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CPD III > Quiz 6- MS > Flashcards

Quiz 6- MS Flashcards

1
Q

Synarthroses

A

‘suture lines’ found in skull

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2
Q

Amphiarthroses

A

adjacent bones bound by flexible fibrocartilage

ex pubic symphysis, SI jt upper 2/3rds, intervertebral discs

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3
Q

Diarthroses

A

articular design, contain synovial membrane and synovial fluid
ex lower 1/3rd SI joint, crico arytenoid, TMJ, facets, knee, etc.

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4
Q

Synovial Fluid

A

Reduction of friction -
Shock absorption - has the rare quality that it becomes more viscous under applied pressure.
Nutrient and waste transportation -supplies O2 and removes CO2

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5
Q

Tenosynovium

A

Protective lining of tendons

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6
Q

Monoarticular

A

involving one joint

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7
Q

Pauciarticular

A

involving 2-4 joints

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8
Q

Polyarticular

A

involving 5 or greater joints

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9
Q

Synovitis

A

Inflammation of the synovial membrane

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10
Q

Tenosynovitis

A

Inflammation of a tendon and its enveloping sheath

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11
Q

Stenosing

A

swelling of a tendon sheath causing “triggering”

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12
Q

Serous synovitis

A

synovitis with a large effusion of nonpurulent fluid

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13
Q

DIP

A

distal interphalangeal

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14
Q

PIP

A

proximal interphalangeal

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15
Q

MCP

A

metacarpophalangeal

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16
Q

morning stiffness lasting >1hr suggests

A

inflammatory disease

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17
Q

Symmetrical joint involvement tends to occur in

A

systemic syndromes:

RA, polymyalgia rheumatica, SLE, viral arthritis and drug/serum sickness reactions.

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18
Q

Asymmetrical joint involvement consider

A

gout, psoriatic arthritis, reactive arthritis.

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19
Q

Monoarthritis

A

infection, crystals, trauma, tumor

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20
Q

Joint exam:

categories of abnormality

A 
Deformity
Swelling (hard or soft?)
Color Change
Muscle atrophy
Changes in ROM
Changes in Gait
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21
Q 
Pattern of joint involvement is very useful in suggesting a diagnosis
Hand
OA
RA
Psoriatic 
SLE
Scleroderma
Crystal arthropathies, Sarcoidosis
A

OA - DIPS, PIPS. rare MCP, wrist
RA - PIPS, MCP’s, wrist. very rare DIPS
Psoriatic - nails involved, more asymmetric than RA. DIP; PIP, MCP all affected, sausage fingers
SLE-similar to RA, interarticular dermatitis, periungual erythema
Scleroderma - skin thickened, flexion contractures, Raynaud’s phenomena
Crystal arthropathies, Sarcoidosis – DIP, PIP, MCP all affected

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22
Q 
Pattern of joint involvement
Feet and Ankle
RA
Reactive arthritis
Psoriatic arthritis 
Gout
A

RA- rubbery below, front of, behind malleoli; MTP’s or whole midfoot swollen, tender
Reactive arthritis, psoriatic- interphangeal synovitis
Gout- interphangeal synovitis, 1st MTP of great toe

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23
Q 
Pattern of joint involvement
Spine
OA
Ankylosing spondylitis
CA
Fibromyalgia
A

OA - decreased cervical flexion, facet joints of the spine often affected
Ankylosing spondylitis- decreased lumbar flexion, chest expansion.
Osteomyelitis, leukemia, cancer, compression fxs, herniated disk- localized
bone pain
Fibromyalgia- trigger points

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24
Q 
Pattern of joint involvement
Hip
OA
Arthritis
Bursitis
A

OA- large weight bearing joints
Arthritis- limp
Bursitis- tenderness over greater trochanter

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25
Lab | ESR
indicates systemic inflammatory response. NON-SPECIFIC | also increased in infection, cancer, pregnancy
26
Lab | CRP (C reactive protein)
Acute phase reactant. More sensitive measure of disease activity and progression.
27
Lab | Serum uric acid
increase in gout
28
``` Lab Rheumatoid factor (RF) ```
45% positive in first 6 months in RA, 85% positive with established disease. Not specific for RA, high titer early is a poor prognostic sign
29
RF negative in
osteoarthritis, gout, rheumatic fever, reactive arthritis, infection arthritis, ulcerative colitis
30
Lab | Anti-CCP (anti-cyclic citrullinated peptide antibody)
more specific than RF in early and fully established disease. May be present prior to the appearance of symptoms of RA. >90% specific for RA
31
Lab | ANA- antinuclear AB
``` SLE - up to 95% + scleroderma - 60 -70% + RA - 20 - 50% + Sjorgen’s - 50 - 60% + polyarteritis - 10% + dermatomyositis -10-50%+ ```
32
Lab | HLA-B27
associated with spondyloarthropathies (AS) reactive arthritis psoriatic arthritis
33
Lab | Vitamin D
def associated with many M/S diseases
34
Where there is any suspicion of septic arthritis (acute monoarthritis), immediate _______ must be carried out
aspiration of synovial fluid
35
Rheumatoid arthritis is characterized by
symmetric, inflammatory, peripheral polyarthritis of unknown etiology. It typically leads to deformity through the stretching of tendons and ligaments and destruction of joints through the erosion of cartilage and bone. If it is untreated or unresponsive to therapy, inflammation and joint destruction lead to loss of physical function, inability to carry out daily tasks of living, and maintenance of employment
36
RA | etiology
Toll Like Receptors Genetics Epigenetics Infections- specifically by P. gingivalis Environment- estrogen mimickers Hormonal aberrations- estrogen metabolism, prolactin, adrenal hormones Nutritional Deficiencies- Vit D, Omega 3’s Sugar
37
RA | Clinical picture
Gender- 3:1 female over male Age- any but peak onset is between the ages of 50 and 75 Frequency 1% of population
38
RA Joints affected Hands Acute
Symmetrical joint swelling Wrists, MCPS and PIPS DIPS spared Tender joints with decreased ROM Reduced grip strength Incomplete fist closure and hand extension Whole hand may be swollen with pitting edema over the dorsum Carpal tunnel syndrome with muscle weakness of the first three fingers and numbness in median distribution
39
RA Joints affected Hands Chronic
``` Ulnar deviation or "ulnar drift" of fingers Swan neck deformities Boutonniere deformities "bow string" sign extensor tendon rupture (esp 4th and 5th) Digital infarcts Volar subluxation of wrist and MCPs Multiple joint dislocations ```
40
RA Joints affected Foot:
MTP’s Midfoot swelling hammer toe and "cock-up" deformities
41
RA Joints affected Wrist:
carpal tunnel syndrome synovitis decreased ROM dorsal tenosynovitis
42
RA Joints affected Elbows
flexion contractures loss of pronation/supination nodules
43
RA Joints affected Shoulders
dislocation and spontaneous tears of the rotator cuff creating chronic pain decreased ROM
44
RA Joints affected Cervical spine
late involvement- atlanto-axial subluxation
45
RA | Lab
- elevated CRP and ESR | - RF-50-95%, high titer helps confirm dx, very high usu.
46
RA | Imaging Findings
``` Periarticular osteopenia Joint space narrowing Bare area erosions Subluxation Ulnar deviation of fingers Carpal collapse Ankylosis ```
47
RA | Diagnostic Criteria: 6 of 10 pts necessary
CCP and RF (0-3) # and size of involved joints (0-5) > 6 weeks duration (1) ESR and CRP (1)
48
Course: Best prognosis Variable prognosis Worst prognosis
Best: spontaneous remissions of months to yrs Variable: relentless progression with debilitating flares Worst: "malignant"- rapid and progressive, severe polyarticular synovitis, nodules, wt loss, high RF titer, vasculitis, scleritis, corneal ulcers, lung nodules and fibrosis, pericarditis, Felty's syndrome (5-10% of RA, splenomegaly, leucopoenia, anemia, thrombocytopenia), neuropathies, joint contractures, deformities
49
RA | DDX
``` Acute viral polyarthritis SLE Reactive arthritis Arthritis of IBD Lyme arthritis Psoriatic arthritis Crystalline arthritis Osteoarthritis Paraneoplastic disease Sarcoid Polymyalgia rheumatica ```
50
Juvenile Idiopathic Arthritis is a diagnosis of
exclusion. | no labs to definitively dx
51
Systemic JIA looks like?
- High fever, malaise, WT loss lymphadenopathy, LOOK LIKE THEY HAVE CA - all joints affected - destruction of joints
52
Systemic JIA is often mistaken for what?
-infection or malignancy
53
Complications of which disease can lead to systemic JIA?
-cardiac tamponade, vaculitis, macrophage activation syndrome (MAS)
54
Lab findings in systemic JIA?
RF/ANA negative, leukocytosis (20,000+), anemia, elevated CRP, neutrophilic leukocytosis, all which may precede the arthritis
55
Polyarthritis JIA looks like?
- bimodal peak age 2-5 then 10-14 - affects all joints - 5 or more joints affected within first 6 months - systemic dz rare - destruction of joints
56
Lab findings for polyarhtritis JIA?
- negative RF, +ANA in younger age group, | - +RF in older age group
57
Pauciarthritis JIA looks like?
- most common - affects fewer than 5 joints within first 6 months - no systemic dz - rarely destructive arthritis - affects larger joints (but not hips) - chronic uveitis
58
Labs for pauciarthritis JIA?
- low titer ANA common esp w/ uveitis | - negative CBC, ESR, CRP, RF
59
Psoriatic JIA looks like?
- Mild enthesitis to polyarticular involvement of multiple axial (spine and sacroiliac joints) and peripheral joints, dactylitis, DIP involvement rare - May or may not have skin involvement. psoriatic plaques, or guttate, nail pitting - Bimodal age of onset
60
Labs for psoriatic JIA?
- +ANA, CRP, ESP and thrombocythemia | - negative RG and CCP
61
Entheses JIA/ Spondyloarthritis looks like?
- commonly misdiagnosed initially with recurrent sprains or strains - Pauciarticular, asymmetric, and primarily involves the joints of the lower extremities - Enthesitis in the lower extremities - Knees, ankles, heel pain, hip pain - Uveitis
62
Labs for entheses JIA/Spondyloarthritis?
- HLA-B27 can be + | - ESR, CRP may be elevated in severe disease
63
Sjogren's syndrome characterized by?
- dry mouth and dry eyes | - due to diminished lacrimal and salivary gland function
64
Primary cause of Sjogren's?
Specific autoimmune disease
65
Secondary cause of Sjogren's?
- RA most common | - also, SLE, scleroderma, pulmonary fibrosis
66
SSX of Sjogren's?
- Xeropthalmia (dry eyes): burning, itching, foreign body sensation, corneal ulcers, conjunctival injection - Xerostomia (dry mouth): difficulty chewing, swallowing, tooth decay, eventual difficulty speaking - Other exocrine effects: vasculitis, vaginal dryness, pleuritis, obstructive lung disease, peripheral neuropathies, pancreatitis, renal disease, dry skin
67
PE for Sjogren's?
Oral cavity, eyes, and skin- signs of dryness Secondary- complete joint exam for red, hot, swollen joints along with screening for other diseases- excessive hair loss, rash, mouth/oral sores, easy bruising, thyroid gland, abdominal tenderness, skin tightening, muscle weakness, and tenderness over the temporal artery.
68
Sjogren's | Diagnostics- Eyes
Schirmer's Test- Strip of filter paper placed inside lateral canthus of both eyes for 5 minutes,
69
Sjogren's | Diagnostics- Salivary glands
Salivary gland biopsy
70
Major complication of oligoarthritis?
Uveitis
71
DDX for Sjogren's
- dehydration | - side effects of meds

CPD III (7 decks)

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