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2013-10-26 20:16:54
medicine rheum

medicine shelf
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  1. Secondary amyloidosis
    epidemiology, causes
    • Extracellular deposit of insoluble polymeric protein fibrils in tissues and organs
    • Elevated amyloid A
    • 2/2 chronic inflammatory conditions: Inflammatory arthritis, chronic infections, inflammatory bowel disease, malignancy, vasculitis
  2. Secondary amyloidosis
    • Asymptomatic proteinuria or nephrotic syndrome
    • Cardiomyopathy with heart failure
    • Hepatomegaly
    • Mixed sensory & motor peripheral neuroapthy, autonomic neuropathy
    • Visible organ enlargement
    • Bleeding diathesis
    • Waxy thickening, easy bruising of skin
  3. Secondary amyloidosis
    diagnosis and treatment
    • Dx: abdominal fat pad aspiration biopsy
    • Tx: underlying condition, and colchicine for prevention and treatment
  4. Reactive arthritis
    • seronegative spondyloarthropathy
    • resulting from enteric or GU infections
    • findings: urethritis, conjunctivits, mucocutaneous lesions, enthesitis (achilles tendon pain), asymmetric oligoarthritis
    • Tx: NSAIDs
  5. Fibromyalgia
    • middle-aged women
    • widespread pain, fatigue, congnitive/mood disturbances
    • Tx: aerobic exercise, good sleep hygiene, tricyclic antidepressants
  6. Hydroxychloroquine
    • tx for SLE with isolated skin and joint involvement
    • AE: retinopathy
  7. polymyositis
    • symmetrical proximal muscle weakness
    • Increasing difficulty climbing stairs, getting up from a chair
    • Labs: elevated muscle enzymes (CK, aldolase, LDH, AST
    • Electromyography abnormal
  8. polymyalgia rheumatica
    • age > 50
    • Aching, morning stiffness
    • Synovitis, bursitis, decreased range of motion
    • no significant muscle tenderness
    • possible systemic symptoms
    • Clinical diagnosis, significantly elevated ESR
    • Sx improve with corticosteroids
  9. Enthesitis
    • inflammation and pain where tendons and ligaments attach to bone
    • HLA-B27-associated arthropathies: ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis
  10. Ankylosing spodylitis
    • seronegative spondyloarthropathies
    • male:female is 2:1
    • morning stiffness that lasts >30min, back typically improves with exercise
    • Dx: AP x-ray of sacroiliac joints, fusion of the sacroiliac joints and/or bamboo spine
    • 90% have HLA-B27
  11. avascular necrosis
    • corticosteroid-induced
    • progressive pain without restriction of motion
    • normal radiograph on early stages
    • Dx: MRI
  12. Cyclophosphamide
    • immunosuppressant in SLE, vasculitis and certain cancers
    • Side effects: acute hemorrhagic cystitis, bladder carcinoma, sterility, and myelosuppression
    • prevent these by drinking fluids
  13. Pseudogout
    • calcium pyrophosphate dehydrate (CPPD) crystals from sites of chondrocalcinosis (calcification of articular cartilage) into the joint space
    • rhomboid-shaped, positively birefringent crystals is diagnostic
    • Attacks: often occur in setting of trauma, surgery, or medical illness
  14. gout
    • urate crystals
    • firm, yellowish nodules
    • needle-shaped, negatively birefringent crystals
  15. Gonococcal infection
    • polyarthralgia
    • tenosynovitis
    • painless vesiculopustular skin lesions
  16. Rheumatoid arthritis
    • Disease-modifying antirheumatic agents (DMARDs)
    • 1. Nonbiologic agents: MTX, hydroxychloroquine, sulfasalazine, leflunomide, azathioprine
    • 2. Biologics: etanercept, infliximab, adalimumab, tocilizumab, rituximab

    Symptomatic relief: NSAIDs, COX-2 inhibitors
  17. Sarcoidosis
    • African american women in the 3-4th decades of life
    • incidental CXR findings: bilateral hilar adenopathy and reticular opacities
    • Sx: cough, dyspnea, fever, weight loss; can also have skin, eye, joint, or other organ involvement
    • Pathology: noncaseating granulomas
    • Elevated angiotensin converting enzyme
    • Tx: glucocorticoids (in symptomatic pts)
  18. Erythema nodosum
    • painful, subcutaneous nodules develop on the anterior surface of the lower legs
    • benign vs early sx of more serious disease
    • most common cause: recent streptococcal infection
    • Other causes: sarcoidosis, TB, histoplasmosis, inflammatory bowel disease
  19. hypercalcemia
    • constipation, fatigue, excessive urination
    • Abdominal pain, urinary stones, mental status changes
    • osteoporosis
  20. Dermatomyositis
    • autoimmune condition
    • proximal extensor muscle inlammatory myopathy
    • cutaneous findings: violaceous poikiloderma, periorbital edema (heliotrope sign)
    • Lichenoid papules overlying the joints (grotton's papules)
    • Females: 6 times more common
    • Anti-Mi-2
    • Risk: internal malignancies (ovarian; breast, lung, female urogenital cancers)
  21. Whipple's disease
    • presentation: h/o chronic malabsorptive diarrhea, protein-losing enteropathy, weight loss, migratory non-deforming arthritis, lymphadenopathy and low-grade fever
    • Can also damage the eye, CNS, myocardium
    • Tropheryma whippelii (gram-positive bacillus)
    • Small intestine biopsy shows PAS-positive macrophages in the lamina propria containing non-acid-fast gram-positive bacilli