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118 Cards in this Set
- Front
- Back
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How long is morning stiffness for OA
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less then half hour
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What are common charecteristics of OA
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Pain, crepitus, tenderness, enlargement, gelling, varus deformity
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What is the most commonly visible joint enlargement on OA
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PIP and DIP
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What are the nodes associated with OA
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Bouchards, and Heberdens
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What do you see in Xray for OA
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decreased joint space, subchondral bone sclerosis and cysts
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Pain is usually due to what in OA
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osteophytes, subchondral microfractures
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Treatment for OA
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NSAIDS, APAP, Zostrix, steriod injection
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Describe what gout looks like
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Red, hot, swollen, tender
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Describe attack of gout
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Abrupt, in one joint, usually MTP
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What does lab show for gout
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negatively bifringent, monosodium urate crystals, hyperurecemia
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Presentation of pseudogout
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Similair to gout
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What do labs look like for pseudogout
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Positively bifringent, calcium pyrophosphate rhomboid shaped cyrstals, NL serum urate level
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Treatment for pseudogout
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NSAIDS, colchicine, intra articular steroids
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Treatment for gout
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NSAIDS, colchince, prebnecid, zyloprim
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Where does uric acid come from in gout?
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purines
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What accounts for hyperurecemia in gout?
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Overproduction or most likely undersecretion
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Risk factors for gout
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Obesity, alcohol, and renal failure
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What happens if gout is untreated?
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Gouty tophi, it spreads to soft tissues
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What is contraindicated in gout treatment?
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Aspirin
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How does cochicine treat gout?
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It decreases neurotrphils and blocks release of chemical junk
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Most commonly affected places in pseudogout?
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Knee or wrist
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Reiters syndrome usually occurs after
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Genitourinary, gastrointestinal and possible resp. infections
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What is SNSAs?
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Seronegative spondyloarthropathies which means that it is not associated with RF or other autoantibodies
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Which disease are SNSAs
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OA, Septic arthritis, lyme, gout, psoriatic arthritis and reactive arthritis
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What is the venereal cause of Reiters
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Chlamydia
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What is the triad for Reiters?
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Nongonococcal urethritis, conjunctivitis, and assymetric oligoarthritis
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What are the other manifestations for Reiters
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Sausage digits, enthesopathy, circinate balanitis, and keratodermal blenorrhagica (rash on palms or soles) SECK
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Treatment for Reiters
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NSAIDS, intraarticular steriods, and DMARDS
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What are the four signs of psoriasis?
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Nail pitting, pink or salmon plaques w/ white scales, auspitz, and koebner
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What treats both psoriatic arthritis and skin
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Enbrel
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What is the clinical features of psoriatic arthritis?
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Oligoarthritis, small joints (DIP, MIP and MCP), sausage digits
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What is arthritis mutilans and what disease is it associated with?
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DIP joints in Psoriatic
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What is the extra-articular involvement in Psoriatic?
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Psoriatic skin lesions, nail changes, sausage digits and enthesopathy
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What is the radiologic features of psoriatic arthritis?
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Decreased interphalangeal space and pencil in cup deformity
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Presentation of septic arthritis
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Red, hot, swollen and painful
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What causes septic arthritis?
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Bacterial joint infection by something like a joint penetrating injury, iv drug use, or sex
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what is most common cause of septic arthritis in young adults?
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Neisseria gonorrhea
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What is the synovial fluid presentation in septic arthritis?
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Increased neutros, increased protein and decreased glucose
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what diseases have high levels of WbC?
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Gout, RA (lymphs) and septic arthritis (neutro)
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Treatment for septic arthritis
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If gonococcal it is rocephin
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Is RA an inflammatory disease?
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YES
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Is OA an inflammatory disease?
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NO
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How long is morning stiffness for RA?
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greater then two hours
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What is the most commonly affected joints?
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MCP and PIP
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What are the finger deformities in RA?
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Opera glass, swan neck, boutonniere, hammar
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what are the early changes in RA
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Injury to vasculature, hyperplasia of synoviocytes, fibrin leakage, t-cells emigrate, hypertrophic synovium, pannus, destroys
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What is autoresponse of RA due to?
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Type 3 hypersensitivity; mores specifically it is RF autoantibodies to Fc portion of IgG
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what disease has CTS and what is it caused by?
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RA and caused by entrapment of the median nerve
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What is Gunyon's canal (cubital tunnel syn) syn and waht disease is it commonly associated with
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RA and it is ulnar nerve entrapment at the wrist
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What is tarsals tunnel syndrome and what disease is it commonly seen in?
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RA and it is entrapment of posterior tibial nerve
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Describe the skin changes in RA
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Rheumatoid nodules of granulomatous inflammation
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Describe ocular change in RA
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keratoconjunctivitis sicca
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Bad systemic complications associated with high RF levels
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pulmonary fibrosis, pericarditis and heart failure and renal failure
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what would an xray present like in RA?
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erosions, osteopenia, narrowing, subluxation
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Treatment for RA?
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NSAIDS, intra steriods, DMARD
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Rash associated with lymes?
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Erythema migrans
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Complications of lymes
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knee arthritis, nuchal rigidity, bells palsy, dysrhythmia
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how do you diagnose lymes
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ELISA and western blot
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Treatment for lymes
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Doxycycline
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What are the three things that will def. confirm SLE
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Buttery mallor rash, light sensitivity and rayneuds phenomenon
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what is rayneuds phenomenon associated with?
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SLE, scleroderma, rheumatoid and smokers
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Is SLE an autoimmune disease?
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YES
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Two unique ANAs to SLE
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Double stranded DNA abs and anti Sm abs
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What is the lab tests to diagnosis SLE?
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Generic ANAs, anti dsDNA and anti Sm, CRP low
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What are the manifestations for limited scleroderma?
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CREST (calcinosis, raynauds, esophageal, sclerodactyly, and telangectasis)
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Where is calcinosis most seen in limited scleroderma?
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Fingertips
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Raynauds progression in scleroderma
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White, blue to red
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What play a central role in pathogenesis of scleroderma?
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T cells (CD4 and CD8) because they activate b cells (activate auto abs), fibroblasts (causes fibrosis), and other inflammatory WBCs
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What problems are associated with diffuse scleroderma
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Skin tightness, previous history of CREST, heart, lung, kidney or GI tract problems
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What is the treatment for Raynauds syndrome with sclerderma disease
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Calcium blockers, Angiotension II blockers
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Treatment for GERD in scleroderma pt
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H2 blockers, proton pump inhibitors
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What is secondary Sjogrens
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Sjogrens with RA, SLE and systemic sclerosis
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What are the two gland dysfunctions in sjogrens
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Lacrimal and salivary
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What is the pathology of Sjogrens
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Emigrations of CD4 T cells contact ductal epithelial cells which destruct glands
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What type of hypersensitivity is sjogrens
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Type 4
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Three tests for sjogrens
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Schirmers, RoseBengal and whole salive sialometry
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Four main categories of clinical features for inflammatory myopathies (polymyositis and dermatomyositis)
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Proximal muscle weakness STAIRS AND CHAIRS, muscle enzymes, emg, and muscle inflammation
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What are the enzymes associated with polymyositis?
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AST,ALT, CPK MM and LDH
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What is rhabdomyolysis and what disease associated with?
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Urine dip is positive for hemoglobin but it is due to muscle breakdown; polymyositis
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What is the fifth clinical feature of polymocystitis?
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Skin rash (dermatomyositis)
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Four signs indicating dermatomyositis
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Shawl sign, gottron's sign (papules), heliotrope rash, and mechanics hands
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Treatment for polymyocisitis and dermatocystisit
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Steriods fuided by CPK MM monitoring and DMARDS (methotraxate)
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what is polymalgia?
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not an autoimmune disease and it is charecterized by myalgia of proximal muscle groups; no permanent muscle weakness or degeneration
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What do people with polymyalgia also develop?
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Temporal arthritis
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What labs are important for diagnosis of polymyalgia
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very high ESR of 50-100
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how is diagnosis made for polymyalgia?
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Increased ESR, good response to steriods and muscle pain and stiffness
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Group most commonly affected by polymyalgia
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White women over 50
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Treatment for polymyalgia
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With temporal arthritis is high steriods; no temporal arthritis is low steriods
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How do you diagnose fibromyalgia?
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11 out of 18 trigger points, history of affective disorders, widespread pain; exclude everything else
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What NT is increased in fibro?
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Substance P
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What is substance P?
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It is a neurotransmittor of pain in the dorsal horn of the spinal column;correlates poorly with degree of tenderness in fibro
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Describe blood flow interuption in fibro
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Decreased blood flow to thalamus and caudate nucleus
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Descrbie sleep interuption in fibro
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Alpha wave intrustion of stage 3-4 sleep
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What type of disease is sarcoidosis?
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non caseating granulomatous disease
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Describe inflammation process of sarcoidosis
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Macros arrive and are mad and they morph into squamous epitheloid cells. Then lymphos arrive and squirt cytokines onto macros to make them more mad to form multinucleated giant cells; then lymphs remain as collar and they attract mono, fibros and macros
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Immune features in sarcoidosis
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Decreased cellular immunity and increased humoral immunity
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What is the pulmonary clinical feature of sarcoidosis
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bilateral hilar and mediastinal lymphadenopathy and dyspnea
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Clinical features of skin in sarcoidosis
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Erythema nodosum which is a good prognosis and lupus pernio which is a bad prognosis
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lab diagnosis of sarcoidosis
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ACE, hypercalcemia and hypercalicuria, and positive kveim-slitzbach test (similair to PPD)
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Treatment for sarcoidosis
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Steriods, bisphosphonate and or miacalcin, colchicine, rheumatrex
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What type of fractures as associated with osteoporosis
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Pathological fx esp. of the femur head, vertrae, pelvis and distal radius
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Biggest risk factor of OP
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post menopausal life
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Xray findings for osteoporosis
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Vertebral fx, visible osteopenia
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How do you detect OP early?
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DEXA scan
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Most effective treatment for OP
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HRT
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What treatments for OP?
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Evista (no increased risk of CVD or CA), Bisphosphonates (inhibits osteoclasts), Miacalcin (increases bone density and stops bone pain)
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What causes primary op
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senile or post menopausal
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What causes secondary op
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Endocrine, neoplastia, malnutriont, drgus, immobilization long term
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Where is bone loss most abundent at in op
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where there is lots of trabeculae
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What disease is Doc my hat don't fit no more
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Pagets
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Three things that are clinical manifestations of Pagets
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bone pain, enlarged and or deformed bones, chalkstick fractures
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What two labs are abnormal in pagets
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Urine calcium and hydroxyproline elevated and alkaline phosphatase is elevated, increased alkaline phosphatase
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What do the xrays look like in pagets
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More radiopaque bone in some areas and less white bone in other areas
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What major microsocopy is seen in pagets
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WOVEN bone
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What are the complications from pagets
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Bone Hypervascularity which has increased CO, back pain and radiculopathy, and entrapment of the cranial nerves for cranial neuropathy
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Treatment for pagets
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Bisphosphonate (fosamax)
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What two disease have pathological fractures
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OP and pagets
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three phases of pagets
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Primary osteolytic phase involves osteoclasts, mixed phase has absorption and formation together, and osteosclerotic phase is new bone formation
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