Kaplan Rheumatology

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  1. ANA Patterns:
    Peripheral-
    Diffuse-
    Speckled-
    Centromere-
    Nucleolar-
    Anti-DS-DNA-
    Anti-SM-
    Antihistone-
    Anti Ro (SSA)
    Anti La (SSB)
    Anticentromere-
    Anti-RNP-
    • Peripheral- SLE
    • Diffuse- Non specific
    • Speckled- Non specific
    • Centromere- CREST
    • Nucleolar- Systemic sclerosis
    • Anti-DS-DNA- SLE only
    • Anti-SM- SLE only
    • Antihistone- Drug indiced lupus
    • Anti Ro (SSA)- Neonatal lupus, sjogren
    • Anti La (SSB)- Sjogren only
    • Anticentromere- CREST
    • Anti-RNP- Mixed connective tissue
  2. P-ANCA disease(s)
    • Perinuclear Ab vs myeloperoxidase
    • PAN
    • Churg-Straus
  3. C-ANCA disease(s)
    • Cytoplasmic Ab in neutrophils
    • Wegener
  4. Most specific marker for RA?
    ESR
    CCP
    CRP
    • Most specific = CCP
    • CRP is the fastest to rise
    • ESR is the slowest to rise but lingers the longest
  5. Sequence for RA Rx... give names
    NSAIDs
    DMARDS?
    TNFalpha inhib?
    NSAIDS -OR- Roids. Not both! Give for 6 wks while others below kick in

    DMARDS- Methotrexate (Liver) Hydroxychloroquine (Retinopathy), Sulfasalazine

    TNFalpha inhib- Infliximab, Adalimumab, Etanercept (Screen for TB before use with these)
  6. RA associations in knee and neck?
    Knee- Ruptured Baker's cyst

    Neck- Atlantoaxial subluxation. Intubation problem! always do XRay of C-Spine
  7. Drugs causing drug induced lupus
    • Hydralazine
    • INH
    • Procainamide
    • Quinidine

    Antihistone! Stop the drug and it clears in 2 wks
  8. Drop of oil in nailbed. Dx?
    Scleroderma

    PSS- SCL70. Pulmonary fibrosis and scleroderma renal crisis. Put on ACE-I (not ARBs!)

    CREST- Anticentromere. Raynauds tx w/ CCB. Pulmonary fibrosis
  9. Most specific marker for Sjogrens?
    Anti-La (SSB)

    Treat symptomatically with pilocarpine and cevimeline to increase tears
  10. Ankylosing Spondy Rx?
    • First= NSAIDs and PT
    • Next- TNF Alpha (infliximab, adalimumab, etanercept) B=Do PPD first!

    No methotrexate as seen in RA
  11. Pencil in cup finger XRay?

    Rx?
    Psoriatic arthritis. EROSIVE!

    • 1st- Methotrexate
    • 2nd- TNFalpha blockers
  12. Sequence for OA Rx?
    • 1. Lifestyle change
    • 2. Acetaminophen (<4g/day. Takes 6 weeks!)
    • 3. NSAIDS
    • 4. Topical caspacin
    • 5. Tramadol
    • 6. 2&4
  13. Acute gout Rx?

    Maintenance gout Rx?
    • Acute
    • 1.NSAIDs
    • 2. Roids
    • 3. Colchicine

    • Chronic
    • 1. Allopurinol

    Pseudogout has same Rx except chronic Rx is low dose colchicine
  14. Septic Arthritis Bug and Rx?

    Old person

    Young person
    • Old
    • Staph or strep. Cover with vanco. Wash out knee

    • Young person
    • GC. Cover ceftriaxone. No wash out
    • Gm stain will be negative!

    • Sexually active IVD user?
    • Cover with vanco and ceftriaxone!
  15. Wegener
    ANCA?
    Confirmatory test?
    Rx?
    C-ANCA

    Biopsy of nasal septum- vasculitis and granulomas

    Glucocorticoids + Immunosuppressant (Cyclophosphamide)
  16. PAN
     
    ANCA?
    Confirmatory test?
    RX?
    P-ANCA

    Biopsy of skin- vasculitis and granulomas

    Glucocorticoids + Immunosuppressant (Cyclophosphamide)
  17. Churg Strauss

    ANCA
    Confirmatory Test?
    RX?
    P-ANCA. EOSINOPHILIA!

    Biopsy of nasal septum- vasculitis and granulomas

    Glucocorticoids + Immunosuppressant (Cyclophosphamide)

Card Set Information

Author:
tbollaert87
ID:
313003
Filename:
Kaplan Rheumatology
Updated:
2015-12-11 03:09:56
Tags:
Rheumatology
Folders:
Rheumatology
Description:
Kaplan rheum
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