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118 Cards in this Set

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  • Back
How long is morning stiffness for OA
less then half hour
What are common charecteristics of OA
Pain, crepitus, tenderness, enlargement, gelling, varus deformity
What is the most commonly visible joint enlargement on OA
PIP and DIP
What are the nodes associated with OA
Bouchards, and Heberdens
What do you see in Xray for OA
decreased joint space, subchondral bone sclerosis and cysts
Pain is usually due to what in OA
osteophytes, subchondral microfractures
Treatment for OA
NSAIDS, APAP, Zostrix, steriod injection
Describe what gout looks like
Red, hot, swollen, tender
Describe attack of gout
Abrupt, in one joint, usually MTP
What does lab show for gout
negatively bifringent, monosodium urate crystals, hyperurecemia
Presentation of pseudogout
Similair to gout
What do labs look like for pseudogout
Positively bifringent, calcium pyrophosphate rhomboid shaped cyrstals, NL serum urate level
Treatment for pseudogout
NSAIDS, colchicine, intra articular steroids
Treatment for gout
NSAIDS, colchince, prebnecid, zyloprim
Where does uric acid come from in gout?
purines
What accounts for hyperurecemia in gout?
Overproduction or most likely undersecretion
Risk factors for gout
Obesity, alcohol, and renal failure
What happens if gout is untreated?
Gouty tophi, it spreads to soft tissues
What is contraindicated in gout treatment?
Aspirin
How does cochicine treat gout?
It decreases neurotrphils and blocks release of chemical junk
Most commonly affected places in pseudogout?
Knee or wrist
Reiters syndrome usually occurs after
Genitourinary, gastrointestinal and possible resp. infections
What is SNSAs?
Seronegative spondyloarthropathies which means that it is not associated with RF or other autoantibodies
Which disease are SNSAs
OA, Septic arthritis, lyme, gout, psoriatic arthritis and reactive arthritis
What is the venereal cause of Reiters
Chlamydia
What is the triad for Reiters?
Nongonococcal urethritis, conjunctivitis, and assymetric oligoarthritis
What are the other manifestations for Reiters
Sausage digits, enthesopathy, circinate balanitis, and keratodermal blenorrhagica (rash on palms or soles) SECK
Treatment for Reiters
NSAIDS, intraarticular steriods, and DMARDS
What are the four signs of psoriasis?
Nail pitting, pink or salmon plaques w/ white scales, auspitz, and koebner
What treats both psoriatic arthritis and skin
Enbrel
What is the clinical features of psoriatic arthritis?
Oligoarthritis, small joints (DIP, MIP and MCP), sausage digits
What is arthritis mutilans and what disease is it associated with?
DIP joints in Psoriatic
What is the extra-articular involvement in Psoriatic?
Psoriatic skin lesions, nail changes, sausage digits and enthesopathy
What is the radiologic features of psoriatic arthritis?
Decreased interphalangeal space and pencil in cup deformity
Presentation of septic arthritis
Red, hot, swollen and painful
What causes septic arthritis?
Bacterial joint infection by something like a joint penetrating injury, iv drug use, or sex
what is most common cause of septic arthritis in young adults?
Neisseria gonorrhea
What is the synovial fluid presentation in septic arthritis?
Increased neutros, increased protein and decreased glucose
what diseases have high levels of WbC?
Gout, RA (lymphs) and septic arthritis (neutro)
Treatment for septic arthritis
If gonococcal it is rocephin
Is RA an inflammatory disease?
YES
Is OA an inflammatory disease?
NO
How long is morning stiffness for RA?
greater then two hours
What is the most commonly affected joints?
MCP and PIP
What are the finger deformities in RA?
Opera glass, swan neck, boutonniere, hammar
what are the early changes in RA
Injury to vasculature, hyperplasia of synoviocytes, fibrin leakage, t-cells emigrate, hypertrophic synovium, pannus, destroys
What is autoresponse of RA due to?
Type 3 hypersensitivity; mores specifically it is RF autoantibodies to Fc portion of IgG
what disease has CTS and what is it caused by?
RA and caused by entrapment of the median nerve
What is Gunyon's canal (cubital tunnel syn) syn and waht disease is it commonly associated with
RA and it is ulnar nerve entrapment at the wrist
What is tarsals tunnel syndrome and what disease is it commonly seen in?
RA and it is entrapment of posterior tibial nerve
Describe the skin changes in RA
Rheumatoid nodules of granulomatous inflammation
Describe ocular change in RA
keratoconjunctivitis sicca
Bad systemic complications associated with high RF levels
pulmonary fibrosis, pericarditis and heart failure and renal failure
what would an xray present like in RA?
erosions, osteopenia, narrowing, subluxation
Treatment for RA?
NSAIDS, intra steriods, DMARD
Rash associated with lymes?
Erythema migrans
Complications of lymes
knee arthritis, nuchal rigidity, bells palsy, dysrhythmia
how do you diagnose lymes
ELISA and western blot
Treatment for lymes
Doxycycline
What are the three things that will def. confirm SLE
Buttery mallor rash, light sensitivity and rayneuds phenomenon
what is rayneuds phenomenon associated with?
SLE, scleroderma, rheumatoid and smokers
Is SLE an autoimmune disease?
YES
Two unique ANAs to SLE
Double stranded DNA abs and anti Sm abs
What is the lab tests to diagnosis SLE?
Generic ANAs, anti dsDNA and anti Sm, CRP low
What are the manifestations for limited scleroderma?
CREST (calcinosis, raynauds, esophageal, sclerodactyly, and telangectasis)
Where is calcinosis most seen in limited scleroderma?
Fingertips
Raynauds progression in scleroderma
White, blue to red
What play a central role in pathogenesis of scleroderma?
T cells (CD4 and CD8) because they activate b cells (activate auto abs), fibroblasts (causes fibrosis), and other inflammatory WBCs
What problems are associated with diffuse scleroderma
Skin tightness, previous history of CREST, heart, lung, kidney or GI tract problems
What is the treatment for Raynauds syndrome with sclerderma disease
Calcium blockers, Angiotension II blockers
Treatment for GERD in scleroderma pt
H2 blockers, proton pump inhibitors
What is secondary Sjogrens
Sjogrens with RA, SLE and systemic sclerosis
What are the two gland dysfunctions in sjogrens
Lacrimal and salivary
What is the pathology of Sjogrens
Emigrations of CD4 T cells contact ductal epithelial cells which destruct glands
What type of hypersensitivity is sjogrens
Type 4
Three tests for sjogrens
Schirmers, RoseBengal and whole salive sialometry
Four main categories of clinical features for inflammatory myopathies (polymyositis and dermatomyositis)
Proximal muscle weakness STAIRS AND CHAIRS, muscle enzymes, emg, and muscle inflammation
What are the enzymes associated with polymyositis?
AST,ALT, CPK MM and LDH
What is rhabdomyolysis and what disease associated with?
Urine dip is positive for hemoglobin but it is due to muscle breakdown; polymyositis
What is the fifth clinical feature of polymocystitis?
Skin rash (dermatomyositis)
Four signs indicating dermatomyositis
Shawl sign, gottron's sign (papules), heliotrope rash, and mechanics hands
Treatment for polymyocisitis and dermatocystisit
Steriods fuided by CPK MM monitoring and DMARDS (methotraxate)
what is polymalgia?
not an autoimmune disease and it is charecterized by myalgia of proximal muscle groups; no permanent muscle weakness or degeneration
What do people with polymyalgia also develop?
Temporal arthritis
What labs are important for diagnosis of polymyalgia
very high ESR of 50-100
how is diagnosis made for polymyalgia?
Increased ESR, good response to steriods and muscle pain and stiffness
Group most commonly affected by polymyalgia
White women over 50
Treatment for polymyalgia
With temporal arthritis is high steriods; no temporal arthritis is low steriods
How do you diagnose fibromyalgia?
11 out of 18 trigger points, history of affective disorders, widespread pain; exclude everything else
What NT is increased in fibro?
Substance P
What is substance P?
It is a neurotransmittor of pain in the dorsal horn of the spinal column;correlates poorly with degree of tenderness in fibro
Describe blood flow interuption in fibro
Decreased blood flow to thalamus and caudate nucleus
Descrbie sleep interuption in fibro
Alpha wave intrustion of stage 3-4 sleep
What type of disease is sarcoidosis?
non caseating granulomatous disease
Describe inflammation process of sarcoidosis
Macros arrive and are mad and they morph into squamous epitheloid cells. Then lymphos arrive and squirt cytokines onto macros to make them more mad to form multinucleated giant cells; then lymphs remain as collar and they attract mono, fibros and macros
Immune features in sarcoidosis
Decreased cellular immunity and increased humoral immunity
What is the pulmonary clinical feature of sarcoidosis
bilateral hilar and mediastinal lymphadenopathy and dyspnea
Clinical features of skin in sarcoidosis
Erythema nodosum which is a good prognosis and lupus pernio which is a bad prognosis
lab diagnosis of sarcoidosis
ACE, hypercalcemia and hypercalicuria, and positive kveim-slitzbach test (similair to PPD)
Treatment for sarcoidosis
Steriods, bisphosphonate and or miacalcin, colchicine, rheumatrex
What type of fractures as associated with osteoporosis
Pathological fx esp. of the femur head, vertrae, pelvis and distal radius
Biggest risk factor of OP
post menopausal life
Xray findings for osteoporosis
Vertebral fx, visible osteopenia
How do you detect OP early?
DEXA scan
Most effective treatment for OP
HRT
What treatments for OP?
Evista (no increased risk of CVD or CA), Bisphosphonates (inhibits osteoclasts), Miacalcin (increases bone density and stops bone pain)
What causes primary op
senile or post menopausal
What causes secondary op
Endocrine, neoplastia, malnutriont, drgus, immobilization long term
Where is bone loss most abundent at in op
where there is lots of trabeculae
What disease is Doc my hat don't fit no more
Pagets
Three things that are clinical manifestations of Pagets
bone pain, enlarged and or deformed bones, chalkstick fractures
What two labs are abnormal in pagets
Urine calcium and hydroxyproline elevated and alkaline phosphatase is elevated, increased alkaline phosphatase
What do the xrays look like in pagets
More radiopaque bone in some areas and less white bone in other areas
What major microsocopy is seen in pagets
WOVEN bone
What are the complications from pagets
Bone Hypervascularity which has increased CO, back pain and radiculopathy, and entrapment of the cranial nerves for cranial neuropathy
Treatment for pagets
Bisphosphonate (fosamax)
What two disease have pathological fractures
OP and pagets
three phases of pagets
Primary osteolytic phase involves osteoclasts, mixed phase has absorption and formation together, and osteosclerotic phase is new bone formation