End game

Drug which binds B7-1 and B7-2 on APCs

Abatacept

FIP1L1/PDGFRa associated with

primary hypereosinophillic syndrome

indicates worse prognosis in eGPA

cardiac involvment

sacral Fx with bone marrow edema, avoid exercise

age around 20 with high CPK and proximal muscle weakness, all refractory to immunosuppression

muscular dystrophy, check dysferlin

: exercise-induced episodes (rhabdomyolysis, myoglobinuria), often normal exam between flares

CPT II

patient with joint pain and likely lung cancer

Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by digital clubbing, periostitis of long bones, and joint pain and swelling

anterior uveitis

limited in active and passive especially external but not as much internal rotation and is most often age 40-60.

highly associated with diabetes

adhesive capsulitis

shoulder OA

can also be limited in active and passive ROM, often older and limited in all planes of motion

SLAC- can be caused by OA, RA, trauma

Kienboeck’s disease

lunate bone in the wrist loses its blood supply, leading to bone death (avascular necrosis)

Right knee AVN

Accumulation of homogentisic acid in connective tissue

of skeletal fluorosis with interosseous membrane calcifications- has been described as endemic in areas with high concentrations of fluoride in the drinking water, excessive tea consumption (100-150 tea bags daily) and consumption of toothpaste

seronegative inflammatory arthritis + myositis + Raynaud’s + ILD symptoms + Gottron’s papules/mechanic’s hands, biopsy shows perifascicular necrosis (not atrophy), less inflammation, often called an “intermediate” or “overlap” pattern

Anti-synthetase syndrome (classically anti–Jo-1 positive)

cholesterol which is indicative of chronic inflammation, rule out infection

drugs which cause seratonin syn

• SSRI + MAOI (most dangerous)

• SSRI/SNRI + linezolid

• SSRI + tramadol or meperidine

• SSRI + triptan

Antidepressants

• SSRIs: fluoxetine, sertraline, paroxetine, citalopram, escitalopram

• SNRIs: venlafaxine, duloxetine, desvenlafaxine

• TCAs: clomipramine, imipramine, amitriptyline (some more serotonergic than others)

• MAOIs: phenelzine, tranylcypromine, isocarboxazid, selegiline

2. Other Psychiatric Drugs

• Atypical antidepressants: trazodone, vilazodone, vortioxetine

• Buspirone (5-HT1A agonist)

• Lithium (rare, but potentiates serotonin)

3. Analgesics

• Tramadol

• Meperidine (pethidine)

• Methadone

• Fentanyl

• Tapentadol

• Dextromethorphan (cough syrup, especially in abuse/OD)

4. Migraine Drugs

• Triptans: sumatriptan, rizatriptan, zolmitriptan (5-HT1B/1D agonists)

5. Antiemetics

• Ondansetron, metoclopramide, granisetron (weaker, but possible in combos)

6. Antibiotics / Other

• Linezolid (acts like an MAOI!)

• Chlorpheniramine (OTC antihistamine with serotonergic activity)

• St. John’s Wort (herbal supplement, induces serotonin release)

• MDMA (ecstasy), LSD, cocaine, amphetamines → recreational causes

macroglossia seen in

amyloidosis

amyloidosis prolonged PTT due to

binding of factor X, Tx chemo or spleenectomy

undetectable complement component is due to

complete deficiency

Belimumab MOA

inhibits a B cell survival factor

Pseudoachondroplasia

to Mutation in the COMP gene –which can also cause multiple epiphyseal dysplasia.

Scleromyxedema

primary cutaneous mucinosis characterized by a generalized, papular and sclerodermoid, cutaneous

eruption that usually occurs in association with monoclonal gammopathy. Skin bx: acid mucopolysaccharide deposition in upper reticular dermis

senstivity

a / (a + c)

Specificity

d / (b + d)

PPV

Sensitivity / (1 − Specificity)

“SpPin” → High Sp → Positive rules in → LR+ ↑

NPV

(1 − Sensitivity) / Specificity

SnNout” → High Sn → Negative rules out → LR− ↓

HBsAg

Current infection (acute or chronic)

HBsAg

Immunity (from vaccination or past infection)

Calcification of C1-C2 ligament- crowned dens, improves with NSAIDs

Apreimlast MOA

inihibits PDE4 which would normally break down cAMP thereby decreasing IL 17 and 23 and TNFa and increasing IL 10

TTP labs

elevated LDH and plt <50

TTP Tx in pregnancy

PLEX

Symmetric bone pain + periostitis + elevated ALP ina patient taking voriconazole

flourinated periostitis→ stimulates osteoblasts

• malar rash, acute, non-scarring, associated with SLE

Histology: Interface dermatitis, dermal-epidermal junction inflammation

Acute Cutaneous Lupus (ACLE)

annular or psoriasiform, photosensitive, anti-Ro/SSA positive, minimal systemic disease.

Histology: Interface dermatitis, epidermal atrophy.

Subacute Cutaneous Lupus (SCLE)

discoid plaques, scarring, localized, minimal systemic disease.

Histology: Hyperkeratosis, follicular plugging, interface dermatitis, basement membrane thickening.

Chronic Cutaneous Lupus (CCLE)

Tx for recently resolved Hep C with RA

enbrel

Eosinophilia-myalgia syndrome (EMS)

characterized by muscle pain (myalgia) and a high count of eosinophils in the blood. It's often associated with the ingestion of L-tryptophan

Hypereosinophilic syndrome (HES)

presence of blood eosinophilia of greater than or equal to 1500/microliter present for more than six months;

DRESS syn

long latency period after stopping drug, may have continued bouts. culprits include- antiepileptic agents (e.g.,

carbamazepine, lamotrigine, phenytoin, phenobarbital) and allopurinol. Sulfonamides (particularly

sulfasalazine), dapsone, minocycline, and vancomycin

Cryoglobulinemia renal histology

Diffuse thickening of the glomerular basement membrane, slight mesangial proliferation, monocyte

infiltrate, and subendothelial immune complex deposits

Osteochondritis dissecans

result of chronic microtrauma and represents a form of avascular necrosis that is small and focal. It is most commonly seen at the lateral aspect of the medial femoral condyle.

itragranulocytic inclusions on peripheral blood smear

anaplasmosis

lyme arthritis joint presentation

usually monoarticular weeks after first infection

Type 2 autoimmune hepatitis

presence of antibodies to liver/kidney microsomes (ALKM-1) and/or to a liver cytosol antigen (ALC-1)

Type 1 autoimmune hepatitis

Ab to ANA or ASMA (anti smooth Ab)

autoimmune hepatitis diagnosis and Tx

Bx, steroids and AZA

Dural ectasia

condition where the dural sac abnormally widens or balloons out. This widening can lead to various symptoms, and is commonly associated with Marfan syndrome and Loeys-Dietz syndrome. In many cases, is asymptomatic, but in some instances, it can cause back pain, headaches, and nerve-related issues

gull wing erosions- erosive OA

gout

MRH

does reclast help clinical (found from symptms) or morphometric (found from imaging) vertebral fx

morphometric (alendronate is clinical)

How does actemra improve anemia and CRP

STAT3 block→ less hepcidin

prodromal arthritis dermatitis

happens weeks before acute hep b as serum sickness like phase, has low complement and resembles RA

Routine imaging for MCTD

echo

palmoplantar pustulosis- anti TNF se

IL6 effect on neutrophils

decreased recruitment

ARR

difference in event rates, divide this into 1 to get NNT (1/this number= NNT)

SAPHO

helps with sleep and can be used with SNRI

pregabalin

CT showing Pulmonary artery dilatation and stenosis with partial pulmonary artery occlusion

50% have this on presentation

TA

Anti Scl 70

increased risk of pulmonary fibrosis and heart disease.

anti centromere

risk of pulmonary artery hypertension and limited scleroderma

knee OA shoe orthotics

lateral wedge insoles

gout prophy Tx in recent MI

colchicine or IL1

age for all vaccines if on biologics (zoster PNA etc)

18

elevated transaminases, diarrhea, arthralgias

CMV

lyme diagonsis

serum Ab with western blot refelex if they never had it before

if they had it before need to do synovial fluid pcr testing

at what age should men with no comorbidities be screened for osteoporosis

70

stress dose streoids for patient adrenally suppressed (cushingoid)

mod risk- hydrocortisone 50 mg IV just before the procedure, followed by hydrocortisone 25 mg IV every 8 hours for 24 hours

high risk is 100mg

patient–physician discordance

difference in opinion of patient and doctor- things like fatigue

risk for tendon rupture aside from flouroquinalones

glucocorticoids, statins, and aromatase inhibitors

Brachial neuritis

severe shoulder and arm pain associated with globally reduced range of movement

severe burning pain around the affected shoulder and upper arm. After days to weeks, this transitions to a flaccid muscle weakness.

causes include exercise, infection, pregnancy, and vaccination

low albumin, high Pro/Cr, TA biopsy showing eosinophilic material

amyloid

classic waxy papules

They are usually widespread and symmetrical, affecting areas like the face, neck, upper trunk, forearms, hands, and thighs. They are often arranged in a linear fashion. Notably, the palms, scalp, and mucous membranes are generally spared.

scleromyxedema,

repetitive trauma causing ischemia of the ulnar artery mimicking raynauds. tx avoidance of trauma

Hypothenar hammer syndrome

heart valve affected in APLS

mitral

PFAPA second line Tx

colchicine

• + COVID IgG in a child with decreased numbers of CD4+ and CD8+ T lymphocytes, decreased numbers of natural killer cells,

• and elevated levels of IL-6, IL-10, and sIL2r

• and features of kawasaki and MAS

Multisystem inflammatory syndrome in children (MIS-C)

telehealth vs in person in a well controlled RA pt has

similar disease activity

Periarticular muscle edema is the single most important predictor of

infectious sacroiliitis

single or multiple, unilateral or bilateral lump(s) that are typically painful and have sinus formation with drainage.of the breast

Idiopathic granulomatous mastitis

affects subq fat

lupus profundus

anti-Smith/anti-RNP antibody + SLE more likely to have

PAH and raynauds

TA artery biposy in younger patient with fibrinoid necrosis

GPA

neuro bechets Tx

non severe- corticosteroids and immunosuppressants like azathioprine or methotrexate.

For severe or refractory cases, cyclophosphamide, TNF-alpha inhibitors or newer agents like tocilizumab

(otezla only for ulcers)

paresthesia and pain in the sole of the foot and in the first through third toes,

Tarsal tunnel syndrome

chronic urticaria is associated with

thyroid disease

patient with autoimmune disease presents with symptoms of rapid onset of lower extremity weakness,

sensory alterations, and bladder dysfunction

Often involves bilateral symptoms.

eval for NMO

transverse myelitis

transverse myelitis spine MRI will show

localized edema and a fusiform lesion with hyperintense T2 signal usually extending over 3 or more

spinal cord segments.

patient with scleroderma, microcytic anemia, chronic bleeding. associated with Cirrhosis / portal hypertension

Gastric vascular ectasia

(MRI) shows bone marrow edema and a focal subchondral lesion about 2 cm in diameter in the medial femoral condyle.

SONK, Tx protected weight bearing if less than 3.5cm

smooth glossy tongue in a patient with sjogrens

canidiasis

patients with RA, when additional cardiac risk factors are present (eg, diabetes mellitus, as in this patient) OR exercise capacity is less than 4 MET(can walk up stairs or perform housework) for intermediate-risk procedure

needs stress testing

involvement of both the cartilaginous auricle and the soft lobule

Infectious chondritis

noninflammatory vasculopathy characterized by disruption of the elastin in the outer layer of the tunica media with associated angiographic findings of dissections, stenoses, and aneurysms.

It is diagnosed using computed tomography angiography (CTA)- may also have string of beads appearance, and the primary symptoms are severe abdominal pain and bleeding into the abdomen

labs normal

Segmental arterial mediolysis (SAM)

Scleroderma with High resolution computed tomography (HRCT) of

the lungs demonstrates multiple consolidative opacities in a patchy centrilobular distribution.

GERD

lateral knee pain, worse with movement, +Ober test (lay on opposite side and flex knee)

IT band