The actual USMLE Step 1 exam will probably test your ability to understand the basic sciences, but as we progress the exam is become increasingly more clinical in nature, so it is essential that you learn to combine the basic sciences while using the clinical side of treatments. When it comes to Arthritis rheumatoid on the Step 1 test, there are a few important things you will need to understand, namely: Main signs and signs or symptoms, clinical findings, lab findings, and finally when and which medications to use to assist you patient.
Here are the main topics we are going to cover to ensure your USMLE Step 1 theory for rheumatoid arthritis is covered completely:
1. The main signs as well as symptoms
2. The main extra-articular signs or symptoms
3. The expected lab studies of RA
4. The steps to proper management for RA
5. Important complications you must be aware of relating to RA
The Main Signs as well as Symptoms:
Morning stiffness that lasts greater than 1hr for at minimum 6 weeks
Swelling of the arms, PIP, or MCP joints for a minimum of 6 weeks
Symmetric joint swelling for no less than 6 week
Swelling of at lowest 3 joints for a minimum of 6 weeks
Deformities involving the PIP as well as DIP joints include “Boutonniere deformity” and “Swan-Neck deformity”. The Boutonniere deformity is flexion in the PIP and extension on the DIP, while the Swan-Neck deformity is usually PIP extension with DROP flexion.
The Main extra-articular warning signs
Rheumatoid nodules (subcutaneous nodules)
Caplan syndrome (rheumatoid nodules inside lungs)
Tendon and ligament injury
The expected lab studies of RA:
Rheumatoid Factor is increased
Anemia is usually identified
ESR is increased (as a result of inflammatory process)
X-ray may show bony erosions
Synovial fluid analysis investigating white blood cell count (need to be elevated)
The steps to right management of RA:
We used to keep NSAIDs because drug of choice, but now we stick to using Methotrexate as the initial line management. Here are the ways to proper management:
Use methotrexate for a week, then add prednisone for 1 week (using prednisone consequently for flare-ups)
If your patient are not able to use methotrexate, we can give them hydroxychloroquine instead, which is an anti-malarial. This drug has a chance to cause retinopathies, so we have to make certain they get regular eyesight exams
Are you intrested in USMLE Step 1, visit https://drnajeeblectures.com/usmle-step-1.html for more details