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77 Cards in this Set
- Front
- Back
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What is the first step in identifying what a disease is?
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distribution
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Polyarticular means what?
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many joints
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Monoarticular means what?
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one joint
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Oligoarticular means what?
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a few joints
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Migratory arthropathy means what?
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it moves around
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What are the 3 polyarticular symmetric diseases?
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rheumatoid arthritis, SLE, viral (hep B, EBV, CMV, B19)
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What is CMV associated with?
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organ transplant
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What is Parvo B19 associated with?
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slap cheek
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What are the 3 diseases associated with monoarticular arthritis?
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osteoarthritis, gout, septic arthritis
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What is a clue pointing at osetoarthritis?
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gets worse as the day goes on- it's bone on bone grinding
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What is the only disease to effect a few joints on either side of the body?
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spondyloarthropathies
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What are the 3 migratory arthropathies?
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rheumatic fever, gonococcal arthritis, lyme disease
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What is the second step is figuring out what disease is causing joint pain?
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acute or chronic
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What is acute, and what is chronic?
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OA is chronic
Septic and Gout are acute |
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What is the 3rd step?
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Is there any evidence of systemic symptoms
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What is the 4th step?
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any inflammation
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When does RA affect women?
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never before menopause
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When does RA affect men?
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in their 30's
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Whenever there is fluid in a joint, you need to do what?
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aspirate it
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What are the contraindications to joint aspiration?
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bleeding disorders, anticoagulants with bleeding, cellulitis overlying
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In what order should you always order tests?
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the 3 C's- WBC's, crystals, cultures
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What are the WBC ranges for OA/traumatic arthritis?
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200-2000
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What is the WBC range for inflammatory arthritis (RA, Gout)?
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5000-50,000
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What is the range for WBCs in septic arthritis?
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> 50,000- BUT, if given a number below 50K, make sure they weren't given Ab's before the tests
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Where does gout affect first? What are the crystals associated with gout?
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big toe- (-) birefringent crystals
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Where does pseudogout affect first? What are the crystals associated with pseudogout?
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knee first- (+) birefringent crystals
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What is the marker for SLE in the blood?
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antinuclear antibodies (ANA)
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What will SLE always be + for on the boards?
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+ ANA
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If you get a positive ANA, what is the next step?
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test for anti DS DNA, anti smith to confirm diagnosis
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What SLE is associated with anti DS DNA?
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SLE, lupus nephritis
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What lupus is associated with anti histones?
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drug induced lupus
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What is associated with anti RO?
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neonatal lupus, Sjogrens
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What is associated with anti LA?
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Sjogrens
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What is associated with anticentromere?
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CREST
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What is associated with anti RNP?
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mixed connective tissue disease
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What is the distribution of rheumatoid arthritis?
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symmetric distribution
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What dot he labs look like for RA?
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increased RF, anemia, increased ESR (infection)
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What is bone described as on x-ray for RA?
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eroded, described as a hook
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What is the old treatment for RA?
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NSAIDS > steroids > methotrexate
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What is the new treatment for RA?
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methotrexate, after 1 week add prednisone for 1 week, only use for flare ups
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What is the treatment for SLE?
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NSAIDS for arthritis
antimalarial- chloroquine steroids- for major organ involvement cytotoxins- azathioprine, cyclophosphamide |
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What is not present in drug induced lupus that is seen in SLE?
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major organ involvement
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What is the treatment for drug induced lupus?
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discontinue the offending drug
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What does the skin look like with scleroderma?
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thick
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What happens to the GI in scleroderma?
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esophageal dysmotility, hypomotility of small bowel
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What happens to the lungs in scleroderma?
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fibrosis
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What happens to the kidneys in scleroderma?
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malignant HTN
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What is the most common cause of death with scleroderma?
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pulmonary
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What is the limited form of scleroderma?
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CREST
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What is seen with crest regarding the skin?
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symmetrical thickening of the skin
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What does CREST stand for?
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c- calcinosis
r- raynaud phenomena e- esophageal dysmotility s- sclerodactly (claw hand) t- telectasia |
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What is the marker for CREST?
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anti centromere antibodies
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What are the symptoms of Sjogren's?
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dry mouth and eyes, lymphoproliferative disease, bilateral parotid enlargement, itchy eyes, 'sand' under eyes
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What is the treatment for Sjogrens?
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artificial tears and pilocarpine to increase secretions
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What are the 4 diseases under the spondyloarthropathies?
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ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthropathy
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What is a big clue pointing at ankylosing spondylitis?
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young male in his 20's, chronic lower back pain, morning stiffness > 1 hr, gets better with exercise
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What is the management for ankylosing spondylitis?
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NSAIDS, physical therapy, exercise
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What causes reactive arthritis?
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complication of an infection somewhere in the body
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What causes reactive arthritis after non-gonococcal urethritis?
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chlamydia, urea plasma
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What causes reactive arthritis after infectious diarrhea?
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camphlobacter, shigella, salmonella
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What is the management for reactive arthritis?
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NSAIDS and prompt antibiotics
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What are 3 major clues pointing to psoriatic arthritis?
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DIP joint involvement, nail pitting, sausage shaped digits
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What are the only 2 disease that affect DIP?
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OA, psoriatic arthritis
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What is the most common joint involvement with osteoarthritis? Second? Joint with the greatest disability?
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1st- knee
2nd- hand or thumb greatest disability- hip |
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On xray, what does osteoarthritis look like?
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unequal joint space, bouchard's nodules (PIP) and heberden's nodules (DIP)
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What type of crystals are seen in gout?
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monosodium urate
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What type of crystals are seen in pseudogout?
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calcium phrophosphate
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When do you seen calcium oxylate crystals?
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in malabsorption and antifreeze ingestion
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What 2 diuretics cause gout?
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hydrochlorthiazide, furosemide
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What 2 antiTB meds cause gout?
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pyrazinamide and ethambutol
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What is the DOC for acute gout?
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indomethacin
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If indomethacin doesn't work, what do you use?
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colchicine
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For chronic gout, if the pt is an undersecretor (U/A <800), what do you give them?
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probenecid
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For chronic gout, if the pt is an oversecretor (U/A >800), what do you give them?
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allopurinol
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What shape are the crystals in gout?
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needle like
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What shape are the crystals in pseudogout?
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rhomboid
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What is the most common cause of septic arthritis?
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gonorrhea
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