Please enable JavaScript.

Coggle requires JavaScript to display documents.

Rheumatology (Sjogren's Syndrome (gland is infiltrated with what? (CD4…

- - - - no systemic systems
  - - - central
- - - - tap it
        
        WBC in normal
        
        <200
        
        WBC in Non-inflam
        
        200 - 2,000
        
        WBC in inflammatory
        
        2,000 - 100,000
        
        WBC in septic
        
        50,000 with 75% PMN
- - - - symptoms
        
        migratory arthritis or tenosynovitis, skin may show vesicular pustular skin lesions
      - joint cultures
        
        <25%
      - which cultures should you get
        
        look for the STD (where the sperm goes)
      - TX: ceftriaxone + azithromycin (for the Chlamidya)
    - - associated illnesses
        
        Sickle cell = salmonella/Staph
        
        IV drug us - MRSA or Pseudonomas
        
        Lyme - needs exposure
      - testing for Lyme
        
        ELISA/confirm with Western blot
  - - - type of crystal
        
        monosodium urate
      - pain syndrome
        
        usually mono-articular podagra, usually with onset at night.
      - what are tophi
        
        deposits that form nodules over bone, average onset 10 years
      - what do the crystals look like
        
        parallel biofringent (yellow) needles
      - trigger foods
        
        red meat, shellfish, alcohol, beer, coffee
      - treatment
        
        inject with corticosteroids, acute pain syndrome (high dose indomethasine), if contraindication then give colchine (If within 36 hours of pain onset
      - indications for uric acid lowering therapy
        
        target uric acid
        
        2 or more attacks 2. one attack and stage 2 kidney or worse 3. tophi 4. past urolithiasis
        
        goal uric <6.0
        
        with tophi < 7.0
    - - type of crystal
        
        biofringent rhomboid, calcium pyrophosphate
      - treatment
        
        Indomethacin (acute pain), NSAID, colchicine (if the patient can't take NSAIDS because of CKD or PUD), and steroids if both fail
  - - - digits
        
        sausage fingers (dacytilis) - soft tissue
      - skin manefesation
        
        6 P's (salmon colored plaque + scales)
      - nail pitting
      - treatment
        
        topical steroids, UV light
    - - hallmark
        
        enthesitis (inflammation of where the tendons meet the bone)
      - what is the marker
        
        HLA-B27 if white
      - which joint is involved
        
        symmetric SI joints
        
        low back pain, morning stiffness
      - Diagnosis
        
        Lumbar lateral spine showing "bamboo spine"
      - cardiac
        
        aortic insufficiency
    - - associated with UC/Chron's + arthritis/peripheral/assymetrical
      - treatment
        
        peripheral, treat the IBD
    - - symptoms
        
        non-gonococcal urthethritis + arthritis + can't see (conjunctivitis) = Reiter's syndrome
      - Dx
        
        Find the STD
      - Treat
        
        doxycycline or azithromycin + ceftriaxone
      - bugs
        
        campylobacter, shigella, salmonella, yersenia, chlamydia
    - - NSAIDs, glucocorticoids, anti-TNF alpha
- - - - Pathology
        
        autoimmune disease caused by complex formation (nuclear material of dying cells are not properly cleared) - increased autoreactive T and B - the immune complexes!
      - Classification Criteria
        
        MD-SOAP-BRAIN 4/11
        Malar rash sparing nasolabial fold (acute)
        Discoid rash (chronic)- causes scaring/atrophy/alopecia/ lupus panniculitis
        Serositis (pleuritis/pericarditis)/ Leimman-Sacks (on both sides of the valve, + cardiovascular acceleration) (CV)
        Oral apthous ulcers
        Arthritis (big joints or small joint)
        Photosenstivity rashes - subacute cutaneous lupus
        "Blood" - decrease plts (<100,000), lymphopenia, decrease Hg,** low C3/C4**, APL syndrome Renal failure (lupus Nephritis) - urine protein:urine creatine > 0.5/ >500 mg/24 hours, Class III (<50% G) /IV (>50% G) /V (membranous)
        ANA postivity 1:80
        Immunologic - serologies - DS DNA (most specific, confers greatest risk to nephritis), Histone (Drug-induced), Smith
        Neuro - cerebritis, mcc headache, cognitive dysfunction, mood disorder
      - indications for kidney biopsy
        
        increasing serum creatinine without explanation, proteinuria >1000 mg/24 h, proteinuria >500 mg/24 h with hematuria, and proteinuria >500 mg/24 h with cellular casts.
      - what antibodies are seen in the
        CSF in lupus
        
        antineuronal, anti-NMDA receptor, antiribosomal P, and antiphospholipid antibodies/lupus anticoagulant (APLA/LAC).
      - most common cause of death
        in older patients with lupus
        
        CV disease
      - acute lupus pneumonitis
        
        potentially serious inflammatory airway disease characterized by fever, cough, shortness of breath, hypoxemia, and pleuritic chest pain.
      - diffuse alveolar hemorrhage
        
        shortness of breath, hypoxemia, diffuse alveolar infiltrates on chest radiograph, a dropping hematocrit, and a high DLCO on pulmonary function tests
      - Evan's syndrome
        
        severe thrombocytopenia (<50,000) with hemolytic anemia
      - indications for bone marrow
        
        no obvious explanation for cytopenia, elevated serum iron, elevated mean corpuscular volume unexplained by medication effect, serum monoclonal spike, and the antiphospholipid antibody syndrome.
      - antiribosomal P antibodies
        
        lupus hepatitis
      - malignancy risk
        
        NHL (especially diffuse large B-cell lymphoma)
      - anti U1-ribonucleoprotein
        
        Raynaud phenomenon and esophageal dysmotility
      - anchor treatment
        
        hydroxycloroquine
        
        flare
        
        glucocorticoids
        
        remission
        
        mycophenelate mofetil/azathioprine, also cyclcosporine
      - only monocolonal
        
        beluzimab
    - - 3 main diagnostic criteria
        
        morning stiffness > 30 minutes 2. polyarticlar (>3 joints), symmetric, sparing the DIP 3. serological test (anti CCP (more specific) and RF (more sensitive)
        
        main pathophysiology
        
        panus formation leads to joint destruction
      - treatment
        
        glucocorticoids to induce remission, methotrexate/leflutamine (initial DMARD), then hydroxyquine/sulfalazaine, if these don't work then add on a biologic
      - skin manefesations
        
        rheumatoid nodules (cholesterol) and pyoderma gangrenosum
      - Felty syndrome
        
        RA+ neutropenia (<2,000), anemia, fever,
      - which joint is spared
        
        DIP
      - where is the lung fibrosis
        
        base
        
        how about in AS
        
        apical
- - - - pulseless or tender arteries of the temple, Caucasian older patient presenting with pain above the neck/headache/vision changes
      - Diagnostic criteria
        
        age > 50, ESR elevated (>50), temporal artery abnormality (nodular, pain), new pain in head, abnormal artery biopsy
      - pathology
        
        giant cells (granulomas)
      - treatment
        
        60 mg/d divided, then decreased to 30mg/d
        threatened vision - IV steroids
        Start methotrexate at the same time
      - monoclonal antibody
        
        IL-6R - Toclizumab
      - how to taper steroids
        
        go down to 10mg/d every 2 weeks until 20 mg/d
        decrease by 2.5mg/d every 4- week until 10 mg/d
        decrease by 1 mg/d every 1-2 months