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Step 3 - Rheum

Rheumatology Subsection of Step 3 Questions

Diagnosis of Lupus - PE, CBC, etc Skin changes (malar rash, solar rash, oral ulcers, discoid); Arhtralgia - 90% of SLE patients; Serositis- Pericarditis, pleuritic chest pain, pul HTN, PNA, myocarditis
Change in complement levels during SLE flare Complements drop
SLE and pregnancy with Anti-Ro. Most Likely fetal problem? Heart Block
Treatment of SLE - Acute flare Prednisone (steroids)
SLE flare that re-flares after stopping steroids? Give blimumab, Azathioprine, cyclophosphamide
CCS: Patient comes in with SLE. What do you order? Complement Levels, ANA, Anti-DSdna; Always.
Lupus Nephritis Treatment Steroids + Mycophenolate
Drugs a/w Drug-induced Lupus Hydralazine, Procainamide, INH.
Diagnose drug-induced lupus: pertinent positives and negatives Antihistone Ab, Or Positive ANA. NEVER has Renal or CNS. Always has normal complements and normal DSdna.
Early Loss of teeth or lots of cavities Sjogren's Syndrome (poor saliva)
Diagnose Sjogren Lip Biopsy
Serology of Sjogren's - 4 types Anti-Ro (SSA) Anti- La (SSB) Ro and La are highly specific but not so sensitive ANA is 90% sensitive RF is also present (70% sensitive)
Sjogren's - Presentation "Sicca Syndrome" Dry mouth, dry eyes, "sand under the eyelid"
Anti SSA, Anti SSB AKA Anti Ro, Anti La. Specific for Sjogren. Also can be seen in ANA-negative lupus
Scleroderma - Clinical Presentation Woman, Tight Skin, Raynaud, Joint Pain
Lung Manifestations of diffuse scleroderma Pulmonary Fibrosis, Pulmonary HTN (leading cause of death for scleroderma)
GI Manifestations of diffuse scleroderma Barrett's, diverticulosis, primary biliary cirrhosis
Cardiac Manifestations of diffuse scleroderma Restrictive cardiomyopathy
Treating renal involvement and HTN of scleroderma ACE inhibitors
Treating pulmonary HTN a/w scleroderma bosentan (endothelin antagonist) Prostacyclin analogs sildenafil
Preventing Raynaud's calcium channel blocker
Treating lung fibrosis a/w scleroderma cyclophosphamide
CREST Syndrome: Findings (positives and negatives) Calcinosis of the fingers Raynaud's Esophageal dysmotility Sclerodactyly Telangectasia Pertinent negatives: No joint pain No heart involvement No lung involvement No kidney involvement
Serology a/w CREST + anti-centromere Ab Never has Anti-Scl70
Raynaud's Phenomenon White -> blue -> red (+/- digital ulceration as a sequela)
Diagnosis of Lupus: Serological ANA, Anti DSdna
Diagnosis of Lupus: CBC Findings Low WBC, PLT, or hemolysis
Eosinophillic Fasciitis thick skin, orange peel appearance, eosinophillia. does not have raynaud's, heart, lung, or kidney involvement.
Polymyositis: presentation Patient that can't get up from seated position. Muscle pain and tenderness.
Polymyositis/Dermatomyositis common physical exam findings Prox muscle weakness
Labs a/w polymyositis Muscle inflammation: Elevated CPK, Aldolase
Difference b/w polymyositis and dermatomyositis Skin Rashes: Grotton's papules (over MCP jt), Heliotrope rash (purple, over periorbital), Shawl Sign (shoulder and neck erythema).
Definitive diagnosis of polymyositis or dermatomyositis Need a biopsy
Anti-Jo in polymyositis Risk of interstitial lung disease
Most common serious complication of dermatomyositis High association with cancer
Treatment options for fibromyalgia Milnacipran (SNRI), Duloxetine (SNRI), pregabalin
Polymyalgia Rheumatica age 50+, Proximal muscle pain and AM stiffness, elevated ESR. Has normal CPK, EMG, Alsolase, muscle biopsy, no muscle atrophy.
Created by: fuboy1986