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M/S 2 > Exam 3 - Musculo/Neuro > Flashcards

Exam 3 - Musculo/Neuro Flashcards

1
Q

chronic systemic autoimmune disease - causing inflammation of the connective tissue, primarily in the joints

A

Rheumatoid Arthritis

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2
Q

cause of RA

A

unknown

2-3 x’s more likely to have if family hx

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3
Q

does RA effect women or men more?

A

women 3x more than men

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4
Q

where does RA originate?

A

synovial tissue at the more distal joint

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5
Q

Rheumatoid factor (RF) is what kind of factor?

A

inflammatory

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6
Q

morning stiffness with RA last how long?

A

> 30 minutes

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7
Q

T or F. RA is symmetrical.

A

True

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8
Q

RA affected joint s/sx

A

pain
swelling
warmth
erythema
limited ROM
spongy, boggy tissue

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9
Q

nonspecific RA s/sx

A

fatigue
anorexia
weight loss
generalized stiffness

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10
Q

RA joints will have what type of shape?

A

spindle

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11
Q

typical RA deformities

A

ulnar drift
boutonniere deformity
hallux valgus
swan neck

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12
Q

systemic RA s/sx

A

fever
weight loss
fatigue
lymph node enlargement
Rheumatoid nodules
nodular myositis
Sjogren’s syndrome
Felty syndrome
Flexion contractures
depression

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13
Q

Rheumatoid nodules are benign nodules that can occur where?

A

fingers
elbows
base of spine
back
heart
lungs

cataracts, vision loss r/t sclera nodules

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14
Q

nodules in the heart and lungs can lead to…

A

pleurisy
pleural effusion
pericarditis
pericardial effusion
cardiomyopathy

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15
Q

what occurs wtih Sjorgren’s syndrome

A

diminished lacrimal, salivary gland secretion

dry mouth
burning
itchy eyes + decreased tearing
photosensitivity

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16
Q

Felty syndrome

A

enlarged spleen
increased WBC

increase risk for infection, lymphoma

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17
Q

extra-articular manifestations are more likely to occur in the person with high levels of ___

A

biomarkers

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18
Q

A score of __ or greater is needed to dx RA

A

6

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19
Q

RA is dx based on a point system involving which 4 criteria

A

joint involvement
serology
acute phase of reactants
duration of symptoms

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20
Q

synovial fluid characteristics in early disease

A

slightly cloudy, milky, dark yellow, straw-colored fluid with fibrin flecks

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21
Q

which lab is a marker of progressive joint damage

A

enzyme MMP-3

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22
Q

WBC in synovial fluid in RA

A

up to 25000

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23
Q

RA treatment goals

A

decrease joint swelling, pain
achieve clinical remission
decrease joint deformity
minimize disability

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24
Q

should a pillow be placed under the knees with RA

A

No; to decrease joint contracture

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25
Q

RA: encourage positions of ___, avoid positions of ___

A

encourage: extension

avoid: flexion

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26
Q

RA: what can be applied to relieve stiffness, pain, and muscle spasm

A

heat, cold application

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27
Q

how long to leave cold application in place

A

10-15 minutes

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28
Q

does heat or cold application provide better relief of chronic stiffness

A

moist heat therapy

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29
Q

heat application should not exceed ___ minutes

A

20 minutes

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30
Q

RA: what can be done daily to keep joints functional

A

gental ROM exercises

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31
Q

RA: this exercise provides 2-way resistance causing the muscles to work harder; allows for easier movement

A

aquatic exercise in warm water (78-86 F)

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32
Q

chronic inflammatory connective tissue disease

A

systemic lupus erythematosus

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33
Q

cause of lupus

A

unknown

genetics, environment, hormonal factors may play a part in development

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34
Q

lupus affects which organs in the body

A

nearly every organ

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35
Q

is lupus mild, severe, or life-threatening?

A

can be any

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36
Q

which races are more likely to be affected by lupus?

A

African-Americans
Asians

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37
Q

pts with active lupus have an increased risk for ___

A

infection

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38
Q

leading causes of lupus death

A

PNA
septicemia

followed by renal, CNS involvement

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39
Q

cause of lupus

A

large production of autoantibodies

results in hyperactive B cells an disordered T cell function

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40
Q

early s/sx of lupus

A

fever
anorexia
malaise
weight loss
arthralgia (joint pain)
arthritis

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41
Q

skin s/sx r/t lupus

A

red rash (esp. non face, nose chest)
photosensitivity
alopecia
skin lesions may develop

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42
Q

cardiac complications r/t lupus

A

pericarditis
**most common; CP aggravated by exertion
Raynaud’s
pleurisy
pleural effusion
lupus pneumonitis

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43
Q

renal complications r/t lupus

A

proteinuria
cellular casts
nephrotic syndrome
renal failure

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44
Q

how soon is the nervous system involved with lupus

A

within the first year

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45
Q

nervous system complications r/t lupus

A

organic brain syndrome
decline in intellect
memory loss
disorientation
psychosis
seizures
depression
stroke

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46
Q

hematologic complications r/t lupus

A

anemia
leukopenia
thrombocytopenia

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47
Q

ocular complications r/t lupus

A

conjunctivitis
photophobia
blindness

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48
Q

GI complications r/t lupus

A

anorexia
nausea
abdominal pain
hepatomegaly

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49
Q

ACR criteria for lupus includes

A

malar rash
discoid rash
photosensitivity
oral, nasal ulcers
arthritis in multiple joints
seroitis (inflammation around lungs or heart)
kidney disease
neurological, lung disorders

50
Q

to be classified with lupus you must have __ or more criteria

A

4 or more

51
Q

lupus goal

A

prevent progressive loss of organ function, reduce the likelihood of acute distress, minimizing disease disabilities, and preventing complications from therapy

52
Q

is there a cure for lupus?

A

No, 10 year survival rate is > 90%

53
Q

should individuals with lupus expose themselves to the sun?

A

No; spf 15+ when outside

54
Q

what to place 24-hour urine collection on

A

ice

55
Q

what is ankylosing spondylitis

A

chronic inflammatory arthritis of the spine

56
Q

ankylosing spondylitis is associated with which 2 diseases

A

juvenile arthritis
psoriatic arthritis

57
Q

ankylosing spondylitis affects ___ ___

A

axial skeleton

leads to pain, progression, stiffening, and fusion of the spine

58
Q

uveitis

A

inflammation of the iris, middle, and vascular layer of the eye

59
Q

ankylosing spondylitis s/sx

A

back pain
arthritis: hip, shoulders, knee joints
anorexia
weight loss
fever
fatigue
uveitis
osteoporosis

60
Q

fibromyalgia is a ____ ___ ___

A

chronic pain syndrome

61
Q

T or F. fibromyalgia is common women with unknown cause.

A

True

62
Q

fibromyalgia s/sx

A

chronic fatigue
generalized muscle aching
stiffness
sleep disturbance
functional impairment
HA
painful menstrual periods
problems thinking and memory

63
Q

is fibromyalgia local or systemic

A

it can be either

64
Q

joints most commonly affected with fibromyalgia

A

neck
spine
shoulders
hips

65
Q

fibromyalgia must have a history of pain for at least ___ months

A

3 months

66
Q

how many tender points for fibromyalgia

A

11 out of 18

67
Q

what should be limited and may be a muscle irritant r/t fibromyalgia

A

sugar
caffeine
alcohol

68
Q

osteoarthritis is aka

A

degenerative joint disease

69
Q

most common form of arthritis

A

osteoarthritis

70
Q

most leading cause of pain and disability in older adults

A

osteoarthritis

71
Q

this is characterized by loss of articular cartilage in articulating joints and hypertrophy of the bones at the articular margins

A

osteoarthritis

72
Q

primary cause of osteoarthritis

A

idopathic

73
Q

are men or women more likely to develop osteoarthritis

A

men > women in early years

women > men by middle adulthood

74
Q

most affected OA joints

A

hands
wrist
neck
lower back
hip
knee
ankle
feet

75
Q

OA risk factors

A

age
excessive weight
possible autosomal recessive trait with genetic defects
inactivity
hormones
—decrease estrogen, excessive growth hormone, increased PTH

76
Q

Heberden’s nodes are at the most ___ point of the finger.

A

distal

77
Q

Bouchard’s nodes are at ___ point of the finger

A

proximal

78
Q

Onset of OA is ___ and ___ with ___ ___

A

gradual; insidious; slow progression

79
Q

how to Dx OA

A

H&P
XR
Synovial fluid

80
Q

conservative OA treatment

A

ROM, muscle strengthening exercises
heat, ice
balance rest, activity
use cane, walker, crutches
weight loss - PRN
analgesics
anti-inflammatory meds

81
Q

chronic demyelinating neurologic disease of the CNS

A

multiple sclerosis

associated with abnormal immune system response to an environmental factor

response to a prior viral infection

82
Q

MS is characterized by periods of ___ and ___

A

exacerbation; remission

83
Q

end result of MS

A

disease progression with increasing loss of function

84
Q

which cells are affected with MS

A

T cells

T cell inflammation destroys myelin and olgiodendrocytes leading to axon dysfunction

85
Q

do individuals die from MS?

A

no but from complications r/t MS

86
Q

possible stressors that trigger MS

A

febrile state
pregnancy
extreme physical exertion
fatigue

87
Q

what are the 4 types of MS

A

relapse-remitting
primary progressive
secondary progressive
progress-relapsing

88
Q

___ is most common in MS affecting almost all pts

A

fatigue

89
Q

what are the 4 location types of MS

A

mixed or generalized (50% of cases)
spinal (25%)
cerebellar (5%)
amaurotic form (5%)

90
Q

pts must have at least 1 of the 3 of the following to be dx with MS

A

2+ exacerbations separated by 1 month, lasting > 24 hours, followed by recovery

hx of repeated exacerbations and remissions with/without complete recovery; progressively severe over 6 months

slowly increasing manifestation for at least 6 months

91
Q

how/what is a positron emission tomography (PET) scan

A

imaging test to eval bodily function

IV dye (radiotracer) absorbed by organs/tissue
lie flat on exam table that is moved into the donut shaped machine

report energy given off by the radiotracer; can be converted into a 3D picture

92
Q

MS diagnostic test

A

MRI
CT
PET
visual/auditory
**will have delayed conduction
analysis of CSF
** ^ T lymphocytes and IgG

93
Q

chronic autoimmune neuromuscular disorder characterized by fatigue and severe skeletal muscle weakness

A

Myasthenia Gravis

94
Q

is muscular weakness associated with myasthenia gravis generalized or limited?

A

can be generalized OR limited to a few muscle groups, especially ocular

95
Q

with MG, antibodies destory/block neuromuscular junction receptor sites cause a decrease in _____ receptors

A

acetylcholine

96
Q

s/sx of myasthenia gravis

A

ptosis
diplopia
dysphagia with gagging, choking
change in quality of voice
increase muscle weakness during cont. use
improved muscle strength with rest
weak cough
difficulty breathing

97
Q

when to notify HCP re: MG

A

ptosis
double vision
difficulty chewing, swallowing
muscle weakness, improvement after rest
Dx with MG and have difficulty breathing

98
Q

test used to dx MG

A

Tension test

99
Q

which medication is used for the Tension test

A

short-acting anticholinesterase (edrophonium; neostigmine)

will show improvement with drug, no improvement with placebo

100
Q

what do anticholinesterases drugs do?

A

prevent the breakdown of acetylcholine at the neuromuscular junction

101
Q

surgical removal of thymus gland

A

thymectomy

102
Q

SLUD in cholinergic crisis

A

Salivation
Lacrimation
Urination
Defecation

103
Q

sudden exacerbation of muscle weakness

can lead to respiratory failure and aspiration

A

myasthenia crisis

104
Q

causes of myasthenia crisis

A

under medicated
missed doses
developing infection

105
Q

s/sx of myasthenia crisis

A

tachycardia
tachypnea
respiratory distress
dysphagia
impaired speech
anxiety

106
Q

this is a result (s/sx) of over OD with anticholinesterase medications (cholinergic crisis)

A

GI manifestations
severe muscle weakness
vertigo
respiratory distress

107
Q

MG education

A

rest periods, conserve energy
avoid stress
avoid cigarette smoke
ETOH
avoid Quinine (tonic water)
notify MD if change in health status
avoid extreme temps
avoid those who are sick or could be contagious

108
Q

sensory and motor abnormality of extremity or bilaterally

A

restless leg syndrome

109
Q

restless leg syndrome risk factors

A

women > men
primary: family hx

secondary:
metabolic deficiency
HTN
iron
CKD
RA
DM

110
Q

s/sx of restless leg syndrome

A

paresthesia
pain
decreased sleep
movement relieves s/sx
increases over time

111
Q

what 5 criteria must be met to have a restless leg syndrome dx?

A

urge to move/uncomfortable sensation
uncomfortable sensation/worse with inactivity
sensation relieved with movement
worse at night
not related to another medical condition

112
Q

progressive, degenerative, inherited neurologic disease

autosomal dominant inherited disease

A

Huntington Disease

113
Q

Huntington Disease is characterized by ___ and ____

A

increasing dementia; chorea

114
Q

Huntington has a decrease in ___ but and increase in ____

A

decrease: acetylcholine

increase: dopamine

115
Q

Huntington triad

A

motor dysfunction
cognitive impairment
behavioral features

116
Q

Huntington motor dysfunction

A

“fidgeting” or restless
grimace
tongue protrusion
jerky movements of distal arm/legs
rhythmic, lurching gait
affects muscles of swallowing, chewing, and speaking

117
Q

Cure for Huntington

A

there is not cure, only treat symptoms

118
Q

what is common in individuals after an amyotrophic lateral sclerosis (ALS) dx

A

SI

119
Q

death occurs ___-___ years after onset of ALS

A

2-5

120
Q

causative factors for ALS

A

smoking
viral infections
autoimmune disease
environmental exposure to toxins

121
Q

s/sx of ALS

A

spastic, weak muscles
increased DTR
slurred speech
**progresses to paresis, paralysis, atrophy
brainstem involvement
atrophy, tongue and facial muscles
dysphagia
dysarthria

122
Q

how to Dx ALS

A

H&P
test to r/o other disorders

M/S 2 (10 decks)

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