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Adult Part II > Auto Immune/ women’s early years > Flashcards

Auto Immune/ women’s early years Flashcards

1
Q

Auto immune

A

Often hereditary
Armenia for RA - normocyctic

Tests are sensitive but not specific

Injury to kidney and liver

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2
Q

Gout - classic presentation

A

30-60 year old man

Obese, hypertensive, freq alcohol

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3
Q

Gout - def

A

Metabolic disease that occurs as a result of mono sodium irate crystal deposits in extra cellular fluids around joints and tendons

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4
Q

Non classic gout

A

Organ transplant medication

People on diuretics

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5
Q

Gouty arthritis

A

Recurrent attacks of articulate and peri articulate inflammation

  • acute gout attacks
  • asymptomatic intervals
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6
Q

Tophi ( chronic tophaceous gout )

A

Chronic

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7
Q

Gout treatment - acute

A

Reduce inflammation and manage symptoms. Initial treatment within the first 24 hours of onset to reduce severity and duration

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8
Q

Gout tx- long term

A

Reduce rheum irate level suppress flares and prevent further attacks

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9
Q

Gout TD - acute flares

A

Rest, ice, elevation

NSAIDs, Oral glucocorticoid or Colchicine

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10
Q

Over production of urate

A 
Hugh purine rich food
Hemolytic disease
Psoriasis 
Obesity 
Hyper triglyceride 
Alcohol
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11
Q

Under excretion of uric acid

A 
Renal insufficiency 
Lactic acidosis 
Dietrich 
Dehydration 
Meds
Hypothyroidism
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12
Q

Gout medications - increase risk

A 
Low dose Asa
Diuretics
Cyclosporin 
Ethanol 
Cytotoxics 
Vit B 12
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13
Q

Gout - clinical presentation

A

Acute onset, red, hot, swollen, tender joint, fever, chills, malaise

Unilateral swollen, red

Great toe, foot, ankle, knee, wrist, finger, elbow

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14
Q

Dx of gout

A

Elevated serum urate
Elevated uric acid in UA
Elevated ESR
Elevated WBC

Synovial fluid - + crystals

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15
Q

Septic arthritis

A

Inflammation into joint

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16
Q

Gout to goals - long term

A

Reduce serum urate level to suppress flares and prevent further attack

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17
Q

Acute flares gout - TX

A

Rest, ice, elevate affected joints

Tx: NSAID’s, Oral glucocorticoids, Colchine

May require rheum consult

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18
Q

NSAIDS - gout

A

Treat until managed

Naproxen 500 mg BID
Motrin 800 mg every 8 hours
Diclodenac 50 mg BID
Indocin 50 mg every 8 hours until resolved 5-10 days

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19
Q

Oral glucocorticoids - gout acute

A

Prednisone 30-40mg until flare resolution begins and then taper 7-10 days

Not for people with
DM, HF, HTN, cocurrent infection

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20
Q

Colchicine - Acute flares

Trad vs low dose

A

Trad
Colchicine 1.2 mg dose followed by 0.6 every 1-2 until symptoms improve
++++ GI symptoms +++++++

Low-dose
Day one 1.2 mg and then 0.6 1 hour later, then 12 hours later 0.6 repeated and continued every 12 hours until resolution

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21
Q

Gout recurrent attacks - medication

A

Allopurinol ( max 800 mg/day)

Uloric

Colchicine

Aviod thiazide, loop diuretic

Lifestyle : weight loss, restrict high purine

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22
Q

RA - definition

A

Chronic inflammatory disease in which the immune system destroys synovial joints and accessory structure. Joints are destroyed over number of years with remissions and exacerbation

Worse in the AM and then it gets been throughout the day

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23
Q

RA - clinical presentation

A

Pain and swelling warmth in small joints ( PIP MCP, MTP)

Usually bilateral

Weight loss, general malaise, lymphadenopathy, low grade fever

Morning stiffness

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24
Q

RA joint

A

PIPS

MCP

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25
Q

OA - joint

A

DPS

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26
Q

RA PE

A 
Decreased weight, 
Joints ( hands, wrists, knees, ankles) - red, warm and swollen 
Decreased ROM
Muscle wasting
Ulnar deviation

Extra articular findings :

  • pleural effusion
  • pericarditis
  • Sjögren’s syndrome
  • Synovial thickening of joints
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27
Q

Look at chart of difference between OA and RA

A

Jk

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28
Q

RA - DX testing

A

RA factor - gold standard

ANA - no specific but sensitive

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29
Q

DX criteria for RA

A 
Morning stiffness
Arthritis of three or more joints 
Arthits of hand joints
Symmetric arthritis 
Rheumatoid nodules
Serum rheumatoid factor 
Radiographic changes
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30
Q

RA- tx is referral

A

Slow disease progression, prevention loss of physical function

PT, OT, rest, hear, ice, exercise, meditation

Corticosteriods - injection when one large joint is involved

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31
Q

Chronic fatigue syndrome and fibromyalgia

A

Autoimmune vs infectious

W>M

Profoundly fatigued
11-18 bilateral pain points

No inflammatory muscle or joint disease

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32
Q

Chronic fatigue syndrome management

A

Low - dose tricyclic agents at bedtime, may need antidepressants

Have an exercise program

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33
Q

Systemic Lupus Erythematous (SLE)

A

Inflammation autoimmune disease marked by exacerbations and remission,

Multiple organs - skin, kidney, CNS

Triggers: emotional stress, pregnancy, post partum, cigarette smoke

From menses to menopause

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34
Q

SLE: clinical presentation

A

Fatigue, malaise, fever, anorexia, unplanned weight loss, blurred vision

Butterfly rash, slope is, fingertip lesions, swollen joints

Systolic murmur, RUQ tenderness
Peripheral parenthesias, diminished deep tendon reflexes

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35
Q

Raynaud’s phenomenon

A

Discoloration of fingers and or toes after exposure to changes in temp or emotional events

Ages 15 - 40

36
Q

Raynaud’s phenomenon treatment

A

Cold protection
Avoid emotional stress
Smoking cessation

Flares : stay calm and get warm

37
Q

Scleroderma

A

A chronic autoimmune disease in which the body produces too much collagen resulting in skin thickening that causes scarring and often leaving the skin with a tight leathered appearance

30-50

38
Q

Morphia scleroderma

A

Hard, oval shaped patches of the skin, the patches usually are whitish with purplish ring around them

39
Q

Linear scleroderma

A

Lines or streaks of thickened skin in areas such as arm legs or forehead

40
Q

Limited scleroderma

A

Course gradually and affects the skin and larger may affect internal organs such as esophagus, lungs or intestine

41
Q

Diffuse scleroderma

A

More suddenly with skin thickening throughout the body

Internal organs can also be affected and cause extensive and fatal damage to organs in the digestive, resp, circulatory and immune system

42
Q

Sjögren’s syndrome

A

Chronic inflammatory disorder caused by exocrine dysfunction

W> M 40-60

TEST QUESTION

43
Q

Sjögren’s syndrome clinical presentation

A

Dry mouth, eyes feels like something is in them, loss of taste, smell, recurrent dental carries, dysphagia

Appears ill, breath odor, mouth and nose bleeds, pale, dry, fissures, beefy red tong,

44
Q

Polymyalgia Rheumatic ( PMR)

A

Understand difference btw PMR and temporal artitis

  1. > 50
  2. Abrupt onset
  3. Bilateral, upper arms, neck, thighs
  4. Morning stiffness
  5. Negative labs
  6. ESR up
  7. Brisk response low-dose steriods
  8. Erosive
45
Q

OA

A

Pain in the afternoon

46
Q

PMR

A

Better as the day goes on

47
Q

Giant Cell Arteritis ( GCA)

A

Headache
Visual signs
Jaw claudication
Fever, malaise, weight loss

Elevated ESR
High acuity
Alk phos High

Tx: bilateral biopsy of temporal artery

48
Q

Pericoital Contraception

A

Preventing sperm from entering female reproductive tract by maintaining a reservoir of spermicide against the cervix thus creating a “ barrier “

  • diaphragm
  • cervical cap
  • contraceptive sponge
  • spermicidal foams
49
Q

Pericoital contraception risks

A

High failure risk
Increased risk of toxic shock
Requires fitting

50
Q

Natural family planning

A

Uses s/s of ovulation for avoidance or achievement of pregnancy

51
Q

Implanon / Nexplanon

A

Implant
Progestin
Effective for 3 years

Irregular menses most frequent reason for discontinuation: either amenorrhea or prolonged bleeding

Fertility may be somewhat delayed after removal

52
Q

Depo-Provera

A

IM injection q 12 weeks

Initial injection given on day 5

Use for two years
Increased risk
- decrease bone density
- increased lipids, weight gain, depression, uterine bleeding

  • fertility issues 1 yr after given thinning of uterine lining
53
Q

Hormonal methods oral contraceptives

A
  1. Most common are 4 weeks pill pack w/4th week placebo. Combination of estrogen and progestin or progestin only pill
  2. Continuous OC with withdrawal bleeds every 3 months
  3. Continuous OC taken 365 days/yea with no placebo or pill free interval
54
Q

Monophasic, Biphasic and Triphasic

A

Same amount in every pill

2 different amounts in different weeks

3 different in different weeks

As estrogen content decreases BTB or spotting increases ( maybe)

55
Q

OC start methods

A

Take pill same time everyday

First day start - start pill on first day of menses and follow as directed

Quick start - active pill can be initiated at any point in menstraul cycle, make sure not pregnant, must use back up for 7 days

56
Q

OC missed pills

A

Single pill : take as soon as realized even if it means taking two pill in one day

Two doses: take two pills x 2 days then 1 pill per day . Need back up for 7 days

If more than 3 doses consult

57
Q

OCP’s contraindications

A

HX of CVA, CAD, HF, DVT

DM with end organ damage

HX breast CA

Preg

Age > 35 yo and smoker ? 15 cig a day

Breast feeding < 6 weeks

Liver dx

Migraine with focal nuero symptoms (aura)

HTN w/ vascular dx

Major surgery with immobility

58
Q

OCP side effects

A

BTB spotting

  • common during 1st 3 months
  • r/o infection
Headaches
  - r/o CVA
  - check BP
  - d/c  if migraine with aura
  Nausea, breast tenderness, bloating
59
Q

Systemic OC’s

A

Increased in total cholesterol, HDL, LDL and triglycerides - no evidence of atherosclerosis though

Increased insulin resistance and decrease glucose tolerance - increase clotting- estrogen related

Increase in BP

Smoking can increase symptoms

60
Q

OC risks

A

VTE, MI, CVA, liver tumors, gallbladder dx

61
Q

OC ACHES

A 
Abdominal pain 
  - abd artery thrombosis, GB, liver 
Chest pain and SOB
 - MI
Headache 
 - CVA, HTN, migraine 
Eyes 
 - Visual changes, retinal artery thrombosis 
Severe leg pain 
- VTE
62
Q

OCP drug interactions - decrease effectiveness

A 
Antibiotics
Barbiturates
Dilatin 
Primidone
Rifampin
Tegretol
Methyldopa
Oral anticoagulant
Oral hypoglycemics
63
Q

OCP - drug interactions - increase effectiveness

A 
Alcohol
Antidepressants
Benzos
Beta blockers
Corticosteriods
Theophylline
64
Q

Transdermal patch

A

Ortho evra patch
- Same side effect profile, use and indication as OCP’s

  • Roatation of sites every week
    • never on breasts

3 weeks on and 1 eek off

65
Q

NevaRing

A

Vaginal ring - inserted for 3 weeks adn followed by 1 week out

Hormones absorbed through the vaginal epithelium and thus supresses ovulation

Can remain in place during intercourse

Doesn’t require fitting by health care provider

66
Q

IUD - Mirena and skyla

A

Progestin containing
Mirena (5)
Skyla (3 )
Thickens cervical mucus therapy inhibiting sperm transport - partially inhibits ovulation

Increased vaginal bleeding 1-6 months, increased cramping infection, perforation of uterus,

67
Q

IUD- Copper

A

10 years
Copper is an spermicidal

Increased vaginal bleeding

68
Q

POst coital prevention

A

Withdrawal, post coital douche

Plan B

  • within 72 hours
  • high doses of progestin
  • prevents fertilization by inhibition of ovulation
69
Q

Overview - vaginal discharge

A

BV, Candidiasis, Trichomoniasis, Chlamydia, Gonorrhea

70
Q

Overview - Volovaginal lesions

A

Genital herpes, syphilis

71
Q

BV

A

Abnormal amount fo vaginal discharge
Fishy order, especially after sex
Vulvar itching

Discharge : thin, gray
Saline wet amount : clue cells
PH > 4.5
+ wiff

< 5 % lactobacilli

Complications: PID, UTI,

72
Q

BV treatment

A

Metronidazole 500mg / PO BID x 7

Metrogel - vaginal x 5 days

Don’t tx partner

Can use clindamycin 300 mg BID x 7

Common that it is recurrent

73
Q

Candida / yeast

A

Inflammatory process involving teh vagina and vulva caused by fungus

Decrease lactobacilli

Can occur with antibiotic use

Thick, clumpy vaginal discharge ( cottage - cheese appearing)
Vulvar itching and burning
Burning with urination
PH< 4.5
KOH test = pseudophae + hyphae and budding yeast

Red, sore looking vulva, vagina

74
Q

Candida TD

A

Diflucan 150 mg / PO one time

75
Q

Trichomoniasis

A

Flagellated protozoan
sexually transmitted disease
Often associated with GC
Can cause nongonococcal urethritis

Forty profuse green discharge; gas produced
Intense vaginal, vulvar irritation
Petechia on cervix - strawberry appearance

T. Vaginalis nucleic acid amplification test

76
Q

Tric TX

A

Flagly 2 grams / PO single dose BID for 7 days

Vaginal flagly - no rec

Partner should be treated

77
Q

Chlamydia

A

Affects transition zone of cervix
Can cause infertility
Asymptomatic some times

Present : muco-purulent cervicitis, vaginal discharge, dysuria, abnormal vaginal bleeding, pelvic pain

78
Q

Chlamydia Clinical manifestations

A

Speculum - inspect for mucopurulent discharge from cerix - yellow or green

Cervix = friability = bleeding

Perform biannual exam for adnexal tenderness, uterine tenderness and cervical motion tenderness

Dx : NAAT

79
Q

Chlamydia tx

A

Partner must be treated
HIV testing

Azithromycin 1 gram /PO single dose
Or
Doxy 100 mg /PO BID for 7 days ( less $)

80
Q

Gonorrhea

A

Can be asymptomatic
Site at urthrea and endocervix
PID caused by gonorrhea
Presents w/ vaginal d/c, dysuria, abnormal bleeding, abdominal or pelvic pain

81
Q

Gonorrhea tx

A

You treat both for GC and chlamydia
Ceftriazone IM + Azithrymocin 1gm PO single dose

Partner must be treated

Can do doxy but will have to be for 7 days

82
Q

Genital Herpes

A

A chronic life long infection
Route of transmission : gential - genital
Viral shedding can occur when patient is asymptomatic

Painful papules followed by vesicles, ulcerations crusting adn healing

DX: cell cultures, PCR, obtain RPR to r/o syphilis

83
Q

Genital herpes simplex 2 TX

A

First episode :
- Acyclovir 400 mg PO TID 7-10 days

Suppressive therapy for recurrence

  • Acyclovir 400 mg PO BID
  • Valacyclovir 500 mg PO QD
84
Q

HPV aka Gential warts

A

Most common sexually transmitted infection

Usually flat or pedunculated growth on the anti genital skin
May be painful, friable, and itchy

HPV vaccine

Can use ointments

85
Q

Syphilis

A

STI caused by treponema pallium

Active episodes and then by latent periods with no signs or symptoms

Painless, single small firm red ( charncre)

Incubation days 21 before any signs become apparent

Heals within 4-8 week w/o treatment and 1- 2 weeks with treatment

Send : RPR

TX : pencillin G benzathine 2.4 IM once

86
Q

Secondary syphilis

A

Systemic illness that includes disseminated rash involving the torso, palms, soles

Fevers, malaise, pharyngitis, hepatitis, slope is

87
Q

Latent syphilis

A

Period of time when patient is infected with treponema pallidum with serologic testing but has no symptoms

Adult Part II (6 decks)

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