Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Shae Cards > Clin Med II midterm > Flashcards

Clin Med II midterm Flashcards

(71 cards)

Start Studying
1
Q

Gene that is genetic risk factor for RA?

A

HLA-DRB1 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for RA?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

Synovial Tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

Pannus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clinical manifestations in joints

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Joints most often affected by RA?

A

PIP
MCP
MTP
wrists, ankles, knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical manifestations of the hands in RA?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

General clinical manifestations

A

fatigue
Weight loss
low grade fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

Rheumatoid Nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: Rheumatoid nodules are soft and tender.

A

false. firm and non-tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ocular manifestations of RA

A

keratoconjunctivitis
scleritis
episcleritis
scleromalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pulmonary manifestations of RA

A

pleuritis
Pleural effusions
Rheum Nodules
interstitial lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cardiac manifestations of RA

A

increased risk of CV disease
pericardial effusion
pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Felty Syndrome is not so rad.

A

Neutropenia
Splenomegaly
RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most specific blood test for RA?

A

Anti-CCP antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Labs to order for RA?

A

Anti-ccp
RF
ESR/CRP
CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would you see in the synovial fluid in RA?

A

Inflammatory effusion

Leukocytes 15k-25k with PMN predominate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

False. Early in disease they are likely normal appearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Intial findings on x-ray for RA

A

soft tissue swelling

osteopenia around joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where could you see early changes in RA?

A

earliest changes show in the wrists or feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Changes you would see later on x-ray?

A

Joint space narrowing and erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A

False: >or=3 joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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

A

> or = 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
RA patients often need a combination of what medications?
Methotrexate + TNF inhibitor
26
What pretreatment screening must you do for RA?
``` Hep B & C Check for latent TB R/O prego Baseline radiographs Baseline labs (CBC, Cr, LFTs, ```
27
T/F: corticosteroids are very helpful for both symptom relief and slowing the rate of joint damage.
True
28
T/F: corticosteroids are recommended for mono therapy in RA.
False. Not recommended for monotherapy or long term use
29
_________ is a good bridge therapy medication to use while starting DMARD therapy.
Corticosteroids: prednisone
30
Starting dose of Methotrexate?
7.5mg PO weekly
31
Methotrexate is contraindicated in?
Pregnancy liver disease heavy ETOH use Severe renal impairment
32
Patients taking methotrexate need to also be taking?
FOLATE everyday 1mg PO or Leucovorin 2.5-5mg weekly
33
S/E of methotrexate?
GI upset | Stomatitis
34
Labs you need to monitor carefully in patients on methotrexate?
CBC for cytopenias | LFTs for hepatotoxicity
35
T/F: TNF inhibitors are inexpensive.
False. EXPENSIVE
36
TNF inhibitors are given____ or _____
SQ or IV
37
Which TNF inhibitor is usually first choice in RA?
Etanercept (Enbrel)
38
Recommended follow up for RA?
Use scale to assess sx and function status (pick one and stick with it) Monitor lab work for tox Radiographs q2yrs
39
Poor prognostic factors for pts with RA?
RF or Anti-ccp + extraarticular disease functional limitations erosions on radiograph
40
What 2 classes of medications are responsible for 2/3 of all hospitalizations related to meds?
Antidiabetic meds | Anticoagulants / antiplatelet meds
41
Tramadol should not be used in patient with hx of seizure. why?
Lowers seizure threshold
42
Levemir and lantus are _____ acting
intermediate to long acting
43
Short acting insulins?
Humalog | Novalog
44
Initiation of insulin to type 2 DM
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
Initial dosing of coumadin?
5mg for 1st 2 days or 2.5mg if frail, elderly, kidney/liver disease or meds making warfarin more sensitive
46
______ is a reduction in bone mass.
Osteoporosis
47
causes of secondary osteoporosis
Meds Vit D deficiency ETOH use
48
Lifetime osteoporotic fracture risk for women who reach age 50 is? Men?
50% Men 20%
49
What is the Frax Algorithm
Fx risk assessment tool | Calcs pts 10 year probability for fx
50
T/F: you can use the Frax algorithm in patients being treated for osteoporosis?
No, only validated for untreated patients.
51
Gold standard for Bone Density?
Bone Densitometry (DXA) scan
52
Who should get DXA scan?
Women>= 65 younger but at risk Pts c path fx Radiographic evidence of diminished bone density
53
Interval btw DXA scans for T score of -1 to -1.5
Every 5 years
54
Interval btw DXA scans for T score of -1.5 to -2.0
every 3-5 years
55
Interval btw DXA scans for T score of
every 1-2 years
56
What is a Z-score
Expresses bone density as a standard deviation from are, race, and sex means
57
T/F: Most recommendations are based off the T score and not the Z score
True
58
WHO dx categories | Normal?
T score > -1.0
59
Who Dx category Osteopenia?
T score -1 to -2.5
60
WHO Dx category osteoporosis?
T score is less than -2.5
61
Clinical Manifestations of osteoporosis?
Asymptomatic until fx | Vertebral fx
62
Signs of vertebral fx
height loss, kyphosis acute pain atraumatic fx
63
Radiographic findings
Radiolucency Cortical Thinning Occult fx
64
How much bone loss is needed to be detected on radiographs?
>30%
65
T/F: Radiographs are the most sensitive to find osteoporosis?
No, DEX scan more sensitive
66
Life style modifications in osteoporosis?
``` Smoking cessation limit ETOH Reg WB exercise (30min x 3x/week) 1200mg Ca/day avoid falls wear brace ```
67
When to treat with bisphophonates?
Hx of hip/vertebral fx | T-score 3% or OP related fx >20%
68
How much Ca++ intake per day?
1200mg qd
69
how Much vit D per day?
800units
70
Ca supplements interfere with ______ and ______ absorption.
Iron and thyroid hormone. Need to take at different times
71
SE of Ca++ suppliments
nephrolithiasis CV disease dyspepsia constipation

Shae Cards (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions