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AANP Paid official review questions

Terms in this set (116)

Basics:
Typically a history of neck, shoulder girdle, and/or hip girdle stiffness and pain, occurring in patients age 50 years or older.

Patients complain of difficulty rising from seated or prone positions, varying degrees of muscle tenderness, shoulder/hip bursitis, and/or oligoarthritis.

More common in women.

About 15% to 20% of patients with polymyalgia rheumatica (PMR) have giant cell arteritis (GCA); 40% to 60% of GCA patients have PMR.

Diagnosis is made via history and with supportive laboratory tests indicating an elevated ESR or CRP.

Rapid improvement often occurs within 24 to 72 hours with low-dose prednisone.

s/s:
Key Factors

shoulder/hip girdle stiffness
shoulder/hip girdle pain
rapid response to corticosteroids

Other Factors

acute onset
low-grade fever
anorexia
weight loss
malaise
depression
asthenia
oligoarticular arthritis

dx:

Criteria: must have any 3 factors, or just 1 and a temporal artery biopsy positive for giant cell arteritis

Age over 65 years

Bilateral shoulder girdle pain

More than 1 hour morning stiffness

Symptom onset <2 weeks

ESR >40 mm/hour

Depression/weight loss

Upper arm tenderness, bilateral.

Tests: 1st Tests To Order

ESR
C-reactive protein (CRP)
CBC
ultrasound

Other Tests to Consider

TSH
MRI
serum protein electrophoresis
serum creatine phosphokinase
TX:
Acute
initial presentation

corticosteroid: prednisone : 10-20 mg orally once or twice daily
calcium + vitamin D + bisphosphonate
nonsteroidal anti-inflammatory drug (NSAID)
methotrexate
folic acid
tocilizumab

Ongoing
treatment-resistant or relapse or disease exacerbation

corticosteroid (increased dose)
calcium + vitamin D + bisphosphonate
methotrexate plus folic acid
tocilizumab or leflunomide
Peptic ulcer:
Usually presents as chronic, upper abdominal pain related to eating a meal (dyspepsia).

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are the most common causes.

There may be some epigastric tenderness, but often there are no other signs on physical examination.

Endoscopy is diagnostic and may show an ulcer in the stomach or proximal duodenum. H pylori infection should be sought.

In the absence of "alarm" (red flag) symptoms or signs, testing for and treating H pylori and/or empiric acid inhibition therapy is appropriate.

Most common complications are gastroduodenal bleeding and perforation, either of which may be the presenting symptom, particularly in patients taking NSAIDs.

Gastritis:
A histologic term for inflammation of the gastric mucosa.

Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs) or alcohol are the most common causes. Other causes include stress (secondary to mucosal ischemia) and autoimmune gastritis. Rare forms include phlegmonous gastritis (a rare bacterial infection).

Diagnosis is based on clinical history and characteristic histological findings. A variety of methods may be used to diagnose H pylori infection.

Presence of suspicious features suggestive of upper GI malignancy requires urgent endoscopy. These include GI bleeding, anemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting.

Treatment depends on the etiology. Options include H pylori-eradication therapy, reduction of NSAIDs or alcohol exposure, and symptomatic therapy with histamine-2 antagonists and/or proton-pump inhibitors.

If untreated, progression to peptic ulcer disease may occur. Other complications include gastric carcinoma and gastric lymphoma.