Rheumatology/Anemia Flashcards by Katherine Lee

Fibromyalgia is a ___ condition of _______

Cause?

chronic condition of connective tissue

unknown cause- infx stress

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Symptoms of fibromyalgia

Associated sx

Widespread persistent pain (stiff, rore, throbbing, numb, burning) “flu”

Associated: IBS, HA, fatigue, sleep disturbance, depression/anxiety

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Fibromyalgia dx based on

dx criteria

History, PE

tenderness 11 of 18 pts for at least 3 months

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Tx fibromyalgia

TCAs first line (amitriptylline)
SSRI SNRI
Anticonvulsant

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Rheumatoid arthritis

How do deformities present?

Symmetrical

Starts with small joints hands/feet moves to larger joints

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Rheumatoid arthritis risk factors

female, smoker, stress, human leukocyte gene

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rheumatoid arthritis dx symptoms

morning stiffness>1 hr
swelling in three or more joints
swelling in wrist, hand, finger
swelling on both sides of body
x 6 weeks

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rheumatoid arthritis labs

rheumatoid factor (present in most), anti-citrullinated peptide/protein antibody test (more specific)
ESR, CRP elevated
Synovial fluid
CBC- anemia and thrombocytosis

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deformities seen with rheumatoid arthritis

History: starts with rheumatoid nodules then joint deformities

ulnar deviation of MCP joints
swan neck deformity- joint of finger tip points into palm, joint closest to palm bends away (DIP flexion, PIP hyperextension)
boutenniere deformities- opposite of above, DIP hyperextension, DIP hyperextension

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tx rheumatoid arthritis

DMARDs - hydroxychloroquine, plaquenil, leflunomide
Sulfasalazine- se low sperm count
Methotrexate- zostavax not to be given until 4 weeks after stopping, do not start within 2-4 weeks of receiving zostavax

Biological DMARDS- humira, cimzia, enbrel, simponi, remicade

PT: relieve pain (NSAIDS/systemic steroids), reduce inflammation, preserve joint, reduce CV risk

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Osteoarthritis is a ____ disease of ____ and ____

Degenerative disease of joint cartilage and bone

Pain stiffness (hip, knee, hands)
decreased ROM, swelling, crepitus, joint enlargement and instability

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Most common chronic condition of joints

osteoarthritis

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risk factors osteoarthritis

joint overuse, age, gender (women), obese, genetics, race (asian less likely)

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Dx osteo arthritis

PE:
Radiology:

Dx: Subjective and visual inspection
Trendelenberg test- stand on one foot, pelvis points down to unaffected side (gluteal weakness)
Heberdens nodes
Xray- shows osteophytes, joint space narrowing, subchondral sclerosis, cysts
MRI- not necessary, may show early stages of defects
U/S- shows synovial inflammation, effusion

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Treatment osteoarthritis
Mild

Mod

Mild- exercise, splint, weight loss (5-10% in 6 months recommended), NSAIDS, capsaicin

Mod- intraarticular steroids, duloxetine, orthopedics, diclofenac gel or drops

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Lyme pathogen?

Most common ____ ____ disease

Borrelia burgdorferi

Most common vector-borne disease

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lyme- tick must feed for?

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24-48 hours

Lyme

pt presentation in three stages

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Early localized (3-30 days): skin lesion (erythema migrans), with or without symptoms

Early disseminated (weeks-months): multiple lesions, skin, heart, musculoskeletal, nervous system changes, persistent fatigue

Late (months-years): arthritis (especially monoarticular arthralgia in knee) + neuro (encephalopathy, polyneuropathy)

Lyme dx
serology, when does it show?

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Dx: lyme antibody through serological testing- may not show for one month and may be positive indefinitely
ELISA (enzyme linked immunosorbent assay) with B burgdorferi antigens
IgM: within first few weeks
IgG: within one month
Immuno blot (Western blot) CONFIRM specificity
IgM 2-3 bands +
IgG 5-10 bands +

Lyme tx (meds) 
med in pregnancy: 
Resolves within?
Pain/fatigue persist for?
Symptoms longer than 6 months called?

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Tx: early disease- doxycycline, amoxicillin, cefuroxime 2-3 weeks
Pregnancy: amoxicillin 2-3 weeks
Jarisch-herxheimer reaction- transient rx, worsening sx (antigens released from dying organisms)
If tx early with abx resolves within 20 days
Pain and fatigue may persist for weeks to months (resolve by 6 months)
Symptoms longer than 6 months is called “post-lyme disease”- difficult to treat

Anemia definition

Is anemia a disease?

Three root cases of anemia:

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Anemia basics: reduced oxygen carrying capacity
-not a disease, sx of another issue
	Poor RBC production
	RBC destruction
	Blood loss

Anemia labs
Most accurate indicator of anemia? 
Define: 
Hgb-
Hct-
MCV-
MCH-
RDW-
Reticulocyte-
Poik-
Aniso-

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HGB** most accurate, less volume dependent- no sx until below 10
Hgb: oxygen carrying
Hct: proportion blood containing RBC (%)
MCV important- red blood cell size
MCH- color, concentration RBC
RDW- variation in sizes, blood cell lives 120 days, iron deficiency anemia increased
Reticulocyte- baby blood cell, normally lose 1% a day hence normal reticulocyte 1%
Poik- abnormal shape
Aniso- divergent blood cell sizes (correlated with rdw)
MCV<80- micro MCV >100- macro

Anemia often presents_____

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asymptomatic

S/S anemia

severe s/s anemia

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Exertional dyspnea, fatigue, headache, tachycardia, palpitations,
pallor (skin/conjunctiva), systolic flow murmur

Severe anemia: angina, glossitis, roaring in the ears,
muscle cramps, phagophagia (craving for ice),
pica, spooning/ridging/thinning of nails, cheilitis

s/s pernicious anemia

neurological symptoms- loss of position | /vibration sense, balance, memory (can’t dx dementia without checking B12)

Iron deficiency anemia lab findings

low ferritin (iron stores) **most specific high- TIBC (“empty baskets that carry iron” MCH and MHCH decreased RDW increased Ferritin- decreased, dx: IDA Reticulocyte low- body doesn’t have building blocks to make new RBCC If IDA in male- suspect GI blood loss

Tx iron deficiency anemia monitoring anemia improvement with lab work shows improvement with 1) 2) 3) tx until?

Ferrous sulfate- take on empty stomach with OJ Monitoring: reticulocyte will improve first (body making new RBC), then H+H improved at 6 weeks, finally ferritin Tx until ferritin normal (12 weeks)

Thalassemia abnormal production of ___ Minor common in ___

Genetic defect- abnormal hgb production Minor- most common mediterranean, middle eastern, african, asian

Dx thalassemia labs definitive dx

NORMAL RDW and iron studies Microcytic and hypochromic like IDA (decreased MCV, MCH) Definitive dx: electrophoresis increased hgbA2

Sideroblastic anemia disorder of??? how do you get it? CBC/labs show?

Enzyme d/o- enough iron but cannot incorporate into hgb- lays down in a ring Hereditary or acquired (ETOH, INH, RA, lymphoma, leukemia) Increased ferritin and Fe (IRON OVERLOAD)** Peripheral smear- ringed sideroblast*** Hematology for bone marrow aspiration

Anemia of chronic disease associated with? CBC/labs? Tx?

Associated with inflammatory disorders, malignancy, HIV NORMAL OR HIGH FERRITIN, normal TIBC Can be microcytic or normocytic, normo or hypochromic Tx: underlying conditions

Microcytic anemias

IDA Thalassemia Sideroblast Anemia of chronic disease

MCV bw 80-100 (normocytic)- look at ____ next... increased? normal? decreased?

next look at reticulocyte increased reticulo- hemolytic (sickle cell, G6PD, drug induced, autoimmune) not managed in primary care normal- metabolic decreased reticulo- renal, aplastic (ER, 0 reticulo-aplastic)

Lab findings with hemolytic anemia Size? Color? Reticulocyte? Increased what (2)? decreased what (1)? Positive _____ test

Normal size and color, INCREASED RETICULOCYTE Increased LDH and bili Decreased haptoglobin Positive coombs test- antibodies against RBC

Metabolic anemias labs Size? Reticulocyte? Causes: - - -

NORMAL SIZE NORMAL RETICULOCYTE Thyroid Addisons Pituitary

Renal/aplastic anemias Size? Reticulocyte? causes: - - -

NORMAL SIZE DECREASED RETICULOCYTE Renal failure Aplastic- Viral illness, drug related, idiopathic Pancytopenia- reticulocyte 0

Macrocytic anemias

b12 and folate deficiency

Sx b12 deficiency

``` Atrophic glossitis Stocking/glove neuropathy Memory loss/dementia Depression Irritability Balance problems Loss position/vibration sense ataxia Anorexia Diarrhea Weight loss ```

Causes b12 deficiency

pernicious anemia gastric bypass vegetarian/vegan

B12 anemia lab findings Size? Color? Reticulocyte? Two key elevated values are? Hypersegmented ______ Oval ______ Tx:

Macrocytic, normochromic Low reticulocyte Methynalonate + homocysteine elevated Antibodies to intrinsic factor in pernicious anemia Hypersegmented neutrophils, oval macrocytes Tx: replacement B12 1000 mcg IM daily x 1 wk, weekly for one month, and monthly for life

Folate deficiency: Two key values are? Causes:

Methylmanolate (NORMAL) + homocysteine elevated Dilantin, tegretol, phenobarb, azt, ETOH, dialysis, malabsorption, celiac Replace 1mg daily

Rheumatology/Anemia Flashcards

(41 cards)