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Sjögren Syndrome
Etiology Lymphoplasmacytic infiltration of exocrine glands Ab against lacrimal/salivary glands 90% women Causes Idiopathic RA SLE Primary biliary cirrhosis Polymyositis Hashimoto Presentation Dry eye Keratocunjunctivitis sicca Sand in eye Burning, itching Dry mouth Need to drink water constantly Difficult swallow Dental caries → Loss of teeth Parotid swelling Dry vagina →...
Read morePolymyositis / Dermatomyositis
Diseases Inclusion Body Myositis → T-cell mediated Polymyositis → T-cell mediated Dermatomyositis → Complex deposition Etiology Proximal muscle weakness Idiopahic Cancer (25%) Ovary Lung GI Lymphoma Presentation Muscle Getting up from chair Walking up stairs Pain/tenderness (25%) Dysphagia → Difficulty initiate swallowing Myocarditis Heart block ↑CK-MB but Cardio is normal! NO facial/ocular...
Read moreSystemic Sclerosis (Scleroderma)
Etiology Collagen deposition Presentation 80% → Limited → CREST Syndrome Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangectasia Can also have primary pulmonary HTN NO damage to the lungs 20% → Diffuse → CREST + organ involvement Raynaud White → Blue → Red Precipitated by cold and stress Skin Fibrosis Telangectasia Pigmentation abnormality GI GERD Large-opening diverticula...
Read moreAntiphospholipid Syndrome
Etiology IgG or IgM against negatively charged phospholipids Lupus anticoagulant Anticardiolipin Ab Presentation Arterial and Venous thromboses Spontaneous abortion (1st and 2nd trimester) → Mostly with Anticardiolipin ↑aPTT → Mostly with lupus anticoagulant Normal PT and INR False positive VDRL/RPR → Lab reagent similar to cardiolipin Diagnosis Best initial → Mixing...
Read moreSLE
Systemic Lupus Erythematosus Etiology Autoimmune complex Women > Men Black > White Presentation DOPAMINE RASH (4 out of 12 criteria) Discoid rash Oral ulcer Photosensitivity Arthritis (90%) → Nondeforming! Malar rash Immunology Anti-dsDNA Anti-Smith (Sm) Antiphospholipid False positive VDRL/RPR Positive LE cell preparation → Phagocyte with nuclear material inside Neuro...
Read moreJuvenile Idiopathic Arthritis (JIA/JRA)
Etiology More common in girls 95% resolve by puberty Presentation Morning stiffness >6w is a <16y patient Subtypes Pauciarticular (Oligoarthritis) Most common ≤4 joints No systemic symptom Uveitis ANA⊕ RF⊖ ↑ESR Later → Uveitis Polyarthritis ≥5 joints Systemic symptoms rare Severe disease RF⊕ Reumatoid Nodules Young children → ANA⊕ Systemic (Still...
Read moreRheumatoid Arthritis
Etiology Unknown Women 35-50y HLA-DR4 Chronic synovitis → Overgrowth, Pannus → Damage everything Presentation Bilateral symmetric joints (≥3 joints) PIP (DIP is spared → Only in DJD) MCP Wrists Knees Ankles Morning stiffness ≥30 (>60) min → Key to diagnosis Skin → Rheumatoid nodule (20%) → Biopsy → Cholesterol Ocular → Episcleritis Lung → Pleural effusion, Nodules Vasculitis →...
Read moreSports Medicine
Rotator Cuff Injury Etiology Damage to muscle, tendon, bursae Presentation Flexion/Abduction impaired Shoulder pain → Worse at night Tenderness → Supraspinatus insertion Diagnosis Most accurate → MRI Treatment NSAIDs Rest Physical therapy Steroid injection Surgery Patellofemoral Syndrome Etiology Trauma Quadriceps strength imbalance Meniscal tear Presentation Anterior knee pain In front...
Read moreCarpal Tunnel Syndrome
Peripheral neuropathy Median nerve compression under flexor retinaculum Etiology Overuse Pregnancy Diabetes RA Acromegaly Amyloidosis Hypothyroidism Presentation Pain in hand Palm Thumb Index Ring finger (radial half) Worse at night Thenar atrophy Tinel sign → Tapping median nerve reproduces pain Phalen sign → Flexing wrist 90º reproduces pain First sensory signs;...
Read moreFibromyalgia
Etiology Unknown Presentation Young woman Chronic MSK pain Neck Shoulder Back Hip Trigger point tenderness Trapezius Knee medial fat pad Lateral epicondyle Stiffness Numbness Fatigue Headache Sleep disorder Diagnosis No test All labs normal Painful areas 11-18 → Fibromyalgia <11 → Myofascial Pain Syndrome Treatment First → Aerobic exercise and...
Read moreLow Back Pain
Lumbosacral Strain Etiology Heavy lifting Straining Presentation Just back pain Diagnosis No test needed Treatment NSAIDs Disk Herniation (Sciatica) Etiology Heavy lifting Straining Presentation Pain/numbness of medial calf/foot ⊖ Knee/ankle reflex ⊕ SLR → 95% sensitive, 50% Specific Roots L4 root (L3/L4 disk puts pressure on it but exits between L4/L5)...
Read moreGout / Pseudogout (CPPD)
Gout Etiology 90% in Men Uric acid metabolism defect ↑Production Idiopathic Cell turnover Cancer Hemolysis Psoriasis Chemotherapy Enzyme deficiency Lesch-Nyhan Syndrome (HGPRT def.) Glycogen storage disease ↓Excretion Renal insufficiency Ketoacidosis Lactic acidosis Drugs Thiazides Aspirin Presentation Acute Attack Man Sudden pain, redness, tenderness of big toe At night After...
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