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Primary care II > Rheumatology/Anemia > Flashcards

Rheumatology/Anemia Flashcards

1
Q

Fibromyalgia is a ___ condition of _______

Cause?

A

chronic condition of connective tissue

unknown cause- infx stress

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2
Q

Symptoms of fibromyalgia

Associated sx

A

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

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

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3
Q

Fibromyalgia dx based on

dx criteria

A

History, PE

tenderness 11 of 18 pts for at least 3 months

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4
Q

Tx fibromyalgia

A

TCAs first line (amitriptylline)
SSRI SNRI
Anticonvulsant

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5
Q

Rheumatoid arthritis

How do deformities present?

A

Symmetrical

Starts with small joints hands/feet moves to larger joints

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6
Q

Rheumatoid arthritis risk factors

A

female, smoker, stress, human leukocyte gene

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7
Q

rheumatoid arthritis dx symptoms

A
  • 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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8
Q

rheumatoid arthritis labs

A

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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9
Q

deformities seen with rheumatoid arthritis

A

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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10
Q

tx rheumatoid arthritis

A

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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11
Q

Osteoarthritis is a ____ disease of ____ and ____

sx

A

Degenerative disease of joint cartilage and bone

Pain stiffness (hip, knee, hands)
decreased ROM, swelling, crepitus, joint enlargement and instability
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12
Q

Most common chronic condition of joints

A

osteoarthritis

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13
Q

risk factors osteoarthritis

A

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

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14
Q

Dx osteo arthritis

PE:
Radiology:

A

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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15
Q

Treatment osteoarthritis
Mild

Mod

A

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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16
Q

Lyme pathogen?

Most common ____ ____ disease

A

Borrelia burgdorferi

Most common vector-borne disease

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17
Q

lyme- tick must feed for?

A

24-48 hours

18
Q

Lyme

pt presentation in three stages

A

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)

19
Q

Lyme dx
serology, when does it show?

-

A

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 +

20
Q 
Lyme tx (meds) 
med in pregnancy: 
Resolves within?
Pain/fatigue persist for?
Symptoms longer than 6 months called?
A

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

21
Q

Anemia definition

Is anemia a disease?

Three root cases of anemia:

A 
Anemia basics: reduced oxygen carrying capacity
-not a disease, sx of another issue
	Poor RBC production
	RBC destruction
	Blood loss
22
Q 
Anemia labs
Most accurate indicator of anemia? 
Define: 
Hgb-
Hct-
MCV-
MCH-
RDW-
Reticulocyte-
Poik-
Aniso-
A

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

23
Q

Anemia often presents_____

A

asymptomatic

24
Q

S/S anemia

severe s/s anemia

A

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

25
Q

s/s pernicious anemia

A

neurological symptoms- loss of position

/vibration sense, balance, memory (can’t dx dementia without checking B12)

26
Q

Iron deficiency anemia lab findings

A

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
27
Q

Tx iron deficiency anemia

monitoring anemia improvement with lab work shows improvement with 1) 2) 3)

tx until?

A

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)
28
Q

Thalassemia
abnormal production of ___

Minor common in ___

A

Genetic defect- abnormal hgb production

Minor- most common mediterranean, middle eastern, african, asian

29
Q

Dx thalassemia

labs
definitive dx

A

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

30
Q

Sideroblastic anemia
disorder of???
how do you get it?

CBC/labs show?

A

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
31
Q

Anemia of chronic disease
associated with?

CBC/labs?

Tx?

A

Associated with inflammatory disorders, malignancy, HIV

NORMAL OR HIGH FERRITIN, normal TIBC
Can be microcytic or normocytic, normo or hypochromic

Tx: underlying conditions

32
Q

Microcytic anemias

A

IDA
Thalassemia
Sideroblast
Anemia of chronic disease

33
Q

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

A

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)

34
Q

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

Positive _____ test

A

Normal size and color, INCREASED RETICULOCYTE
Increased LDH and bili
Decreased haptoglobin

Positive coombs test- antibodies against RBC

35
Q

Metabolic anemias labs
Size?
Reticulocyte?

-
-

A

NORMAL SIZE NORMAL RETICULOCYTE

Thyroid
Addisons
Pituitary

36
Q

Renal/aplastic anemias
Size? Reticulocyte?

-
-

A

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

37
Q

Macrocytic anemias

A

b12 and folate deficiency

38
Q

Sx b12 deficiency

A 
Atrophic glossitis
Stocking/glove neuropathy
Memory loss/dementia
Depression
Irritability
Balance problems
Loss position/vibration sense
ataxia
Anorexia
Diarrhea
Weight loss
39
Q

Causes b12 deficiency

A

pernicious anemia
gastric bypass
vegetarian/vegan

40
Q

B12 anemia lab findings
Size? Color?
Reticulocyte?
Two key elevated values are?

Hypersegmented ______
Oval ______

Tx:

A

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

41
Q

Folate deficiency:
Two key values are?

Causes:

A

Methylmanolate (NORMAL) + homocysteine elevated

Dilantin, tegretol, phenobarb, azt, ETOH, dialysis, malabsorption, celiac
Replace 1mg daily

Primary care II (13 decks)

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