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Exam 1 Flashcards

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1
Q

3 stages of Primary Gout

A

1) Hyperuricemia
2) Acute Gouty Arthritis
3) Chronic Tophaceous Gout

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2
Q
  • Deposits of urate crystals under skin
  • Other major organs (renal)
  • Kidney stone formation
  • 3-40 years after acute episode
  • Uncommon in US
A

Chronic Tophaceous Gout

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3
Q
  • Sodium urate deposited in synovium
  • Excruciating pain
  • Inflammation in small joints, usually great toe (podagra)
A

Acute Gouty Arthritis

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4
Q

Most common inflammatory arthritis in older adults

A

Gout

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5
Q
  • May be genetic X-linked
  • Inborn errors of purine metabolism
  • Production of uric acid exceeds excretion
A

Primary Gout

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6
Q

-Excessive uric acid in the blood caused by another dz

Renal insufficiency, crash diets, diuretics, chemo

A

Secondary Gout

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7
Q

Allopurinol pt instructions

A

Take after meals with a glass of water to prevent GI distress

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8
Q

DOC for Gout

A

Allopurinol

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9
Q

What can cause a gout attack?

A

Alcohol and starvation diets

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10
Q

Diet instructions for gout

A

Increase alkaline ash foods (to increase pH) such as citrus fruits, juices, dairy products

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11
Q

How to treat Polymyositis

A
  • High dose steroids
  • Immunosuppressive agents
  • Monitor nutrition for swallowing problems
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12
Q

What is Polymyositis coupled w/ a rash?

A

Dermatomyositis

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13
Q

What type of rash w/ Dermatomyositis?

A

Heliotrope rash (iliac) & periorbital edema

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14
Q

What Dz?

  • Mostly men
  • Involves every body system
  • Renal and cardiac problems: leading cause of death
A

Polyarteritis nodosa

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15
Q

What Dz?
Most common form of vasculitis
Skin lesions as an allergic response

A

Hypersensitivity vasculitis

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16
Q

What Dz?

  • Japanese women in 20s
  • Aortic arch syndrome
  • Cerebral ischemia
  • Visual changes, syncope, vertigo
A

Takayasu’s arteritis

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17
Q

DOC for vasculitis dzs?

A

Steroid therapy (prednisone)

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18
Q

First symptoms of systemic Necrotizing Dzs?

A

Arteritis, ischemia

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19
Q

DOC for Temporal Arteritis

A
  • Corticosteroids URGENTLY

- Calcium and Vitamin D for prevention of osteoporosis

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20
Q

What Dz?

  • 20% of patients with PMR
  • Systemic affecting large and mid size arteries
A

Temporal Arteritis

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21
Q

Women over 50 report declining vision, probably have?

A

Polymyalgia rheumatica (PMR)

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22
Q

What Dz?

  • Stiffness, weakness, aching
  • Low grade fever, arthralgias, stiffness, fatigue, weight loss
  • Neck, shoulder, hip joints most affected
A

Polymyalgia rheumatica (PMR)

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23
Q

What Dz?Exact cause unknown
-Genetic risk: HLA-B27 alleles
Affects vertebral column, spinal deformities
-White men

A

Ankylosing Spondylitis

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24
Q

What Dz?

  • Genetic association: HLA-B27 antigens
  • Mostly young white men
  • From exposure to STD or Intestinal infection
A

Reiter’s Syndrome

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25
Reiter's Syndrome Triad of Symptoms
1. Arthritis 2. Conjunctivitis 3. Urethritis * May also experience balantitis circinata (inflammation around penis)
26
What Dz? - Autosomal dominant - Abnormalities of skeletal, ocular, cardiopulmonary & CNS - Excessively tall, scoliosis, funneled chest - Decreased visual acuity or glaucoma - Hyperextensibility of joints - Elongated hands and feet
Marfan Syndrome
27
Why do most deaths from Marfan Syndrome occur?
- Cardio problems (usually in 30s) - Mitral valve prolapse - Mitral valve regurgitation - Aortic aneurysm rupture
28
Treatment of Marfan Syndrome?
- Palliative (deal w/ symptoms, not cause) - Monitor CV status - CV medications - Orthopedic surgery
29
What Dz? - Systemic infectious disease - Borrelia burgdorferi spirochete - Bite of infected deer tick - Most common vector borne disease in US
Lyme Dz
30
Stage 1 Lyme Dz
- Localized, flu-like symptoms - Round or oval, flat or slightly raised rash - Pain and stiffness in muscles and joints - Bull’s-eye lesion - Symptoms usually 7-14 days after bite - With treatment (ABX), no symptoms 4-5 weeks
31
Stage 2 Lyme Dz
- Early disseminated (spread), 2-12 weeks after bite - Pt may develop carditis, dysrhythmias, dyspnea, dizziness, palpitations, CNS disorders, Meningitis, facial paralysis, peripheral neuritis
32
Treatment of Stage 2 Lyme Dz
IV antibiotics for 30 days
33
Stage 3 Lyme Dz
``` Chronic persistent Arthritis Chronic fatigue Memory and thinking problems Months to years after bite ```
34
What Dz? - Mimics gout - Deposited crystals are calcium pyrophosphate - Crystals migrate to cartilage - Older hospitalized males - Highest in men with metastatic cancer
Pseudogout
35
What Dz? - 30% of people with psoriasis - 30-50 years of age - Genetic, environmental, infectious agents, immune system dysfunction - Early morning stiffness, neck and back pain - Fingernail and toenail lifting
Psoriatic arthritis
36
Psoriatic Arthritis Tx
- Manage joint pain and inflammation - Control skin lesions - Health teaching similar to skin care for lupus - Management similar to rheumatoid arthritis
37
What Dz? - Chronic pain syndrome, not inflammatory - Arthritis commonly present - Pain, stiffness, tenderness - Neck, upper chest, trunk, low back, extremities (trigger points) - Pain intermittent but worsens with stress, increased activity, weather - 30-50 years of age
Fibromyalgia
38
Precipitating factors of Fibromyalgia
- Chronic fatigue syndrome - Lyme disease - Trauma - Flu-like illness
39
Fibromyalgia Tx
- Antidepressants - Teach that these drugs cause drowsiness - Avoid alcohol - NSAIDS - Sleep aids * Be careful with older pts (may cause confusion and orthostatic hypotension) - Muscle relaxants - Physical Therapy
40
What Dz? - Chronic illness w/ fatigue 6 months or longer - Flu-like symptoms
Chronic Fatigue Syndrome
41
Four of more of what criteria must be met for Chronic Fatigue Syndrome?
- Sore throat - Substantial impairment in short-term memory or concentration - Tender lymph nodes - Muscle pain - Multiple joint pain with redness or swelling - Headaches of a new type, pattern, or severity (not familiar to the patient) - Unrefreshing sleep - Postexertional malaise lasting over 24 hours
42
Supportive Treatments for Chronic Fatigue Syndrome
- Aches and Pains: NSAIDS - Sleeplessness and depression: Antidepressants - Teach: adequate sleep, proper nutrition, regular exercise, stress management, energy conservation, CAM
43
What Dz? - Symptoms atypical of any one connective tissue disease - 10% of patients with CTD - 2 diseases may overlap at one time - Systemic lupus erythematosus AND systemic sclerosis - Rheumatoid arthritis AND SLE
Mixed Connective Tissue Dz
44
What Dz? | "I'm sick of always being sick"
Mixed Connective Tissue Dz
45
What do you assess for Scleroderma?
-Skin: painless pitting edema of hands and fingers, taunt, shiny, wrinkle free, decreased ROM, ulcerations, contractures -Myocardial fibrosis: EKG changes, dysrhythmias, chest pain -Vasculitic lesions -Nailbeds: digit necrosis Autoamputation -Renal:malignant HTN, urine output and BP -Respiratory: pulmonary fibrosis, pulmonary HTN -Gastrointestinal: ability to swallow
46
Main cause of death in Scleroderma?
Renal
47
Important teaching priorities for SLE
Skin Protection, monitor body temperature
48
SLE leading cause of death?
Renal: Lupus Nephritis
49
Classic sign of exacerbation for SLE
Fever
50
What Dz? | -Affects skin ONLY, round coin-like scarring lesions
Discoid DLE
51
What Dz? - Alopecia (hair loss), dry, scaly, raised rash on the face (butterfly rash), mouth ulcers - Autoimmune - Combination of genetic and environmental factors - Onset 20-40 years of age - Women 10 times more than men - Women of color more often affected
SLE
52
Patho of SLE
-Antinuclear Antibodies (ANA) affect DNA, RNA -Immune complexes form in serum & organ tissues -Inflammation, damage, destruction -Invade organs or vessels (vasculitis) *Particularly attracted to kidney glomeruli (leading cause of death) -Deprives organs/tissues of arterial blood & oxygen
53
Chronic therapy complications of RA
-Diabetes mellitus, infection, fluid/electrolyte imbalances, HTN, Osteoporosis, Glaucoma
54
Teaching for RA
- Take steroids with calcium plus vitamin D | - Rest and ice after injection in single joint
55
DOC for RA
Prednisone
56
Cox-2 inhibitor for RA
- Celebrex | * Cardiovascular WARNING!
57
Pts with MS or TB cannot take what drugs?
BRMs
58
BRMs for RA
``` etanercept (Enbrel) Monitor CBC, creatinine, liver panel infliximab (Remicade) Infusion reaction: tachycardia, shortness of breath, lightheadedness adalimumab (Humira) anakinra (Kineret) Patients with MS or TB cannot take this drug abatacept (Orencia) ```
59
Most pts w/ RA are managed with what initially?
DMARDs
60
DMARDs for RA
- Leflunomide (Arava) * Hair loss, diarrhea, decreased WBCs/platelets, increased liver enzymes, avoid alcohol, pregnancy not recommended - Hydroxychloroquine (Plaquenil), Antimalarial drug * Retinal damage, generally tolerated well, mild stomach discomfort, light-headedness/headache
61
DOC for RA
Methotrexate (MTX) (Rheumatrex) *Immunosuppressive= decreased WBCs, platelets, elevated liver enzymes/creatinine, pregnancy not recommended, risk for infection, avoid crowds
62
Arthrocentesis
Fluid is drained from a joint, can be done with RA
63
Sjögren's Syndrome
- Dry eyes, dry vagina, dry mouth | - Seen in RA
64
Infectious organism possibly causing RA?
Epstein-Barr virus

Adult 1 (8 decks)

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