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Foundations 3 > Osteoporosis, Fibromyalgia, Vasculatides > Flashcards

Osteoporosis, Fibromyalgia, Vasculatides Flashcards

1
Q

MC clinical presentation of osteoporosis

A

ASYMPTOMATIC

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2
Q

How else can osteoporosis present?

A

Fractures (vertebral, hip, pelvic)

Loss of height (d/t compression fractures)

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3
Q

According to USPSTF who needs to be screened for osteoporosis

A

Women, 65 years and older (grade B)

Women < 65 y/o, when fracture risk ≥ 65 y/o white woman with no additional risk factors (grade B)

Men, insufficient evidence for screening (grade I)

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4
Q

What tool is used to assess fracture risk for osteo?

A

FRAX tool

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5
Q

How does the FRAX tool work to assess risk for osteoporosis

A

Calculates 10-year risk for osteoporotic fractures in women < 65 y/o

Baseline risk = 65 y/o woman with no other risk factors

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6
Q

Compoenents assessed with the FRAX tool

A 
Age
Sex
Weight
Height
Previous fracture
Parent fractured hip
Current smoking
Glucocorticoids (chronic use of these)
Rheumatoid arthritis
Secondary osteoporosis
Alcohol 3 or more units/day
Femoral neck BMD (g/cm2)
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7
Q

GOLD standard for osteoporosis diagnosis

A

DEXA scan

T score < -2.5

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8
Q

What is a alternative fractures can be used to diagnose osteoporosis

A

Fragility fractures (from height level or below)

Spine
Hip
Wrist
Humerus
Rib
pelvis
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9
Q

What labs can be used to determine osteoporosis

A

Chem panel (calcium, phosphorous, albumin, total protein, creatinine, liver enzymes including alkaline phosphatase, electrolytes)

25-hydroxyvitamin D (25[OH]D)

CBC

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10
Q

Non pharmacologic methods to manage osteoporosis?

A 
***EXERCISE
Diet
Avoid corticosteroids
Tobacco cessation
Avoid excessive alcohol intake
Fall prevention measures
No need to memorize
***most effective
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11
Q

What amount of Vitamin D and calcium should be used to manage osteoporosis?

A

Vitamin D = 600-800

Calcium = 1000 mg (all adults)
1200 MG (postmenopausal women, men>70 y/o)
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12
Q

MOA of Bisphosphonates?

Contraindications?

A

MOA: inhibits osteoclasts induced bone resorption

Contraindications: CKD

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13
Q

Complications when taking Bisphosphonates?

A

osteonecrosis of the jaw, atypical low-impact fractures of femoral shaft

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14
Q

ADE of Bisphosphonates?

A

nasuea
chest pain
hoarsness
erosive esophagus

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15
Q

What is IV form of Bisphosphonates

What must be educated after giving to patient?

A

Zoledronate (Reclast) - 15-30 min annually

Acute phase response (flu-like symptoms)

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16
Q

MOA of Denosumab (Prolia)

A

Monoclonal antibody that inhibits the proliferation and maturation of preosteoclasts into mature osteoclast bone-resorbing cells

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17
Q

What kind of drug is Teriparatide?

A

Parathyroid hormone analog

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18
Q

What is the MOA of Teriparatide (Forteo)

A

Stimulates production of new collagenous bone matrix that must be mineralized

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19
Q

Contraindications of using Teriparatide (Forteo)

A

patients with increased risk of osteosarcoma

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20
Q

What are drugs that fall under Selective EStrogen Receptor modulators?

A

Raloxifene

Tamoxifen

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21
Q

MOA of SERMs?

A

Reduces risk of vertebral fractures, and invasive breast cancer

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22
Q

ADE of taking SERMs

A

Increased risk of thromboembolic events, hot flashes

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23
Q

Slide 26- calcitonin

A

calcitonin

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24
Q

How do you monitor Osteoporosis using DEXA scans with a T score of -1.0 - -1.5

A

DEXA every 5 years

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25
Q

How do you monitor osteoporosis in someone with a T score -1.5 to -2.0:

A

3-5 years

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26
Q

How do you monitor osteoporosis in someone with a T score < -2.0

A

every 1-2 years

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27
Q

MC fracture of osteoperosis?

A

Vertebral fracture

28
Q

What is Fibromyalgia?

A

Soft tissue pain syndrome

29
Q

How is Fibomyalgia best diagnosed

A

Very Good H&P

30
Q

Classic presentation of Fibromyalgia?

A

Chronic wide spread musculoskeletal pain

Pain is out of proportion

Fatigue
Cognitive disturbances
Multiple somatic symptoms
Psychiatic symptoms

31
Q

What parts of the body do fibromyalgia most commonly happen around

A

Neck
Shoulders
Low back
Hips

32
Q

Trigger points of pain are seen in what disease?

A

Fibromyalgia

33
Q

What are red flags that can point towards Fibromyalgia?

A

Family history of myopathy

Personal history of cancer

Unexplained weight loss or fevers

Joint inflammation

Neurologic abnormalities

34
Q

What in the patients History is a positive sign towards Fibromyalgia?

A
  1. Chronic wide spread pain in All 4 quadrants of the body

2. Sleep and mood disturbance

35
Q

On Physical exam what is needed in order to diagnose fibromyalgia?

A

Pressure point assessment showing 11 out of 18 tender points

Must complete a join exam

36
Q

What is the most effective non-pharmacologic method to treat Fibromyalgia?

A

EXERCISE

37
Q

What Alternative criteria can be used to diagnose

A

Widespread pain index

Symptoms severity scale

38
Q

1st line medications for Fibromyalgia?

A

Tricyclic Antidepressants

-Amytriptiline

39
Q

What has the lowest/no level of evidence when treating Fibromyalgia?

A

Opioids

40
Q

What Vasculitides syndrome?

A

Inflammatory process within the wall of affected blood vessels

41
Q

Symptoms of Vasculitides are generally associated with with?

A

Organ dysfunction

42
Q

Symptoms from Large vessel disease are seen where?

A

Life or Limb

limb claudication, asymmetric blood pressures, absence of pulses, bruits, aortic dilation

43
Q

Medium vessels disease symptoms

A

cutaneous nodules, ulcers, livedo reticularis, digital gangrene, mononeuritis multiplex, microaneurysms

44
Q

What is Polymyaglica Rheumatic commonly associated with

A

Giant Cell arteritis

up to half of patients with TA have PMR

45
Q

Clinical Presentation of Polymyalgia Rheumatica?

A

Stiffness
aching
pain in muscles of neck
shoulder and pelvic girdle

Difficulty combing hair, rising from chair

46
Q

How is Polymyalgia Rheumatica diagnosed

A

Clinical – based on pain and stiffness
Anemia
Elevated acute phase reactants

47
Q

Treatment and dosage for Polymyalgia Rheumatica?

What needs to monitored as well?

A

Prednisone 10-20 mg/day (low dose)
Expect dramatic response in 72 hours
Slow taper after 2-4 weeks

Monitor for GCA

48
Q

How does Polymyalgia Reheumatica differ from Polyarteritis nodosa?

A

NO muscle weakness

Does not cause blindness like temporal arteritis

Responds to low dose prednisone, whereas TA requires high dose prednisone

49
Q

What is Polyarteritis Nodosa?

A

Necrotizing inflammation of medium sized vessels and small arteries

50
Q

What labs help diagnose Polyarteritis nodosa?

A

Anemia
Leukocytosis
Elevated ESR
ANC-neg

Test for HBsAg and HBeAg

51
Q

What do you need to perform in order to diagnose Polyarteritis Nodosa

A

Tissue biopsy

Angiogram finding of aneurysmal dilations in renal, mesenteric, or hepatic arteries

52
Q

Treatment for polyarteritis nodosa?

A

High dose corticosteroids

Cyclophosphamide in refractory disease
-Prophylaxis against Pneumocystis jirovecii

53
Q

What is Kawasaki Disease?

A

Mucocutaneous lymph node syndrome

54
Q

What 5 clinical findings are indicative of Kawasaki disease?

A 
Conjunctivitis
Mucositis
Rash
Lympadenopathy
Extremity changes
55
Q

What is the diagnostic criteria for Kawasaki

A

4 out of 5 symptoms plus fever

56
Q

Labs that indicate Kawasaki disease

A 
Leukocytosis with left shift
Normochromic, normocytic anemia
Elevated acute phase reactants
Elevated ALT/AST
Thrombocytosis 
Pyuria
57
Q

Treatment for Kawasaki

A

2 g/kg of IVIG administered over 10–12 hours

80–100 mg/kg/d of aspirin in four divided doses

58
Q

What are patients with Kawasaki at risk for developing

A

Cardiac complications

If untreated can lead to aneurysm

59
Q

What triad of symptoms are seen in Granulmatosis with Polyangiitis

A
  1. Upper respiratory sx
  2. Lower respiratory
  3. Kidney disease

OR

  1. Vascular
  2. Inflammation
  3. Necrotization
60
Q

Treatment for Granulomatosis with Polyangiitis

A

Cyclophosphamide plus corticosteroids

OR

Rituximab plus corticosteroids +/- plasma exchange

61
Q

comback and make more cards for Cyclophosphamide plus corticosteroids

A

yee

62
Q

patients with Eosinophilic Granulomatosis with Polyangiitis are 90% likely to have what other condition?

A

Asthma

63
Q

Blood tests in those with Eosinophilic Granulomatosis with Polyangiitis would have what finding?

A

Eosinophilia

64
Q

What is the gold standard when diagnosing Eosinophilic Granulomatosis with Polyangiitis

A

Lung biopsy or other affected tissue

65
Q

Treatment of Eosinophilic Granulomatosis with Polyangiitis

A

Systemic glucocorticoids

66
Q

Finish slids 82 and 92

A

92

67
Q

Treatment for Behcet’s disease?

A

Aphthous ulcers – topical or intralesional steroids

Prednisone

Foundations 3 (25 decks)

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