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ClinMed_test2 Flashcards

1
Q

When are the symptoms typically worse for JRA pt?

A

In the morning and after a nap.

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2
Q

T/F

Having JRA does not lead to adult RA

A

True

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3
Q

What is the name of the systemic form of JRA?

A

Still’s disease

Affects 20% of pts

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4
Q

Name the most common type of JRA

A

Pauciarticular.
1 to four joints are affected
40% of JRA pts
Ocular complication(uveitis) is common

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5
Q

Name the second most common form of JRA

A

Polyarticular
5 or more smaller joints
30%
bumps or nodules are present-Sim to JRA

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6
Q

Define Spondyloarthropathies

A

Group of interrelated chronic inflammatory diseases

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7
Q

What are some clinical features of Spondyloarthropathies

A 
Arthritis
Involvement of sacroilliac joints
HLA-B27
NO ASSOCIATION WITH rheumatoid factor
Uveitis
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8
Q

What are the four types of spondyloarthropathies

A

Ankylosing spondylitis
Reactive arthritis
psoriatic arthritis
Inflammatory bowel disease

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9
Q

Demographics of those affected with ankylosing spondylitis

A
  1. More common in young men
  2. Onset 15-35 years of age
  3. More common in native americans
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10
Q

Clinical features of AS

A

95% positive for HLA-B27
Morning stiffness/back pain that is greater than 3 months
Forward flexation of the spine (kyphosis)
Fusion of the joints of the spine and sacroiliac
Episodic uveitis

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11
Q

Talk about Reactive arthritis

A

Male predisposition
Classic triad of: conjunctivitis, arthritis, urethritis
Can’t see, can’t pee, can’t bend the knee
Genital infection may follow sex. Test for chlamydia and HIV

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12
Q

Behcet’s disease

A

Young adults
Hypopyon, iritis, mouth and genital ulcers
Can’t chew, can’ view, can’t screw

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13
Q

What are the two systemic involvement of Reactive arthritis

A

Keratoderma blennorrhagica

Balanitis Circinata

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14
Q

What do you find in pts with psoriatic arthritis

A

Arthritis is associated with scaly skin patches
Conjunctivitis and uveitis
Pitting and/or discoloartion of fingernails/toenailes

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15
Q

Name the two types of IBD

A

CHron’s disease

Ulcerative colitis

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16
Q

T/F

Pts w/ IBD are more likely to have demyelinating disease like MS and optic neuritis

A

True

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17
Q

What are some risk factors for gout

A 
Obesity
Genetics
High alcohol intake
Foods high in purine - Red meat
BP meds
Longstanding kidney disease
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18
Q

Management of Gout

A

NSAIDs - indomethacin
Allopurinol
Steroids

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19
Q

Ocular manifestations from Indomethacin

A

Corneal deposits

Retinal disturbance

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20
Q

What organisms do you need to rule out for infectious arthritides(infection that affects the joint via bacterial, viral, or fungal)

A

Nisseria Gonorrhoeae
HIV
Pseudomonas in IV drug user

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21
Q

What are some ocular manifestations for infectious arthritides

A 
Conj splinter hemes
Retinal infarcts - roth spot hem.
1. CWS
2. Septic emboli
3. Leukemic or lymphomic plaque.
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22
Q

How to manage infectious arthritides

A

Aggressive trt w/ intravenous antibiotics

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23
Q

Does lyme disease cause joint inflammation

A

Yes

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24
Q

What are the three stages for Lyme DIsease

A

Early localized-conjunctivitis
Early disseminated-bell’s palsy, optic neuritis
Late disseminated-Severe neurological deficits

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25
Q

What to order to confirm Lyme Disease?

A

Lyme titer

  • ELISA
  • Western blot
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26
Q

Trt for Lyme

A

3-4 weeks with doxycycline or amoxicillin
IV ceftriaxone or PCN for 4 weeks or more
-LYMErix is no longer available.

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27
Q

What is SLE

A

Chronic multisystem microvascular inflammation with the generation of autoantibodies

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28
Q

Demographics for SLE

A

Affects young middle age women
Greater prevalence in black females
Affects all body systems

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29
Q

Diagnosis of SLE

A

Pt needs 4 out of 11 for SLE -Diagnostic criteria

  1. Malar rash (butterfly rash)
  2. Discoid rash
  3. Photosensitivity
  4. Oral ulcers
  5. Arthritis
  6. Renal disorder
  7. Neurological disorder
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30
Q

T/F

Medications have been reported to trigger SLE

A

True
Hydralazine - HBP
Phenytoin - epilepsy
INH - TB

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31
Q

Describe discoid lupus

A

Occurs in the absense of other systemic symptoms or organ involvement, and these pts rarely develop SLE

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32
Q

How often does Raynaud’s syndrome occur in those with SLE

A

20-30%
Take vaigra due to vasodilation properties.
Will have ulcerations on the tips of hands or feet

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33
Q

Ocular complications of SLE

A

Retinal ischemia - CWS
Uveitis
Conjunctivitis
Optic neuritis

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34
Q

How to diagnose SLE

A

Sensitive but not specific = ANA

Specific but not sensitive = Anti-DS DNA

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35
Q

Management for SLE

A

Depends on the organs involved
NSAID
Corticosteroid
Immunosuppressive medication like methotrexate and plaquenil

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36
Q

What percentage of ocular structures does collagen makes up?

A

80%

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37
Q

Define CVD

A

Disease characterized by pain and inflammation in joints and connective tissues
-Affects women in childbearing years more often than men

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38
Q

MOA of aspirin

A

Reduces prostaglandins by blocking COX 1 and 2.

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39
Q

Side effects of aspirin

A

Gastric irritation
Cornea - whorl keratopathy
COnj and retinal hemes

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40
Q

Why were the super aspirins like Vioxx and celebrexx pulled off the market?

A

Due to increased risk of heart attack and stroke

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41
Q

Side effects of corticosteroids

A 
Steroid induced diabetes
HTN
Wt gain
Mental disturbance
Glaucoma/Cataract
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42
Q

GO OVER THE PLAQUENIL risk assessment

A

OKEE

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43
Q

Which Disease modifying anti-rheumatological therapy drug is the best?

A

Methotrexate

Need to supplement with folate.

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44
Q

Side effect of methotrexate?

A

Persistent cough

Unexplained SOB

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45
Q

What is so special about biological agents like
Etanercept
Infliximab
Humira

A

Need to be injected

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46
Q

What can the majority of DMARDs cause

A

Bone marrow toxicity

Liver toxicity

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47
Q

What to suspect if pt experiences recurrent episcleritis?

A
  1. Idiopathic

2. Syphilis

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48
Q

What is the most common cause for uveitis/episcleritis/scleritis?

A

RA

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49
Q

What are the diagnostic findings for RA

A
  1. RF factor
  2. ANA: anti nuclear antibodies
  3. elevated ESR
  4. CBC
    X-Ray
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50
Q

Management for RA

A

Exercise/PT
Meds
Surgical intervention
Treat ocular complications

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51
Q

What are the two diseases that Sjogren is usually associated with

A

RA

SLE

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52
Q

Manifestation of Sjogren?

A

Xerostomia
Xerophthalmia
Drying of the nasopharynx
Salivary gland enlargement

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53
Q

Define gout

A

Arthritis produced by accumulation of monosodium urate crystals (tophi)

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54
Q

T/F

20-25% of SLE have increase antiphospholipid antibodies

A

True

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55
Q

Define Antiphospholipid Syndrome

A

Life and vision threatening multi-symptomatic disorder that affects multiple organs.

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56
Q

What is the main thing that points fingers to APS

A

Recurrent spontaneous abortions

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57
Q

How to diagnose APS

A
  1. anticardiolipin antibodies

2. Lupus anticoagulant antibodies

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58
Q

Treatment of APS

A
  1. Thrombosis - Heparin IV. Warfarin PO

2. Prophylactic therapy

59
Q

Name two common Vasculitides

A
  1. Giant Cell arteritis

2. Behcet’s syndrome

60
Q

T/F

Men are twice more likely to get GCA then females

A

False

61
Q

Symptoms of GCA?

A

Temporal headaches
Scalp tenderness
jaw/tongue claudication
AF

62
Q

Diagnosis of GCA

A

Elevated ESR in 85%
Elevated C-reactive protein
Temporal artery biopsy

63
Q

What is the most common ocular complication for GCA?

A

AION - This is an ocular emergency

Other complications include AF, CRVO/BRVO, CN6

64
Q

Trt of GCA

A
  1. Stat trt of Prednisone 30 mg BID

2. If AION present; trt w/ methylpredniosne 250mg IV q 6 hrs

65
Q

What is the triad for Behcet’s disease

A
  1. Oral
  2. Genital ulcers
  3. Uveitis
66
Q

What retinopathy will Behcet’s have

A

Exudative retinal detachment
Uveitis
Hypopyon

67
Q

What is sarcoidosis

A

Multisystem granulomatous inflammatory disease

68
Q

Clinical features for Sarcoidosis

A 
Bilateral lymphadenopathy
Pulmonary infiltration
Arthritis
Neurological involvement
Cardiac involvement
69
Q

Ocular complication for Sarcoidosis

A

KC sicca
Granulomatous anterior/posterior uveitis
Lacrimal gland enlargement
Granulomatous lid/conj lesion

70
Q

Diagnosis/Management of Sarcoidosis

A

ACE
PPD
Chest x-ray = hilar lymphadenopathy

71
Q

Trt of sarcoidosis

A

Nsaids
Steroids
Hydroxychloroquine

72
Q

What is seen in the ocular manifestation for dermatomyositis?

A

Heliotrope - purple brownish blush of the eyelid

73
Q

What is scleroderma CREST syndrome

A 
Calcinosis
Raynaud's
Esophagus
Scerodactyly
Telangiectasia
74
Q

What is arteriosclerotic retinopathy

A 
If pt BP is normal but see retinopathy like
Cu wiring
Ag wiring
Increase in arterial light reflex
Increased tortuosity
Small hemes
Exudates
75
Q

What are the two main sources for cholesterol?

A
  1. Body produces it

2. Food sources

76
Q

T/F

Skinny ppl are not at risk for dyslipidemia

A

False

77
Q

What is the primary etiology of Dyslipidemia?

A

Genetics
-single or multiple gene mutations that result in either overproduction or defective clearance of TG and LDL cholesterol or in underproduction or excessive clearance of HDL

78
Q

What are some visible signs of Familial Hypercholesterolemia?

A 
Xanthelasma
Corneal arcus
Achilles tendon xanthomas
Tendon xanthomas
tuberous xanthomas
Palmar xanthomas
79
Q

Familial hyperholesterolema vs familial combined hyperlipidemia

A

FH: co-dominant genetic disorder

FCH - autosomal dominant; increased secretions of VLDLs

80
Q

What are some secondary causes for dyslipidemia?

A
  1. Sedentary lifestyle
  2. Diet
    Medications
    alcohol overuse
81
Q

Purpose of lipids?

A

Help to make lipoproteins

82
Q

Purpose of lipoproteins

A

How cholesterol travels through the blood. It transports lipids to and from cells

83
Q

What is the composition of lipoprotein

A

Protein + Fat

84
Q

T/F

Macromolecules have the ability to dissolve in the blood

A

Nope.

85
Q

T/F

Pts could have high tryglyceride numbers from the chylomicrons, but still have good HDL and LDL

A

True

86
Q

Talk about chylomicrons

A

Transport fats from the intestinal mucosa to the liver.

In the liver, the chylomicrons release triglycerides

87
Q

Talk about VLDL

A

Synthesized in the liver and is the primary transport for endogenous triglyceride.

88
Q

Talk about LDL

A

the principle transport mech of cholesterol and also represents the final catabolism of VLDL.
LDL then carries fat and cholesterol to the body’s cells

89
Q

Talk about HDL

A

responsible for the reverse transport of cholesterol.

Carry fat and cholesterol back to the liver for excretion

90
Q

Nonfasting lipid panel

A

Measures HDL and total cholesterol

91
Q

Fasting lipid panel

A

Measures HDL, total cholesterol, and triglycerides

92
Q

How many hours is considered a fasting lipid panel

A

9-12 hours

93
Q

What is the calculation for total cholesterol

A

Optimal: below 200
Borderline: 200-239
High: 240 and above

94
Q

How do you calculate total cholesterol levels

A

HDL + LDL + 20 percent of your tryglycerides

95
Q

What is the name of the organizations that tell u to check lipid panels

A
  1. Adult trt panel of the National Cholesterol education program
  2. United States Preventative Services Task Force
96
Q

Tell me about triglycerides

A

Form of Fat

Trigger liver to make more cholesterol, rising LDL and total cholesterol

97
Q

Guidelines for triglyceride

A

Normal: less than 150
High: 200-499

98
Q

Tell me about VLDL cholesterol

A

COllects in the walls of blood vessels, causing the blockages of atherosclerosis

99
Q

Guidelines for LDL

A

Optimal: less than 100
High: 160-189

100
Q

HDL cholesterol

A

HDL cholesterol scavenges and removes LDL

HDL reduces, reuses, and recycles LDL cholesterol by transporting it to the liver where it can be reprocessed

101
Q

Guidelines for HDL

A

Low: less than 40
High: 60 and above

102
Q

T/F

There is a relationship b/w cholesterol concentration and coronary risk?

A

True

103
Q

Define CHD equivalents

A

risk factors that put the pt at sim risk CHD as a hx of CHD itself

104
Q

What are some Coronary Heart Disease Equivalents

A

Diabetes mellitus
Symptomatic Carotid Artery disease
Peripheral Artery Disease (DVP)
Abdominal Aortic Aneurysm

105
Q

What are some CHD Risk Factors

A 
Family History
Cigarette Smoking
HTN
Diabetes
Obesity
106
Q

What is a negative risk factor for CHD

A

HDL

107
Q

CHD Risk factor involving cholesterol values

A

IF…..
TC is greater than 200 and above
HDL is less than 40 mg/dl
LDL is 130 and above

108
Q

LDL goal for 0-1 risk factors

A

LDL goal is 160
If 160 and above initiate therapeutic lifestyle changes
If 190 and above, initiate pharmaceutical trt

109
Q

LDL goal for2+ risk factors

A

LDL goal is 130
If 130 and above initiate therapeutic lifestyle changes
If 160 and above, initiate pharmaceutical trt

110
Q

If have CHD or CHD risk equialent

A

LDL goal is 100
Optimal = 70
If 100 and above, initate TLC and pharmaceutical trt.

111
Q

What does the 2013 Choelsterol guideline say?

A

If LDL is 160 or higher, place on a statin.

If pt has diabetes and HTN; put on statin if LDL is 130 or higher.

112
Q

Side effects of statin

A

Macular edema

Hyperglycemia

113
Q

Can statins cause diabetes?

A

Reports have shown elevated blood sugars

114
Q

Name some therapeutic lifestyle changes

A

Diet
Wt management
Increased PA

115
Q

How to raise HDL

A 
NEAF
1. Niacin
Exercise
Alcohol
Fish oil
116
Q

What is the ocular sign for Familial cholesterolemia

A

Lipemic retinopathy
Vasculature is salmon colored
U won’t see this in acquired hypercholesterolemia

117
Q

What can a hollenhorst plaque finding indicate?

A

Carotid artery disease

Bust out your bell steth

118
Q

Name some things you see for Carotid Artery Disease

A
  1. AF
  2. TIA
  3. Crescendo TIAs
  4. Stroke in evolution
  5. Cerebral infarction
119
Q

Name the 5 families of the common cold

A 
Rhinovirus
Influenza
Coronavirus
Adenovirus
Paravirus
120
Q

How do u trt rhinovirus

A

Trt the symptoms, not the virus

-Decongestants, warm saline gargles, cough syrups, hydration and rest

121
Q

What do u need to watch out for in common colds?

A

Secondary bacterial infections
Infection of the paranasal cavity.
Commonly follows colds, but can be due to allergic or anatomic problems

122
Q

When does sinusitis typically occr

A

In adults.
Sinuses do not fully develop until adolescence.
U get it from bacteria.

123
Q

What is the name of the aerosolized Abs for sinusitis?

A

SinuNEB

124
Q

How to trt Sinusitis

A

Abs with a 10 day course
-Amoxicillin
Cephalosporin
Ampicillin

125
Q

What is the name of the family for MMR

A

Paramixovirus

126
Q

What is the main symptom for mumps

A

Swollen parotid glands due to a viral infection

127
Q

How do you diagnose MMR

A

Serology

128
Q

How do you prevent MMR

A

MMR vaccine

129
Q

T/F

Measles is highly contagious

A

True

130
Q

What is the main sign for Measles

A

Koplik spots

131
Q

What are some symptoms of congenital rubella who contracted it during prego

A 
Deafness
Retardation
Cardiac abnormalities
Encephalitis
Immune disorders
132
Q

What is the main ocular manifestation of rubella?

A

Rubella retinopathy - salt and pepper vaccine.

133
Q

What is the etiology of rheumatic fever

A

Grade A Streptococcus Pyogenes

134
Q

What is the most common symptom for Rheumatic Fever

A

Pharangitis = strep throat

135
Q

Rheumatic fever: what happens if u have a damaged heart valve?

A

Lead to the risk of bacterial endocarditis - dental examination risk.
Prolapse mitral valve.

136
Q

What are the two main symptoms for Rheumatic fever

A

Carditis - tissue degeneration; heart valve tissue

Chorea - neurologic syndrome

137
Q

How to trt RF

A

Analgesics

ASA/prednisone p.o.

138
Q

T/F

Humans are the only reservoir for Tb

A

True

139
Q

Name the two clinical presentations in Tb

A
  1. Primary infection - sympto or asympto
  2. Reactivation Tb - host defense fail to contain the mycobacterium resulting in multiplication of the organism esp in the lung apices.
140
Q

Diagnosis of Tb

A
  1. Latent w/o disease: Skin test, x-ray

2. Active Tb: sputum smears staining for acid fast bacilli culture.

141
Q

Are ppl with latent Tb considered part of the high risk group?

A 
Yes.
Others include:
substance abuse
diabetes
cancer of the head or neck
low body wt
142
Q

What is the prophylactic drug used to prevent reactivation of Tb disease

A

Isoniazid

143
Q

Name the four drugs used for active disease of Tb

A

INH
Rifampin

-Ethambutol and Pyrazinamide (need to wiat for culture staining for both these drugs to be used).

Clinical Medicine (3 decks)

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