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CMN 574 Final Review > Final review > Flashcards

Final review Flashcards

1
Q

What is the most common cause of chest

pain?

A

Musculoskeletal

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2
Q

CHEST PAIN
Is musculoskeletal pain described as
gradual or sudden?

A

Gradual onset

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3
Q

CHEST PAIN
What is something you could ask the
patient to do regarding assessing the
pain?

A

Localized pain; point with 1 finger
where you are hurting
Remember: reproducible is a GOOD thing

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4
Q

CHEST PAIN
Are any tests required for musculoskeletal
chest pain?

A

no tests unless hx of trauma

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5
Q

CHEST PAIN

What is the treatment for musc chest pain?

A

rest, NSAIDs, ice/heat

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6
Q

CHEST PAIN
What is the 2nd most common cause of
chest pain?

A

GI

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7
Q

CHEST PAIN
What risk factors accompany GI chest
pain?

A

Hx of ulcers, smoking, ETOH, NSAID
or ASA overuse
Always ask about OTC MEDS!

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8
Q

CHEST PAIN

How is GI chest pain described?

A

Recurrent episodes of SUBSTERNAL
BURNING pain; pain is WORSE WITH MEALS
or when lying supine

Pain is WORSE with palpation to
EPIGASTRIUM
If the patient has an esophageal spasm – they
may characterize the pain as “squeezing or
pressure”

PUD will complain of epigastric pain that may
radiate to their back

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9
Q

CHEST PAIN
What tests would you order for to rule
in/out GI chest pain?

A

▫ Urea breath test: H. pylori

▫ PUD: EGD to evaluate for ulcers

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10
Q

CHEST PAIN

What is the treatment for GI chest pain?

A

▫ Lifestyle modifications: Diet, elevate
HOB when sleeping
▫ PPIs: GERD or PUD
▫ Antibiotics: +H.pylori

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11
Q

CHEST PAIN
What is the 3rd most common cause of
chest pain?

A

Psych

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12
Q

CHEST PAIN
What are some risk factors for psych as
the cause of chest pain?

A

▫ Acute stress (home, workplace, school)
▫ Hx of panic disorder
▫ Hx of depression

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13
Q

CHEST PAIN
A patient presents with chest pain. Hx of
depression. What might this patient
describe their chest pain as?

A

heaviness that is either sudden or

gradual

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14
Q

CHEST PAIN
A patient presents with chest pain. Hx of
anxiety. What might this patient look like?

A

▫ Hyperventilating 🡪 numbness or tingling

to BILATERAL extremities

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15
Q 
CHEST PAIN
What 2 screening questions are
IMPORTANT when assessing a patient with
chest pain to help your differential in
psych being the cause?
A 
In the last 6 months, have you
experienced either of the following:
▫ Spell or attack of feeling anxious
▫ Felt like your heart was racing or felt
faint?
If patient responds with YES to EITHER
question, SUSPECT PSYCH and
investigate further.
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16
Q

CHEST PAIN
What risk factors place the patient at risk
for a respiratory cause of chest pain?

A 
▫ Recent immobility
▫ Recent pregnancy
▫ Pelvic or femur trauma (fracture, surgery)
▫ Hypercoagulability
▫ Estrogen use (HRT) or birth control
▫ Are they a smoker
▫ Hx or current cancer
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17
Q

CHEST PAIN
A patient was recently dx with pneumonia.
What chest pain symptoms might this
patient report?

A

dull ache (could have no pain at all)

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18
Q

CHEST PAIN
A patient presents to clinic with c/o pain
worse with inspiration, characterized as
stabbing to posterior LL lobe. Vitals reveal
tachycardia of 101hr. What do you
suspect? What should be included in your
assessment of this patient?

A

PE (pulmonary embolism). You
should perform a Wells score to determine
imaging.

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19
Q

CHEST PAIN
What Wells score indicates low risk? What
would be your next NP action?

A

<2 you would order a d-dimer
▫ Depending on patient complaint, may
order a lower extremity US to rule out
DVT

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20
Q

CHEST PAIN
What Wells score indicates high risk?
What would be your next NP action?

A

Answer: >6 you would order a CT scan and
LE US
▫ If a clot is found, begin anticoagulation.

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21
Q

CHEST PAIN
Patient presents to clinic with cough,
fever, and increased shortness of breath
with exertion. What do you suspect in this
patient? What would you order to rule in /
out?

A

▫ Order a 2-view CXR

▫ Treat with antibiotics

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22
Q 
CHEST PAIN
Woman presents to clinic for annual exam.
Constitutional: healthy, thin, cooperative.
CV: pansystolic murmur with mid-systolic
click. Spine: pectus excavatum. What
cardiac issue do you suspect in this
patient? How do you diagnose
definitively? What is treatment?
A 
Mitral Valve Prolapse
▫ Diagnose: Echo
▫ Treatment: None required UNLESS
symptomatic – this would be a
beta-blocker “olol”
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23
Q

CHEST PAIN
Patient presents to clinic with c/o abrupt onset
of stabbing / ripping chest pain that is radiating
to his back. Hx of smoker. Patient appears
anxious upon exam. What assessment
technique is important to perform? What do you
suspect? What is your treatment?

A 
BP in left and right arm
▫ Difference in BP >15mmHg = positive
assessment
▫ Diff Dx: Abdominal aortic aneurysm
▫ Diagnostics: Stat CT, prayer, surgery
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24
Q

CHEST PAIN
Patient presents to clinic with c/o substernal
chest pain, radiates to shoulders. Patient reports
increased pain when lying down. Vitals reveal
100.5oral temp, 92hr, 22rr. What information
would be IMPORTANT to obtain from this
patients hx? What do you suspect? What are
your orders? What is the treatment?

A

▫ HPI: Do you have history of recent viral
infection, SLE/RA? Cancer? Post-MI?
▫ Diff Dx: pericarditis
▫ Labs: ESR, CBC, cardiac enzymes
▫ Diagnostics: ECG, Echo
▫ Treatment: Bedrest, ASA/NSAIDs, possibly
steroids

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25
Q

CAD

What is #1 cause of CAD?

A

atherosclerotic disease

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26
Q

CAD

What are the risk factors for CAD?

A 
▫ Male
▫ >age
▫ FHx of CAD
▫ High LDL with low LDL
▫ High trig [esp. women]
▫ Hx of HTN, DM
▫ Smoker
▫ Inactivity
▫ Abdominal obesity
▫ Stress
▫ Diet low in fruits &
veggies
▫ Excessive ETOH use
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27
Q

CAD

What can REDUCE CAD risk?

A 
▫ Initiate statin
▫ Manage HTN properly (meds, lifestyle
modifications)
▫ Smoking cessation
▫ Weight loss
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28
Q

CAD

What is ROUAN decision Rule?

A

Aids in predicting which patients are

at higher risk of MI

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29
Q

CAD
What are the components of ROUAN
decision MI?

A

> 60y, diaphoresis, hx of MI/angina,
males, pain [pressure], radiates to
arm/shoulder/neck/jaw

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30
Q 
ANGINA
A 26yr old patients presents to ER c/o
sudden onset of chest pain, onset 1 hr
ago. What would aid in differentiating the
cause of this patient’s chest pain?
A

▫ Urine drug screen (possible cocaine use)
▫ ECG: ST elevation with attack but pain
subsides when not in pain (think
Prinzmetal)

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31
Q

Prinzmetal risk factors include?

A

women, <50yr [occurs in AM,

awaken pt from sleep]

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32
Q

ANGINA

What is the tx for Prinzmetal?

A

nitrate or CCBs; REFER TO

CARDIOLOGY

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33
Q

ANGINA
32y female presents to clinic with c/o chest
pain, intermittent. Associated symptoms
include generalized fatigue. Vitals: 92hr,
100% room air. Physical exam reveals pale
conjunctiva. Based on your findings, how
1 would you proceed?

A 
Suspect iron-deficiency anemia.
▫ Labs: CBC + iron studies
▫ Treatment: iron supplement
▫ Education: Increase daily fiber and water
intake
▫ Follow-up: 1 month to recheck labs.
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34
Q

ANGINA

What murmur can present with chest pain?

A

severe aortic stenosis or aortic

regurgitation

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35
Q

CHRONIC STABLE ANGINA
What is a KEY component to a patient with
hx of chronic stable angina?

A

Pain occurs during activity, and is

relieved by rest

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36
Q

CHRONIC STABLE ANGINA
What aggravating factors are associated
with chronic stable angina?

▫ A: standing up, greasy food
▫ B: sexual activity, exposure to heat
▫ C: angry outbursts, worse in AM
▫ D: lying down, exposure to heat

A

C: angry outbursts, worse in AM

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37
Q

CHRONIC STABLE ANGINA
What are the predominate locations noted
with chronic stable angina?

A

behind/left of midsternal, radiates to

left shoulder/arm, felt in neck, jaw, back

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38
Q

CHRONIC STABLE ANGINA
What is the first line treatment for chronic
stable angina?

A

Nitro SL

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39
Q

CHRONIC STABLE ANGINA
When assessing a patient in clinic with a
hx of MI, what is an expected finding on
the EKG?

A

Q wave

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40
Q

CHRONIC STABLE ANGINA
What is some important education
regarding the use of nitro SL that you
should provide your patient?

A

admin 1 tablet under the tongue (or
between the cheek and gum) at the first sign
of an angina attack.

1 tablet may be used every 5 minutes as needed, for up to 15 minutes.

Do not take more than 3 tablets in 15
minutes.

To prevent angina from exercise or
stress, use 1 tablet 5 to 10 minutes before the
activity.

Don’t take Viagra.

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41
Q

CHRONIC STABLE ANGINA
What is an expected finding you should
warn your patient of regarding the use of
nitroglycerin?

A

Headache is common
With Nitro patch, inform your patient they must
leave it off at least 8-10hr at night. Doing so
ensures it efficacy.

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42
Q

CHRONIC STABLE ANGINA
What is a prevention medication used in
patient with hx of MI? Who would this be
contraindicated in?

A

BB; prolong life post-MI [no labetalol,
pindolol]; do not give in asthma, DM, COPD,
bradycardia, decompensated HF

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43
Q 
CHRONIC STABLE ANGINA
What drug can be used monotherapy, has
no effect on BP/HR and is safe with erectile
dysfunction meds? Who can this NOT be
given to?
A

Ranolazine
▫ Long QT syndrome, if pt is taking
macrolides, fluoroquinolone, and if hx of
severe liver/kidney dx

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44
Q

CHRONIC STABLE ANGINA
What is the MAJOR sign indicating patient
is having an acute coronary event?

A

CP @ rest, minimal exertion,

radiates to jaw, left arm/shoulder, >30min

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45
Q

CHRONIC STABLE ANGINA
What is the natural progression of heart
electrophysiology seen on the EKG during
an acute coronary event?

A

Normal 🡪 hyperacute T wave 🡪 ST
elevation w/hyperacute T 🡪 Q wave, less ST,
T wave inverts 🡪 Q wave, t wave inversion 🡪
Q wave, upright T wave

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46
Q

CHRONIC STABLE ANGINA
What component on the EKG signals
correlates with ischemia?

A

T wave

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47
Q

CHRONIC STABLE ANGINA
What component on the EKG signals
correlates with injury?

A

ST wave

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48
Q

CHRONIC STABLE ANGINA
What component on the EKG signals
correlates with irreversible cell death?

A

Q wave

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49
Q

CHRONIC STABLE ANGINA
Following an acute MI, what drugs would
you expect your patient to leave the
hospital on?

A

aspirin + anticoagulant + nitro (prn),
BB, ACE-I (HTN), statin (high intensity);
Educate to stop smoking! No CCBs

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50
Q

HEART FAILURE

What is considered a normal EF?

A

55-70%

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51
Q

HEART FAILURE
HFpEF is an EF of _____%? This is
considered a _________ heart failure.

A

> 40%; diastolic

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52
Q

HEART FAILURE
HFrEF is an EF of _____%? This is
considered a _________ heart failure.

A

<40%; systolic

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53
Q

HEART FAILURE
What is a KEY lab marker used to detect
patients at risk of HF?

A

BNP

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54
Q

HEART FAILURE
According to the new guidelines, patients
who present with HFpEF should have a BP
goal of?

A

<130/80

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55
Q

HEART FAILURE
According to the new guidelines, patients
who present with HFrEF the preferred drug
of choice is?

A

ARNi

Entresto

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56
Q

HEART FAILURE
What are some of the common causes of
HF?

A

CAD, HTN, DM, ETOH, a-fib,
hyperthyroid, COPD, obesity, anemia, OSA,
older age

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57
Q

HEART FAILURE
A patient presents to your clinic with c/o
progressive fatigue. Upon physical exam
you note: GI: distended abdomen, with
palpable liver edge; CV: +s3 heart sound,
+BLE edema non-pitting. Pulm: mild
tachypnea, no crackles or rales. What do you
suspect in this patient? What would be
your NEXT action as the NP?

A

Right-sided HF; Order BNP, CXR

2-view, Echo.

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58
Q

HEART FAILURE
A patient presents to your clinic with c/o
worsening sob, especially with exertion.
Upon physical exam you note: Pulm:
bilateral crackles lower lung fields, mild
tachypnea; CV: +s1/s2 irregularly irregular
rate/rhythm. Vitals: 92HR, 98.7F oral, 26RR,
96% room air. What do you suspect in this
patient? What orders would be appropriate
to confirm your diagnosis?

A

Left-sided HF; Order BNP, CXR

2-view, Echo.

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59
Q

HEART FAILURE
In a patient with HFpEF >40% EF: what is
the mainstays of treatment?

A

tx CANNOT decrease mortality;

manage comorbid dx AND diuretics

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60
Q 
HEART FAILURE
Brand-new patient, taking no medications
currently. Patients hx is as follows: HF 55%
EF, essential HTN, pre-diabetes. Labs
today: A1C 8.7%, eGFR 57, Cr 1.0. K: 3.7,
Na 137. Random BG 190. 146/72 BP. 86 HR.
No allergies. What medications would be
1 appropriate to order?
A 
HTN: lisinopril 10mg PO once daily.
HF: HCTZ 12.5mg PO once daily. DM:
Metformin 500mg PO once daily. Encourage
exercise [3-4x/week, 40min sessions of
moderate activity]; Check lipid panel [HLD is a
co-existing risk factor for HF].
61
Q

HEART FAILURE
What patient with HF would it be
appropriate to treat with BB?

A

Control tachycardia [rate control in
A-fib], lower BP in patients with angina or
had a recent MI

62
Q 
HEART FAILURE
An AA 53y male with HF EF 53% presents
to clinic c/o cough while taking ACE-I for
their HTN. Hx of CKD stage 3a. What drug
would be MOST appropriate [effective] to
initiate in this situation?
A

CCB – amlodipine. Pt is AA with
CKD. Ok in diastolic HF, DO NOT GIVE IN
decompensated HF EF <40%.

63
Q

HEART FAILURE

What diuretic is potassium sparing?

A

Spironolactone; caution when using

this and what drug together? [ACE or ARB]

64
Q

A-FIB
A patient with a-fib has a CHA2DS2VASc
score of 1 – this signals to the NP to:

A

consider a blood thinner.
▫ Score of 2: ORDER BLOOD
THINNER.
▫ Score of 0: no blood thinner

65
Q

WARFARIN

Warfarin interactions include?

A

NSAIDS; herbal supplements;
medications

▫ Increase INR (longer it takes to clot, blood
is THINNER, risk for bleeding): phenytoin,
erythromycin, metronidazole, Bactrim,
amiodarone, cimetidine, ETOH, statins

▫ Decrease INR (blood clots more quickly,
blood is THICKER, risk for clots):
phenytoin, rifampin, carbamazepine,
phenobarbital, ginseng, ETOH

66
Q

HEART FAILURE
In a patient with HFpEF <40% EF: What is
the mainstays of treatment?

A

manage comorbid dx + lifestyle +

cardiac rehab + meds

67
Q

HEART FAILURE

What is the 1st line drug for HF <40% EF?

A

ACE-I w/diuretic

68
Q

HEART FAILURE
What drug decreases mortality in HF
patients?

A

BB

69
Q 
HEART FAILURE
Patient presents with HF 30%. Vitals: 101,
BP 130/72, 100% room air, 20 RR. Meds:
Metoprolol 400mg/day (200mg AM, 200mg
PM), Lisinopril 20mg PO once daily. With
the patient’s vitals in mind, what drug
could the patient be prescribed?
A

Ivabradine [Corlanor]

70
Q

HEART FAILURE
What drug is used in A-fib to control the
patient’s rate?

A

Digoxin

71
Q

HEART FAILURE
When deciding the appropriate diuretic for
a patient with an EF 32%, you would want
to know which lab?

A

eGFR; >40 = HCTZ; <40 = Lasix

72
Q 
HEART FAILURE
With respect to medications in
decompensated HF, which should be
avoided – SELECT ALL THAT APPLY:
▫ A: TZDs
▫ B: CCBs
▫ C: PD5E inhibitors
▫ D: NSAIDs / Cox-2 inhibitors 1
A

▫ A: TZDs
▫ B: CCBs
▫ C: PD5E inhibitors
▫ D: NSAIDs / Cox-2 inhibitors 1

A, B, C, D
Also, AVOID Na products – Na bicarb, fleets
enema, phosphorous = soda

73
Q

MURMURS
Which valves are OPEN during systolic
(s1)?

A

aortic / pulmonic

74
Q

MURMURS
What valves are OPEN during diastole
(s2)?

A

tricuspid / mitral

75
Q

MURMURS
A STENOTIC murmur is blowing or
low-pitched rumble?

A

low-pitched rumble

76
Q 
MURMURS
Female pt presents to your clinic for
wellness exam. You note upon exam:
low-pitched rumbling murmur w/opening
snap heard during S2. What murmur is
being auscultated?
A

Tricuspid stenosis – diastolic

murmur

77
Q 
MURMURS
Male pt presents to your clinic for wellness
exam. You note upon exam:
crescendo-decrescendo low-harsh pitched
rumbling murmur w/pulmonary ejection
click - heard during S1. What murmur is
1 being auscultated?
A

Pulmonic stenosis – systolic murmur

78
Q

MURMURS
A patient presents to clinic with hx of
mitral stenosis. Is this a diastolic or
systolic murmur?

A

Diastolic – opening snap; hx of
rheumatic fever; symptoms caused by
pregnancy, a-fib. Tx: mechanical valve when
symptomatic + warfarin

79
Q

MURMURS
A patient presents to clinic with hx of
aortic stenosis. Is this a diastolic or
systolic murmur?

A

Systolic – pt is OLD and SAD =
syncope, angina, dyspnea. Radiates to
carotids. Tx: replacement, clopidogrel +
aspirin; NO DOACs

80
Q

MURMURS
Holosystolic MUSICAL murmur often seen
in those with hx of IVDA?

A

Tricuspid Regurgitation

81
Q

MURMURS
Tricuspid Regurgitation - is this SYSTOLIC
or DIASTOLIC?

A

Systolic

82
Q

MURMURS
High-pitched decrescendo murmur, heard
best leaning forward, INCREASES with
INSPIRATION?

A

Pulmonic regurgitation

83
Q

MURMURS
Pulmonic regurgitation - is this SYSTOLIC
or DIASTOLIC?

A

Diastolic

84
Q

MURMURS
Pansystolic murmur with mid-systolic
clicks. It is blowing, high-pitched. Hx of
rheumatic fever. A-FIB IS COMMON.
Radiates to axilla. Name the murmur – is it
SYSTOLIC or DIASTOLIC?

A

Mitral Regurgitation; Systolic

85
Q

MURMURS
What lab is vital to observe with any
murmur that deals with the left side of the
heart?

A

BNP

86
Q

AUTOIMMUNE CONDITIONS
In ordering an autoimmune panel on a
patient, you know this includes what lab
orders?

A 
ANA, RA, ESR
Other important labs to consider when
working up a patient with suspected
autoimmune disorder include: B12, TSH,
CBC, CMP
87
Q 
AUTOIMMUNE CONDITIONS
Pt presents to clinic with INTENSE pain
localized to the 1st toe on left foot. Upon
physical exam you note the toe is red and
warm to touch. Pt displays no systemic
symptoms. Based on your findings, what
is your preliminary diagnosis of this
patient?
A

Gout

88
Q

AUTOIMMUNE CONDITIONS

Gout is most common in what patient?

A

Males, ETOH beer, use of diuretics,

aspirin, cyclosporine, niacin

89
Q

AUTOIMMUNE CONDITIONS

Is Gout an acute or insidious onset?

A

acute

90
Q

AUTOIMMUNE CONDITIONS
What is the other name for the Great toe
used in Gout?

A

podagra

91
Q

AUTOIMMUNE CONDITIONS
What other major system can be affected
by Gout?

A

kidneys

92
Q

AUTOIMMUNE CONDITIONS
What is the serum uric acid level for Gout
diagnosis?

A

> 6.8mg/dl

93
Q

AUTOIMMUNE CONDITIONS
To confirm Gout in a patient, what must
you obtain?

A

US

94
Q

AUTOIMMUNE CONDITIONS
What is the standard treatment for Gouty
attack?

A

Colchicine 1.2mg bolus dose, 0.6mg

1hr later

95
Q

AUTOIMMUNE CONDITIONS

What is the dose for Gout prophylaxis?

A

Colchicine 0.6mg BID; allopurinol is

also used

96
Q

AUTOIMMUNE CONDITIONS
How many episodes per year should signal
to the NP to initiate urate lowering meds?

A

2+ episodes per year 🡪 colchicine

97
Q

AUTOIMMUNE CONDITIONS
You are educating your patient on gout
prevention. What key interventions should
you include?

A

avoid ETOH, high-purine foods
[organ meat, yeast, seafood, beans, peas,
lentils, oatmeal, spinach, asparagus,
cauliflower, mushrooms, corn syrup drinks].
Ensure HIGH fluid intake. Avoid meds:
thiazide, loop diuretics, niacin.

98
Q

AUTOIMMUNE CONDITIONS
What is considered the goal serum uric
acid?

A

> 6.0mg/dL

99
Q

AUTOIMMUNE CONDITIONS
Gout increases the patients risk for what
other co-morbid diagnoses?

A

HTN, kidney dx, DM,

hypertriglycerides, atherosclerosis

100
Q

AUTOIMMUNE CONDITIONS
Pt presents to clinic with c/o gradual onset
fatigue and stiffness occurring in the AM
upon awakening. Pain is localized to left
hip. Pt displays no systemic symptoms.
Based on your findings, what is your
3 preliminary diagnosis of this patient?

A

Osteoarthritis

101
Q

AUTOIMMUNE CONDITIONS
Is Osteoarthritis inflammatory or
non-inflammatory?

A

non-inflammatory

102
Q

AUTOIMMUNE CONDITIONS
What is a KEY factor to include in
obtaining hx from patient suspected of
osteoarthritis?

A

pain relieved at rest, AM stiffness

<30m

103
Q

AUTOIMMUNE CONDITIONS
Osteoarthritis is more prevalent in women
or men?

A

Women

104
Q

AUTOIMMUNE CONDITIONS

Osteoarthritis – ESR elevated or normal?

A

Normal; synovial fluid

non-inflammatory

105
Q

AUTOIMMUNE CONDITIONS

What is the treatment for osteoarthritis?

A

weight loss; vitD management;

splinting hands; *TYLENOL 3g/24hr

106
Q

AUTOIMMUNE CONDITIONS
What is important to remember regarding
steroid injections?

A

*NO STEROID INJECTIONS IN

HANDS

107
Q

AUTOIMMUNE CONDITIONS
Pt with osteoarthritis has failed treatment
using Tylenol. What is your next best
intervention to relieve pain?

A

Triamcinolone [knee/hip] if no

response to OTC meds

108
Q

AUTOIMMUNE CONDITIONS
Pt presents to clinic with c/o pain to the
DIP joint. Upon exam, you note pitting of
the nails. Labs: elevated ESR with high
uric acid. Based on your findings, what is
your preliminary diagnosis of this patient?

A

Psoriatic arthritis

109
Q

AUTOIMMUNE CONDITIONS
In psoriatic arthritis, what lab is expected
to be absent from patients’ profile?

A

No RA or ANTI-CCP antibodies

110
Q

AUTOIMMUNE CONDITIONS
Pt presents to clinic with bilateral swelling
of wrists, elbows, knees that occurs upon
wakening and lasts until lunch time. This
pain will recur throughout the day
especially with activity. What is your
3 preliminary diagnosis of this patient?

A

RA

111
Q

AUTOIMMUNE CONDITIONS
What lab would you obtain to confirm a
patient’s diagnosis of RA?

A

1st – ANA/RA, if + then obtain

Anti-CCP antibodies

112
Q

AUTOIMMUNE CONDITIONS

RA – inflammatory or non-inflammatory?

A

inflammatory

113
Q

AUTOIMMUNE CONDITIONS

What is the treatment for RA?

A

Methotrexate 7.5mg/PO per week.

114
Q

AUTOIMMUNE CONDITIONS
What should you obtain prior to initiating
Methotrexate in RA?

A

Baseline labs – CMP and CBC

115
Q

AUTOIMMUNE CONDITIONS
What is important to watch for with
Methotrexate?

A

GI irritation, pancytopenia

116
Q

AUTOIMMUNE CONDITIONS
What drugs should be AVOIDED when
using Methotrexate?

A

Bactrim, amox, probenecid; AVOID

in liver/renal failure

117
Q

AUTOIMMUNE CONDITIONS
What MUST be administered with
Methotrexate?

A

1mg Folic acid daily

118
Q

AUTOIMMUNE CONDITIONS
What is an important component to
managing RA properly?

A

Early referral to Rheumatology

119
Q

AUTOIMMUNE CONDITIONS
Pt presents with acute onset of swelling,
redness, warmth to left elbow. Labs: wbc
>20,000. Upon physical exam, you note
multiple scars with bruising in various
stages of healing noted to arms. What is
3 your preliminary diagnosis of this patient?

A

Acute bacterial septic arthritis r/t IV
drug use – admit to hospital with stat ortho
referral

120
Q

AUTOIMMUNE CONDITIONS
Women, malar rash, + ANA, joint pain. 99.9
temp, c/o malaise. What do preliminary
diagnosis is suspected in this patient?

A

SLE

121
Q

AUTOIMMUNE CONDITIONS

What is the treatment for SLE?

A

Plaquenil

122
Q

AUTOIMMUNE CONDITIONS
With Plaquenil – what should you watch
for?

A

Retinal damage, prior to initiating

you must obtain optho referral

123
Q 
AUTOIMMUNE CONDITIONS
Woman presents to clinic with c/o new
onset dyspnea and left knee pain. G3P1.
Labs: prolonged PTT. What do you suspect
in this patient? What should be your next
action?
A

Anti-phospholipid syndrome; Refer

to ED for DVT / PE work-up

124
Q

AUTOIMMUNE CONDITIONS
Treatment for anti-phospholipid
syndrome?

A

Warfarin, INR 2-3 for life. If

pregnant, Hep subQ + low dose aspirin

125
Q

AUTOIMMUNE CONDITIONS
What lab is + in Anti-Phospholipid
syndrome?

A

Russell viper venom

126
Q

AUTOIMMUNE CONDITIONS
When performing an arthrocentesis – what
is IMPORTANT to remember about this
procedure?

A

*NEVER pass needle through

overlying cellulitis or psoriatic plaque

127
Q

AUTOIMMUNE CONDITIONS

Non-inflammatory SF is expected to be?

A

transparent

128
Q

AUTOIMMUNE CONDITIONS

Mild inflammatory SF is expected to be?

A

translucent

129
Q

AUTOIMMUNE CONDITIONS

Purulent SF is expected to be?

A

opaque

130
Q

AUTOIMMUNE CONDITIONS

Bleeding r/t trauma – SF is expected to be?

A

bloody

131
Q

AUTOIMMUNE CONDITIONS
Cell count in non-inflammatory SF is
expected to be?

A

<2000

132
Q

AUTOIMMUNE CONDITIONS
Cell count in inflammatory SF is expected
to be?

A

2000-7500

133
Q

AUTOIMMUNE CONDITIONS
Cell count in purulent SF is expected to
be?

A

> 100,000

134
Q

AUTOIMMUNE CONDITIONS
Women presents to clinic with c/o bilateral
fingertip blueness especially when its cold
outside. What preliminary diagnosis is
suspected in this patient?

A

Raynaud syndrome [pallor, cyanosis,

rubor – relieved by warmth]

135
Q

AUTOIMMUNE CONDITIONS
What education should be provided to a
patient with dx of Raynaud’s?

A

wear gloves, warm shirts/coats.
STOP SMOKING. No sympathomimetic drugs
[decongestants, diet pills, amphetamines – no
cocaine].

136
Q

Treatment for Raynaud’s if medication is

necessary?

A

CCBs; referral to Rheumatology

137
Q

AUTOIMMUNE CONDITIONS
Skin thickening, +ANA, +anti-SCL 70,
prevalent in women – what dx is
suspected?

A

Scleroderma

138
Q

AUTOIMMUNE CONDITIONS
Treatment for scleroderma is based on
systems affected.

A
  • CCBs: Raynaud’s
  • PPIs: Esophageal disease
  • Methotrexate: skin
  • Sildenafil: Pulm HTN
  • # 1 Mortality cause: pulm fibrosis/HTN
  • CKD + HF: common cause of death
  • Admit+ACE-I: HTN
139
Q

AUTOIMMUNE CONDITIONS
Pt presents to clinic c/o bilateral weakness
in legs. Electromyographic studies:
muscle abnormality. Labs: 5300 CK, +ANA.
What is your preliminary dx of this patient?
What do you need to confirm?

A

Idiopathic inflammatory myopathy –

polymyositis; Confirm with muscle biopsy

140
Q

AUTOIMMUNE CONDITIONS

What is the treatment for polymyositis?

A

Prednisone 40-60mg taper 3

141
Q 
AUTOIMMUNE CONDITIONS
Pt presents to clinic with heliotrope
violaceous rash with mechanic hands.
Labs: +anti-Jo1, ESR/CRP normal. What is
your preliminary dx of this patient?
A

Dermatomyositis

142
Q

AUTOIMMUNE CONDITIONS
In dermatomyositis, you must be aware of
what complication?

A

malignancy

143
Q

AUTOIMMUNE CONDITIONS
Pt presents to clinic with c/o xerostomia
and feeling like there’s “grains of sand in
eyes”. What finding(s) would add to your
differential in diagnosing this patient with
Sjogren syndrome?

A

+RA factor, + ANA, +SS-A / SS-B;
enlarged parotids; several dental caries @
gum line.

144
Q

AUTOIMMUNE CONDITIONS
What is the treatment for Sjogren
syndrome?

A

Artificial tears (dry eyes);
Pilocarpine, frequent sips of water, sugar free
gum/hard candies, proper oral hygiene (dry
mouth).

145
Q

AUTOIMMUNE CONDITIONS
What should a patient AVOID if dx with
Sjogren syndrome?

A

atropine drugs / decongestants

146
Q

AUTOIMMUNE CONDITIONS
What is a COMPLICATION of Sjogren
syndrome?

A

Risk for lymphoma

147
Q 
AUTOIMMUNE CONDITIONS
36y Caucasian male presents to ER for
chest pain noted to left chest radiating
down left arm. Labs: 1.76 trop, BNP 56,
BUN 32, Cr 0.9, Na 147, K 4.2, CK 9600, UA
amber-colored, SG 1.071. What do you
suspect in this patient?
A 
Possible acute MI (need EKG),
Rhabdomyolysis (high CK), due to age –
possible cocaine use, Elevated BUN/Normal
Cr, amber-colored urine, elevated SG
(dehydration).
148
Q

AUTOIMMUNE CONDITIONS
What is the standard tx for
Rhabdomyolysis?

A

IV fluids

CMN 574 Final Review (1 decks)

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