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OPT 537 > Exam 1 -- Rheumatology #5 > Flashcards

Exam 1 -- Rheumatology #5 Flashcards

1
Q

What is another name for osteoarthritis?

A

Degenerative Joint Disease (DJD)

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2
Q

True or false: osteoarthritis is the most common type of arthritis

A

True.

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3
Q

Which gender has a higher prevalence of osteoarthritis?

A

Female

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4
Q

True or false: osteoarthritis is the second most common cause of diability

A

False; it is the most common cause of diability

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5
Q

Osteoarthritis is uncommon below what age?

A

50

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6
Q

Fact: Osteoarthritis is related to aging.

A

Free card!

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7
Q

What are some risk factors for osteoarthritis?

A

Obesity, trauma, estrogen, smoking

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8
Q

Focal erosion of cartilage occurs in osteoarthritis, leading to bone rubbing on bone. What is the name for the bone overgrowth that occurs as the bone attempts to repair itself?

A

Osteophyte

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9
Q

Osteoarthritis normally affects which joints?

A

Knees, hips, fingers, spine

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10
Q

Imbalances in which factors contribute to the degeneration of tissue in osteoarthritis?

A

MMPs, IL’s, TNF-alpha, and VEGF all increase, IGF decreases

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11
Q

True or false: symptoms of osteoporosis improve with use and are worse with rest

A

False; symptoms are exacerbated by use and reduced by rest

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12
Q

What is the term for the crackling of joints that can sometimes be heard in a patient with osteoarthritis?

A

Crepitus

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13
Q

Which joints in the hand can become affected in osteoarthritis?

A

CMC (proximal joint of thumb) and DIP and PIP (two most distal joints of the other fingers)

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14
Q

What is the name for the bony spurs that can occur in the DIP joint?

A

Heberden’s nodes

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15
Q

What is the name for the bony spurs that can occur in the PIP joint?

A

Bouchard’s nodes

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16
Q

What manifestation can osteoarthritis have in the feet?

A

Hallux valgus (big toe points toward second toe)

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17
Q

True or false: spinal stenosis (narrowing of spinal column) can occur in osteoarthritis

A

True.

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18
Q

What is the name for the pockets of synovial fluid that can occur in the back of the knee in osteoarthritis?

A

Baker’s cysts

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19
Q

What sort of testing might help distinguish osteoarthritis?

A

X-rays (for osteophytes), MRIs (for cartilage injury)

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20
Q

What are some non-medical treatment options for osteoarthritis?

A

Weight loss, light exercise, alternating heat and ice packs, massages

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21
Q

What are some medical treatment options for osteoarthritis?

A

Acetominophen (drug of choice), low-dose NSAIDs, topical capsaicin (for pain relief), corticosteroid injections, surgery

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22
Q

What is most commonly the first sign of osteoporosis?

A

Fragility fracture (usually in the spine)

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23
Q

What are some risk factors for osteoporosis?

A

Low estrogen, female, light weight, smoking, age (over 80 years)

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24
Q

Secondary osteoporosis can be caused by what conditions?

A

Corticosteroids, hyperthyroidism, hyperparathyroidism

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25
Q

A DEXA scan is one way to measure bone density. A score of how many standard deviations below the norm indicates osteoporosis?

A

2.5

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26
Q

What supplements can be taken to help with osteoporosis?

A

Calcium (1,000-1,200 extra mg per day) and Vitamin D (800 IU per day)

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27
Q

What lifestyle changes can be made to help with osteoporosis?

A

Exercise, smoking cessation, fall prevention, alcohol avoidance

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28
Q

What medications can be used for osteoporosis?

A

Bisphosphonates (ibandronate q1mo, aldendronate q1week), estrogen therapy (raloxifene)

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29
Q

Relapsing polychondritis is an autoimmune mediated inflammation of what type of tissue?

A

Cartilage

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30
Q

Relapsing polychondritis is associated with what conditions?

A

Vasculitis and arthritis

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31
Q

What effects can relapsing polychondritis have in the ears?

A

Cauliflower ear, floppy ear, hearing loss

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32
Q

What effects can relapsing polychondritis have in the nose?

A

Saddle-nose

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33
Q

What effects can relapsing polychondritis have in the eyes?

A

Episcleritis, scleritis, proptosis

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34
Q

What effects can relapsing polychondritis have in the lungs?

A

COPD, apnea

35
Q

True or false: relapsing polychondritis can feature non-erosive joint pain

36
Q

What percentage of relapsing polychondritis patients get valvular disease?

37
Q

Which gender has a higher prevalence of relapsing polychondritis?

A

Neither; prevalence is equal between the genders

38
Q

What is the general age of onset for relapsing polychondritis?

A

Greater than 40 years

39
Q

Which ethnicity has a higher prevalence of relapsing polychondritis?

40
Q

What is the 5-year survival rate for relapsing polychondritis?

A

65-75% (45% if systemic vasculitis involved)

41
Q

What are the medical treatment options available for relapsing polychondritis?

A

NSAIDs, oral steroids, DMARDs, TNF inhibitors (cyclophosphamide reserved for severe cases)

42
Q

What is the main difference between gout and pseudogout?

A

Gout has sodium urate crystals, pseudogout has calcium crystals

43
Q

What is another name for pseudogout?

A

Calcium pyrophosphate deposition (CPPD)

44
Q

Patients with what conditions have an increased risk of gout?

A

Psoriasis and psoriatic arthritis

45
Q

What is the main characterizing symptom of gout?

A

Podagra (pain, redness, and swelling in big toe at MTP)

46
Q

Podagra affects what percentage of gout patients?

47
Q

True or false: the pain of podagra usually begins at night

48
Q

Attacks of gout may be separated by what length of time?

49
Q

In addition to elevated uric acid levels, what else must occur to trigger gout?

A

Trauma or inflammation

50
Q

True or false: patients with gout have a lower risk of CVD

A

False; they have a higher risk of CVD

51
Q

Which gender has a higher prevalence of gout?

A

Male (10:1)

52
Q

What is the usual age of onset for gout?

A

30-50 years

53
Q

True or false: Pacific Islanders have a higher prevalence of gout

54
Q

What is the prevalence of gout in the U.S.?

55
Q

What are some common causes of gout?

A

Purine foods*, high saturated fats, fructose in drinks, alcohol, obesity, trauma

56
Q

What medications can cause an attack of gout?

A

Cyclosporine, aspirin, diuretics

57
Q

True or false: diabetes and renal failure can induce attacks of gout

58
Q

List the stages of gout:

A

Hyperuricemia, urate deposition, trauma/inflammation, podagra, chronic tophaceous gout

59
Q

Serum uric acid raised to what level is indicative of gout?

A

Higher than 6.8 mg/dL

60
Q

Joint aspiration shows what shape of cystals in gout?

A

Rod-shaped

61
Q

Tophaceous gout is characterized by very high levels of uric acid, as well as tophi. What are tophi and where can they be found?

A

They are white deposits which can ulcerate. They form on the ears, fingers, and ankles.

62
Q

Tophaceous gout is caused by what?

A

Inflammation adjacent to urate crystalsin synovium

63
Q

Tophaceous gout is associated with what conditions or medications?

A

Renal impairment and long-term diuretic use

64
Q

75% of untreated gout patients develop tophi after how many years?

65
Q

Renal failure is very common gout patients who also have what other conditions?

A

Diabetes, CKD, HTN, obesity

66
Q

Uric acid stones cause what percentage of kidney stones?

67
Q

What sort of dietary restriction can help with gout?

A

Reduce alcohol, reduce calories and cholesterol, reduce soft drinks, reduce offal/organ meats, increase water intake

68
Q

By what percentage can dietary restriction reduce serum uric acid?

69
Q

What medical options are available in acute gout?

A

High dose NSAIDs (naproxen, diclofenac, indomethacin, but not aspirin; aspirin can induce gout); low-dose colchicine, oral or injected corticosteroids

70
Q

What are some side effects of colchicine?

A

Kidney failure, liver failure, GI upset in 80%

71
Q

What medical options are available in chronic gout?

A

Allopurinol (blocks synthesis of uric acid, decreases purine synthesis), febuxostat, probenecid (increases excretion and stop resorption of uric acid)

72
Q

What are some side effects of allopurinol?

A

Skin rash, GI upset, can induce acute gout

73
Q

Febuxostat plays the same type of role as allopurinol in treating gout. When would it be preferred to allopurinol?

A

If patient has kidney failure, since it is less toxic to the kidney

74
Q

What are some side effects of febuxostat?

A

Cardiovascular risk factors

75
Q

What is a side effect of probenecid?

A

Kidney stones

76
Q

Which gender has a higher prevalence of pseudogout?

77
Q

Which joints are affected in pseudogout

A

Knee*, elbow, ankle

78
Q

What is the typical age of onset for pseudogout?

A

Above 65 years

79
Q

True or false: pseudogout is more painful than gout

A

False; it is less painful

80
Q

What can cause pseudogout?

A

Trauma or increased iron uptake

81
Q

What testing can be done to test for pseudogout?

A

X-ray (to see calcium deposits), synovial fluid analysis (looking for calcium pyrophosphate)

82
Q

Pseudogout crystals have what shape?

A

Triangular or rhomboid

83
Q

How would you treat pseudogout?

A

Steroid injections, NSAIDs, colchicine, methotrexate, hydroxychloroquine

OPT 537 (21 decks)

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