Exam IV: RA

Question 1

Most common _____ _____ disease - 1% of adults
More _____ than _____ —2-3x more

Answer 1

chronic inflammatory
women than men

Question 2

_____ etiology—thought to be genetic, environmental, autoimmune?

Answer 2

Unknown

Question 3

proximal interphalangeal/metacarpophalangeal joints of hands and feet
VS
OA - ____ ____ joints and _____ interphalangeal joints

Answer 3

weight bearing
distal

Question 4

_______ and remissions

Answer 4

Exacerbations

Question 5

Pathophysiology

Exact etiology remains ______
* Heredity - minor
* Autoimmunity pivotal

Answer 5

elusive

Question 6

Circulating _______ “rheumatoid factors” in ___-___ of patients

Answer 6

autoantibodies
70-80%

Question 7

• ______ assault
• Cartilage, ligament, tendons and bones
• _____ and ______ of skeletal structures
• Deformed joints that have no _____ and minimal or no _____

Answer 7

Immune
Dislocation and dissolution
stability
ROM

Question 8

RA - SYSTEMIC INVOLVEMENT

• Inflammatory ______

Answer 8

cytokines

Question 9

RA - SYSTEMIC INVOLVEMENT

_____ of articular surfaces and _____ of adjoining cartilage, tendons, and ligaments

Answer 9

Erosion
destruction

Question 10

RA - SYSTEMIC INVOLVEMENT

Tumor necrosis factor inhibitors:

Answer 10

• Etanercept - Enbrel®
• Infliximab - Remicade®
• Adalimumab - Humira® (“human monoclonal Ab in RA”)
• Golimumab - Simponi®

Question 11

RA-systemic involvement

Heart - aortic or mitral ____ _____ _____

Answer 11

regurgitation pericardial effusion

Question 12

_____ _____: RA, splenomegaly, neutropenia

Answer 12

Felty’s Syndrome

Question 13

Peripheral neuropathy — ____ ____ is most common

Answer 13

Carpal Tunnel

Question 14

Joint Involvement (4)

Answer 14

• limits ROM
• severe pain
• joint instability
• crippling deformities

Question 15

most important to the CRNA joint involvement

Answer 15

• TMJ
• Cricoarytenoid joint
• Atlanto-axial joint

Question 16

Cricoarytenoid joints of the larynx may be _____, ______, or ______ in a position that obstructs airflow

Answer 16

swollen, inflamed, or fixed

Question 17

_____ may be friable

Answer 17

mucosa

Question 18

CRICOARYTENOID JOINTINVOLVEMENT

sensation of foreign body - ____% of patients
hoarseness - ____% of patients
sensation of fullness - ____% of patients
dyspnea - ____% of patients

Answer 18

17
15
14
10

Question 19

TMJ INVOLVEMENT - Flexion contractures and soft tissue swelling may lead to marked limitation in _____ to _____ _____

Answer 19

ability to open jaw

Question 20

TMJ INVOLVEMENT - ____ to ____ have involvement of the Temporomandibular joint

Answer 20

30% to 80%

Question 21

TMJ INVOLVEMENT - *** Patient may be able to open mouth only ___ or ___ ____

Answer 21

1 or 2 cms

Question 22

RA – CERVICAL SPINAL INVOLVEMENT

Answer 22

RA and ankylosing spondylitis have major cervical spinal involvement

Question 23

Involvement of the cervical spine may be extensive causing (3)

Answer 23

• instability
• limited movement of the neck
• severe laryngeal deviation

Question 24

_____ _____ may occur in 20-40% of population

Answer 24

Atlantoaxial subluxation

Question 25

____-_____ most common site for cervical involvement

Answer 25

C1 - C2

Question 26

Anesthetic Implications

• ______ History (NSAIDs, steroids, methotrexate, tumor necrosis factor inhibitors)
• airway assessment (TMJ, cricoarytenoid joints)
• MRI or radiographic evaluation cervical spine for advanced disease
• careful positioning - ______, _____
• observe closely for post-extubation _____ _____ and stridor
• dry eyes (_____ Syndrome)

Answer 26

Medication
osteopenic, steroids
laryngeal edema
Sjogren’s