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26 Cards in this Set
- Front
- Back
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a pt is on methotrexate c/o weakness, hct of 30, MCV of 110. what's the most likely diagnosis?
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folate deficiency. megaloblastic anemia due to methotrexate.
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pt on methotrexate c/o fever shortness of breath, non-productive cough, CXR shows diffuse interstitial infiltrate. what's the diagnosis? how do you treat?
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hypersensitivity pneumonitis. stop MTX and start steroids.
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pt w/ rhematoid arthritis has granulocytopenia and splenomegaly. what is this called. and how do you treat?
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called Felty's syndrome. treat w/ disease modifing drug (like hydroxychloroquine and methotrexate) plus steroids.
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young female w/ arthritis, rash on the face, in the lab has leukopenia, anemia, what's the diagnosis?
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SLE
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pt w/ lupus is on steroids, develops acute hip pain, has difficutly walking. what's the diagnosis? what's the best investigation.
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avascular necrosis of the femoral head. best investigation is MRI.
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lupus patient has proximal muscle weakness, CPK is elevated. what's the diangnosis. what's the next test you want to order.
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mixed connective tissue disorder. order anti-RNP.
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lupus patient on high dose steroids p/w psychosis. how do you determine if it's lupus or steroid induced psychosis.
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steroid causes auditory hallucinations. lupus causes visual and tactile hallucinations. order markers of disease activity. if high lupus is causing the psychosis. if it's low steroid is causing the psychosis.
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pregnant pt w/ antiphospholipid antibody, no h/o spontaneous abortion. how do you treat?
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give aspirin throughout the pregnancy
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pregnant pt w/ antiphospholipid antibody, w/ h/o spontaneous abortion. how do you treat?
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aspirin plus heparin throughout the pregnancy
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a young female comes w/ symptoms of Raynaud's phenomenon. has no other systemic symptoms. which of the following next test would you like to order??
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nail fold capillary microscopy!
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a young female comes w/ symptoms of Raynaud's phenomenon. has no other systemic symptoms. nail fold capillary microscopy test is normal. what would you do next?
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no further workup is required.
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pt w/ scleroderma comes w/ exertional SOB and dry cough. CXR diffusely increased lung marking. what's the diagnosis?
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interstitial lung disease due to scleroderma
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which drug causes scleroderma like illness??
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bleomycine
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scleroderma pt comes w/ marked HTN and acute renal failure. what's the diagnosis? what drug is best?
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scleroderma renal crisis. ACE inhibitor is the DOC.
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a pt w/ polymyositis is started on steroids. patient has improved symptomatically. CPK level is normal. after a few weeks the pt came back w/ same symptoms w/ proximal muscle weakness. CPK is still normal. what's the diagnosis?
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steroid-induced myopathy; decrease the dose of steroid.
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55 y.o. female w/ difficulty climbing stairs w/ purplish rash around the eye. what's the diagnosis and what's the next test you want to order? how do you confirm diagnosis?
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dermatomyositis order CPK levels. confirm w/ muscle biopsy.
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65 y.o. F c/o l. sided HA, jaw pain while eating for the past few days. O/E l. temporal scalp area is tender. what's the next to order?
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ESR?
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65 y.o. F c/o l. sided HA, jaw pain while eating for the past few days. O/E l. temporal scalp area is tender. ESR is 110. what next would you like to do?
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start high dose prednisone and arrange for temporal artery biopsy.
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young female w/ recent h/o fever and rash about 1 week ago came w/ complaint of bilateral symmetrical pain and swelling of metacarpal phalangeal joint and proximal interrphalangeal joint. she also feels stiffness in the joint. what's the diagnosis?
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viral arthritis
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pt comes in for routine physical found to have uric acid level of 8.5 mg/dl. there's no h/o gout. what do you do?
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no treatment for asymptomatic hyperuricemia.
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pt on HCTZ, uric acid level of 8.6, pt is asymptomatic. what do you do?
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continue HCTZ, don't stop if pt is asymptomatic
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pt w/ reccurent gout. how do you treat?
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lifestyle modification weight loss, EtOH cessation if relevant, low purine diet, discontinue diuretic. if gout remains start colchicine for prophylaxis.
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pt w/ reccurent gout that's resistant to colchicine. how do you treat?
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treat hyperuricemia. collect 24 hour urine for uric acid. if less than 800 mg. start uricosuric drug probenacide. if it's more than 800 mg start allopurinol. pt must stay on colchicine during this time.
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whent is allopurinol used instead of probenacide for gout.
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if patient has kidney stone, chronic kidney disease (creatinin >2), serum uric acid level >11, if gouty tophi is present
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pt started on allopurinol and develops erythematous pruritic rash. what do you do?
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discontinue allopurinol because many people are hypersensitive to it
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pt w/ h/o osteoarthritis taking HCTZ for HTN comes w/ worsening of pain in the r. knee joint. on examination has joint effusion. joint fluid has WBC 700. gram stain negative. what's the cause of joint pain and swelling?
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osteoarthritis
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