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Clin path final intranet > Clin Path Final > Flashcards

Clin Path Final Flashcards

1
Q

What are rheumatic diseases?

A

Chronic systemic processes and affected patients often have musculoskeletal complaints that are not resolving with chiropractic care.

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2
Q

What is SLE?

A

a chronic inflammatory disease in which there is production of auto-antibodies to components of the cells of various structures like joints, kidneys, serous surfaces and vessel walls.

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3
Q

What are the lab findings like for SLE?

A

Hematology- anemic. Serology- screen with ANA, but is not very specific, use anti-native DNA or anti-SM to be specific for SLE.

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4
Q

What is systemic sclerosis?

A

A tissue hardening disease where dense connective tissue replacement happens in dermis of skin, submucosa of esophagus and parts of GI, heart, lungs, kidneys.

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5
Q

What are the lab findings like for scleraderma aka systemic sclerosis?

A

Hematology- mild anemia due to iron and B12 deficiency. Urinalysis- proteinuria. Serology- screen with ANA, anti-scleroderma antibody aka Scl-70 is highly specific. Skin biopsy is also helpful.

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6
Q

What is Sjogren syndrome?

A

Autoimmune mediated chronic dysfunction of exocrine glands in many areas of the body.

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7
Q

What are the lab findings like for Sjogren syndrome?

A

Hematology- Mild anemia, leukopenia, eosinophilia. Serology- Screen with ANA, more specific with anti-SSA or anti-SSB, RF, and polyclonal hypergammaglobulinemia.

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8
Q

What is idiopathic inflammatory myopathies?

A

2 distinct diseases with very similar muscular involvment that are most frequent primary myopathies observed in adults with the most common symptom being muscle weakness.

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9
Q

What are the 2 types of idiopathic inflammatory myopathies?

A

Polymyositis and dermatomyositis.

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10
Q

What are the lab findings for idiopathic inflammatory myopathies?

A

Hematology- no anemias. Serology- no ESR, no RF, Anti-jo1 in antisynthetase syndrome patients, elevated CK (CK MM aka CK3) is the best test, EMG helpful but not specific, muscle biopsy most specific lab finding.

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11
Q

What is Mixed connective tissue disease?

A

A disorder that contains elements of SLE, progressive systemic sclerosis, and inflammatory myopathy and over time the clinical manifestations evolve to one perdominate disease, most commonly SLE. Currently the title of MCTD is given to patients having features of different rhematic diseases.

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12
Q

What are the lab findings like for mixed connective tissue disease?

A

ANA 95%, Anti-RNP if positive disease wil likely evolve to SLE.

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13
Q

What is temporal arteritis aka giant cell arteritis?

A

A granulomatous inflammation disrupting internal elastic membrane in medium and large sized arteries of the aorta and branches.

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14
Q

What are the lab findings like for giant cell arteritis aka temporal arteritis?

A

50% will be anemica. Most consitant finding is elevated ESR. Temporal artery biopsy is also done.

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15
Q

What is polymyalgia rheumatica aka PMR?

A

it is closely related to temporal arteritis and is thought to be same disease as temopral arteritis.

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16
Q

What are the lab findings for PMR?

A

anemia is possible. Most consitant finding is an elevalted ESR. Temporal artery biopsy is also done.

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17
Q

What is acute Rheumatic fever?

A

A systemic immune respone to infectious pharyngitis with group A beta-hemolytic streptococcus and causes focal granulomatous reaction with vasculitis, hence an inflammatory reaction in various tissues, necrosis of collagen.

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18
Q

What are the lab findings for acute rheumatic fever?

A

ESR is usually elevated. Anti streptolysin-O or anti-DNAseB will develop 7-10 days after infection and be highest 3 weeks after infection and will not be detectable after 12 months. Throat cultures usually negative when ARF is suspected.

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19
Q

What is Adult rheumatoid arthritis?

A

A systemic inflammatory disease that predominantly manifests in the synovial membrane of diarthroidal joints. This will develop in a genetically predisoped person, but exogenous triggers have not been identified. The inflammatory process causes changes in cellular composition and gene expression of the synovial membrane leading to hyperplasia of synovial fibroblasts and structural damage of cartilage, bone and ligaments.

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20
Q

What are the Lab findings for adult RA?

A

Best test is Anti-CCP which has 60% sensitivity and a 98-99% specificity. ESR or CRP can be used to monitor the course. RF is only 75-85% sensitive and 60-65% specific. RF is seen with a lot of other conditions. Hematology- microcytic- hypochromic anemia with low ferritin and this makes the anemia hard to distinguish from iron deficiency anemia.

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21
Q

What are serongegative spondyloarthorpathies?

A

Diseases without RF.

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22
Q

What is ankylosing sponylitis?

A

a chronic systemic inflammatory disorder of the axial skeleton and large peripheral joints. SI is the hallmark feature.

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23
Q

What are the lab findings for AS?

A

Mild anemia. ESR is elevated with an active disease. HLA-B27 is used to rule out AS. Most people with HLA-B27 do not have AS. Radiographic evidence is the best test.

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24
Q

What is Psoriatic arthritis?

A

inflammatory arthropathy that combines clinical features of RA and Seronegative spondyloarthropathies.

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25
Q

What are the lab findings for Psoriatic arthritis?

A

None in the notes, but there are 3 patterns. 1. asymmetric oligoarthritis or monarthritis. 2. polyarthritis resembling RA. 3. Axial disease with or without peripheral joint disease.

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26
Q

What is reactive arthritis and what is it aka?

A

aka reiters syndrome. Arthritis with specific nonarthicular manifestations that appear shortly after certain infections (shigella, salmonella and campylobacter) of genitourinary or GI tract.

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27
Q

What are the lab findings for Reactive arthritis aka reiters syndrome?

A

HLA-B27 in 85%. Elevated ESR in 70%. Aneima, leukocytosis, thrombocytosis in 30%.

28
Q

What is enteropathic arthritis aka colic arthritis?

A

peripheral and or spondylitic arthritis that develops in 20% of patients with inflammatory bowel disease. Most commonly seen with chrons and ulcerative colitis.

29
Q

What are the lab findings for enteropathic arthritis?

A

HLA-B27 in 50%. Elevated ESR. When patients have had a JI bypass the lab will show + RF and ANA.

30
Q

What is gouty arthritis?

A

Recurrent arthritis of peripheral joints that results from deposition, in and about the joints and tendons, pf crystals of monsodium urate from supersaturated hyperuricemic body fluids. This arthritis can become chronic and deforming.

31
Q

What are the lab findings for gouty arthritis?

A

Hyperuricemia in 90% of patients during first visit (often need serial determinations), Leukosytosis, elevated ESR, monosodium urate crystals found in synovial joint fluid or from tophi.

32
Q

What is pseudogout?

A

A degenerative arthritis of unknown etiology associated with intermittent attacks of acute arthritis affecting larger more proximal joints than gout. It may be asymptomatic calcinosis of characteritistic joints including intervertebral cartilage and symphysis pubis.

33
Q

What are the lab findings for pseudogout?

A

calcium pyrophosphate crytals detected in aspirated joint fluid. Chondrocalcinoisis is seen in affected joint with imaging.

34
Q

What is infectious arthritis?

A

arthritis resulting from infection of synovial tissue with pyogenic bacteria or less commonly other infectious agents.

35
Q

What is nongonococcal septic arthritis?

A

A type of infectious arthritis commonly seen in IV drug abusers, immunocompromised, joints damaged by things like RA, recent prosthetic or arthroscopic surgical procedures.

36
Q

What are the lab findings like for nongonococcal septic arthritis?

A

Analysis of synovial fluid for; high WBC (neutrophilia), infectious agent (staph aureus, A and B strep, E. coli, pseudomonas aeruginosa).

37
Q

What is gonococcal septic arthritis?

A

a type of infectious arthritis commonly seen in women 2-3 times more than males, also seen in homosexual males.

38
Q

What are the lab fingings like for gonococcal septic arthritis?

A

synovial fluid analysis of high neutrophils, gram negative stain and culture. Cultures of blood, urethral, throat, rectal may be helpful. Imaging reveals soft tissue swelling at best.

39
Q

What is lyme disease?

A

a potentially multisystem inflammatory disease that can occur in anyone bitten by Ixodes tick that spreads the infection of the spirochete borrelia burgdorferi.

40
Q

What are the lab findings for Lyme disease?

A

Detection of borrelia spirochete antibodies by an EIA or ELISA screen and then a confirmatory test of IgM or IgG via western blot.

41
Q

What is osteoarthritis?

A

The most common joint disease which can occur in anyone regarless of age, race, or geographic location. 90% of population will have some evidence by the age of 40.

42
Q

What are the lab findings for OA?

A

Imaging is key to Dx. NO signs of inflammation. Labs can be used to rule in or out other types of arthritis.

43
Q

What is fibromyalgia?

A

A chronic musculoskeletal pain syndrome of widespread pain distribution and multiple painful pints to palpation.

44
Q

What are the lab findings like for fibromyalgia?

A

Just used to rule in or out other diseases.

45
Q

Conversion of Vitamin D is under direct influence of what?

A

PTH.

46
Q

When should you check intact PTH and total serum calcium?

A

When radiographically you suspect bone density loss.

47
Q

When you have low and high amounts of serum calcium how can you tell if it is from malignancy, or hyper or hypo parathyrodism?

A

Hypoparathyroidism- if low calcium and low PTH. Malignancy- if high calcium and low PTH. Hyperparathyroidism- high calcium and high PTH.

48
Q

Colecalciferol is converted to what where?

A

25-hydroxy vitamin D in the liver.

49
Q

25-hydroxy vitamin D is converted to what and where?

A

1,25-dihydroxy vitamin D in the kidneys.

50
Q

What is Pagets disease and it is aka?

A

aka osteitis deformans. A chronic disorder of unknown origin that displayes abnormally softened bones and enlarged bone material as a result of highly vascularized weakened , heavy calcified bone with coarsely thickened lamellae and trabeculae.

51
Q

What are the lab findings like with pagets disease?

A

Markedly increased levels of alkaline phosphatase (will give you one of the highest levels), increased urinary hydroxyproline.

52
Q

What is primary hyperparathyroidism?

A

Over secretion of PTH

53
Q

What are the lab findings for hyperparathyroidism?

A

Serum chem: hypercalcemia (intermittent early and sustained later), hypophosphatemia, increased alkaline phosphatase. Urine: hypercalciuria.

54
Q

What is secondary hyperparathyroidism?

A

Hypocalcemia due to renal disease and partial resistance of the metabolic action of PTH and this low levels of serum calcium will increase PTH production.

55
Q

What are the lab findings for secondary hyperparathyroidism?

A

Hypocalcemia, hyperphosphatemia, increased alk phos, increased PTH, increased osteocalcin, increased Dpd, Increased NTX, alterned renal function studies.

56
Q

What is euthyroid?

A

Normal functioning thyroid.

57
Q

What thyroid hormone is physically active?

A

T3.

58
Q

Where is the largest amounts of T3 made at?

A

at the cellular level from T4 via an enzymatic process removing one of the iodine molecules from T4.

59
Q

What happens to T3 if T4 is over or underproduced?

A

T3 will be similarly increased or decreased besides in the one disease where the thyroid selectily overproduces just T3.

60
Q

How are most thyroid hormones released?

A

Bound to a protein called thyroid binding globulin (TBG).

61
Q

Will thyroid hormones be physically active while bound to TBG?

A

No.

62
Q

What thyroid hormone posseses the most physically active form?

A

The free portion (not bound to tbg.

63
Q

What is the best test used to evaluate thyroid funciton?

A

TSH since everyone has there own levels of normal FT4, and they can be higher and lower than other people. Increased TSH suggests hypothyroidism and decreased TSH suggests hyperthyroidism.

64
Q

What is graves and what is hashimotos?

A

Graves- hyperthyroidism. Hashimotos- Hypothyroidism.

65
Q

What are the lab test results for hypothyroidism?

A

Increased: TSH, total and LDL cholestrol, AST, CK, LDH. Decreased: TT4, THBR, FT4, Total and free T3, hemoglobin.

66
Q

What are the lab test results for hyperthyroidism?

A

Increased: TT4, THBR, FT4, Total and free T3, calcium. Decreased: TSH, Total and LDL cholesterol.

67
Q

What is hyper- and what is hypo- adrenocortical problems called?

A

Hyper- Cushings. Hypo- addisons.

Clin path final intranet (1 decks)

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