Medicine: Electrolytes/Rheumatology
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Created by:
kaylsworth on August 5, 2012
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93 terms
Terms | Definitions |
|---|---|
 SIADH Diagnostic criteria | Serum osmolality <270 Urine osmolality >Serum osmolality Urine Na> 20 mEq/L Absence of hypovolemia Normal renal, adrenal, thyroid fix No obvious surgical traumatic or painful stimulus knowto activate neurogenic stress response (ADH release) Absence of other causes of hyponatremia |
| Treatment of symptomatic hypercalcemia | IV fluids, then loop diuretic |
| Addison's disease causes what kind of acid-base disturbance? | non-anion gap hyperkalemic, hyponatremic metabolic acidosis. Can occur in the setting of TB if it invades the adrenals |
| Increased serum calcium, increased/Normal PTH in a 20 year old male also looks like ____ and how to differentiate? | familial hypercalciuric hypercalcemia 24 hour urine, creatinine excretion can distinguish from hyperparathyroidism |
| Pyloric stenosis pH and electrolytes | metabolic alkalosis, contraction alkalosis |
| Hypokalemia treatment | Membrane stabilization with calcium, shifting potassium intracellularly (with insulin and glucose), decreasing total body potassium content. |
| Cushing's disease electrolyte imbalance | Hypokalemia |
| Pregnancy acid-base disturbance | mild respiratory alkalosis (pH 7.44) due to tachypnea due to progesterone's stimulatory effect on dorsal respiratory group of medullar respiratory center |
| Hyperventilation causes which electrolyte imbalance? | respiratory alkalosis |
| trimethoprim and pentamide make which electrolyte imbalance? | Hyperkalemia |
| Lithium causes which electrolyte imbalance? | nephrogenic diabetes insipidus- euvolemic hypernatremia |
| Agents used to shift potassium intracellularly | 1) glucose and insulin 2) sodium bicarbonate 3) beta-2 agonists (albuterol) |
| Schizophrenic patient's reason for being severely hyponatremic | primary polydipsia |
| elderly mechanism of hypernatremia | due to decreased access to free water, decreased thirst |
| Salicylate intoxication metabolic disturbances (2) and mechanisms | 1) respiratory alkalosis due to tachypnea bc of stimulations of medullary respiratory center 2) Metabolic acidosis (hi anion gap) uncoupling of oxidative phosphorylation, salicylate inhibits enzymes in carb and lipid metabolism, also impair renal fuxn |
| Post-seizure acidosis due to ____? Treated with? | Lactic acid Observation- resolves in 60-90 minutes |
| Progressive hip/groin pain without limitation of range of motion, normal plain film xray...diagnosis? What study necessary? | Avascular necrosis of femoral head 2/2 corticosteroids hip MRI |
| chronic malabsorptive diarrhea, weight loss, migratory arthritis, lymphadenopathy, low grade fever... may also cause damage to CNS, eye, myocardium Diagnosed with... | Whipple's disease Small intestine biopsy and PCR- PAS positive macrophages in lamina propria with non-acid fast base gram + bacilli |
| How can hypothyroidism cause carpal runnel syndrome? | widespread deposition of mucopolysaccharides in tissues- in perineurium and within median nerve compress median nerve |
| leg pain, hearing loss, headaches.... calcium, phosphate, alk phos, and urinary hydroxyproline levels | Paget's disease (osteitis deformans) Serum Ca= nl Serum phos= nl Alk phos= hi hydroxyproline= hi |
| facial rash, arthritis, painless oral ulcers, renal disease... diagnosis? | SLE Diag w kidney biopsy, + anti-dsDNA |
| Temporal arteritis suspected... immediate treatment? | hi dose prednisone |
| hi alk phos in an otherwise healthy pt | Paget's disease |
| back pain, fevers, chills, leukocytosis | epidural abscess |
| Positive rheumatoid factor, weakly positive ANA, arthritis which is relieved by NSAIDs and lasts 2 months | viral arthritis likely due to mumps, parvo, rubella etc. |
| Proximal weakness, malar rash, violaceous eye rash | Dermatomyositis, assoc w/ internal malignancy- ovarian MC |
| Treatment of inflammatory polymyopathy (polymyositis, dermatomyositis) | corticosteroids |
| SLE nephritis mechanism | immune complexes circulate and are deposited in renal glomeruli |
| Diagnosing osteonecrosis imaging | MRI |
| Proximal muscle weakness with wasting, along with weight loss, tremor, tachycardia, normal reflexes | Hyperthyroid myopathy |
| 34 yo M w/ progressive, back pain worse at night than during day, dull and aching, associated with decreased range of motion | ankylosing spondylitis HLA B27 |
| Hydroxycholorquinolone is used for treatment of ______________ but can damage the _________. | SLE Retina |
| blue toes, abdominal pain, elevated creatinine in patient with MI... cause? | Cholesterol embolism |
| bilateral hilar adenopathy with reticulonodular infiltrates, cough, fever, dyspnea, weight loss, leukocytes in the anterior chamber of the eye in a 35 year old african american female | Sarcoidosis |
| Patients over 40 with knee pain... | osteoarthritis |
| treatment of fibromyalgia | Tricyclic antidepressant like amitriptyline if depression also present, use SSRI also |
| Straight leg test in leg pain implies... and how to treat it? | disk herniation NSAIDs, early mobilization for 4-6 weeks |
| Patients with rheumatoid arthritis are likely to develop which bone disease? | Osteoporosis and osteopenia |
| nongonococcal urethritis, oligoarthritis, conjunctivitis, mouth ulcers txt | Reactive arthritis, seronegative spondylarthropathy (formerly Reiter's) NSAIDs |
| Rheumatoid arthritis tends to affect which section of the spine? | cervical spine |
| back pain which improves as the day goes on and uveitis in a young female | ankylosing spondylitis |
| RA DMARD cause | LFT abnormalities, |
| mom lifting baby, thumb pain test to diagnose it | De Quervain Tenosynovitis Finkelstein test- passively stretch tendon |
| Age >50, aching pain in neck, shoulders, pelvic girdle, at least one month, morning stiffness over an hour, ESR >40 with no other disease that could cause these things. And treatment? | Polymyalgia rheumatica low dose prednisone (when not associated with giant cell arteritis) |
| Systemic sclerosis antibodies | Anti-topoisomerase I, also anti-nuclear antibodies |
| anti-smooth muscle antibodies | autoimmune hepatitis |
| anti-neutrophil antibodies | Wegener's granulomatosis |
| anti-mitochondrial antibodies | Primary billiary cirrhosis |
| Where do you find rheumatoid factor + in? (4) | Rheumatoid arthritis, SLE, Sjogren, dermatomyositis, HCV infections (also others) |
| On muscle biopsy of a muscle with polymyositis, what do you see? | mononuclear infiltrate surrounding necrotic and regenerating muscle fibers... at later stage may be fibrotic fibers |
| Anti-Ro, Anti-La | Sjogren's antibodies, akaAnti-SSA, anti-SSB |
| Women 20-50, generalized pain and poor sleep precipitating problems (not necessarily causes) | fibromyalgia fatigue, poor sleep, depression |
| low grade fever, localized tenderness to palpation of spine, elevated ESR...diag? modality of imaging? lab? | Vertebral osteomyelitis MRI spine blood cultures |
| pain, inflammation at sites where tendons attach to bone. Diag? genotype? | Enthesitis HLA-B27 found along w ankylosing spondylitis |
| hyperparathyroidism and monoarthritis, no fever | Pseudogout- rhomboid, positively birefringent crystals (calcium pyrophosphate dihydrate) |
| low back pain, stiffness, chest wall restriction, FEV1/FVC 80%, FRC 100% | Ankylosing spondylitis |
| Gout... best lifestyle changes (2)? | Avoid alcohol, low purine diet |
| Most effective lifestyle change in prevention of progression of DJD? | Weight loss |
| polyarthralgia, tenosynovitis, vesiculopustular lesions | Disseminated gonnorhea |
| Is serum sickness a true drug allergy? | nope. |
| X ray findings in OA Synovial fluid findings in OA | narrowed joint spaces, osteophytes Synovial fluid <2,000 WBC/nl, no organisms, no crystals |
| Gout prevention med mechanism | Allopurinol xanthine oxidase inhibitor |
| Gout prevention | allopurinol, probenecid |
| Gout flare txt | colchicine, NSAIDs, steroids |
| Young woman with lower back and sacroiliac pain > 3 mos. next step? | ankylosing spondylitis plain film |
| Erythema nodosum... next step? Why? | CT abdomen Can be in the presence of sarcoid, histo, TB, IBD |
| Low spine pain when walking, standing, relieved by lying down - NORMAL ABI. | neurologic claudication... spinal canal narrowing due to disc disease |
| Tender mass in popliteal fossa in a 45 year old female with RA | Baker's cyst= overproduction of synovial fluid |
| macrocytic anemia in a pt with rheumatoid arthritis... what are they taking? | Methotrexate nausea, stomatitis, rash, hepatotoxicity, interstitial lung dz, fever, alopecia |
| Recurrent painful oral and genital ulcers, eye lesions, erythema nodosum in turkish, asian and middle eastern ppls | Behcet's syndrome |
| First site of symptomatic gout | Big toe |
| headaches, fatigue, weight loss in 62 year old female patient with shoulder pain... what else can be a complication? what is this? | Aortic aneurysm giant cell arteritis |
| morning hand joint stiffness, dactyltis, deformity, nail involvement txt? what is CONTRAindicated? | psoriatic arthritis NSAIDs, anti-TNF agents, methotrexate systemic steroids |
| Cyclophosphamide dreaded side effect? Other terrible side effects? prevent with: | Bladder carcinoma hemorrhagic cystitis, sterility, myelosuppression MESNA (antioxidant) |
| +p-ANCA, bloody diarrhea, lower back pain, erythema nodosum in 30 year old male | Ulcerative colitis |
| paravertebral tenderness, negative leg raise test, after lifting heavy stuff | lumbosacral strain |
| Schoolteacher with MCP and PIP arthritis, no fever | ParvoB19 virus- antiB19 IGM + |
| Fatigue, painless oral ulcers, non-deforming arthritis, proteinuria, rash, hematologic abnormalities in a 20-40 year old African American female | SLE. |
| What makes rotator cuff tendonitis feel better? what test confirms it? | lidocaine injection Neer test- passive raising of arm reproduces pain |
| what does CREST stand for? | Calcinosis cutis- calcium deposits in skin Raynaud's phenomenon Esoghageal dysmotility Sclerodactyly Telangiectasias |
| Septic arthritis in a young person | Gonorrhea |
| The real name for tennis elbow | Lateral epicondylitis- pain with supination, extension of wrist, point tenderness just distal to lateral epicondyle |
| back pain radiating to buttocks and thighs reproduced by extension | lumbar spinal stenosis |
| pain in buttocks, medial thighs, SCM, trapezius and tenderness to palpation in a 20-55 yr old female, normal ESR | fibromyalgia |
| Rheumatoid arthritis treatment | Indomethacin, Methotrexate |
| sharply localized pain anteromedial tibial plateau, no reproduction of pain on valgus stress test, mb caused by a recent fall | Anserine bursitis has NORMAL Xray (no MCL strain due to (-) valgus stress test) |
| warmth, swelling in knee after trip to New York | Lyme arthritis |
| acute severe pain in absence of precipitating injury in a 75 year old woman with normal neurological exam | compression fracture 2/2 osteoporosis |
| ankylosing spondylitis for 20 yrs... fall.. back pain? | Fracture! AS-> increased fractures |
| Non-caseating granulomas, perihiar adenopathy, hi ACE...txt? | Sarcoid, obvs. Glucocorticoids. |
| Nephrotic syndrome + hepatomegaly in a 46 yo caucasian male | amyloidosis |
| Cause of paget's disease | OsteoCLAST dysfunction |
| Suspected lumbar spinal stenosis... test? | Lumbar MRI also, lumbar spinal stenosis is caused by DJD |
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