Rheum Test: Packet 3
5 Written Questions
5 Matching Questions
- How do you dx myasthenia gravis?
- A pt comes in with ptosis, diplopia, difficulty in chewing and swallowing, respiratory difficulties and limb weakness. The muscle weakness increases with activity and improves after periods of rest. What do they have?
- What is the tx for ITP?
- A pt comes in with purpura, petechiae and hemorrhagic bullae in their mouth. What do they have?
- What is a group of vascular dz's that cause inflammatory injury and necrosis of the blood vessels? They are classified as small, medium or large.
- a PISD = initial tx: Prednisone 1-2 mg/kg/day; high dose IV Ig of 1 g/kg for 1-2 days for platelet counts < 5000; Splenectomy is definitive tx; Danazol 600 mg/day if all of above fail
- b lateral and ap x-rays of the chest and CT scans to demonstrate a co-existing thymoma; dx can be confirmed by response to a short-acting anticholinesterase (Phone Eddie)/ Edrophonium IV 10 mg will improve muscle strength, EMG, assay of serum for elevated levels of circulating acetylcholine receptor antibodies (ANA increased but lower titers than SLE)
- c Myasthenia Gravis (chronic autoimmune neuromuscular disorder with varying degrees of weakness of skeletal (voluntary) muscles of body)/ mya - muscles, anticholinesterase, acetylcholine receptor antibodies
- d Systemic Vasculitis
- e idiopathic thrombocytopenia purpura (ITP); chief complaint - mucosal or skin bleeding
5 Multiple Choice Questions
- Polyarteritis Nodosa; poor prognosis
- PoG -> Wegman's for Japanese + German food = Polyarteritis Nodosa, Giant Cell Arteritis, Wegener's Granulomatosis, Takayasu's arteritis, Churg-Strauss Syndrome
- congestion, crusting, bleeding around nasal mucosa, inflamed gums/ otitis media, conjunctivitis, dvt and pe
- Polyarteritis Nodosa
- Wegener's Granulomatosis (fatal if not treated)
5 True/False Questions
What is tx for Churg-Strauss Syndrome? → P M & M: Prednisone 1 mg/kg/d tapered to < 20 in 8-20 wks with maintenance at 10 mg; Methotrexate 25 mg/wk and mycophenolate mofetil 1500 mg bid for those who are refractory
What has asthma as its cardinal feature and the pt also has nasal polyps and allergic rhinitis. This affects small to medium sized vessels and can also be associated with tingling in extremities, can affect the lungs, etc... → Polyarteritis Nodosa
How do you dx Takayasu's arteritis? → P M & M: Prednisone 1 mg/kg/d tapered to < 20 in 8-20 wks with maintenance at 10 mg; Methotrexate 25 mg/wk and mycophenolate mofetil 1500 mg bid for those who are refractory
What should you screen for in pt's with polyarteritis nodosa? → high dose corticosteroids (60 mg Prednisone daily), Methylprednisolone 1 g IV daily for 3 days if critically ill, immunosuppressive agents like Cyclophosphamide; Hep B responds to short course of prednisone + lamivudine 100 mg/d and plasmapheresis 3 wk for 6 weeks
How do you tx myasthenia gravis? → NAP: (since it improves with rest)/ otherwise CT
Anticholinesterase drugs give symptomatic relief
i.e. Neostigmine 15 mg qid and Pyridostigmine 60 mg qid; thymectomy; failure of above - corticosteroids