Step studying 2

Question 1

Describe presentation of Guillain Barre

Answer 1

♣ Ascending symmetrical paralysis over days to weeks
♣ Absent/depressed deep tendon reflexes
♣ Respiratory compromise if paralysis reaches the diaphragm

Question 2

Diagnosis of Guillain Barre

Answer 2

♣ Lumbar puncture

• High protein with few cells

Question 3

Tx of Guillan Barre

Answer 3

♣ IV immunoglobulin or plasmapheresis

♣ Intubation if ascending paralysis has extended to the diaphragm

Question 4

Describe presentation of myasthenia gravis

Answer 4

• Ptosis, diplopia, weakness
• Worsens with muscle use (fatiguability)
o Most prominent in eyes, swallowing, and fine movements of distal extremities

Question 5

Diagnosis of MG

Answer 5

• Antibodies (anti-Ach)
• EMG (will show waning muscle activity)
• CT scan to look for thymoma

Question 6

Tx of MG

Answer 6

• Cholinesterase inhibitors
• Steroids to decrease autoimmune component
• IVIG = plasmaphoresis for myasthenic crisis
• Thymectomy

Question 7

Presentation of lambert eaton

Answer 7

• Proximal muscle weakness that improves with use

Question 8

Diagnosis of lambert eaton

Answer 8

• Antibodies (anti-Ca)
• EMG (will show increasing amplitude with prolonged muscle use)
• CT to look for small cell lung cancer

Question 9

How many WBCs do you expect to see in a normal joint, OA, RA, and septic joint

Answer 9

• Normal = <200
• OA = 200-2,000
• RA = 2,000-50,000
• Septic = >50,000

Question 10

How many PMNs do you expect to see in a normal joint, OA, RA, and septic

Answer 10

• Normal = <25%
• OA = 25%
• RA = often >50%
• Septic = 80-90%

Question 11

Symptoms of lupus

Answer 11

RASH OR PAIN
R = rash
A = arthritis
S = serositis
H = hematologic (anemia, thrombocytopenia)
O = oral ulcers
R = renal disease
P = photosensitivity
A = ANA 
I = immunologic (anti-dsDNA)
N = neuro (psychosis, seizures)

Question 12

What antibody is more specific for lupus

Answer 12

Anti-dsDNA

ANA is sensitive but not specific

Question 13

What antibody is specific for drug-induced lupus

Answer 13

Anti-histone antibody

Question 14

What drugs are associated with drug-induced lupus

Answer 14

SHIPP-E

• Sulfa drugs
• Hydralazine
• Isoniazid
• Procainamide
• Phenytoin
• Etanercept

Question 15

Tx of lupus nephritis

Answer 15

• Cyclophosphamide

- Mycophenylate

Question 16

Will RA be symmetric or asymmetric, and what joints does it involve

Answer 16

Symmetric, usually involving smaller joints

• PIP with sparing of DIP

Question 17

What part of the spine is involved in RA

Answer 17

Cervical spine

Question 18

Tx of RA

Answer 18

NSAIDs + DMARDs

• NSAIDs as monotherapy do not prevent disease progression

Question 19

What DMARDs should you use in RA

Answer 19

o Methotrexate*, Leflunomide, Hydroxychloroquine, Sulfasalazine

o REMEMBER: MTX for RA and Hydroxychloroquine for SLE

Question 20

What about steroids in RA

Answer 20

o Only for acute flares

o Do not use long term due to side effects/morbidity/mortality

Question 21

Describe presentation of limited type scleroderma

Answer 21

CREST syndrome

• C = calcinonis
• R = raynoud
• E = esophageal dysmotility
• S = sclerodactyly
• T = telangiectasias

Question 22

Describe presentation of diffuse type scleroderma

Answer 22

Same as limited type PLUS heart, lungs, kidney. . .

• Myocardial ischemia and fibrosis
• Interstitial lung disease
• Renal crisis

Question 23

What antibody is associated with limited vs. diffuse scleroderma

Answer 23

Limited = anti-centromere (THINK: the C in CREST also stands for centromere)

Diffuse = anti-scl-70 aka anti-topoisomerase

Question 24

What antibodies are associated with Sjogrens

Answer 24

Anti-SSA (Anti-Ro) and Anti-SSB (Anti-La)

Question 25

What antibodies are associated with polymyositis and dermatomyositis

Answer 25

Anti-Jo-1

Question 26

Describe difference between polymyositis and polymyalgia rheumatica

Answer 26

Polymyositis will have elevated CK and polymyalgia rheumatica will not

Question 27

Tx of acute gout attack

Answer 27

o NSAIDs (indomethacin) o Colchicine – stabilizes tubulin to impair leukocyte chemotaxis o Glucocorticoids

Question 28

Tx of chronic gout

Answer 28

o Allopurinol – inhibits xanthine oxidase, thus inhibiting uric acid synthesis ---- Do not start Allopurinol in an acute flare – will worsen the attack o Febuxostat – also xanthine oxidase inhibitor o Probenecid – inhibits reabsorption of uric acid in PCT

Question 29

What are the seronegative spondyloarthropathies

Answer 29

``` PAIR: P = psoriatic arthritis A = ankylosing spondylitis I = IBD R = reactive arthritis ```

Question 30

Tx of prolactinoma

Answer 30

Dopamine agonists (e.g. Cabergoline or Bromocriptine)

Question 31

MOA of Hydroxychloroquine

Answer 31

TNF and IL-1 suppressor Used in lupus

Question 32

Adverse effect of Hydroxychloroquine

Answer 32

Retinopathy

Question 33

Describe complete abortion: - Intrauterine products remaining - Cervical os (closed/open) - Vaginal bleeding

Answer 33

o Complete passage of all products of conception o Vaginal bleeding o Closed cervical os

Question 34

Describe incomplete abortion: ♣ - Intrauterine products remaining ♣ - Cervical os (closed/open) ♣ - Vaginal bleeding

Answer 34

o Occurs when some, but not all, of the products of conception have passed o Associated with cramping, vaginal bleeding, an open cervical os

Question 35

Describe missed abortion ♣ - Intrauterine products remaining ♣ - Cervical os (closed/open) ♣ - Vaginal bleeding

Answer 35

o An embryo larger than 5 mm without cardiac activity, often “missed” term is used for nonviable pregnancy in which patient has no symptoms of pain or bleeding o Pregnancy <20 weeks with embryonic or fetal demise but no sx such as bleeding or cramping o No vaginal bleeding o Closed cervical os

Question 36

Describe threatened abortion ♣ - Intrauterine products remaining ♣ - Cervical os (closed/open) ♣ - Vaginal bleeding

Answer 36

o Vaginal bleeding <20 weeks in the presence of an embryo with cardiac activity and closed cervix

Question 37

Describe inevitable abortion ♣ - Intrauterine products remaining ♣ - Cervical os (closed/open) ♣ - Vaginal bleeding

Answer 37

o Bleeding and cramping in the presence of a dilated cervix o Products of conception may be seen or felts at or above the cervical os o Indicates that passage of the conceptus is unavoidable

Question 38

At what gestational age is external cephalic version appropriate

Answer 38

>/= 37 weeks

Question 39

Most common cause of anemia in chronic alcoholics

Answer 39

Folate deficiency

Question 40

What are antibodies against in pemphigous vulgaris

Answer 40

♣ Autoimmune destruction of desmosomes (connection between cells of the stratum spinosum)

Question 41

Presentation of pemphigous vulgaris

Answer 41

* Flaccid bullae and ulcers * (+) Nikolsky sign (separation of epidermis upon manual stroking of skin) thin-walled bullae that rupture easily * Oral mucosa involved

Question 42

What are antibodies against in bullous pemphigoid

Answer 42

♣ Autoimmune (IgG) destruction of hemidesmosomes (connection between basal cell layer and basement membrane)

Question 43

Presentation of bullous pemphigoid

Answer 43

♣ Tense bullae do not rupture easily (- Nikolsky sign) | ♣ Oral mucosa NOT involved

Question 44

Tx of psoriasis

Answer 44

(1) phototherapy | (2) topical steroids

Question 45

Describe pityriasis rosea

Answer 45

o Initial lesion (“herald patch”) followed by scaly erythematous plaques in a “Christmas tree” distribution on trunk ♣ Spares palms and soles (if it does not, consider syphilis)

Question 46

Tx of pityriasis rosea

Answer 46

None - self limiting

Question 47

Describe lichen planus

Answer 47

- Pruritic, purple, polygonal, planar, papules and plaques | - Wickham striae (reticular white lines) = mucosal involvement

Question 48

Tx of tinea capitis

Answer 48

Oral griseofulvin

Question 49

Tx of onychomycosis

Answer 49

Oral terbinafine

Question 50

Tx of tinea corporis

Answer 50

Topical antifungal