Cold Agglutinin
	Cryoglobulins. Asso?	Cryoglobulins. Asso?Hepatitis C
	Cold Agglutinin. Asso?	Cold Agglutinin. Asso?EBV, Mycoplasma, Lymphoma
	Cryoglobulins. Px?	Cryoglobulins. Px?Joint Pain, Glomerulonephritis, Purpuric Skin lesions, Neuropathy.
	Cold Agglutinin. Px?	Cold Agglutinin. Px?Hemolysis
	Cryoglobulins. Tx?	Cryoglobulins. Tx? Hepatitis C
	Cold Agglutinin. Tx?	Cold Agglutinin. Tx? Stay Warm, Rituximab, Cyclophosphamide, Cyclosporine
	What is pathergy?	What is pathergy? Sterile skin Pustules from minor trauma (needle stick)
	Sterile skin Pustules from minor trauma. Term?	Sterile skin Pustules from minor trauma. Term? Pathergy - Sterile skin Pustules from minor trauma (needle stick)
	What is behcet syndrome? Px? Lx? Tx?	What is behcet syndrome? Px? 1 Asian or Middle Eastern, 2 Painful Oral and Genital Ulcers, 3 asso Erythema Nodosum-like lesions of skin. 4 Ocular lesions (Uveitis and Blindness), 5 Arthritis, 6 CNS lesions (mimicking Multiple Sclerosis). Lx? no lab abnormality. Tx? 1 Corticosteroids. To wean pt off Steroids, use 2 Azathioprine, 3 Cyclophosphamide, 4 Colchicine, 5 Thalidomide.
	Asian. Oral ulcers. Erythema nodosum-like lesions. Arthritis. Dx?	Asian. Oral ulcers. Erythema nodosum-like lesions. Arthritis. Dx? Behcet syndrome.
	What is enthesopathy? Seen in what disease?	What is enthesopathy? Enthesopathy is inflammation where tendons and ligaments attach to bones. Seen in what disease? It is seen in seronegative spondyloarthropathies (1 Ankylosing spondylitis, 2 Psoriatic arthritis, 3 Reactive arthritis (Reiter syndrome).
	What are seronegative spondyloarthropathies? Types? Common Px? Tx?	What are seronegative spondyloarthropathies? They are rheumatoid factor Negative. Types? 1 Ankylosing Spondylitis, 2 Psoriatic Arthritis, 3 Reactive Arthritis (Reiter syndrome). Common Px? They present with 1 Men, 2 Under 40 yo, 3 Spine and Large joint involved, 4 Negative Rhematoid Factor (Seronegative), 5 Enthesopathy(inflamation where tendons and ligaments attach to bones), 6 Uveitis, 7 HLA-B27. Tx? Steroids are not a good Tx for seronegative spondyloarthropathy.
	What is Ankylosing spondylitis Px? Lx? Tx?	What is Ankylosing spondylitis Px? 1 Young Man, 2 Backache (Worsened by Rest. Bamboo Spine is late finding), 3 Stiffness, 4 Flattening of Normal Lumbar Curvature, 5 Decreased Chest Expansion, 6 Enthesopathy at Achilles Tendon. 7 Transient peripheral Arthritis of Knees, Hips, and Shoulders. 8 AtrioVentricular Block. 9 Aort ic Insufficiency. Lx? Initial 1 X-ray of Sacroiliac (SI) joint - Narrowing. Most Accurate - 2 MRI. 3 ESR elevated in 85 perc. Tx? Best initial - 1 Exercise program, and 2 NSAIDs. If NSAIDs are insufficient, use 3 Anti-TNF drugs (Etanercept, Adalimumab, or Infliximab.)
	Etanercepts. What type of drugs? Anti-TNF (Etanercept, Adalimumab, or Infliximab).	Etanercepts. What type of drugs? Anti-TNF (Etanercept, Adalimumab, or Infliximab).
	Adalimumab. What type of drugs? Anti-TNF (Etanercept, Adalimumab, or Infliximab).	Adalimumab. What type of drugs? Anti-TNF (Etanercept, Adalimumab, or Infliximab).
	Infliximab. What type of drugs? Anti-TNF (Etanercept, Adalimumab, or Infliximab).	Infliximab. What type of drugs? Anti-TNF (Etanercept, Adalimumab, or Infliximab).
	What is Psoriatic Arthritis Px? Lx? Tx?	What is Psoriatic Arthritis Px? 1 Preceding Psoriasis, 2 Severe Skin disease, 3 Sacroiliac joint involvement, 4 Sausage Digits from Enthesopath, 5 Nail Pitting. Lx? 1 ESR elevated. Initial - 2 X-ray of Joint - Pencil in a Cup deformity. 3 Bony Erosion, 4 Irregular Bone Destruction, 5 Uric Acid level Elevated (Increased skin turnover). Tx? Best initial - 1 NSAIDs, if no response, 2 Methotrexate, 3 Anti-TNF agents if Methotrexate does Not control disease.
	What is Reactive Arthritis Etiology? Px? Lx? Tx?	What is Reactive Arthritis Etiology? aka Reiter Syndrome. Occurs secondary to 1 Inflammatory Bowel Disease (equal sex incidence), 2 Sexually Transmitted Infection (greater in men), 3 Gastrointestinal Infection (Yersinia, Salmonella, Campylobacter). Px? Triad - 1 Joint pain, 2 Ocular findings (Uveitis, Conjunctivits), 3 Genital abnormalities (Urethritis, Balanitis - inflammation of the gland of penis). Keratoderma Blennorhagicum - skin lesion unique to Reiter. it looks like pustular psoriasis. Lx? No specific test. Hot swollen joints should be tapped to Rule out Septic joint. Tx? 1 NSAIDs, and correct the underlying cause. 2 Sulfaslazine if NSAIDs do Not control it.
	What is Reiter Syndrome?	What is Reiter Syndrome? aka Reactive Arthritis.
	Keratoderma Blennorhagicum. Dx?	Keratoderma Blennorhagicum. Dx? Reactive Arthritis, aka Reiter syndrome.
	What is Balanitis?	What is Balanitis? Inflammation of the gland of penis.
	What is Osteoporosis Px? Lx? Tx?	What is Osteoporosis Px? 1 Older person, 2 Woman frequently, 3 Vertebral Fractures (Loss of Height), 4 Wrist fracture, 5 Asymptomatic - found on routine screening (Bone Densitometry - DEXA - recommende for Over 65). Spontaneous fractures of weight bearing joint. Lx? Most accurate - 1 Bone Densitometry (DEXA. T-score compare bone density with normal density of a young woman. Osteopenia - T-score between 1 and 2.5 standard deviations below normal. Osteoporosis - T-score More than 2.5 standard deviations below normal). All blood tests are Normal in Osteoporosis (Normal - Calcium, Phosphate, and PTH). Tx? 1 Vitamin D and Calcium - best initial. 2 Bisphosphonates (Alendronate, Risendronate, Iandronate) - T-score More than 2.5 standard deviation below normal. 3 Estrogen Replacement (useful in Post-menopausal). 4 Rloxifene (substitute for Estrogen in PostMenopausal, also reduces the risk of breast cancer and decreases LDL levels). 5 Teriparatide - Analogue of PTH that stimulates New Bone Matrix formation. 6 Nasal spray - Calcitonin - decreases risk of Vertebral Fractures. Vitamin D, Calcium, and Bisphosphonates are most effective Tx.
	Alendronate. What type of medication?	Alendronate. What type of medication? Bisphosphonates (Alendronate, Risendronate, Ibandronate)
	Risendronate. What type of medication?	Risendronate. What type of medication? Bisphosphonates (Alendronate, Risendronate, Ibandronate)
	Ibandronate. What type of medication?	Ibandronate. What type of medication? Bisphosphonates (Alendronate, Risendronate, Ibandronate)
	What is Raloxifene?	What is Raloxifene? Raloxifene is used as a Substitute for Estrogen in PostMenopausal Woman.
	What are Bisphosphonates? AE?	What are Bisphosphonates? Bisphosphontes (Alendronate, Risendronate, Ibandronate). AE? Pill Esophagitis (prolonged contact with esophagus). Bisphosphnates - very rarely asso with OsteoNecrosis of Jaw.
	What is Teriparatide?	What is Teriparatide? Teriparatide is Analogue of PTH - Stimulates New Bone Matrix formation.
	What medicatio is Analogue of PTH? Function? AE?	What medicatio is Analogue of PTH? Function? Teriparatide is Analogue of PTH - Stimulates New Bone Matrix formation. AE - 1 OsteoSarcoma in rats, 2 HyperCalcemia.
	What is Septic Arthritis? Etiology? Px? Lx? Tx?	What is Septic Arthritis? Septic arthritis - infection of any kind finding its way into Joint Space. Etiology? Septic Arthritis is Relatively Rare in an Undamaged Joint. Risk of infection is Directly Proportional to degree of Joint Damage. 1 Osteoarthritis (DJD) provides a slight Risk, with 2 Rheumatoid Arthritis having Greater risk (greater destrution), greatest risk - 3 Prosthetic Joint. 4 Bacteremia can spread into joint space - 5 Endocarditis, and 6 IVDU causes septic Arthritis. Etiology - 1 Staph, 2 Strep, 3 Gram-Negative Rod. Px? Joint is 1 Warm, 2 Red, and 3 Immobile, and often has a 4 Palpable Effusion. 5 Chill and 6 Fever due to Bacteremia. Lx? best initial and most accurate - 1 Aspiration of Joint (Arthrocentesis) - aaa Leukocytosis (50k to 100k cells - NEutrophils, bbb Gram Stain - Positive (50 perc) Gram-Negative Bacilli and (75 perc) with Staph, ccc Synovial Fluid Culture (70 to 90 perc Sensitive), ddd Blood Cultures (50 perc Sensitive). Tx? 1 Ceftriaxone and 2 Vancomycin - best intial empiric tx. Gram-Negative Bacilli - 3 Quinolones, 4 Aztreonam, 5 Cefotaxime, 6 Piperacillin, 7 Aminoglycosides. Gram-Positive Cocci (Sensitive) - 8 Oxacillin, 9 Nafcillin, 10 Cefazolin, 11 Piperacillin with Tazobactam. Gram-Positive Cocci (Resistant) - 12 Linezolid, 13 Daptomycin, 14 Tigecycline. Prosthetic joint infection Px - Warm, Red, Immobile, and Tender Joint. Lx - Xray or CT (whether spread into bone around implantation - Lucency.) Tx - 1 Remove the joint, 2 Antibiotics for 6 to 8 weeks, 3 Replace the joint.
	Septic arthritis of Prosthetic joint Px? Lx? Tx?	Septic arthritis of Prosthetic joint Px? Lx? Tx? Prosthetic joint infection Px - Warm, Red, Immobile, and Tender Joint. Lx - Xray or CT (whether spread into bone around implantation - Lucency.) Tx - 1 Remove the joint, 2 Antibiotics for 6 to 8 weeks, 3 Replace the joint.
	Most common organism for recently placed artificial joint septic arthritis?	Most common organism for recently placed artificial joint septic arthritis? Staph Epidermidis.
	When is gonococcal arthritis more frequent?	When is gonococcal arthritis more frequent? During Menses.
	What is gonococcal arthritis Px? Lx? Tx?	What is gonococcal arthritis Px? aka Gonorrhea. 1 Hx of STD or Sexually Active Young person, Contrast Septic arthritis - 2 Polyarticular, 3 Tenosynovitis (Inflammation of Tendon Sheaths, making finger movement Painful), 4 Petechial Rash. Lx? detecting Gonorrhea is more difficult than detecting Staph, Streph, and Gram-Negative bacilli of Septic arthritis. 1 Synovial Fluid Analysis - aaa Leukocytosis (30k - 50k cells per ul), bbb Gram Stain (25 perc Sensitive), ccc Culture (Less than 50 perc Sensitive), ddd Blood Cultures (Less than 40 perc Sensitive). MULTIPLE Diffuse Sites must be Cultured for Gonorrhea (Pharynx, Rectum, Urethra, Cervix). Culture everywhere when triad (Rash, Tenosynovitis, Polyarticular). Tx? 1 Ceftriaxone, 2 Cefotaxime, or 3 Ceftizoxime - best empiric for Disseminated Gonorrhea. 4 FluoroQuinolones only if Sensitive. If recurrent gonorrhea infection - Terminal Complement Deficiency.
	Contrast Septic Arthritis and Gonococcal Arthritis.	Contrast Septic Arthritis and Gonococcal Arthritis. Septic Arthritis - Px (Damaged Joint, Single joint), Lx (Easy to detect Staph, Strep, and Gram Neg bacilli. Leukocytosis 50k-100k, Gram Stain 50-75 perc Sensitive, Culture 90 perc Sensitive, Blood Culture 50 perc Sensitive), Tx (Ceftriaxone and Vancomycin Empiric). Gonococcal Arthritis - Px (STD, Young, Polyarticular, Tenosynovitis, Rash), Lx (difficult to detect. multiple diffuse sites - Pharynx_Rectum_Urethra_Cervix. Leukocytosis - 30k-50k, Gram Stain 25 perc Sensitive, Culture Less than 50 perc Sensitive, Blood Culture Less than 40 perc Sensitive), Tx (Ceftriaxone, Cefotaxime, or Ceftizoxime - Empiric).
	Recurrent gonococcal infection. Next Step?	Recurrent gonococcal infection. Next Step? Test for Terminal Complement Deficiency.
	What is Osteomyelitis? Etiology? Px? Lx? Tx?	What is Osteomyelitis? Infection of the Bone. Etiology? Most common cause is Staph Aureus (any organism can infect bone). Children - Hematogenous Spread. Adult - Contiguous infection - Vascular Insuffiency and Diabetes. Salmonella is most common identified in Sickle cell disease. Px? 1 Diabetic patient with 2 Ulcer (Peripheral neuropathy or Vascular disease) - 3 Warmth, 4 Redness, 5 Swelling. 6 Draining Purulent Sinus Tract in lesion. Most patient are Afebrile. Lx? Best initial - 1 Xray. Most accurate - 2 Biopsy. 3 MRI if Xray is normal (4 Bone Scan if MRI is contrindicated due to Pacemaker). 5 ESR - to Follow response to Tx. Never culture drainage. Tx? Takes weeks to progress. Obtain Biopsy to get organism. Sensitive Staph - 1 Oxacillin, 2 Cefazolin, 3 Nafcillin, or 4 Ceftriazone. Resistant Staph - 5 Vancomycin or 6 Linezolid. Gram-Negative Bacilli (E Coli) - 7 Fluoroquinolones (Ciprofloxacin - the only Oral Tx in Osteomyelitis. AE - Achilles Tendon Rupture - interfering with Growth of Chondrocytes. Contraindicated in Pregnancy and in Children - interfere with Bone Growth).
	What is most common cause of Osteomyelitis?	What is most common cause of Osteomyelitis? Staph Aureus.
	What is most common identified organism in sickle cell disease with Osteomyelitis?	What is most common identified organism in sickle cell disease with Osteomyelitis? Sickle Cell Disease.
	When to do Bone Scan in osteomyelitis?	When to do Bone Scan in osteomyelitis? Need to get MRI, but patient has pacemaker (contraindication), then get Bone Scan.

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