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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
Q

Lab

ESR

A

indicates systemic inflammatory response. NON-SPECIFIC

also increased in infection, cancer, pregnancy

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26
Q

Lab

CRP (C reactive protein)

A

Acute phase reactant. More sensitive measure of disease activity and progression.

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27
Q

Lab

Serum uric acid

A

increase in gout

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28
Q 
Lab
Rheumatoid factor (RF)
A

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

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29
Q

RF negative in

A

osteoarthritis, gout, rheumatic fever, reactive arthritis, infection arthritis, ulcerative colitis

30
Q

Lab

Anti-CCP (anti-cyclic citrullinated peptide antibody)

A

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
Q

Lab

ANA- antinuclear AB

A 
SLE - up to 95% +	
scleroderma - 60 -70% +
RA - 20 - 50% +		
Sjorgen’s - 50 - 60% +
polyarteritis - 10% +	          
dermatomyositis -10-50%+
32
Q

Lab

HLA-B27

A

associated with spondyloarthropathies (AS) reactive arthritis
psoriatic arthritis

33
Q

Lab

Vitamin D

A

def associated with many M/S diseases

34
Q

Where there is any suspicion of septic arthritis (acute monoarthritis), immediate _______ must be carried out

A

aspiration of synovial fluid

35
Q

Rheumatoid arthritis is characterized by

A

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
Q

RA

etiology

A

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
Q

RA

Clinical picture

A

Gender- 3:1 female over male
Age- any but peak onset is between the ages of 50 and 75
Frequency 1% of population

38
Q

RA
Joints affected
Hands Acute

A

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
Q

RA
Joints affected
Hands Chronic

A 
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
Q

RA
Joints affected
Foot:

A

MTP’s
Midfoot swelling
hammer toe and “cock-up” deformities

41
Q

RA
Joints affected
Wrist:

A

carpal tunnel syndrome
synovitis
decreased ROM
dorsal tenosynovitis

42
Q

RA
Joints affected
Elbows

A

flexion contractures
loss of pronation/supination
nodules

43
Q

RA
Joints affected
Shoulders

A

dislocation and spontaneous tears of the rotator cuff creating chronic pain
decreased ROM

44
Q

RA
Joints affected
Cervical spine

A

late involvement- atlanto-axial subluxation

45
Q

RA

Lab

A
  • elevated CRP and ESR

- RF-50-95%, high titer helps confirm dx, very high usu.

46
Q

RA

Imaging Findings

A 
Periarticular osteopenia
Joint space narrowing
Bare area erosions
Subluxation
Ulnar deviation of fingers
Carpal collapse
Ankylosis
47
Q

RA

Diagnostic Criteria: 6 of 10 pts necessary

A

CCP and RF (0-3)
# and size of involved joints (0-5)
> 6 weeks duration (1)
ESR and CRP (1)

48
Q

Course:
Best prognosis
Variable prognosis
Worst prognosis

A

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
Q

RA

DDX

A 
Acute viral polyarthritis
SLE
Reactive arthritis
Arthritis of IBD
Lyme arthritis
Psoriatic arthritis
Crystalline arthritis
Osteoarthritis
Paraneoplastic disease
Sarcoid
Polymyalgia rheumatica
50
Q

Juvenile Idiopathic Arthritis is a diagnosis of

A

exclusion.

no labs to definitively dx

51
Q

Systemic JIA looks like?

A
  • High fever, malaise, WT loss lymphadenopathy, LOOK LIKE THEY HAVE CA
  • all joints affected
  • destruction of joints
52
Q

Systemic JIA is often mistaken for what?

A

-infection or malignancy

53
Q

Complications of which disease can lead to systemic JIA?

A

-cardiac tamponade, vaculitis, macrophage activation syndrome (MAS)

54
Q

Lab findings in systemic JIA?

A

RF/ANA negative, leukocytosis (20,000+), anemia, elevated CRP, neutrophilic leukocytosis, all which may precede the arthritis

55
Q

Polyarthritis JIA looks like?

A
  • 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
Q

Lab findings for polyarhtritis JIA?

A
  • negative RF, +ANA in younger age group,

- +RF in older age group

57
Q

Pauciarthritis JIA looks like?

A
  • 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
Q

Labs for pauciarthritis JIA?

A
  • low titer ANA common esp w/ uveitis

- negative CBC, ESR, CRP, RF

59
Q

Psoriatic JIA looks like?

A
  • 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
Q

Labs for psoriatic JIA?

A
  • +ANA, CRP, ESP and thrombocythemia

- negative RG and CCP

61
Q

Entheses JIA/ Spondyloarthritis looks like?

A
  • 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
Q

Labs for entheses JIA/Spondyloarthritis?

A
  • HLA-B27 can be +

- ESR, CRP may be elevated in severe disease

63
Q

Sjogren’s syndrome characterized by?

A
  • dry mouth and dry eyes

- due to diminished lacrimal and salivary gland function

64
Q

Primary cause of Sjogren’s?

A

Specific autoimmune disease

65
Q

Secondary cause of Sjogren’s?

A
  • RA most common

- also, SLE, scleroderma, pulmonary fibrosis

66
Q

SSX of Sjogren’s?

A
  • 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
Q

PE for Sjogren’s?

A

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
Q

Sjogren’s

Diagnostics- Eyes

A

Schirmer’s Test- Strip of filter paper placed inside lateral canthus of both eyes for 5 minutes,

69
Q

Sjogren’s

Diagnostics- Salivary glands

A

Salivary gland biopsy

70
Q

Major complication of oligoarthritis?

A

Uveitis

71
Q

DDX for Sjogren’s

A
  • dehydration

- side effects of meds

CPD III (7 decks)

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