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AGM 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

causes of immunosenecence

A

Thymic involution causes decrease in production of T-cells, with memory T-cell proliferation increasing to compensate. Decreased IL-2 production and decreased expression of IL-2 receptors

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2
Q

what does IL-2 do

A

tells the T-cells to proliferate

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3
Q

what accounts for increase in autoimmunity in the elderly?

A

decreased regulation of CD8 T-cells, so they attack “self”

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4
Q

definition of sarcopenia

A

loss of skeletal muscle and function due to a variety of causes

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5
Q

what assesses for sarcopenia

A

DEXA scan

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6
Q

DEXA aka

A

dual-energy x-ray absorptiometry

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7
Q

prevalence of sarcopenia ages 60-69

A

15%

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8
Q

prevalence of sarcopenia over age 80

A

> 40%

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9
Q

muscle mass loss after age 65

A

5% per year

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10
Q

pathophysiology of IBM

A

MAC triggers cytokines amyloid deposits

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11
Q

CK levels in IBM

A

normal

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12
Q

Muscle biopsy IBM

A

CD8 MHC1 lesion

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13
Q

IBM distribution

A

distal

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14
Q

poly distribution

A

proximal

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15
Q

dermato distribution

A

everywhere

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16
Q

treatment for inflammatory myopathies

A

steroids, methotrexate, IVIG

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17
Q

long term treatment for dermato

A

methotrexate

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18
Q

short term treatment for dermato flare-ups

A

steroids

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19
Q

dermatomyositis presentation

A

transient weakness with hand, foot, face rash

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20
Q

muscle effects of statins

A

rhabdomyolysis, increased CK, myalgias, myoglobinuria

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21
Q

muscle effects of glucocorticoids

A

atrophy with proximal weakness

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22
Q

muscle effects of alcohol

A

muscle breakdown, rhabdo, myoglobinuria

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23
Q

muscle effects of local drug injections

A

necrosis, skin induration, limb contractures

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24
Q

PR presentation

A

bilateral shoulder and pelvic girdle pain “belt area” with upper limbs more painful, weight loss, night sweats, fever

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25
Q

PR tests

A

no muscle biopsy, elevated CRP/ESR, low CK

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26
Q

PR treatment

A

prednisone (long-term) 100 mg

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27
Q

what tests to monitor PR/GCA treatment

A

CRP, ESR

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28
Q

PR/GCA treatment

A

prednisone 200 mg

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29
Q

GCA presentation

A

headache, jaw claudication, temporal artery tenderness, transient unilateral vision loss, fever, anemia

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30
Q

GCA management

A

refer to ophthalmology for biopsy (not evident on ophthalmic exam)

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31
Q

GCA treatment for vision loss

A

IV steroids

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32
Q

GCA treatment, if no vision loss

A

oral steroids

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33
Q

ESR CRP for GCA

A

elevated

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34
Q

common locations for GCA

A

temporal artery, aortic arch

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35
Q

how to distinguish GCA from takayasu

A

Takayasu more common in young females

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36
Q

amaurosis fugax aka

A

transient monocular vision loss

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37
Q

if GCA biopsy is negative…

A

treat anyway

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38
Q

presentation of OA

A

monoarticular, goes away after 30 minutes

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39
Q

RA joints affected

A

MCP, (ulnar deviation)

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40
Q

OA joints affected

A

DIP (herberden) and PIP (bouchard)

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41
Q

inflammatory markers for RA/OA

A

positive for RA, negative for OA

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42
Q

presentation of RA

A

“malar rash” polyarticular pain and stiffness, unchanging

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43
Q

pathophys of RA

A

immune cells complex within the synovium of a joint leading to pannus formation and joint destruction

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44
Q

peak incidence of RA

A

60s to 80s

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45
Q

possible etiologies of RA

A

genetic, infectious, hormonal, environmental

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46
Q

diagnosis of RA

A

RF, anti-CCP antibodies

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47
Q

RA management

A

non-pharmacologic: education, support, OT/PT, psych. Pharmacologic: DMARDs (methotrexate), NSAIDs, biological DMARDs (eternacept - expensive, leflunomide), antimalarials

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48
Q

what to do before starting immunosuppressants

A

test for TB, renal, LFTs, vaccinate, examine comorbidities (HIV)

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49
Q

SLE presentation in elderly

A

malar rash, glomerulonephritis, cytopenia

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50
Q

SLE most affected population

A

young females, elderly people

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51
Q

SLE delay in diagnosis causes

A

must have 4/11 diagnostic criteria; they don’t always present all at once

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52
Q

early SLE symptoms

A

malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis

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53
Q

causes of drug induced SLE

A

antibiotics, seizure meds, TB meds

54
Q

treatment for drug induced SLE

A

discontinue meds

55
Q

autoantibodies in SLE

A

anti-DNA, anti-Smith, ANA, anti-phospholipid

56
Q

treatment for SLE

A

steroids, NSAIDs, avoid sun, immunosuppressant

57
Q

Sjogrens pathophys

A

autoimmune destruction of exocrine glands

58
Q

Sjogrens presentation

A

sicca symptoms (dry eyes, dry mouth), Raynauds

59
Q

2 most common AI

A

RA, Sjogrens

60
Q

Sjogrens is associated with what antigens

A

HLA

61
Q

Sjogrens associated with what other AI disorders

A

SLE, RA

62
Q

Sjogrens associated with what cancer

A

lymphoma

63
Q

Sjogrens treatment

A

treat the symptoms (eye drops, etc)

64
Q

Sjogrens autoantibodies

A

anti-ssa, anti-ssb

65
Q

drug-induced rheumatic syndromes

A

myopathy, drug-induced SLE

66
Q

what is Raynauds triggered by

A

triggered by cold, stress

67
Q

Raynauds treatment

A

calcium channel blockers (vasodilation)

68
Q

labs for Raynauds

A

cryoglobulin

69
Q

ages for scleroderma

A

30-50

70
Q

CREST syndrome aka

A

calcinosis, raynauds, esophageal dysfunction, sclerodactyly, telangectasia

71
Q

risk for scleroderma

A

silica dust

72
Q

AI disorders associated with scleroderma

A

polymyositis, SLE

73
Q

scleroderma plus additional AI is called

A

mixed connective tissue disease

74
Q

Reiters syndrome aka

A

reactive arthritis

75
Q

Reiters syndrome occurs after

A

GI infections, chlamydia

76
Q

test for Reiters syndrome

A

HLA-B27, CRP, ESR, X-ray, urinalysis

77
Q

Reiters syndrome presentation

A

conjunctivitis, joint pain, urethritis (can’t see, can’t pee, can’t climb a tree)

78
Q

Reiters treatment

A

treat any infection, pain, variable duration

79
Q

when is ANA positive

A

autoimmune disorders

80
Q

anti-DNA

A

SLE

81
Q

anti-Smith

A

SLE

82
Q

anti-scl

A

scleroderma

83
Q

anti-centromere

A

limited scleroderma

84
Q

anti ssa, ssb

A

Sjogrens

85
Q

anti Jo

A

polymyositis, dermatomyositis

86
Q

anti ANCA

A

granulomatosis

87
Q

most common cause of fever in elderly

A

infection

88
Q

algorithm for fever in elderly

A

skin survey, urine analysis, CBC, BMP (kidney), TSH, ESR/CRP (if very increased, GCA or malignancy), PPD

89
Q

immunosenescence effect on vaccines

A

don’t respond well to vaccines; need higher dose and boosters

90
Q

pneumovax aka

A

23

91
Q

prevnar aka

A

13

92
Q

Zostavax benefits

A

decreases post-herpetic neuralgia, less severe shingles

93
Q

when to give pneumonia vaccine if under 65

A

immunocompromised, COPD, asplenia, history of recurrent pneumonia

94
Q

when to test pregnant women for HIV

A

first and third trimester

95
Q

HIV presentation

A

weight loss, recurrent infections (shingles, syphilis, pneumonia), TB, dementia

96
Q

recent exposure HIV test

A

4th generation screen (serology; antibody/antigen)

97
Q

nonadherent to meds HIV test

A

CD4, CD8, viral load

98
Q

adherent to meds HIV test

A

viral load, CD4

99
Q

infant HIV test

A

antigen only

100
Q

what ferritin is iron deficiency anemia

A

less than 30

101
Q

hematocrit

A

percentage of blood that is composed of red blood cells

102
Q

MCV

A

average volume of red blood cells

103
Q

RDW

A

range of blood cell sizes (“SIZE”)

104
Q

MCHC

A

average concentration of hemoglobin

105
Q

MCH

A

average weight of cells

106
Q

which anemia has high MCHC

A

spherocytosis

107
Q

neutrophils increased means

A

acute bacterial infection

108
Q

eosinophils/basophils increased means

A

allergy/parasite

109
Q

what is ferritin

A

iron storage

110
Q

what transferrin

A

iron transport protein

111
Q

when ferritin is low, TIBC is

A

high

112
Q

low reticulocyte count means

A

bone marrow failure

113
Q

blast cells are an indication of

A

leukemia

114
Q

Auer rods are an indication of

A

AML/CML

115
Q

bite cells

A

G6PD deficiency

116
Q

teardrop cells

A

lead poisoning

117
Q

most common type of anemia

A

IDA

118
Q

hepcidin in anemia of chronic disease

A

increases (hepcidin is produced by liver due to inflammation)

119
Q

transferrin in anemia of chronic disease

A

normal or slight increase

120
Q

anemia of chronic disease is how severe

A

mild

121
Q

reticulocytes in ACD

A

normal or decrease

122
Q

EPO in ACD

A

decrease

123
Q

3 etiologies of anemia of old adults

A

nutritional, chronic disease, unexplained

124
Q

how many people over 65 are anemic

A

> 10%

125
Q

B12 deficiency blood smear

A

macrocytic, hyperchromic, hypersegmented neutrophils, macroovalocytes

126
Q

other test for B12 deficiency other than serum

A

MMA

127
Q

B12 vs folate

A

B12 has neuropathy and elevated MMA. Folate has elevated homocysteine

128
Q

thalassemia blood smear

A

target cells and acanthocytes, microcytic, hypochromic

129
Q

aplastic anemia

A

hypocellular bone marrow, recurrent infections, pancytopenia

130
Q

sickle cell anemia presentation

A

bone pain

131
Q

hemolytic anemia

A

normocytic, normo- to hyperchromic

132
Q

lead poisoning blood smear

A

teardrops, basophilic stippling, microcytic

AGM 2 (4 decks)

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