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100 Cards in this Set
- Front
- Back
what is the female to male ratio with RA
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2:1 to 4:1
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what is RA
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autoimmune disease of unknown origin
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where does the autoimmune reaction in RA occur
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synovial tissue
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what does pannus in RA do
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erodes bone and destroys cartilage
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what happens with RA
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- phagocytosis w/ enzyme production in joint
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what do enzymes in RA breakdown (4)
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collagen and cause
- edema - proliferation synovial membrane - pannus formation |
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where do degenerative changes occur with RA
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muscle fibers
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result of RA
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- loss tendon and ligament elasicity and contractile power
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S&S of RA (6)
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- joint pain
-swelling -warmth - erythema - lack of function - deformity |
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what does deformity in RA depend on
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disease stage and severity
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where does Ra usually begin
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small joints (hands, wrist, feet)
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progression of RA goes where (7)
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- knees
-shoulders - hips -elbows - ankles - cervical spine -TMJ |
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what are the Sx like during onset of RA
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bilateral and symmetric
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when is RA the worst
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AM (joint stiffness)----classic sign
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common with RA
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deformities of hands and feet
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what type of disease is RA
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systemic
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what are the common S&S of RA (10)
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- fever
-wt loss - fatigue - anemia - lymph node enlargement - raynauds phenonmenon - arteritis - neuropathy -pericarditis - splenomegaly - sjogren syndrome |
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what is sjorgens syndrome
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dryness of eyes and mucus membranes
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what are rheumatoid nodules
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- non tender, movable nodules in SQ tissue
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rheumatoid nodules are associated with what
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rapid progression/destructive disease
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DX for RA (7)
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- Px exam
- xray - rheumatoid factor (75%) - elevated ESR - decreased RBC and C4 complement - positive CRP -positive antinuclear antibody |
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mgnt for RA early disease (5)
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- education (balancing rest and exercise)
- salicylates or NSAIDS, COX2 - DMARDS - methotrexate - biologic response modifiers |
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what are the DMARDS (4)
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- antimalarial
-gold - penicillamine - sulfasalazine |
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successful in preventing joint destruction and long term disability
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methotrexate
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what are the biologic response modifiers (5)
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- etanercept ( enbrel)
- infliximab (remicade) - adalimumab (humira) - golimumab (simponi) - anakinra (kineret) |
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what do the BRM do with RA
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inhibit cytokines
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mgnt for moderate erosive RA (3)
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- OT/PT
- cyclosporine -immunosuppressants |
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what are the cyclosporins (3)
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- neoral
-sandimmune - gengraf |
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can help enhance methotrexate
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immunosuppresants
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mgnt for persistent erosive RA (2)
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- recontructive surg
- corticosteriods |
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used when pain is not controlled and it interferes with independence
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reconstructive surg (synovectomy, tenorrhaphy, arthrodesis, arthroplasty)
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low dose while slower acting meds take effect
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corticosteriods
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mgnt for advanced unremitting RA
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- immunosuppressive agents
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affec antibody production at cellular level
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- immunosuppressive agents
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what are the - immunosuppressive agents (4)
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- rhematrex
- cytoxan - imuran - arava |
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what can result with use of immunosuppressive agents (4)
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-bone marrow suppression
-anemia -GI disturbance -rashes |
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what should be done if RA is unresponsive to DMARDS
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apheresis (filters out IgG )
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inborn errors of immune function
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primary immunodeficiencies
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when are primary immunodeficiencies typically diagnosed
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infancy in the 4-6 mth period
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S&S of phagcytic dysfunction (6)
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- bacterial inf
- fungal inf - viral inf - recurring abscesses - sinusitis - bronchitis |
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tx for phagcytic dysfunction (4)
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- abx
- antifungal/antivirals - GM-CSF - G-CSF |
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Dx for phagcytic dysfunction (2)
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- S&S
- prolonged infection with no response to tx |
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used cautiously with phagcytic dysfunction
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prophylactic medication
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considered a curative option for phagcytic dysfunction
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hematopoietic stem cell transplantation (HSCT)
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replaces abnormal production with normal functioning cells
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HSCT
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lack plasma cells and antibody production
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agammaglobulinemia (brutons disease)
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decreased production with decreased immunity
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B cell def
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diminished antibody production from lack of differentiation into plasma cells
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hypogammaglobulinemia
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hypogammaglobulinemia AKA
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CVID
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risks with CVID (4)
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- autoimmune diseases
- granulomatous - malignancy - pernicious anemia |
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Tx for B cell def (3)
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- IVIG
- cyroprecipitate - plasma |
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what can t cell def lead to
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opportunisitc infections
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Digeorge syndrome
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thymic hypoplasia (lask of thymus)
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what are the T cell cef (2)
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- thymic hypoplasia
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Tx for chronic mucotaneous candidiasis (3)
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- transplant fetal/ postnatal thymus
- BMT - IVIG |
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what does chronic mucotaneous candidiasis effect (5)
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- mucous membranes
- skin -nails - endocrine abnormalities - hypofunction parathyroid and adrenal cortex |
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when does thymic hypoplasia occur and what does it look like (4)
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- soon after birth
- cardiac anomaly - hypocalcemic tetany - facial abnormailites |
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huge concern with IVIG and can cause what
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-cardiac issues
-wt gain |
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what is SCID
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B and T cell missing
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what is wiskott aldrich syndrome
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variation of SCID
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tx for combined B and T cell def (3)
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- IVIG
- thymus gland transplant - HSCT |
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what is telangiectasis
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development and dilation of extra vessels
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now viewed as chronic disease treated as outpt
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HIV
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more acute condition, and may require hospitalization
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AIDS
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transmission of body fluids containing free virions and infected CD4+ Tcells
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HIV 1
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how can HIV 1 be transmitted (5)
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- blood
- seminal fluid - vaginal secretions - amniotic fluid -brst milk |
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most important with HIV and AIDS
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prevention
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replicates RNA strand and then forms DNA and can divide and form new cells
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retrovirus
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what type of virus is HIV
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retrovirus
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what are stages of HIV based on (2)
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- clinical condition
- CD4 +T cell ct |
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when are antibodies usually produced with HIV
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within 3-12 wks after infection
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test done to confirm HIV
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- enzyme immunoassay (EIA) and if positive then western blot confirms it
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uses saliva to perform EIA
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OraSure
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tx for HIV
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HARRT
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adverse effects of HARRT (4)
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- hepatoxicity
- nephrotoxicity - osteopenia - increased risk of CVD, MI, DM |
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is tr of HARRT is disrupted what is the result (3)
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viral rebound
immune decompensation - clinical progression |
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GI effects with HIV (6)
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- wt loss
- progressive tissue wasting - chronic diarrhea - loss appetite - N/v -oral and esophageal candidiasis |
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most common (80%) w/o prophylactic tx in HIV
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pneumocystis pneumonia (PCP)
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what does edema from scleroderma cause
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- taut
-smooth - shiny skin |
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what happens with scleroderma (2)
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- tissues become nonfunctional
- fibrotic changes causing loss of elasticity and movement |
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where does scleroderma changes occur (3)
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- blood vessels
- major organs - body systems |
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S&S of scleroderma (13)
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- raynauds pheno
-swelling of hands - hardness and rigidity of skin - wrinkles/lines obliterated - stiff extrem (loss of mobility) - frozen face -rigid mouth - L vent heart failure - esophagus hardens - lungs become scarred - hardened intestinal mucosa - renal failure - CREST |
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what is CREST (5)
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- calcinosis
- raynauds phenom -esophageal hardening -sclerodactyly -telangiectasia |
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mgnt for scleroderma (8)
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-depends on presentation
- pain mgnt - limit disability - exercise to reduce contractures - avoid extreme temps - lotion to minimize dryness -CCBs - anti inflammatory agents |
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used to control stiffness, arthralgia, and general discomfort with scleroderma
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anti inflammatories
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help improve raynauds phenom
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CCBs
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what is sclerodactyly
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loss of use of digits
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more at risk for SLE
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females
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disturbed immune regulation exaggerated production autoantibodies
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SLE
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cause of SLE (3)
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- combo genetics
-hormonal factors - environmental factors |
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meds r/t chemical induced SLE (5)
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- hydralazine
- procainamide - isoniazid - chlorpramazine - some antisz meds |
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promote onset of flare ups in SLE
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B cells
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S&S of SLE (10)
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- arthritis
- papulosquamous -annular lesions - chronic rash -erythematous rash bridge of nose and cheeks -oral lesions - pericarditis - early atherosclerosis in women - renal involvement (HTN) - neurologic changes |
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dx for SLe (2)
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- hx and px
- blood tests |
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what can be noted on examination of SLE (7)
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- skin rashes
- hyper/depigmentation - sensitivity to sunlight or ultraviolet light -alopecia - oral ulcers -pleural effusions - infiltrates |
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topicals corticosteriods with SLE used for what
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cutaneuos
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low dose corticosteriods with SLE used for what
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minor disease activity
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high dose oral or IV corticosteriods with SLE used for what
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major disease activity
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tx for SLE (5)
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- NSAIDS adjunt to corticos
- immunosuppresives - cytoxan - imuran - sanimmune |
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why are immunosuppresives (cyclosporins) given in the AM
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bc it can cause hemorrhagic cystitis so need plenty of fluids to flush it out
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