Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
214 Cards in this Set
- Front
- Back
|
pleocytosis
|
increased ABC count in CSF
|
|
|
IgM conversion to IgG
|
lyme disease
|
|
|
spirochete in LD
|
borrelia burgdorferi
|
|
|
erythema migrans
|
LYME
|
|
|
symps of Lyme
|
erythema migrans, headaches, nuchal rigidity, bilateral bells palsy, AV block, fever. fatigue,
|
|
|
most common joint pain in lyme
|
knee effusions
|
|
|
genus of tick
|
ixodes
|
|
|
pleocytosis & increased CSF protein
|
lyme
|
|
|
treatment for lyme
|
vibramycin (doxy) or amox
|
|
|
drug for carditis/meningitis
|
rocephin (ceftriaxone)
|
|
|
rocephin
|
ceftriaxone
|
|
|
intense osteoclast & hypervascularity of bone with osteoblastic activity
|
pagets disease
|
|
|
symptoms of pagets
|
often asym. BONE pain is first sympt, increased warmth of skin, kyphosis, bowed legs, increased hat size and headaches
|
|
|
pathophys of pagets
|
primary osteolytic, mixed, osteosclerotic
|
|
|
osteolytic phase of pagets
|
highly vascular CT replaces marrow, osteoclastrs reabsorb bone
|
|
|
mixed phase of pagets
|
bone absoprtion and new bone formation
|
|
|
osteosclerotic phase of pagets
|
new bone formation continues, thickening of bone,
|
|
|
bone patterns in pagets
|
lack normal lamellar structure, woven bone, mosaic pattern
|
|
|
woven bone
|
pagets
|
|
|
mosaic pattern
|
pagets
|
|
|
chalkstick fracture
|
pagets disease
|
|
|
lab findings for pagets
|
-serum calcium and phosphorous are normal
-alkaline phosphotase increased during osteoblast phase -urine calcium increase during osteolytic -hydroxyproline increase during active phase |
|
|
xray findings for pagets
|
multiple fissue fractures and more radiopaque
|
|
|
vascular complications of pagets
|
increase CO, CHF, steal phenom, ischemic neuro
|
|
|
skull growth and cranial nerve entrapment
|
pagets
|
|
|
treatment/drugs for pagets
|
bisphosphates
boniva (ibandronate) fosamax (alendronate) |
|
|
therapy for pagets
|
bisphosphates when alkaline phos is high, drug holiday, then continue when increased again
|
|
|
boniva
|
ibandronate
|
|
|
fosamex
|
alendronate
|
|
|
signs for PD/DM
|
proximal muscle weakness elevated skel muscle enzymes EMG evidence muscle biopsy infam ND 5TH SKIN RASH
|
|
|
when do you see PD/DM
|
slow onset 3-6 months without identiable event
|
|
|
muscles involved in PM/DM
|
mostly proximal and large, neck, limbs, trunk
laryngeal (dysphonia) |
|
|
are facial muscles seen in PM/DM
|
nooooooooo
|
|
|
difficulty chairs and stairs/ lifting head off pillow
|
PM/DM is one
|
|
|
labs for PM/DM
|
increased ALT, AST, aldolase, CPK-MM, LDH
increased sed urine dip positive for hem/myo |
|
|
rhabdomyolysis
|
in PM/DM.
|
|
|
immunopath for DM/PM
|
anti-jo1 abs, tcells and macros surround non nectrotic fibers
|
|
|
DM signs
|
gattrons
v sign shawl mechanics perungual telangiectasis heliotrope rash |
|
|
treatment for PM/DM
|
glucocorticoids
prednisone methylpred tx guided by CPK MM monitoring DMARDS- methotrex or azathioprine |
|
|
affective disorder
|
fibromyalgia
|
|
|
mostly middle aged women, races equal
|
fibromyalgia
|
|
|
mechanism for fibromyalgia
|
CNS mech
|
|
|
lab findings for fibromyalgia
|
NONE
|
|
|
attempted findings for fibromyal
|
increased levels of substance P in CSF
decreased blood flow to thalamus and caudate nucleus stage 3-4 sleep increased alpha wvae intrusion |
|
|
treatment for fibromyalgia
|
steroids are no good
exercise and stretching muscle relaxant nsaids ehhh (cox2 inhib) tricycl antidep SSRI combo |
|
|
COX2 INHIBI
|
fibro myalgia
vioxx celebrex |
|
|
diagnosing fibromyalgia
|
11 of 18 trigger points
widespread pain >3 months |
|
|
epidemiology of polymyalgia rheum
|
whites oldd women
|
|
|
labs for polymyalgia rheum
|
none specific
increasedsed rate |
|
|
temporal arterities is seen in
|
polymyalgia rheum
|
|
|
signs of polymyalgia rheum
|
slow onset 3-6
proximal muscle weakness stairs chairs combing hair cleaning windows lifting head off pillow morning stiffness gelling |
|
|
no evidence of muscle degeneration
|
polymyalgia rheum
|
|
|
treatment for polymyalgia rheum
|
w/o TA- low dose and monitor ESR
w/ TA high dose sterods |
|
|
granulamatous disease
|
sarcoidosis
|
|
|
sarcoidosis is chronic oracute inflam
|
chronic
|
|
|
phys of sarcoidosis
|
macros become epitheloid in center of granuloma
lymphos arrive screte cytokines multinucleated giant cells by fused macros fibroblasts come and contribute and block off collar |
|
|
collar
|
sarcoidosis
|
|
|
causesfor granulomatous rxn
|
sutures breat implants vascular grafts syphilis silica leprosy tb
|
|
|
distributed granulomas
|
liver lymph and lungs
NON CASEATING |
|
|
etiology of sarcoid
|
unkown, possibly environmental agent- eaggerated inflam response
|
|
|
epidem of sarcoid
|
african americans and northern european whites
|
|
|
immune features of sarcoid
|
depressed cell immunity- lymphopenia
heightened humoral imunity- lots of antibody |
|
|
lymphopenia seen in
|
sarcoidosis
|
|
|
antibodies of sarcoidosis and labs
|
ANA
increase liver enzymes ACE high hypercalcemia hpercalciuria |
|
|
clinical features of sarcoid
|
fever, weight loss, malaise, skin involvement, peripheral lymphadenopathy nontender, dry cough, dyspnea, nonspec chest pain, bilateral hilar and mediastinal lymphadenopathy arthitis in ankles myalgia hepatic granulomas
|
|
|
skin involvment of sarcoid
|
erythema nodosum- acute good
lupus pernia- chronic bad |
|
|
test for sarcoidosis
|
kviem-sitlzbach
|
|
|
treatment for sarcoidosis
|
no trmt for lymphaden
colchicine for arthritis steroids for hypercal and sarcoids bisphosphates for steroids and miacalcin DMARDS |
|
|
prescriptions for sarcoidosis
|
rheumatrex-methotrexate
miacalcn |
|
|
septic arthritis presentation
|
hot swollen red painful joint
|
|
|
how septic infxn wears away joint
|
hydrolytic enzymes from neutrophils destroy it and absorb cartilage
|
|
|
SA in kids
|
osteomyelitis open epiphysis
|
|
|
sa in teens and adults
|
neisseria gonorrhea
more women than men bc of menses |
|
|
SA labs
|
blood culture 50% +
increased protein and lactate decreased glucose increased WBC neutros |
|
|
normal syn fluid
|
<200/dl WBCs
10 mg/dl plasma glucose <2g/dl protein viscous 4-6 cm clear straw colored |
|
|
treatment for SA
|
treat early, empirically
antibiotic rocephin or nafcillin plus gentimycn iv |
|
|
rocephin
|
ceftriaxone
|
|
|
acanthosis
|
thickening of epidermis
psoriasis |
|
|
nail changes in PA
|
nail pits
oil slick brown yllow onycholysis nail thickening |
|
|
auspitz sign
|
PA
small bleeding points |
|
|
koebner phenom
|
psoriatic lesions on smal cuts surgical incs
|
|
|
may be form of reactive
|
PA
|
|
|
clinical features of psoriatic arthritis
|
oligoarthritis in scattered small joints
dactylitis arthritis mutilans- telescoping |
|
|
extra articular involvement of PA
|
nail pitting
enthesopathy psoriatic skin lesions |
|
|
radiological features of PA
|
pencil in cup deformity
acro osteolysis joint space loss |
|
|
pencil in cup
|
Psoriatic arth
|
|
|
acro osteoly
|
psoriatic arth
|
|
|
psoriasis trmt
|
vit d
vit a coal tar prep topical steroids puva rheumatrex enbrel |
|
|
enbrel
|
etanercept
|
|
|
PA treatment
|
enbrel
nsaids rheumatrex intra artic inject CAREFUL |
|
|
triad of reiters
|
conjuctivitis
arthritis urethritis |
|
|
grastroenteritis causes of reiters
|
salmonella
shingella yersinia camplyobacter clostridium difficile |
|
|
genitourin causes of reiters
|
chlamydia trachomatis
ureaplasma |
|
|
chylamia presentations of male
|
dyuria mucopurulent discharge
prostatitis epididmytitititititis |
|
|
chlaymia presen of females
|
dysuria vaginal dischasrge purulent vaginiits cervicitis
|
|
|
when articular menifestations appear after urethritis
|
1-3 weeks
|
|
|
appearance of pts with reiters
|
sausage digits
assymetric oligoarth warm swollen dusky blue joint enthesopathy |
|
|
extra articular manifestations of rewiters
|
circinate balanitis
keratodermal blenorrhagica |
|
|
circinate balanitis
|
ulcers of glans or shaft of penis
|
|
|
keratodermal blenorrhagica
|
palms and soles have sores LACK PITS IN NAILS**
|
|
|
las for reiters
|
no viable organisms in fluid
increased WBCs neutros increased sed rate C REACTIVE PROTEIN trbid fluid |
|
|
treatment for reactive
|
nsaids and exercise
DMARDS rheum |
|
|
joint destruction and systemic complications
|
rheumatoid arth
|
|
|
recurring synovitis
|
rheum
|
|
|
symmetric polyarthritis
|
rheum
|
|
|
commonly affected joints of rheum
|
MTP
PIP MCP Knees capral and wrist |
|
|
pathology of rheum
|
synovial microvasculature injurty
hypertrophy of synoviocutes type a and b congestion edema fibrin leakage hypertophic synovium pannus |
|
|
pannus
|
rheum
|
|
|
hypertrophic synovium
|
rheum
|
|
|
cytokines associates with rheum
|
IL-1b TNF alpha
|
|
|
collagenase
|
rheum arthritis
|
|
|
type of hypersens that rheum is
|
3
IC |
|
|
immune compenent of Rheum
|
antibodies autoimmune bind to Fc portion of IgG
|
|
|
rheum arth uses wich immungo
|
IgG
|
|
|
labs for rheum arth
|
>WBC lymphos
RF factor increased ESR C reactive anemia |
|
|
c reactive protein
|
reiters and rheum
|
|
|
morning stiffness for >2hrs
|
rheum
|
|
|
clinical manifestations of rheuma rth
|
adhesive capsulitis
morning stiffness >2hrs ulnar nerve entrapment at elbow (5flex, 45 parest) nodules in fingers, locking opera glass hands carpal tunnel guyons canal tendon rupture- buttouneris swan neck |
|
|
opera hands
|
rheum
|
|
|
finger locking
|
rheum
|
|
|
guyons canal
|
entrapment of ulnar nerve t wrist,
rheum |
|
|
DIP spared
|
rheum
|
|
|
bakers cyst
|
rheum
posterior herniation of joint capsule |
|
|
tarsal tunnel syndrome
|
posterior tibial nerve parethesis of sole
RHEUM |
|
|
MTP subluxations
|
rheum
|
|
|
skin/ocular/resp in rheum
|
rheum nodules granulatomaouososus inflam
keratoconjuctivitis sicca cricoarytenoid and fibrosis pleurisy/pleural effusion |
|
|
arytenoid--> dysphonia
|
RHEUM
|
|
|
GI tract sx with rheum
|
none only associated w/ NSAIDS
|
|
|
heart issues w/ rheum
|
pericarditis (restric)
pericardial effusion |
|
|
naproxen
|
alleve
|
|
|
treatment for rheum
|
NSAIDS
alleve, advil, naproxen corticosteroids intra atricular inj short course p.o. steroids DMARDS |
|
|
DMARDS for rheum
|
rheumatrex
enbrel (etanercept) kineret (anakira) |
|
|
calcium pyrophosphate
|
pseudogout
|
|
|
positively birefringent
|
pseudogout
|
|
|
patients w/ pseudogout
|
<60
trauma surgery severe illnes red hot swollen joint |
|
|
treatment for pseudogout
|
NSAIDS
colchicine intra artic |
|
|
primary degeneration of articular cartilage
|
osteoarthritis
|
|
|
most common arthritis
|
osteoarth
|
|
|
pathology of OA
|
eburnation
irregularities and splitting ulceration of cartilage & loss decreased glycosamingoglycan, keratan sulfate, chondroitin sulfate, hyaluronic acid increased MMP |
|
|
MMP
|
matrix metalloproteinase
osteoarth |
|
|
route theory of osteoarth
|
mechanical stress--> change chondrocyte metab -->MMPs-->cartilage disrup
|
|
|
crystals of calcium phosphate
|
OA
|
|
|
clinical features of OA
|
pain stiffness
periostitis subchondral microfractures periarticular muscle spasm morning stiffness <30 irritation of nerves by osteophytes gelling knee pain gait decreased manual dext spine pain crepitus varus deform |
|
|
osteophytes
|
OA
|
|
|
subchondral microfract
|
OA
|
|
|
periarticular muscle spasm
|
OA
|
|
|
bouchards
|
OA
PIP |
|
|
heberdens
|
OA
DIP |
|
|
subchondral bony sclerosis
|
OA
|
|
|
labs for OA
|
H&P and xray
|
|
|
OA treatment
|
exercise
heat massage OT PT lose weight |
|
|
drugs of OA
|
APAP
NSAIDS capsaicin cream ZOSTRIX oral chondoitin sulfate intra art steroid inj/hyaluronic acid synvise hyalgan |
|
|
zostric
|
OA
capsaicin cream |
|
|
surgery
athroplasty arthroscopic debride |
OA
|
|
|
hyperuricemia
|
gout
|
|
|
patients w. gout
|
men in 40s
hyperuricemia alcohol obesity renal dysfxn |
|
|
high in gout
|
monosodium urate
|
|
|
treatment for gout
|
zyloprim allupurinol
benicid (probenicid) colchicine NSAIDS indocin |
|
|
absent phase in gout
|
intercritical phase
|
|
|
negatively birefringer monosoidum urate
|
gout
|
|
|
gout contraindic
|
apsirin
|
|
|
how colchicine works
|
decrease neutrophil emig
blocks chem junk release |
|
|
benicid
|
increase urate excre
probenicid |
|
|
zyloprim
|
allopurinol
inhibits xanthine oxidase |
|
|
schirmer test
|
sjogrens
|
|
|
antibodies for sjogrens
|
anti SS A Ab Ro
anti SS B Ab La |
|
|
tests for sjogrens
|
rose bengal
schirmer whole saliva sialometry |
|
|
sjogrens trmt
|
avoid anticholinergics
hypotears restasis (cyclosporine) sugarless gum parrafin evoxac (cevimeline) steoirds DMARDS vag lub |
|
|
evoxac
|
sjogrens
cevimeline |
|
|
antibodies of SLE
|
anti dsDNA
anti Sm ANAs |
|
|
cell abn in SLE
|
hyperglobulinemia
increased Ab producing cells heightened response ICs |
|
|
raynaud
|
sjogrens
SLE |
|
|
features of SLE
|
discoid lesions
malar alopecia mucus membrane lesions myalgia fibromyalgia renal dysfxn neuropsychiatric serositis |
|
|
chorea
|
SLE
|
|
|
OBS
|
SLE
|
|
|
LOW C reative
|
SLE
|
|
|
crush fx
|
OP
|
|
|
types of OP
|
localized & generalized
local- disuse primary post men senile secondary various causes |
|
|
secondary OP causes
|
cushing
parathy multiple myeloma malnutr drugs |
|
|
OP lab findings
|
serum calc and parathy alkaline phos normal
|
|
|
OP therpay
|
HRT
EVISTA bisphos |
|
|
diffuse scleoderma
|
systemic sclerosis
|
|
|
limited scleroderma
|
calcinosis
raynaud esophageal dysmotility sclerodactyly telangioectasis |
|
|
barrets esoph
|
scleroderma
precancerous lesion |
|
|
dysphagia
gerd |
scleroderma
|
|
|
systemic sclerosis caused by deposition of
|
collagen
fibroblasts cause |
|
|
antibodies in scleroderm
|
limited: anti-centromere
diffuse SCL-70 |
|
|
centrol role in scleroderm pathology
|
activated tcells
|
|
|
t cell isues in scleroderm
|
activate b cell-->antibodies
activate fibroblasts -->fibrosis injured endothel -->ischemia actv of WBCs -->inflam |
|
|
saccular diverticuli
|
scleroderm
|
|
|
treatment for sclerod/sys sclero
|
NONE
symptomatic no steroids for raynaud: c.c. blockers, angiotensin ii recep blockers gerd-h2 blockers proton pump inhib hypertension ACE inhib |
|
|
decreased slveolar uptake of o2
|
sclero/system
|
|
|
decreased GFR
|
systemic sclero
|
|
|
acute inflam
|
neutros
min to days blood -->tissues resolves |
|
|
chronic inflam
|
lymph macros
days to years tissue destruction tissue repair neovascularizaton and fibrosis |
|
|
3 parts of acute inflm
|
local hyperemia
vascular permeability wbc emigration |
|
|
local hyperemia
|
increase blood flow decrease velociuty
red and warm |
|
|
vascul perm
|
swollen painful
endothelial cell leakiness histamine release stasis of bv |
|
|
chemical mediators in acute inflam
|
TNF
leukotrienes bradykinin interleukin-1 histamine |
|
|
leukocyte emig
|
decrease laminar flow
diapedesis in venules |
|
|
chem mediators of inflam
|
vasoactive amines
eicosanoids |
|
|
vasoactive amines
|
chiefly histamine in mast cells
IgE binds to mast cells arteriolar dilation venular leakage edema |
|
|
eicosanoids
|
prostaglandins and leukotrienesC5a activates phospholipases to chew up membrane and release AA
|
|
|
c5a
|
in eiconasoids activates phospholipases to make AA
|
|
|
NSAIDS do what
|
block cycloyxgenase patghway
|
|
|
how do steroids work
|
block phos lip induced oroduction of AA
|
|
|
LEUKOTRIENE RECEPTOR ANTAGONISTS
|
ACCOLATE (zafirlukast)
SINGULAR (montelukast) |
|
|
5 lipoxygenase inhibitor
|
zyflo (zileuton)
|
|
|
acute phase reaactions
|
lethargy
fever dec'd appetite |
|
|
hepatic production of acute phase reactants
|
fibrinogen
creactive complement |
|
|
makes no
|
tnf
|
|
|
outcomes of acute inflam
|
complete resolution
scarring abscess progression to chronic |
|
|
morphologic patterns in acute and chronic inflam
|
suppuritive
fibrinous ulceration serus |
|
|
where lymphs drain
|
from left sub and left intn jug
|
