Term
| in general what is the best type of information to have to make a diagnosis |
|
Definition
| clinical, LABS NEVER GIVE THE ANSWER, CANNOT RELY ON LABS |
|
|
Term
| what is the most common cause of arthritis in adults |
|
Definition
|
|
Term
| what is the most common cause of long term dissability in the US |
|
Definition
|
|
Term
| 10 causes of osteoarthritis |
|
Definition
| age, female, race, genetics, obesity, injury, repetitive trauma, altered body mechenics, low vitamin d and C, joint dysplasia |
|
|
Term
| symptoms of osteoarthritis 17 |
|
Definition
history of joint pain, stiffness, deformity, loss of finction
insidious onset of pain, increases with use, decreases with rest, increases with age
gait disturbance, decreased ROS, joint instability
swelling, deformity, tenderness, joint effusion, morning stiffness
heperdines nodules |
|
|
Term
| what are heperdines nodules |
|
Definition
| PIP enlargement in osteoarthritis |
|
|
Term
| what is the most useful in diagnosing osteoarthritis |
|
Definition
| PLAIN X-RAY: HYPERTROPHIC REACTION ON X-RAY, CARTILAGE LOSS |
|
|
Term
| x-ray signs of osteoarthritis 7 |
|
Definition
hypertrophic reaction
cartilage loss
osteophytes/bone spur: lateral on spine
bony sclerosis
joint space loss
subchondral cysts
asymmetric narrowing |
|
|
Term
| complications of osteoarthritis 4 |
|
Definition
loose bodies
rotator cuff tear
spinal stenosis
spondylolesthesis |
|
|
Term
| 4 goals of osteoarthritis treatment |
|
Definition
control symptoms
maintain function
limit dissability
avoid toxicity |
|
|
Term
| osteoarthritis treatment of the hand: goals 2, RX 3, non RX 3 |
|
Definition
goals: prevent progression, tx symptoms
non: joint conservation, heat, cold
TX: NSAID, capsaicin, tramodol (NO opioids, do not even work) |
|
|
Term
| osteoarthritis treatment of the knee: non RX 7, RX 2 |
|
Definition
weight loss, strengthening quads, manual supervised therapy, patellar taping, wedge insoles
RX: acetaminophen or NSAID topical, oral, injection |
|
|
Term
| what pt cannot recieve normal knee osteoarthritis tx, why |
|
Definition
| chronic renal disease stage IV/V, no NSAIDS |
|
|
Term
| what should bever be used in knee osteoarthritis tx 6 |
|
Definition
| chondroitin, topical capsaicin, glucosamine, opioids (don't work for chronic pain), duloxetine, hyalyronates |
|
|
Term
| treatment of hip osteoarthritis: non RX 4, RX 4 |
|
Definition
weight loss, CV exercise, hot/cold therapy
acetminophen, NSAID, tramadol, intraarticular injection |
|
|
Term
| what is not recommended for hip osteoarthritis tx 5 |
|
Definition
| chondroitin, glucosamine, topical NSAID, duloxetine, opioids, hyaluronate |
|
|
Term
| what is DISH - not objective |
|
Definition
diffuse idiopathic skeletal hyperostosis: bone hypertrophy at ligament and tendon insertions associated with DM2
seen on thoracic spine on the right, calcifications, asymptomatic, non-crippling |
|
|
Term
| what is chondromalacia patellae - not objective |
|
Definition
localized OA of patella precursor of OA of knee seen in young women
x-ray normal, grap patella and have them tighten and theyll scream |
|
|
Term
| define rheumatoid arthritis |
|
Definition
| progressive, systemic, inflammatory disorder of unknown etiology |
|
|
Term
|
Definition
symmetric synovitis
joint erosions
multisystem extra-articular manifestations |
|
|
Term
| pro-inflammatory fectors of RA 12 |
|
Definition
IL-1, 6, 8, 12, 15, 16, 17, 18
TGF-B, INF-y, GM-CSF, TNF |
|
|
Term
| anti-inflammatory factors 8 |
|
Definition
IL-4, 10, 11, 13, 18BP, IRa
SIL-IR, sTNFR |
|
|
Term
|
Definition
4+ FOR >6WK
MORNING STIFFNESS >1H
ARTHRITIS OF >3 JOINT AREAS
ARTHRITIS OF FINGER JOINTS
SYMMETRIC JOINT SWELLING
SERUM RF
RHEUMATOID NODULES
TYPICAL RADIOGRAPHIC CHANGES |
|
|
Term
| new criteria for RA categories |
|
Definition
MUST HAVE 4 POINTS
joint involvement
serology
duration
phase reactant |
|
|
Term
| new RA criteria: joint involvement 5 categories |
|
Definition
1 medium large joint = 0
2-10 medium large joint = 1
1-3 small joint = 2
4-10 small joint = 3
>10 small joint = 5 |
|
|
Term
| new RA criteria: serology 3 categories |
|
Definition
negative RF, anti-CCP = 0
one positive low titer (<3x) = 2
one positive high titer = 3 |
|
|
Term
| new RA criteria: duration 2 categories |
|
Definition
|
|
Term
| new RA criteria: phase reactant 2 categories |
|
Definition
normal ESR/CRP = 0
abnormal ESR/CRP = 1 |
|
|
Term
|
Definition
| RF, anti-CCP, ESR, CRP, CBC, phase reactants |
|
|
Term
| what role does x-ray have in RA |
|
Definition
obtain baseline films
ask for evidence of specific patterns
not diagnostic by itself |
|
|
Term
| 5 categories of RA treatment |
|
Definition
NSAID
COX-2
steroids
DMARDs
biologicals |
|
|
Term
| NSAID: why used in RA 2, SE 4 |
|
Definition
controls symptoms (decreases swelling and stiffness) DOES NOT ALTER COURSE OF DISEASE
GI bleed- common RA COD
renal, hepatic, cardiac |
|
|
Term
| COX-2: why use for RA, 3 SE |
|
Definition
improved tolerability over NSAID
risk of bleeding, perforation, cardiac risk |
|
|
Term
| 3 methods of steroid use in RA |
|
Definition
intra-articular
systemic
pulse |
|
|
Term
|
Definition
|
|
Term
|
Definition
methotrexate - DOC RA
hydroxychloroquine - RA
sulfasalazine - RA
Rituximab - RA
anti-TNFa - RA
penicillamine - RA
cyclosporine - RA |
|
|
Term
| GI, renal, signs of RA 6 - not objective |
|
Definition
mesenteric vasculitis
ulcer disease
pernicious anemia
interstitial nernal disease
proteinuria
mesangial GN |
|
|
Term
| neuro signs of RA 4 - not objective |
|
Definition
C1-C2 sublexation
entrapment neuropathy
peripherial neuropathy
vasculitis |
|
|
Term
| bone signs of RA 6 - not objective |
|
Definition
osteoperosis
avascular necrosis
osteomyelitis
swelling in MCP/PIP
swan neck: flex MCP, extend PIP, flex DIP
boutineer: extend MCP, flex PIP, extend DIP |
|
|
Term
| hematologic signs of RA 5 - not objective |
|
Definition
| anemia, leukopenia, thrombocytopenia, lymphadenopathy, lymphoma |
|
|
Term
| when does structural damage usually occur in RA - not objective |
|
Definition
2-3y after disease, slow progression is linked to early tx
progressive benign disease |
|
|
Term
| what RA tx prevents long term dissability and premature mortality |
|
Definition
| DMARDs - methotrexate, hydroxychloroquine, sulfasalazine, penicillamine, cyclosporine, anti-TNFs, rituximab |
|
|
Term
| treatment of acute gout 8 |
|
Definition
colchine immediate than 1h later
indomethacin
NSAID
pain meds
steroids
ACTH: to make their own steroids
joint injection: clotrazine if normal renal function, endothecin in liver cirrhosis
NEVER STOP ALLOPURINOL IT CAUSES JOINT TO FLARE |
|
|
Term
| treatment of chronic gout 7 |
|
Definition
allopurinol
febuxostaat
probenecid: increase uric acid secretion in kidney, need to prove low uric acid in urine
sulfinpyrazone
NSAID
colchicine
pegloticase |
|
|
Term
|
Definition
exclusivly around joints
polyarticular - may mimic RA
oligoarticular - usually in eldelry |
|
|
Term
| signs of early/acute pseudogout 3 |
|
Definition
mimics OA
similar to gout
may have fever, leukocytosis, elevated ESR |
|
|
Term
| signs of late/chronic pseudogout 5 |
|
Definition
charcot joint, similar to OA
symmetrical around mostly knees, some wrist and hips
isolated patellofemoral disease |
|
|
Term
|
Definition
calcium pyrophosphate crystals
pyrophosphate arthropathy |
|
|
Term
| cause of chondrocalcinosis |
|
Definition
Ca chyrophosphate crystals formed due to elevated inorganic phosphate in synovial fluid and NTPPPHase (nucleoside triphosphate pyrophosphorlyase)
autosomal dominant
spiratic (rare <40yo) |
|
|
Term
| diseases associated with chondrocalcinosis 3 |
|
Definition
RA 5% (10% RF positive)
gout 25%
OA 50% |
|
|
Term
| epidemiology of chondrocalcinosis |
|
Definition
sporatic rare <40
4% of adults
50% of >90yp |
|
|
Term
| what diseases can lead to chondrocalcinosis (non-hereditary) 8 |
|
Definition
hemochromatosis
hyperparathyroid
hypothyroid
amyloid
hypomagnesmia
hypophosphatemia
rickets
familial hypocalcuric hypocalcemia |
|
|
Term
| x-ray findings in chondrocalcinosis 6 |
|
Definition
incidental
chondrocalcnosis
crowned dens: neck pain due to crystal deposits surrounding dens
cord compression
weap around patella
erosive OA |
|
|
Term
| lab signs of chondrocalcinosis 2 |
|
Definition
crystals in joints test positive biphringent
10% RF positive |
|
|
Term
| how can you distinguish between gout and chondrocalcinosis in the lab |
|
Definition
ca chyrophosphate is positive biphringent
monosodium urate is negative biphringent |
|
|
Term
|
Definition
NSAID
colchicine
steroids: injected, oral for flare
PT
surgery |
|
|
Term
| how can you diagnose apatite like crystals |
|
Definition
all have Ca and cannot be seen on light microscopy so need to stain with lizerin red and convasa back stain (Ca makes black flecks)
crystals not visible on microscopy
alizaren red stain red
von kossa stain black |
|
|
Term
| 2 type sof apatite like crystals |
|
Definition
carbonate substituted apatite
octacalcium phosphate
tricalcium phosphate
dicalcium phosphate dihydrate (brushite) |
|
|
Term
|
Definition
bursitis
tendonitis
arthritis
renal failure
epiphyseal dysplasia
destructive OA |
|
|
Term
| things associated with urate increase 14 - not objective |
|
Definition
estroegn
alcohol
age
BUN/CR
obesity
DM
TG
HTN
athlerosclerosis
hypothyroid
syndrome X
pregnancy
acute illness
dehydration |
|
|
Term
| negative associations with gout 3 - not objective |
|
Definition
| RA, SLE, ankylosing spondylitis |
|
|
Term
| causes of primary hyperuricemia 3 categories with many examples - not objective |
|
Definition
inhibition of tubular urate excretion: DKA, lactic/keto acidosis, MSUD
Drug/toxin: hyperparathyroid, lead, cyclosporine, ASA, ethembutol, pyrzidamide, nicotinic acid, ethanol
over production: diet, muscle excretion, psoriasis, myeloproliferative, hemolytic, lymphoproliferative, glycogen storage diseases, G6PDH deficiency, Fructose-1-P aldolase deficiency, HGPRT, PRPP synthease superactivity |
|
|
Term
| progression of gout - not objective |
|
Definition
1. asymptomatic hyperuricemia
2. acute gout: hot painful swollen red joint
3. incurrent period
4. chronic gout |
|
|
Term
| most common locations of gout - not objective |
|
Definition
big toe #1
wrist, finger, elbow
hip - least common |
|
|
Term
| indications of treatment of gout 6 - not objective |
|
Definition
acute gout
trophi (nodules on finger / outer ear with white)
uric acid stones
uric acid nephropathy
interstitial nephritis
repid: teeth marks on bony erosions on xray |
|
|
Term
| what is the goal uric acid level of someone with gout - not objective |
|
Definition
|
|
Term
|
Definition
dose related diarrhea (stop at diarrhea, severe SE soon)
aplastic anemia
death |
|
|
Term
|
Definition
| chronic widespread musculoskeletal pain syndrome with tender points at discrete sites |
|
|
Term
| associated conditions with fibromyalgia 4 |
|
Definition
80% SLE
13% sleep apnea
15% OA
2% RA |
|
|
Term
| epidemiology fibromyalgia |
|
Definition
2% population
3-6 million people
5% of general medical practice
female 40-60yo |
|
|
Term
| economic impact of fibromyalgia |
|
Definition
10% work disabled
8 seperate physician evaluations cost of 5+ years prior to diagnosis |
|
|
Term
|
Definition
it isnt real disease
crazy women
it is just depression
its all in their head
waste basket diagnosis for all chronic pain and complainers |
|
|
Term
|
Definition
it has been described in medical lit for 200y
research proves existance in pt with no psych illness
classifications based on ACR in 1990 revised in 2012 |
|
|
Term
|
Definition
thyroid disease
sleep apnea
psychogenic rheumatism
chronic fatigue syndrome
myofascial pain syndrome |
|
|
Term
| lab signs of fibromyalgia |
|
Definition
increased substance P
decreased epinepherine
decreased serotonin |
|
|
Term
| sleep signs of fibromyalgia 5 |
|
Definition
nonrestorative
alpha wave intrusion
decreased stage 3-4
moldofsky et al
fatigue |
|
|
Term
| physical symptoms of fibromyalgia 6 |
|
Definition
persistent generalized pain
headache
abdominal pain
numbness
swelling
temperature sensitivity |
|
|
Term
| psychological symptoms of fibromyalgia 4 |
|
Definition
mood disturbance
numbness
anxiety
depression - most common |
|
|
Term
| pathology of fibromyalgia |
|
Definition
| decreased cerebral blood flow to the caudate nucleus |
|
|
Term
| new criteria for fibromyalgia diagnosis |
|
Definition
history of widespread pain for >3mo
no other condition causing symptoms
note number of areas of pain in teh past week:
chest
back
neck
jaw
abdomen
shoulder girdle
upper arm
lower arm
upper leg
lower leg
buttock or trochanter
diagnostic if severity >5 and widespread pain >7
OR severity >9 |
|
|
Term
| what is the severity scale based on 3 |
|
Definition
cognitive symptoms
waking unrefreshed
somatic symptoms: pain, fatigue, IBS, nervousness |
|
|
Term
| old criteria for fibromyalgia diagnosis - requirements 7 |
|
Definition
history of widespread pain >3mo
no other condition causing symptoms
pain on left side of body
pain on right side of body
pain above waist
pain below waist
axial skeletal pain |
|
|
Term
| old criteria for fibromyalgia diagnosis - 9 trigger points |
|
Definition
pain in 11/18 trigger points required
occiput
lower cervical (C5-7)
trapezius: midpoint upper border
supraspinatus: border of scapula
2nd costochondral junction
lateral epicondyle
gluteal
greater trochanter
knee: medial fat pat |
|
|
Term
| diagnostic tests for suspected fibromyalgia 6 |
|
Definition
labs: normal
x-ray: normal
muscle biopsy: normal
sleep study
CSF
always check TSH |
|
|
Term
| treatment of fibromyalgia - not objective |
|
Definition
support groups
sleep training
consult: rheumatologist, PMNR, psychologist, psychitraist, counsler, PT
injections, biobeedback, acupuncture, massage, ultrasound
aerobic conditioning exercise 30 min daily no excuses
NSAID, analgesics, hyponotics, SSRI, steroids |
|
|
Term
| myofacial pain syndrome vs fibromyalgia: pain, fatigue, AM stiffness, tender points, prognosis, treatment |
|
Definition
pain: F: diffuse M: local
fatigue: F: common M: not
AM: F: common M: not
tender point: F: diffuse M: local
prog: F: chronic M: resolve/relapse
tx: F: exercise, meds M: local |
|
|
Term
| chronic fatigue syndrome vs fybromyalgia: cause, myalgias, fatigue, sleep, depression, onset, fever, pharyngitis, adenopathy |
|
Definition
cause: F: unk C: viral
myalgia: F: chronic C: chronic
fatigue: F: chronic C: chronic
sleep: F: poor C: poor
depression: F: common C: common
onset F: gradual C: acute
fever F: none C: low grade
pharyngitis F: no C: yes
adenopathy: F: no C: yes |
|
|
Term
| feinbergs 3 rules of rheumatology |
|
Definition
use your brain, hx, physical. lab is secondary
always remember lupus is true systemic disease
always ask is it more likley lupus or something else causing the symptoms today |
|
|
Term
|
Definition
17-40yo
female > male
more common in black than white |
|
|
Term
|
Definition
4/11
MALAR RASH
PHOTOSENSITIVE RASH
DISCOID RASH
ORAL ULCERS
SEROSITIS
ARTHRITIS
CNS
RENAL
ANA
HEMATOLOGIC
LAB: ANDI-dsDNA, ENE, OR VDRL |
|
|
Term
| new SLE criteria (general description) |
|
Definition
posiive renal biopsy with ANA or anti-dsDNA
OR
4 criteria (1 clinical, 1 immunological (lab), 1 skin reaction, 1 any additional) |
|
|
Term
| what are the clinical criteria for new SLE criteria 9 |
|
Definition
oral or nasal ulcers
nonscarring aloplecia
serositis
arthritis
renal: 500mg protein in 24h urine, RBC casts
neurological lupus signs
hemolytic anemia
leukopenia
thrombocytopenia |
|
|
Term
| what are the signs of neurological lupus 6 |
|
Definition
seizure
psychosis
monpneuritis multiplex
myelitis
peripheral/cranial neuropathy
acute confusion |
|
|
Term
| what are the labs signs of lupus clinical criteria 6 |
|
Definition
ANA
anti-dsDNA
anti-SM
anti-phospholipid Ab
low complement (C3, C4, CH50)
direct coombs in absence of hemolytic anemia |
|
|
Term
| what are the 3 skin reaction types in lupus |
|
Definition
acute cutaneous
subacute cutaneous
curonic cutaneous - scaring |
|
|
Term
| 6 acute cutaneous lupus rashes |
|
Definition
malar rash: spares nasolabial folds and under lips
billous lupus
photosensitive rash
oral apothous ulcers
maculopapular lupus
toxic epidermal necrolysis |
|
|
Term
| 7 chronic cutenous lupus rashes |
|
Definition
discoid lupus
lcalized - above neck
generalized - below beck
chillblains
hypertrophic (verucous)
lupus erythemaatosis tumidus
lupus panniculitis (profundus) |
|
|
Term
| what is a rheumatoid profile 4 |
|
Definition
|
|
Term
|
Definition
subacute/chronic cuteneous lupus
discoid: scarring rash with central atrophy
lupus perino: variant of sarcoidosis
systemic SLE |
|
|
Term
| signs of subacute/acute cutaneous lupus 3 |
|
Definition
non-fixed rash
non-scaring
SS-A antibody |
|
|
Term
|
Definition
violacious plaques over face and ears
hepatic granulomas
hepatomeagly |
|
|
Term
| proven causes of drug induced lupus 7 |
|
Definition
procanamide
isoniazide
hydralazine
methyldopa
chlorpromazine
dilantin
quinidine
penicillamine |
|
|
Term
| possible causes of drug induced lupus 2 |
|
Definition
riseofulbin antibiotics
gold salts |
|
|
Term
| labs of drud induced lupus 2 |
|
Definition
ANA+ for 1y
ANTI-HISTONE ANTIBODY POSITIVE (watch out can be positive in SLE)
no change in complenent
CNS/Renal disease rare |
|
|
Term
| what lab must be positive to diagnose lupus |
|
Definition
| ANA, watch out often false negative |
|
|
Term
|
Definition
ENA-SSA Ro: shograns
ENA-SSB-La: shograns B
ENA-RMP: CT disease
ENA-SM: anti-smith
ENA-SCL-70: scleroderma
ENA-PM-1: polymyositis
ENA-histone
ENA-centromere
anti-dsDNA
VDRL: syphillis false positive
anti-ribosomal P protein: CNS lupus
B-ANA
anti-phospholipid Ab
CBC
ESR
BUN/CR
CRP
PT/PTT/INR
complement |
|
|
Term
| treatment lupus - not objective |
|
Definition
control symptoms, none prevent progression
hydroxychloroquine
azothiaprim
methotrexate
steroids: life saving for brain involve
cyclophosphamide: DOC for CNS/renal
mycofenolate mofetil: DOC lupus nephritis in AA
marrow transplant |
|
|
Term
|
Definition
HEENT
CV
pulmonary
GI
GU
MSK
skin
psych
neurology
renal |
|
|
Term
| list a bunch of SLE signs - not objective |
|
Definition
aloplecia
rashes
dysphagic
iritis, uvitis, conjunctivitys
sicca
nasal and oral ulcers
pericarditis, myocarditis
pericardial effusions
conduction abnormalities
tamponade
libman sacs endocarditis
vasculitis
raynauds
pleural effusions, pleuritis
pneumonitis
pulmonary emboli
shrinking lung (diaphram weak)
pancreatitis
mesenteric vasculitis
lupus peritonitis (small vessel vasculitis)
impaired fertility
pregnancy complications
vaginal dryness
neurogenic bladder
interstitial cystitis
dysmenorrhea
amenorrhea
oligomenorrhea
prostatitis
inflammatory arthritis: sublexation of MCP
avascular necrosis
malar, photosensitive, discoid, or bullous rash
livedo reticularis
lupus profundus/panniculitis
psychosis, depression
sleep disturbance
white matter plaquest
seizure, stroke, coma
subarachnoid hemorrhage
dementia ataxia
corea, tremor, rigidity
transverse myelitis
gullian barre
hemibalismus
mononeuritis multiplex
IgG deposits on nephron
mesangial lupus nephritis
focal proliferative lupus nephritis
diffuse proliferative glomerulonephritis
membranous glomerulonepheitis
sclerosing GN |
|
|
Term
| what is libman sacs endocarditis - not objective |
|
Definition
| warts/rugae on mitral in SLE |
|
|
Term
| antiphospholipid syndrome: criteria, labs, diagnosis, tx - not objective |
|
Definition
vascular thrombosis and pregnancy related morbidity (miscarrage, blood clots, preeclampsia, eclampsia)
lupus anti-coagulant, aCL antibody, anti-B2 glycoprotein
1 clinical and 1 lab criteria
aspirin for life with lupus, cumidin for life it had clot |
|
|
Term
| what are the varients of scleroderma 6 - not objective |
|
Definition
Localized: morphea
localized: linear
CREST
shulman's syndrome
progressive systemic sclerosis
toxic scleroderma |
|
|
Term
| localized scleroderma: signs, tx - not objective |
|
Definition
thickening and hardened skin usually on extremities, no organs involved, that can retract skin
no tx |
|
|
Term
| what does CREST stand for - not objective |
|
Definition
calcinoids: puss like
raynauds: vasospasm (cyanotic>red)
esophageal motility
scleroderma: localized linear
telangestica toxic |
|
|
Term
| shulman's syndrome: signs - not objective |
|
Definition
when do do aerobic exercise with get patch of scleroderma
usually following trauma of single limb |
|
|
Term
| progressive systemic sclerosis signs 7 |
|
Definition
thickening and hardening of a tissue
pulmonary fibrosis
cardiac fibrosis: arrhythmias
renal A fibrosis: seen hypoten so systemically causes HTN
skin pulled tight, no wrinkles
raynauds
sicca complex |
|
|
Term
| major criteria for scleroderma diagnosis |
|
Definition
|
|
Term
| minor criteria for scleroderma diagnosis 3 |
|
Definition
must have 2
sclerodactyly
digital pitting scars
bibasilar pulmonary fibrosis |
|
|
Term
| research criteria for scleroderma diagnosis 9 |
|
Definition
must have all
skin thickeniing proximal to MCP
skin thickening distal to MCP
puffy fingers: non-pitting edema
digital ulcers
digital pitting scars
telangestica
abnormal nailfold capillaries
raynauds
antibodies |
|
|
Term
| treatment for scleroderma - not objective |
|
Definition
penicallamine, steroids, methotrexate, cyclophosphamide
immune supression
marrow transplant |
|
|
Term
| criteria for sjogers diagnosis 3 - not objective |
|
Definition
positive lab: SS-A/SS-B OR RF/ANA
minor salivary biopsy
keroconjundtivitis sicca |
|
|
Term
| many signs of sjogerns - not objective |
|
Definition
ocular dryness, pain, itch
dilated conjunctiva vessels
decreased salivary flow and dry mouth
oral candidiasis
dental carries
chronic bronchitis
interstitial pneumonitis
pseudolymphoma
pleural effusions
pulmonary HTN
atrophic gastritis
biliary cirrhosis
sclerosing cholangitis
vaginal dryness
raynauds
vasculitis
neutropenia
anemia
thrombocytopenia
lymphoma
angioblastic lymphadenma
glomerulonephritis
mixed cryoglobulinemia
amyloidosis
renal artery vasculitis
tubuloinerstitial nephritis
thyroiditis
myalgias
peripherial neuropathy
mononeuritis multiplex |
|
|
Term
| secondary causes of sjogerns 5 - not objective |
|
Definition
| RA, SLE, PSS, polyomyositis, primary biliary cirrhosis |
|
|
Term
| 4 seronegative spondyloarthropathies |
|
Definition
ankylosing spondylitis
psoriatic arthritis
reiter syndrome
enteropathic arthritis |
|
|
Term
| what seronegative spondyloarthropites is male predominated |
|
Definition
|
|
Term
| diagnostic criteria for ankylosing spondylitis 7 |
|
Definition
low back pain for 3mo
cannot get head against wall spine fused
decreased ROM in spine
decreased chest expansion
symmetric fused SI (progresses up spine)
lumbar limitation in sagital and frontal
bilateral/unilateral sacroilitis - REQUIRED |
|
|
Term
| genetic sign of ankylosing spondylitis |
|
Definition
HLA-B27 positive
higher in caucasian |
|
|
Term
| akylosing spondylitis: signs in back 6, chest 2, joints 3 |
|
Definition
back pain: dull, diffuse, improves with activity, insidious, 3mo min, worse in morning
chest: pain worse with cough/sneeze, fusion of costovertebral joints
joints: more in kid form, hip and shoulder most common, TMJ in 10% |
|
|
Term
| akylosing spondylitis: signs in eye 3, renal 1, systemic 4 |
|
Definition
eye: iritis, uveitis, sterile conjunctivits
renal: IgA nephropathy
systemic: fatigue, weight loss, temp, malaise |
|
|
Term
| akylosing spondylitis: CV signs 5 |
|
Definition
ascending aoritis
aortic insufficiency
conduction abnormalities: SVT, AFib
cardiomeagly
pericarditis |
|
|
Term
| akylosing spondylitis: pulmonary signs 3, neuro signs 3 |
|
Definition
pulmonry: decreased volume, ibrosis, aspergillus (likes fibrotic lung)
neuro: AA sublexation, nerve compression, cauda equine syndrme
*due to fracture, no shock absorption |
|
|
Term
| 6 x-ray signs of akylosing spondylitis |
|
Definition
sacroilitis
whiskering
osteoperosis: brittle bones without stress
bamboo spine: white between vertebrae
syndesmophytes: verticle growing spurs
calcification of anterior longitudinal ligament: fuses sacrum |
|
|
Term
| 2 physical exam tests of akylosing spondylitis - not onjective |
|
Definition
schober test: test spinal movility ASIS/5th vertebrae <15cm movement
chest expansion: <5cm movement |
|
|
Term
| tx akylosing spondylitis - not objective |
|
Definition
posture, pain control, sleep habits,
methotrexate, sulfasalazine
no sports
anti-TNFa |
|
|
Term
| reactive arthritis: signs 3 categories - not objective |
|
Definition
cannot see: conjunctivitis, iritis, uveitis
cannot pee: painless ulcer of penis, IgA nephritis, urethritis 1-2wk after GI infection
cannot climb a tree: aortic regurgitation, conduction abnormalities, fatigue, arthritis 1-2wk after exposure |
|
|
Term
| reactivie arthritis causes 6 - not objective |
|
Definition
| salmonella, shigella, yersenia, HLA-B27, yersinia, chalmydia |
|
|
Term
| reactive arthritis x-rays signs 4 - not objective |
|
Definition
asymmetric
erosions of small joints hands/feet, SI
sacroilitis
asymmetric spondylitis: skip lesions, comma ossifications |
|
|
Term
| tx teactive arthritis - not objective |
|
Definition
systemic: sulfasalazine, methotrexate, anti-TNFa (in spinal form stops progression)
eye: antibiotic drops, steroid drops
joint: NSAid, steroid injections
skin: topical steroid, PUVA |
|
|
Term
| epidemiology of psoriatic arthritis |
|
Definition
7-42% of those with psoriasis have psoriatic arthritis
2-7% with psoriatic arthritis has psoriasis |
|
|
Term
| psoriatic arthritis causes 6 |
|
Definition
genetic: HLA-B27 (high in those with spinal disease), HLA-DR7 (high in those with psoriasis)
environmental
immunogenic: decreased CD4, increased IL-1B, increased leukotriene B4 |
|
|
Term
| clinical signs of psoriatic arthritis 12 |
|
Definition
DIP
asymetric oligoarthritis
sausage digit
arthritis multilans
spondyloarthropathy
skin psoriasis
nails: pitting, ridges, onchoyolysis
eye: conjunctivitis, iritis
enthesopathy |
|
|
Term
| labs in psoriatic arthritis 3 |
|
Definition
NOT DIAGNOSTIC
ESR elevated
hypergamaglobulinemia IgA
elevated complement |
|
|
Term
| x-ray signs in psoriatic arthritis 5 |
|
Definition
asymmetric
DIP
sacroilitis
pencil in cup deformity
bone erosions |
|
|
Term
| treatment psoriatic arthritis 3 |
|
Definition
NSAID
steroids
DMARDS: methorexate DOC
DMARDS also: gold salts, penicillamine, asothiaprime, cyclosporine, antimalarias |
|
|
Term
| enteropathic arthritis - not objective |
|
Definition
ulcerative colitis or chrons leads to peripherial arthritis or spinal arthritis
migratory oligoarthritis, apthous ulcers, liver disease, uveitis, clubbing, vasculitis, pyogerma gangrenosum
ESR elevated, RF negatie, ANA either positive or negative |
|
|
Term
| whipples disease - not objective |
|
Definition
| middle age white male with diarrhea, wasting, joint inflammation, PAS+ macrophages, rash, SQ nodules, clubbing, pleuritis, sudden cardiac death, aortic insufficiency, thyroiditis, nephritis, liver disease, uveitis, hyperpigmentation |
|
|
Term
| collagenous colitis - not objective |
|
Definition
intermittent diarrhea and bleeding
10% have arthritis
linear deposit of hayline in colon subepithelium |
|
|
Term
| poncets disease - not objective |
|
Definition
sterile arthritis in pt with extra-pulmonary TB
puyrexia, weakness, peripheral arthritis, lymphadenopathy |
|
|
Term
| gluten sensitive enteropathy - not objective |
|
Definition
celiac disease
arthritis of large joints
sjogerns |
|
|
Term
| bypass arthritis - not objective |
|
Definition
bacterial overgrowth within 1y post gastric bypass
raynauds, uricaria, e. nodosum, papules, painful, ESR elevated, cryoglobulins
antibiotics, NSAIDs |
|
|
Term
|
Definition
| inflammation of the bone caused by pathogenic organism |
|
|
Term
| how does osteomyelitis happen 4 |
|
Definition
hematogeosus spread from any location (pneumonia, surgery, abscess, trauma)
contigous spread: cutaneous ulcer, infected joint or prosthetic, abscess |
|
|
Term
| microbes in osteomyelitis 12 |
|
Definition
S. aureus
coag negative staph
strep
polymycrobial - esp foot
salmonella - esp sickle cell
gram negative
candidia - HIV
M. kanasii - HIV
nocardia asteroides - HIV
histoplasmosis - compormised
coccidiomycosis - compormised
blastomycosis - compormised |
|
|
Term
| signs of acute osteomyelitis in kids 4 and adults 4 |
|
Definition
adult: fever, point tenderness, muscle spasm, vague pain
kid: acute onset fever, chills, lethargy, irritability |
|
|
Term
| signs of chronic osteomyelitis 6 |
|
Definition
| night sweats, low grade fever, weight loss, draining sinus, muscle spasm, point tenderness |
|
|
Term
| sighs of TB osteomyelitis 4 |
|
Definition
weight bearing joints affected
potts: TB of spine that destorys disc
vertebral collapse
spinal cord compression |
|
|
Term
| labs of acute osteomyelitis 6 |
|
Definition
increased ESR, WBC, phase reactants
positive urine culture
positive bone biopsy
positive blood culture |
|
|
Term
| labs of chronic osteomyelitis 3 |
|
Definition
increased ESR
normal WBC
negative cultures/biopsy |
|
|
Term
| signs of osteomyelitis of x-ray 2 |
|
Definition
not positive for 10d
lytic lesions not present for 6wk |
|
|
Term
| explain the control of thyroid hormone release |
|
Definition
TRH released from hypothalamus stimulates anterior pituitary to release TSH and prolactin
TSH from thyrotrope cells stimulates synthesis of thyroglobulin, iodine uptake, iodiniation of TGB to T3/T4, storate of T3/T4, release of T3/T4
increased T3/T4 cause feedback to hypothalamus and pituitary |
|
|
Term
| which thyroid hormone is more active, which is more prevalent, why does this not matter |
|
Definition
T3 IS MORE ACTIVE
T4 is more prevalent
T4>T3 by 5-deiodinase in the tissues
T3/T4 bound to albumin is unavailable |
|
|
Term
|
Definition
estrogen
OPC/pregnancy
tamoxifen
hepatitis
biliary cirrhosis
narcotics |
|
|
Term
|
Definition
androgens
glucacorticoids
nephrortic syndrome |
|
|
Term
| what blocks conversion of T3/T4 (4) |
|
Definition
propranolol
steroids
PTU
methimazole |
|
|
Term
| what blocks synthesis of T3/T4 (5) |
|
Definition
lithium
iodine
amiodarone
PUT
methimazole |
|
|
Term
| what are the thyroid function tests 6, which is test of choice |
|
Definition
serum TSH - TEST OF CHOICE
TRH stimulation
free T4
thyroid U/S
thyroid scan
radioactive iodine uptake |
|
|
Term
| Serum TSH: normal levels, what does it indicate |
|
Definition
SCREENING TEST OF CHOICE FOR THYROID FUNCTION
NORMAL 0.5-5 UU/ML
knowning TSH and free T4 can dx most disorders |
|
|
Term
| thyroid ultrasound: what does it determine, how is it done |
|
Definition
determines size and monitors change
can be used for guiding fine needle aspiration
solid nodule: possible malignancy
cystic nodule: usually benign |
|
|
Term
| thyroid scan: how is it done, what does it determine |
|
Definition
radioiodine or scintillation scan uses isotopes to mesure thyroid activity
hot nodule: functional more likley benign
cold: non functional more likley malignant |
|
|
Term
| radioactive iodine uptake: how is it done and interperteted |
|
Definition
give radioactive I, 24h later detect percent taken into thyroid
used to differentiate between thyroid disorders |
|
|
Term
| diseases causing increased radioactive iodine uptake 4 |
|
Definition
graves
TSH secreting tumor
hot nodules: toxic adenoma, toxic multinodular goiter |
|
|
Term
| diseases causing decreased radioactive iodine uptake 8 |
|
Definition
thyroditis: painless, autoimmune, post partum, subacute, amiodarine induced
thyroditis factitia: exogenous thyroid
iodine excess: contrast dye, diet, amiodarone |
|
|
Term
| what does amiodarone have to do with iodine 3 |
|
Definition
iodine rich so blocks peripheral conversion of T4>T4
can induce thyrotoxicosis: iodine induced hyperthyroid (type 1), destructive thyroiditis (type 2) |
|
|
Term
| explain how to evaluate a thyroid nodule |
|
Definition
if TSH is low get thyroid scan and RAIU, if nodule is functioning it has no malignant potential
if TSH is high then nodule is not functioning get thyroid U/S
...if benign serial follow up
...if insufficient repeat FNA
...if follicular neoplasm get surgery
...if malignant get surgery |
|
|
Term
| when do you biopsy a thyroid nodule |
|
Definition
NODULE > 1CM!
NODULE < 1CM IF...
...family hx, cervical lymphadenopathy, suspicious of cancer (hypoechogenicity, central vascularity, microcalcifications), incidental thyroid nodule |
|
|
Term
| symptoms of hypothyroidism 12 |
|
Definition
fatigue
dyspnea
cold intolerance
dry skin
constipation
weight gain
poor appetite
horse voice
difficult concentrating
menstural irregularities
diffuse aloplecia
myexedema: puffy hands, face, feet
bradycardia
serous cavitary effusion
delayed DTR / relaxation
carpel tunnel syndrome |
|
|
Term
| causes of primary hypothyroidism 10 |
|
Definition
autoimmine: hashimotos - most in US
iratogenic: iodine, thyroidectomy, radiation to neck
congenital
infiltrative disorders
iodine excess: amiodarone, IV dye
lithium
anti-thyroid drugs
iodine deficiency
post-partum thyroiditis
in course thyroiditis (burn out) |
|
|
Term
| diagnosis of subclinical hypothyroidism 2 |
|
Definition
|
|
Term
| tx subclinical hypothyroidism |
|
Definition
recheck and repeat labs in 6wk
tx those at risk for hypothyroid (TSH >10, pregnant, anti-TPO Ab, family hx, goiter)
30% convert to hypothyroid |
|
|
Term
| treatment of hypothyroid: normal, secondary, pregnancy, emergency |
|
Definition
levothyroxine: start low, increase over 2wk, monitor TSH (lags by 6wk)
secondary hypothyroid: replace cortisol
pregnancy hypothyroid: always tx, monitor for thyroxine need
emergency hypothyroid: never postpone emergency surgery |
|
|
Term
|
Definition
| caution in cardiac and elderly pt |
|
|
Term
| symptoms of hyperthyroid 20 |
|
Definition
hyperactivity
irritability
palpitations
tachycardia/AFib
heat intolerance
sweating
fatigue
weakness
weight loss
increased appetite
diarrhea
oligomenorrhea
loss of lobido
tremor
proximal myopathy
lid retraction/lag
goiter
gynecomastic
opthalmopathy and dermopathy in graves |
|
|
Term
| lab signs in hyperthyroid 4 |
|
Definition
decreased TSH, N-T4
increased T4, total T3
watch for T3 toxicosis |
|
|
Term
| causes of primary hyperthyroid 3 |
|
Definition
graves
toxic multinodular joiter
toxic adenoma |
|
|
Term
| causes of secondary hyperthyroid 2 |
|
Definition
TSH mediated increase in T4/TSH
pituitary adenoma |
|
|
Term
|
Definition
1. release: thyrotoxic
2. recovery: hypothyroid
3. euthyroid: normal thyroid |
|
|
Term
| diseases caused by thyroid damage 4, which are painful, which are painless |
|
Definition
subacute thyroiditis/de-quervan (painful)
postpartum thyroiditis (painless)
early hashimotos
destructive thyroiditis |
|
|
Term
| treatment of hyperthyroid symptomatic |
|
Definition
|
|
Term
| treatment of hyperthyroid therapeutic 4 |
|
Definition
antithyroid drugs: methimazole DOC, PTU DOC in pregnancy
radioactive iodine: good for goiter
surgery: causes hypothyroid, often needed in second trimester of pregnancy |
|
|
Term
| thyroid storm signs 4 and tx - not objective |
|
Definition
fever, delirium, tachycardia, hypotension
emergency: BB, antithyroid (PTU), iodine, stress steroids, tylenol, fluids, cooling blanket |
|
|
Term
| cause, signs, TX of graves disease - not objective |
|
Definition
IgG to TSH receptors increases free T4
thyrotoxicosis
goiter: diffuse, soft, symmetric
opthalmopathy: PROPOPTOSIS
dermopathy: periorbital myexedema
AFib/CHF in elderly
TX: thyroid ablation, PTU/methimazole, surgery |
|
|
Term
| SE of methamiazole and PTU 3 |
|
Definition
AGRANULOCYTOSIS, HEPATOTOXICITY
METHIMAZOLE CAN CAUSE APLASIA CUTIS IN FETUS |
|
|
Term
| what are the general characteristics of a benign thyroid nodule, what is the tx - not objective |
|
Definition
solitary, cold 85% benign
95% solid nodules benign
100% hot cystic benign
tx complications: compression, neck pain, cosmetic, anxiety
sclerosing agents: ethanol, tetracycline, unilateral lobectomy |
|
|
Term
| what are the types of thyroid cancers and their prevalence 5 |
|
Definition
thyroid adenoma: benign
papillary carcinoma - most common
follicular carcinoma - less common
anaplastic carcinoma - rare
medullary carcinoma - sporatic |
|
|
Term
| thyroid adenoma: morphology, athogenesis, tx - not objective |
|
Definition
hyperfunctioning non-TSH dependent thyroid tissue, benign, slow, follicular, solitary
if hot: large hyperfunctioning nodule in turned off thyroid
if cold: hemorrhagic necrosis causes pain and loss of function
TX: ablation, PTU/MMZ |
|
|
Term
| prognosis and tx of the 4 thyroid carcinomas - not objective |
|
Definition
papillary: indolent, lymph spread, 95% 5y
follicular: NEEDS BIOPSY, MIMICS NORMAL TISSUE, hematogenous spread to lung and bone
anaplastic: very malignant, rapid, poor prognosis
medullary: distant metastasis, often with MEN2A/B, high serum calcitonin, cervical lymphadenopathy |
|
|
Term
| treatment for thyroid carcinoma - not objective |
|
Definition
total thyroidectomy then total body scan
replace with synthroid
maintain TSH 0.5-2 to prevent hypertrophy of remnant
OR
radioactive ablation: TBG IS USED AS TUMOR MARKER NOT SCREEN |
|
|
Term
| DDX of a painful anterior neck mass 4 |
|
Definition
SUBACUTE THYROIDITIS
hemorrhage into thyroid cyst
acute suppurative thyroiditis
rapid growth of thyroid cancer or tumor
infected thyroglossal duct cyst or branchial cleft cyst
cellulitis of anterior neck
radiation thyroiditis |
|
|
Term
| what is the screening redigmein for the thyroid - not objective |
|
Definition
WOMEN 35-50YO
(men >35?)
TSH assay repeat q5y if F-T4/TSH normal |
|
|
Term
| what are the 2 types of goiters and their tx - not objective |
|
Definition
nontoxic: normal TSH/T4, tx if causing compression of trachea, veins, or going into thoracic via thyroidectomy or ablation
toxic: patchy hot nodules, high T3/T4, iodine ablation, anti-thyroid therapy life long |
|
|
Term
| hashimotos thyroiditis: signs 7 |
|
Definition
thyroid is NON-TENDER, firm, mild enlargement
chronic lymphocytic thyroiditis
GOITER, smooth symmetrical firm
metabolic normal
slow progression
LOW RAIU (GRAVES IS HIGH)
TPO-AB LEVELS HIGH |
|
|
Term
| post partum thyroiditis signs 3 |
|
Definition
PAINLESS SILENT
resolves in 8-12mo
hyperparathyroid in mo 1 then hypothyroid
ALWAYS TREAT |
|
|
Term
| when toes radiation thyroditis occur - not objective |
|
Definition
|
|
Term
| subacute thyroiditis: signs 7 |
|
Definition
VERY TENDER THYROID
pain radiates to ears
POST VIRAL URI OR PHARYNGITIS
thyrotoxic then euthyroid
SELF LIMITED 1-2WK
LOW RAIU
HIGH ESR |
|
|
Term
|
Definition
| ASA AND STEROIDS FOR INFLAMMATION |
|
|
Term
| functions and regulation of PTH |
|
Definition
release: low Ca, high P, epinepherine
inhibits: high Ca, VITAMIN D
stimulates osteoclasts
stimulates VITAMIN D PRODUCTION
increases Ca reabsorption
decreases P reabsorption |
|
|
Term
| signs of hypercalcemia - not objective |
|
Definition
bones: oseoperosis, bone pain
stones: kidney, nephrogenic DI, polydupsia, dehydration
groans: ulcers, dyspepsia, constipation, vomiting
psychic overtones: fatigue, forgetfulness, weakness, coma
EKG: PVC, short QT |
|
|
Term
| causes of hypercalcemia 12 |
|
Definition
primary hyperparathyroid
lymphoma
solid tumor: breast, SCC lung
VITAMIN D: INTOXICATION, SARCOIDOSIS
hyperthyroidism
immobilization
thiazides
vitamin A intoxication
milk alkali syndrome
addisons disease |
|
|
Term
| diagnosis of hypercalcemia |
|
Definition
elevated PTH and CA: primary hyperparathyroid
normal PTH or low with high Ca: PTH related peptide, VITAMIN D CAUSED |
|
|
Term
| primary hyperparathyroid lab signs 4 |
|
Definition
high Ca, PTH, urine Ca >400 mg/24h
low P |
|
|
Term
| primary hyperparathyroid tx 7 |
|
Definition
surgery: radioguided minimal access
non surgery
..follow biannually with serum Ca
..follow annually with serum CR and DEXA scan
..modest Ca intake 1000-1200 mg and VITAMIN D 400-600mh
..bisphosphonates if osteopenic
..hydration, avoid thiazide diuretic |
|
|
Term
| indications for surgery primary hyperparathyroid 5 |
|
Definition
elevated serum Ca >1mg.dl
CR clearance < 60ml/min
age <50
bone density <-2.5
previous fragility fracture
medical surveillance not possible |
|
|
Term
| secondary hyperparathyroid: cause 2, labs 3, tx 5 |
|
Definition
cause: malabsorption, renal disease
labs: low Ca and VIT D, high PTH
tx: Ca, VIT D, decrease P
cinacalet if due to ESRD on dialysis
calcimimetic increases PTH receptor sensitivity |
|
|
Term
| tertiary hyperparathyroid: cause, tx |
|
Definition
secondary progresses to autonomous production of PTH
parathyroidectomy |
|
|
Term
| tx of acute hyperparathyroid 5 |
|
Definition
volume replacement NS 200-300ml/h maintain urine >100ml/h (euvolemic)
bisphosphonates: inhibit bone resorb
calcitonin: if severe hypercalcemia
prednisone: if hematologic malignancies, sarcoidosis, VIT D TOXICITY
gallium nitrate: inhibit osteoclast and PTH secretion |
|
|
Term
| what do you do if there is volume overload during hyperparathyroid tx |
|
Definition
| add furosemide NO THIAZIDES |
|
|
Term
| bisphosphonates: 2 drugs, effect timeline |
|
Definition
pamidronate: effects for 1-2wk
zoledronate: effects for 4wk, more potent
lag in onset, combine with IVF or calcitonin |
|
|
Term
| calcitonin: why use, when it takes effect |
|
Definition
severe hypercalcemia
rapid response
decreases in 4-6h
gone in 48h |
|
|
Term
|
Definition
|
|
Term
| which calcium disorder is most common |
|
Definition
| hypocalcemia, in 50% of ICU patients |
|
|
Term
| causes of hypocalcemia 20 |
|
Definition
hypoparathyroid: post-surfical, digeorge, infiltrative
DISORDERS OF VITAMIN D METABOLISM: NO SUNLIGHT, DERMATOLOGICAL DISORDERS, DIET DEFICIENCY, MALABSORPTION, RENAL DISEASE, LIVER DISEASE, RESISTANCE
PTH resistance: pseudoparathyroidism
hypomagnesia
anticonvulsants enhance VITAMIN D catabolism
cimetidine: decrease Ca absorption
extravascular resistance: pancreatitis, rhabdomyolysis, tumor lysis syndrome
sepsis
acute respiratory alkalosis
pseudohypoparathyroidism |
|
|
Term
| pseudohypoparathyroidism; cause, aka, 3 signs, 3 labs |
|
Definition
post-receptor resistance to effect of PTH
aka albright disease
short stature, short digits, MR
low Ca, high PTH, high P |
|
|
Term
| signs of hypocalcemia 15 (3 severe, 2 chronic) |
|
Definition
SEVERE: HYPOTENSION, SEIZURE, DEATH
chronic: cararacts, basal ganglia calcification
increased excitability of nerves and muscles: paresthesias, myalfias, chevosteck and trosseau sign
lethargy, laryngospasm, CHF, prolonged QT, biliary colic, steatorrhea |
|
|
Term
| causes of low PTH and hypocalcemia 2 |
|
Definition
| hypoparathyroid, Mg <1 (impairs PTH secretion) |
|
|
Term
| causes of high PTH and hypocalcemia 2 |
|
Definition
| vit D deficiency, pseudoypoparathyroid |
|
|
Term
| what level of Ca indicates hypocalcemia |
|
Definition
|
|
Term
| causes of high P and hypocalcemia 2 |
|
Definition
primary hypoparathyroid
pseudohypoparathyroid |
|
|
Term
| causes of low P and hypocalcemia 2 |
|
Definition
secondary hypoparathyroid
VITAMIN D DEFICIENCY |
|
|
Term
| treatment of acute hypocalcemia 3 |
|
Definition
always correct Ca to albumin level (may falsley low in hypoalbuminemia)
emergency: symptomatic or prolonged QT: Ca glyconate DOC, Ca chlorid
if hypomagnesia is cause give Mg sulfate |
|
|
Term
| SE of Ca glyconate and Cal chlorid |
|
Definition
|
|
Term
| why do you not give bicarbonate or phosphorus in severe emergent hypocalcemia |
|
Definition
| can form insoluble Ca salts |
|
|
Term
| tx asymptomatic hypocalcemia 4 |
|
Definition
oral Ca carbonate: 1500 mg/d DOC goal Ca >8 (if gets hypercalcuria add thiazide)
VITAMIN D SUPPLEMENTS 50,000 UINT/WK
calcitrol in renal failure
phosphate binder if P >6: calcium calcitrate or calcium acetate
monitor Ca q3-6mo |
|
|
Term
| what is the dx is Ca is >13? what if they had Ca kidney stones? what if they have hypercalcemia for >6mo? |
|
Definition
malignancy until proven otherwise
if has stones likely benign
if >6mo likely benign |
|
|
Term
| primary causes of adrenal insufficiency 7 |
|
Definition
autoimmune
TB
fungal
metastic cancer
adrenal hemorrhage
ectomidate
ketoconazole |
|
|
Term
| central causes of adrenal insufficiency 6 |
|
Definition
steroid
hypothalamus
pituitary adenoma
crainopharyngioma
sarcoidosis
cranial irritation |
|
|
Term
| signs of primary adrenal insufficiency 12 |
|
Definition
salt craving
postural dizziness
dehydration
hypotension
fatigue
nausea
anorexia
weight loss
abdominal pain
decreased lobido
decreased pubic and axillary hair
hyperpigmentation |
|
|
Term
| signs of central adrenal insufficiency 8 |
|
Definition
fatigue
nausea
anorexia
weight loss
abdominal pain
decreased lobido
decreased pubic and axillary hair
dehydration and slight decreased BP |
|
|
Term
| primary adrenal insufficiency lab signs 12 |
|
Definition
low cortisol, DHEA, ALD, Na, glucose, leukopenia
high ACTH, renin, K, eosinophilia
poor response to cosvnotropin
azotemia |
|
|
Term
| central adrenal insufficiency lab signs 9 |
|
Definition
low cortisol, DHEA, ACTH, Na, glucose, leukopenia
high eosinophilia
poor response to cosvnotropin
azotemia |
|
|
Term
| treatment of primary adrenal insufficiency 2 |
|
Definition
| corticosteroid and mineralcorticoid replacement |
|
|
Term
| treatment of central adrenal insufficiency |
|
Definition
| corticosteroid replacement |
|
|
Term
| what is the mineralcorticoid and corticosteroid used in adrenal insufficiency |
|
Definition
hydrocortisone
fludrocortisone (mineralcorticoid) |
|
|
Term
| 4 thyroid disorders and their ALD and cortisol levels - not objective |
|
Definition
primary hypercortisolism: inc cortisol, dec ACTH
secondary hypercortisolism (pituitary): inc cortisol, inc ACTH
primary hypocortisolism (addisons): dec cortisol, inc ACTH
secondary hypocortisolism (pituitary): dec cortisol, inc ACTH |
|
|
Term
| exogenous and endogenous causes of cushings - not objective |
|
Definition
ACTH dependent: pituitary adenoma, SCLC, pancreatic CA, bronchial CA
ACTH independent: adrenal adenoma, adrenal carcinoma
exogenous: iratogenic due to steroid use (most common), drugs with steroid activity (megestrol acetate) |
|
|
Term
| signs of cushings - not objective |
|
Definition
HTN
DM
glucose intolerance
central obesity
purple striae
muscle wasting esp proximal
osteoperosis
androgen excess: histurism, acne, oligomenorrhea
personality changes
facial plethora
peptic ulcer disease |
|
|
Term
| what is the main lab that helps diagnose cause of cushings, 6 tests for cushings, which is the best - not objective |
|
Definition
ACTH
24h urinary free cortisol - BEST
dex supression test - overnight
...high: pituitary adenoma, etopic ACTH
salivary cortisol levels - night
MRI pituitary
octerotide (ectopic ACTH) scan
CT adrenal glands |
|
|
Term
| causes of primary and secondary hyperaldosteronism - not objective |
|
Definition
primary: excess adrenal (adrenal adenoma, bilateral adrenal hyperplasia)
secondary: stimulating adrenal (decreased renal perfusion, CHF, renal artery stenosis, liver cirrhosis) |
|
|
Term
| signs of hyperaldosteronism - not objective |
|
Definition
HTN
hypokalemia
metabolic alkalosis
polydypsia, polyuria
edema in secondary hyperALD (not primary) |
|
|
Term
| pheochromocytoma: cause, signs, tx - not objective |
|
Definition
MEN2A/B
10% extra-adrenal
10% asymptomatic
10% malignant
headache
sweating
palpitations
anxiety
tremor
arrhythmia
abd pain
orthostatic HTN
weakness
nausea
SURGERY IS DOC BUT REQUIRES PREOP A BLOCKER SO B BLOCKER IN SURGERY DOES NOT CAUSE HTN CRISIS FROM UNOPPOSED A-ADRENERGIC STIMULATION |
|
|
Term
| adrenal incidentaloma: prognosis and tx - not objective |
|
Definition
size determines malignancy >6cm 25% malignant
surgical resection if >6cm or increases by 1cm
observe if <4cm |
|
|
Term
| risk factors for DM1 - not objective |
|
Definition
| HLA type, family hx DM1/2, diet high in cow milk, no breast feeding, enterovirus, vit D deficiency, obesity, high socioeconomic statis, maternal age, preeclampsia, neonatal jaundice, low birth weight |
|
|
Term
| genes associated with DM1 4 |
|
Definition
| MHC on CH6 HLA-DR3, DR4, B8, B15 |
|
|
Term
|
Definition
| destory Beta cells leading to indirect deficit of insulin and absolute deficiency |
|
|
Term
| what are environmental triggers of DM1 3 |
|
Definition
| emotion, physical stress, diet |
|
|
Term
|
Definition
polyruia
polydypsia
polyphagia - uncommon
anorexia
weight loss
fatigue/lethargy
muscle cramps
abd discomfort
nausea
vision changes
headache
ketoacidosis
altered performance |
|
|
Term
| 3 criteria for DM1 diagnosis |
|
Definition
CLASSIC SYMPTOMS (P, P, WEIGHT LOSS) + RANDOM GLUCOSE >200
FG >126 on 2 OCCASIONS(FASTING 8h)
2h GLUCOSE >200 DURING OGTT USING 75h GLUCOSE LOAD
has HBA1C >6.5 |
|
|
Term
| other than glucose, what are three diagnostic tests used for DM1 |
|
Definition
islet cell Ab
GAD-65 Ab
C PEPTIDE LEVEL: PROINSULIN SPLIT INTO C-PEPTIDE. DM1 CANNOT MAKE INSULIN SO C-PEPTIDE LOW
...DM2 HAVE HIGH OR NORMAL C-PEPTIDE
...FACTITIOUS DISORDER (HYPOGLYCEMIA) HAVE LOW C-PEPTIDE (INSULIN ABUSE) |
|
|
Term
|
Definition
diet and exercise: consistency in carb, fat protein ratio, eat at same time, carb count with insulin, no exercise restrictions
glargine or detemie long acting SQ 1-2x/d
lispro, aspart, glulisine SQ before eating 1 unit for 10g carbs
insulin pump: lispro or aspart
ORAL HYPOGLYCEMIA WILL NOT WORK FOR DM1 DUE TO DEFICIENCY OF INSULIN |
|
|
Term
| complications of DM1 (13) |
|
Definition
microvascular disease: retinopathy, neuropathy, nephropathy, CAD, stroke, PAD
hyperlipidemia
chronic foot ulcer
charcot joint
hypoglycemia
diabetic ketoacidosis
weight gain
psych disorders |
|
|
Term
| ongiong monitoring of DM1 (7) |
|
Definition
BP
height
weight
sexual maturation in children
blood glucose 4-6x/d
HBAIC q3mo
yerly screen after 5y with DM |
|
|
Term
| parts of the yearly DM1 screen 9 |
|
Definition
microalbuminuria for early sign of nephropathy
opthalmology exam after 3-5y
diabetic foot exam
cardiology exam
lipid profile
thyroid testing
CBC
chemistry pannel
annual influenza vaccine |
|
|
Term
|
Definition
BP <140/90
HBA1C <7%, <8% if older, <6% if younger
LDL <100 (<70 if CAD)
TG <150
HDL male >40, female >50
no microalbuminuria |
|
|
Term
| 6 diagnostic requirements for DKA |
|
Definition
glucose >250
pH <7.2
HCO3 <18
metabolic acidosis
ketones
acetone |
|
|
Term
|
Definition
noncompliance
insulin deficiency: bad vial or pump
infection
illnes
infarction
surgery
stress
meds |
|
|
Term
|
Definition
mostly DM1
insulin deficiency increases counter regulatory normones (glucagon, cortisol, GH, epinepherine) causing increase in hepatic gluconeogenesis, glycogenolysis, and lipolysis
hepatic metabolism of FA as alt energy sources causes ketones (esp B-HYDROXYBUTYRATE) which exceede buffer capacity and spill into urine, decrese pH and bicarb |
|
|
Term
|
Definition
EVOLVES OVER FEW DAYS
KUSSMAUL RESPIRATIONS: RAPID SHALLOW, THEN DEEP AND LABORED, GASPING
N/V: KETONES CAUSE
ABDOMINAL PAIN
MENTAL STATUS CHANGES
FRUITY ODOR TO BREATH
GLYCOSURIA: DEHYDRATION, THIRST, HYPOPERFUSION, LACTIC ACIDOSIS
HYPERKALEMIA
HYPOKALEMIA IF TOTAL DEPLETION
HYPONATREMIA |
|
|
Term
| why is the hyponatremia in DKA 2 |
|
Definition
DILUTIONAL EFFECT: WATER SHIFTS FROM IC TO EC SPACE
NA LOST IN URINE DUE TO OSMOTIC DIURESIS
FOR 100 MG/DL GLUCOSE OVER 100 NA IS DECREASED BY 1.6 MEQ/L |
|
|
Term
|
Definition
glucose >250
ketones
acetone
amylase/lipase normal (RO pancreatitis)
anion gap >12
pH <7.35 causes acidosis
HCO3 <17 causes acidosis
both decreased so metabolic acidosis
serum osmolarity
possible ketones in urine |
|
|
Term
| causes of high anion gap 10 |
|
Definition
MUDPILES
METHANOL
UREMIA
DKA
PARALDEHYDE
ISONIAZID/INFECTION/ISCHEMIA
LACTIC ACIDOSIS
ETHYLENE GLYCOL
SALICYLATES |
|
|
Term
|
Definition
FLUIDS THEN INSULIN
NS until glucose <250 then D5
0.1 unit insulin bolus
insulin gtt at 0.1 unit/kg/h
decrease glucose 100 mg/dl/h
check K q2h
if pH <7.1 IV bicarb
if P <1 give IV P 12mm/8h
if Mg low give IV Mg |
|
|
Term
| why does glucose have to drop slow |
|
Definition
if over correction can shift water into IC space causing cerebral edema
will show improved metabolic state with worsening mental status
dont stop insulin gtt once acidosis resolved you have to give long acting insulin WAIT 2-3H |
|
|
Term
| why do we monitor K in DKA tx |
|
Definition
| K will drop fast due to shift into cells as acidosis resolves |
|
|
Term
|
Definition
pt is eating
pt is on long acting insulin (2h before stop IV regular insulin)
HCO3 >18
anion gap/acidosis normal |
|
|
Term
| risk factors for DM2 (4) - not objective |
|
Definition
family hx: 1st degree relative
gestational DM
obesity: causes insulin resistance
ethnicity: AA, latino, native american, asian, pacific islander |
|
|
Term
|
Definition
HIGH FAMILIAL SUSCEPTABILITY 100% IN IDENTICAL TWINS
pt retain some endogenous insulin secretion from pancreas
progressive resistance at receptor |
|
|
Term
|
Definition
polyuria
polydypsia
polyphagia
anorexia
weight loss
increased fatigue
lethargy
weakness
muscle cramps
vision changes
blurred vision
frequent infections |
|
|
Term
| 3 diagnostic criteria DM2 |
|
Definition
glucose >200 and symptoms
FG >126 on 2 occasions
2h glucose >200 during OGTT with 75g glucose load |
|
|
Term
|
Definition
exercise
ADA diet
oral hypoglycemics
insulin if not controlled |
|
|
Term
|
Definition
glucophage and metformin
sulfonylureas: glipizide, glyburide, glimepiride
nateglinide
thiazolidinediones
A-GLUCOSIDASE INHIBITORS: ACARBOSE, MIGLITOL
dipeptodyl peptidase inhibitor: stigliptin, saxagliptiin, lingiliptin
EXENATIDE
pramlintide
lieaglutide |
|
|
Term
| SE metformin and glucophage (DOC for DM2) 4 |
|
Definition
weight loss, helps insulin resistance, lactic acidosis
cannot be used in renal disease |
|
|
Term
| SE glipizide, glyburide, glimepiride |
|
Definition
|
|
Term
|
Definition
| stimulates B cell insulin release |
|
|
Term
| contraindications of thiazolidinediones 3 |
|
Definition
| CHF, LE edema, liver disease |
|
|
Term
| MOA and SE acarbose and miglitol |
|
Definition
a-glucosidase inhibitors
flatulence |
|
|
Term
| stifliptin, saxagliptin, linagliptin: use, nausea |
|
Definition
can use alone or in combination with other classes
nausea most common |
|
|
Term
|
Definition
| INJECTION MIMICS EFFECTS OF INCRETINS (GLP-11) DPP-4 MECHANISM |
|
|
Term
|
Definition
| decreases appearance of glucose in blood by slowing gastric emptying, supresses post prandial glucagon secretion, increases satiety |
|
|
Term
|
Definition
| mimics effect of incretins (GLP-1) |
|
|
Term
|
Definition
weight loss, more than others
pancreatitis |
|
|
Term
|
Definition
basal: latnus, levemir SQ 1-2x/d
paradial: humalog, novolog SQ before meals
...1unit/10g carbs
insuln pump: humalog, novolog |
|
|
Term
| complications of DM2 (13) |
|
Definition
retinopathy
nephropathy
neuropathy
CAD
PAD
stroke
hyperlipidemia
chronic foot ulcers
hypoglucemia
hyperosmolar nonkeratotoc state
excess weight gain
psychologicl problems
charcot foot deformity: foot broken down |
|
|
Term
|
Definition
regular exercise and diet
BP <149/90
glucose 3-4x/d
HBA1C 3mo
yearly annual screening |
|
|
Term
| yearly annual screenings 10 |
|
Definition
microalbuminuria: early nephropathy sign
opthalmology exam
diabetic foot exam
cardiology evaluation
lipid profile
thyroid testing
CBC
chemistry pannel
annual influenza vaccine |
|
|
Term
|
Definition
BP <130/80
HBA1C <7
fasting flucose 70-105
bedtime 100-140
LDL <100 (<70 if CAD)
HDL male >40 female >50
no microalbuminuria |
|
|
Term
| hyperosmolar nonketotic state: signs 14 |
|
Definition
hyperglucemia >600
altered mental status
thirst, polyuria, polydypsia, weight loss, dehydration, hypotension, seizure, myoclonic jerks
elevated plasma osmolarity >320
drhydration
no ketoacidosis
pH 7.3
HCO2 >15 |
|
|
Term
| hyperosmolar nonketotic state: pathogenesis |
|
Definition
in DM2 insulin resistance (esp due to obesity) and decreased secetion
toxic effect of glucose on B cells in DM1 after 1st phase of insulin resistance lowering serum insulin |
|
|
Term
| hyperosmolar nonketotic state: causes 11 |
|
Definition
noncompliance
fever
sepsis
burns
MI
stroke
renal failure
BB
HCTZ
phenytoin
anesthesia |
|
|
Term
| hyperosmolar nonketotic state: goals of tx 4 |
|
Definition
rehydration with electrolyte hormones
correct hyperglycemia
tx underlying cause
monitor and assist CV, pulmonary, renal, CNS function |
|
|
Term
| hyperosmolar nonketotic state: tx |
|
Definition
fluids first: NS and monitor urine, replace 1/2 volume deficit in first 12h and last 1/3 of the next 12h. switch for D5 with glucose until glucose 250
electrolyes and insulin: treat K like you do in DKA, checking BMP q2h. insulin gtt like DKA with switching over to long acting insulin and sliding scale once glucose under control |
|
|
Term
| somogyi effect pathogenesis |
|
Definition
| ELEVATED MORNING GLUCOSE OUT OF PROPORTION TO NORMAL DUE TO 2-3AM GLUCOSE LOW AND COUNTER REGULATORY HORMONES KICK IN CAUSING HYPERGLYCEMIA |
|
|
Term
| somogyi effect labs and tx |
|
Definition
DECREASE OR MAINTAIN INSULIN DOSE
MAY HAVE LOW HBA1C |
|
|
Term
| dawn phenomenon pathogenesis |
|
Definition
| GLUCOSE INCREASES DUE TO RELEASE OF REGULATORY HORMONES (GH, CORTISOL, CATECHOLAMINES) MADE IN EARLY MORNING HOURS |
|
|
Term
| dawn pneomen signs and tx |
|
Definition
2-3AM GLUCOSE NORMAL OR ELEVATED
INCREASE NIGHTLY INSULIN DOSE |
|
|
Term
| diabetic retinopathy: epidemiology, signs - not objective |
|
Definition
leading cuse blindness 24-74 in US
DM 25x more likley
develops over time
atymptomatic until late
rapidly progressive once it begins |
|
|
Term
| signs of non-proliferative diabetic retinopathy 6 |
|
Definition
late 1st decade to early 2nd decade
MICRO ANEURYSM
OCCLUDED VESSELS
BLOT HEMORRHAGES
COTTON WOOL SPOTS
VISION LOSS USULLY VIA MACULAR EDEMA |
|
|
Term
| signs of proliferative diabetic retinopathy - not objective |
|
Definition
| neovascularization in response to retinal hyoxia leading to vitreous hemorrhage, fibrosis, retinal detachment |
|
|
Term
| prevention of diabetic retinopathy 5 |
|
Definition
BP CONTROL
LIPID CONTROL
TIGHT GLUCOSE CONTROL
KEEP HBA1C <7
YEARLY OPTHALMASCOPE EXAM |
|
|
Term
| dianetic nephropathy: signs 5, screening/labs, prevention - not objective |
|
Definition
mesangial expansion, BM thickening, glomerular sclerosis, loss og GFR, proteinuria
BP each office visit with goal of <130.80
microalbuminuria 30-300 CR excretion and albumin excretion daily
yearly urine collection to assess protein, good glycemic control, control HTN <130/80, avoid nephrotoxic drugs, dietary protein restriction, strict lipid control, ACEI decrease HTN and proteinuria |
|
|
Term
| diabetic neuropathy polyneuropathy signs - not objective |
|
Definition
| distal symmetric from feet up proximal parasthesia and pain (tingling, sharp, burning), worse at rest and at night, sensory loss, loss of ankle reflex, abnormal position sense |
|
|
Term
| diabetic neuropathy mononeuropathy signs - not objective |
|
Definition
| cranial nerve palsy (III, IV, VII, bells), unlar and peroneal nerve palsy |
|
|
Term
| tx and prevention diabetic neuropathy - not objective |
|
Definition
pregabain, gabapentin, TCA
improve glycemic control |
|
|
Term
| gastroparesis: epidemiology, pathogenesis, signs, dx - not objective |
|
Definition
more in DM1
delayed gastric emptying due to neuropathy of vagus nerve when BG is high, muscles of stomach and intestines do not work normally, movememnt of food slowed or stopped
anorexia, N/V, early sariety, bloating, poor glycemic control
gastric emptying study with radiolabeled meal |
|
|
Term
| gastroparesis treatment 5 |
|
Definition
glycemic control: frequent small meals
metoclopramide: prokinetic and antiemetic
octerotide: induce digestive motor complex
ERYTHROMYCIN: MACROLIDE ANTIBIOTIC, PROMOTES GASTRIC EMPTYING
gastric electral stimulation |
|
|
Term
| genitourinary changes in DM - not objective |
|
Definition
diabetic cystopathy: cant feel bladder or void, increased post-void residual, uti
tx: timed voiding, self cath, bethaencol
erectile dysfunction and retrograde ejaculation: early sign of DM neuropathy
tx: slidenafil |
|
|
Term
| CV diseases in DM and prevention, epidemiology - not objective |
|
Definition
DM2 2x risk in men 4x risk in women
DM1 risk even higher
MI causes 70% death in DM
coronary artery disease
MI
peripheral vascular disease
stroke
silent ischemia: SOA, BP change
prevention: control HTN <130/80, ACEI IS DOC, control LDL, aspirin 81mg/d, smoking cessation |
|
|
Term
| diebetic foot ulcers: signs - not objective |
|
Definition
delayed wound healing and skin ulcerations even with minor traums
untreated penetrate tissue, ischemia, gangrene, need amputations |
|
|
Term
| diabetic foot ulcer prevention 4 |
|
Definition
TEACH YOUR PATIENTS TO EXAMINE THEIR FEET
foot exam yearly
if affected specailist exam yearly
pressure relief: orthotics, shoes |
|
|
Term
| necrobiosis lipoidica diabeticorum: epidemiology |
|
Definition
1% of diabetics
usually young female with DM2, neuropathy, retinopathy
no correlation with metabolic control |
|
|
Term
| necrobiosis lipoidica diabeticorum: signs 8 |
|
Definition
inflammation
yellow brown indurated plaque
central atrophy
central ulcer
talengictasia
ulcerations
pretibial red plaque that enlarges, darkens, irregular margins
asymptomatic or painful |
|
|
Term
| necrobiosis lipoidica diabeticorum: treatment |
|
Definition
| TOPICAL STEROIDS IF NO ULCERATIONS |
|
|
Term
| describe acanthosis nigricans, duptens contracture, xanthoma of DM - not objective |
|
Definition
acanthosis: velvety hyperpigmented plaque on neck of axillae due to insulin resistance
contracture: thickening of palmar fascia leading to thickening and contraction
xanthoma: associated with elevated TG |
|
|
Term
| common infections of DM - not objective |
|
Definition
foot infection
UTI
superificial fungal: oral candidiasis, onchymycosis
malignant external otiits (pseudomonas)
zygomycosis (mucormycosis)
pneumonia
empysematous cholecystitis
necrotizing fasciitis
rhinocerebral mucormycosis |
|
|
Term
| rhinocerebral mucormucosis signs - not objective |
|
Definition
tissue destruction
poorly controlled diabetic
epistaxis
altered mental status
unilateral headache and eye irritation
black necrotic nasal turbinates |
|
|
Term
| malignant otitis media: cause, signs, tx, prognosis - not objective |
|
Definition
pseudomonas aeruginosa
rapid evolving
ear and facial pain and swelling
osteomyelitis of skull base
purulent meningitis
multiple cranial palsies
urgent anti-pseudomonal pen or 3rd gen ceph with aminoglycoside or ciproflaxcin
surgical debridement of necrotic tissue
mortality rate high |
|
|
