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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
How do you monitor osteoporosis in someone with a T score -1.5 to -2.0:
3-5 years
26
How do you monitor osteoporosis in someone with a T score < -2.0
every 1-2 years
27
MC fracture of osteoperosis?
Vertebral fracture
28
What is Fibromyalgia?
Soft tissue pain syndrome
29
How is Fibomyalgia best diagnosed
Very Good H&P
30
Classic presentation of Fibromyalgia?
Chronic wide spread musculoskeletal pain Pain is out of proportion Fatigue Cognitive disturbances Multiple somatic symptoms Psychiatic symptoms
31
What parts of the body do fibromyalgia most commonly happen around
Neck Shoulders Low back Hips
32
Trigger points of pain are seen in what disease?
Fibromyalgia
33
What are red flags that can point towards Fibromyalgia?
Family history of myopathy Personal history of cancer Unexplained weight loss or fevers Joint inflammation Neurologic abnormalities
34
What in the patients History is a positive sign towards Fibromyalgia?
1. Chronic wide spread pain in All 4 quadrants of the body | 2. Sleep and mood disturbance
35
On Physical exam what is needed in order to diagnose fibromyalgia?
Pressure point assessment showing 11 out of 18 tender points Must complete a join exam
36
What is the most effective non-pharmacologic method to treat Fibromyalgia?
EXERCISE
37
What Alternative criteria can be used to diagnose
Widespread pain index Symptoms severity scale
38
1st line medications for Fibromyalgia?
Tricyclic Antidepressants | -Amytriptiline
39
What has the lowest/no level of evidence when treating Fibromyalgia?
Opioids
40
What Vasculitides syndrome?
Inflammatory process within the wall of affected blood vessels
41
Symptoms of Vasculitides are generally associated with with?
Organ dysfunction
42
Symptoms from Large vessel disease are seen where?
Life or Limb limb claudication, asymmetric blood pressures, absence of pulses, bruits, aortic dilation
43
Medium vessels disease symptoms
cutaneous nodules, ulcers, livedo reticularis, digital gangrene, mononeuritis multiplex, microaneurysms
44
What is Polymyaglica Rheumatic commonly associated with
Giant Cell arteritis up to half of patients with TA have PMR
45
Clinical Presentation of Polymyalgia Rheumatica?
Stiffness aching pain in muscles of neck shoulder and pelvic girdle Difficulty combing hair, rising from chair
46
How is Polymyalgia Rheumatica diagnosed
Clinical – based on pain and stiffness Anemia Elevated acute phase reactants
47
Treatment and dosage for Polymyalgia Rheumatica? What needs to monitored as well?
Prednisone 10-20 mg/day (low dose) Expect dramatic response in 72 hours Slow taper after 2-4 weeks Monitor for GCA
48
How does Polymyalgia Reheumatica differ from Polyarteritis nodosa?
NO muscle weakness Does not cause blindness like temporal arteritis Responds to low dose prednisone, whereas TA requires high dose prednisone
49
What is Polyarteritis Nodosa?
Necrotizing inflammation of medium sized vessels and small arteries
50
What labs help diagnose Polyarteritis nodosa?
Anemia Leukocytosis Elevated ESR ANC-neg Test for HBsAg and HBeAg
51
What do you need to perform in order to diagnose Polyarteritis Nodosa
Tissue biopsy Angiogram finding of aneurysmal dilations in renal, mesenteric, or hepatic arteries
52
Treatment for polyarteritis nodosa?
High dose corticosteroids Cyclophosphamide in refractory disease -Prophylaxis against Pneumocystis jirovecii
53
What is Kawasaki Disease?
Mucocutaneous lymph node syndrome
54
What 5 clinical findings are indicative of Kawasaki disease?
``` Conjunctivitis Mucositis Rash Lympadenopathy Extremity changes ```
55
What is the diagnostic criteria for Kawasaki
4 out of 5 symptoms plus fever
56
Labs that indicate Kawasaki disease
``` Leukocytosis with left shift Normochromic, normocytic anemia Elevated acute phase reactants Elevated ALT/AST Thrombocytosis Pyuria ```
57
Treatment for Kawasaki
2 g/kg of IVIG administered over 10–12 hours 80–100 mg/kg/d of aspirin in four divided doses
58
What are patients with Kawasaki at risk for developing
Cardiac complications If untreated can lead to aneurysm
59
What triad of symptoms are seen in Granulmatosis with Polyangiitis
1. Upper respiratory sx 2. Lower respiratory 3. Kidney disease OR 1. Vascular 2. Inflammation 3. Necrotization
60
Treatment for Granulomatosis with Polyangiitis
Cyclophosphamide plus corticosteroids OR Rituximab plus corticosteroids +/- plasma exchange
61
comback and make more cards for Cyclophosphamide plus corticosteroids
yee
62
patients with Eosinophilic Granulomatosis with Polyangiitis are 90% likely to have what other condition?
Asthma
63
Blood tests in those with Eosinophilic Granulomatosis with Polyangiitis would have what finding?
Eosinophilia
64
What is the gold standard when diagnosing Eosinophilic Granulomatosis with Polyangiitis
Lung biopsy or other affected tissue
65
Treatment of Eosinophilic Granulomatosis with Polyangiitis
Systemic glucocorticoids
66
Finish slids 82 and 92
92
67
Treatment for Behcet's disease?
Aphthous ulcers – topical or intralesional steroids Prednisone

Foundations 3 (25 decks)

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