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Shae Cards > Clin Med II midterm > Flashcards

Clin Med II midterm Flashcards

1
Q

Gene that is genetic risk factor for RA?

A

HLA-DRB1 gene

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2
Q

Risk factors for RA?

A

Smoking
HLA-DRB1 gene
female>Male
age 25-55

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3
Q

Which tissue type is main target for autoimmune process of RA?

A

Synovial Tissue

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4
Q

________ is formed from synovial proliferation. It invades & destroys bone and cartilage

A

Pannus

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5
Q

Clinical manifestations in joints

A

insidious onset
morning stiffness >30 min, or after inactivity
SYMMETRIC swelling
joint are tender/painful

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6
Q

Joints most often affected by RA?

A

PIP
MCP
MTP
wrists, ankles, knees

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7
Q

Clinical manifestations of the hands in RA?

A

Ulnar deviation of MCP joints (classic)
Swan neck deformity
Boutonniere deformity

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8
Q

General clinical manifestations

A

fatigue
Weight loss
low grade fever

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9
Q

_________ __________ are almost only found in those who are RF positive. Often on extensor surfaces, over joints, or pressure points.

A

Rheumatoid Nodules

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10
Q

T/F: Rheumatoid nodules are soft and tender.

A

false. firm and non-tender

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11
Q

Ocular manifestations of RA

A

keratoconjunctivitis
scleritis
episcleritis
scleromalacia

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12
Q

Pulmonary manifestations of RA

A

pleuritis
Pleural effusions
Rheum Nodules
interstitial lung disease

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13
Q

Cardiac manifestations of RA

A

increased risk of CV disease
pericardial effusion
pericarditis

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14
Q

Felty Syndrome is not so rad.

A

Neutropenia
Splenomegaly
RA

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15
Q

What is the most specific blood test for RA?

A

Anti-CCP antibodies

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16
Q

Labs to order for RA?

A

Anti-ccp
RF
ESR/CRP
CBC

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17
Q

What would you see in the synovial fluid in RA?

A

Inflammatory effusion

Leukocytes 15k-25k with PMN predominate

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18
Q

T/F: you can see early findings of RA on x-ray.

A

False. Early in disease they are likely normal appearing

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19
Q

Intial findings on x-ray for RA

A

soft tissue swelling

osteopenia around joint

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20
Q

Where could you see early changes in RA?

A

earliest changes show in the wrists or feet

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21
Q

Changes you would see later on x-ray?

A

Joint space narrowing and erosions

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22
Q

T/F: for a dx of RA you must >or= 2 joints having inflammatory arthritis

A

False: >or=3 joints

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23
Q

Goals of treatment for RA include early Dx and initiation of _________ drugs? Name some others as well.

A 
DMARDs (disease modifying anti-rheumatic drugs)
Control of pain and inflammation
preserve function 
prevent deformity
refer to rheumatology
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24
Q

How long must a patient have had sx before you can dx RA?

A

> or = 6 weeks

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25
Q

RA patients often need a combination of what medications?

A

Methotrexate + TNF inhibitor

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26
Q

What pretreatment screening must you do for RA?

A 
Hep B & C
Check for latent TB
R/O prego
Baseline radiographs
Baseline labs (CBC, Cr, LFTs,
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27
Q

T/F: corticosteroids are very helpful for both symptom relief and slowing the rate of joint damage.

A

True

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28
Q

T/F: corticosteroids are recommended for mono therapy in RA.

A

False. Not recommended for monotherapy or long term use

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29
Q

_________ is a good bridge therapy medication to use while starting DMARD therapy.

A

Corticosteroids: prednisone

30
Q

Starting dose of Methotrexate?

A

7.5mg PO weekly

31
Q

Methotrexate is contraindicated in?

A

Pregnancy
liver disease
heavy ETOH use
Severe renal impairment

32
Q

Patients taking methotrexate need to also be taking?

A

FOLATE everyday
1mg PO
or
Leucovorin 2.5-5mg weekly

33
Q

S/E of methotrexate?

A

GI upset

Stomatitis

34
Q

Labs you need to monitor carefully in patients on methotrexate?

A

CBC for cytopenias

LFTs for hepatotoxicity

35
Q

T/F: TNF inhibitors are inexpensive.

A

False. EXPENSIVE

36
Q

TNF inhibitors are given____ or _____

A

SQ or IV

37
Q

Which TNF inhibitor is usually first choice in RA?

A

Etanercept (Enbrel)

38
Q

Recommended follow up for RA?

A

Use scale to assess sx and function status (pick one and stick with it)

Monitor lab work for tox

Radiographs q2yrs

39
Q

Poor prognostic factors for pts with RA?

A

RF or Anti-ccp +
extraarticular disease
functional limitations
erosions on radiograph

40
Q

What 2 classes of medications are responsible for 2/3 of all hospitalizations related to meds?

A

Antidiabetic meds

Anticoagulants / antiplatelet meds

41
Q

Tramadol should not be used in patient with hx of seizure. why?

A

Lowers seizure threshold

42
Q

Levemir and lantus are _____ acting

A

intermediate to long acting

43
Q

Short acting insulins?

A

Humalog

Novalog

44
Q

Initiation of insulin to type 2 DM

A

Levimir or lantus at morning or bedtime

Fasting BGL check and can increase dose by 2 units q 3 days until fasting target range achieved

45
Q

Initial dosing of coumadin?

A

5mg for 1st 2 days or 2.5mg if frail, elderly, kidney/liver disease or meds making warfarin more sensitive

46
Q

______ is a reduction in bone mass.

A

Osteoporosis

47
Q

causes of secondary osteoporosis

A

Meds
Vit D deficiency
ETOH use

48
Q

Lifetime osteoporotic fracture risk for women who reach age 50 is? Men?

A

50%

Men 20%

49
Q

What is the Frax Algorithm

A

Fx risk assessment tool

Calcs pts 10 year probability for fx

50
Q

T/F: you can use the Frax algorithm in patients being treated for osteoporosis?

A

No, only validated for untreated patients.

51
Q

Gold standard for Bone Density?

A

Bone Densitometry (DXA) scan

52
Q

Who should get DXA scan?

A

Women>= 65
younger but at risk
Pts c path fx
Radiographic evidence of diminished bone density

53
Q

Interval btw DXA scans for T score of -1 to -1.5

A

Every 5 years

54
Q

Interval btw DXA scans for T score of -1.5 to -2.0

A

every 3-5 years

55
Q

Interval btw DXA scans for T score of

A

every 1-2 years

56
Q

What is a Z-score

A

Expresses bone density as a standard deviation from are, race, and sex means

57
Q

T/F: Most recommendations are based off the T score and not the Z score

A

True

58
Q

WHO dx categories

Normal?

A

T score > -1.0

59
Q

Who Dx category Osteopenia?

A

T score -1 to -2.5

60
Q

WHO Dx category osteoporosis?

A

T score is less than -2.5

61
Q

Clinical Manifestations of osteoporosis?

A

Asymptomatic until fx

Vertebral fx

62
Q

Signs of vertebral fx

A

height loss, kyphosis
acute pain
atraumatic fx

63
Q

Radiographic findings

A

Radiolucency
Cortical Thinning
Occult fx

64
Q

How much bone loss is needed to be detected on radiographs?

A

> 30%

65
Q

T/F: Radiographs are the most sensitive to find osteoporosis?

A

No, DEX scan more sensitive

66
Q

Life style modifications in osteoporosis?

A 
Smoking cessation
limit ETOH
Reg WB exercise (30min x 3x/week)
1200mg Ca/day
avoid falls
wear brace
67
Q

When to treat with bisphophonates?

A

Hx of hip/vertebral fx

T-score 3% or OP related fx >20%

68
Q

How much Ca++ intake per day?

A

1200mg qd

69
Q

how Much vit D per day?

A

800units

70
Q

Ca supplements interfere with ______ and ______ absorption.

A

Iron and thyroid hormone. Need to take at different times

71
Q

SE of Ca++ suppliments

A

nephrolithiasis
CV disease
dyspepsia
constipation

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