Romato

Question 1

Gout ttt

Answer 1

Acute: 1.NSAID 2.colchicin

Main: Allopurinol

Question 2

Child, palpable red rash leg and arm, arthritis, abdominal pain, stool + blood

Answer 2

Henoch-Schonlein purpura (HSP) is a disease involving inflammation of small blood vessels. It most commonly occurs in children (2-6). The inflammation causes blood vessels in the skin, intestines, kidneys, and joints to start leaking.

There is no specific treatment for HSP other than rest and recuperation, and symptoms usually go away within several weeks. Paracetamol or ibuprofen can be given to relieve any joint pains. Steroids may be used in children with severe symptoms, particularly bad tummy pain or kidney damage.

Question 3

Gower’s sign What is? In which dis?

Answer 3

Gowers’s sign is a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to “walk” up their own body from a squatting position due to lack of hip and thigh muscle strength.

Classically seen in Duchenne muscular dystrophy

Question 4

Duchenne muscular dystrophy diagnose?

Answer 4

Diagnosis of DMD is based on the symptoms, clinical exam, and the result of a biopsy to remove a small piece of muscle for examination under a microscope. The result of genetic testing may also help confirm the diagnosis.

Question 5

SLE
diagnostic criteria

Answer 5

soap brain md

Serositis (pleuritis, precarditis)
Oral ulcers
Arthritis
Photosensivity

Blood disorders
Renal involvement
ANA +
Imunologic(anti-sm,anti-dsDNA)
Neurologic disorders

Malar rash
Discoid rash

Question 6

HSP defnition

Answer 6

Henoch-Schonlein purpura (also known as IgA vasculitis) is a disorder that causes the small blood vessels in your skin, joints, intestines and kidneys to become inflamed and bleed. The most striking feature of this form of vasculitis is a purplish rash, typically on the lower legs and buttocks

Question 7

Sjogern’s synd

Answer 7

a disorder of your immune system identified by its two most common symptoms — dry eyes and a dry mouth. The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus

There’s currently no cure for Sjögren’s syndrome, but there are several treatments that can help, such as: eye drops that keep your eyes wet (artificial tears) sprays, lozenges (medicated sweets) and gels that keep your mouth wet (saliva substitutes) medicine that helps your body produce more tears and saliva

Question 8

Tupe 4 hypersensivity

Answer 8

Type four hypersensitivity reaction is a cell-mediated reaction that can occur in response to contact with certain allergens resulting in what is called contact dermatitis or in response to some diagnostic procedures as in the tuberculin skin test. Certain allergens must be avoided to treat this condition

The fourth type is considered a delayed hypersensitivity reaction because it usually occurs more than 12 hours after exposure to the allergen, with a maximal reaction time between 48 and 72 hours

Ocular examples of type IV hypersensitivity include phlyctenular keratoconjunctivitis, corneal allograft rejection, contact dermatitis, and drug allergies, although drug sensitivities can lead to all four types of hypersensitivity reaction

Question 9

Middle aged woman with osteoarthritis best advice

Answer 9

Decrease weight

Question 10

Osgood-schlatter dis

Answer 10

Osgood-Schlatter disease is a condition that causes pain and swelling below the knee joint, where the patellar tendon attaches to the top of the shinbone (tibia), a spot called the tibial tuberosity. There may also be inflammation of the patellar tendon, which stretches over the kneecap

Osgood Schlatters will not cause permanent damage and will usually resolve when the child has reduced activity and stopped growing. It can, however, cause a bump to form on the shin bone underneath the tendon insertion

Question 11

RA pathophysio

Answer 11

Although the pathophysiology of RA is not completely understood, the process generally involves dysregulated inflammation, with antigen presentation, T-cell activation, and autoantibody production all serving as mediators in the inflammatory process

Question 12

prevent permanent joints loss in RA

Answer 12

In many cases, it is now possible to prevent these deformities by using disease-modifying anti-rheumatic drugs (DMARDs) and biologic drugs before the loss of bone (bony erosions) occurs.

Question 13

What are Bouchard’s Nodes?

Answer 13

Bouchard’s nodes are bumps on the joints in the middle of your fingers (the proximal interphalangeal joint, or PIP), and are a sign of advanced finger osteoarthritis (OA), which is a degenerative joint disease

Question 14

Heberden’s nodes

Answer 14

Heberden’s nodes are small bony growths that appear on the joint closest to the tip of your finger. Along with Bouchard’s nodes, Heberden’s nodes are a symptom of osteoarthritis of the hands. They can cause pain and limited motion in your hands

Question 15

Boutonniere deformity

Answer 15

Boutonnière deformity is a condition that affects your ability to straighten the middle joint of a finger or — less commonly — a toe. Your joint is stuck in a bent position and won’t straighten. At the same time, the joint toward the tip of your finger or toe (extremity) is flexed upward

PIP flexion with DIP hyperextention

Question 16

Polymyalgia rhumatica dif

Answer 16

An inflammatory disorder causing muscle pain and stiffness around the shoulders and hips.
Most people develop polymyalgia rheumatica after age 50. Sometimes this condition occurs with temporal arteritis, a more serious condition that causes inflammation of the lining of the arteries.

The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks. You may also have pain in your neck and hips. Both sides of the body are usually affected. The stiffness is often worse first thing in the morning after you wake up.

Question 17

Polymyalgia rhumatica ttt

Answer 17

Treatment consists of steroids
Treatment is usually a low dose of an oral corticosteroid, such as prednisone. Although treatment often lasts two to three years, most people start to feel better within a day or two.

Question 18

Juvenile arthritis

Answer 18

The most common type of childhood arthritis is juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis. Childhood arthritis can cause permanent physical damage to joints. This damage can make it hard for the child to do everyday things like walking or dressing and can result in disability

Symptoms:
Swollen, stiff, and painful joints in the knees, hands, feet, ankles, shoulders, elbows, or other joints, often in the morning or after a nap
Eye inflammation
Warmth and redness in a joint
Less ability to use one or more joints
Fatigue
Decreased appetite, poor weight gain, and slow growth
High fever and rash (in systemic JIA)
Swollen lymph nodes (in systemic JIA)

Question 19

Lupus criteria

Answer 19

The EULAR/ACR classification requires an 💯antinuclear antibody (ANA) titer of at least 1:80 on HEp-2 cells or an equivalent positive test at least once; otherwise, the patient is considered not to have SLE💯. If it is present, 22 “additive weighted” classification criteria are considered, comprising seven clinical domains and three immunologic domains. Each criterion is assigned points, ranging from 2 to 10. Patients with at least one clinical criterion and 10 or more points are classified as having SLE.

Table 1. EULAR/ACR Clinical Domains and Criteria for SLE
1️⃣Constitutional:
(1)Fever *2

2️⃣Hematologic:
(1)Leukopenia *3
(2)Thrombocytopenia *4
(3)Autoimmune hemolysis *4

3️⃣Neuropsychiatric:
(1)Delirium *2
(2)Psychosis *3
(3)Seizure *5

4️⃣Mucocutaneous:
(1)Non-scarring alopecia *2
(2)Oral ulcers *2
(3)Subacute cutaneous or discoid lupus *4
(4)Acute cutaneous lupus *6

5️⃣Serosal:
(1)Pleural/pericardial effusion *5
(2)Acute pericarditis *6

6️⃣Musculoskeletal:
(1)Joint involvement *6

7️⃣Renal
(1)Proteinuria > 0.5 g/24 h *4
(2)Renal biopsy class II or V lupus nephritis *8
(3)Renal biopsy class III or IV lupus nephritis *10

Table 2. EULAR/ACR Immunologic Domains and Criteria for SLE (Open Table in a new window)
Domain
Criteria
Points
Antiphospholipid antibodies
Anti-cardiolipin antibodies or
Anti-β2GP1 antibodies or
Lupus anticoagulant
2
Complement proteins
Low C3 or low C4
Low C3 and low C4
3
4
SLE-specific antibodies
Anti-dsDNA antibody or
Anti-Smith antibody
6
Note the following [5, 6] :
A criterion should not be counted if there is a more likely explanation for it than SLE
Occurrence of a criterion on at least one occasion is sufficient
Criteria need not occur simultaneously
Within each domain, only the highest-weighted criterion is counted toward the total score

Question 20

Kawasaki disease

Answer 20

is a condition that mainly affects children under the age of 5. It’s also known as mucocutaneous lymph node syndrome. A child with Kawasaki disease has a high temperature that lasts for 5 days or longer, and possibly 1 or more of the following symptoms: a rash. swollen glands in the neck.

Most kids with Kawasaki disease recover completely, especially when they are diagnosed and treated early. Some, especially those who develop heart problems from Kawasaki disease, might need more testing and to see a cardiologist (a doctor who specializes in conditions that affect the heart)

There’s no specific test available to diagnose Kawasaki disease. Diagnosis involves ruling out other diseases that cause similar signs and symptoms, including: Scarlet fever, which is caused by streptococcal bacteria and results in fever, rash, chills and sore throat. Juvenile rheumatoid arthritis

Clinical signs include fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips, and throat. Kawasaki disease primarily affects children younger than 5 years of age.

Question 21

What is the first line treatment for lupus?

Answer 21

Hydroxychloroquine is first-line treatment unless contraindicated and is useful in almost all manifestations of lupus. Other treatments are titrated against type and severity of organ involvement. Monoclonal antibodies have a limited role in the management of lupus

Nowadays, antimalarials are the basic treatment for every patient with SLE, whereas glucocorticoids should only be used when acutely indicated. If reduction or tapering of glucocorticoids proves impossible, extended immunosuppression with azathioprine, methotrexate, or mycophenolate mofetil is recommended

Question 22

ra swelling hand ttt

Answer 22

Apply an ice pack to inflamed joints to help ease swelling. Cold can also help to numb pain and relax muscle spasms. A 2013 research review suggested that cryotherapy, or cold therapy, may reduce pain in people with RA

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain. These may be combined with biological treatments.
…
The DMARDs that may be used include:
methotrexate.
leflunomide.
hydroxychloroquine.
sulfasalazine

Question 23

Reiter’s syndrome

Answer 23

Reactive arthritis, also known as Reiter’s syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. is usually preceded by an infection caused by bacteria, such as Chlamydia trachomatis (a sexually transmitted disease) or Salmonella (a bacteria that can contaminate foods).

Symp:

Joint pain and inflammation that often affect the knees, feet, and ankles.
Inflammation of a tendon that is attached to bone. …
Bony growths in the heel (heel spurs) that can cause chronic pain.
Inflammation of the spine (spondylitis)

Question 24

Ankylosing spondylitis

Answer 24

Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply.Azar 4, 1400 AP
Symptoms: Uveitis; Joint stiffness; Inflammation

Early signs of AS
pain in the lower back, hips, and buttocks.
stiffness in the lower back, hips, and buttocks.
neck pain.
ligament and tendon pain where these structures attach to the bones.
tiredness.
night sweats.
mild fever.
appetite loss

Question 25

Pattelofemoral pain synd

Answer 25

A condition in which the cartilage under the kneecap is damaged due to injury or overuse.
Patellofemoral pain syndrome is the most common cause of knee pain seen by doctors. It’s common in people who participate in sports, especially women and young adults (15-30y).

The most common symptom is knee pain that increases with stair climbing or squatting movements

Overuse. In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee —such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity.

It usually takes six weeks or more to recover with non-surgical treatment, but it can take longer if surgery is required

Question 26

Perthes’ disease

Answer 26

is an uncommon condition that affects children between the ages of three and 11 years. Blood supply to the head of the thigh bone is disrupted which causes the bone to deteriorate. This can cause pain, limping and limited movement of the hip joint.

The long-term prognosis for children with Perthes is good in most cases. After 18 to 24 months of treatment, most children return to daily activities without major limitations. The hip is a “ball-and-socket” joint.

Question 27

Which nerve is damaged in winging of scapula?

Answer 27

A winged scapula occurs when these muscles weaken and fail to hold the scapula close against the back of the rib cage. This condition results in the scapula sticking outwards and upwards, causing the shoulder blade to resemble a wing. Winged scapula symptoms can be painful and debilitating.

The most common etiology of a winged scapula is usually due to damage or impaired innervation to the serratus anterior muscle. The nerve that innervates this muscle is the long thoracic nerve. Sometimes, this nerve can be damaged or impinged, leading to malfunction of the serratus anterior muscle.

Question 28

Areflexia

Answer 28

Areflexia means the absence of deep tendon reflexes. Tendons are the tight cords of tissue that connect muscles to bones. Typically, when you tap on a tendon, it causes the muscle to contract and move involuntarily.

There are no current specific medications available to treat detrusor areflexia. People with detrusor areflexia will need to urinate at regular intervals to make sure that the bladder doesn’t get too full. A doctor may recommend using a urinary catheter to make sure that the bladder is emptied.

Question 29

Gout ttt prevention for the attacks

Answer 29

Febuxostat (Uloric) and allopurinol (Zyloprim) are equally effective in preventing recurrent gout. To prevent recurrent gout, patients should reduce their consumption of high-fructose corn syrup–sweetened soft drinks, fruit juices, and fructose-rich vegetables and fruits (e.g., applesauce, agave)

Allopurinol is used for the long-term treatment and prevention of gout. Taken regularly, it can stop attacks of gout and help prevent damage to your joints. Gout occurs in people who have high levels of urate in their blood. Every day, the body naturally produces urate.

Question 30

What foods make gout worse?

Answer 30

Sugary drinks and sweets. Standard table sugar is half fructose, which breaks down into uric acid. Any food or drink with higher sugar content can trigger gout.
High fructose corn syrup. This is a concentrated form of fructose. If you start looking at labels, you’ll find high fructose corn syrup in all kinds of packaged food products that you wouldn’t necessarily expect.
Alcohol. Even though not all alcoholic drinks are high in purines, alcohol prevents your kidneys from eliminating uric acid, pulling it back into your body, where it continues to accumulate.
Organ meats. These include liver, tripe sweetbreads, brains and kidneys.
Game meats. Specialties such as goose, veal and venison are among the reasons why gout was known in the Middle Ages as the “rich man’s disease.”
Certain seafood, including herring, scallops, mussels, codfish, tuna, trout and haddock.
Red meats, including beef, lamb pork and bacon.
Turkey. This leaner meat is nonetheless high in purines. Especially avoid processed deli turkey.
Gravy and meat sauces.
Yeast and yeast extract.

Question 31

What are the best foods to eat when you have gout?

Answer 31

While eating particular foods won’t be enough to make gout go away, studies suggest that certain foods and drinks may help reduce uric acid in your body. For example:

Milk. Some early research suggests that drinking skim milk may help reduce uric acid and gout flare-ups. It speeds up the excretion of uric acid in your urine and also reduces your body’s inflammatory response to uric acid crystals in your joints.
Cherries. Scientists are currently researching the benefits of cherries and cherry juice for managing gout symptoms, and early results are promising. Cherries have known anti-inflammatory properties, and they may also help reduce uric acid in your body.
Coffee. You may have heard that coffee is acidic, but the type of acid in coffee is very different from uric acid. In fact, drinking coffee daily can reduce your uric acid levels by several means. It slows the breakdown of purine into uric acid and speeds the rate of excretion.
Water. People who drink five to eight glasses of water a day are less likely to experience gout symptoms. This makes sense since your kidneys use water to excrete uric acid in your urine. Water is also good for kidney health. Impaired kidney function is one factor that can contribute to gout.