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82 Cards in this Set
- Front
- Back
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What are the most common fracture sites in osteoporosis?
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Vertebrae (most common), femoral neck, pubic rami, radius (wrist), rib
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What are the non-modifiable risk factors for osteoporosis?**
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Age, sex, race, body size, genetics, previous fx/ relatives w/ hx, chronic illness/ poor health, dementia, endocrine
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What are the modifiable risk factors for osteoporosis?**
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Low Ca+, low vit D, exercise (too little OR too much), low body weight.**
Also: etoh, caffeine, smoking, low sex hormones |
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What are meds used for osteoporosis?**
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Steroids, anti-seizures, thyroid replacement (synthroid), antisex hormones
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What is the main treatment for osteoporosis?
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Calcium, vit D, bisphosphonates
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Dx of osteoporosis?
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Labs, xray, DEXA to confirm
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What are polymyalgia rheumatic and temporal arteritis (giant cell arteritis)?
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Polymyalgia rheumatica is a rare, inflammatory condition that causes pain or aching in the large muscle groups, especially around the shoulders and hips.
TA: inflammation that damages large and med size arteries. Many ppl have both PMR and TA. |
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What patient pops are usually at risk for PMR and TA?
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Women more than men, >60 yo
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What are the symptoms of PMR?**
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Morning stiffness (shoulder, hip), sudden onset, knee effusions, carpel tunnel.
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What lab changes would you see in PMR?
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Increased ESR, CRP and anemia
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What is tx for PMR?**
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Low dose steroids (10-20 mgs prednisone). Most pts have a rapid response.
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What are the classic sx of temporal arteritis?**
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HA, Visual loss*, temporal artery tenderness, jaw claudication, fever, weight loss, PMR
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What is treatment for TA/GCA?**
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High dose steroids*, 60 mg prednisone IMMEDIATELY, then daily thereafter.
Call ophthalmologis for bx** |
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For which (of PMR and TA) would you give low dose vs high dose steroids?
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PMR: low dose.
TA: high dose. |
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What would you use to treat RA as a combo therapy?
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2/3 DMARD (disease modifying antirheumatic drug) + biological
Don't use two biologicals together --> side effects |
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What should you know about RF in testing for RA?**
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Never base diagnosis solely on RF! Not diagnostic. Many false positives and false negatives. RF positivity increases w/ disease duration, high titer more meaningful and worse prognosis.
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What is anti-CCP (cyclic citrullinated peptide)?**
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Newer test for RA. More specific and more sensitive, but not essential for dx. High titer = worse prognosis.
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What would you see on PE in RA?**
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Symmetry, soft tissue swelling, PIPs, MCPs and wrists
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What xray findings would you expect in RA?**
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Symmetrical and bilat joint space loss. PIPs, MCPs. Atlanto-axial subluxation (transverse ligament gets eroded), corner erosions of small joints ("mouse bite erosions")
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What is an important extra-articular manifestation of RA?**
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Pulmonary interstitial fibrosis (MAY INTERACT W/ METHOTREXATE). Very similar to methotrexate pulmonary toxicity.
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What are some advances in RA treatment that have been made?**
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Early, aggressive intervention improves outcome, Methotrexate! (main tx, low side effects, cheap, widely used). Biologic agents! (humira, remicade, etc).
Combo therapy!!: DMARD + another DMARD or biologic. |
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What are 5 indications of a poor prognosis of RA?**
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High anti-CCP, High RF, erosions, high esr or crp, extra-articular manifestations
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What lab tests would you work up for RA?
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ESR, CRP, RF, Anti-CCP, ANA, CBC
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What are the pros of treating RA with oral steroids?**
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Good for treating flares, minimizes or controls disease activity
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What are the cons of treating RA with oral steroids?**
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Higher doses or duration means more side effects. Difficult to discontinue
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What are precautions to take into consideration with using oral steroids to treat RA?**
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Glucose, bone density, bp, weight gain , cataracts
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What is the Gold Standard treatment for RA?**
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Methotrexate. - Basic first line treatment.
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How is Methotrexate administered?**
Dose?** |
PO, IM, Subcu, IV or intra-articular. Parenteral absorbed better than PO>
2.5-25 mg once a week. |
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What are possible side effects of Methotrexate?**
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Megaloblastic anemia (folic acid deficiency), leukopenia, thrombocytopenia, rash, oral ulcers, increased liver enzymes, GI upset.
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When would you want to treat RA with DMARDS (hydroxycholoroquine, sulfaslalzine) instead of Methotrexate?
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Mild disease or if methotrexate isn't working well enough. (can also be given in combo w/ methotrexate).
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What is a side effect of Hydroxychlloroquine (Plaquino) (DMARD)?
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Can rarely cause macular inflammation. Need to have an eye exam once per year.
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What is carpel tunnel syndrome?
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Median Nerve dysfunction due to trauma, disease or compression
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What are the symptoms of Carpel Tunnel syndrome?**
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Numbness, pain, weakness of first 3.5 fingers
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What are the signs of carpel tunnel syndrome?**
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Swelling, Tinel's sign, Atrophy of thenar or interosseous muscles first 3.5 fingers.
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What is Tinel's sign?
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Way to detect irritated nerves. Involves light tapping over the area of the nerve looking for tingling or pain.
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What risk factors are associated with carpel tunnel syndrome?**
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Idiopathic, endocrinopathies (DM, hypothyroid), RA, PMR, isolated or repetative trauma (most common!)*, pregnancy, obesity
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What should you do first if suspecting a Baker Cyst (PTP - pseudo- thrombophlebitis)?**
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Rule out DVT!! with doppler US.
Then: PE, xray, labs if approp, synovial fluid analysis |
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What are the extra-articular manifestations of a RA?
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Anemia, fever, weight loss, vasculitis, pulm fibrosis, pericarditis, pleuritis, nodules, Felty's syndrome (RA, low WBC, enlarged spleen)
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What is SLE?
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Multi-system autoimmune disease/ connective tissue disease
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What are the criteria for classification of SLE?
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Malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, nero disorder, hematologic disorder, immuno disorder, ANAs, renal disorder
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What is a reasonable INITIAL lab screen for SLE?**
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CBC, esr, UA, RF, ANA, CK, RPR or VRDL for syphilis, chem panel, thyroid functions
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What is ANA?
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Antinuclear antibody - INDIRECT immunofluorescent test, primary test for SLE
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What is a reasonable SECONDARY lab screen for SLE when ANA is pos?**
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Complement (decreased), DNA binding (increased), ACLs (anti cardiolipin), LAC (lupus anti-coag)
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What systems are most invovled in SLE?
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Joints (most), skin, serositis, kidney, Raynaud's, mucosa, CNS
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What is Swan Neck deformities in SLE?
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Extension deformity at PIP and flexion deformity at DIP. Due to lysis of flexor tendons at PIP
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What are 6 joint issues in SLE?
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Early inflammatory arthritis, non-deforming arthritis, Swan neck deformities, Ulnar drift, RA erosive arthritis, aseptic necrosis (bony mineralization increased)
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What is indicated if a patient has renal involvement in SLE?
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Much worse prognosis
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What is treatment for SLE?
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Usually benign, annoying and easily controlled. Treat clinically probs, not lab tests.
NSAIDS, Plaquenil, mtx, steroids, benlysta, immunizations |
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What are two exceptions to minimal treatment for SLE?
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High or increasing anti-DNA antibodies, Low or decreasing C3 or C4.
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What is the correlation between thromboembolitic disease and SLE?
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Increased risk. Anti-phospholipids, Lupus anti-coag. Plaquenil may help by inhibiting platelet aggregation and adhesion.
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What is APLS (anti phospholipid antibody syndrom)?
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Assoc w/ SLE or other connective tissue diseases, but can also be isolated. Hypercoagulable state.
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What are the clinical criteria of APLS?**
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Venous thrombosis, arterial thrombosis, miscarriage, thrombocytopenia, hemorrhage (due to treatment).
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What is Sjogren's syndrome?
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Exocrine glands that produce tears and saliva dysfunction due to autoantibodies against them.
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What should you expect to see in Sjogrens syndrome?**
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Dry eyes, dry mouth, painful sex due to lack of lubrication.
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What autoimmune disorders are associated with Sjogrens?
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SLE, RA, PSS, PM/DM, Cryoglobulinemia, autoimmune hepatitis
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What is the Schirmer test?
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Paper put in eye to determine if eyes are being lubricated. If paper stays dry, decreased tears.
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What is polymyositis and dermatomyositis (PM/DM)?
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Weakness and pain in all muscles.
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What is it important to test enzymes in PM/DM?**
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Need to know them in order to identify medication side effects.
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What enzymes effect the muscle only?**
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CPK, Aldolase
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What enzymes effect the liver only?**
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ALT. If ALT is normal, then Myositis is not drug-induced
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What does a normal ALT tell you in PM and DM when CPL and aldolase are elevated?**
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Muscle is the source of PM
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What does an elevated ALT but normal CK and aldolase tell you in PM?**
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Liver is the source.
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What is PSS (progressive systemic sclerosis, scleroderma)?
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Extremely rare, progressive fibrosis/ sclerosis of skin and other organs. Pulmonary or renal involvement can be fatal.
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What is Fibromyalgia?**
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Chronic pain syndrome with painful points in characteristic locations. Muscular - NOT articular.
Assoc w/ a sleep abnormality. |
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What is the criteria for dx fibromyalgia?**
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Widespread pain, axial pain must be present, at least 11 of 18 tender points, pain present at least 3 months, can be assoc w/ illnesses
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What is management of fibromyalgia?**
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Education, meds, pt, exercise, trigger point injections of steroid + lidocaine or botox. Does not cure disease.
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What are 9 tender point locations in fibromyalgia?
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Occiput, low cervical, trap, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, knee
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What are common drugs used for fibromyalgia?**
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Approved: Savella, Lyrica, Cymbalta**
Unapproved: NSAIDS, Anti-depressants, analgesics, anti-seizure* TCAs* (amitriptyline, imipramine, nortriptyline) |
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What is the SINGLE LARGEST CATEGORY of known "causes" of fibromyalgia?
Cause: precipitating event, not patho-phys |
Trauma - physical injury
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What should be a concern when prescribing pain meds for fibromyalgia?
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Addiction potential of opioids.
No perfect tx for chronic/ acute pain, numerous treatments. |
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What are the 4 basic types of pain?
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Nociceptive (pain caused by stimulus), neuropathic, acute, chronic
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What occurs in chronic pain neurologically?
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Pain signals are generated for no reason and may be intensified. Pain continues even after healing due to structural CNS changes that alter neural transmission.
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What are several treatments for chronic pain?
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Treat underlying disease, PT, Topical agents, tylenol, aspirin/nsaids, local injections, nerve blocks, opioids, implantable pumps, surgery
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What are 4 types of topical pain treatments for chronic pain?
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Steroids, capsaicin, lidocaine, nsaids
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What are co-analgesics?
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Enhance analgesia when combined w/ an opioid.
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What are 3 examples of co-analgesics?**
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Anti-depressants (tcas, snris), analeptics (anti-seizure), nsaids.
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What is the most effective modality of pain control? No target organs..**
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Opioids.
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What are the disadvantages of opioids?**
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Social stigma, regulatory pressures. **
Physical dependence doesn't necessarily signify addiction. |
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Is physical dependence an addiction?**
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NO**
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What is addiction?**
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Compulsive drug-seeking despite harm.
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What is the most commonly prescribed opioid, most commonly prescribed analgesic, and most commonly prescribed medication in the US?
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Hydrocodone
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What are some side effects of opioids?
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Constipation, itching, n/v, urinary retention, dependence, addiction potential, decreased sex hormones, sedation
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