ClinMed_test2 Flashcards
(143 cards)
1
Q
When are the symptoms typically worse for JRA pt?
A
In the morning and after a nap.
2
Q
T/F
Having JRA does not lead to adult RA
A
True
3
Q
What is the name of the systemic form of JRA?
A
Still’s disease
Affects 20% of pts
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
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
6
Q
Define Spondyloarthropathies
A
Group of interrelated chronic inflammatory diseases
7
Q
What are some clinical features of Spondyloarthropathies
A
Arthritis Involvement of sacroilliac joints HLA-B27 NO ASSOCIATION WITH rheumatoid factor Uveitis
8
Q
What are the four types of spondyloarthropathies
A
Ankylosing spondylitis
Reactive arthritis
psoriatic arthritis
Inflammatory bowel disease
9
Q
Demographics of those affected with ankylosing spondylitis
A
- More common in young men
- Onset 15-35 years of age
- More common in native americans
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
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
12
Q
Behcet’s disease
A
Young adults
Hypopyon, iritis, mouth and genital ulcers
Can’t chew, can’ view, can’t screw
13
Q
What are the two systemic involvement of Reactive arthritis
A
Keratoderma blennorrhagica
Balanitis Circinata
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
15
Q
Name the two types of IBD
A
CHron’s disease
Ulcerative colitis
16
Q
T/F
Pts w/ IBD are more likely to have demyelinating disease like MS and optic neuritis
A
True
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
18
Q
Management of Gout
A
NSAIDs - indomethacin
Allopurinol
Steroids
19
Q
Ocular manifestations from Indomethacin
A
Corneal deposits
Retinal disturbance
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
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.
22
Q
How to manage infectious arthritides
A
Aggressive trt w/ intravenous antibiotics
23
Q
Does lyme disease cause joint inflammation
A
Yes
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
25
What to order to confirm Lyme Disease?
Lyme titer
- ELISA
- Western blot
26
Trt for Lyme
3-4 weeks with doxycycline or amoxicillin
IV ceftriaxone or PCN for 4 weeks or more
-LYMErix is no longer available.
27
What is SLE
Chronic multisystem microvascular inflammation with the generation of autoantibodies
28
Demographics for SLE
Affects young middle age women
Greater prevalence in black females
Affects all body systems
29
Diagnosis of SLE
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
30
T/F
| Medications have been reported to trigger SLE
True
Hydralazine - HBP
Phenytoin - epilepsy
INH - TB
31
Describe discoid lupus
Occurs in the absense of other systemic symptoms or organ involvement, and these pts rarely develop SLE
32
How often does Raynaud's syndrome occur in those with SLE
20-30%
Take vaigra due to vasodilation properties.
Will have ulcerations on the tips of hands or feet
33
Ocular complications of SLE
Retinal ischemia - CWS
Uveitis
Conjunctivitis
Optic neuritis
34
How to diagnose SLE
Sensitive but not specific = ANA
| Specific but not sensitive = Anti-DS DNA
35
Management for SLE
Depends on the organs involved
NSAID
Corticosteroid
Immunosuppressive medication like methotrexate and plaquenil
36
What percentage of ocular structures does collagen makes up?
80%
37
Define CVD
Disease characterized by pain and inflammation in joints and connective tissues
-Affects women in childbearing years more often than men
38
MOA of aspirin
Reduces prostaglandins by blocking COX 1 and 2.
39
Side effects of aspirin
Gastric irritation
Cornea - whorl keratopathy
COnj and retinal hemes
40
Why were the super aspirins like Vioxx and celebrexx pulled off the market?
Due to increased risk of heart attack and stroke
41
Side effects of corticosteroids
```
Steroid induced diabetes
HTN
Wt gain
Mental disturbance
Glaucoma/Cataract
```
42
GO OVER THE PLAQUENIL risk assessment
OKEE
43
Which Disease modifying anti-rheumatological therapy drug is the best?
Methotrexate
| Need to supplement with folate.
44
Side effect of methotrexate?
Persistent cough
| Unexplained SOB
45
What is so special about biological agents like
Etanercept
Infliximab
Humira
Need to be injected
46
What can the majority of DMARDs cause
Bone marrow toxicity
| Liver toxicity
47
What to suspect if pt experiences recurrent episcleritis?
1. Idiopathic
| 2. Syphilis
48
What is the most common cause for uveitis/episcleritis/scleritis?
RA
49
What are the diagnostic findings for RA
1. RF factor
2. ANA: anti nuclear antibodies
3. elevated ESR
4. CBC
X-Ray
50
Management for RA
Exercise/PT
Meds
Surgical intervention
Treat ocular complications
51
What are the two diseases that Sjogren is usually associated with
RA
| SLE
52
Manifestation of Sjogren?
Xerostomia
Xerophthalmia
Drying of the nasopharynx
Salivary gland enlargement
53
Define gout
Arthritis produced by accumulation of monosodium urate crystals (tophi)
54
T/F
| 20-25% of SLE have increase antiphospholipid antibodies
True
55
Define Antiphospholipid Syndrome
Life and vision threatening multi-symptomatic disorder that affects multiple organs.
56
What is the main thing that points fingers to APS
Recurrent spontaneous abortions
57
How to diagnose APS
1. anticardiolipin antibodies
| 2. Lupus anticoagulant antibodies
58
Treatment of APS
1. Thrombosis - Heparin IV. Warfarin PO
| 2. Prophylactic therapy
59
Name two common Vasculitides
1. Giant Cell arteritis
| 2. Behcet's syndrome
60
T/F
| Men are twice more likely to get GCA then females
False
61
Symptoms of GCA?
Temporal headaches
Scalp tenderness
jaw/tongue claudication
AF
62
Diagnosis of GCA
Elevated ESR in 85%
Elevated C-reactive protein
Temporal artery biopsy
63
What is the most common ocular complication for GCA?
AION - This is an ocular emergency
| Other complications include AF, CRVO/BRVO, CN6
64
Trt of GCA
1. Stat trt of Prednisone 30 mg BID
| 2. If AION present; trt w/ methylpredniosne 250mg IV q 6 hrs
65
What is the triad for Behcet's disease
1. Oral
2. Genital ulcers
3. Uveitis
66
What retinopathy will Behcet's have
Exudative retinal detachment
Uveitis
Hypopyon
67
What is sarcoidosis
Multisystem granulomatous inflammatory disease
68
Clinical features for Sarcoidosis
```
Bilateral lymphadenopathy
Pulmonary infiltration
Arthritis
Neurological involvement
Cardiac involvement
```
69
Ocular complication for Sarcoidosis
KC sicca
Granulomatous anterior/posterior uveitis
Lacrimal gland enlargement
Granulomatous lid/conj lesion
70
Diagnosis/Management of Sarcoidosis
ACE
PPD
Chest x-ray = hilar lymphadenopathy
71
Trt of sarcoidosis
Nsaids
Steroids
Hydroxychloroquine
72
What is seen in the ocular manifestation for dermatomyositis?
Heliotrope - purple brownish blush of the eyelid
73
What is scleroderma CREST syndrome
```
Calcinosis
Raynaud's
Esophagus
Scerodactyly
Telangiectasia
```
74
What is arteriosclerotic retinopathy
```
If pt BP is normal but see retinopathy like
Cu wiring
Ag wiring
Increase in arterial light reflex
Increased tortuosity
Small hemes
Exudates
```
75
What are the two main sources for cholesterol?
1. Body produces it
| 2. Food sources
76
T/F
| Skinny ppl are not at risk for dyslipidemia
False
77
What is the primary etiology of Dyslipidemia?
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
What are some visible signs of Familial Hypercholesterolemia?
```
Xanthelasma
Corneal arcus
Achilles tendon xanthomas
Tendon xanthomas
tuberous xanthomas
Palmar xanthomas
```
79
Familial hyperholesterolema vs familial combined hyperlipidemia
FH: co-dominant genetic disorder
| FCH - autosomal dominant; increased secretions of VLDLs
80
What are some secondary causes for dyslipidemia?
1. Sedentary lifestyle
2. Diet
Medications
alcohol overuse
81
Purpose of lipids?
Help to make lipoproteins
82
Purpose of lipoproteins
How cholesterol travels through the blood. It transports lipids to and from cells
83
What is the composition of lipoprotein
Protein + Fat
84
T/F
| Macromolecules have the ability to dissolve in the blood
Nope.
85
T/F
| Pts could have high tryglyceride numbers from the chylomicrons, but still have good HDL and LDL
True
86
Talk about chylomicrons
Transport fats from the intestinal mucosa to the liver.
| In the liver, the chylomicrons release triglycerides
87
Talk about VLDL
Synthesized in the liver and is the primary transport for endogenous triglyceride.
88
Talk about LDL
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
Talk about HDL
responsible for the reverse transport of cholesterol.
| Carry fat and cholesterol back to the liver for excretion
90
Nonfasting lipid panel
Measures HDL and total cholesterol
91
Fasting lipid panel
Measures HDL, total cholesterol, and triglycerides
92
How many hours is considered a fasting lipid panel
9-12 hours
93
What is the calculation for total cholesterol
Optimal: below 200
Borderline: 200-239
High: 240 and above
94
How do you calculate total cholesterol levels
HDL + LDL + 20 percent of your tryglycerides
95
What is the name of the organizations that tell u to check lipid panels
1. Adult trt panel of the National Cholesterol education program
2. United States Preventative Services Task Force
96
Tell me about triglycerides
Form of Fat
| Trigger liver to make more cholesterol, rising LDL and total cholesterol
97
Guidelines for triglyceride
Normal: less than 150
High: 200-499
98
Tell me about VLDL cholesterol
COllects in the walls of blood vessels, causing the blockages of atherosclerosis
99
Guidelines for LDL
Optimal: less than 100
High: 160-189
100
HDL cholesterol
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
Guidelines for HDL
Low: less than 40
High: 60 and above
102
T/F
| There is a relationship b/w cholesterol concentration and coronary risk?
True
103
Define CHD equivalents
risk factors that put the pt at sim risk CHD as a hx of CHD itself
104
What are some Coronary Heart Disease Equivalents
Diabetes mellitus
Symptomatic Carotid Artery disease
Peripheral Artery Disease (DVP)
Abdominal Aortic Aneurysm
105
What are some CHD Risk Factors
```
Family History
Cigarette Smoking
HTN
Diabetes
Obesity
```
106
What is a negative risk factor for CHD
HDL
107
CHD Risk factor involving cholesterol values
IF.....
TC is greater than 200 and above
HDL is less than 40 mg/dl
LDL is 130 and above
108
LDL goal for 0-1 risk factors
LDL goal is 160
If 160 and above initiate therapeutic lifestyle changes
If 190 and above, initiate pharmaceutical trt
109
LDL goal for2+ risk factors
LDL goal is 130
If 130 and above initiate therapeutic lifestyle changes
If 160 and above, initiate pharmaceutical trt
110
If have CHD or CHD risk equialent
LDL goal is 100
Optimal = 70
If 100 and above, initate TLC and pharmaceutical trt.
111
What does the 2013 Choelsterol guideline say?
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
Side effects of statin
Macular edema
| Hyperglycemia
113
Can statins cause diabetes?
Reports have shown elevated blood sugars
114
Name some therapeutic lifestyle changes
Diet
Wt management
Increased PA
115
How to raise HDL
```
NEAF
1. Niacin
Exercise
Alcohol
Fish oil
```
116
What is the ocular sign for Familial cholesterolemia
Lipemic retinopathy
Vasculature is salmon colored
U won't see this in acquired hypercholesterolemia
117
What can a hollenhorst plaque finding indicate?
Carotid artery disease
| Bust out your bell steth
118
Name some things you see for Carotid Artery Disease
1. AF
2. TIA
3. Crescendo TIAs
4. Stroke in evolution
5. Cerebral infarction
119
Name the 5 families of the common cold
```
Rhinovirus
Influenza
Coronavirus
Adenovirus
Paravirus
```
120
How do u trt rhinovirus
Trt the symptoms, not the virus
| -Decongestants, warm saline gargles, cough syrups, hydration and rest
121
What do u need to watch out for in common colds?
Secondary bacterial infections
Infection of the paranasal cavity.
Commonly follows colds, but can be due to allergic or anatomic problems
122
When does sinusitis typically occr
In adults.
Sinuses do not fully develop until adolescence.
U get it from bacteria.
123
What is the name of the aerosolized Abs for sinusitis?
SinuNEB
124
How to trt Sinusitis
Abs with a 10 day course
-Amoxicillin
Cephalosporin
Ampicillin
125
What is the name of the family for MMR
Paramixovirus
126
What is the main symptom for mumps
Swollen parotid glands due to a viral infection
127
How do you diagnose MMR
Serology
128
How do you prevent MMR
MMR vaccine
129
T/F
| Measles is highly contagious
True
130
What is the main sign for Measles
Koplik spots
131
What are some symptoms of congenital rubella who contracted it during prego
```
Deafness
Retardation
Cardiac abnormalities
Encephalitis
Immune disorders
```
132
What is the main ocular manifestation of rubella?
Rubella retinopathy - salt and pepper vaccine.
133
What is the etiology of rheumatic fever
Grade A Streptococcus Pyogenes
134
What is the most common symptom for Rheumatic Fever
Pharangitis = strep throat
135
Rheumatic fever: what happens if u have a damaged heart valve?
Lead to the risk of bacterial endocarditis - dental examination risk.
Prolapse mitral valve.
136
What are the two main symptoms for Rheumatic fever
Carditis - tissue degeneration; heart valve tissue
| Chorea - neurologic syndrome
137
How to trt RF
Analgesics
| ASA/prednisone p.o.
138
T/F
| Humans are the only reservoir for Tb
True
139
Name the two clinical presentations in Tb
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
Diagnosis of Tb
1. Latent w/o disease: Skin test, x-ray
| 2. Active Tb: sputum smears staining for acid fast bacilli culture.
141
Are ppl with latent Tb considered part of the high risk group?
```
Yes.
Others include:
substance abuse
diabetes
cancer of the head or neck
low body wt
```
142
What is the prophylactic drug used to prevent reactivation of Tb disease
Isoniazid
143
Name the four drugs used for active disease of Tb
INH
Rifampin
-Ethambutol and Pyrazinamide (need to wiat for culture staining for both these drugs to be used).
