Rheumatoid Arthritis

Prevalence: 1 in 100, 75% women
Sx: progressive disability, systemic complications, early death

Dx: Anti-citrullinated protein antibody
Rx: initial aggressive therapy. Escalate based on disease intensity. Goal: remission.

COMBO DMARD plus prednisone/infliximab

DMARDs:
Methotrexate
Jakvinus (Tofacitinib) (JAK inhibitor class)

The endemic mycoses compared

Histoplasmosis:
Prevalence: Most common
Sx:Caves. Small yeast forms in neutrophils, patients on TNF-alpha inhibitors, hypoadrenalism. Pancytopenia, tongue ulcer,
Dx: Urinary antigen, narrow-based multiple budding reproduction.
Tx: Itraconazole, but beware of heart failure, in which case, or in pregnancy, use Amphotericin B.


Coccidioidomycosis:
Prevalence: 150,000 cases a year, Second Most common
Sx: mucosal lesions in 25% of cases, "Valley fever", "desert bumps" =  erythema nodosum, most often in anterior tibia region
Dx: with serology, biopsy with granulomas, no budding reproduction, CS fluid shows high eosinophils, pathognomonic.
Tx: 1 month fluconazole and serial serology q2-4 months, for meningitis requires life-long fluconazole for prophylaxis: Relapse extremely common. Amphotericin 2nd line and for pregnant.


Blastomycosis:
Prevalence: Third most common
Sx: Ohio River Valley, acute PNA, miliary lung lesions, affects skin, bone, GU tract, prostatitis, verrucous lesions in head/neck region.
Dx: with culture. broad-based single budding reproduction.


Paracoccidiomycosis:
Prevalence: 80% cases in Brazil.
Dx: Captain's wheel on microscopy


Generally (except yeast), mold in cold (environment), yeast in heat (host organism).

Always: Mold-hyphae, yeast-spherical unicellular

Disorders of Structure

Marfan's Syndrome (Autosomal Dominant)
Prevalence:
Defect: Fibrillin
Symptoms: tall stature, arachnodactyly, prone to ascending aortic aneurysm, ligamentous laxity, pectus excavatum, myopia, scoliosis

Osteogenesis Imperfecta (Autosomal Dominant)
Prevalence: 1 in 7,000 in USA
Defect: Type I Collagen
Symptoms: prone to fracture, hearing loss later in life.

Ehlers-Danlos Syndrome (variable inheritance)
Prevalence: 1 in 5,000 worldwide
Defect: Type III Collagen
Symptoms: Hyperflexible joints, fragile joints, early onset Osteoarthritis, Easy bruising, extra skin folds, Livedo reticularis, piezogenic papules, Raynaud's phenomenon, Valvular heart disease, Hiatal hernia, GERD, Gorlin's sign (can touch tongue to nose), sleep apnea

Types of Arm Somatic Dysfunctions

Anterior Radial Head: Falls backwards onto a supinated arm

Posterior Radial Head: Falls backwards onto a pronated arm

Lateral epicondylitis (Tennis elbow): Repetitive stress to extensor carpi radialis (brevis: deep radial nerve, longus: radial nerve). Chronic injury.

Medial epicondylitis (Golfer's elbow): Repetitive stress to the flexor carpi ulnaris (ulnar nerve)

Subluxation of radial head (nursemaid's elbow): arm pulled up suddenly. Common in children.
Tx: Manual reduction by supinating arm held at 90 degrees of flexion.

Subluxation of ulnar head: uncommon in fall on outstretched hand (FOOSH) often with frx.

Common Rash Diseases of Childhood

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APGAR Scoring

`If baby has apnea, cyanosis, poor muscle tone, and bradycardia (<100bpm) during first minute of life, positive pressure ventilation on room air is warranted.

Oxygen may also be titrated to achieve SpO2 of 90%.