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OPT 537 > Exam 1 -- Rheumatology #2 > Flashcards

Exam 1 -- Rheumatology #2 Flashcards

1
Q

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

A

True.

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2
Q

True or false: rheumatoid arthritis presents bilaterally and symmetrically

A

True.

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3
Q

Does RA present peripherally or axially?

A

Peripherally

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4
Q

True or false: RA leads to destruction of bone, cartilage, and tendons, but not of ligaments.

A

False; it leads to destruction of all of these.

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5
Q

What percentage of the US population is affected with rheumatoid arthritis (RA)?

A

1%

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6
Q

Which gender has a higher incidence of RA?

A

Women (3:1)

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7
Q

What is the most common age of onset for RA?

A

45-75 years

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8
Q

True or false: pregnancy can be protective against RA.

A

True.

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9
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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10
Q

True or false: RA is genetically associated with HLA-B27

A

False; HLA-B27 is associated with the spondyloathrothopy conditions, not RA.

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11
Q

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

A

True.

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12
Q

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

A

More than 3

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13
Q

Which joint(s) of the fingers are affected by RA?

A

MCP and PIP, not DIP (the proximal two joints, but not the distal joint)

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14
Q

What symptoms may be indicative of RA?

A

Pain, stiffness, swelling, and limited movement of small joints. Less common: weight loss, fever, fatigue, malaise

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15
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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16
Q

True or false: the pain from RA is worse in the morning and gets better with activity.

A

True.

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17
Q

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

A

Within 3-6 months

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18
Q

What is citrullination? What effect does it have in terms of inflammation?

A

The conversion of an arginine to a citrulline. In the synovial fluid, the citrullinated site fits into the antigen binding site of HLA. This starts an inflammatory response.

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19
Q

Part of testing for RA can involve testing for Anti-Citrullinated Protein Antibodies (ACPAs). What percentage of RA patients have ACPAs?

A

50-70%

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20
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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21
Q

What percentage of RA patients have rheumatoid factor?

A

70%

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22
Q

Rheumatoid factor is found in what percentage of healthy patients over the age of 70?

A

25%

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23
Q

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

A

Seronegative

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24
Q

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

A

80-97%

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25
Q

Which Ig is the largest?

A

IgM

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26
Q

Which Ig is the fastest responder?

A

IgM

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27
Q

Which Ig can cross the placenta?

A

IgG

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28
Q

Which Ig is the most common?

A

IgG (75% of all Ig)

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29
Q

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

A

IgA

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30
Q

Which Ig is involved in allergic responses?

A

IgE

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31
Q

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

A

No

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32
Q

True or false: about 25% of patients in the advanced stages of RA have rheumatoid nodules.

A

True.

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33
Q

Where can rheumatoid nodules be found?

A

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

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34
Q

True or false: rheumatoid nodules are tender to the touch

A

False; they are non-tender

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35
Q

What medication can cause rheumatoid nodules?

A

Methotrexate

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36
Q

What is a normal value for a CRP?

A

Less than 1.0 mg/dL (less than 10 mg/L)

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37
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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38
Q

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

39
Q

Systemic effects are present in what percentage of RA patients?

40
Q

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

A

Difficulty breathing, fibrosis, cough, nodules

41
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)

42
Q

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

A

Chronic kidney disease (CKD)

43
Q

What is amyloidosis?

A

Incorrectly folding proteins that can cause nodules inside the body

44
Q

True or false: RA is the #1 cause of secondary amyloidosis

45
Q

What neurologic effects may be present in a patient with RA?

A

Peripheral neuropathy

46
Q

What is the most common ocular effect of RA?

A

Dry eye (occurs in 15-25% of RA pts)

47
Q

What ocular effects can occur with RA?

A

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

48
Q

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

49
Q

What are possible treatment options for a patient with RA?

A

Physical therapy, NSAIDs, corticosteroids, DMARDs

50
Q

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

51
Q

Juvenile Idiopathic Arthritis presents with symmetric or asymmetric joint pain?

52
Q

How old must a patient be in order for their condition to be considered Juvenile Idiopathic Arthritis, assuming all other symptoms match?

A

Under age 16 years

53
Q

For how long must a patient have symptoms in order to be diagnosed with Juvenile Idiopathic Arthritis?

A

More than 3-6 weeks

54
Q

What symptoms may be indicative of Juvenile Idiopathic Arthritis?

A

Symmetric joint pain, fever, rash

55
Q

Patients with Juvenile Idiopathic Arthritis are at risk for what ocular conditions?

A

Chronic uveitis and band keratopathy

56
Q

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

A

Oligoarticular/pauciarticular (50-60%)

57
Q

How many joints are affected in oligoarticular Juvenile Idiopathic Arthritis?

A

Four or fewer

58
Q

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

A

False; girls are more affected than boys

59
Q

True or false: patients with oligoarticular Juvenile Idiopathic Arthritis are RF (-)

60
Q

What is the peak onset age for oligoarticular Juvenile Idiopathic Arthritis?

61
Q

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

62
Q

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

63
Q

How many joints are affected in polyarticular Juvenile Idiopathic Arthritis?

A

More than four

64
Q

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

A

Girls age 2-5 or 10-14

65
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

66
Q

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

A

False; it is progressive and destructive

67
Q

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

A

True, up to age 5, then girls are more affected than boys

68
Q

What symptoms accompany systemic Juvenile Idiopathic Arthritis?

A

Fever and a rash that doesn’t itch

69
Q

Fill in the blank: patients with systemic Juvenile Idiopathic Arthritis usually have ______ (high/low) CRP, _____ (high/low) ESR, and are RF ______ (positive/negative)

A

High, high, negative

70
Q

What are symptoms of psoriatic Juvenile Idiopathic Arthritis?

A

Multiple rashes, sausage digits, nail pitting

71
Q

What is another term for “sausage digits?”

A

Dactylitis

72
Q

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

73
Q

Enthesis-related Juvnile Idiopathic Arthritis is sometimes referred to by what other name?

A

Pediatric spondyloarthropathy

74
Q

The symptoms of enthesis-related Juvnile Idiopathic Arthritis are usually seen in which portion of the skeleton?

75
Q

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

A

Boys age 8-12 years

76
Q

True or false: patients with enthesis-related Juvnile Idiopathic Arthritis can be HLA B27 (+)

77
Q

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

A

False; they are usually RF (-)

78
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)

79
Q

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

A

Tocilizumab

80
Q

Acute rheumatic fever occurs most commonly in what age group?

A

5-15 years

81
Q

What causes acute rhematic fever?

A

Streptococcal pharyngitis infection followed 2-4 weeks later by migratory arthritis

82
Q

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

83
Q

Describe migratory arthritis

A

Affects several joints in quick succession for 1-3 days each

84
Q

What symptoms might accompany acute rheumatic fever?

A

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

85
Q

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

A

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

86
Q

If acute rheumatic fever is left untreated, it can lead to rheumatic heart disease. How much time can pass before the onset of the rheumatic heart disease?

A

10-20 years

87
Q

How would you treat rheumatic heart disease?

A

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

88
Q

What is lyme arthritis?

A

Arthralgia (joint pain) secondary to late stage lyme disease

89
Q

What joints are most commonly involved in lyme arthritis?

A

Knee, ankle, elbow, wrist

90
Q

True or false: lyme arthritis typically presents bilaterally

A

False; it typically presents unilaterally

91
Q

80% of lyme disease patients get what sort of sign?

A

Bull’s eye rash at site of tick bite

92
Q

Lyme arthritis is accompanied by what symptoms?

A

Joint swelling, bursitis, tendonitis, fatigue, fever, HA, weight loss

93
Q

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

A

B. burgdorferi, ESR, CRP

94
Q

How would you treat a patient with lyme arthritis?

A

Oral doxycycline or amoxicillin for a month, followed by another month if needed. If those fail, treat with IV ceftriaxone

OPT 537 (21 decks)

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