Final (lectures 19-30) Flashcards
(53 cards)
what is the number one risk factor for acute septic arthritis involving Genococcus?
sexually active young adult
what is the key way to identify organisms with septic arthritis? what about GC?
The key way to identify is through joint fluid aspiration and identification. Note: some reactions like GC will not have organisms (but can) and therefore you will end up with a negative culture because its an immune reaction.
what are the first 2 steps in the management of septic arthritis?
1) drain the joint
2) start antibiotics as needed.
which organism is the #1 cause of osteomyelitis?
Staph. aureus
how do you treat acute osteomyelitis? chronic osteomylitis?
acute= IV antibiotics for 4-6 weeks chronic= surgical debridement + antibiotics
what is the key feature the distinguishes spondyloarthritis for RA?
Enthesitis (inflammation where tendon attaches to the bone)
which disease group has the classic sausage fingers? Which 2 diseases within this grouping?
1) spondyloarthritis. It is called dactylitis and it forms beacuse of enthesitis.
2) Reactive arthritis and Psoriatic arthritis
4 major finding will be in the P.E. for ankylosing spondylitis which are?
1) tenderness to direct palpation of the joint
2) pain with movement of the hips
3) loss of ROM in the spine
4) abnormal schober test (spinal flexion less than 5cm)
vertebral squaring, bamboo spine, syndesmophyte formation, and sacroilitis (required for DX) are all describing the X ray images from which disease?
ankylosing spondylitis
what is 1st line treatment for ankylosing spondylitis?
NSAIDS. They alter the course of the disease.
steroid injections and Anti-TNF treatements would follow
In lupus, which two antibody tests are the most specific? what happens to C3 and C4 levels?
1) most specific = Anti-dsDNA and Anti-Smith
2) C3 and C4 levels drop because they are being used up
which 4 main drugs are used for lupus?
1) NSAIDS (symptoms)
2) Hydroxychloroquin (prevent flares)
3) Cyclophosphamide (for renal glomerulonephritis)
4) Corticosteroids (decrease inflammation)
T/F Patients with SLE should all receive coriticosteroids?
False. Many do but there are different levels depending on the severity.
FYI: [low dose (cutaneous), moderate dose (pleurisy or pericaditis), and high dose (glomerulonephritis and cerebritis)]
what is podagra?
gout in the 1st MTP joint
What are the 3 drugs given to treat acute gout?
1) NSAID
2) corticosteroids
3) colchicine
what are the 4 criteria for treating hyperuricemia?
1) 1 gout attack with kidney disease
2) 2 or more gout attacks in a year
3) Tophi
4) history of urolithiasis
A patient comes in with symmetrical joint enlargement but NO redness and complains about stiffness worse in the morning…what should be your first thought for diagnosis?
R.A.
what is the best test for ruling in R.A. in a patient?
CCP antibody is the best test because it is so specific
what is first line treatment for R.A?
1) NSAIDS to help with the pain/inflammation followed by disease-modifying antirheumatic drugs (DMARDs) such as methotrexate.
A patient is seen in clinic with 1) splenomegly 2) granulocytopenia 3) a + R.A factor for many years. What is now going on with this patient? What are they at an increased risk for?
1) the patient now has felty syndrome
2) increased risk for lymphoma
If you see a red swollen joint in someone with R.A., what should you be thinking?
secondary infection because joints are never red in pure R.A.
You give a TNF alpha inhibitor to a patient with R.A. What is a major risk factor for this treatment?
reactivation of T.B. or histoplasmosis
what is first line treatment for the overall dryness associated with shogrens disease?
Pro cholinegrics: specifically pilocarpine
You have a patient with PULMONARY HYPERTENSION presenting as progressive dyspnea. You also have the same patient with INCREASED RENIN levels because of decreased blood flow to the kidneys. These are both a DO NOT MISS for which disease?
systemic sclerosis
