Flashcards in Ortho/Rheum Deck (59)
Pt p/w arthritic symptoms at multiple joints and has a positive anti-cyclic citrullinated peptide antibody blood test. Diagnosis?
What is the order of medications used in treatment of osteoarthritis?
Tylenol first then NSAIDs
What medications should be started in a newly diagnosed rheumatoid arthritis patient?
NSAIDs and a DMARD usually methotrexate first + a biologic like rituximab or infliximab
Patient presents with pain in a joint, the joint fluid comes back with 35k WBCs, likely diagnosis? Other options and why did you rule them out?
Dx Rheumatoid arthritis - 200-300 wbcs is usually OA, > 50k is usually septic joint
What is the typical sex of a Rheumatoid Arthritis patient?
A 14 yo F p/w recent high fevers, salmon-pink maculopapular rash in the evenings, polyarthragias and myalgias for > 6 weeks. Pt has lymphadenopathy on exam. Dx? Treatment?
Juvenile rheumatoid arthritis: NSAIDs
What is the probability that a patient with juvenile RA will progress to full RA?
higher if positive for rheumatoid factor (10-15% of pts) but generally only 20%
What is the most common pathogen for septic arthritis?
S. Aureus usually following procedure
What is the typical starting treatment for septic arthritis?
IV ceftriaxone - 2 total weeks of IV abx then more PO
What is the treatment for hip septic arthritis?
requires arthrotomy for drainage before IV antibiotics for 2 weeks
Patient with finger arthritis has a Pencil in Cup deformity of the proximal phalynx on xray. Diagnosis?
Pitting nails with arthritis
What is the treatment for reactive arthritis?
Patient with a painful joint has joint fluid analysis which shows rod-shaped, negatively birefringent urate crystals. Diagnosis?
What is the initial drug of choice in Gout?
NSAIDs, usually indomethacin, until symptoms resolve
A patient with a painful joint's joint fluid analysis shows rhomboid-shaped calcium pyrophosphate crystals that are positively birefringent. Diagnosis?
Calcium pyrophosphate dihydrate disease (pseudogout)
What is the treatment for Calcium pyrophosphate dihydrate disease (pseudogout)?
NSAIDs, Colchicine, intra-articular steroids
Pt being treated for HTN with hydralazine develops poly articular arthritis, oral ulcers and a malar rash which have occurred for several days a month for the past 6 months. What is the next step in diagnosis?
Switch to a different medication for HTN management to see if symptoms subside. Hydralazine can cause a lupus-like syndrome
A 56 yo female presents with proximal muscle weakness, rash and dysphagia. CPK is elevated. What is the next step in diagnosis? What condition commonly is concurrent?
Muscle biopsy to r/p polymyositis, commonly concurrent with occult malignancy
What is the treatment for polymyositis?
high-dose steroids, methotrexate or azothioprine until symptoms resolve
62 yo F p/w stiff neck and b/l hip joints worst in the morning, she reports feeling under motivated recently and has just been placed on an SSRI by her PCP. Diagnosis?What associated condition should be ruled out?
Polymyalgia rheumatica, temoral arteritis should be ruled out by biopsy
What is the treatment for polymyalgia rheumatica?
slow long term steroid taper
43 yo F with h/o Hep B presents with minor weight loss, anorexia, arthralgia, palpable purpura and levido reticularis (red mottling of extremities). What is the likely diagnosis?
What is the treatment of polyarteritis nodosa?
high dose steroids
35 yo F patient with finger/hand swelling and raynauds p/w dysphagia and new facial skin changes. Likely diagnosis?
Patient with decreased oral secretions has a biopsy of the lower lip which shows lymphocytic infiltrate and gland fibrosis. What is the diagnosis?
What is a medical management for the dry mouth associated with sjogren's syndrome?
What are the treatments for fibromyalgia? (3 fold)
1. SSRIs, SNRIs, or TCAs
3. Aerobic exercise/sleep assistance