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OPT 537 > Exam 1 -- Randomized List of All Exam 1 Flashcards -- part 2 > Flashcards

Exam 1 -- Randomized List of All Exam 1 Flashcards -- part 2

1
Q

What is the typical age of onset for ankylosing spondylitis?

A

Late teens to early 30s

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2
Q

True or false: all biologic drugs for RA are safe to use in pregnancy

A

False; none of them are safe to use during pregnancy

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3
Q

What is a normal value for an ESR?

A

For males: less than half their age in years; for females, less than half of (their age in years + 10)

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4
Q

What ocular effects can occur with RA?

A

Dry eye, episcleritis, scleritis, scleromalacia perforans, PUK (peripheral ulcerative keratitis; abnormal bacterial ulcers)

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5
Q

Which biologic drug can be used to treat Juvenile Idiopathic Arthritis?

A

Tocilizumab

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6
Q

Which vasculitis conditions are considered to be large vessel conditions?

A

Giant cell arteritis, polymyalgia rheumatica, Takayasu arteritis

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7
Q

How does cyclophosphamide work?

A

Suppresses B and T cell function by 30-40%

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8
Q

The spondyloarthropathy conditions typically present _____________ (bilaterally/unilaterally).

A

Unilaterally

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9
Q

Which gender has a higher prevalence for reactive arthritis?

A

Male

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10
Q

Up to ___________% of lupus patients will have ocular involvement

A

30

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11
Q

What joints are most commonly involved in lyme arthritis?

A

Knee, ankle, elbow, wrist

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12
Q

True or false: symptoms of lupus can be exacerbated by UV light and also by stress

A

True.

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13
Q

Interleukin-1 (IL-1) is produced by what type of cell?

A

Activated macrophages

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14
Q

What is the role of SAA?

A

Recruits immune cells to inflammatory sites; induces enzymes that degrade ECM; is also associated with cancer (especially breast) and RA

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15
Q

What are the main symptoms of polyarteritis nodosa?

A

Fever, malaise, weight loss, kidney failure, livedo reticularis*, abdominal pain, MI and heart failure, gangrene, neuropathy, purpura, ulcers, liver failure, large joint arthritis

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16
Q

Which gender has the higher prevalence of polyarteritis nodosa?

A

Male (2:1)

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17
Q

In addition to elevated uric acid levels, what else must occur to trigger gout?

A

Trauma or inflammation

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18
Q

The symptoms of RA can be similar to the symptoms of an infection. How long do the symptoms of RA last?

A

More than 6 weeks (longer than symptoms from an infection)

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19
Q

What effects can relapsing polychondritis have in the ears?

A

Cauliflower ear, floppy ear, hearing loss

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20
Q

What is another term for the bending of the spine that occurs in ankylosing spondylitis?

A

Kyphosis

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21
Q

How many patients with ankylosing spondylitis test HLA B27 (+)?

A

90-95%

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22
Q

What systemic effects may be present in the heart of a patient with RA?

A

Coronary artery disease (CAD), myocarditis (inflammation of muscles around the heart), atrial fibrillation (abnormal heartbeat)

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23
Q

How would you treat giant cell arteritis?

A

40-60mg oral prednisone (IV methylprednisolone if very severe), low dose aspirin as an anti-platelet, can add concurrent methotrexate or cyclophosphamide if patient isn’t responding to steroids or doesn’t tolerate high-dose steroids)

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24
Q

How would you treat Kawasaki disease?

A

Single, high-dose IV Ig, aspirin daily 200-300 mg

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25
Q

Up to ___________% of lupus patients will have lung involvement.

A

50

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26
Q

Which Ig is found in bodily fluids (tears, saliva, breast milk, etc.)?

A

IgA

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27
Q

What percentage of Sjogren’s patients are ANA (+)?

A

70-80%

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28
Q

What percentage of patients with Sjogren’s experience arthralgia?

A

50%

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29
Q

True or false: systemic sclerosis affects only the skin

A

False; it can affect the internal organs as well

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30
Q

Patients with untreated chlamydia infection have what percentage chance of developing reactive arthritis?

A

4-8%

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31
Q

True or false: patients with enthesis-related Juvnile Idiopathic Arthritis are usually RF (+)

A

False; they are usually RF (-)

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32
Q

Patients with what conditions have an increased risk of gout?

A

Psoriasis and psoriatic arthritis

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33
Q

What percentage of normal patients are ANA (+)?

A

15%

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34
Q

What is the upper limit of how long a corticosteroid should be used?

A

About 3 months

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35
Q

Polymyalgia rheumatica is characterized by sudden stiffness and severe pain in what parts of the body?

A

Neck, shoulders, and hips

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36
Q

What symptoms might accompany acute rheumatic fever?

A

Carditis, CNS involvement (psychosis), subcutaneous nodules, multiple skin rashes

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37
Q

Articular cartilage is made of what type of collagen?

A

Type 2

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38
Q

Patients with psoriatic Juvenile Idiopathic Arthritis are typically RF ______________(positive or negative)?

A

Negative

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39
Q

By what method do CD8+ cells cause damage?

A

They themselves release perforin and granzymes

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40
Q

True or false: smoking, obesity, and heavy coffee drinking are all considered risk factors for RA

A

True.

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41
Q

How many joints must be affected in order to diagnose a condition as RA?

A

More than 3

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42
Q

True or false: oligoarticular Juvenile Idiopathic Arthritis affects girls and boys equally

A

False; girls are more affected than boys

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43
Q

What type of modified macrophage is found in gramulomatous inflammation?

A

Epithelioid cells

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44
Q

Which proteins have elevated levels during acute phase reaction?

A

C-reactive protein (CRP), fibrinogen, serum amyloid A (SAA)

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45
Q

How long do patients take to respond to hydroxychloroquine treatment?

A

3-6 months

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46
Q

How long do patients take to respond to sulfasalazine treatment?

A

3-6 months

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47
Q

True or false: patients with Sjogren’s have less dental cavities than the rest of the population

A

False; they have more

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48
Q

Extracellular fluid is made of what components?

A

Collagens, elastins, glycoproteins, proteoglycans, and cells

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49
Q

The muscle weakness of polymyositis and dermatomyositis is usually in which areas of the body?

A

Hips and shoulders

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50
Q

Inflammation in ankylosing spondylitis generally occurs in which joints?

A

Sacroiliac joints

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51
Q

Which ethnicities have a higher prevalence of lupus?

A

African and Caribbean (1 in 250)

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52
Q

What is the average age of onset for giant cell arteritis?

A

72 (onset is rare below age 50)*

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53
Q

What percentage of patients with reactive arthritis experience complete recovery within 6 months?

A

70%

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54
Q

How does UV phototherapy work for patients with psoriatic arthritis?

A

An enhancing agent (Psoralen) is ingested. Upon exposure to UV light, this agent helps the body to absorb the UV-A or UV-B light, which is supposed to decrease the inflammatory response

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55
Q

True or false: Type IV reactions are a function of T cells, not antibodies

A

True.

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56
Q

What percentage of patients with microscopic polyangitis are ANCA (+)?

A

70%

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57
Q

What percentage of lupus patients experience myalgia?

A

About 50%

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58
Q

True or false: patients with systemic sclerosis can get nail pitting and dactylitis

A

True.

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59
Q

True or false: azathioprine and leflunomide (DMARDs) are safe to take during pregnancy

A

False.

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60
Q

How would you treat tenosynovitis?

A

Split, corticosteroid injection, surgery

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61
Q

How many patients with systemic sclerosis experience a renal crisis?

A

10%

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62
Q

What is another name for Type IV hypersensitivity?

A

Cell-mediated (or delayed)

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63
Q

True or false: less common symptoms of giant cell arteritis include peripheral muscle weakness and respiratory difficulty

A

True.

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64
Q

The lipoxygenase pathway results in the production of what products?

A

Leukotrienes (5-LO) and lipoxins (5-LO then 12-LO)

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65
Q

What symptoms may be indicative of Juvenile Idiopathic Arthritis?

A

Symmetric joint pain, fever, rash

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66
Q

In delayed-type hypersensitivity, which T cell is responsible for the reaction?

A

CD4+

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67
Q

What is a side effect of probenecid?

A

Kidney stones

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68
Q

How is microscopic polyangitis differentiated from granulomatosis with polyangitis?

A

Microscopic polyangitis has no inflammatory granulomas in the lung

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69
Q

What tests can be performed to screen for polymyositis and dermatomyositis?

A

Chest x-ray, muscle biopsy, MRI

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70
Q

What mnemonic can help you remember some of the common symptoms of reactive arthritis?

A

Can’t see, can’t pee, can’t dance with me. (Uveitis, urethritis, lower limb arthritis)

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71
Q

How does doxycycline work?

A

It inhibits MMPs, TNF, T cells, and cytokines

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72
Q

What are some of the side effects of sulfasalazine use?

A

Nausea, rash, reversible infertility in males

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73
Q

Microscopic polyangitis is associated with what specific form of ANCA?

A

P-ANCA*

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74
Q

Giant cell arteritis often occurs with what other large vessel vasculitis?

A

Polymyalgia rheumatica

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75
Q

What medications can be used for osteoporosis?

A

Bisphosphonates (ibandronate q1mo, aldendronate q1week), estrogen therapy (raloxifene)

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76
Q

Where can rheumatoid nodules be found?

A

Toes, elbows, knuckles, spine, lungs, heart, liver, skin

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77
Q

What are possible treatment options for a patient with RA?

A

Physical therapy, NSAIDs, corticosteroids, DMARDs

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78
Q

Raynaud’s phenomenon is most commonly associated with what condition? Which other conditions can it be associated with?

A

Systemic sclerosis; lupus and Sjogren;s

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79
Q

In granulomatosis with polyangitis, lesions occur in what parts of the body?

A

Lungs/respiratory tract, kidneys, skin (purpura, subcutaneous nodules)

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80
Q

How would you treat Takayasu arteritis?

A

45-60 mg oral prednisone, methotrexate, azathioprine, TNF agents, cyclophosphamide, bypass grafts, low dose aspirin

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81
Q

True or false: rheumatoid arthritis is the most common type of autoimmune arthritis

A

True.

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82
Q

What are some treatment options for Raynaud’s?

A

Decrease vasoconstrictors (smoking), take vasodilators, treat any underlying disease with DMARDs

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83
Q

What percentage of IBD patients have Type 2 enteropathic arthritis?

A

3%

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84
Q

The spondyloarthropathy conditions typically involve the _____________ (axial/peripheral) joints.

A

Axial

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85
Q

Which complement molecules act as chemoattractants?

A

C5a and C5-C7 complex

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86
Q

What is dysplasia?

A

Disorderly proliferation of cells (but not neoplastic); sometimes called precancer

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87
Q

What percentage of patients with granulomatosis with polyangitis test ANCA (+)?

A

95%

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88
Q

True or false: rheumatoid arthritis presents bilaterally and symmetrically

A

True.

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89
Q

What ocular symptoms can occur in giant cell arteritis?

A

Blurred vision, monocular transient vision loss, APD, swollen or pale optic nerve, diplopia, CRAO, visual field loss

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90
Q

How would you treat a mild case of granulomatosis with polyangitis?

A

Prednisone, methotrexate

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91
Q

The biologic drugs have what type of suffix?

A

“-mab”

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92
Q

Secondary osteoporosis can be caused by what conditions?

A

Corticosteroids, hyperthyroidism, hyperparathyroidism

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93
Q

What are two examples of Type II reactions involving opsonization and phagocytosis?

A

Hemolytic anemia; transfusion hemolysis

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94
Q

Up to ___________% of lupus patients will have heart issues.

A

25

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95
Q

How does the enthesis (end of a bone) differ from the shaft of the bone?

A

The enthesis is more porous and is vascularized; the shaft is denser and avascular

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96
Q

Polyarticular Juvenile Idiopathic Arthritis is more common in what gender and age groups?

A

Girls age 2-5 or 10-14

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97
Q

What actions are the end result of the kinin cascade?

A

Vasodilation, increased vascular permeability, bronchial constriction, PGI2 and NO release

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98
Q

Which populations have a higher incidence of RA? Which have a lower incidence?

A

White and hispanic; African American and Chinese

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99
Q

What is/are the actions of IL-1?

A

Activates vessel endothelium to increase WBC adhesion (activates selectins and integrins), enhances the production of AA and NO (?)

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100
Q

Which vasculitis conditions are considered to be medium vessel conditions?

A

Polyarteritis nodosa, Kawasaki disease

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101
Q

What percentage of patients with granulomatosis with polyangitis are ANCA (+)?

A

90%

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102
Q

What are the main symptoms of EGPA?

A

Rhinitis, asthma, peripheral neuropathy, skin lesions, GI bleeding

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103
Q

Which biologic drug for RA is approved for children?

A

Tocilizumab

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104
Q

Attacks of gout may be separated by what length of time?

A

2-3 years

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105
Q

True or false: African Americans are affected more with giant cell arteritis than are Caucasians

A

False; Caucasians are more often affected

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106
Q

What is another name for tenosynovitis?

A

Trigger finger

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107
Q

Which gender has a higher prevalence of psoriatic arthritis?

A

Neither; prevalence is equal between the genders

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108
Q

Mast cells release what types of molecules?

A

Histamine and AA metabolites

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109
Q

True or false: hydroxychloroquine is safe to take during pregnancy

A

True.

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110
Q

Treatment of conditions involving the joints can consist of different classes of drugs. What class is meant to treat the actual condition, not just relieve the pain?

A

DMARDs (including biologics and tetracyclines)

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111
Q

What is the typical age of onset for psoriatic arthritis?

A

30-50 years

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112
Q

What cell types are associated with chronic inflammation?

A

Lymphocytes and macrophages

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113
Q

Giant cell arteritis increases risk of what type of aneurysm?

A

Aortic

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114
Q

True or false: oligoarticular Juvenile Idiopathic Arthritis usually doesn’t cause lasting harm.

A

True.

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115
Q

Rheumatoid factor is associated with what Ig? Which portion of which other Ig does it target?

A

IgM; Fc portion of IgG

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116
Q

What are some symptoms of polymyositis and dermatomyositis?

A

Muscle weakness, dysphagia, polyarthritis, Raynaud’s phenomenon, interstitial lung disease, myocarditis

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117
Q

True or false: uveitis is more common in Juvenile RA than in RA.

A

True.

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118
Q

What is the prevalence of gout in the U.S.?

A

2.70%

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119
Q

How many joints are affected in polyarticular Juvenile Idiopathic Arthritis?

A

More than four

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120
Q

What age group is most commonly affected by Kawasaki disease?

A

Under 5 years

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121
Q

What gender and demographic is common for patients with Behcet’s disease?

A

Young men of Middle or Far East descent

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122
Q

True or false: Pacific Islanders have a higher prevalence of gout

A

True.

123
Q

How would you treat a mild case of microscopic polyangitis?

A

Prednisone, methotrexate

124
Q

True or false: osteoarthritis is the most common type of arthritis

A

True.

125
Q

True or false: patients with fibromyalgia have a higher than normal pain tolerance

A

False; their pain tolerance is less than normal

126
Q

What sort of ocular findings might a patient with granulomatosis with polyangitis have?

A

Proptosis, uveitis, scleritis, episcleritis

127
Q

What is the name for a spondyloarthropathy following an infection?

A

Reactive arthritis

128
Q

Matrix Metalloproteinases (MMPs) 2 and 9 degrade CT. What specific portions of the ECM do they degrade?

A

Collagen, proteoglycans, and fibronectin

129
Q

Renal failure is very common gout patients who also have what other conditions?

A

Diabetes, CKD, HTN, obesity

130
Q

What is/are the actions of interferon-gamma (IFN)?

A

Limits spread of inflammatory process, activates macrophages and neutrophils, stimulates synthesis of NO, protects against viral infection (inhibits viral replication), induces production of IgG from plasma cells

131
Q

HLA B27 is present in what percentage of anterior uveitis cases?

A

20-40%

132
Q

What are the two types of Type IV reactions?

A

Delayed-type hypersensitivity (DHT); T-cell mediated cytotoxicity

133
Q

What is the result of serotonin release during the inflammatory response?

A

Vasodilation and easier clot formation

134
Q

True or false: using two biologic drugs is completely safe for treatment of RA

A

False; it decreases the immune response too much

135
Q

Apart from pain, what are some symptoms of polymyalgia rheumatica?

A

Fatigue, weight loss, malaise, night sweats, bursitis, pitting edema

136
Q

True or false: pregnancy can be protective against RA.

A

True.

137
Q

True or false: migratory arthritis is the earliest manifestation of acute rheumatic fever

A

True.

138
Q

True or false: methotrexate is safe to take during pregnancy

A

False.

139
Q

What type of adhesion molecule causes slowing of WBC movement along the vessel wall?

A

Selectin

140
Q

What is amyloidosis?

A

Incorrectly folding proteins that can cause nodules inside the body

141
Q

What would you test for in a patient you suspect of having lyme disease?

A

B. burgdorferi, ESR, CRP

142
Q

What is the action of lipoxin?

A

Vasodilation, inhibition of neutrophil chemotaxis, stimulation of monocyte adhesion (?)

143
Q

What percentage of patients with Behcet’s disease experience ocular symptoms?

A

33%

144
Q

Juvenile Idiopathic Arthritis presents with symmetric or asymmetric joint pain?

A

Symmetric

145
Q

How long do DMARDs take for their full effect?

A

6 weeks to 6 months

146
Q

True or false: the tapering of corticoteroids in treating giant cell arteritis can take years

A

True.

147
Q

Which complement molecules form the MAC?

A

C5b, C6-C9

148
Q

A patient is tested for ANCA. If the patient only has polyarteritis nodosa, are they likely to test ANCA (+) or ANCA (-)?

A

ANCA (-)

149
Q

By what percentage can dietary restriction reduce serum uric acid?

A

15%

150
Q

Which cytokines are the most important in acute phase reaction?

A

TNF, IL-1, IL-6

151
Q

What systemic effects may be present in the kidneys of a patient with RA?

A

Chronic kidney disease (CKD)

152
Q

What are treatment options for Juvenile Idiopathic Arthritis? Which one should be used with caution?

A

NSAIDs, DMARDs, TNF modulators, oral steroids with caution (interfere with bone growth)

153
Q

How does cyclosporine work?

A

It inhibits IL-1 and IL-2 and T cells

154
Q

What percentage of systemic sclerosis patients are RF (+)?

A

30%

155
Q

What is the main characterizing symptom of gout?

A

Podagra (pain, redness, and swelling in big toe at MTP)

156
Q

What sort of systemic findings might a patient with Sjogren’s have?

A

Arthralgia, RA, lupus*, thyroid disease, MG, hepatitis, pulmonary fibrosis, vasculitis, Raynaud’s phenomenon

157
Q

Which gender has a higher prevalence of gout?

A

Male (10:1)

158
Q

What can cause pseudogout?

A

Trauma or increased iron uptake

159
Q

What causes tenosynovitis?

A

Repetitive use, RA, injury, genetics

160
Q

After fibrin has formed a clot, which molecule has the potential to break it down?

A

Plasmin; its precursor, plasminogen, entered the area with the fibrinogen and is activated by the endothelium once this has healed

161
Q

What are some side effects of febuxostat?

A

Cardiovascular risk factors

162
Q

Briefly outline a Type III reaction.

A

Ag-Ab complex deposits in tissue and activates complement system; inflammation and tissue damage occur

163
Q

Tophaceous gout is caused by what?

A

Inflammation adjacent to urate crystalsin synovium

164
Q

What is the general age of onset for relapsing polychondritis?

A

Greater than 40 years

165
Q

What is another term for “sausage digits?”

A

Dactylitis

166
Q

Imbalances in which factors contribute to the degeneration of tissue in osteoarthritis?

A

MMPs, IL’s, TNF-alpha, and VEGF all increase, IGF decreases

167
Q

What percentage of patients with microscopic polyangitis have glomerulonephritis?

A

60-90%

168
Q

What are some side effects that can arise from corticosteroid use?

A

Osteoporosis, diabetes, HTN, weight gain, infections, Cushing’s syndrome (not disease), cataracts, glaucoma

169
Q

What are some side effects of colchicine?

A

Kidney failure, liver failure, GI upset in 80%

170
Q

What percentage of cases of type 1 enteropathic arthritis are self-limiting?

A

90%

171
Q

What are some side effects that can arise from COX-1 inhibition?

A

GI upset, GI bleeding, nausea

172
Q

What percentage of patients with Raynaud’s phenomenon have an underlying condition?

A

40-80%

173
Q

Briefly describe the chest expansion test for ankylosing spondylitis

A

Measure the chest circumference of the patient when they breathe in and when they breathe out; abnormal measurement is less than 2.5 cm difference

174
Q

What is tenosynovitis?

A

Inflammation of the synovium around a tendon (not inflammation of the tendon itself

175
Q

What are some of the common symptoms of lupus?

A

Arthralgia, malar rash, fatigue, fever, weight loss, alopecia

176
Q

EGPA involves what parts of the body?

A

Skin, lungs, kidneys, heart

177
Q

Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the hand?

A

Dactylitis in 6% of AS patients; also, skin lesions (red papules on palms)

178
Q

What percentage of ankylosing spondylitis patients have inflammatory bowel disease?

A

About 50%

179
Q

True or false: cytokines stimulate fibronectin

A

False; they inhibit fibronectin, decreasing tissue rebuilding

180
Q

In what way (relating to activity and rest) does bursitis differ from reheumatoid arthritis?

A

Bursitis is exacerbated by activity and improved by rest; RA is the opposite.

181
Q

Whipple’s disease is a bacterial infection that might be mistaken for enteropathic arthritis. What part of the GI tract does Whipple’s effect?

A

Small intestine (enteropathic affects the large intestine)

182
Q

True or false: mild anemia is present in nearly all rheumatoid conditions

A

True.

183
Q

One-third of patients with polyarteritis nodosa also have what viral infection?

A

Hepatitis B*

184
Q

What testing can be done for polymyalgia rheumatica?

A

ESR and CRP

185
Q

What percentage of lupus patients have kidney involvement?

A

50%

186
Q

Does RA present peripherally or axially?

A

Peripherally

187
Q

What are some clinical features of systemic sclerosis?

A

Small mouth, beak-like nose, digital ulcers, arthralgia, fatigue*, telangiectasia, dry eyes, ED, vaginal dryness

188
Q

There are five forms of Juvenile Idiopathic Arthritis. Which is most common?

A

Oligoarticular/pauciarticular (50-60%)

189
Q

What tests can be performed for polyarteritis nodosa?

A

Skin biopsy, ESR, angiography

190
Q

What term is used to indicate a lack of rheumatoid factor?

A

Seronegative

191
Q

What symptoms accompany systemic Juvenile Idiopathic Arthritis?

A

Fever and a rash that doesn’t itch

192
Q

What manifestation can osteoarthritis have in the feet?

A

Hallux valgus (big toe points toward second toe)

193
Q

10-40% of patients with ulcerative colitis or Crohn’s disease develop what kind of arthritis?

A

Enteropathic arthritis

194
Q

Rheumatoid factor can be associated with viral infections. Can ACPA also be associated with viral infections?

A

No

195
Q

What tests can be performed to screen for ankylosing spondylitis?

A

ESR, CRP, HLA B 27

196
Q

What are the main symptoms of granulomatosis with polyangitis?

A

Rhinorrhea, sinusitis, hearing loss, oral ulcers, hemoptysis, saddle-nose, kidney disease*, painful breathing/cough, hematuria, joint pain

197
Q

Tophaceous gout is associated with what conditions or medications?

A

Renal impairment and long-term diuretic use

198
Q

What role do omega-3 and fish oil supplements play in treating RA or other conditions that involve the joints?

A

They inhibit MMPs

199
Q

True or false: granulomatosis with polyangitis is more common in Caucasians

A

True.

200
Q

Relapsing polychondritis is an autoimmune mediated inflammation of what type of tissue?

A

Cartilage

201
Q

Which medications can be used for maintenance of microscopic polyangitis?

A

Methotrexate or azathioprine

202
Q

True or false: Kawasaki disease is the most common vasculitis in children

A

True.*

203
Q

Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the eyes?

A

Uveitis in 20-40% of AS patients

204
Q

How would you treat polyarteritis nodosa?

A

Prednisone and/or immunosuppressants, antivirals if patient has hepatitis

205
Q

75% of untreated gout patients develop tophi after how many years?

A

20 years

206
Q

What are the three basic mechanisms of Type II reactions?

A

Opsonization and phagocytosis; inflammation; Ab-mediated cellular dysfunction

207
Q

True or false: bursitis normally presents bilaterally and symmetrically

A

False; it presents unilaterally and asymmetrically

208
Q

Serum uric acid raised to what level is indicative of gout?

A

Higher than 6.8 mg/dL

209
Q

What are some common causes of gout?

A

Purine foods*, high saturated fats, fructose in drinks, alcohol, obesity, trauma

210
Q

True or false: serotonin is found in mast cells

A

False; it is found primarily in platelets

211
Q

What is the action of prostacyclin?

A

Vasodilation and inhibition of platelet aggregation

212
Q

Hydroxycloroquine binds to melanin, making it especially toxic for what part of the eye?

A

The macula

213
Q

What are some side effects of allopurinol?

A

Skin rash, GI upset, can induce acute gout

214
Q

What lifestyle changes can be made to help with osteoporosis?

A

Exercise, smoking cessation, fall prevention, alcohol avoidance

215
Q

How many patients with oligoarticular Juvenile Idiopathic Arthritis also suffer from uveitis?

A

25%

216
Q

Of the spondyloarthropathy conditions, which is most common?

A

Ankylosing spondylitis

217
Q

What are two examples of Type IV delayed-type reactions?

A

Tuberculin reaction, contact dermatitis

218
Q

True or false: pain in psoriatic arthritis is alleviated with activity

A

True.

219
Q

Which gender has a higher prevalence for lupus?

A

Female (9:1)

220
Q

What enzyme do corticosteroids target?

A

Phospholipase A2 (releases arachidonic acid from the cell membrane–AA is the precursor molecule for thromboxanes, prostacyclins, and prostaglandins

221
Q

What are two of the most common causes of secondary Sjogren’s?

A

RA and lupus; 7% of RA patients and 17% of lupus patients have Sjogren’s

222
Q

80% of patients with granulomatosis with polyangitis die within how many years, if untreated?

A

2 years

223
Q

What are the main symptoms of Kawasaki disease?

A

Fever for more than 5 days, conjunctival injection, dry red lips and tongue, redness and edema of the palms and soles, lymphadenopathy*, rash/skin peeling, arthritis

224
Q

Patients with what type of allergy should not be given celecoxib?

A

Sulfa

225
Q

True or false: the spondyloarthropathy condtions are associated with HLA B27, just like RA.

A

Trick question: they ARE associated with HLA B27, but RA is not.

226
Q

Raynaud’s phenomenon can cause ___________, which may result in having to remove the affected digits.

A

Gangrene

227
Q

Which gender has a higher incidence of RA?

A

Women (3:1)

228
Q

What substances contribute to the chemotaxis that pulls WBCs toward the damaged area?

A

Bacterial products, C5a, LTB4, IL-8

229
Q

What purpose do proteoglycans have in the extracellular fluid?

A

They are GAG chains that bind the fluid together and retain nutrients

230
Q

How would you treat enteropathic arthritis?

A

Treat the underlying disease; NSAIDs (though can worsen diarrhea); corticosteroids, sulfasalazine, methotrexate, infliximab is preferred

231
Q

Rheumatic heart disease involves calcification of what structure in the heart?

A

The mitral valve (and the aortic valve, to a lesser degree)

232
Q

What medical options are available in chronic gout?

A

Allopurinol (blocks synthesis of uric acid, decreases purine synthesis), febuxostat, probenecid (increases excretion and stop resorption of uric acid)

233
Q

What is the usual age of onset for gout?

A

30-50 years

234
Q

True or false: bursitis is more common than RA and lupus

A

True.

235
Q

Joint aspiration shows what shape of cystals in gout?

A

Rod-shaped

236
Q

What is the 5-year survival rate for relapsing polychondritis?

A

65-75% (45% if systemic vasculitis involved)

237
Q

What is the typical age of onset for pseudogout?

A

Above 65 years

238
Q

What is another name for osteoarthritis?

A

Degenerative Joint Disease (DJD)

239
Q

Fill in the blank: pain in ankylosing spondylitis improves with ________(movement/rest) and is worse with (movement/rest).

A

Movement; rest

240
Q

Acute inflammation in Kawasaki disease lasts for how long?

A

12 days

241
Q

True or false: systemic sclerosis has the highest mortality of any autoimmune rheumatic disease

A

True.

242
Q

Which cytokine activates immature macrophages?

A

Interferon gamma

243
Q

What is/are the actions of platelet activating factor?

A

Platelet aggregation/adhesion, vasodilation, increased permeability, stimulates synthesis of AA metabolites, chemotaxis

244
Q

What percentage of lupus patients experience malar rash?

A

More than 75%

245
Q

Which NSAIDs are very COX-1 selective? Which are COX-2 selective?

A

Aspirin and piroxicam are very COX-1 selective; celecoxib and meloxicam are COX-2 selective

246
Q

How does hydroxychloroquine work?

A

It impairs the cytokine response

247
Q

What percentage of lupus patients have nervous system involvement?

A

20-80%

248
Q

Which gender has a higher prevalence of enteropathic arthritis?

A

Neither; prevalence is equal between the genders

249
Q

Takayasu arteritis is rare, except in which country?

A

Japan

250
Q

Which NSAIDs are used as topical agents to reduce macular swelling after cataract surgery (and prophylactically, too)?

A

Ketorolac, diclofenac

251
Q

What types of agents may cause a granulomatous inflammation?

A

Bacteria, fungi, inorganic materials

252
Q

True or false: patients with gout have a lower risk of CVD

A

False; they have a higher risk of CVD

253
Q

What medical options are available in acute gout?

A

High dose NSAIDs (naproxen, diclofenac, indomethacin, but not aspirin; aspirin can induce gout); low-dose colchicine, oral or injected corticosteroids

254
Q

What is metaplasia?

A

A cell type changing to another cell type to cope with the environmental factors

255
Q

What percentage of all spondyloarthropathies is reactive arthritis?

A

1%

256
Q

What percentage of patients with psoriasis will develop psoriatic arthritis?

A

10-30%

257
Q

What substance does the WBC release in order to pass through the basement membrane?

A

Collegenase

258
Q

Psoriatic arthritis typically affects which joints?

A

Distal interphalangeal joints in hand

259
Q

What are some common symptoms of vasculitis conditions?

A

Peripheral neuropathy, fever, fatigue, malaise, palpable purpura, pulmonary and renal involvement

260
Q

What is/are the major actions of cytokines?

A

They cause WBC adherence to the vessel endothelium (activate, aggregate, and aggravate)

261
Q

Which gender has a higher prevalence for Takayasu arteritis?

A

Female (90%)*

262
Q

Acute rheumatic fever occurs most commonly in what age group?

A

5-15 years

263
Q

What is the name for the bony spurs that can occur in the DIP joint?

A

Heberden’s nodes

264
Q

True or false: doxycycline has both antibiotic and anti-inflammatory effects

A

True.

265
Q

Which Ig can cross the placenta?

A

IgG

266
Q

If a patient tests positive for both RF and ACPA, what is the likelihood that they have RA?

A

80-97%

267
Q

True or false: cyclophosphamide is safe to take during pregnancy

A

False.

268
Q

Which Ig is the fastest responder?

A

IgM

269
Q

True or false: polyarticular Juvenile Idiopathic Arthritis usually shows up RF (+)

A

False; it can show up RF (+) or RF(-) depending on the age of diagnosis

270
Q

List the stages of gout:

A

Hyperuricemia, urate deposition, trauma/inflammation, podagra, chronic tophaceous gout

271
Q

What are three examples of Type III reactions?

A

Reaction arthritis (ReA), Systemic lupus erythematosus (SLE), Sjogren’s syndrome

272
Q

What medication can cause rheumatoid nodules?

A

Methotrexate

273
Q

Kawasaki disease is common in what parts of the world?

A

Japan and East Asia

274
Q

Lupus can be caused by some medications. Which medication most commonly causes lupus?

A

Procainamide (anti-arrhythmia drug; sodium channel blocker)

275
Q

Granulomatous inflammation is characteristic of what type of hypersensitivity?

A

Type IV hypersensitivity

276
Q

The COX-2 pathway leads to what kind of prostaglandins?

A

Inflammatory–recruitment of inflammatory cells, sensitization of skin pain receptors.

277
Q

True or false: Raynaud’s phenomenon presents symmetrically and bilaterally

A

True.

278
Q

How quickly can arthritis manifest from the onset of RA (not diagnosis, but onset)?

A

Within 3-6 months

279
Q

Enthesis-related Juvnile Idiopathic Arthritis is most common in what gender and age group?

A

Boys age 8-12 years

280
Q

True or false: the ophthalmic artery and the posterior ciliary arteries can be affected in giant cell arteritis

A

True.

281
Q

What percentage of relapsing polychondritis patients get valvular disease?

A

10%

282
Q

Is articular cartilage vascular or avascular?

A

Avascular

283
Q

Are bursitis, carpal tunnel syndrome, and tenosynovitis rheumatologic in nature?

A

No, but they are dealt with by rheumatologists often

284
Q

What is the typical age of onset for EGPA?

A

30 years

285
Q

How would you treat rheumatic heart disease?

A

Antibiotics* (penicillin, amoxicillin, azithromycin), aspirin*, anti-inflammatories

286
Q

True or false: pseudogout is more painful than gout

A

False; it is less painful

287
Q

In T-cell mediated cytotoxicity, which T cell is responsible for the reaction?

A

CD8+

288
Q

What are overall causes for vasculitis conditions?

A

Infection (hepatitis B and C; HIV), autoimmune diseases, medications (diabetic meds, diuretics, gout meds, antibiotics), smoking

289
Q

What effects can relapsing polychondritis have in the eyes?

A

Episcleritis, scleritis, proptosis

290
Q

True or false: Juvenile Idiopathic Arthritis (JIA) is the exact same condition as RA, just in younger patients

A

False.

291
Q

Which gender has a higher prevalence of pseudogout?

A

Female

292
Q

What is the age of onset for Takayasu arteritis?

A

10-40 years*

293
Q

True or false: symptoms of osteoporosis improve with use and are worse with rest

A

False; symptoms are exacerbated by use and reduced by rest

294
Q

How long can cyclophosphamide be used for?

A

3-6 months

295
Q

True or false: polyarticular Juvenile Idiopathic Arthritis usually doesn’t cause lasting harm.

A

False; it is progressive and destructive

296
Q

What sort of testing might help distinguish osteoarthritis?

A

X-rays (for osteophytes), MRIs (for cartilage injury)

297
Q

What percentage of Sjogren’s patients have xerostomia?

A

90%

298
Q

Which gender has a higher prevalence for giant cell arteritis?

A

Female (2:1)

299
Q

What is another term for acute phase reaction?

A

Systemic inflammatory response syndrome

300
Q

What sort of testing can be done for Sjogren’s?

A

Salivary gland or lip biopsy, anti-Ro or anti-La, RF, ANA, ESR, CRP

301
Q

Which joints in the hand can become affected in osteoarthritis?

A

CMC (proximal joint of thumb) and DIP and PIP (two most distal joints of the other fingers)

302
Q

What percentage of giant cell arteritis patients eventually have some improved vision?

A

30%

303
Q

Osteoarthritis is uncommon below what age?

A

50

304
Q

Tophaceous gout is characterized by very high levels of uric acid, as well as tophi. What are tophi and where can they be found?

A

They are white deposits which can ulcerate. They form on the ears, fingers, and ankles.

OPT 537 (21 decks)

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