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Comps - Mod 3 > NP 614 Test 4 - Sheet1 > Flashcards

NP 614 Test 4 - Sheet1 Flashcards

1
Q

Benigh prostatic hyperplasia

A

A nonmalignant adenomatous overgrowth of the periurethral prostate gland.

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2
Q

Prevalence of benign prostatic hyperplasia (BPH)

A

Men aged 55-74 without prostate cancer (19%)

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3
Q

Urinary flow criteria for BPH

A

Voiding a max flow rate of 50 ml

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4
Q

International Prostate Symptom Score (IPSS)

A

A survey developed by the American Urological Association to determine how bothersome BPH symptoms are and to check the effectiveness of treatment. Scores >10 are abnormal.

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5
Q

Digital rectal exam

A

An integral part of the evaluation of a man with urinary complaints and is not necessarily recommended as a screening test in asymptomatic men <40

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6
Q

Prostate characteristics in BPH

A

Usually symmetrically enlarged

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7
Q

How to palpate nodules or induration (hardness) of the prostate that may indicate cancer

A

Press firmly into the substance of the prostate

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8
Q

Assessment of post-void residual

A

Transabdominal ultrasound has replaced cath assessment

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9
Q

Visualization of prostate

A

Can not be visualized transabdominally via ultrasound. Must be completed via transrectal sonography.

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10
Q

Tests to detect urinary obstruction

A

Cystoscopy may be helpful, but has been replaced by urodynamic studies

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11
Q

Herb saw palmetto

A

Herb used to self-treat BPH. Lowers PSA numbers (as does Proscar) and may mask early detection of prostate cancer.

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12
Q

Concern with herb saw palmetto

A

May be being used by high-risk men and is self-prescribed. May not share this info with their provider who is interpreting their PSA.

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13
Q

Classifications of inflammatory or irritative conditions of the prostate

A

Acute prostatitis. Chronic bacterial prostatitis. Chronic prostatitis/pelvic pain syndrome, inflammatory. Chronic prostatitis/pelvic pain, noninflammatory. Asymptomatic inflammatory prostatitis

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14
Q

Chronic prostatitis

A

Can occur as a result of acute prostatitis or without any recognized initial infection and is more subtal than the acute form

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15
Q

Most common cause of UTI in men

A

Gram-negative rods with E. coli causing 75-80% of cases

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16
Q

Presentation of chronic prostatitis

A

Complaints of lower UTI and a low-grade fever. Sexual dysfunction may be present. Rectal exam - tenderness, hypertrophy and edema of prostate, though it is often normal.

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17
Q

Diagnosis of chronic prostatitis

A

Analyzing specimens obtained following prostatic massage for leukocytes adn bacteria. Called the so-called four-glass test.

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18
Q

So-called four-glass test

A

Massage of the prostate allows for analyzing of specimens. Not often used and does not support determination of pts that require antibiotics.

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19
Q

Treatment of chronic prostatitis

A

4-week course of fluoroquinolone (cipro 500 every 12 hr or levofloxacin 500 daily)

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20
Q

Relapse of chronic prostatitis

A

Common and should be treated with a second course of antibiotics. May use cipro again. Bactrim is an alternative.

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21
Q

Prostate massage and acute prostatitis

A

Be cafeful because no sense in massaging bacteria into the system. Let it go and just treat.

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22
Q

Tenative diagnosis of 25 yo male reports dysuria, frequency and lower abd pain x 1 day, temp of 100.4. Tender, boddy prostate on exam

A

Acute bacterial prostatitis

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23
Q

PSA result that is consistent with prostate cancer

A

A doubling of PSA value in serial annual tests

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24
Q

Pt is taking finasteride (Proscar) and asks if he can take terazosin (Hytrin). You would advise…

A

The the patient that those medications are absolutely contraindicated together

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25
Q

What medical condition increases the risk of ED, which affects 18-30 million men in the U.S.

A

Type II diabetes

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26
Q

Which medications can cause erectile dysfunction?

A

Antihypertensive, antipsychotic, and anticholinergic

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27
Q

Can a patient who is taking isosorbide mononitrate tale sildenafil (Viagra)?

A

No. Viagra is contraindicated with isisorbide mononitrate; let’s discuss other option

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28
Q

The most common cause of end-stage renal disease in the U.S.

A

Diabetic nephropathy

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29
Q

What is a normal GFR

A

120-130 ml/min

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30
Q

Colitis and Chron’s are diagnosed by

A

Intestinal biospy

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31
Q

The results of nightly mescalamine enemas and 5-ASA tabs daily for a patient with ulcerative colitis

A

Reduce flares, decrease chance of colorectal cancer, decrease relapses, induce and maintain remission

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32
Q

Definition of ED

A

The inability to achieve or sustain an erection sufficient for sexual intercourse, on >50% of attempts, for at least 3 months, and that this interferes with the man’s life/roles. 75% of cases have an organic cause

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33
Q

Common causes of ED

A

Long term cigarette smoking, low testosterone or high prolactin levels, vascular disease (arteriosclerosis of the pelvic muscles and macrovascular disease of diabetes), brain or spinal cord injury, peripheral neuropathy including diabetic neuropathy, heavy metal exposure, alcoholism, vitamin B12 or B6 deficiency, amyloidosis and uremia, pelvic trauma or surgery (especially prostate surgery), and depression. More than 50% of men with diabetes are impotent..

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34
Q

Medications that cause erectile dysfunction

A

Digoxin. Meds that end in “ine” or “ide”. Antidepressants, especially SSRIs slow sexual response and antihypertensive meds. Antihistamines. Over 200 meds!

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35
Q

Success for couples in which one suffers from erectile dysfunction

A

Involve the partner and help couples be comfortable with therapy and proper use.

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36
Q

Consultation or referral for patients with erectile dysfunction

A

Long-standing ED, those not responding to prescribed therapy, patients needing diagnostic tests or selecting treatment that is beyong the scope of NP practice, those with complicated problems such as a history of childhood sexual abuse, and whenever you are unsure.

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37
Q

Phosphodiesterase inhibitors

A

Sildenafil (viagra) 25, 50, and 100 mg. Tadalafil (Cialis) 2.5,5,10, and 20 mg. Vardenafil (Levitra) 2.5, 5, 10, and 20 mg

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38
Q

How phosphodiesterase-5 (PDE-5) inhibitors work

A

When sexually arounsed, men release nitric oxide into the penis, which activates guanylate cyclase. Guanylate cyclase leads to increased levels of cGMP, which causes smooth muscle relaxation and increased blood flow. The inhibitors keep cGMP from being broken down so they stay longer, increasing its effects and helping to maintain an erection. They do not cause erection without sexual stimulation

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39
Q

Doses, onset, and duration of PDE-5 inhibitors

A

Viagra - 50 mg QD, 1 hr prior and lasts 2-4 hours. Cialis - 10mg QD, 30 min prior and lasts up to 36 hrs. Levitra - 10 mg QD 1 hr prior and lasts 5 hrs.

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40
Q

Nitrates and PDE5Is

A

Nitrates and alpha blockers should not be given together. PDE5Is lower BP and together can cause dangerously low BP. No nitrates within 24 hrs of sildenafil or vardenafil, or 48 hrs of tadalafil. Tamsulosin has less additive hypotensive effect.

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41
Q

PDE5Is and other drug interactions

A

Antifungals, statins, macrolide, antibiotics, protease inhibitors, and any cyp3A4 inducers or inhibitors. Do not take with grapefruit juice.

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42
Q

Medical conditions in which PDE5Is are contraindicated

A

Pt, who in the last 6 months, have had an MI, stroke, or life-threatening arrhythmia. These drugs affect circulation and BP

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43
Q

Common adverse effects of PDE5Is

A

Headache, heartburn, flushing, nasal congestion, changes in vision (color, glare), back pain (with cialis).

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44
Q

Symptoms which indicate pt should stop taking PDE5Is

A

Rash, painful erection, erection lasting >4 hrs (priapism), fainting (from low BP), chest pain, or itching/burning during urination (UTI).

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45
Q

NAION

A

Nonarteritic Anterior Ischemic Optic Neuropothy

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46
Q

NAION and PDE5Is

A

Blood flow to the optic nerve is blocked, causing a sudden loss of eyesight that may be temporary or permanent. Rarely interaction. Men more at risk >50, smokers, heart disease, DM, HTN, high cholesterol, glaucoma. If still needed, try Sildenafil is more selective and PDE5 and PDE6 is found in the eye.

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47
Q

Alprostadil - ED drug that can be injected or as a suppository

A

Cause local vasodilation and entrapment of blood in the corpus cavernosum; relaxes smooth muscle

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48
Q

Carverject and Edex

A

Injectable drugs for ED. 10mcg, 20mcg, and 40 mcg. Produces erection in 80% of men. After reconstitution, use within 24 hrs. Edex - injected along the shaft of the penis.

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49
Q

Muse

A

Penile suppository (1/2 the size of a grain of rice). 250 mcg, 500 mcg, and 1000 mcg. Produces erection in 30-40% of men. Can be left at room temp for 14 days.

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50
Q

Alprostadil (carverject, edex, and muse) onset, duration

A

Begins to work in 5-10 min. Intercouse should be attempted in 10-30 min. Erection lasts about 1 hr. Do not use >3x/wk or more than once every 24 hrs for injection and no more than twice daily with suppository. Injection must be initially titrated in office and pt must stay until full resolution of erection.

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51
Q

Cautions when using alprostadil drugs

A

Use condom and is pregnancy risk X. Suppository - bleeding, stinging, and pain in urethra. Injection - bleeding, pain, bruishing, painful erection, HTN/hypotension. Stop if curving, swelling, pain, erection longer than 4-6 hrs, dizziness, fainting, flu-like symptoms. May cause apnea within 1st hr of administration.

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52
Q

Drug interactions with alprostadil

A

HTN meds because can cause hypotension. Use caution when consuming ETOH. Do not give blood for 1 month after. Must follow-up every 3 months to ensure technique and dosage titration are adequate.

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53
Q

Causes of testosterone deficiency

A

Many things including injury, infection, loss of testicles, hemochromatosis, chemo or radiation, pituitary abnormality, medications (corticosteroids), stress, alcoholism, cirrhosis, genetic abnormalities (Klinefelter’s syndrome)

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54
Q

Treatment option of testosterone deficiency

A

IM injections, every 2-3 weeks; patch on body or scrotum; gel; mucoadhesive material put on teeth twice daily; oral tablets

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55
Q

Adverse reactions of testosterone replacement

A

Acne, edema, prostate enlargement, breast enlargement, aggravation of sleep apnea, decreased size of testes, changes in lipid panel, increased RBCs, infertility, and increased PSA

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56
Q

5 stages of chronic kidney disease

A

Stage I - GFR 90. Stage II - GFR 60-89. Stage III GFR 30-59. Stage IV GFR 15-29. Stage V GFR <15.

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57
Q

Recommendations for testing for chronic kidney disease

A

Calculation of GFR. Proteinuria. Microalbuminuria (particularly in diabetics), spot urine for albumin, creatining rations for those positive for microalbumin.

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58
Q

Prevention of kidney disease

A

Glucose control, BP control with wise medication choice, lipid control and smoking cessation.

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59
Q

Renal stenosis and ACE inhibitors

A

DO NOT USE

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60
Q

Serum creatinine

A

Crude indicator and in the elderly is unreliable. Creatinine produced by skeletal muscle and as muscle mass decreases creatinine production decreases. So, if rate of creatinine clearance is decreased secondary to renal disease but there is less creatinine produced a small change is significant.

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61
Q

24 hr creatinine clearance

A

Cumbersome, inconvenient. Must stay refrigerated. For elderly, incontinence is a problem.

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62
Q

Cockcroft-Gault formula for calculating GFR

A

Predicts renal function by estimating GFR using weight, sex, and serum creatinine. Ex - [(140 - age in years) x (wt in kg) x (.085 if female)] /72 x serum creatining

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63
Q

MDRD - Modified Diet in Renal Disease for estimating GFR

A

Developed after a rigorous study and usesthe inulin infusion clearance. Uses sex, age, ethnicity, serum creatinine (no weight). More accurate than the Crockcroft formula. Neither formula well studied in the elderly.

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64
Q

Elderly considerations of renal status

A

Age and weight are the most important factors. The two formulas cannot be used interchangeable for GFR. Must stick with one formula for each pt. The Crockcroft underestimates the GFR in frail elderly and for safety this may be the best one to use.

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65
Q

Albumin to creatinine ratio

A

Looking for protein in the urine again based on age, weight, sex. Normal ration - in general <0.025 (or 25 mg albumin to 1 gm creatinine)

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66
Q

Hallmark lab for determining kidney disease

A

Protein

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67
Q

Spot microalbumin

A

Thought to be a marker for CV disease (endothelial damage alone the vascular tree) as well as renal disease) and is easy to conduct in the office

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68
Q

Microalbumin

A

Detects abnormal amounts of protein in the urine that is below the detection capability of the urine dipstick which is sensitive at spills of 300-500 mg/day. It is positive if >30-300 mg/day which correlates well with the urine albumin: creatinine ratio.

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69
Q

What is inflammatory bowel disease

A

A chronic inflammatory condition of the GI tract that has periods of flare and remission. Includes Chron’s disease, ulcerative colitis, and indeterminate colitis (difficult to differentiate between Chron’s and ulcerative coitis)

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70
Q

Presentation of inflammatory bowel disease

A

Males and females equally effected. Generally during ages 15-35, but can present in older pts

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71
Q

Genetic predisposition to IBS

A

First-degree relative puts one at a 3-20x greater likelyhood. Infection - maybe specific pathogens trigger this abnormal inflammatory response. Smoking - + correlation to smoking and Chron’s, but - to ulcerative colitis. Other - oral contraception, app before age 20, nutritional deficiencies.

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72
Q

Presentation of IBD

A

Symptoms dictated by severity and location of disease.Can be difficult to diagnose if do not have classic symptoms.

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73
Q

Presentation of ulcerative colitis

A

Often have more rectal symptoms with urgency, tenesmus (dry-heaves of rectum), bloody-mucus diarrhea

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74
Q

Presentation of Chron’s disease

A

Small bowel - no diarrhea or blood, but constipation, fever, abd pain, weight loss, arthralgia, etc

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75
Q

Who to refer with IBS

A

Alteration of bowel habits (chronic diarrhea or constipation), hematochezia, unintentional weight loss, feve, abd pain, N/V

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76
Q

Diagnosis of IBS

A

Based on big pic. Colonscopy - gold standard and useful in differentiating between UC and Chron’s. CT or abd and pelvis to r/o obstruction, structuring, or abscess or fistula. Small bowel follow through. Stool studies - C. Diff, WBC, culture, O&P. CBC, BMP, sed rate, c-reactive protein.

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77
Q

Chron’s disease

A

Inflammatory condition that can involve the translumen of the entire GI tract. Can effect anywhere in the GI from mouth to anus. Most common small bowel. Usually skips areas of colon or small bowel. No cure!

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78
Q

Complications of Chron’s disease

A

Fistualizing disease, abscess, stenosis, abscess.

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79
Q

Ulcerative colitis

A

Inflammatory condition limited to mucosal layer of colon. Almost always involves rectum and extends proximal and is continuous. Cure is possible with surgery

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80
Q

Complications of ulcerative colitis

A

Profuse bleeding, fulminant colitis with toxic megacolon, rupture / perforation of bowel. Increased risk of colon cancer.

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81
Q

Location of Chron’s disease

A

Ileitis - inflammation limited to small bowel and often the terminal ileum. Colitis - inflammation limited to colon and usually patchy in presentation. Ileo-colitis - affects both small adn large bowel

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82
Q

Location of ulcerative colitis

A

Proctitis - limited inflammation the rectal area. Recto-sigmoid colitis. L sided colitis. Pancolitis

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83
Q

Trreatment of IBS

A

Aminosalicylates. Immunomodulators. Biologic therpay. Antibiotics. Corticosteroids.

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84
Q

Aminosalicylates and IBS

A

Sulfasalazine, mesalamine, olsalazine, and balsalazide. Often foundation of treatment. Comes in suppository, enema, and oral. Works as a topical med coating the colon reducing inflammation. Often takes weeks for med to help minimize or control symptoms.

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85
Q

Immunomodular therapy and IBS

A

Azathioprine, 6-Mercaptopurine, adn methotrexate. Treat mod-severe IBS. Often started if pr fails 5 ASA therapy, contraindication to 5 ASA, or if involves the small bowel. Suppresses immune systems. Need specific monitoring secondary risk of lymphoma, hepatic toxicity, severe bone marrow suppression

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86
Q

Biologic therapy and IBS

A

Remicade, Humira, Cimzia and treat Chron’s. Remicade only biologic agent to treat UC. Treats mod-severe disease. Pts have often failed immunomodulators or are steroid dependent.

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87
Q

Antibiotics and IBS

A

Flagyl and cipro are common

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88
Q

Corticosteroids and IBS

A

Prednisone and entocort. Used to get control of symptoms cause most therapies take weeks. Not recommended for maintenance. Entocort commonly used for small bowel disease.

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89
Q

History and IBS

A

Often the key. Clarify when started, # BM in 24 hrs. Night awakening for BM? Seeing blood or mucus in stool and how much? Abd pain, fever, chills, night sweats, weight loss, arthralgia, N/V. Recent antibiotics (3 months), camping, foreign travel, recent virus, food borne illness?

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90
Q

Physical exam and IBS

A

Focused exam very helpful in building big pic. Does pt look ill? Mouth, mucosa, lungs, heart, abd exam essential, skin turger. This is a systemic disease - eyes, skin, hypercoagulability, arthritis, perirectal disease.

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91
Q

Test indicators to determine renal status

A

Serum creatinine, 24-hr creatinine clearance, albumun to creatinine ratio, and spot microalbumin

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92
Q

Treatment of IBS

A

Antibiotics - flagyl. Maintenance - must take them. Steroids - prednisone for flares. May need to be hospitalized. Diet - bland avoiding dairy and high fiber and avoid caffeine and artificial sweeteners. Imodium or lomotil if no C-diff

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93
Q

Treatment for active inflammatory Chron’s disease

A

Glucocoticoids are the gold standard. Enternal nutrition is very effective and the treatment of choice in adults and children with malnutrition. IM Methotrexate is second-line and has slow onset.

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94
Q

Maintenance therapy for Chron’s disease

A

Thiopurines are first choice and are very beneficial in children.

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95
Q

Canasa

A

Used to treat active ulcerative colitis. Suppository and retian for 1-3 hrs. used for 3-6 weeks. Side effects dizziness, rectal pain, and mild hair loss. Caution in pts with kidney problems, pancreatitis, pregnancy, pericarditis. Will stain surfaces dark brown

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96
Q

Rowasa

A

Used to treat mild to moderate distal ulcerative colitis. Retain enema for 8 hrs. Side effects abd pain, headache, gas, nausea, pain on insertion, and mild hair loss. Caution in sulfite allergy. Possible acute intolerance syndrome

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97
Q

Asacol

A

Used to treat mild-mod active UC and for maintenance of remission. Released in terminal ileum. Side effects headache, abd pain, nausea, pharygitis. Caution in renal disfunction and allergy to ASA. Caution when nursing. Swallow tabs whole.

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98
Q

Lialda

A

Used for induction of remission in pts with active, mild-mod UC. Released in terminal ileum. Safety past 8 weeks not established.

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99
Q

Pentasa

A

Used for induction of remission and treatment of mild-mod active UC. Releases in stomach

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100
Q

Colazol

A

Used for mild-mod active UC in pt 5 and older. May be opened and sprinkled on applesauce.

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101
Q

Dipentum

A

Used for maintenance of remission of UC and those intolerant of sulfasalazine. Caution with coagulopathies and pregnancy.

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102
Q

Sulfasalazine

A

Used in treatment of mild-mod UC and as adjunct of severe UC. Side effects - anorexia, headache, N/V, GI distress, reversible oligospermia.

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103
Q

Corticosteroids

A

Used for induction and maintenance of UC and Crohn’s. Use is limited due to frequent and significant side effects

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104
Q

Cyclosprine A

A

Not indicated for UC. Response seen within 7 days

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105
Q

Infliximab

A

Used for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eleminating corticosteroid use in pt with mod-severe active UC who have had inadequate response to conventional therapy. Significant risk of infection

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106
Q

Thiopurines

A

Used for off-label reduction of steriod use in the maintenance of UC. Especially useful in cyclosporine induced remission.

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107
Q

Active fistulizing Crohn’s disease

A

Control of sepsis is primary goal. Antibiotics may aid in fistula drainage.

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108
Q

Conditions that often accompany BPH

A

Bladder outlet obstruction, lower UTIs, or a combo.Symptoms are either obstructive or irritative

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109
Q

Obstructive symptoms of BPH

A

Urinary hesitancy, decreased caliber and force of stream, and postvoid dribbling. Related to bladder outlet obstruction.

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110
Q

Irritative symptoms of BPH

A

Frequency, urgency, and nocturia and occur as result of decreased functioningal bladder capacity and instability or infection. Lower UTIs used to describe. Detrusor overactivity is a known cause of lower UTIs.

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111
Q

Evaluation of prostate

A

A digital rectal exam and a focused neurological exam assessing sacral nerve roots and evaluation of the anal sphincter tone. Assess for prostatic nodules or induration.

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112
Q

Diagnostics regarding prostate disorders

A

Urinalysis - UTI or hematuria. Creatinine level - renal function. PSA - if life expectancy more than 10 yrs

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113
Q

Symptoms of bladder outlet obstruction

A

Evaluate of bladder calculi, urethral stricture, cancer of prostate, and bladder neck contracture. Consider bladder CA. Exclude UTI.

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114
Q

When to consider prostate CA

A

When there is an asymmetric enlargement, nodule, or induration is palpated on rectal exam.

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115
Q

Common sequalae of BPH

A

UTI and urinary retetion. Urinary retention can lead to renal problems.

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116
Q

When to refer to urologist for BPh

A

When surgical intervention is required. Indications for surgery - urinary retention; intractable symptoms related to obstruction; recurrent or persistent UTI; bleeding; changes in kidney or bladder; abnormally low urinary flow rate; bladder calculi.

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117
Q

Prostatitis and types

A

Inflammation of the prostate gland. Types - acute bacterial, chronic bacterial, nonbacterial, and prostatodynia.

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118
Q

Most common type of prostatitis

A

Nonbacterial prostatitis - no identifiable cause

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119
Q

Prostatodynia

A

Characterized by symptoms of prostatic infection but without signs of inflammation of physical exam. Unknown cause.

120
Q

Organisms of acute and chronic prostatitis

A

Gram-negative organisms, most often E. coli and Klebsiella, N. gonorrhoeae, Chlamyida have been implicated.

121
Q

Clinical presentation of acute bacterial prostatitis

A

Fever, chills, malaise, myalgias, and arthralgias. GU symptoms - hesitancy, frequency, urgency, dysuria. PSA levels often very elevated. Prostate enlarged with tenderness and induration. No massaging of prostate.

122
Q

Presentation of chronic prostatitis

A

Varied and may include a hx of recurrent UTI and complaints of urinary frequency, urgency, and burning on urination. Perineal, inguinal, or suprapubic pain may be present. Prostate - tender or boggy.

123
Q

Presentation of nonbacterial prostatitis

A

Prostatic pain or vague discomfort of suprapubic, scrotal, inguinal, lower back, or perineal areas. Pain with ejaculation. Urinary symptoms also. Prostate - normal, but soft, boggy sometimes.

124
Q

Symptoms of prostatodynia

A

Pain and discomfort in pelvic area and problems related to urinary flow, such as hesitancy, interrupted flow, postvoid dribbling, and decreased flow. Penile pain. No hx of UTI and often a lifetime history of voiding difficulty. Prostate unremarkable with exception of increased anal sphincter tone and paraprostatic tenderness.

125
Q

Diagnostics of prostatitis

A

Exam of expressed prostate secretions. Segmented urine specimens. No prostate massage if acute bacterial prostatitis is suspected. Urine culture, urinarlysis, CBC.

126
Q

Management of prostatitis

A

May require hospitalization or out-pt oral antibiotic use. Bactrim and Cipro for 2-6 weeks.

127
Q

Risk factors for prostate CA

A

Advanced age, African American race, and a positive family history for prostate cancer. More AA than white men affected. Mortality in AA twice that of white.

128
Q

Presentation of prostate CA

A

Urinary hesistancy, urgency, nocturia, and frequency, although asymptomatic in early stages. Symptoms increase drastically in short time. Weight loss, constipation, malaise, hematuria, and rectal pan. Does not correlate with PSA values.

129
Q

Exam of prostate that suggests CA

A

A firm nodule on rectal exam, induration, or a stony, asymmetric prostate

130
Q

Diagnostics of prostate CA

A

Measurement of PSA combined with DRE is most sensitive and specific

131
Q

Normal prostate level

A

below 4ng/ml

132
Q

PSA that indicates early prostate CA and benign conditions

A

4-10 ng/mL

133
Q

PSA indicative of prostate CA

A

above 10 ng/mL

134
Q

Treatment of prostate CA

A

Based on stage of diagnosis, features of tumor, pt’s age and medical conditions. Cryotherapy is most common. Pain management is important and palliative care with chemo or radiation.

135
Q

When to refer for prostate CA

A

WHen abnormal DRE or PSE is elevated.

136
Q

Etiology of ED

A

May be multifactorial and 70% are physiologic. Can be associated with vascular supply, hormonal changes, neurologic dysfunction, or medications and associated systemic disease.

137
Q

Meds that cause ED

A

Hormonal agents (antiandrogens), protease inhibitors, and cytotoxic agents.

138
Q

Proteinuria

A

Excretion of more than 150 mg/day is the hallmark of renal disease.

139
Q

Microalbumnuria

A

Excretion of 30-150 mg/day of protein and is a sign of early renal disease, particularly in diabetics.

140
Q

Transient proteinuria

A

Temporary and usually self-limiting and can be caused by orthostatic proteinuria, dehydration, fever, exerise, and emotional stress, CHF, seizures

141
Q

Persistent proteinuria

A

1+ protein on a standard dipstick two or more times during a 3-month period. Indicates a pathologic process.

142
Q

Leading causes of ESRD in the U.S.

A

Diabetes and microalbuminuria is the first sign of deteriorating renal function. HTN is second leading cause.

143
Q

Urinary albumin excretion indicators

A

Predictor of BP progression in nondiabetic, nonhypertensive individuals and is a biomarker for HTN. Associated with increased cardiac morbidity and mortality.

144
Q

Treatment of proteinuria

A

ACE inhibitors or ARBS. Goal is protein excretions rates of 1g/day or less. Higher rates have been shown to increase cardiovascular disease.

145
Q

Consequences of proteinuria

A

Nephrotic syndrome with associated edema, hypoalbuminemia, and extrarenal complications

146
Q

When to refer for proteinuria

A

All pts with renal disease or abnormal renal funciton. Nephrotic syndrome, acute renal failure, renal failure of unknown origin, or unstable vital signs, and new onset proteinuria in pregnant women.

147
Q

Gross hematuria in older men

A

Significant risk of malignant disease and most bladder CA are diagnosed after induction of hematuria

148
Q

Presentation of glomerulonephritis

A

Hematuria accompanied by edema, HTN, and a sore throat or skin infection

149
Q

Chronic kidney disease

A

Diagnosed solely by a loss of function that has been present for at least 3 months.

150
Q

Acute renal failure

A

Diagnosed via kidney biospy and loss of function occurs during days to weeks.

151
Q

Most important diagnostic tool in monitoring renal failure

A

Dipstick urinalysis and should be performed at every office visit. Presence of proteinuria alerts clinical to perform a full 24-hr urine analysis for creatinine clearance.

152
Q

Management of chronic kidney disesae

A

ACE inhibitors and ARBs aggressively and concurrently.

153
Q

Best tool to assist in differentiating between UC and IBS

A

Flexible sigmoidoscopy of the lower colon.

154
Q

When to perform a digital rectal exam

A

Useful for assessing gland size and contour (marker of progression, potential response to alpha-reductase inhibitors; nodules would be evaluated), and sphincter tone (r/o neuro etiology)

155
Q

Adverse effects of alpha blockers

A

Hypotension

156
Q

5 Alpha reductase adverse effects

A

Inability to have an erection

157
Q

When to refer to urology regarding BPH

A

When the enlarged prostate causes symptoms of retention. Urinary retention = post renal failure. Only cure is a TURP

158
Q

Causes of pre-renal failure

A

Dehydration and shock

159
Q

Causes of renal failure

A

Polycystic kidney disease and glomulonephritis

160
Q

Causes of post-renal failure

A

Obstruction like BPH

161
Q

What to do with prostatitis

A

No massage! Symptoms of urinary origin. Pain when sitting. Urine with C&S. Treatment with cipro or bactrium for 2-4 weeks.

162
Q

USPSTF guideline for PSA screening

A

No. Grade D recommendation. No evidence to support screening for black men. No evidence because prostate CA does not have a high mortality rate. You want the goal to be near 0 for PSA after cancer treatment.

163
Q

One strategy regarding PSA levels

A

Watchful waiting and looking for the velocity of change.

164
Q

Post-prostate CA and PSA

A

Evaluated yearly and goal is for level to be close to zero.

165
Q

How is prostate CA diagnosed

A

Biospy

166
Q

IBS and referral to GI dr

A

A history that strongly favors IBS will prompt referral to GI for eval and diagnosis. Can order colonscopy first then refer. Also, order stool specimens to rule out other etiologies.

167
Q

Presentation of Crohn’s

A

Transmural inflammation in any part of GI tract (mouth to anus). Prone to fistulas, abscesses, strictures. May show “skip” lesions on colonscopy. May have non-specific symptoms for years prior to diagnosis. B-12 deficiency if ileal involvement. Osteoporosis d/t Vit D deficiency, Ca++ malabsorption, steroid treatment.

168
Q

Diagnosis of Crohn’s

A

Colonscopy or ileoscopy. Endoscopy may show “skip lesions” and disease outside colon

169
Q

Ulcerative colitis

A

Usually confirmed to mucosal layer; limited to colon. Begins at the rectum and proceeds proximally, and continuously (rectal sparing suggests Crohn’s). Stricture and rare massive hemorrhage adverse effects.

170
Q

Symptoms with IBS

A

Pain improved with defacation, constipation and diarrhea predominate

171
Q

Goals of IBS, UC, and Crohn’s therapy

A

Prevent flares, maintain full life.

172
Q

Diet and IBS, UC, and Crohn’s

A

Advise food journal, hydration, and know what to do with flares

173
Q

Immunizations and use of biologics in treatment of Crohn’s

A

Used for mod-to-severe disease and fistulas. Caution with use in infection. Insure neg TB test and no live vaccines after starting.

174
Q

Use of probiotics and UC, IBS, and Crohn’s

A

Probably fine to start pt on while waiting for eval. Available OTC, select one with as many strains of bacteria as possible.

175
Q

Symptoms that support a diagnosis of a pt who reports feeling achy and stiff in joints

A

Has symmetric early morning stiffness that lasts at least one hour

176
Q

Most specific lab test in identifying rheumatoid arthritis is an elevated…

A

Rheumatoid factor (RF)

177
Q

Treatment for rheumatoid arthritis is to follow the principle of …

A

Early use of disease-modifying antirheumatic drugs (DMARD)

178
Q

The goal of pain management is in the treatment of ankylosing spondylitis is to ….

A

Decrease immobility

179
Q

Systemic Lupus Erythematosus (SLE) is difficult to diagnose because…

A

It manifests in many different ways

180
Q

Patients with SLE would always be encouraged to…

A

Always wear sunscreen and protective clothing and hate

181
Q

Symptoms that would support a diagnosis of ankylosing spondylitis

A

Low back pain that presents every morning and gets better and then worse in evening.

182
Q

A positive ANA is always suggestive of rheumatoid arthritis

A

FALSE

183
Q

What does interleukin activate

A

Associated with inflammation

184
Q

What does interferon activate

A

Adhesion and activates endothelial

185
Q

What is the most helpful diagnostic test in the diagnosis of rheumatic disease?

A

The history and physical

186
Q

Characteristics of rheumatoid arthritis

A

Morning stiffness in and around joints for more than 1 hr before maximum improvement. Involves at least 3 joint areas simultaneiously, have swelling observed by the HCP; 14 areas commonly affected - R or L PIP, MCP, wrist, knee, ankle, MTP or elbow. Symptoms typically symmetrical.

187
Q

Radiographic changes of rheumatoid arthritis

A

Show erosion or unequivocal bony decalcification

188
Q

Criteria for rheumatoid arthritis

A

Need 4 of 7 criteria and must be present for 6 weeks

189
Q

Definition of rheumatoid arthritis

A

Systemic, inflammatory disease involving synovial membranes. Genetic. More women than men. Usually occurs in the 4th -6th decades.

190
Q

Labs indicitive of rheumatoid arthritis

A

ESR, CRP, hypergammaglobulins, hypocomplementemia, thrombocytosis, eosinophilis

191
Q

Treatment goal for rheumatoid arthritis

A

Relieve pain, swelling, and fatigue; improve joint function; stop joint damage; and prevent diability and disease-related morbidity

192
Q

Drugs for rheumatoid arthritis

A

NSAIDs, corticosteroids, DMARDS (hydroxychloroquine, sulfasalazine, methotrexate (no ETOH, teratogenic, and need folic acid), azathioprine), TNF alphas (Enbrel, humira, Remicade)

193
Q

Presentation of lupus

A

Malar rash - erythema, flat or raised rash over malar eminences. Discoid rash - erythematosus rasied patches with adherent keratotic scaling and follicular plugging. Photosensitivity. Arthritis - tenderness joints, small joints. Do not cause erosive changes with RA. Pleuritis and pericarditis. Renal problems. Hematologic disorders, too.

194
Q

Most common cause of disability in the U. S.

A

Arthritis

195
Q

Primary prevention of arthritis

A

Weight control and injury prevention

196
Q

Secondary prevention of arthritis

A

Early diagnosis and skilled management

197
Q

Tertiary prevention of arthritis

A

Self-care and rehab services

198
Q

Pathophysiology of arthritis

A

Degenerative changes with progressive loss of cartilage adn hypertrophic changes in surrounding bone

199
Q

Who is most affected by arthritis

A

Most common in older people, women> men, risk factors - obesity, family hx, metabolic disorders, neuromuscular dysfunction

200
Q

When are symptoms present for arthritis

A

Joint pain worsens with activity and improves with rest, worse in the evening. Stiffness is expected more in the evening and after sitting for extended periods

201
Q

Pain with arthritis

A

Asymmetrical, hands, knees, hips and varies

202
Q

Diagnostics and physical exam of arthritis

A

No diagnostics. May see Herbeden nodules on exam, bony enlargement joint instability, restricted movement. Osteophytes on x-ray

203
Q

Goal of therapy for arthritis

A

Pain relief and maintaining function

204
Q

Treatment approaches of arthritis

A

NSAIDs, yoga, muscle stretching, lidocaine patches

205
Q

Morbidity of RA

A

If not treated, severe disability can occur within 10 years of diagnosis

206
Q

Morbidity of osteoarthritis

A

Secondary diagnoses are bigger issue, as well as immobility

207
Q

Prevelance of lupus

A

More common in women, ages 20-45, African-Americans, Asians, and some American Indian tribes

208
Q

Criteria of lupus

A

Must have 4 of 11 manifestations, either serially or simultaneously. Fatigue is universal complaint. Raynaud’s is common and may include fever and weight loss

209
Q

Diagnostic criteria for lupus

A

Malar rash. Discoid rash. Photosensitivity. Oral ulcers. Arthritis. Serositis. Renal disorder. Neurological disorder. Hematological disorder. Immunologic disorder. Positive antinuclear antibody > or = to 1:160

210
Q

Negative ANA titer

A

<1:40

211
Q

Classes of meds to treat lupus

A

Corticosteroids. Topic steroid preparations. Immunosuppressive drugs (methotrexate). Mycophenolate mofetil. Autologous hematopoietic stem cell transplant. Immunoablation.

212
Q

Understanding triggers for flares for UC or Crohn’s

A

Forget or lower doses of meds. Incorrect dosing of meds. Use of NSAIDs (disrupt the lining of intestines and cause ulcerations). Diet. Stress. Smoking.

213
Q

Parts of treatment for UC or Crohn’s

A

Getting the disease under control and keeping the disease under control or maintaining remission

214
Q

Smoking and UC and Crohn’s

A

Protect against UC and makes Crohn’s worse

215
Q

Role of diet and nutrition in IBD

A

No evidence that diet can cause or cure. Not related to food allergy, but may be worsened by food intolerance. Proper diet may improve symptoms and promote healing

216
Q

Diet and nutrition strategies to help control IBD symptoms

A

Know and avoid food tiggers. Strive for a well-balanced, healthy diet based on: hydration and adequate nutrient intake. Consider vitamin and mineral supplementation

217
Q

Stress and IBD

A

No causal link. Stress can affect the digestive tract and impacts symptoms.

218
Q

Current standard approach to IBD

A

Currently “bottom up”. Mild symptoms - antibiotics and aminosalicylates. Moderate symptoms - corticosteroids, prednisone, budesonide, AZA/6-MO.MTX. Severe symptoms - bilogics or bowel rest and then surgery

219
Q

Approaching change to treating IBD

A

Treat aggressively in the beginning to help decrease overall symptoms.

220
Q

Long-term side effects of IBD meds

A

Goal is to keep pt in remission without steroids. Immunomodulators have low risk of long-term side effects and corticosteroids have serious effects. Anti-tumor necrosis factor (TNF) biologics have a small increased risk of infection. Generally no increased risk of CA

221
Q

Preventing complications from IBD therapies

A

Immunizations UTD before steroids, immune suppressants, or biologics (Hep A&B, HPV, Pneumonia). Calcium and vit D in pts taking steroids (bone density every 3-6 months). Monitor blood counts every 3 months with immunosuppressants. CBC and chem yearly.

222
Q

IBD and fertility and pregnancy

A

Little effect on fertility. Should be controlled prior to pregnancy. IBD can improve during pregnancy. Meds should be maintained during pregnancy.

223
Q

IBD drugs to avoid for women

A

Aminosalicylates and corticosteroids appear to be safe. Avoid methotrexate, antibiotics, thalidomide

224
Q

IBD drugs to avoid in men

A

Sulfasalazine, methotrexate, 6-mercaptopurine, azathioprine

225
Q

When is emergency surgery recommended for IBD

A

Perforations, obstructions, toxic megacolon

226
Q

Elective surgery for UC

A

Actually cures the disease

227
Q

Does behavior of Crohn’s disease change over time?

A

Yes, the behavior changes often, but the location of the disease does not. Risks of complications increase over time.

228
Q

Definition of RA

A

Autoimmune disorder characterized by symmetric inflammatory polyarthritis and varying degrees of extra-articular movement that results in joint destruction, deformity, disability, and premature death.

229
Q

Initial symptoms of RA

A

General systemic manifestations of inflammation, weakness, weight loss, malaise, fatigue, anorexia, aching, adn stiffness. Localized - painful, tender, swollen joints. Morning stiffness lasts 1-2 hrs. Small joints of hands, wrists, and feet are commonly affected first.

230
Q

Physical exam of RA

A

Palpation - inflammed joints feel warm and tender with synovial membrane feeling thickened and boggy. Painful and weak joints.

231
Q

Sjogren’s syndrome

A

Common in RA and characterized by dry eyes and dry mouth. Salled sicca syndrome.

232
Q

Feltys syndrome

A

Seen in long-standing RA and characterized by skin ulcers, leukopenia, splenomegaly, and increased risk for bacterial infectios.

233
Q

Aspiration of inflamed synovial joints of RA

A

Fluid has poor viscosity and high WBC count of more than 10,000 with predominance of neurtrophils

234
Q

Standard goal of RA treatment

A

Remission or low disease activity. Goal should be achieved as rapidly as possible after diagnosis. Management if multifaceted.

235
Q

Risk of CV in RA patients

A

CV risks are multiplied by 1.5 if they have had the disease > 10 yrs, RF or anti-CCP positive, or presence of certain extra-articular manifestations.

236
Q

Complications of RA

A

Joint deformity (sequalae of muscle, tendon, and ligament weakening), small vessel vasculitis, osteoporosis, retinal toxicity, GI irritation and bleeding, hepatic toxicity.

237
Q

Systemic lupus erythematosus

A

A chronic multisystem inflammatory rheumatic disease that may cause diverse symptoms such as fatigue, joint pain, rashes, seizures, edema, and chest pain. More women 15-35.

238
Q

Pathophysiology of lupus

A

Idiopathic. Develops antibodies against components of “self” tissues.

239
Q

Medication treatment for lupus - pain

A

NSAIDs for joint pain, fever, and serositis. Monitor for NSAID toxicity.

240
Q

Anemia of chronic disease

A

Unproduction, usually normocytic, normochromic, with a Hgb level above 10g/L. Most common cause of anemia and most common anemia of hospitalized patients.

241
Q

Labs of anemia of chronic disease

A

Marked by low serum iron levels, but total iron stores are normal or elevated.

242
Q

Clinical presentation of anemia of chronic disease

A

Often mild or asymptomatic. General symptoms are associated with underlying diseases rather than the anemia itself. Advanced symptoms - fatigue and poor activity tolerance. Usually no changes in physical exam

243
Q

Diagnostics of anemia of chronic diseaes

A

CBC - normocytic anemia usually. Hgb - 10-11 g/dL. Serum iron - low. Ferritin level - normal or high. TIBC - normal or elevated.

244
Q

Treatment of anemia of chronic disease

A

May not need treatment. Standard treatment is recombinant human erythropoietin. Intermittent transfusions.

245
Q

Prevalence of iron deficiency anemia

A

Most common anemia in the world and most comon nutritient deficiency. Usually affects women of reproductive age and older adults. Most common cause is chronic blood loss.

246
Q

Recommended daily allowance of iron

A

15 mg/day in non-pregnant women and 30 mg/day for pregnant women.

247
Q

Where is iron absorbed

A

Duodenum and amount is determined by iron in meal, form of iron ingested, the individual’s iron status, and presence or absence of other substances that can enhance or inhibit iron absorption.

248
Q

Labs of iron deficiency anemia

A

Ferritin - low. Transferrin saturation - low. CBC - low Hgb, MCV decreased, MCH decreased, MCHC decreased. TIBC - elevated

249
Q

Clinical presentation of iron deficiency anemia

A

Mild - mod - no symptoms. Severe - fatigue, decreased exercise tolerance, weakness, palpitaitons, irritability, headaches, paresthesias, sore tongue, brittle nails, spoon-shaped nails, pica, crazing for ice.

250
Q

Physical exam of iron deficiency anemia

A

Forceful apical pulse, tachycardia with exertion, and a systolic flow murmur, pallor of conjunctiva, mucous membranes, nail beds, and palmar creases. Spoon shaped nails

251
Q

Treatment of iron deficiency anemia

A

Dose of 150-200 mg in divided daily doses for 4-6 months or until serum ferritin exceeds 50. Common side effects - nausea, constipation, heartburn, black stools, and diarrhea.

252
Q

Labs of improving iron deficiency anemia

A

Hematoligic markers seen in 1-2 weeks.

253
Q

Progression of ankylosing spondylitis

A

Inflammation of bone insertions or ligaments and tendons. Beins with ligametous inflammatory granulation and is gradually replaced by fibrocartilage and then ossifies.

254
Q

Presentaiton of anklyosing spondylitis

A

Begins in the lumbosacral spine and progresses to the upper portions. Peripheral joint involvement is asymmetric, involves large joints and found in lower limbs. Involvement of hip is early sign. Low-grade fever, fatigue, weight loss, red eye, uneitis is unilateral.

255
Q

Management of anklyosing spondylitis

A

NSAIDs, bilogic anti-tumor necrosis factor (TNF), analgesics - tylenol, muscle relaxants, and low dose corticosteroids. Heat and massage. Small dose narcotics intermittently.

256
Q

Diagnosis of rashes

A

Through morphology and pattern of recognition

257
Q

Pityiasis Rosea

A

Commonly on truck with a “herald patch”

258
Q

Psoriasis

A

Patchy, scaly, red

259
Q

Rosacea

A

Flushing, telangiactesias, possibly papules

260
Q

Perioral dermatitis

A

Fine papules aroung mouth

261
Q

Tinea corporis

A

Annular with scay edge, pruritic

262
Q

Differentials of fatigue

A

Thyroid, diabetes, anemia, cancer, renal failure, chronic HD, MS, infectious etiology, immune diseases, chronic fatigue syndrome

263
Q

Most common causes of fatigue

A

Side effects of meds, sleep disorders, psych disorders, and substance abuse

264
Q

When trying to determine cause of joint pain

A

Is it articular or extra-articular; is one joint, more than one joint involved; are involved joints inflamed

265
Q

Basic pathophysiology of lupus

A

Autoantibodies produced against DNA, RBC’s, plaelets, WBC’s, phospholipids; immune complexes circulate and deposit in kidneys, skin, lungs, heart, etc. High risk for CAD disease. > 4 of the symptoms is 85% sensitive for the diagnosis.

266
Q

Diagnostic labs of lupus

A

ANA, CBC with diff, ESR, CRP, U/A, CMP - do not order conformatory labs without high suspicion of disease.

267
Q

ANA levels

A

1:160 considered confirmatory. 5% of healthy people have a + ANA

268
Q

Treatment of lupus

A

Individualized. NSAIDS - anti-i nflammatory. Antimalarials - Plaquenil. Take months to see results. Corticosteroidsl - low dose. Methotrexate. Cyclosprine. Mycophenolate. Cyclophosphamide. Biologicals. NP only prescribe steroids.

269
Q

Management of acute illness and flares of lupus

A

Fevers should be investigated. significant fever may be reason for admission. Consult and refer

270
Q

Pregnancy and lupus

A

Estrogen exacerbates symptoms and is always a risk

271
Q

Rheumatoid arthritis diagnosis

A

More on history and less on labs

272
Q

Osteoarthritis

A

Affects cartilage layer at ends of affected bones; mono- or poly-articular, not symmetric at onset, usually weight-bearing joings; sx’s greater after inactivity and relieved by rest; possible neuropathy and radiculopathy from c-spine involvement; Heberdene’s & Bouchard’s nodes; symptoms non-systemic; non-inflammatory. Sx often in evening after day of use

273
Q

Rheumatoid arthritis

A

Insidious onset over weeks to months; 15% acute; systemic sxs initially d/t inflammation, weakness, weight loss, fatigue, anorexia, stiffness. Normocytic anemia. Localized sxs: painful, tender, swollen joints; am stiffness up to 1-2 hr; joints sx are bilateral and symmetric, often in hands initially; inflammation. DIP often spared; ulnar deviation of MCPs, rheumatoid nodules over extensor surfaces; dry eyes; pulmonary disease; pericardial disease; microcytic anemia (anemia of inflammation)

274
Q

Folic acid and RA

A

Folic acid because Metheltrexate takes 10 weeks to therapeutic effect

275
Q

TNF use and RA

A

May not give if pt presents with an infection!!!

276
Q

Other considerations in treatment of pt with RA

A

Be supportive. Look out for depression. Be aware of drug dependency. Be collaborative with the rheumatologist. Be motivating and thoughtful in terms of exercise options. Be aware that RA is not fun or easy!

277
Q

Beginning signs of lupus

A

Lesions begin as small, erythematosus, scaly papules or plaques that can evolve into papulosquamous or annular polycyclic forms

278
Q

Meds to treat lupus

A

NSAIDs, corticosteroids, antimalarials, Azathioprine, cyclophosphamide, methotrexate, cyclosporine, myclophenylate mofetil

279
Q

Gout

A

Disease resulting from urate crystal deposition in tissues or from super saturation of uric acid into extracellular fluids. Articular inflammation, tophi formation

280
Q

Prevalence of gout

A

Usually men, age 50+, affected by weight, diet, lifestyle, and Hgb

281
Q

Clinical presentation of gout

A

Warmth, swelling, erythema, and pain in joint. Often affects midfoot, ankles, heels, knees and less commonly wrists, fingers, elbows

282
Q

Med treatment of gout

A

NSAIDs, colchicine, corticosteroids

283
Q

Prophylaxis of gout

A

Low purine diet, weight loss, decrease trauma, 2 L fluid/day, no ASA, watch for drug interactions

284
Q

Presentation of fibromyalgia

A

Diffuse pain, long hx of pain, sleep disturbances, IBS, fatigue and memory problems. weakness and inflammation

285
Q

Etiology of fibromyalgia

A

Possibly familial + environmental exposure (trauma, infection, emotional stressor, endocrine d/o, immune d/o

286
Q

Diagnostic criteria of fibromyalgia

A

Chronic widespread pain - all 4 quads of body. 11 of 18 tender points, migratory pain, memory difficultires, fatigue, feelings of weakness, IBS, parathesia, TMJ, heel pain, noncardiac chest pain

287
Q

Treatment of fibromyalgia

A

TCAs, cyclobenzaprine, tramadol, neurontin/lyrica, aerobic exercise, sleep hygiene

288
Q

Polymyalgia rheumatica

A

Pain and stiffness, 4 weeks, muscles in neck shoulders and pelvis. More women than men and generally >50. Responsive to corticosteroids

289
Q

Scleroderma

A

Progressive thickening of skin.

290
Q

Psoriatic arthritis

A

Psoriasis, digital pits, sclerdactyly, sausage like digits, radiographic changes, RF neg, treatment similiar to RA

291
Q

Ankylosing spondylitis

A

Chronic inflammatory disease, SI joint and spine, young males, progressive stiffness with fusion of some/all joints. Shares features of psoriasis, IBD, and reactive arthritis

292
Q

Treatment of ankylosing spondylitis

A

NSAIDS, exercise, intra-articular and systemic corticosteroids, sulfasalazine, methotrexate, enbrel

293
Q

Sarcoidosis

A

Granulomatous, chronic, systemic disease. Young adults 20-30. Etiology unknown. Presents as pulmonary symptoms, asymptomatic hilar adenopathy, constitution symptoms, arthritis

294
Q

Sjogren’s syndrome criteria for diagnosis

A

Must have 3 of 6. Ocular symptoms. Oral symptoms. Ocular signs: Schirmer-I test or Rose bengal score. Histopathologic features. Salivary gland involvement. Autoantibodies - anti Ro/SSA, anti La/SSB, ANA, FR

295
Q

Giant cell arteritis

A

Criteria for diagnosis - > 50, new headache, temporal artery abnormality. elevated ESR, abnormal artery biospy

Comps - Mod 3 (5 decks)

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