K Rheumatology Iii And Hematology I

Front 1

Best Initial Test for Ankylosing Spondylitis

Back 1

X ray of the sacroilliac joint. Shows joint space narrowing. Also bamboo spine.

Front 2

Most Accurate Test for Ankylosing Spondylitis

Back 2

MRI as it detects defects earlier than x-ray by years.

Front 3

Labs and Ankylosing SPondylitis

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ESR elevated 85% of the time.

Front 4

Treatment for Ankylosing Spondylitis

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NSAID's and exercise program. Anti-TNF if NSAIDs fail.

Front 5

Presentation of Psoriatic Arthritis

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80% will skin psorasis prior. The more severe the more likely the arthritis. Other findings include sausage fingers and nail pitting.

Front 6

Best Initial Test for Psoriatic Arthritis

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Xray showing pencil in couopd deformity.

Front 7

Labs and Psoriatic Arthitis

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Elevated ESR and Uric acid from high skin turnover.

Front 8

Treatment for Psoriatic Arthritis

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NSAIDs first treatment. Methotrexate second. Then TNF inhibitors 3rd line

Front 9

Reactive Arthritis

Back 9

Is arthritis that occurs secondary to Inflammatory bowel disease, sexual transmission, and GI infections such as salmonella, yersina or campylobacter.

Front 10

Most Likely Diagnosis Reactive Arthritis

Back 10

Look for triad of joint pain, uvietis, conjunctivitis, and genital abnormalities such as urethritis and balantitis.

Front 11

Keratoderma blennohagicum

Back 11

Is a skin lesion unique to reactive arthritis that looks like pustular psoriasis.

Front 12

Diagnosis of Reactive Arthritis

Back 12

Clinically diagnosed, should do arthocentisis of the knee joint to rule out septic joint.

Front 13

Treatment of Reactive Arthritis

Back 13

NSAIDs. Sulfasalizine if NSAIDs fail to control.

Front 14

Screening Test for Osteoperosis

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Any woman over 65 receives a bone densiometry, DEXA scan.

Front 15

Interpreting DEXA Scan and DIagnosing Osteoperesosis

Back 15

Compare DEXA score to T score. 1 to 2.5 standard deviations from the mean means osteopenia. If greater than 2.5 standard deviations below mean means osteopersosis. There has to be normal calcium, PTH, and phosphate levels.

Front 16

Presentation of Osteoperosis

Back 16

Most are asymptomatic and fractures are found on routine bone scanes. Typically women who is older with vertebral fractures leading to decreased height or wrist fractures.

Front 17

Treatment of Osteoperosis

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VIt-D and calcium supplementation. Biphosphanates (-aldronate). Estrogen replacement. Raloxifene. Teriparatide. Nasal spray calcitonin

Front 18

Raloxifene

Back 18

Simulates estrogen effects on bones, and protects against breast cancer.

Front 19

Teriparatide

Back 19

Analogue of PTH that stimulates bony matrix formation.

Front 20

Teriparatide ADE

Back 20

Osteosarcoma. Hypercalcemia.

Front 21

Septic Arthritis

Back 21

Occurs when bacteria enter joint space that is typically damaged. The more damage the more risk. Therefore greater risk of septic joint for RA then Osteoarthritis. Characerized by warm, red, and immobile joints.

Front 22

Pathogens of Septic Arthritis

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Staphylcoccus. Streptococcus. Gram negative rods.

Front 23

Best Initial Test for Septic Arthritis

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Arthocentisis. Shows leukocytosis, gram stain, gram culture, and blood culture. Most sensitive is synovial culture.

Front 24

Empiric Antibiotics for Septic Arthritis

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Vancomycin. Ceftriaxone.

Front 25

Gram Negative Septic Arthritis Treatment

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Quinolones. Aztreoname. Piperacillin. Cefotaxime. Aminoglycosides.

Front 26

Gram Positive Sensitive Septic Arthritis Treatment

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PIperacillin with tazobactam. Oxacillin. Naficillin. Cefazolin.

Front 27

Gram Positive Resistant Septic Arthritis Treatment

Back 27

Linezolid. Daptomycin. Tigecycline.

Front 28

Prosthetic Joint Infection and Work Up

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Impossible to tell with out x-ray if infection has spread beyond implant to bone. Raidolucency or loose implant indicate spread of infection.

Front 29

Treatment of Septic Joint Prosthetic

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Have to remove joint. Treat with antibiotics for 6 to 8 weeks, then replace joint.

Front 30

Pathogen and Prosthetic Joints

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Staphyloccus epidermidis.

Front 31

Presenation of Gonococcal Arthritis

Back 31

Polyarticular. Tenosynovitis. Petichial rash.

Front 32

Diagnostic Tests for Gonnococcal Infection

Back 32

Synovial fluid sampling is less sensative for gram stain, culture, and blood culture. WBC is between 30,000-50,000, fewer than septic arthritis. Must culture pharynx, rectum, urethra, and cervix for gonorrhea.

Front 33

Treatment of Gonoccal Arthritis

Back 33

Cefriaxone. Cefotaxime. or cefrizoxime.

Front 34

Recurrent Gonococcal Infections Test

Back 34

Test for C5-C9 complement deficiency.

Front 35

Osteomyelitis Presenation

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Is an infection of the bone. Most commonly from Staph auerus. Spreads through blood in children and in adults through direct dissemination due to vascular insuffiency or diabetes. Salmonella is the most common in sicklers. Look for afebrile patient with warm, swelling area, possibly with purulent tract.

Front 36

Best Initial Test for Osteomyelitis

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X-ray. If x-ray is normal then do MRI. If MRI contraindicated then Bone Scan.

Front 37

Most Accurate Test for Osteomyelitis

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Biopsy.

Front 38

ESR and Osteomyelitis

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ESR is raised with osteomyelitis, however, only used to follow response with treatment.

Front 39

Treatment of Osteomyelitis

Back 39

Need biospy for resistance. The only oral treatment that can be given is in the case of sensative gram negative bacili, fluoroquinolones can be given.

Front 40

Best Initial Test for Anemia

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CBC. Hct establishes presence of anemia.

Front 41

Hct and Symptoms

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30 to 35% none
25 to 30% Dyspnea
20 to 25% Chest pain light headedness
Under 20% Syncope and chest pain

Front 42

MCV

Back 42

Is a measure of the average size of RBC. 80 to 100 normal

Front 43

Microcytosis

Back 43

Is an MCV less than 80. Caused by iron defiency, thalessemias, Siderblastic anemia. AOCD.

Generally has low reticulocyte count.

Front 44

Microcytosis and Elevated Reticulocyte Count

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Barts alpha thalessemia is the only one with elevated reticulocyte count

Front 45

Macrocytic Anemia

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MCV gretaer than 100. Include VIt B12 and folate defiency. Alcoholism. LIver disease. Hypothyroidism. Myelodysplastic syndrome.

All of reticulocyte count

Front 46

Medications and Macrocytic Anemia

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Zidovudine. Phenytoin.

Front 47

Normocytic Anemia

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80 to 100 MCV. Typically seen with acute blood loss.

Front 48

Transfusion and Anemic

Back 48

Is the patient stable (chest pain, hypotensive, tachycardic, syncope). Eldery. Heart disease patient.

25 to 30% in Elderly or Heart disease patient.

Front 49

Blood Products

Back 49

Packed red blood cells has about 150ml of plasma removed. Fresh frozen plasma is used to replace clotting factors (do not use in Hemophillia a or b or Von williebrand). Cryopercipate is used to replace fibrinogen in DIC.

Front 50

HCT and Packed red blood cells

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Should see an increase in 3 points for ever unit of packed red blood cells.

Front 51

Whole Blood

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Never given. Give packed red blood cells for anemia transfusion.

Front 52

Iron Deficency and Requirements

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For a normal person 1 to 2mg, mensturating women 2 to3mg, for pregnant women 5 to 6mg. Only a tsp loss of blood daily can lead to anemia.

Front 53

Anemia of Chronic Disease

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Is a microcytic anemia due to constant inflammation causing the release of hepcidin. This causes iron to be stored in the liver and marcophages as ferritin. There for low iron in blood and in transferrin.

Front 54

Siderblastic Anemia

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Is a microcytic anemia when caused by lead poisoning or B6 defiency that stops iron from being incorparated into the heme group. Alcohol also can cause.

Front 55

Siderblastic Anemia and Macrocytosis

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Myelodysplasia. Preleukemic syndrome.

Front 56

HIstory and Microcytosis

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Blood loss. Menstruation - Iron deficiency
Cancer. Rheumatoid Arthritis - AOCD
Alcoholic - Siderblastic
Asmptomatic - Thalessemia

Front 57

Best Initial Test for Microcytic Anemia

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Iron Studies.

Front 58

Low Ferritin and Micorcytosis

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Iron deficiency

Front 59

High Iron and Microcytosis

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Siderblastic.

Front 60

Normal Iron Studies

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Thalassemia.

Front 61

Iron Defiency and Other Lab Values

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Increased RDW. Elevated Platelet Count. Most accurate test for iron defieicny is bone marrow biopsy stainable iron.

Front 62

Siderblastic Anemia and Other Lab Tests

Back 62

Prussian blue stain for ringed siderblasts most accurate test. Basophillic stippling can occur in any cause of sideroblastic anemia.

Front 63

Thalessemia and Tests

Back 63

Most accurate is hemoglobin electrophoresis. All forms have normal RDW.

Front 64

Alpha Thal Presentations

Back 64

One gene deleted : Normal
Two genes deleted - mild anemia normal Hgb electrophoresis
Three Genes deleted - Moderate anemia, hemoglobin H. Increased reticulocytes.
Four Genes Deleted - gamma 4 terads. CHF in utero.

Front 65

Beta Thal Presenations

Back 65

One Gene deleted - Increased Hgb F and A2
Two genes deleted - Beta thal intermedia normal hemoglobin F, no transfusion dependence.

Front 66

Treatment of Iron Defiency

Back 66

Iron supplementation with ferrous sulfate.

Front 67

Treatment of Chronic Disease

Back 67

Correct underlying cause. Renal failure EPO tends to help.

Front 68

Beta Thal Major Treatment

Back 68

Chronic Transfusion. Iron overload is managed with defasirox or parenterally deferoxamine.

Front 69

First Step in Managment of B12 Def after CBC

Back 69

Peripheral blood smear for hypersegmented neutrophils. Then Vit B12 level. Alcohol will not cause this.

Front 70

Causes of VIt B12 Deficiency

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Decrease intake. Pernicious anemia. Pancreatic cancer. Blind loop from gastric bypass. Chrons disease. Diphyllobothrium latum.

Front 71

Folate Deficiency Causes

Back 71

DIetary. Psoarisis form turn over of skin cells. Drugs phenytoin or sulfa.

Front 72

VIt B12 and Neurological Issues

Back 72

Most common peripheral neuropathy. Dementia is least common. Subacute combined degeneration effecting posterior column. Will recover is short in duration and severity.

Front 73

Lab Value Only Raised in Vit B12 Deficiency

Back 73

Methylmonyl acid level.

Front 74

Confirmation of Perncious Anemia

Back 74

Anti-intrinsic factor or Anti-parietal cell antibody.

Front 75

B12 and Reticulocyte Count

Back 75

Low as RBC are destroyed as they leave the bone marrow.

Front 76

B12 Deficiency and Bone Marrow

Back 76

Folate and B12 deficiency can lead to pancytopenia.

Front 77

B12 Replacement Complication

Back 77

Hypokalemia due to packing of potassium into cells as the new bone marrow cells are being made.