Term
| Rheumatology lab tests include __ and __, these are present in the acute phase response and helpful for monitoring treatment. |
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Definition
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Term
| 3 things that can produce false positives with ESR: |
|
Definition
- obesity
- age
- female sex |
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|
Term
| 3 things that can produce false positives with CRP: |
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Definition
|
|
Term
CRP
normal < 0.2
intermediate 0.2-1.0
inflammatory >1.0 |
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Definition
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Term
| Patients with a CRP greater than __ mg/dL have a bacterial infection. |
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Definition
|
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Term
| Just because a patient has a normal ESR and/or CRP doesn’t mean that the patient does not have an inflammatory disorder (ie. 10% of patients with RA have normal ESR; 20% of patients with Polymyalgia Rheumatica have normal ESR; Patients with active SLE can have normal ESR and CRP) |
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Definition
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Term
| Antinuclear antibodies may indicate autoimmune but not always. ANA can also be high in the following conditions: |
|
Definition
- Hepatitis C
- Thyroid disorders
- Patients on multiple meds
- Healthy patients |
|
|
Term
| Sensitivity measures the proportion of actual ___ which are correctly identified. |
|
Definition
positives
example: the percentage of sick people who are correctly identified as having the condition |
|
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Term
| Specificy measures the proportion of __ which are correctly identified as such. |
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Definition
- negatives
the percentage of healthy people who are correctly identified as not having a condition |
|
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Term
| ANA has a high __ in SLE, meaning a negative ANA makes the disease of SLE less likely. |
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Definition
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Term
| Since ANA has a low ___ for many inflammatory disorders, it is recommended that you only order ANA if you suspect __. |
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Definition
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Term
| ANA is a WEAK test for __, __, __, and __ __. But remember only recommended to order ir you suspect SLE. |
|
Definition
- polymyositis
- dermatomyositis
- RA
- Sjogren's syndrome |
|
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Term
| ANA is not a __ __ of Scleroderma, but is useful in ruling it out. |
|
Definition
| - not a positive predictor |
|
|
Term
| ANA is or is not useful in predicting disease activity? |
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Definition
|
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Term
| Rheumatoid factor is the __ against the __ portion of __, but in clinical practice it is measured as ___. |
|
Definition
- antibody
- Fc portion of IgG
- IgM |
|
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Term
| Role of RF is unclear but it may attach to antibodies on B cells and enhance the humeral response |
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Definition
|
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Term
| Sensitivity of RF for RA is ___%, increasing over time, meaning it may be initially negative but later be positive. |
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Definition
|
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Term
| with RA, 50% are negative for RF early on and 15% stay negative. Because of this only order RF in right situations includinig: |
|
Definition
- joint effusions
- synovitis
- erosive changes on xray |
|
|
Term
| Anti-cyclic citrullinated peptide (Anti-CCP) is an amino acid that is an __ marker. It has a __ of 90-95%. Its major advantage is its increased ___. |
|
Definition
- RA
- specificity
- specificity |
|
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Term
|
Definition
An amino acid
RA marker since 1964
It has a specificity of 90-95%; its major advantage is its *increased specificity*
It has a sensitivity of 50-85%
May be useful in the prognosis of RA
Good sensitivity in early prognosis of the disease, but also late in the disease
May be present even before disease manifests itself
Good to help RF diagnosis early in the disease and with the patients who are RF negative |
|
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Term
| Classes of pharm drugs for rheumatology: |
|
Definition
- Non-steroidal anti-inflammatories
- corticosteroids
- disease modifying anti-rheumatic drugs
- biologics
- analgesics |
|
|
Term
| What is a non-steroidal anti-inflammatory good for pts with h/o stomach ulcers/reflux? |
|
Definition
| COX-2 INHIBITOR: CELEBREX |
|
|
Term
| Cant patients on blood thinners take Celebrex? |
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Definition
|
|
Term
| NSAIDs have antipyretics and analgesic effects but in high dose have __ effects. |
|
Definition
|
|
Term
|
Definition
Ibuprofen (Motrin)
Naproxen (Aleve) |
|
|
Term
|
Definition
- Naprosyn
- Mobic
- Diclofenac
- Relafen
- Celebrex aka Celecoxib |
|
|
Term
| ibuprofen amount for adults: |
|
Definition
| 3-4 OTC ibuprofens 3 times a day with food (600-800 mg 3 times/day) |
|
|
Term
| how much OTC naproxen should pt take? |
|
Definition
| 2 OTC Naproxen 2 times with food |
|
|
Term
|
Definition
| expensive and not covered by insurance |
|
|
Term
| what NSAID is great for perioperative pain, especially orthopedics? |
|
Definition
|
|
Term
| Celebrex is CI in perioperative pain with __. |
|
Definition
|
|
Term
| Celebrex good for RA and OA also |
|
Definition
|
|
Term
| patients who are on long term tmt with NSAIDs need to have their __ and __ checked periodically. |
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Definition
|
|
Term
| higher dose nsaids are used in the following conditions: |
|
Definition
- familial adematous polyposis
- primary dysmenorrhea
- ankylosing spondylitis |
|
|
Term
| corticosteroid side effects: |
|
Definition
- AVN
- adrenocortical insufficiencies
- tendon rupture
- psychic derangements
lowest possible dose used |
|
|
Term
| mores steroid side effects: |
|
Definition
- weight gain with long term use
- water retention
- osteoporosis
- GI problems
- impaired wound healing
- do NOT use if getting flu shot (wait a few weeks)
- lowers seizure threshold
- do not give to pts with glaucoma
- careful in diabetic pts |
|
|
Term
| If pt is about to get a flu shot, what should you wait a few weeks to start them on? |
|
Definition
|
|
Term
| Do NOT give steroids to pts with __. |
|
Definition
|
|
Term
| acute flare of radiculitis tmt: |
|
Definition
- Medrol dose pack OR
- tapered dose of prednisone |
|
|
Term
| Corticosteroid injections- use a combo of steroid in __ in a 10 cc needle. |
|
Definition
|
|
Term
ON FINAL:
Need to know the order of treating arthritis:
nothing, just watch
Oral antiiflammatories and or physical therapy
Steroid shot
Viscosupplementation
If nothing has worked– surgery for replacement of joint. |
|
Definition
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