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108 Cards in this Set
- Front
- Back
Uveitis caused by what rhematic diseases?
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HLAB27 disease, Behect's, JRA, Sarcoidosis
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_____ uveititis: Inflammatory cells in anterior chamber with minimal spillover into the retrolental space
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Anterior. Must ddx: hla27, behects, sarcoid, guchs, JRA, sphyilis, herpes, maduarede syndrome
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_____ uveitis: inflammatory cells in the vtreous
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intermediate
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_______ uveitis: inflammation of retin or choroid, with or without vitritis
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posterior
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panuveitis=
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inflammatory cells eveyrwhere
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if you classfy uveitiis as limited it means it occurred for
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less than 3 months
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If you classify uveitis as reucurrent that means there was
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greater than 3 months between episodes
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If you classify uveitis as chronic that means that
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the episodes are lessn tha 3 months apart, not including treatment time.
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Standard workup for a pt with uveitits:
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FTAABS, Lyme antibiody, chest x ray, cbc differentials. Also consider getting HLA-B27 and ANA (for kids with uveitis)
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HLA-B27 is associated with
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ankylosing spondylitis, reiters syndrome, psoriatic arthritis, IBS
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With anterior uveitis, 50% tend to be ____ positive
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HLAB27
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30-40% of pts with ankylosing spondylitis will have at least one episode of __________
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uveitis
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HLA-B27 is positive 71% in what kind of uveitis?
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unilateral and recurrent
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HLAB27 positive patients present __________% unilaterally or unilateral alternating
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93%
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Duration of treatment for anterior uveitis due to HLAB27? Number of attacks?
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4-9 weeks per attack. Median number of attacks is 3 (range 1-26)
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This syndrome involves urethritis, conj inflammation, polyarthritis, and possibly keratitis. It is triggered by diarrhea or dysentary.
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Reiters. Cant see, can't pee, can't climb a tree)
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IBS with uveitis is usually _________________. Wherease IBS wih sclerouveitis is usually _____________
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psoitive HBLAB27 with sacroilitis. Usually negative HLAB27 and have other RA type arthritis but NOT sacroilitis
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How do you treat anterior uveitis due to IBS?
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topcial corticosteroids, ALWAYS use pred forte. 58% require oral corticosteriods.
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How do you taper steriods?
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When there is a 2 step decrease in number of cells= 1 grade level decrease.
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For unilateral, intermittent uveitis you should use
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periocular steriod injectsion. Also, given for CME
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Oral cortiocsteriods are prescribed for
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bilateral, chronic, vision threatening diseaess
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After steriods hae been stoped in chronic uveitis, you shuold give
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immunosuppresive drugs
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If your pt is a steriod responsder ggive
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rimexolone, a mild steriod, and prssure lowering meds. MUST check IOP at every visit
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Differeneces between Episclertitis and Sclertitis 1. Symptoms? 2. Inflammation? 3.Systemic dsease? 4Treatment?
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Episcleritis: inrritation, superifical inflammation, uncommon to have systemic disease and you ise TOPICAL treatment. Scleritis: you have pain, deep inflammation, commonly involving systemic diseases, and treatment is SYSTEMIC
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_____% of Sceritis cases are associated with systemic disease
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48%
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You can get necrotizing scleritis in pts with
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Wegener;s granuomatosis!!!! A vasculitis. See inflammation of small and medium sized blood vessels. Look for scleral thinning, peripheral ulcervative keratitis and painful red eye
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_______% of RA pts get sclertisi
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18
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4% of pts with _______ get scleritis
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Lupus
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Treatment of Scleritis:
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(90% of cases are inflammatory and are either given oral NSAIDS, oral Predniosone, or immunosuppressive therapy) (!0% are infectiosu and reuire antibiotics)
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If your pt presents with scleritis what must you do?
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ALWAYS DDX for syphilis and sarcoids (FTAABS, chest x tray), ANCA C and P (WEGENER'S test), urinalysis, chest x ray, lyme antibody, and RF and ANA
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Dr. N's favorite food?
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ice cream
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Dr. N's favorite mode of transportation?
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trains
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What tests for Wegener's?
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ANCA
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Age,Race,and Sex of a typeical SLE pt?
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9x more common in women, aged 20-30, more common in AF, Hispanics, and Asians.
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clinical manifestations of lupus
“DOPAMINe RASH” |
Discoid rash
Oral ulcers (+) photosensitivity Arthritis/Arthralgias (+) Malar rash: Redness on cheeks and bridge of nose (“butterfly” rash); photosensitive Immunological: Decreased WBC count Neurological Renal disorders (+) Anti-nuclear antibody (ANA +) Serositis (+): Inflammation of serous areas of the body, e.g. pleural cavity (pleuritis) Hematological (+): Anemia, thrombocytopenia |
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3 antibody Lupus blood testing
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Auto-antibodies (ANA, Anti-dsDNA, Anti-Smith, APLA)
i. Anti-dsDNA: Antibodies to own DNA that is very specific for Lupus ii. Anti-Smith: Specific for Lupus **important iii. APLA (Anti-phospholipid antibody): Antibodies directed to the phospholipids |
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What does the anti-smith Ab test specific for?
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lupus
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__________;Heterogeneous group of conditions linked by the presence of thickened, sclerotic skin lesions
Manifestations are diverse and include abnormalities of the vasculature and involvement of multiple organ systems. **mixed CT diseases often affect kidneys |
Sclerodera
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90% of pts with Scleroderma have what condition, as well?
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>90% of patients have antecedent Raynaud’s phenomenon
i. If have Raynaud’s, then will be diagnosed with scleroderma at some point |
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localized scleroderma characteristics;
CREST |
i. Calcinosis: Ca2+ deposits in skin, nodules
ii. Raynaud’s phenomenon iii. Esophageal dysmotility: Trouble swallowing, and acid reflux iv. Sclerodactyly: Fibrosis of skin on fingers, long tapering fingers, thin, long pointed fingers v. Telangiectasia: Small, red blood vessels all over the body |
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_______________:
Chronic inflammatory disorder caused by a lymphocytic infiltrate that destroys the lacrimal and salivary glands Characterized by a particular form of dry eyes (keratoconjunctivitis sicca, KCS) and dry mouth (xerostomia) |
Sjogren’s Syndrome
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___________________: is an overlap syndrome that embraces features of several connective tissue/rheumatic diseases such as SLE, scleroderma, and polymyositis
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Mixed Connective Tissue Disease (MCTD)
Patients appear to have a lupus-like disease or myositis, and over time develop scleroderma-like manifestations |
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what is the antibody used to test Mixed Connective Tissue Disease (MCTD)
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Characteristic antibody: Anti-RNP (ribonucleoprotein antibody)
Usually responsive to steroids |
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a. Reiter’s syndrome: Usually follows a________
b. Reactive arthritis: Usually follows gastrointestinal problems___________- |
STD
gastrointestinal problems |
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what is Enthesitis?
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a. Inflammation at sites where tendons, ligaments, and joint capsules attach to bone
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what is Sacroiliitis?
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a. Inflammation of sacro-iliac joints
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What is Dactylitis ?
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a. Inflammation of 1 or more fingers; sweating and pain in fingers
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what isSpondylitis ?
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a. Inflammation of 1 or more vertebrae
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T/F . The Seronegative Spondyloarthropathies affect MEN more than women
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T!!!!
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What Disease has
Musculoskeletal manifestations a. Transient (50%) or permanent (25%) peripheral arthritis b. Enthesopathy (Achilles tendonitis, Plantar fasciitis): Pain in soles of feet c. Predilection for sacro-iliac joints and spine; bilateral sacroilitis-fusing of bones in area of joints, where there should normally be a space d. Decreased range of motion of lumbar spine: Cannot bend over and touch toes e. Limitation of chest expansion f. Limited lumbar flexion |
Ankylosing Spondylitis
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dIAGNOSIS of Ankylosing Spondylitis made with?
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Diagnostic X-ray changes in sacro-iliac joints and squaring of vertebrae (“bamboo” spine), which causes the limitation of movement
b. HLA-B27 (+) in 90% c. Rheumatoid factor (-) d. Anemia e. Elevated erythrocyte sedimentation rate (ESR) |
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Post-Infectious Arthritis: “Reactive Arthritis” (old terminology: Reiter’s Syndrome)
1. Classic triad |
a. Urethritis
b. Conjunctivitis c. Arthritis |
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Psoriatic Arthritis affects men and women _________
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equally
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Psoriatic Arthritis clinical manifestations
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a. Arthritis: Usually upper extremity, asymmetric, and oligoarticular (involves many joints), often distal interphalangeal (DIP) joints with nail pitting, “sausage” digits (dactylitis)
b. Sacroiliac joint involvement can have joint destruction c. Can turn into arthritis mutilans, where psoriatic arthritis becomes so severe that the joints are mutilated d. Often HLA-B27 (+): Axial disease e. Extensive skin manifestations (scaly) |
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Treatment of psoriatic arthritis
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a. Symptomatic, NSAIDs, Methotrexate, or Cyclosporine
b. Newer agents (Biologics): Etanercept, Infliximab (TNF-alpha inhibitors) c. Efalizumab, Alefacept: T-cell inhibitors |
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Most patients with _______present with:
i. Oligoarthritis predominantly involving the lower extremities ii. Episodes of peripheral arthritis Extra-articular manifestations: Uveitis, erythema nodosum, pyoderma gangrenosum (spontaneous gangrene of the skin), etc. |
Inflammatory Bowel Disease-Associated Spondyloarthropathy
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clinical manifestations of UVEITIS CAUSE BY AS?
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AS
Ankylosing Spondylitits Acute, unilateral, recurrent, rarely involves posterior elements |
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clinical manifestations of UVEITIS CAUSE BY ReA?
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Rheumatoid Arthritis Acute, unilateral, recurrent,
rarely involves posterior elements |
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clinical manifestations of UVEITIS CAUSE BY PsA?
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Psoriatic Arthritis Chronic, bilateral,
more often involves posterior elements |
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clinical manifestations of UVEITIS CAUSE BY IBD-SpA?
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Inflammatory Bowel Disease Chronic, bilateral,
more often involves posterior elements |
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clinical manifestations of UVEITIS CAUSE BY USpA?
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Uncommon, usually acute, unilateral, recurrent
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2 bilateral causes of uveitis/
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Psoriatic Arthritis
IBD |
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______________:
1. Can involve small, medium or large blood vessels 2. Most common in people from the “Old Silk Route” (China, Japan, Korea etc.) 3. Associated with HLA-B51 |
Behcet’s Disease
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Most characteristic features (triad): of Behcet's Disease
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know**
a. Oral and genital ulcers b. Uveitis c. Arthritis |
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Diagnosis and Treatment og Behcet's
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a. Diagnosis: Pathergy test (needle prick test - causes non-specific inflammation from prick alone)
b. Treatment: Topical steroids, Colchicine, Thalidomide for resistant oral and genital ulcers which is also used for some cancers, can’t use if pregnant b/c has caused severe birth defects (child born w/o limbs) |
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Polyarteritis Nodosa
affects _____________ vessel vasculitis ( |
Medium-sized
vessels to heart, therefore can get MI) |
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______________:Granulomatous vasculitis of small arteries, arterioles and capillaries
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Wegener’s Granulomatosis
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Wegener’s Granulomatosis triad
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a.Upper respiratory tract:
i. Sinusitis, otitis media, epistaxis, saddle-nose deformity where nasal septum collapses (also seen in syphilis) b.. Lungs: Symptoms include hemoptysis i. Pulmonary nodules, alveolar hemorrhages c. Kidney: i. Rapidly progressive glomerulonephritis (RPGN) –inflammation in glomerulus that suddenly activates and kidney fxn completely shuts down within hours |
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Gold standard diagnosising technique for Wegener’s Granulomatosis
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Tissue diagnosis: Biopsy (sinuses or lung)
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_______________:. Definition: A metabolic bone disorder characterized by decreased bone mass per unit volume (density) of normally mineralized bone.
Most common skeletal disorder in the world |
Osteoporosis (common in elderly men with Vit D defic or post-menopausal women)
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____________:Bone mass value 1 to 2.5 SD below young adult mean values
_____________: Bone mass value > 2.5 SD below young adult mean values (with or without a fracture) |
“Osteopenia”:
Osteoporosis”: |
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What doe DEXA scans test for?
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Osteoporosis
DEXA Scans (DEXA = Dual Energy X-ray Absorptiometry) i. Bone mineral density is essential for diagnosis and management of osteopenia and osteoporosis ii. A decrease in BMD parallels fracture risk iii. Reported as a “T” or a “Z” score 1) T score: Normal bone density for young and healthy 2) Z score: Normal/average bone density for age-matched iv. Dx osteoporosis: 2.5 or more standard deviations below Dexa Z score |
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___________ means joint pain without inflammation
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Arthralgia:.
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________: Inflammation of the joints.
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Arthritis:
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____________:: 1 joint involved.
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Monoarthritis
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_________: 2-3 joints involved.
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Oligoarthritis:
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_____________:4 or more joints involved
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Polyarthritis:
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Axial arthritis:
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affecting the spine.
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Para-axial arthritis:
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affecting the shoulders and/or hips.
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T/F Osteoarthritis is due to infammation
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FALSE
Most common joint disease; normal “degenerative wear and tear,” not inflammation |
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T/F One of the causes of osteoarthritis is obesity
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T
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Primary Osteoarthritis is caused by:
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1. Obesity.
2. Contact sports. 3. Old age. |
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Secondary Osteoarthritis is caused by:
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1. Fracture.
2. Inflammation (septic arthritis). |
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Three characteristics of osteoarthritis (KNOW)
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1. narrowing of joint space.
2. osteophytes. 3. bony cysts. |
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Crystal deposition diseases:
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Crystalline Arthropathy (crystal deposits in joints incite inflammation, recruiting macrophages and neutrophils
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Gout characteristics
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1. Often familial.
2. Hyperuricemia (high uric acid levels): a. Only 10% of people with hyperuricemia get gout. b. Present in all patients who get gout. 3. Episodic or constant. |
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2 causes of Hyperuricemia:
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a. Under-excretion (90%):
i. Renal failure. ii. Alcohol, Medications (ASA, HCTZ, etc.). b. Overproduction (10%): i. Primary (Purine synthesis enzymes). ii. Increased uric acid consumption. iii. Increased uric acid production. iv. Alcohol. |
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What occurs during an acute gout attack?
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Acute gout attack:
i. Podagra (50% of initial presentations):big red inflammation of the big toe. ii. Polyarticular: involve multiple joints. |
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What changes in treatment if a person with gout is either an under or over excretor?
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Determine if the patient is an underexcretor or overproducer of uric acid:
i. Overproduction: Treat with Allopurinol (inhibits uric acid formation) Allopurinol is never given during acute attack of gout because it will make worse (KNOW). ii. Underexcretion: Treat with Probenecid (increases secretion of uric acid). c. Renal calculi (kidney stones) are common. |
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What causes Pseudogout?
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Calcium Pyrophosphate Dihydrate Deposition (CPPD): NOT uric acid
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What are the differences between the crystals in gout versus psuedogout?
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a. Pseudogout: Crystals are rounded, oval, rhomboid shape and blue in color.
b. Gout: Crystals are needle-shaped and yellow in color |
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__________Arthritis
1. Very rare, very destructive, and very painful. 2. Severe destructive arthritis with erosions. 3. Periarticular ligamentous instability. 4. Knees and shoulders. 5. Usually in older females. |
Hydroxyapatite
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Infectious arthritis: Septic Arthritis (infection in joints) often caused by
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1. Neisseria gonorrhea *** (young, STI).
2. Staphylococcus sp. *** |
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What is the most important aspect of diagnosising Septic Arthritis?
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Septic Arthritis: Diagnosis
Arthrocentesis: important to culture, because if there is an infection, steroids are contraindicated! |
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Rhuematoid Arthritis life expectency?
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Life expectancy is reduced by 3 to 18 years because of the disease and also the treatment.
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Rhuematoid Arthitis affects who more?
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women
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Hallmark of Rhuematodi arthritis?`
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Pathological hallmark: pannus (inflammation of the tissues lining joints and is a systemic dx)-vs osteoarthritis which is not inflammatory and is limited to the joints.
1. Inflammatory, proliferative synovial membrane. |
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most common complication of rhuematoid arthritis?
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Coronary Artery Disease: leading cause of death due to inflammation of blood vessels.
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what are DMARDS?
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treatment for rheumatoid arthritis
DMARDs (disease-modifying anti-rheumatic drugs): Immunomodulators that target pathophysiology by suppressing inflammatory cells (e.g. macrophages) |
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Polymyositis and dermatomyositis is diagnosed by how?
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Muscle biopsy: Gold standard.
inflammation of muscles, with skin changes. |
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most common areas of body affected by Paget's disease?
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Most commonly involved sites: (important)
1. Sacrum. 2. Spine. 3. Femur. 4. Tibia. 5. Skull. 6. Pelvis. |
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__________________:Most common cause of musculoskeletal pain in US in women 20-55 y.o.
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Fibromyalgia
Disturbed sleep. 5. Profound fatigue. 6. Multiple tender points (‘everywhere hurts’). 7. Women > Men (10 : 1). |
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______:Most common presenting symptom everywhere (in MD office/ER).
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Acute Back Pain
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In pts with acute back pain:
_________%better in 1 week. ___% better in 2 months. |
40%
90% |
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Carpal Tunnel Syndrome is most common in
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More common in: (KNOW)
1. Pregnancy, and women using oral contraceptives. 2. Hypothyroidism. 3. Diabetes. 4. Dialysis patients. |
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______________: “tennis elbow”, involves extensor muscles of forearm and lateral epicondyle
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Lateral epicondylitis
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_____________-: “golfer elbow”, involves flexor muscles of forearm and medial epicondyle.
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Medial epicondylitis
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___________-: Inserts into calcaneus bone (heel).
1. Largest tendon in the body. 2. Most commonly ruptured tendon. |
Achilles Tendon
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