Rheum final review pt2 Flashcards
In advanced RA undergoing surgery, what are you concerned about? What must you do?
there is synovial tissue btwn odontoid process of C2 and C1 keeping it in place.
This lining can be eroded in RA patients.
This is an issue if they have to go under general anesthesia and get neck hyper-extended to be ET tubed, you need to do flexion-extension view of the neck to see if there is an odontoid atlanto-axial subluxation. If you don’t, the odontoid peg could hit the spinal cord and could cause paralysis.
Dx of Fibromyalgia syndrome
chronic pain above and below the waist in 3 diff quadrants for 3 months or more (that doesn’t have another explanation)
Associated symptoms besides the diagnostic criteria for Fibromyalgia (9)
Irritable bowel Irritable bladder Chronic fatigue Restless legs Postural hypotension Dizziness “Fibro-fog” Cold intolerance Multiple sensitivities
What are these sx associated with? Irritable bowel Irritable bladder Chronic fatigue Restless legs Postural hypotension Dizziness “Fibro-fog” Cold intolerance Multiple sensitivities
Fibromyalgia
What are the 3 FDA approved tx for Fibromyalgia?
Pregabalin (Lyrica),
Duloxetine (Cymbalta - MC one used),
Minacipran
What are 3 non-approved but freq used drugs to tx Fibromyalgia?
Tricyclics
Short acting hypnotics
Muscle relaxants (Cyclobenzprine)
Non-medication therapies indicated for Fibromyalgia (4)
Patient education
Encourage gradual exercise
Assess their sleep
Treat psych distress
Still's disease. (sx onset of JRA) Characterized by (2) Other sx (4)
High fevers & transient rash
Lymphadenopathy, hepatosplenomegaly, pleural effusions, huge leukocytosis
Still’s Disease is the systemic onset of ____
Juvenile Rheumatoid Arthritis
> 50 yo patient has stiffness & pain in shoulder girdle. What is this?
What test level would you notice?
PMR
ESR elevated, systemic
What is the key 95% finding in PMR?
when is the pain worse in PMR?
Symmetric shoulder girdle pain
Morning»_space; Evening
List the systemic sx of PMR (9)
symmetric shoulder pain pelvic pain upper arm pain thigh pain Weight loss Fever Malaise Difficulty standing Difficulty grooming
Findings in Temporal Arteritis
which gender? average age?
Sx?
usu women, mean age is 74
Pain in jaw, new headache late in life, unequal blood pressure in extremities, bruits.
Gold standard to dx temporal arteritis
Tx of temporal arteritis
Temporal artery biopsy
Tx: prednisone and aspirin for 4 weeks
Cluster of sx found in Lupus: (2 clusters)
Cutaneous, articular and renal manifestations tend to appear “together”
CNS thrombotic and muscular symptoms also cluster, although to a lesser extent
What does the body produce in Sjogren’s syndrome?
Anti-SSA and/or Anti-SSB
___ is specific for Lupus
Also, must check the UA looking for __
Anti-Sm (Smith)
protein
What will a CBC look like w/ Lupus?
penias: anemia with - thrombocytopenia, lymphopenia, & neutropenia
In Idiopathic inflammatory myositis
(Muscle weakness with inflammation in the muscle tissue)
What are the enzymes associated? Which are muscle/liver/both-related?
Elevation of serum muscle enzymes:
Muscle only: CPK, Aldolase
Liver only: ALT
Muscle & Liver: AST, LDH
SLE has a ___ staining pattern
Drug-induced a ____ staining pattern.
speckled ANA
homogenous ANA
Risk factors for developing OA (6)
Age
Sex - W: Knee & hand; M: hip
Genetic predisposition
Obesity (b/c of adipokines)
Malalignment (ex: scoliosis, valgus/varus deformity at knee)
Congenital condition (ex: Legg-Calve-Pethes - osteo necrosis of epiphysis)
Arthritis along with Malar rash, photosensitivity, nephropathy, oral ulcers (but mainly the malar rash) are common signs of:
SLE
What is this?
joint swelling, stiffness, increasing pain as the day goes on
OA
b/c as you bear weight across this joint, the most weight & pressure on irregular cartilage.
OA:
Synovial fluid looks
Yellow, clear, WBC <2000, no crystals
4 common locations of OA: (which is most common?)
Phys findings
Hand-70% - most common site of OA. Base of thumb
Spine-60%
Knee-30%
Hip-10%
Must involve some DIP joints, and few MCP joints
