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ICM Exam 2 Rheumatology (MC) > ICM - Rheum 2 > Flashcards

ICM - Rheum 2 Flashcards

1
Q

factors that determine peak bone mass

A

genetics, nutrition (calcium/VitD), endocrine status (early menopause, decreased gonadal activity), physical activity/health during growth

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2
Q

these are associated with increased bone loss

A

aging, hypogonadism/menopause, high bone turnover

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3
Q

pathology of osteoporosis (in cancellous bone)

A

thinning of trabeculae, loss of trabecular plates (architecturally weakened)

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4
Q

lifestyle risk factors for osteoporosis

A

alcohol, smoking, inadequate diet (low Ca/VitD, excess VitA, salt), inadequate physical activity

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5
Q

this kind of diet will increase risk of osteoporosis

A

low Ca/VitD, excess vitA/salt

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6
Q

rheumatologic disease risk factors for osteoporosis

A

RA, SLE, ankylosing spondylitits

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7
Q

endocrine risk factors for osteoporosis

A

adrenal insufficient, Cushing’s syndrome (corticosteroid excess), excess thyroid, diabetes, hyperparathyroid, central adiposity

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8
Q

hypogonadal risk factors for osteoporosis

A

menopause, androgen insensitivity, hyperprolactinemia, anorexia nervosa, Turners (XO), Klinefelters (XXY), panhypopituitarism

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9
Q

areas of predilection for fracture in osteoporosis

A

hip, wrist, vertebral spine

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10
Q

asymptomatic fractures of dorsal spine can lead to this

A

kyphosis

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11
Q

main screen and diagnostic study for osteoporosis; what does this measure?

A

DEXA (dual xray absorbiometry); bone density

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12
Q

BMD T score >-1 (bone one standard deviation below young adult mean)

A

normal

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13
Q

-1

A

osteopenia

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14
Q

BMD T score > -2.5 standard deviation below young adult mean

A

osteoporosis

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15
Q

women above this age, and men above this age, should be tested for osteoporosis

A

65, 70

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16
Q

impaired mineralization of bony matrix

A

osteomalacia

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17
Q

osteomalacia conditions that are DDX for osteoporosis

A

VitD deficiency/dysfunction, phosphate deficiency, acidosis, hypophospatasia, mineralization inhibition

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18
Q

cornerstone for pharmaceutical therapy of osteoporosis –> decrease hip/spine fracture by 50%

A

bisophosphonates (Fosamax, Boniva, Actonel/Atelvia, Reclast)

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19
Q

what do bisophosphonates inhibit?

A

osteoclast function (some osteoblast)

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20
Q

possible adverse effects of bisophosphonates

A

irritate esophagus/stomach, renal insufficiency

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21
Q

possible late side effects of bisophosphonates

A

osteonecrosis of jaw, atypical femur fractures (not at neck)

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22
Q

pharmaceutical therapy for osteoporosis….reduces vertebral fracture 30% (intranasally or w/ subcu injection), decrease pain vertebral fracture, could have allergic reaction (if allergic to salmon)

A

calcitonin

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23
Q

exercise recommended in osteoporosis

A

weight-bearing and muscle strengthening

24
Q

women >51 and men>71 should get this much calcium per day

A

1200 mg/day

25
Q

recommended daily calcium for men 50-70 yo

A

1000 mg/day

26
Q

recommended VitD daily allowance for adults >50

A

800-1000u VitD/day

27
Q

% of patients that regain full prefracture functioning

A

40%

28
Q

possibly complications of vertebral fractures

A

loss of height, restrictive lung disease, constipation, abdominal pain, bloating, early satiety

29
Q

these are responsible for cell mediated immune resopnse in RA

A

CD4 in synovial membrane

30
Q

white patients with RA express this MHC haplotype more than non RA patients (nonwhite RA patients also seem to share amino acid sequences with this MHC)

A

HLA DR4

31
Q

pathology of RA

A

hypertrophied/hyperplasia synovial membrane, angiogenesis, CD4 and B cell infiltrate, synovial membrane invades cartilage

32
Q

this forms as synovial membrane transformed to inflammatory tissue –> tissue invades/destroys cartilage and bone

A

pannus

33
Q

these make up pannus in RA

A

type A/MP like and type B/FB like synoviocytes, plasma cells

34
Q

history of RA

A

gradual/palindromic onset swelling/pain, symmetric distribution (usually small joints, but some larger), constitutional symptoms

35
Q

peak onset age of Ra

A

30-55 (3:1 women)

36
Q

corticosteroids as treatment for RA can cause these ocular problems

A

glaucoma and cataracts

37
Q

hydroxychloroquin as treatment for RA can cause this ocular problem

A

retinal pigment epithelial toxicity

38
Q

acute phase proteins measured in RA

A

ESR, CRP, HgB

39
Q

antibodies are directed at this in rheumatoid factor

A

fc portion IgG

40
Q

if patient has inflammatory polyarthritis AND positive rheumatoid factor, more predictive of these future conditions

A

erosions and subcu nodules

41
Q

seronegative spondyloarhtropathies that are DDX for RA

A

psoriatic arthritis, Reiter’s syndrome, enteropathic arthritis (Chrons, Sprue), reactive arthritis

42
Q

acute onset of pain in shoulders and hips in patients >50 yo…ESR very high…*responsive to corticosteroids* (DDX for RA)

A

polymyalgia rheumatica

43
Q

infectious causes of inflammatory polyarthritis –> DDX for RA

A

parvovirus B19, rubella, Hep B, gonoccal arhtritis, polyarticular septic arthritis

44
Q

gold inhibits these enzymes (DMARD)

A

acid phosphatase, collagenase, PKC, phospholipase C

45
Q

possible side effects of gold therapy for RA

A

myelosuppresion, oral ulcers, rash proteinuria

46
Q

DMARDS that affect purine NT synthesis

A

methotrexate and azathiprine

47
Q

this DMARD affects pyrimidine NT synthesis

A

leflunomide (Arava)

48
Q

side effects for methotrexate

A

oral ulcers, pneumonitis, hepatic toxicity, myelosuppression

49
Q

side effect for azathioprine

A

myelosuppression

50
Q

side effects for leflunomide

A

myelosuppression, hepatic toxicity, hair loss, diarrhea, weight loss

51
Q

this DMARD causes fusion of TNF receptor and Fc portion IgG (TNFa antagonist)

A

etanercept (Enbrel)

52
Q

this DMARD is recombinant fully human IgG Ab to TNF (TNFa antagonist)

A

adalimumab (Humira)

53
Q

this DMARD TNFa antagonist is binding region of mouse Ab to TNF fused to Fc portion of human Ig

A

infliximab (Remicade)

54
Q

possible future targets for RA treatment

A

MP, IL 4/10

55
Q

triple drug therapy that is considered more effective in treatment of RA with no increase in toxicity

A

methotrexate, sulfasalazine, hydroxychloroquin

56
Q

these are indicated for early control of pain and inflammation in RA

A

NSAIDs and corticosteroids

ICM Exam 2 Rheumatology (MC) (5 decks)

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