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38 Cards in this Set
- Front
- Back
What is inclusion body myositis? x4
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oddball: i)men ii)distal muscles iii)no autoIgs iv)low elevated CK
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What is inclusion body myositis? x4
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oddball: i)men ii)distal muscles iii)no autoIgs iv)low elevated CK
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What are 3 ass'd findings in both poly and dermato?
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i)arthralgias ii)interstitial lung dz (rare) iii)CHF and conduction defects (rare)
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What is tx for Ankylosing spondy? x4
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i)NSAID for sympto relief ii)PT iii)SX for severe spinal deformity iv)strictly immobilize if neck or back pain and have trauma until image it
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What is Ig for MCTD? What are clinical findings?
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i)Anti-U1 RNP Igs ii)overlap syndrome for SLE, RA, SS, polymyositis. Can have pulm dz, raynaud, eso dysfcn, etc
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What are 7 conditions where ANAs are elevated?
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i)SLE ii)RA iii)Scleroderma iv)Sjogrens v)MCTD vi)polymyositis and dermatomyositis vii)drug induced lupus
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What is life threatening complication of RA? If pt w/RA and needs sx, what should be done? Why?
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i)Instability of cervical spine (C1-2 subluxation) ii)spine radiograph b/c neurologic injury possible during intubation
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How long does polymyalgia rheumatica last for? What are clinical features x3? what is tx?
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i)self limited in 1-2 yrs (diff from RA). ii)a)constitutional sxs b)hip and shoulder stiffness that is b/l; morning stiffness c)jt swelling in knees, wrists, hands possible. iii)Elevated ESR. iv)treat w/steroids to suppress inflammation till dz resolves
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What is Reactive arthritis pattern of arthritis? Wen does it occur? What are the organisms? x4
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i)assymetric oligoarthritis of lower extremities that progresses sequentially from one jt to another, preceded by infectious process that is remote from site of arthritis (1-4 wks prior), usually after enteric or urogenital infections. ii)shigella, campy, chlam, salmon, NOT gonococcal urethritis
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Which joints are affected in psoriatic arthritis? What is initial tx?
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i)upper ext ii)NSAIDs, may need same drugs as RA
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What are Ro and La + in? x5
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i)complement deficiency (C2/C4) ii)Sjogren's iii)SLE iv)ANA neg lupus v)neonatal lupus
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What is used for symptomatic tx in RA? x2
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i)NSAID: best for pain ii)steroids: if nsaid no good; low dose long term may be Dz modifying (decr radiographic progression)
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What is Felty's syndrome?
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variant of RA: anemia, splenomegaly, RA; also thrombocytopenia, lymphadenopathy; high titers of RF w/extraarticular dz
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What are the symptoms of lupus?
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constitutional sxs and SOAPBRAIN MD: Serositis; Oral ulcers; Arthritis; Photosensitivity; Blood (hemolytic anemia, lymphopenia, thrombocytopenia); Renal: GN or nephrotic; ANA; Immuno d/o: Anti-Sm, Ro-La, DsDNA, APLS; Neuro; Malar rash; Discoid rash
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What are clinical features of fibromyalgia? x3
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i)stiffness, body aches, fatigue aggravated by weather changes, stress, sleep deprivation ii)sleep patterns fucked and unrefreshing iii)depression and anxiety common
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What are 4 poor prognostic indicators in RA?
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i)High RF titers ii)subQ nodules (ass'd w/high RF) iii)erosive arthritis iv)autoIgs to RF
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What is diff b/w PAN and weg? what systems does PAN hit x2. What are its assn's? x3 What is the WBC type that is responsible?
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i)no pulm involvement in PAN. ii)a)nervous system and GI tract iii)a)Hep B, HIV, drug rxns iv)PMN invade all layers and fibrinoid necrosis+intimal proliferation leads to reduced luminal area. v)PMN
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What are the lab tests for Lupus? x9
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i)ANA ii)Anti-Sm iii)Anti-dsDNA iv)Anti ssDNA v)Anti-histone (drug induced) vi)VDRL+ vii)Lupus anticoag and APLS viii)Anti-Ro and La ix)complement levels are decreased
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What is APLS? What are the findings x5? What are labs? x3 What is treat?
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i)hypercoag state that can be ass'd w/SLE or other collagen vasc dz. ii)a)livedo b)venous thrombus c)arterial thrombus d)abortions e)thrombocytopenia iii)a)lupus anticoag b)anticardiolipin Ig c)prolonged PTT/PT not corrected w/added normal plasma iv)long term anti-coag
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What is CRP elevated in? x3 What is it used for? If >15, what does it mean?
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i)a)inflamm states and infection b)misc conditions: MI, vasculitis, trauma, malig, panc ii)For infection: more sens and sp than ESR iii)>15=bacterial infection probably present
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How to DX Weg's? what confirms dx?
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i)cxr w/nodules or infiltrates ii)labs: incr ESR; anemia; hematuria; pos c-ANCA, possible thrombocytopenia iii)open lung bx
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What is Takayasu's vessel involvement? How to DX? What triad do you think of for Takayasu's?
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i)aortic arch and its major branches: get narrowed vessels. ii)arteriogram iii)a)decr/absent peripheral pulse b)discrepancies of BP (arm vs leg) c)arterial bruits.
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What are serology is found in ANA neg lupus (x2)? What are the symptoms? x3 What does it cause incr risk for?
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i)a)Ro+ (SS-A) b)ANA-neg. ii)a)arthritis b)cutaneous lupus c)raynaud's. iii)neonatal lupus in infants
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What is the diagnostic criteria of polymyositis?
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all four means definite, 3 is probable.i)symmetric prox muscle weakness ii)elevated CK iii)EMG findings of myopathy iv)biopsy evidence of myositis
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What causes the pathologic changes in muscle for poly vs dermatomyositis?
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i)dermato: humoral immune mech ii)poly and inclusion body: cell mediated process
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What other arteries can be involved w/temporal arteritis? What is it ass'd w/incr risk of? x2
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i)aorta or carotids ii)a)aortic dissection b)aortic aneurysm
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What is Sjogrens caused by? What is primary Sjogren's? What is secondary? What do pts have incr risk of getting? What is most common cause of death?
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i)lymphocytes infiltrate and destroy lacrimal and salivary glands. ii)primary: dry eyes and dry mouth only iii)2/2: 1/1 + CT dz (RA, SS, SLE, polymyositis). iv)NHL v)malignancy is most common cause
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What is dx criteria for fibromyalgia? x2 How to treat x3?
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i)tender points at 11/18 places ii)widespread pain including axial pain for 3 mths. iii)a)stay active and productive b)SSRI and TCAs, no narcotics c)CBT, exercise, psych eval
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What is 1st line in RA and what are 3 s/e?; what is alternate 1st lines (x2) and what do you need to do?
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i)MTX: a)GI upset; oral ulcers; BM suppression ii)a)hydroxychloroquine: eye exams b/c can get retinopathy iii)sulfasalazine
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What is ESR seen in? x4 Wat is the use of it? x2
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i)a)infection (acute or chronic) b)malig c)rheumatologic dz ii)a)dx or r/o inflam process and monitor course of inflamm process
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What is most common cause of death in Lupus? x2
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OI and renal failure
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What are features unique to dermatomyositis? x5
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i)heliotrope rash (butterfly) ii)Gottron's papules: papular, erythematous, scaly lesions over knuckles. iii)V sign: rash on face, chest iv)shawl sign: rash on shoulders, upper back, elbows. v)periungual erythema w/telangiectasias
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What drugs should you avoid in gout? x2
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i)ASA: makes gout worse ii)acetaminophen (no anti-inflamm)
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What is pseudogout? What does deposition increase w/? x2 What are 3 dz's that incr crystal deposition?
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i)Ca-PP crystals in jt cause inflammation ii)a)age b)OA iii)a)hemochromatosis b)HPTH c)hypothyroidism.
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What is tx for Sjogren's? For 2/2?
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i)pilocarpine: incr secretions ii)eye drops iii)NSAIDs/steroids for joints iv)therapy for CT dz
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What are the 4 parts to the pathophysiology of SLE?
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i)autoantibodies ii)complement activation iii)deposition of immune complexes iv)accompanying tissue destruction/vasculitis
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What dz manifestations are not seen in drug induced lupus? x5 What are 3 agents causing it? What are lab findings in drug induced and what isn't present? x2
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i)a)CNS dz b)renal dz c)no butterfly rash d)alopecia e)ulcers ii)a)hydralazine b)procainamide c)INH iii)anti-histone Igs present but no anti-dsDNA or Anti-Sm Ab
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How to DX reactive arthritis? What is TX? x2
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i)synovial fluid analysis (r/o infection or crystals) ii)a)NSAIDs are 1st line b)immunosuppressive: sulfasalazine, azathioprine. NO ABX!
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