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CMN574 > Module 3 Endocrine > Flashcards

Module 3 Endocrine Flashcards

1
Q

Heberden’s Node
-location
-RA or OA?

A

-DIP
-OA

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2
Q

Bouchard’s node
-location
-RA or OA?

A

-PIP
-OA

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3
Q

Differential diagnoses
-if inflammation is present
-if inflammation if absent

A

-RA, systemic lupus, erythematosus, GOUT
-GOUT

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4
Q

Differential diagnosis
-Monoarticular
-Oligoarticular
-Polyarticular

A

-gout, trauma, septic arthritis, Lyme disease, osteoarthritis
-reactive arthritis, psoriatic arthritis
-RA, SLE

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5
Q

Differential diagnosis
-site of joint involvement
*DIP
*Metacarpophalangeal, wrists
*first metatarsal phalangeal

A

-OA, psoriatic arthritis
-RA, SLE
-Gout, OA

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6
Q

OA
-what population is this most common in?
-cause
-onset acute or insidious?
-elevated labs?
-dx

A

-women
-degeneration of cartilage and hypertrophy of bone
-insidious
-no
-radiology reveals narrowing of joint space and osteophyte formation

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7
Q

OA
-prevention
-treatment

A

-weight reduction (#1 intervention) and maintaining normal vit D levels
-treat sx: splinting hands, weight loss, regular exercise, acetaminophen is first line tx for mild osteoarthritis, NSAIDS, injections/surgery

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8
Q

When to use Tylenol or NSAIDs for OA treatment

A

-Tylenol for normal OA
-NSAIDS for severe OA

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9
Q

If using NSAIDS for OA treatment, what should you be thinking about?

A

GI issues: gastric ulcer, perforation, GI hemorrhage = most common complications of NSAID use

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10
Q

If using NSAIDS, what should also be used in conjunction?

A

PPI

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11
Q

When should you be cautious in using NSAIDS for OA therapy?

A

over age 70
on anticoagulant therapy
taking corticosteroids
h/o peptic ulcer disease
alcoholism

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12
Q

OA
-intra-articular injections and surgery

A

-triamcinolone 20-40mg to knee or hip (given up to 4x a year)
-injections not recommended for hand OA
-total hip and knee replacements as tx for pt with ambulation restrictions d/t pain from OA

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13
Q

Gouty arthritis
-idiopathic or hereditary?
-insidious or acute onset?
-monoarticular or polyarticular joint involvement?
-what lab level is elevated?

A

-hereditary
-acute
-monoarticular
-hyperuricemia (serum uric acid level > 6.8)

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14
Q

Acute gout
-when uric acid is above ______, uric nephrolithiasis is common
-what is a common area of acute gout?
-is WBC elevated during attack?
-common comorbidities of these patients
-what time of year is occurrence most common?

A

->13mg/dL
-PODAGRA (MTP joint of great toe)
-yes, WBC elevated
-HTN, DM, CKD, hypertriglyceridemia and atherosclerosis
-summer months

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15
Q

Gouty arthritis
-TX

A

-NSAIDS
-Colchicine
-Corticosteroids
-urate-lowering therapy

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16
Q

Gouty arthritis: TX
-oral NSAID options

A

-Naprosyn 500mg BID
-Indomethacin 25-50mg every 8 hours

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17
Q

Gouty arthritis: TX
-Colchicine

A

-loading dose 1.2mg followed by 0.6mg one hour later; 0.6mg BID for prophylaxis
**treatment for flair, not maintenance

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18
Q

Gouty arthritis: TX
-xanthine oxidase inhibitors

A

-allopurinol
*cautious in CKD patients; causes rash in 20% of pts taking drug with ampicillin
*DRESS syndrome possible SE –> looks like SJS
-febuxostat

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19
Q

Gouty arthritis: TX
-corticosteroids

A

-prednisone 30-40mg QD for 2-5 days, then taper off
-avoid excessive alcohol, esp beer, high purine foods, high fructose corn syrup, thiazide or loop diuretics, niacin

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20
Q

In what circumstance is urate-lowering therapy initiated?

A

When patient has 2 or more gout attacks a year

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21
Q

what is the goal of urate-lowering therapy?

A

maintain the serum uric acid at or lower than 6mg/dL

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22
Q

RA: most common cause of mortality

A

cardiovascular disease

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23
Q

RA
-def
-acute or insidious onset?
-how long is morning stiffness?

A

-chronic systemic inflammatory disease
-insidious
-morning stiffness >30 min

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24
Q

RA
-S/S

A

-Multiple joints are involved with swelling, tenderness, and pain
-20% of RA patients have subcutaneous nodules which are usually seen over bony prominences

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25
Q

RA
-other comorbidities associated

A

-interstitial lung disease, small vessel vasculitis, nodules in lungs/sclera/other tissue

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26
Q

RA: clinical findings
-what test is the most specific blood test for RA?

A

-anti-CCP antibodies

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27
Q

RA: clinical findings
-dx labwork

A

-RA
-anti-CCP (confirms diagnosis)

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28
Q

RA
-what labs are typically elevated?

A

-ESR, CRP, platelets

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29
Q

RA
-TX

A

-DMARDS (disease-modifying anti-rheumatic drugs)
-biologic agents/drugs
-NSAIDS

30
Q

RA
-common DMARDS

A

-Methotrexate –> drug of choice; produces a positive effect in 2-6 weeks (take with FA)
-sulfasalazine (need ophthalmology eval prior to initiating therapy)
-hydroxychloroquine (Plaquenil)
-Leflunomide (Arava) (screen for hepatitis prior to initiating tx)
-Cyclosporine

31
Q

RA: Biologic agent/drugs
-def
-examples
-used with DMARDS?

A

-created or produced from living organisms or at least contain some part of living organism (wide variety of products made from human, animal, or microorganisms via biotechnology)
*include vaccines, blood, blood components, cells, allergens, genes, tissues, and recombinant proteins
-enbrel, humira, orencia, remicade, xeljanz, cosentyx, stelara
-YES

32
Q

Systemic lupus erythematosus (SLE):
-men or women are more commonly diagnosed?
-what classic symptom appears in 50% of pts?
-what lab will be positive along with _________?

A

-women
-butterfly molar rash
-ANA will be positive along with anemia

33
Q

Systemic lupus erythematosus (SLE):
-sx
-how many criteria need to be met to diagnose SLE?
-What can drug-induced lupus be caused by?

A

-fever, malaise, anorexia, weight loss, and positive ANA (antinuclear antibodies)
-4 of 11
-minocycline, hydralazine, isoniazid (most common)

34
Q

Systemic lupus erythematosus (SLE):
-TX

A

-tailor drug therapy to each patient due to fluctuation of disease
-antimalarials (hydroxychloroquine) may help with joint discomfort and rashes
-corticosteroids can be used for sx relief but always taper down and use the lowest dose that gives relief

35
Q

Antiphospholipid syndrome
-def
-clinical findings
-Russel viper venom

A

-hypercoagulability with recurrent arterial and/or venous thrombus
-recurrent fetal loss after first trimester; patients with DVT and/or PE (without dx of CA); embolic CVA
-test on blood that would be positive to indicate anti-phospholipid syndrome

36
Q

Things to avoid with gout risk

A

-alcohol
-high purine foods (organ meat, yeast (beer), seafood; beans/peas/lentils/oatmeal/spinach/asparagus/cauliflower/mushrooms
-corn syrup drinks
-avoid loop/thiazide diuretics or niacin

37
Q

what is the goal serum uric acid level for those at risk for gout?

A

<6.0mg/dL

38
Q

Antiphospholipid syndrome:
-what tx is used?
-goal level of important lab?

A

-lifetime anticoagulant like warfarin
-goal INR 2-3

39
Q

what is a clue that lupus anticoagulant is present?

A

prolonged PTT (partial thromboplastin time

40
Q

how is antiphospholipid syndrome dx?

A

IgG and IgM anticardiolipin, antibodies beta-2 glycoprotein, and lupus anticoagulant

41
Q

Raynaud phenomenon
-def
-men or women?
-TX
-referral?

A

-distal ischemia of the fingers due to vasoconstriction of the arterioles in response to cold or stress; can also affect toes, nose and ears
-women
-wearing mitts, keeping body warm, smoking cessation, avoiding sympathomimetic drugs; responds to CCB and vasodilators (amlodipine); surgically: cervical sympathectomy
-rheumatology referral b/c Raynaud’s syndrome can be early indication of Sjogren’s syndrome

42
Q

what other disease commonly coincides with antiphospholipid syndrome?

A

SLE

43
Q

What surgical procedure can be done for severe and frequent attacks of Raynaud syndrome?

A

cervical sympathectomy

44
Q

Scleroderma
-def
-CREST

A

-diffuse fibrosis of the skin and internal organs
-limited form of scleroderma (80%) have CREST (calcinosis cutis, Raynaud phenomenon, esophageal motility disorder, sclerodactyly, and telangiectasia)
*hardening of skin is limited to face and hands
*diffuse scleroderma (20%) involves hardening of skin to face and hands along with trunk and proximal extremities

45
Q

Scleroderma
-sx

A

-diffuse scleroderma: polyarthralgia, weight loss, malaise

46
Q

Scleroderma
-clinical findings

A

-ulcerations around finger tips (Raynauds)
-hypomobility of GI tract due to fibrosis
-diffuse pulmonary fibrosis which causes poor diffusing ability
-HTN and renal crisis due to proliferation of the small renal arteries along with proteinuria
-anemia due to trauma to the RBC from diseased small vessels

47
Q

Scleroderma
-TX

A

No effective drug to slow progression of disease; treat sx of underlying organ involvement
-lung involvement: pulmonary fibrosis and pulmonary HTN is the #1cause of mortality
-CKD and heart failure are also common causes of death

48
Q

1 cause of mortality in scleroderma

A

pulmonary fibrosis/HTN; death

49
Q

Idiopathic inflammatory myopathies: polymyositis
-def
-what occurs in late disease process?
-what lab is elevated?
-what to watch for…

A

-progressive proximal muscle weakness over weeks to months; no facial or ocular weakness; dysphagia
-muscle atrophy and contractures
-elevated CK-MB
-watch for respiratory muscle weakness, CO2 retention or hypercapnia and need for mechanical ventilation

50
Q

Idiopathic inflammatory myopathies: Dermatomyositis
-sx
-what labs are elevated?
-what can this dx be mistaken for?
-classic sign

A

-dusky red rash in malar region and my mimic SLE rash, but usually extends beyond malar area
*shawl sign - rash extends to back
*purplish stain over the eyelids called heliotrope
-liver enzymes elevated (ALT, AST)
-Hepatitis dx
-mechanic’s hands –> hyperkeratosis to radial and palmar aspects of hands

51
Q

Idiopathic inflammatory myopathies:
-sx
-what lab will be high
-will ANA be positive?
-DX
-TX

A

-bilateral proximal muscle weakness, causing involuntary movements
-CK will be extremely high with a + ANA
-ANA will be positive
-Muscle biopsy
-corticosteroids (prednisone) and methotrexate

52
Q

Sjogren syndrome
-what type of disease process?
-SX
-what determines type of Sjogren’s patient has?

A

-autoimmune
-dry eyes and mouth
-+SS-A or SS-B; will also be +RA factor and +ANA

53
Q

Sjogren syndrome
-women or men?
-keratoconjunctivitis sicca
-Xerostomia
-dental
-parotid

A

-women
-grain of sand in eye sensation
-difficulty swallowing/speaking
-rampant dental caries at gum line
-parotid enlargement

54
Q

Sjogren syndrome
-DX
-TX

A

-diag occular test (lip biopsy) will reveal lymphoid foci in accessory salivary glands
*ANA, then confirm with DS antiDNA test
-satirical tears, mouth lubricants, good oral hygiene; keep it wet/moist

55
Q

Rhabdomyolysis
-def
-cause
-what is this associated with?

A

-acute necrosis of skeletal muscle
-acute tubular necrosis is result caused from increased myoglobin in the hypovolemic state (patient is dry; myoglobin higher = ATNF)
-immobility, crush injuries, hypothermia exposure, use of statins in patient with compromised liver or kidney fx

56
Q

Rhabdomyolysis
-TX

A

Aggressive IVF resuscitation

57
Q

Vasculitis
-def
-involves what structures of the body?
-what is present in lab work?

A

-inflammation within walls of affected blood vessels
-involves arteries, veins, or both
-Anti-neutrophil cytoplastic antibodies present on lab work

58
Q

Giant Cell (temporal artery) arteritis)
-common in what age?
-SX
-elevated labs
-Urgent?

A

->50yrs
-HA, malaise, vision changes
-Elevated ESR (usually >100)
-YES, urgent!! –> can cause blindness

59
Q

Giant Cell (temporal artery) arteritis
-TX

A

high dose steroids
-ESR returns to normal after about a month of steroids
-poss ICU admission until cleared of organ involvement

60
Q

What can giant cell arteritis lead to?

A

aneurysms

61
Q

Polymyalgia Rheumatica (PMR)
-SX
-ESR lab value elevated?
-what else is often present along with this disease?
-TX

A

-many pains - wide-spread aching, flu-like sx
-ESR elevated
-Anemia often present
-oral prednisone (treat 6-12 months)
*go as low as you can go to manage sx

62
Q

Psoriatic arthritis
-what does psoriatic arthritis precede?
-what does this disease resemble?
-elevated ESR? elevated RA?
-what has a severe deformity in this disease process?

A

-arthritis
-RA
-elevated ESR, not elevated RA factor
-severe deformity in DIP joints

63
Q

Psoriatic arthritis
-TX

A

NSAIDS
-add methotrexate if not effective enough
-DMARDS can be used in moderate to severe cases

64
Q

Septic arthritis
-acute or chronic?
-monoarticular or polyarticular?
-sx
-synovial fluid

A

-acute
-monoarticular
-swelling and pain often in weight bearing joints
-WBC is elevated in synovial fluid

65
Q

Septic arthritis
-associated with?
-common organism responsible?
-DX
-TX

A

-infection: bacteremia, immunosuppressed and loss of skin integrity
-staphylococcus aureus 50%
-CT/MRI determines if bony erosion is present
-abx appropriate for treating bacteria involved

66
Q

Acute pyogenic osteomyelitis
-def
-DX
-elevated labs
-TX

A

-serious infection that is caused from bacteria invading bone; if untreated, can affect adjacent bone
-CT/MRI will reveal extension of bone involvement
-elevated ESR
-debridement of necrotic bone and extended abx therapy (IV first, then oral)

67
Q

Fibromyalgia
-men or women? (age)
-def
-elevated labs?
-trigger points

A

-women (20-50)
-generalized chronic aching pain and stiffness, fatigue, numbness, IBS, and sleep disorders
-none
-trigger points of tenderness upon palpation; traps, medial fat pad (knee, lateral epicondyle, elbow)

68
Q

Fibromyalgia
-TX

A

-meditation, exercise, amitriptyline (hard to get off amitriptyline)
-no opioids or NSAIDS

69
Q

Fibromyalgia
-what medication should not be given to manage pain?

A

Opioids or NSAIDS

70
Q

Osteonecrosis
-what is the most common site?
-TX

A

-proximal and distal femur heads; leads to hip or knee pain
-vascularized and non-vascularized bone grafting procedures; total hip replacement if usually needed

CMN574 (6 decks)

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