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234 Cards in this Set
- Front
- Back
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What if you see a woman >50yr. with joint pain on both of her hands, and wrists for the past 10 weeks, what are you thinking?
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RA
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What are you thinking if a woman complains of pain in her knees for 1 hour in the morning for the past 10 weeks?
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RA
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Waht if a 60 y/o cc. is malasie, wt. loss for the past 10 weeks and she has stiffness after rest for more than hour that improves as the day goes on...what are you thinking?
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RA
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How many of the positive features must you have to be present for the diagnosis of RA
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4=
morning stiffness for more than one hour wrist and finger invol swelling of 3 joints symmetric invol RA nodules X-ray with erosions positive RA factor |
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Is there a single cure to treat RA?
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no
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What is the MOST accurate test for RA?A
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Anti-CCP
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What other systems are involved in RA?
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Nerve--mononeur multiple
Heart--pericarditis, Valve ds Lung--pleural effusion (LOW glucose) and lung nodules Blood--Anemia with Normal MCV Skin--Nodules |
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What will you find in a RA pt. with heart problems?
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pericarditis, and valve disease
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What will you find in a RA pt. with nerve problems?
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Mononeuritis multiplex
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What will you find in a RA pt. with lung problems?
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pleural effusion and pulmonary nodules
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What will you find in a RA pt. with blood problems?
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anemia with normal MCV
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What will you find in a RA pt. with pleural effusion when you do your analysis?
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LOW glucose
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What will you find in a RA pt. with SKIN problems?
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NODULES
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wHAT will you find in RA pt. and joint findings?
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MCP swelling and pain
Swan neck boutinourries Bakers cyst C1/c2 sublux Knee |
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What will you find on peripheral smear in a RA pt?
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Normochromic, normocytic Anemia
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What syndrome involves RA, neutropenia, and SPLENOMEGALY?
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Felty's syndrome
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Is the SI joint involved in RA?
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NO
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What do you order for a pt. who has RA?
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NSAIDs (Ibuprofen)
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What if MTX is NOT enough or pt. can't tolderate when you treat your RA pt?
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Give a biological agent like
enterecept, infliximab, abadulimab |
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How do the biological agents work in RA?
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TNF inhibitors
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What if you need more than ibuprofen to treat RA? What should you do?
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Give MTX
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What is the side effect to be aware of with MTX
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bone marrow suppression and pneumonitis
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Does NSAIDs delay the progression of the disease?
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NO
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What is the medication you will order for a pt. with MILD RA disease in addition to NSAIDS that is Not MTX?
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Hydroxychloriquine
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If you have a pt. on Hydroxychloroquine what test would you order to do routine f.u? and Why?
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optho exam, cuz
side effect is retinopathy |
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What drug can be given to RA pt. that is also used in UC pt's? and what should you watch out for?
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Sulfasalazine a
A/E= bone marrow suppression |
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What if you can't use DMARD's for RA, what are some of the alternatives?
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"GALA"
Gold salt Abatacept--inhib T-cell activ Leflunamide--less toxic than MTX ANAKINRA--IL-1 Recptor antagonist |
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Are Steroids considered DMARDS in RA?
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NO
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Why do you use prednisone in RA?
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As a bridge in acute management until you start DMARDS
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What do you do if a RA pt. comes with pericarditis, nodules, and pleural effusion, what should you treat them with first?
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Steroids, so it can treat the acute illness and act as a bridge to start DMARDS
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What are the diseases that are seroneg. spondyloartlhrop
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ARPI
Ankylo Spondy Reiters Psoriatic JRA (Still's disease) |
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What will you find in seroneg. spondyloarthrop
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neg RA factor
it will show on the spine SI joint involved Assoc with HLA-B27 |
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What are you thinking if you see a young male with back pain that is WORSE at night, and helps when he leans forward?
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Anky Spondy
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What physical exam will be the most important in an Anky spondy pt?
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Lung exam ---diminished lung expansion
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What will you see in Anky Spondy on spinal exam?
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Kyphosis
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What are the rare findings with Anky Spondy?
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Uveitis and Aortitis
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What tests will you order if you suspect a pt. with Anky Spondy?
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Xray, MRI, HLA-B27, ESR, RF
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What will you treat an Anky Spondy pt. with?
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NSAID,
Biolog Agent--enterecept, inflix, abadulbamab Sulfasalazine |
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What are you thinking if you have a pt. with rt. knee pain, left ankle pain and recently just returned from Guatemala?
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Reiter's arthris
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What are you thinking if you see a pt. with asymmetric joint pains after having a GI infx?
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Reiter's arthritis
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What are you thinking if you see a pt. with rt. knee pain, left ankle pain and was recently treated with Ceftriaxone and Azithromax?
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Reiters arthrisits
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What might you find in a Reiter's pt. on physical exam?
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Arthritis--one, multi, or diffuse
Urethritis or Cervicitis Conjunctivits Keratoderma Blenorhagium |
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What are some of the common bugs to look for if you suspect a pt. with Reiter's?
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Chlamydia
Salmonella Shigella Campylobact yersinia |
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What will you treat a Reiter's pt. with?
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NSAIDS
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What if you see a pt. with silver scaly skin and joint pain, what are you thinking?
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Psoriatic arthritis
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Will there be SI joint involvement in psoriatic arthritis?
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Yes
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What physical exam findings are you gonna look for on a psoriatic arthritis pt?
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joint pain invol. DIP
sausage fingers nail pitting |
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What will you treat a pt. with silver scaly skin and joint pain and nail pitting?
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NSAID
Biological agent--enterecept, infliximab, abadabimab |
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What if your intial treatment is not effective in treating psoriatic arthritis, what will you treat with ?
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MTX
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What are you thinking if you see a pt. with fever, salmon colored rash, polyarthritis (joint pain), LAD, muscle pain?
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Juvenille RA (adult onset Still)
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What might you see in a pt. with fever, salmon colored rash, LAD, polyarthritis, myalgias, and high LFTS?
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hepatosplenomegaly
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What will you find on iron studies in a JRA (still's ds) pt?
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HIGH Ferritin
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What will you find in CBC in a JRA
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High WBC
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What is association of RFactor and ANA with JRA (Still's disease)
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Neg RA factor
Neg ANA factor |
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What do you treat JRA with initally?
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NSAID
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What if JRA is not controlled with NSAIDs, what should you try next?
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MTX
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What should you think of if you see a pt. with joint pain and diarrhea or fat malabsorption?
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Whipples' disease
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What is the MOST SPECIFIC test (accurate) test to do to diagnose a pt. with joint pain and diarrehea with fat malabsorption?
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Biopsy of the bowel
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What woudl you treat Whipples' disease with ?
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Bactrim
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Is treatment with Bactrim for Whipples' disease curative?
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Yes
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How long does the stiffness after rest last for in OA?
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less than 30 min
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Does fatigue get worse or better as the day progresses with OA?
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Worse
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What are herbedens's nodes?
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DIP osteophytes
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What are Bouchard's nodes?
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PIP osteophytes
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What if the best inital test for OA?
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X-ray
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What will you find on XRAy of a OA pt
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joint space narrowing
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What will you order if you suspect a pt. with OA?
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Xray
ESR anti-CCP RA ANA |
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If you did a joint aspiration on a OA pt. what will you find?
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WBC <2000
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What will you treat an OA pt. with first?
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NSAID,
Glucosamine sulfate Chondroitin sulfate |
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Are PIPs involved in both RA and OA?
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YES
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What are the 11 criteria for lupus?
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DISCOID RASH
Discoid rash Inflammation Serology Cerbral Oral ulcer Renal Arthralgia Serositis Hematology |
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How many of the 11 criteria do you need to make a SLe diagnosis?
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4
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What are the 2 serological markers found in SLE?
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Anti-Ds DNA and ANA
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What is the best intial test to do in SLE pt? and how sensitive is the test?
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ANA--95 % sensitive
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What is the MOST specific test for SLE?
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Anti-DS DNA or Anti-Sm
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What is the best test to f/u for flair up of SLE?
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Complement level (Low in flare)
and Anti-DS DNA (HIGH in flare) |
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When you suspect a pt. with SLE, what will you oreder to work it up?
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ANA
RA Anti-ds DNA complement ESR Anti-Sm AB |
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If you see a pt. who is negative for anti-cardiolipin AB but has a positive Anti-Ro (SSA) ab, what is the baby at risk for?
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Heart block
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Why would pt. with lupus be at risk for abortions?
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Antiphospholipid ab is also sometimes found in lupus pts.
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What do you treat a lupus pt. who has and acute flare up with?
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Prednisone
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What do you treat a pt. who has joint pains with lupus with?
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NSAIDS
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What do you treat a pt. who has rash and joint pain that is not responding to NSAIDS with lupus with?
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hydroxychloroquine and antimalarials
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What must you check when you start using hydroxychloroquine in a pt. with Lupus
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Eyes for retinopathy
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What do you treat a pt. who has rash and joint pain that is coming back when you stop the steroids?
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Azathoprine and Cyclophosphamide
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What do you treat a pt. who has rash and joint pain that has nephritis?
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Steroids and mycophenolate mofetil
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Why do we use mycophenolate mofetil instead of cyclophosphamide?
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B/c it is a superior drug comparatively
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What if you suspect a pt. has drug-induced Lupus...what drugs will you look for?
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HIP
Hydralazine Isoniazid Procainamide |
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What lab test will you look for to diagnose drug induced lupus?
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Anti-histone AB
Complement level and Anti-DS DNA will be NORMAL |
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aRe the renal and CNS involved in Drug induced lupus?
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NO
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What do you think of when you see a pt. who has dry eyes, dry mouth, and sand under eyelid?
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Sjogrens syndrome
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What will you do if you for the MOST Accurate test to diagnose a pt. with positive Anti-SSA or SSB
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lip biopsy
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What will the Schirmer test show?
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Decreased wetting of paper held to an eye after 5 min shows decreased lacrimation
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Why will there be loss of teeth in a young age in a pt. with sjogren's disease?
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B/c saliva is needed for preventing dental caries
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What is the treatment for Sjogren's?
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keep eyes and mouth moist
and Pilocarpine and Cevimiline |
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How do pilocarpine and cevimiline work to help in Sjogrens?
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Increase Ach which increases oral and ocular secretions
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What do you thinki of when you see RASH + joint pain + Fatigue
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LUPUS
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What do you think of when you see Tight skin, heartburn and Raynauds'?
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Scleroderma
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What are the 3 main symptoms that Scleroderma pt. face?
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Tight skin--sclerodactyly
Raynauds'--Vascular hyperactivity (white--blue--red) with digital ulceration and giant capillaries in nailfolds Joint pain---mild and symmetrical |
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What is the leading cause of death in a scleroderma pt?
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Lung fibrosis and pulm HTN
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Why do sleroderma pt. get GERD and Barrett's esophagus?
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B.c of wide colonic mouth and esophageal dysmotility
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What other disease is assoc. with Scleoderma about 15% of pt. have it and my show Anti-mitochondrial AB?
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Primary biliary cirrhosis
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What heart prob. might a scleroderma pt. show?
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Restrictive cardiomyopthay
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What renal problem might a scleroderma pt. present with?
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Malignant HTN
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What antibody is assoc. with Scleroderma?
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Anti-Scl70---Anti-topoisomerase
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What do you give for treatment with a Scleroderma pt. with renal involvement and HTN?
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ACE-I
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What do you give for treatment with a Scleroderma pt with Pulm HTN?
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Bosetan, protsacyclin analong (epoprostanil, treporstanil, iloprost) or
Sildenafil |
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What do you give for treatment with a Scleroderma pt with Raynaud's?
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CCB--Verapamil
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What is CREST
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Calcinosis
Raynauds (WHITE-blue-red) Esoph Dysmotil Sclerodactyly Telangiectasia |
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Does CREST have lung, renal, heart, or joint problems?
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NO
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What antibody is specific for CREST?
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Anti-centromere AB
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What are yo thinking if yo usee a pt. who can't get up from a seated position?
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Polymyositis or Dermatomyosistis
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What is the distiguishing features of polymyo vs dermatomyo?
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Poly==prox muscle weakness and muscle inflam
Demato is the same as polymyo but it has RASHES |
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What are Gottron's paapules and assoc with what?
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RAS over MCP joints and DErmatomy
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What are Heliotrope and assoc with whtat/
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RASH over periorbital and purple rash over eyes and Dermatomyo
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What is shawl sign? and associ with what?
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Rash over shoulder and NECK
Dermatomyositis |
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What tests will you order to find polymyositis adn dermato?
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CPK and ALDOLASE they will be high
LFT ANA EMG |
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What is a pt. at risk for if they have anti-SSA ab?
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heart block
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What is a pt. at risk for if they have anti-Jo Ab/
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Interstitial lung disease
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Which has a greater risk of malignancy PM or Dermatomyo?
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DM
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What do you do to treat DM or PM?
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STEROIDS
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What are you suspecting if a pt. comes and says they can't sleep adn have pressure points adn trigge points of pain?
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Fibro
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What will you find in a fibromyalgia pt on blood work?
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Normal blood work
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What do you suggest to the pt. with fibromyalgia?
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Exercise
TCA--amytriptyline, pregabalin, gabapentin |
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What are you thinking if you see a pt. with pain more than Weakness?
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Polymyalgia Rhematica
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What will a pt. complain of with PMR?
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PAIN more in the muscle girdle of proximal MUSCLES rther than joints in the morning
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What do you think of when you see a pt. older than 50, with MUSCLE pain and elevated ESR?
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PMR
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How do you treat a pt. with PMR?
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STEROIDS
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What is the treatment for chronic fatigue syndrom?
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NONE
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What is the treatment for Fibro?
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Exercise and (TCA, pregabalin, or gabapentin)
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What is the treatment for PMR
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Steroids
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Which one will have trigger points positive (chronic pain, fibro, or PMR)?
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Fibro
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Which one will have high ESR
(chronic pain, fibro, or PMR)? |
pmr
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WHAT Are you thinking if you see thickened skin that looks like scleroderma with marked eosinophils and an orange looking color?
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Eosinophilc Fascitis
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When r/o Scleroderma what is NOT involved in Eosinophilic Fascitis?
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Hand, Raynauds, heart, lung, kidney
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How do you treat esoinophilc fascitis?
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Steroids
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What lab findings will you see in a vasculitis pt with CBC>? what will the correlation be to ESR level?
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Normocytic anemia
Thrombocytopenia High ESR |
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What is the most accurate test for vasculitis?
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BIOPSY
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What do you give a pt. with vascultis?
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steroids= prednisone and glucocorticoids
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What if you have a pt. with normocytic anemia, thrombocytopenia, and high esr and you treated them with Steroids, but that didn't help, but you suspect they have VAsculitis...what will you do?
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Give Cyclophosphomide
Azathioprin/6-Mercaptopurine MTX |
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What are COMMON features in all Vasculitis?
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fatigue, malasie, wt.loss
FEVER Skin lesion--palpable purpura, rash Joint pain Neuropathy--mononeuritis multiplex |
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What organ does PAN not affect?
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Lung
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What are the2 areas that PAN is most affected?
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Abdomen
Renal |
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What is the best inital test to diagnose PAN?
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Angiography of Abdominal vessesl
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What is MOST ACCurate test to diagnose PAN?
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Biopsy of skin, muscle, or sural nerve
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What hepatitis is assoc. with PAN?
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Hep B
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what is the treatment for PAN??
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Steroids and cyclophosphomide
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What organ does Wegner's affect that PAN does not?
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Lungs--Upper and Lower respiratory
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What vasculitis do you think of when you see c-ANCA?
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Wegner's
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What is the most accurate test for Wegner's?
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BIOPSY
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What do you treat Wegners' Pt. with medically?
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Prednisone and Cyclophosphamide
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What are you thinking if you see ASTHMA, eosinophilia, and vasculitis?
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Churg-Strauss
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What are you thinking if you see anti-myeloperoxidase and p-ANCA?
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Churg-Strauss
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What is the most ACCurate test for Churg-Strauss?
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biopsy
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What is teh best treatment for Churg-Strauss?
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Steroids
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What is Temporal Arteritis related to which muscle problem?
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PMR
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What is the most accurate diagnositc test for Giant cell arteritis?
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Biopsy
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What is the best thing to do if you see HIGH ESR, scalp tenderness, visual disturb, jaw claudication, and HA?
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Give pt. steroids
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What if you see a Young ASIAn female with low pulses, what are you thinking/
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Takayaus's ARteritis
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What comes first in Takayasu's fever, wt. loss, malasie, fatigue, joint pain, and purpuric rash or loss of pulses?
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loss of pulses come AFTER vasculitis symptoms
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What are you worried about in a Young ASian woman with diminshed pulses?
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TIA and stroke
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How do you diagnose Takayasu's Arteriatis?
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MRA or AO angiography
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What is Takayasu's arteritis treated with?
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Steroids
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What if you have the common symptoms of vasculitis and you see association with
Hep C and Kidney's involved...what are you thinking? |
cryoglobulinemia
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What do you treat Hep C with?
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Interferon and Ribavirin
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What are you thinking if you see oral or genital ulcers, with uveitis, or optic neuritis, and hyperreactivity to needles...where the pt develops an abscess....what are you thinking?
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Behcet Ds
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What will you treat a pt. who has hyperreactivity to a needle stick and develops a skin infx. and you notice they have oral and genital ulcers?
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Prednisone and COLCHINE
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Is the most ACCURATE test for Takayasu's Arteritis a biopsy?
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NO
MRA or AO Arteriography |
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What are you thinking if you see painful burning sensation btwn webs of 3rd and 4th toes, Tenerness at the 3rd and 4th Metatarsals, and sharp intermittten pain radiating inot the toes that feels better with shoes off?
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Morton's neuroma
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Which is true? More pain or less pain with more steps taken in plantar fascitis?
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LESS pain with more steps
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Which is true plantar fascitis needs surgical repair or resovlsve on it's own?
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resolves on its own
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Which is true? pLANTAR fascitis or tarsal tunnel recommends not wearing high heels adn boots?
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Tarsal tunnel
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When looking and diagnosing inflammed joints, what will they normally have?
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Effusions
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What are teh inflammed joints we need to know?
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Gout, Pseudogout, and septic arthritis
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What is the MOST accurate test for inflammed joints?
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Joint asipiration
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What is the best initial test for a septic arthritis inflamed joint whne looking at the joint fluid?
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CELL Count
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When evaluating synovial cell count in a inflammed joint, what will you consider if it less than 2000 WBC's?
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Normal
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When evaluating synovial cell count in a inflammed joint, what will you consider if it btween 2000-50,000 WBC?
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Gout or pseudogout
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When evaluating synovial cell count in a inflammed joint, what will you consider if it more than 50,000 WBC?
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Septic Infectious ARthritis
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what are you thinking if you see a man with SUDDEN pain in his rt. toe that wakes him up at night in severe pain?
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GOUT
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What are you thinking if you have an alcoholic pt. that has a red, swollen, tender toe with occurred in pain suddenly?
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GOUT
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What are you thinkingif you see a pt. on HCTZ that got sudden onset of pain in his toe? What do you think is the cause?
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Gout
due to Thiazide |
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What do you think if you see a pt. whom you started on a lipid (TG) lowering drug and he comes to you saying he has a red, tender, swollen toe?
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GOUT due to NICOTINIC acid
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When you have a pt. that comes with a red, tender, swollen joint, what is the first thing you should do as best initial test?
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Arthrocentesis
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What is teh MOST accurate test to diagnose GOUT?
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polarized light examination with shows neg. birefringent needles.
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When you get a pt. comes with a red, tender, swollen joint, what are the orders you will write on the exam?
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Arthrocentesis
CBC BMP Xray Joint fluid analysis, cell count, gram stain, culture, protein Serum uric acid |
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What will you order to treat with first if you think a pt. has ACUTE gout?
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NSAID
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What if you treat gout with Ibupropen and there is no response, what will you order next?
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Steroid for acute gout
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Is colchichine useful in a pt. who has had an attack and it has been 36 hours?
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NO, useful in the first 24 hours
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What if the pt. whom you want to treat his ACute gout with Ibuprofen has a peptic ulcer disease, what would you treat with?
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Colchichine
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What if the pt. has renal failure and you need to treat his ACUTE gout, what can you use?
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Colchichine
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Is colchichine or NSAIDs useful for preventive therapy?
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Colchichine
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What do you have to tell the pts. who are gonna start on colchichine?
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It may cause nausea and diarrhea, and bone marrow suppression
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What other drugs are know to be used to prevent gout?
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allopurinol, probenecid, and sulfinyrazone
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How does allopurinol work?
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lowers uric acid level
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How does probencid work?
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lowers uric acid level
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How does sulfinyrazone work?
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lowers uric acid level
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What should you tell a pt. who is going to start allopurinol?
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Can develop rash, allergic interstial nephritis, and hemolysis
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Should you start allopurinol during and acute attack?
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NO
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What preventive measures can you suggest other than RX for preventing gouty attack?
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Weight loss
no alcohol Avoid high purine diet |
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When you see a pt. with knee and wrist pain but not the toes, and you see some endocrine disorder lik (hemochromatosis, hyperPTH, acromegaly, or hypoTH), what should you think of?
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Pseudogout
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Is pseudogout slow or sudden?
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Slow
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Does psedogout wake you up at night?
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NO
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What should you do if you find a swollen, tender, red knee joint?
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Arthrocentesis
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What would you look for in joint fluid with pseudogout?
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Positively birefringent crystals
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Waht shape are pseudogout cryystals?
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Rhomboid sahped
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What is the first intiial treatment for pseudogout?
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NSAID
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Can colchichine be used in pseudogout?
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Yes, but it's not as effective
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What types of joints are risk factors for septic arthritis?
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Arthritic and Prosthetic
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What is more risky for a septic arthritic joint...RA or prosthetic?
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Prosthetic
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What is more risky for a septic arthritic joint OA or prosthetic?
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Prosthetic
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What is more risky for a septic arthritic joint RA or OA?
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RA
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What type of joint is MOST risky for septic arthritis?
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Prosthetic
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What is the most common bug to cause a septic arthritis?
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S. Aureus
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What is the second most likely bug to cause septic arthritis?
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Strep
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What is the thrid mos likely bug to cause septic arthritis?
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G-neg. bacilli
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What is the first thing to do to diagnose a septic joint?
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Arthrocentiseis
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What should you order after you order an arthrocentesis on a septic joing?
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Gram stain, culture, cell count
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What do you start treatment with first if you have a synovial tap with >50,000 wbc on alalysis, and no crystals on the CCS?
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Rocephin and Vanc
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What do you order to treat to cover staph, strep, and gram neg bacilli for a septic arthritic joint?
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Staph/Strep:
Oxacillin/Nafacillin, Cefazolin G-neg: Ceftriaxone Ceftazadime Gent |
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What do you order to treat to cover staph, strep, and gram neg bacilli for a septic arthritic joint who is PCN allergic anaphylaxis?
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Staph/Strep:
Vanc, Linezolid, Dapto, Clinda G-neg Aztreonam FluroquAinolone |
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What if you have an older pt. who gets pain, stiffness, aches, and new onset fracture, what are you thinking?
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MM or
Paget's Ds of Bone |
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What do you suspect if a pt. got bowing of the tibias?
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Paget's disease of the bone
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What malignancy is assoc. with Paget's disease of the bone?
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Sarcomas
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What would you order initially to see if a pt. has Paget's ds of the bone?
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Alkaline phosphatase will be HIGH
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What other 2 organ will Alk phos be high?
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Paget's disease of bone and GB disease
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What is the most accurate test to assess Paget's Ds of Bone?
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Xray
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What other orders will you order for Paget's ds of bone other tahn Alk phos and Xray for teh CCS?
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Alk phos
Xray urinary hydroxyproline Serum Ca--normal Serum phos--normal Bone scan |
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What do you treat a pt. with Paget's disease of the bone with?
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Bisphosphonates and Calcitonnin
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What if you see Osteolytic lesions of the bone, what are you thinking?
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Paget;s disease or Osteoporosis
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What if you see osteoblastic lesions of the bone, what are you thinking?
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Metatstic disease from breast, prostate
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What are you thinking if you see a pt. with OA or RA and a palpable or ruptured mass on back of knee
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Baker's cyst
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What is a Baker's cyst?
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herniation of the synovium in the back of the knee
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how do you treat a baker's cyst?
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Nsaids or
Steroid injections |
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What are pseudogout crystals made of?
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calcium pyrophosphate (CPP)
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