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health assessment and primary care > thyroid, musculoskeletal, derm, psych > Flashcards

thyroid, musculoskeletal, derm, psych Flashcards

1
Q

hyperthyroidism
-etiology
-sx

A
  1. Grave’s disease: autoimmune condition; excess thyroid hormone caused by antibodies that stimulate TSH receptors
  2. Thyroiditis: group of inflammatory diseases (usually self limited)

SX:
-increased appetite, weight loss
-irritability, nervousness, sleep disturbances
-heat intolerance exertional SOB
-palpitations
-eye irritation, vision changes
-diarrhea
-amenorrhea, infertility

PHYSICAL:
-enlarged thyroid gland
-hyperfelxia
-tachycardia

Grave’s: exopthalamos/proptosis and pretibial myxedema (non pitting thickening of skin)

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2
Q

best test for diagnosing hyperthyroidism?

lab resuls?

A

TSH!! best initial test for dgx

-Free T4 is usually elevated, serum t3 elevated (most useful when T4 is normal, TSH is low and patient is symptomatic)
-TSH is low
-antithyroid peroxidase (anti-TPO): may be detected in Grave’s disease
-radioactive iodine (RAI) scan with uptake if clinical presentation is not diagnostic of Grave’s disease (uptake increased in Graves, but decreased in thyroiditis)

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3
Q

antithyroid drugs/treatment for hyperthyroidism
1. thionamides (PTU)

  1. RAI therapy
A
  1. PTU: permanent remission in half of patients in 15-20 years
    -clinically euthyroid in 4-8 weeks

*monitor CBC, LFTs, should be treated in pregnancy, PTU first trimester and Methimazole in second

  1. RAI therapy: damages functioning thyroid tissue, reduces symptoms in 6-12 weeks; SE: hypothyroidism in 70% of patients; NOT ok in pregnancy- avoid pregnancy 6-12 months after RAI
  2. beta blockers
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4
Q

management of thyroiditis- often no treatment required but may need…

A

NSAIDs for pain/inflammation

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5
Q

s/sx of thyroid storm
-educate patients on this!

A

exacerbations of hyperthyroidism; acute, life threatening

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6
Q

hypothyroidism
-TSH
-Free t4
-antithyroid peroxidase)

A

-deficient level of thyroid hormone

  1. primary thyroid failure: Hashimoto’s (autoimmune), previous RAI treatment, surgery
    -TSH will be high, Free t4 will be low, + antithyroid peroxidase in Hashimoto’s
  2. secondary: pituitary or hypothalamic disease
    -TSH will be low or normal, free T4 will be low
  3. transient

subclinical hypothyroidism: TSH is high, Free T4 is normals

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7
Q

symptoms of hypothyroidism (think: low and slow)

A

-lethargic, weak
-dry skin, pallor
-slow speech, forgetfulness
-constipation
-amenorrhea, infertility
-weight gain

PHYSICAL: thyroid gland may be normal, diminished reflexes, skin cool, bradycardia, diminished bowel sounds,

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8
Q

T/F women with + TPO antibodies (even when euthyroid) have increased risk for recurrent miscarriage with or without infertility

A

true

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9
Q

management
-primary hypothyroidism

A

NEED LIFELONG TREATMENT
-Levothyroxine: synthetic T4
-dose adjusted every 6 weeks
-safe in pregnancy: measure TSH every 4-6 weeks in pregnancy and adjust dose as needed on trimester-specific TSH levels

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10
Q

treatment of subclinical hypothyroidism
-treat if TSH greater than…

A

TSH > 10–> tx
TSH 5-10 with elevated anti-TPO: also tx

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11
Q

T/F untreated hypothyroidism is asx with LBW, PTD, pp hemorrhage

A

true

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12
Q

low back pain
-acute vs chronic
-lumbosacral vs herniated intervertebral disc
-sxs

A

acute (<3 months), chronic, recurrent

etiology:
-lumbosacral strain from stretching, tearing muscles, tendons, ligaments, due to trauma or repetitive mechanical stress; SX: pain located in lower back and butt, sharp, spasms/achey, pain aggravated by standing/flexion, RELIEVED W/ REST
-lumbosacral physical findings: increased pain with back flexion, negative SLR, normal neuro exam

-herniated intervertebral disc causes nerve root compression, resulting in pain below the knee and other neuro signs and symptoms; SX: pain in butt that radiates to lower extremity, sharp, burning shooting, pain increased with bending and maneuvers that increase intra-abdominal pressure like straining for BM, also asx with numbness and tingling
-herniated physical findings: increased pain with back flexion, POSITIVE STRAIGHT LEG RAISE: radicular pain when leg is passively raised

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13
Q

most common disc ruptures involve the L5 or S1 nerve roots
1. L5 root/L4-5 disc
2. S1 rot/L5-S1 disc

A
  1. L5 root/L4-5 disc: pain/numbness lateral calf; weakness of dorsiflexion of great toe; decreased sensation anterior/medial dorsal foot
  2. S1 rot/L5-S1 disc: pain in buttocks, lateral leg, and malleolus, numbness in lateral foot and posterior calf; weakness of plantar flexion/tiptoe walking, diminished achilles reflex
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14
Q

Cauda equina syndrome

A

-characterized by saddle anesthesia, bladder or bowel incontinence, muscle weakness
-immediate referral to neurosurgery

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15
Q

“red flags” with back pain

A

fever, chills, weight loss, recent-onset bladder/bowel dysfunction, lower extremity sensory or neuro deficit

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16
Q

radiograph of lumbosacral spine is only indicated when…

A

-suspicious of fracture
-suspicious of malignancy (pt > 50 years old with persistent bone pain unrelieved by bed rest; hx of malignancy)

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17
Q

MRI or CT is recommended for…

A

suspected disc herniation

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18
Q

nonpharm management and pharm for low back pain

A

NONPHARM: continue daily activities, apply heat/warm baths, physical therapy, low-stress exercises

PHARM
-NSAIDS
-muscle relaxants (Cyclobenzaprin/Flexeril): may cause somnolence, potentiates alcohol and other CNS depressants
-opioids as last resort; no more than 72 hours/3 days

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19
Q

Osteoarthritis
-definition
-SXs
-physical findings

A

noninflammatory joint disease characterized by degeneration of articular cartilage with new bone formation at articular surface

joints commonly involved: distal and proximal interphalangeal joints of hands, hips, knees, and cervical and lumbar spine

can be primary of secondary

SX: gradual onset of joint pain, pain aggravated by join use and subsides with rest, morning stiffness that last less than 30 minutes, ASYMMETRICAL
-bone ends thicken and osteophytes or spurs form

Physical Findings: effusions with minimal warmth/erythema, enlargement of DIP joints (Herberden’s nodes), enlargement of PIP joints (Bouchard’s nodes), CREPITUS with joint movement

20
Q

risk factors for osteoarthritis

A

-increasing age
-female
-obesity
-major joint trauma
-repetitive joint stress

21
Q

diagnostic tests/findings
1. radiography

-4 cardinal radiology features?

A

-radiography will not demonstrate deterioration of cartilage
4 cardinal radiology features:

  1. narrowed joint space
  2. sclerosis of subchondral bone
  3. bony cysts
  4. osteophytes
22
Q

diagnostic joint fluid aspiration
-only if joint effusion

-other labs?

A

-synovial fluid analysis: WBC count < 2000, negative cultures, negative for crystals

rule out RA: with RF/ANA, CBC

23
Q

management of osteoarthritis
-nonpharm
-pharm

A

nonpharm: appliances, exercise, yoga, TENNS

pharm: acetaminophen, Tramadol, NSAIDs, topical analgesic, intra-articular injection (glucocorticoids, hylauraonic acid)

24
Q
A

low bone mass and structural deterioration of bone tissue, leading to increased risk of hip, spine, and wrist fracture

25
osteopororsis risk factors
-increasing age -female -lifestyle: low calcium intake, alcohol (>3 drinks/day), current cigarette smoking, Vit D deficiency, high salt intake, inadequate physical activity, immobilization, falling, prior hx of osteoporotic fracture, thin, low BMI -genetic: parental hx of hip fracture -anorexia nervosa and bulimia -diabetes mellitus -meds: glucocorticoids (long term se), aromatase inhibitors
26
loss of height of...
>1.5 cm could indicate osteoporosis kyphosis "hunchback"
27
Bone mineral density tests -normal -osteopenia -osteoporosis
-normal: BMD within 1 SD of a young adult women; T score above -1.0 -osteopenia (low bone mass): BMD between 1 and 2.5 SD of young normal adults' T score between -1 and -2.5 -osteoporosis: BMD 2.5 SDs or more below that of young normal adults; T score at or below -2.5
28
Vertebral Fracture Assessment (VFA) should be considered in women who are: (3)
1. 70 or older and BMD T score is at or below -1 2. 65-59 if BMD T score is at or below -1.5 3. post menopause with low trauma fracture during adulthood, historical height loss of 4 cm or more, prospective height loss of 2 cm or more, recent or ongoing long term glucocorticoid treatment
29
what is the FRAX score used to?
calculates 10 year probability of hip fracture and 10 year probability of a major osteoporotic fractures used to make decisions regarding medications for postmenopausal women with osteopenia
30
mangement/tx -non pharm: prevention
a. adequate intake of calcium and vitamin d: 12000 mg Calcium and 800 IU of vitamin D/day b. regular weight bearing exercises (thirty minutes three to four times each week) c. strength training d. fall prevention strategies
31
pharm interventions should be considered for postmenopausal women presenting with any of the following: (3)- consider T score, fracture probability
1. hip or vertebral fracture 2. T score of -2.5 or less at femoral neck or spine 3. T score between -1.0 and -2.5 at femoral neck or spine and 10 year probability of hip fracture of 3% or greater or a 10 year probability of major osteoporotic-related fracture of 20% or greater based on FRAX
32
PHARM FOR OSTEOPOROSIS 1. estrogen/hormone therapy 2. bisphosphonates 3. estrogen agonist/antagonists (SERMS)
1. estrogen/hormone therapy: short term (<5 years) for prevention if patient needs treatment for VMS or vulvovaginal atrophy; not approved tx for existing osteoporosis 2. bisphosphonates: Alendronate; indicated for prevention and treatment; inhibits osteoclast activity; PT EDU: must sit upright for 30 minutes after taking it, take on empty stomach (interacts with calcium and antacids) 3. estrogen agonist/antagonists (SERMS): Raloxifene (Evista); indicated for prevention and treatment; may cause hot flashes and leg cramps 4. Denosumab (Prolia) tx of postmenopausal women with osteoporosis at high risk for fracture; subq admin every 6 months; ok to use if they are using aromatase inhibitor for breast cancer 5. calcitonin: indicated for treatment ONLY; increased risk of malignancy **- NOT TO BE USED AS FIRST LINE and must be use LESS THAN 6 months -directly inhibits bone resorption of calcium 6. Parathyroid hormone: PTH approved for tx if patient is at high risk for fracture 7. Humanized monoclonal antibody (IGG2), Romosozumab (Evenity) -12 doses
33
monitoring pharm therapy effectiveness in osteoporosis patient -BMD -repeat test every... -urine/serum biochemical markers
-baseline BMD before onset of therapy -repeat test every... 2 years -urine/serum biochemical markers: only as adjunt
34
criteria for fibromyalgia a. widespread pain index b. symptoms present for at least... c. exclusion d. WPI 3. SS scale score
a. widespread pain index: score of 7 or greater and symptom severity (SS) scale score of 5 or greater or WPI of 3-6, SS scale score of 9 b. symptoms present for at least...3 months c. exclusion of other disorders d. WPI: number of areas in which patient has had pain over the last week (0-19) 3. SS scale score: presence and severity of fatigue, waking unrefreshed, cognitive symptoms over past week (0-12)
35
FDA-approved drugs to tx fibromyalgia a. gamma aminobutyric (GABA) analogue b. SNRIs
a. gamma aminobutyric (GABA) analogue: Pregabalin (Lyrica) b. SNRIs: Cymbalta both cause CNS depression
36
strain vs sprain
strain- injury to muscle or tendon; temporary weakness, pain with stretching sprain- stretching or tearing of ligaments; marked swelling and loss of function RICE: rest, ice, compression, elevation
37
Headaches (primary) 1. migraine headaches 2. tension headaches 3. cluster headaches
1. migraine headaches a. migraine with aura/classic migraine: aura consist of focal neuro symptoms that may precede or accompany HA (flashing lights, difficulty focusing) b. unilateral tendency, lasts 4-72 hours, moderate to severe intensity, throbbing, pounding, N/V, photophobia, phonophobia, fatigue 2. tension headaches; most common form of headache a. gradual onset, bilateral, diffuse, dull, pressure, episodic = less than 15/month, can last hours to days 3. cluster headaches a. abrupt onset, unilateral, retro-orbital, usually 35-40 minutes, asx with facial pain, nasal congestion, occurs in CLUSTERS lasting a few weeks
38
headache phases 1. prodrome 2. aura 3. early and late stages of migraines 4. postdrome
1. prodrome: occurs 24 hours prior to onset of HA: fatigue, euphoria 2. aura 3. early and late stages of migraines 4. postdrome: individual feels "wiped out", fatigued
39
headache "red flags" suggesting secondary cause
-headache beginning after 50 -sudden onset, worse HA ever -headaches increasing in frequency or severity -headache initiated by exertion: coughing or straining -focal neurologic symptoms that do not resolve within 60 minutes of headache onset -headache subsequent to head trauma -systemic illness/fever (meningitis)
40
what lab needs to be drawn on all patients with new onset headaches older than 40 years to rule out temporal arteritis?
erythrocyte sedimentation rate
41
CT/MRI is only indicated when...
there is persistent focal neuro findings or history of trauma
42
migraine abortive therapy -first line 1. mild to moderate 2. moderate to severe
1. first line: a. NSAIDs, acetaminophen b. Combination analgesics: acetaminophen 250 mg/aspiring 250 mg/ caffeine 65 mg- one table every 6 hours 2. first line: moderate to severe a. sumatriptan, zolmitriptan: may initially cause tightness of throat/chest, flushing, numbness, tingling; some concerns about use in pregnancy
43
second line migraine abortive therapy
ergotamines -do NOT give with triptan -CI during pregnancy
44
Migraine headache- prophylactic therapy should be considered in patients who...
...who experience more than two severe headaches per month, need acute tx more than two times per week, or are unable to tolerate abortive agents 1. beta blockers 2. CCB- Verapamil 3. Anti-epileptic agents- Valproic acid (Valproate)
45
Tension- episodic vs chronic tx
EPISODIC: -NSAIDs, acetaminophen -combination caffeine, butabital, acetaminophen CHRONIC -TCAs -SSRIs

health assessment and primary care (5 decks)

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