Auto Immune/ women’s early years Flashcards
(87 cards)
1
Q
Auto immune
A
Often hereditary
Armenia for RA - normocyctic
Tests are sensitive but not specific
Injury to kidney and liver
2
Q
Gout - classic presentation
A
30-60 year old man
Obese, hypertensive, freq alcohol
3
Q
Gout - def
A
Metabolic disease that occurs as a result of mono sodium irate crystal deposits in extra cellular fluids around joints and tendons
4
Q
Non classic gout
A
Organ transplant medication
People on diuretics
5
Q
Gouty arthritis
A
Recurrent attacks of articulate and peri articulate inflammation
- acute gout attacks
- asymptomatic intervals
6
Q
Tophi ( chronic tophaceous gout )
A
Chronic
7
Q
Gout treatment - acute
A
Reduce inflammation and manage symptoms. Initial treatment within the first 24 hours of onset to reduce severity and duration
8
Q
Gout tx- long term
A
Reduce rheum irate level suppress flares and prevent further attacks
9
Q
Gout TD - acute flares
A
Rest, ice, elevation
NSAIDs, Oral glucocorticoid or Colchicine
10
Q
Over production of urate
A
Hugh purine rich food Hemolytic disease Psoriasis Obesity Hyper triglyceride Alcohol
11
Q
Under excretion of uric acid
A
Renal insufficiency Lactic acidosis Dietrich Dehydration Meds Hypothyroidism
12
Q
Gout medications - increase risk
A
Low dose Asa Diuretics Cyclosporin Ethanol Cytotoxics Vit B 12
13
Q
Gout - clinical presentation
A
Acute onset, red, hot, swollen, tender joint, fever, chills, malaise
Unilateral swollen, red
Great toe, foot, ankle, knee, wrist, finger, elbow
14
Q
Dx of gout
A
Elevated serum urate
Elevated uric acid in UA
Elevated ESR
Elevated WBC
Synovial fluid - + crystals
15
Q
Septic arthritis
A
Inflammation into joint
16
Q
Gout to goals - long term
A
Reduce serum urate level to suppress flares and prevent further attack
17
Q
Acute flares gout - TX
A
Rest, ice, elevate affected joints
Tx: NSAID’s, Oral glucocorticoids, Colchine
May require rheum consult
18
Q
NSAIDS - gout
A
Treat until managed
Naproxen 500 mg BID
Motrin 800 mg every 8 hours
Diclodenac 50 mg BID
Indocin 50 mg every 8 hours until resolved 5-10 days
19
Q
Oral glucocorticoids - gout acute
A
Prednisone 30-40mg until flare resolution begins and then taper 7-10 days
Not for people with
DM, HF, HTN, cocurrent infection
20
Q
Colchicine - Acute flares
Trad vs low dose
A
Trad
Colchicine 1.2 mg dose followed by 0.6 every 1-2 until symptoms improve
++++ GI symptoms +++++++
Low-dose
Day one 1.2 mg and then 0.6 1 hour later, then 12 hours later 0.6 repeated and continued every 12 hours until resolution
21
Q
Gout recurrent attacks - medication
A
Allopurinol ( max 800 mg/day)
Uloric
Colchicine
Aviod thiazide, loop diuretic
Lifestyle : weight loss, restrict high purine
22
Q
RA - definition
A
Chronic inflammatory disease in which the immune system destroys synovial joints and accessory structure. Joints are destroyed over number of years with remissions and exacerbation
Worse in the AM and then it gets been throughout the day
23
Q
RA - clinical presentation
A
Pain and swelling warmth in small joints ( PIP MCP, MTP)
Usually bilateral
Weight loss, general malaise, lymphadenopathy, low grade fever
Morning stiffness
24
Q
RA joint
A
PIPS
MCP
25
OA - joint
DPS
26
RA PE
```
Decreased weight,
Joints ( hands, wrists, knees, ankles) - red, warm and swollen
Decreased ROM
Muscle wasting
Ulnar deviation
```
Extra articular findings :
- pleural effusion
- pericarditis
- Sjögren’s syndrome
- Synovial thickening of joints
27
Look at chart of difference between OA and RA
Jk
28
RA - DX testing
RA factor - gold standard
ANA - no specific but sensitive
29
DX criteria for RA
```
Morning stiffness
Arthritis of three or more joints
Arthits of hand joints
Symmetric arthritis
Rheumatoid nodules
Serum rheumatoid factor
Radiographic changes
```
30
RA- tx is referral
Slow disease progression, prevention loss of physical function
PT, OT, rest, hear, ice, exercise, meditation
Corticosteriods - injection when one large joint is involved
31
Chronic fatigue syndrome and fibromyalgia
Autoimmune vs infectious
W>M
Profoundly fatigued
11-18 bilateral pain points
No inflammatory muscle or joint disease
32
Chronic fatigue syndrome management
Low - dose tricyclic agents at bedtime, may need antidepressants
Have an exercise program
33
Systemic Lupus Erythematous (SLE)
Inflammation autoimmune disease marked by exacerbations and remission,
Multiple organs - skin, kidney, CNS
Triggers: emotional stress, pregnancy, post partum, cigarette smoke
From menses to menopause
34
SLE: clinical presentation
Fatigue, malaise, fever, anorexia, unplanned weight loss, blurred vision
Butterfly rash, slope is, fingertip lesions, swollen joints
Systolic murmur, RUQ tenderness
Peripheral parenthesias, diminished deep tendon reflexes
35
Raynaud’s phenomenon
Discoloration of fingers and or toes after exposure to changes in temp or emotional events
Ages 15 - 40
36
Raynaud’s phenomenon treatment
Cold protection
Avoid emotional stress
Smoking cessation
Flares : stay calm and get warm
37
Scleroderma
A chronic autoimmune disease in which the body produces too much collagen resulting in skin thickening that causes scarring and often leaving the skin with a tight leathered appearance
30-50
38
Morphia scleroderma
Hard, oval shaped patches of the skin, the patches usually are whitish with purplish ring around them
39
Linear scleroderma
Lines or streaks of thickened skin in areas such as arm legs or forehead
40
Limited scleroderma
Course gradually and affects the skin and larger may affect internal organs such as esophagus, lungs or intestine
41
Diffuse scleroderma
More suddenly with skin thickening throughout the body
Internal organs can also be affected and cause extensive and fatal damage to organs in the digestive, resp, circulatory and immune system
42
Sjögren’s syndrome
Chronic inflammatory disorder caused by exocrine dysfunction
W> M 40-60
TEST QUESTION
43
Sjögren’s syndrome clinical presentation
Dry mouth, eyes feels like something is in them, loss of taste, smell, recurrent dental carries, dysphagia
Appears ill, breath odor, mouth and nose bleeds, pale, dry, fissures, beefy red tong,
44
Polymyalgia Rheumatic ( PMR)
Understand difference btw PMR and temporal artitis
1. > 50
2. Abrupt onset
3. Bilateral, upper arms, neck, thighs
4. Morning stiffness
5. Negative labs
6. ESR up
7. Brisk response low-dose steriods
8. Erosive
45
OA
Pain in the afternoon
46
PMR
Better as the day goes on
47
Giant Cell Arteritis ( GCA)
Headache
Visual signs
Jaw claudication
Fever, malaise, weight loss
Elevated ESR
High acuity
Alk phos High
Tx: bilateral biopsy of temporal artery
48
Pericoital Contraception
Preventing sperm from entering female reproductive tract by maintaining a reservoir of spermicide against the cervix thus creating a “ barrier “
- diaphragm
- cervical cap
- contraceptive sponge
- spermicidal foams
49
Pericoital contraception risks
High failure risk
Increased risk of toxic shock
Requires fitting
50
Natural family planning
Uses s/s of ovulation for avoidance or achievement of pregnancy
51
Implanon / Nexplanon
Implant
Progestin
Effective for 3 years
Irregular menses most frequent reason for discontinuation: either amenorrhea or prolonged bleeding
Fertility may be somewhat delayed after removal
52
Depo-Provera
IM injection q 12 weeks
Initial injection given on day 5
Use for two years
Increased risk
- decrease bone density
- increased lipids, weight gain, depression, uterine bleeding
- fertility issues 1 yr after given thinning of uterine lining
53
Hormonal methods oral contraceptives
1. Most common are 4 weeks pill pack w/4th week placebo. Combination of estrogen and progestin or progestin only pill
2. Continuous OC with withdrawal bleeds every 3 months
3. Continuous OC taken 365 days/yea with no placebo or pill free interval
54
Monophasic, Biphasic and Triphasic
Same amount in every pill
2 different amounts in different weeks
3 different in different weeks
As estrogen content decreases BTB or spotting increases ( maybe)
55
OC start methods
Take pill same time everyday
First day start - start pill on first day of menses and follow as directed
Quick start - active pill can be initiated at any point in menstraul cycle, make sure not pregnant, must use back up for 7 days
56
OC missed pills
Single pill : take as soon as realized even if it means taking two pill in one day
Two doses: take two pills x 2 days then 1 pill per day . Need back up for 7 days
If more than 3 doses consult
57
OCP’s contraindications
HX of CVA, CAD, HF, DVT
DM with end organ damage
HX breast CA
Preg
Age > 35 yo and smoker ? 15 cig a day
Breast feeding < 6 weeks
Liver dx
Migraine with focal nuero symptoms (aura)
HTN w/ vascular dx
Major surgery with immobility
58
OCP side effects
BTB spotting
- common during 1st 3 months
- r/o infection
```
Headaches
- r/o CVA
- check BP
- d/c if migraine with aura
Nausea, breast tenderness, bloating
```
59
Systemic OC’s
Increased in total cholesterol, HDL, LDL and triglycerides - no evidence of atherosclerosis though
Increased insulin resistance and decrease glucose tolerance - increase clotting- estrogen related
Increase in BP
Smoking can increase symptoms
60
OC risks
VTE, MI, CVA, liver tumors, gallbladder dx
61
OC ACHES
```
Abdominal pain
- abd artery thrombosis, GB, liver
Chest pain and SOB
- MI
Headache
- CVA, HTN, migraine
Eyes
- Visual changes, retinal artery thrombosis
Severe leg pain
- VTE
```
62
OCP drug interactions - decrease effectiveness
```
Antibiotics
Barbiturates
Dilatin
Primidone
Rifampin
Tegretol
Methyldopa
Oral anticoagulant
Oral hypoglycemics
```
63
OCP - drug interactions - increase effectiveness
```
Alcohol
Antidepressants
Benzos
Beta blockers
Corticosteriods
Theophylline
```
64
Transdermal patch
Ortho evra patch
- Same side effect profile, use and indication as OCP’s
- Roatation of sites every week
- never on breasts
3 weeks on and 1 eek off
65
NevaRing
Vaginal ring - inserted for 3 weeks adn followed by 1 week out
Hormones absorbed through the vaginal epithelium and thus supresses ovulation
Can remain in place during intercourse
Doesn’t require fitting by health care provider
66
IUD - Mirena and skyla
Progestin containing
Mirena (5)
Skyla (3 )
Thickens cervical mucus therapy inhibiting sperm transport - partially inhibits ovulation
Increased vaginal bleeding 1-6 months, increased cramping infection, perforation of uterus,
67
IUD- Copper
10 years
Copper is an spermicidal
Increased vaginal bleeding
68
POst coital prevention
Withdrawal, post coital douche
Plan B
- within 72 hours
- high doses of progestin
- prevents fertilization by inhibition of ovulation
69
Overview - vaginal discharge
BV, Candidiasis, Trichomoniasis, Chlamydia, Gonorrhea
70
Overview - Volovaginal lesions
Genital herpes, syphilis
71
BV
Abnormal amount fo vaginal discharge
Fishy order, especially after sex
Vulvar itching
Discharge : thin, gray
Saline wet amount : clue cells
PH > 4.5
+ wiff
< 5 % lactobacilli
Complications: PID, UTI,
72
BV treatment
Metronidazole 500mg / PO BID x 7
Metrogel - vaginal x 5 days
Don’t tx partner
Can use clindamycin 300 mg BID x 7
Common that it is recurrent
73
Candida / yeast
Inflammatory process involving teh vagina and vulva caused by fungus
Decrease lactobacilli
Can occur with antibiotic use
Thick, clumpy vaginal discharge ( cottage - cheese appearing)
Vulvar itching and burning
Burning with urination
PH< 4.5
KOH test = pseudophae + hyphae and budding yeast
Red, sore looking vulva, vagina
74
Candida TD
Diflucan 150 mg / PO one time
75
Trichomoniasis
Flagellated protozoan
sexually transmitted disease
Often associated with GC
Can cause nongonococcal urethritis
Forty profuse green discharge; gas produced
Intense vaginal, vulvar irritation
Petechia on cervix - strawberry appearance
T. Vaginalis nucleic acid amplification test
76
Tric TX
Flagly 2 grams / PO single dose BID for 7 days
Vaginal flagly - no rec
Partner should be treated
77
Chlamydia
Affects transition zone of cervix
Can cause infertility
Asymptomatic some times
Present : muco-purulent cervicitis, vaginal discharge, dysuria, abnormal vaginal bleeding, pelvic pain
78
Chlamydia Clinical manifestations
Speculum - inspect for mucopurulent discharge from cerix - yellow or green
Cervix = friability = bleeding
Perform biannual exam for adnexal tenderness, uterine tenderness and cervical motion tenderness
Dx : NAAT
79
Chlamydia tx
Partner must be treated
HIV testing
Azithromycin 1 gram /PO single dose
Or
Doxy 100 mg /PO BID for 7 days ( less $)
80
Gonorrhea
Can be asymptomatic
Site at urthrea and endocervix
PID caused by gonorrhea
Presents w/ vaginal d/c, dysuria, abnormal bleeding, abdominal or pelvic pain
81
Gonorrhea tx
You treat both for GC and chlamydia
Ceftriazone IM + Azithrymocin 1gm PO single dose
Partner must be treated
Can do doxy but will have to be for 7 days
82
Genital Herpes
A chronic life long infection
Route of transmission : gential - genital
Viral shedding can occur when patient is asymptomatic
Painful papules followed by vesicles, ulcerations crusting adn healing
DX: cell cultures, PCR, obtain RPR to r/o syphilis
83
Genital herpes simplex 2 TX
First episode :
- Acyclovir 400 mg PO TID 7-10 days
Suppressive therapy for recurrence
- Acyclovir 400 mg PO BID
- Valacyclovir 500 mg PO QD
84
HPV aka Gential warts
Most common sexually transmitted infection
Usually flat or pedunculated growth on the anti genital skin
May be painful, friable, and itchy
HPV vaccine
Can use ointments
85
Syphilis
STI caused by treponema pallium
Active episodes and then by latent periods with no signs or symptoms
Painless, single small firm red ( charncre)
Incubation days 21 before any signs become apparent
Heals within 4-8 week w/o treatment and 1- 2 weeks with treatment
Send : RPR
TX : pencillin G benzathine 2.4 IM once
86
Secondary syphilis
Systemic illness that includes disseminated rash involving the torso, palms, soles
Fevers, malaise, pharyngitis, hepatitis, slope is
87
Latent syphilis
Period of time when patient is infected with treponema pallidum with serologic testing but has no symptoms
