Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Olson Day one
Clin Med II- OA, RA, FIbromyalgia, Arthritis, Septic
| Question | Answer |
|---|---|
| Chronic widespread pain, not otherwise explained, often w/ fatigue | fibromyalgia |
| Syndrome of heightened pain perception | fibromyalgia |
| Some syndromes that may lead to sensory amplification | IBS, intersticial pain, TMJ, low back pain, HA’s, many depressive disorders |
| Criteria for Fibromyalgia | WIDESPREAD pain for >3 m, 11 of 18 tender points when palpated with enough pressure to blanch upper nail bed |
| Main tx of fibromyalgia cycle | exercise! Start small, don’t want to lose fxn |
| Is fibromyalgia genetic | No links yet, but it is environmental |
| What % of pt’s with sjogren’s syndrome may have fibromyalgia | 50%! |
| How do we asses for fibromyalgia | pain w/ tender pts. Fatigue, sleep and its quality, psych: depression w/pain, PA and exercise everyday! |
| What methods may be needed to improve sxs of fibromyalgia | tx sleep disturbance, mood disturbance, relaxation training, aerobic exercise training |
| Pharm tx | TCAs, SSRIs, SNRIs, AEDs, pain relievers: NO to chronic narcotic, muscle relaxants, sedative hypnotics, dopamine agonists |
| Use of tramadol in fibromyalgia tx | bw ASA and narcotics, |
| MOI of bone spurs | Underlying bone responds ^production of bone d/t damage of wear and tear→bone spurs or osteophytes |
| Main classification of OA | joint space narrowing |
| 5 common radiographic features of OA | Joint space narrowing, marginal osteophytes, subchondral cysts, bony sclerosis, malalignment |
| Common signs of OA | knobby PIP, DIP joints, “squaring” of the CMC thumb joint: thenar muscle wasting, pain related to use, gets worse during the day, morning stiffness, ↓ROM, bony enlargement, crepitus, restricted movement d/t bone remodeling |
| RF’s of earlier OA | Female, obesity, heredity for certain joitns, trauma, neuromuscular dysfxn, metabolic disorders: hemochromatosis |
| MC OA sites | neck, low back, hips, knees, big toe, fingers |
| Non pharm txs for OA | heat, exercises: PT, Bracing, |
| Pharm tx | APAP, NSAIDs, tramadol/opiod, CS injection, surgery: replacement |
| When do we use the thumb CMC joint brace | depending on the occupation, usually improved pain after 12m use vs 1m use |
| Topical NSAIDS | tid, ketoprofen 20% or diclofenac gel 1% |
| Tx for varus or valgus OA knees | Unloader knee brace: for young, active pt’s, $600 plus |
| When do we use hyluraonic acid injections | AKA synvisc viscosupplement, or lubricant, used when CS injections don’t work. Last step before surgery |
| Most effective tx for knee OA | quad strengthening, wt reduction |
| Supplement trial for OA | Glucosamine/Chrondroitin, try 3m if no improvement stop, an expensive supplement and varies bw pt’s |
| Tylonol and NSAIDs effect what | Tylenol: Liver, NSAIDs: Kidney |
| When will benefit seen with capsaicin | 2 wks, must use daily, and it BURNS |
| Common strong analgeisics used for OA | Tramadol, propoxyphene, codeine, hydrocodone, oxycodone |
| Pharm tx for nonsurgical canidates | morphine and fentanyl patches |
| Major cell types involved w/ RA | T lymphocytes, macrophages |
| Minor cells in RA pannus | fibroblasts, plasma cells, endothelium, dendritic cells, Neutrophils in synovial fluid |
| What is the test for RA | rheumatoid factor, + in first 6m 85% w/ established dz, Anti-CCP? More commonly used test |
| What commonly causes a + RA factor | RA, Hep C, genetic factors for genes for RA! |
| More specific RA test | CCP antibody, won’t b + w/ Hep C, |
| Firm spongy yet squishy joints | synovitis consistent w/ RA |
| What joints are NOT effected by RA | DIP, thoracic or lumbar spine, Cervical spine CAN be |
| Can you have both RA and OA | yes, can effect different/same joints, get OA with age anyway |
| Signs on XR of RA, OA | RA: erosions, bone loss: periarticular osteopenia, less dense around the bone edges, OA: sclerosis, or lightning up near edge of bone |
| d/t chronic inflammation, what happens to the MCP joints | Ulnar drift d/t laxity in the ligaments, swelling in MCP and PIP joints |
| RF’s for RA | female, heredity, HLA antigen DR-4, environment and traumatic triggers |
| Common deformities of the fingers | swan neck deformity and boutiners finger |
| Commonly form on the extensor surfaces of the affected joints | RA nodules subQ or periosteal at pressure pts |
| Inflammation where tendons/ligaments insert to bone | enthesitis |
| Thickened synovial tissue | pannus: eats away at bone underneath it |
| Do joint dz’s kill pt’s | no, the chronic inflammation of other organs kills the pt, chronic inflammation of BV’s: Ht dz |
| Associated dz’s with RA | Sjogrens: dry mouth, eyes, Schermer’s test, intersticial lung dz |
| Tx RA | Pharm within 3m dx use safest related to aggressiveness of the dz, ↓pain, inflammation, Start NSAID if applicable |
| Substitute for NSAIDS | low-dose prednisone (<10mg) but not LONG term: bridging until long term are effective |
| What do we need to remember with low dose predinisone tx | prophylactic tx for osteoporosis, ↑blood surgar: diabetics |
| Gold std for RA pharm tx | Methotrexate (MTX) |
| Can’t tolerate methotrexate use what | leflunomide |
| When is TNF elevated | RA, psoriatic arthritis, psoriatic plaques |
| The more TNF, the more what | Inflammation |
| Monitoring for RA drugs | Liver, lung, blood, kidney testing 4-8wks |
| What is gout | build up of uric acid in joints d/t overproduction or underexcreation of uric acid |
| Red hot swollen joint d/t uric acid crystals | gout: more painful acutely than RA |
| Common places of gout | extremity, unilateral, uni-joint, in cold extremities |
| Signs, sxs of gout | acute onset, asymmetric, monoarticular |
| Cause of gout | high purine diet or alcohol binge |
| MC location of gout | 1st MP joint in foot, |
| Can you dx gout from a blood test? | No must aspirate joint and test fluid for crystals |
| Swelling of big toe joint | podagra |
| Collection of uric acid that comes to the surface of the skin | tophus |
| Does gout disfigure for life? | no tx usually makes it all go away |
| What is most common w/ cause of Hyperuricemia | overproduction 10%, Underexretaion 90%: usually d/t kidney dz |
| How is uric acid formed | end produce of purine metabolism |
| Is gout autoimmune? Genetic? | genetic predisposition but not autoimmune |
| Dx of gout | synovial fluid high WBC and PMN count w/ polarized microscopy |
| Tx acute gout | NSAID, colchicine, predinisone, IA injection |
| When do we use allopurinol? | ONLY for chronic tx, lowers uric acid, DO NOT start during an acute attack, will ↑ attack and spread to another joint |
| What inhibits PMN migration | colchicine |
| When are prednisone usually used | w/ renal insufficiency, and elderly, can exacerbate diabetes |
| Non pharm tx | p ted: Beer bad, lower purine diets, meat, fish, diary, maintain hydration, D/C diuretics, wt loss, control BP |
| Pseudogout | Chondrocalcinosis: d/t calcium, common in elderly, embedded in cartilage |
| Location of pseduogout | shoulders, writs, funky shapes under microscope, |
| Difference bw gout and pseudogout | gout: uric acid, pseudogout: Calcium, embedded in cartilage on XR |
| Infection in a joint | septic arthritis |
| Common ppl who get septic arthritis | RA, DM, immunocomprimised, Trauma, Sepsis, Medical emergency |
| Dx of Septic arthritis | aspiration: milky murky, thick, high in WBC (>100,000) in infected joint, culture |
| Why is septic arthritis so critical | can cause death in 10-40% |
| Back pain and stiffness in adolescence and early adulthood, worsens w/ inactivity, ↑w/ Physical activity | ankylosing spondylitis |
| Dx of ankylosing spondylitis | limited lumbar motion, Schobar test: <20cm flexion common in men |
| A sausage shaped swelling of finger or toe | dactylitis |
| Onset of ankylosing spondylitis | prior to age 40, insidious, longer than 3m, morning stiffness, decrease w/ exercise |
| Inflammatory arthritis in DIP joints, asymmetric, sausage digits | psoriatic arthritis |
| What is pitting of the nails or onycholysis associated w/ | psoriatic arthritis |
| Triad of arthritis, urethritis, conjucivitis | Reactive arthritis or Reiter’s syndrome hx of all of these but not at same time |
| Enteropathic arthritis | ulcerative colitis and crohn’s dz |
| Tx for spondyloarthropathy dz | exercise, NSAIDS, SI and peripheral joint CS injections |
| What is TNF associated w/ | Inflammation, pain, plaque hyperproliferation, joint destruction |
Created by:
streetsmarts
Popular Clinical Skills sets