Tuesday, May 21, 2013

USMLE Step Exam - All that you should Know About Rheumatoid Arthritis

The USMLE Step 1 exam is likely to test your ability to educate yourself on the basic sciences, but as we advance the exam is become a whole lot clinical in nature, it is essential that you learn techniques to combine the basic sciences on an clinical side of medicine. When it comes to Rheumatoid Arthritis within the Step 1 exam, usually there are some important things you retain understand, namely: Main pain Symptoms, clinical findings, research laboratory findings, and finally when or sometimes which medications to use to lead patient.

Here are the main topics we should cover to ensure your USMLE Action 1 theory for Rheumatoid Arthritis is included completely:

1. The main manifestation Symptoms

2. The main extra-articular manifestation Symptoms

3. The expected labrador findings of RA

4. The steps to proper management with their RA

5. Important complications you should be aware relating to RA

The Main Symptoms Symptoms:

  • Morning stiffness that carries on more than 1hr that is at least 6 weeks

  • Swelling of the people wrists, PIP, or MCP joints that is at least 6 weeks

  • Symmetric joint swelling that is at least 6 week

  • Swelling for a minimum of 3 joints for almost 6 weeks

Deformities involving originates from PIP and DIP articulations include "Boutonniere deformity" women for marriage "Swan-Neck deformity". The Boutonniere deformity is flexion of the people PIP and extension from the DIP, while the Swan-Neck incapability is PIP extension without trouble DIP flexion.

The Main extra-articular pain Symptoms

  • Rheumatoid nodules (subcutaneous nodules)

  • Caplan syndrome (Rheumatoid nodules within the lungs)

  • Tendon and structures damage

The expected lab studies of RA:

  • Rheumatoid Challenge is increased

  • Anemia is found

  • ESR is becomes wider (due to inflammatory process)

  • X-ray they should show bony erosions

  • Synovial fluid analysis located on white blood cell calculate (should be elevated)

The steps to proper management of RA:

We used to keep NSAIDs as the drug of choice, but now we adhere using Methotrexate as among the initial line management. Here are classified as the steps to proper govt:

  • Use methotrexate for few days, then add prednisone for a single week (using prednisone subsequently in their eyes flare-ups)

  • If your patient cannot use methotrexate, we should give them hydroxychloroquine realistically, which is an anti-malarial. This drug has the ability to cause retinopathies, so we have to ensure they get the actual eye exams.

Important complications you should be aware in RA:

  • An extension of the people inflamed synovium into the popliteal space brings about a Baker's cyst, which presents with a swollen, tender, and affected calf

  • Prior to any means, it is important to rule out a subluxation of pick a atlantoaxial joint, which can accidentally be hyperextended during intubation and potentially for you to post-operative paralysis.

Understanding and following some other high-yield Rheumatoid Arthritis information above will assure you cover all the RA information you need for your USMLE Action 1 exam.


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