Final review Flashcards by Michele Burr

What is the most common cause of chest

pain?

Musculoskeletal

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CHEST PAIN
Is musculoskeletal pain described as
gradual or sudden?

Gradual onset

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CHEST PAIN
What is something you could ask the
patient to do regarding assessing the
pain?

Localized pain; point with 1 finger
where you are hurting
Remember: reproducible is a GOOD thing

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CHEST PAIN
Are any tests required for musculoskeletal
chest pain?

no tests unless hx of trauma

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CHEST PAIN

What is the treatment for musc chest pain?

rest, NSAIDs, ice/heat

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CHEST PAIN
What is the 2nd most common cause of
chest pain?

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CHEST PAIN
What risk factors accompany GI chest
pain?

Hx of ulcers, smoking, ETOH, NSAID
or ASA overuse
Always ask about OTC MEDS!

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CHEST PAIN

How is GI chest pain described?

Recurrent episodes of SUBSTERNAL
BURNING pain; pain is WORSE WITH MEALS
or when lying supine

Pain is WORSE with palpation to
EPIGASTRIUM
If the patient has an esophageal spasm – they
may characterize the pain as “squeezing or
pressure”

PUD will complain of epigastric pain that may
radiate to their back

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CHEST PAIN
What tests would you order for to rule
in/out GI chest pain?

▫ Urea breath test: H. pylori

▫ PUD: EGD to evaluate for ulcers

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CHEST PAIN

What is the treatment for GI chest pain?

▫ Lifestyle modifications: Diet, elevate
HOB when sleeping
▫ PPIs: GERD or PUD
▫ Antibiotics: +H.pylori

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CHEST PAIN
What is the 3rd most common cause of
chest pain?

Psych

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CHEST PAIN
What are some risk factors for psych as
the cause of chest pain?

▫ Acute stress (home, workplace, school)
▫ Hx of panic disorder
▫ Hx of depression

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CHEST PAIN
A patient presents with chest pain. Hx of
depression. What might this patient
describe their chest pain as?

heaviness that is either sudden or

gradual

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CHEST PAIN
A patient presents with chest pain. Hx of
anxiety. What might this patient look like?

▫ Hyperventilating 🡪 numbness or tingling

to BILATERAL extremities

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CHEST PAIN
What 2 screening questions are
IMPORTANT when assessing a patient with
chest pain to help your differential in
psych being the cause?

In the last 6 months, have you
experienced either of the following:
▫ Spell or attack of feeling anxious
▫ Felt like your heart was racing or felt
faint?
If patient responds with YES to EITHER
question, SUSPECT PSYCH and
investigate further.

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CHEST PAIN
What risk factors place the patient at risk
for a respiratory cause of chest pain?

▫ Recent immobility
▫ Recent pregnancy
▫ Pelvic or femur trauma (fracture, surgery)
▫ Hypercoagulability
▫ Estrogen use (HRT) or birth control
▫ Are they a smoker
▫ Hx or current cancer

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CHEST PAIN
A patient was recently dx with pneumonia.
What chest pain symptoms might this
patient report?

dull ache (could have no pain at all)

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CHEST PAIN
A patient presents to clinic with c/o pain
worse with inspiration, characterized as
stabbing to posterior LL lobe. Vitals reveal
tachycardia of 101hr. What do you
suspect? What should be included in your
assessment of this patient?

PE (pulmonary embolism). You
should perform a Wells score to determine
imaging.

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CHEST PAIN
What Wells score indicates low risk? What
would be your next NP action?

<2 you would order a d-dimer
▫ Depending on patient complaint, may
order a lower extremity US to rule out
DVT

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CHEST PAIN
What Wells score indicates high risk?
What would be your next NP action?

Answer: >6 you would order a CT scan and
LE US
▫ If a clot is found, begin anticoagulation.

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CHEST PAIN
Patient presents to clinic with cough,
fever, and increased shortness of breath
with exertion. What do you suspect in this
patient? What would you order to rule in /
out?

▫ Order a 2-view CXR

▫ Treat with antibiotics

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CHEST PAIN
Woman presents to clinic for annual exam.
Constitutional: healthy, thin, cooperative.
CV: pansystolic murmur with mid-systolic
click. Spine: pectus excavatum. What
cardiac issue do you suspect in this
patient? How do you diagnose
definitively? What is treatment?

Mitral Valve Prolapse
▫ Diagnose: Echo
▫ Treatment: None required UNLESS
symptomatic – this would be a
beta-blocker “olol”

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CHEST PAIN
Patient presents to clinic with c/o abrupt onset
of stabbing / ripping chest pain that is radiating
to his back. Hx of smoker. Patient appears
anxious upon exam. What assessment
technique is important to perform? What do you
suspect? What is your treatment?

BP in left and right arm
▫ Difference in BP >15mmHg = positive
assessment
▫ Diff Dx: Abdominal aortic aneurysm
▫ Diagnostics: Stat CT, prayer, surgery

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CHEST PAIN
Patient presents to clinic with c/o substernal
chest pain, radiates to shoulders. Patient reports
increased pain when lying down. Vitals reveal
100.5oral temp, 92hr, 22rr. What information
would be IMPORTANT to obtain from this
patients hx? What do you suspect? What are
your orders? What is the treatment?

▫ HPI: Do you have history of recent viral
infection, SLE/RA? Cancer? Post-MI?
▫ Diff Dx: pericarditis
▫ Labs: ESR, CBC, cardiac enzymes
▫ Diagnostics: ECG, Echo
▫ Treatment: Bedrest, ASA/NSAIDs, possibly
steroids

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CAD | What is #1 cause of CAD?

atherosclerotic disease

CAD | What are the risk factors for CAD?

``` ▫ Male ▫ >age ▫ FHx of CAD ▫ High LDL with low LDL ▫ High trig [esp. women] ▫ Hx of HTN, DM ▫ Smoker ▫ Inactivity ▫ Abdominal obesity ▫ Stress ▫ Diet low in fruits & veggies ▫ Excessive ETOH use ```

CAD | What can REDUCE CAD risk?

``` ▫ Initiate statin ▫ Manage HTN properly (meds, lifestyle modifications) ▫ Smoking cessation ▫ Weight loss ```

CAD | What is ROUAN decision Rule?

Aids in predicting which patients are | at higher risk of MI

CAD What are the components of ROUAN decision MI?

>60y, diaphoresis, hx of MI/angina, males, pain [pressure], radiates to arm/shoulder/neck/jaw

``` ANGINA A 26yr old patients presents to ER c/o sudden onset of chest pain, onset 1 hr ago. What would aid in differentiating the cause of this patient’s chest pain? ```

▫ Urine drug screen (possible cocaine use) ▫ ECG: ST elevation with attack but pain subsides when not in pain (think Prinzmetal)

Prinzmetal risk factors include?

women, <50yr [occurs in AM, | awaken pt from sleep]

ANGINA | What is the tx for Prinzmetal?

nitrate or CCBs; REFER TO | CARDIOLOGY

ANGINA 32y female presents to clinic with c/o chest pain, intermittent. Associated symptoms include generalized fatigue. Vitals: 92hr, 100% room air. Physical exam reveals pale conjunctiva. Based on your findings, how 1 would you proceed?

``` Suspect iron-deficiency anemia. ▫ Labs: CBC + iron studies ▫ Treatment: iron supplement ▫ Education: Increase daily fiber and water intake ▫ Follow-up: 1 month to recheck labs. ```

ANGINA | What murmur can present with chest pain?

severe aortic stenosis or aortic | regurgitation

CHRONIC STABLE ANGINA What is a KEY component to a patient with hx of chronic stable angina?

Pain occurs during activity, and is | relieved by rest

CHRONIC STABLE ANGINA What aggravating factors are associated with chronic stable angina? ▫ A: standing up, greasy food ▫ B: sexual activity, exposure to heat ▫ C: angry outbursts, worse in AM ▫ D: lying down, exposure to heat

C: angry outbursts, worse in AM

CHRONIC STABLE ANGINA What are the predominate locations noted with chronic stable angina?

behind/left of midsternal, radiates to | left shoulder/arm, felt in neck, jaw, back

CHRONIC STABLE ANGINA What is the first line treatment for chronic stable angina?

Nitro SL

CHRONIC STABLE ANGINA When assessing a patient in clinic with a hx of MI, what is an expected finding on the EKG?

Q wave

CHRONIC STABLE ANGINA What is some important education regarding the use of nitro SL that you should provide your patient?

admin 1 tablet under the tongue (or between the cheek and gum) at the first sign of an angina attack. 1 tablet may be used every 5 minutes as needed, for up to 15 minutes. Do not take more than 3 tablets in 15 minutes. To prevent angina from exercise or stress, use 1 tablet 5 to 10 minutes before the activity. Don’t take Viagra.

CHRONIC STABLE ANGINA What is an expected finding you should warn your patient of regarding the use of nitroglycerin?

Headache is common With Nitro patch, inform your patient they must leave it off at least 8-10hr at night. Doing so ensures it efficacy.

CHRONIC STABLE ANGINA What is a prevention medication used in patient with hx of MI? Who would this be contraindicated in?

BB; prolong life post-MI [no labetalol, pindolol]; do not give in asthma, DM, COPD, bradycardia, decompensated HF

``` CHRONIC STABLE ANGINA What drug can be used monotherapy, has no effect on BP/HR and is safe with erectile dysfunction meds? Who can this NOT be given to? ```

Ranolazine ▫ Long QT syndrome, if pt is taking macrolides, fluoroquinolone, and if hx of severe liver/kidney dx

CHRONIC STABLE ANGINA What is the MAJOR sign indicating patient is having an acute coronary event?

CP @ rest, minimal exertion, | radiates to jaw, left arm/shoulder, >30min

CHRONIC STABLE ANGINA What is the natural progression of heart electrophysiology seen on the EKG during an acute coronary event?

Normal 🡪 hyperacute T wave 🡪 ST elevation w/hyperacute T 🡪 Q wave, less ST, T wave inverts 🡪 Q wave, t wave inversion 🡪 Q wave, upright T wave

CHRONIC STABLE ANGINA What component on the EKG signals correlates with ischemia?

T wave

CHRONIC STABLE ANGINA What component on the EKG signals correlates with injury?

ST wave

CHRONIC STABLE ANGINA What component on the EKG signals correlates with irreversible cell death?

Q wave

CHRONIC STABLE ANGINA Following an acute MI, what drugs would you expect your patient to leave the hospital on?

aspirin + anticoagulant + nitro (prn), BB, ACE-I (HTN), statin (high intensity); Educate to stop smoking! No CCBs

HEART FAILURE | What is considered a normal EF?

55-70%

HEART FAILURE HFpEF is an EF of _____%? This is considered a _________ heart failure.

>40%; diastolic

HEART FAILURE HFrEF is an EF of _____%? This is considered a _________ heart failure.

<40%; systolic

HEART FAILURE What is a KEY lab marker used to detect patients at risk of HF?

BNP

HEART FAILURE According to the new guidelines, patients who present with HFpEF should have a BP goal of?

<130/80

HEART FAILURE According to the new guidelines, patients who present with HFrEF the preferred drug of choice is?

ARNi | Entresto

HEART FAILURE What are some of the common causes of HF?

CAD, HTN, DM, ETOH, a-fib, hyperthyroid, COPD, obesity, anemia, OSA, older age

HEART FAILURE A patient presents to your clinic with c/o progressive fatigue. Upon physical exam you note: GI: distended abdomen, with palpable liver edge; CV: +s3 heart sound, +BLE edema non-pitting. Pulm: mild tachypnea, no crackles or rales. What do you suspect in this patient? What would be your NEXT action as the NP?

Right-sided HF; Order BNP, CXR | 2-view, Echo.

HEART FAILURE A patient presents to your clinic with c/o worsening sob, especially with exertion. Upon physical exam you note: Pulm: bilateral crackles lower lung fields, mild tachypnea; CV: +s1/s2 irregularly irregular rate/rhythm. Vitals: 92HR, 98.7F oral, 26RR, 96% room air. What do you suspect in this patient? What orders would be appropriate to confirm your diagnosis?

Left-sided HF; Order BNP, CXR | 2-view, Echo.

HEART FAILURE In a patient with HFpEF >40% EF: what is the mainstays of treatment?

tx CANNOT decrease mortality; | manage comorbid dx AND diuretics

``` HEART FAILURE Brand-new patient, taking no medications currently. Patients hx is as follows: HF 55% EF, essential HTN, pre-diabetes. Labs today: A1C 8.7%, eGFR 57, Cr 1.0. K: 3.7, Na 137. Random BG 190. 146/72 BP. 86 HR. No allergies. What medications would be 1 appropriate to order? ```

``` HTN: lisinopril 10mg PO once daily. HF: HCTZ 12.5mg PO once daily. DM: Metformin 500mg PO once daily. Encourage exercise [3-4x/week, 40min sessions of moderate activity]; Check lipid panel [HLD is a co-existing risk factor for HF]. ```

HEART FAILURE What patient with HF would it be appropriate to treat with BB?

Control tachycardia [rate control in A-fib], lower BP in patients with angina or had a recent MI

``` HEART FAILURE An AA 53y male with HF EF 53% presents to clinic c/o cough while taking ACE-I for their HTN. Hx of CKD stage 3a. What drug would be MOST appropriate [effective] to initiate in this situation? ```

CCB – amlodipine. Pt is AA with CKD. Ok in diastolic HF, DO NOT GIVE IN decompensated HF EF <40%.

HEART FAILURE | What diuretic is potassium sparing?

Spironolactone; caution when using | this and what drug together? [ACE or ARB]

A-FIB A patient with a-fib has a CHA2DS2VASc score of 1 – this signals to the NP to:

consider a blood thinner. ▫ Score of 2: ORDER BLOOD THINNER. ▫ Score of 0: no blood thinner

WARFARIN | Warfarin interactions include?

NSAIDS; herbal supplements; medications ▫ Increase INR (longer it takes to clot, blood is THINNER, risk for bleeding): phenytoin, erythromycin, metronidazole, Bactrim, amiodarone, cimetidine, ETOH, statins ▫ Decrease INR (blood clots more quickly, blood is THICKER, risk for clots): phenytoin, rifampin, carbamazepine, phenobarbital, ginseng, ETOH

HEART FAILURE In a patient with HFpEF <40% EF: What is the mainstays of treatment?

manage comorbid dx + lifestyle + | cardiac rehab + meds

HEART FAILURE | What is the 1st line drug for HF <40% EF?

ACE-I w/diuretic

HEART FAILURE What drug decreases mortality in HF patients?

``` HEART FAILURE Patient presents with HF 30%. Vitals: 101, BP 130/72, 100% room air, 20 RR. Meds: Metoprolol 400mg/day (200mg AM, 200mg PM), Lisinopril 20mg PO once daily. With the patient’s vitals in mind, what drug could the patient be prescribed? ```

Ivabradine [Corlanor]

HEART FAILURE What drug is used in A-fib to control the patient’s rate?

Digoxin

HEART FAILURE When deciding the appropriate diuretic for a patient with an EF 32%, you would want to know which lab?

eGFR; >40 = HCTZ; <40 = Lasix

``` HEART FAILURE With respect to medications in decompensated HF, which should be avoided – SELECT ALL THAT APPLY: ▫ A: TZDs ▫ B: CCBs ▫ C: PD5E inhibitors ▫ D: NSAIDs / Cox-2 inhibitors 1 ```

▫ A: TZDs ▫ B: CCBs ▫ C: PD5E inhibitors ▫ D: NSAIDs / Cox-2 inhibitors 1 A, B, C, D Also, AVOID Na products – Na bicarb, fleets enema, phosphorous = soda

MURMURS Which valves are OPEN during systolic (s1)?

aortic / pulmonic

MURMURS What valves are OPEN during diastole (s2)?

tricuspid / mitral

MURMURS A STENOTIC murmur is blowing or low-pitched rumble?

low-pitched rumble

``` MURMURS Female pt presents to your clinic for wellness exam. You note upon exam: low-pitched rumbling murmur w/opening snap heard during S2. What murmur is being auscultated? ```

Tricuspid stenosis – diastolic | murmur

``` MURMURS Male pt presents to your clinic for wellness exam. You note upon exam: crescendo-decrescendo low-harsh pitched rumbling murmur w/pulmonary ejection click - heard during S1. What murmur is 1 being auscultated? ```

Pulmonic stenosis – systolic murmur

MURMURS A patient presents to clinic with hx of mitral stenosis. Is this a diastolic or systolic murmur?

Diastolic – opening snap; hx of rheumatic fever; symptoms caused by pregnancy, a-fib. Tx: mechanical valve when symptomatic + warfarin

MURMURS A patient presents to clinic with hx of aortic stenosis. Is this a diastolic or systolic murmur?

Systolic – pt is OLD and SAD = syncope, angina, dyspnea. Radiates to carotids. Tx: replacement, clopidogrel + aspirin; NO DOACs

MURMURS Holosystolic MUSICAL murmur often seen in those with hx of IVDA?

Tricuspid Regurgitation

MURMURS Tricuspid Regurgitation - is this SYSTOLIC or DIASTOLIC?

Systolic

MURMURS High-pitched decrescendo murmur, heard best leaning forward, INCREASES with INSPIRATION?

Pulmonic regurgitation

MURMURS Pulmonic regurgitation - is this SYSTOLIC or DIASTOLIC?

Diastolic

MURMURS Pansystolic murmur with mid-systolic clicks. It is blowing, high-pitched. Hx of rheumatic fever. A-FIB IS COMMON. Radiates to axilla. Name the murmur – is it SYSTOLIC or DIASTOLIC?

Mitral Regurgitation; Systolic

MURMURS What lab is vital to observe with any murmur that deals with the left side of the heart?

BNP

AUTOIMMUNE CONDITIONS In ordering an autoimmune panel on a patient, you know this includes what lab orders?

``` ANA, RA, ESR Other important labs to consider when working up a patient with suspected autoimmune disorder include: B12, TSH, CBC, CMP ```

``` AUTOIMMUNE CONDITIONS Pt presents to clinic with INTENSE pain localized to the 1st toe on left foot. Upon physical exam you note the toe is red and warm to touch. Pt displays no systemic symptoms. Based on your findings, what is your preliminary diagnosis of this patient? ```

Gout

AUTOIMMUNE CONDITIONS | Gout is most common in what patient?

Males, ETOH beer, use of diuretics, | aspirin, cyclosporine, niacin

AUTOIMMUNE CONDITIONS | Is Gout an acute or insidious onset?

acute

AUTOIMMUNE CONDITIONS What is the other name for the Great toe used in Gout?

podagra

AUTOIMMUNE CONDITIONS What other major system can be affected by Gout?

kidneys

AUTOIMMUNE CONDITIONS What is the serum uric acid level for Gout diagnosis?

>6.8mg/dl

AUTOIMMUNE CONDITIONS To confirm Gout in a patient, what must you obtain?

AUTOIMMUNE CONDITIONS What is the standard treatment for Gouty attack?

Colchicine 1.2mg bolus dose, 0.6mg | 1hr later

AUTOIMMUNE CONDITIONS | What is the dose for Gout prophylaxis?

Colchicine 0.6mg BID; allopurinol is | also used

AUTOIMMUNE CONDITIONS How many episodes per year should signal to the NP to initiate urate lowering meds?

2+ episodes per year 🡪 colchicine

AUTOIMMUNE CONDITIONS You are educating your patient on gout prevention. What key interventions should you include?

avoid ETOH, high-purine foods [organ meat, yeast, seafood, beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower, mushrooms, corn syrup drinks]. Ensure HIGH fluid intake. Avoid meds: thiazide, loop diuretics, niacin.

AUTOIMMUNE CONDITIONS What is considered the goal serum uric acid?

>6.0mg/dL

AUTOIMMUNE CONDITIONS Gout increases the patients risk for what other co-morbid diagnoses?

HTN, kidney dx, DM, | hypertriglycerides, atherosclerosis

AUTOIMMUNE CONDITIONS Pt presents to clinic with c/o gradual onset fatigue and stiffness occurring in the AM upon awakening. Pain is localized to left hip. Pt displays no systemic symptoms. Based on your findings, what is your 3 preliminary diagnosis of this patient?

Osteoarthritis

AUTOIMMUNE CONDITIONS Is Osteoarthritis inflammatory or non-inflammatory?

non-inflammatory

AUTOIMMUNE CONDITIONS What is a KEY factor to include in obtaining hx from patient suspected of osteoarthritis?

pain relieved at rest, AM stiffness | <30m

AUTOIMMUNE CONDITIONS Osteoarthritis is more prevalent in women or men?

Women

AUTOIMMUNE CONDITIONS | Osteoarthritis – ESR elevated or normal?

Normal; synovial fluid | non-inflammatory

AUTOIMMUNE CONDITIONS | What is the treatment for osteoarthritis?

weight loss; vitD management; | splinting hands; *TYLENOL 3g/24hr

AUTOIMMUNE CONDITIONS What is important to remember regarding steroid injections?

*NO STEROID INJECTIONS IN | HANDS

AUTOIMMUNE CONDITIONS Pt with osteoarthritis has failed treatment using Tylenol. What is your next best intervention to relieve pain?

Triamcinolone [knee/hip] if no | response to OTC meds

AUTOIMMUNE CONDITIONS Pt presents to clinic with c/o pain to the DIP joint. Upon exam, you note pitting of the nails. Labs: elevated ESR with high uric acid. Based on your findings, what is your preliminary diagnosis of this patient?

Psoriatic arthritis

AUTOIMMUNE CONDITIONS In psoriatic arthritis, what lab is expected to be absent from patients’ profile?

No RA or ANTI-CCP antibodies

AUTOIMMUNE CONDITIONS Pt presents to clinic with bilateral swelling of wrists, elbows, knees that occurs upon wakening and lasts until lunch time. This pain will recur throughout the day especially with activity. What is your 3 preliminary diagnosis of this patient?

AUTOIMMUNE CONDITIONS What lab would you obtain to confirm a patient’s diagnosis of RA?

1st – ANA/RA, if + then obtain | Anti-CCP antibodies

AUTOIMMUNE CONDITIONS | RA – inflammatory or non-inflammatory?

inflammatory

AUTOIMMUNE CONDITIONS | What is the treatment for RA?

Methotrexate 7.5mg/PO per week.

AUTOIMMUNE CONDITIONS What should you obtain prior to initiating Methotrexate in RA?

Baseline labs – CMP and CBC

AUTOIMMUNE CONDITIONS What is important to watch for with Methotrexate?

GI irritation, pancytopenia

AUTOIMMUNE CONDITIONS What drugs should be AVOIDED when using Methotrexate?

Bactrim, amox, probenecid; AVOID | in liver/renal failure

AUTOIMMUNE CONDITIONS What MUST be administered with Methotrexate?

1mg Folic acid daily

AUTOIMMUNE CONDITIONS What is an important component to managing RA properly?

Early referral to Rheumatology

AUTOIMMUNE CONDITIONS Pt presents with acute onset of swelling, redness, warmth to left elbow. Labs: wbc >20,000. Upon physical exam, you note multiple scars with bruising in various stages of healing noted to arms. What is 3 your preliminary diagnosis of this patient?

Acute bacterial septic arthritis r/t IV drug use – admit to hospital with stat ortho referral

AUTOIMMUNE CONDITIONS Women, malar rash, + ANA, joint pain. 99.9 temp, c/o malaise. What do preliminary diagnosis is suspected in this patient?

SLE

AUTOIMMUNE CONDITIONS | What is the treatment for SLE?

Plaquenil

AUTOIMMUNE CONDITIONS With Plaquenil – what should you watch for?

Retinal damage, prior to initiating | you must obtain optho referral

``` AUTOIMMUNE CONDITIONS Woman presents to clinic with c/o new onset dyspnea and left knee pain. G3P1. Labs: prolonged PTT. What do you suspect in this patient? What should be your next action? ```

Anti-phospholipid syndrome; Refer | to ED for DVT / PE work-up

AUTOIMMUNE CONDITIONS Treatment for anti-phospholipid syndrome?

Warfarin, INR 2-3 for life. If | pregnant, Hep subQ + low dose aspirin

AUTOIMMUNE CONDITIONS What lab is + in Anti-Phospholipid syndrome?

Russell viper venom

AUTOIMMUNE CONDITIONS When performing an arthrocentesis – what is IMPORTANT to remember about this procedure?

*NEVER pass needle through | overlying cellulitis or psoriatic plaque

AUTOIMMUNE CONDITIONS | Non-inflammatory SF is expected to be?

transparent

AUTOIMMUNE CONDITIONS | Mild inflammatory SF is expected to be?

translucent

AUTOIMMUNE CONDITIONS | Purulent SF is expected to be?

opaque

AUTOIMMUNE CONDITIONS | Bleeding r/t trauma – SF is expected to be?

bloody

AUTOIMMUNE CONDITIONS Cell count in non-inflammatory SF is expected to be?

<2000

AUTOIMMUNE CONDITIONS Cell count in inflammatory SF is expected to be?

2000-7500

AUTOIMMUNE CONDITIONS Cell count in purulent SF is expected to be?

>100,000

AUTOIMMUNE CONDITIONS Women presents to clinic with c/o bilateral fingertip blueness especially when its cold outside. What preliminary diagnosis is suspected in this patient?

Raynaud syndrome [pallor, cyanosis, | rubor – relieved by warmth]

AUTOIMMUNE CONDITIONS What education should be provided to a patient with dx of Raynaud’s?

wear gloves, warm shirts/coats. STOP SMOKING. No sympathomimetic drugs [decongestants, diet pills, amphetamines – no cocaine].

Treatment for Raynaud’s if medication is | necessary?

CCBs; referral to Rheumatology

AUTOIMMUNE CONDITIONS Skin thickening, +ANA, +anti-SCL 70, prevalent in women – what dx is suspected?

Scleroderma

AUTOIMMUNE CONDITIONS Treatment for scleroderma is based on systems affected.

- CCBs: Raynaud's - PPIs: Esophageal disease - Methotrexate: skin - Sildenafil: Pulm HTN - #1 Mortality cause: pulm fibrosis/HTN - CKD + HF: common cause of death - Admit+ACE-I: HTN

AUTOIMMUNE CONDITIONS Pt presents to clinic c/o bilateral weakness in legs. Electromyographic studies: muscle abnormality. Labs: 5300 CK, +ANA. What is your preliminary dx of this patient? What do you need to confirm?

Idiopathic inflammatory myopathy – | polymyositis; Confirm with muscle biopsy

AUTOIMMUNE CONDITIONS | What is the treatment for polymyositis?

Prednisone 40-60mg taper 3

``` AUTOIMMUNE CONDITIONS Pt presents to clinic with heliotrope violaceous rash with mechanic hands. Labs: +anti-Jo1, ESR/CRP normal. What is your preliminary dx of this patient? ```

Dermatomyositis

AUTOIMMUNE CONDITIONS In dermatomyositis, you must be aware of what complication?

malignancy

AUTOIMMUNE CONDITIONS Pt presents to clinic with c/o xerostomia and feeling like there’s “grains of sand in eyes”. What finding(s) would add to your differential in diagnosing this patient with Sjogren syndrome?

+RA factor, + ANA, +SS-A / SS-B; enlarged parotids; several dental caries @ gum line.

AUTOIMMUNE CONDITIONS What is the treatment for Sjogren syndrome?

Artificial tears (dry eyes); Pilocarpine, frequent sips of water, sugar free gum/hard candies, proper oral hygiene (dry mouth).

AUTOIMMUNE CONDITIONS What should a patient AVOID if dx with Sjogren syndrome?

atropine drugs / decongestants

AUTOIMMUNE CONDITIONS What is a COMPLICATION of Sjogren syndrome?

Risk for lymphoma

``` AUTOIMMUNE CONDITIONS 36y Caucasian male presents to ER for chest pain noted to left chest radiating down left arm. Labs: 1.76 trop, BNP 56, BUN 32, Cr 0.9, Na 147, K 4.2, CK 9600, UA amber-colored, SG 1.071. What do you suspect in this patient? ```

``` Possible acute MI (need EKG), Rhabdomyolysis (high CK), due to age – possible cocaine use, Elevated BUN/Normal Cr, amber-colored urine, elevated SG (dehydration). ```

AUTOIMMUNE CONDITIONS What is the standard tx for Rhabdomyolysis?

IV fluids

Final review Flashcards

(148 cards)