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CPD Spring Term > Quiz 6 - MS I > Flashcards

Quiz 6 - MS I Flashcards

1
Q

What parts of the body do MS disorders arise?

A

muscles, joints, tendons, ligaments and nerves

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2
Q

What are the three actions of synovial fluid?

A

reduction of friction via lubrication
shock absorption - becomes VISCOUS under pressure**
Nutrient and waste transportation - provides O2 and allows the movement of CO2 out

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3
Q

Any acute mono arthritis (involving one joint) is ______ until proven otherwise

A

INFECTIOUS

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4
Q

what does pauciarticular mean?

A

MS disease involving 2-4 joints

meaning polyarticular is 5+ joints.

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5
Q

what is the name for “swelling of a tendon sheath causing ‘triggering’”

A

stenosing

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6
Q

when you have synovitis with a large effusion of non purulent fluid you have..

A

serous synovitis

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7
Q

what are the 8 carpal bones of the hand

A

Some Lovers Try Positions That They Can’t Handle

Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
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8
Q

when discussing the onset and progression of disease with MS patients - what is important?

A

Speed of onset!

Location

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9
Q

What is one of the most important questions to ask specifically to MS patients?

A

Do you have morning stiffness and how long does it last?

This is important because it helps differentiate functional abnormalities vs pathology.
- AI inflammatory arthridities last >1 hr.

Does pain occur at rest?
Travel? Where and when?
What joints, where, swelling?
Toxic exposure

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10
Q

What patterns are seen on the hand that should help differentiate specific AIs?

A

OA - DIPS, PIPs, wrist (rarely MCP)
RA - PIPs, MCPs, writest (rarely DIPs)
PA - nails, asymm, sausage fingers (MCP, PIP and DIP - all affected)
Scleroderma - skin is thickened, flexion contractors, Raynaud’s is common
Sarcoidosis - DIP, PID, MCP all affected

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11
Q

what does ESR assess?

A

indicates systemic inflammatory response.
NON-SPECIFIC

can increase in: cancer, pregnancy, infection

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12
Q

what does CRP assess?

A

acute phase reactant - more sensitive measure of disease activity and progression

*** BEST OBJECTIVE MEASURE of DISEASE ACTIVITY in RA, even though it’s non-specific

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13
Q

what lab value increases for gout - but is associated with these other conditions

A

serum uric acid

also increases with low dose
ASA, Diuretics, other drugs and alcohol

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14
Q

what does Rheumatoid Factor tell us?

A

RF is antibodies directed agains the Fc portion of an IgG antibody.
May be representative of previous microbe interaction with antibodies
therefore indicated CHRONIC INFECTION (perhaps asx)

85% positive when disease is established.

NOT SPECIFIC FOR RA

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15
Q

what is anti-CCP and what is this lab value good for?

A

anti-cyclic citrullinated peptide antibody

> 90% SPECIFIC FOR RA!!!

as sensitve, but more specific than IgM RF.

May be present prior to RA symptoms.

Sjogren’s and TB can also show positives in this one

can predict increased risk for erosive disease

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16
Q

HLA-B27 is associated with which 3 conditions?

A 
sponyloarthropathies (AS)
reactive arthritis (RA)
psoriatic arthritis (PA)
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17
Q

Which vitamin is definitely associated with many MS disease?

A

Vitamin D deficiency

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18
Q

When there is any suspicion of septic arthritis (acute monoarthritis), immediate what must be carried out?

A

immediate aspiration of synovial fluid must be carried out

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19
Q

What is the broad differential to know for most any autoimmune disorder?

A 
Cancer
AI disease
Infection
Exposure (pharmaceutical/environment)
Metabolic
Trauma
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20
Q

What are common etiologies of Rheumatoid Arthritis? What is the clinical picture? What joints are commonly affected? What labs would you order?

A

Etiologies

TLR

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21
Q

What are MMPs and why are they important?

A

Matrix metalloproeinases (MMPs)

implicated in many diseases of MS

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22
Q

what are the steps in the general approach to the MS patient?

A 
first, listen. second, listen.
examine
gather data
provide a differential
make a plan
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23
Q

Recent GU/GI infection suggests which AI?

A

reactive arthritis

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24
Q

Bloody Diarrhea suggests?

A

Enteropathic arthropathy

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25
Q

When you have an individual present with Photosensitive rash, seizures, hallucinations, renal disease, what is suggested?

A

SLE

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26
Q

if patient presents with painful red eye, what does this suggest?

A

seronegative disease

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27
Q

Dry as a desert.. Dry eyes, mouth, vagina..

A

Sjogren’s

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28
Q

Which condition present swift severe morning stiffness, amaurosis fugal and jaw claudation

A

Temporal Arteritis

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29
Q

Rash in the gluteal fold suggests which condition

A

Psoriatic Arthritis

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30
Q

Elderly lady on aspirin and diuretic suggest ..

A

Hand gout

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31
Q

What are the 6 broad categories of abnormalities possibly present

A 
deformity
swelling
color change
muscle atrophy
changes in ROM
changes in gait
32
Q

what are the 6 assessments for an upper extremity?

A 
observe surfaces for atrophy
spread all fingers (ext)
make a fist (flex)
pronate and supinate with fist
Flex/Ext wrist then elbow
AROM of shoulder in all directions
33
Q

what are the 6 assessments for a lower extremity?

A 
inspect (standing, lying)
hip flexion - lift knee and ext rot
return leg to neural and internally rotate ankle for hip internal rot
flex/ext knee
feel of the shin for cool knees
BALLOTTEMENT of the patella!!
34
Q

What does a typical hand of osteoarthritis look like?

A
  • hard bony enlargements
  • Heberden’s nodes (DIPs)
  • Bouchard’s nodes (PIPs)
  • squared CMC at first joint
35
Q

what does a typical Rheumatoid Arthritis hand look like?

A
  • soft synovial swelling
  • synovitis and volar subluxation at the MCP joints
  • synovitis of the wrists
  • Swan neck deformities (synovitis of PIPs)

incomplete fist closure
reduced grip strength
pitting edema over dorsum (boxing glove appearance)
Carpel Tunnel (+ tinel’s/+ phalens)

36
Q

what is the difference between the Swan Neck Deformity and the Boutonniere Deformity?

A

Swan Neck: PIP extension, DIP flexion

Boutonniere Deformity: PIP flexion, DIP extension

in RA - Swan neck is digist 2-4, Boutonniere digit 5

37
Q

what do the hands of psoriatic arthritis look like?

A 
inflamed DIP jts
SAUSAGE FINGERS
Joint involvement in a radial pattern
- NAIL CHANGES
- Psoriatic Patches
- Arthritis may precede skin condition
38
Q

what are pertinent labs for data gathering?

A

ANA, RF, CCP, HLA-B27, CBC, comp panel, ESR, uric acid, CPK, markers of bone metabolism, TFTs, B12, Vit D, HIV, Hepatitis

39
Q

What are anti-MCV antibodies? what are they very similar to?

A

anti-mutated citrullinated veimentin (anti-MCV)

found in RA patients where glycine replaces arginine

very similar to predictive value for progression

40
Q

what is arthrocentesis?

A

joint aspiration!!

must be done quickly, do not wait - aspirate and culture ALL involved joints.

41
Q

Rheumatoid arthritis what are some causes?

A

TLRs - our DNA reacting with TLRs to trigger inflammation

Epigenetics - fold your clothing neatly, or .. be sloppy

Infections

Environment

Nutritional Deficiencies

42
Q

Which TLRs are involved in RA? Which are the prevalent cytokines present? and characterized by what?

A

TLR 3, 7, 8, 9
IFN-alpha, beta, IL-6, TNF-alpha

a diverse set of systemic autoimmune syndromes including lupus are characterized by IFN-1 activation

43
Q

If you were to give me the quick and dirty regarding TLRs, what would be their significance in AI?

A

many autoantigens (made via tissue injury) - act as AUTOADJUVANTS - which directly activate INNATE IMMUNITY to induce a SELF-DIRECTED IMMUNE RESPONSE

44
Q

what’s the importance of the thymus?

A

deletes self-reactive lymphocytes

45
Q

Autoimmunity in RA is characterized by… what specific antigen is involved?

A

an antibody response to citrullinated proteins

citrullinated proteins like - P. gingivalis (could be a potential causative agent)

citrullinated enolase is the specific antigen involved

46
Q

what risk factor increases the production of citrullinated proteins?

A

smoking

47
Q

why are probiotics so critical?

A

Probiotics STIMULATE TLRs and protect from allergies and AI

48
Q

when an individual is vitamin D deficient what are increased?

A

IL-17
IFN-gamma producing T cells

  • vitamin D supplementation was associated with increase percent Treg cells - immunomodulatory effect!
49
Q

RA patients with elevated prolactin levels have what?

A

more active disease

50
Q

Ra - describe it

A

hand and foot swelling
often symmetric (MCPs, PIPs, wrists, MTP, elbow, knees, midfoot)
morning stiffness for > 1 hr

51
Q

differentiate PE findings for early RA vs late RA

A

early:
soft, spongy PIP swelling

late:
ulnar drift, muscle wasting 
swan neck/boutenneire
bow string
extensor tendon rupture
52
Q

palindromic onset, means what?

A

episodic attacks - resolve as they have come on.

may be related to HLA genetic susceptibility
likely to develop into full blown RA

53
Q

what extraarticular involvements are seen with RA?

A

anemia (pattern anemia of chronic disease)

54
Q

what is the difference between scleritis and episcleritis?

A

scleritis
more painful, more dangerous, CILIARY INJECTION

episcleritis
ciliary injection ABSENT

55
Q

where are rheumatoid nodules commonly found?

A

extensor surfaces, MCPs, PIPs, DIPs

56
Q

what is vasculitis

A

macular rash (erythematous, raised plateau like)

57
Q

what joints are NOT affected by RA?

A

spine

DIPs

58
Q

DDX for RA

A 
acute viral polyarthritis
SLE
reactive arthritis
lyme/psoriatic arthritis
sarcoidosis
59
Q

what is one of the most common chronic disease of childhood?

A

juvenile idiopathic arthritis

  • onset 6 week duration
  • dx of exclusion
60
Q

systemic onset/still’s disease -comes on how?

A

fever, rash (pale pink, transient, blanching)
LAD, hepatosplenomegaly
serositis (pleuritis, pericarditis)

KID appears ILL - BAD SICK. LAD could be axillary

61
Q

when and only when can you dx systemic onset/still’s disease?

A

ONLY AFTER there has been

  • no response to antibiotic therapy
  • malignancy has been excluded
62
Q

which joints are most commonly involved in JIA?

A

wrists, knees, ankels

cervical spine, hands, hips, TMJs may be affected

63
Q

what is a proper laboratory assessment in JIA?

A

Increased WBC (20-30,000/mm3)
elevated platelet count
elevated feratin
hypoalbuminemia and INCREASED globulin

64
Q

what are the complication of systemic onset JIA?

And what are some ddx?

A

cardiac tamponade
spinal fusion (cervical)
vasculitis
macrophage activation syndrome

DDX:
malignancy (leukemia)
infectious arthritis (Parvo B12)
reactive arthritis

65
Q

what is micrognathia and what disease does it present in? what other symptoms are concurrent?

A

micrognathia - small mandible

seen in JIA polyarthritis
growth retardation, osteopenia, delayed sexual maturation, fatigue, anorexia

66
Q

what lab values are seen for JIA polyarthritis?

A 
RF + or -
ANA in young children often +
hypergammaglobulinemia
elevated ESR, CRP
anemia
67
Q

what is the most common sub group of JIA and what is the peak onset age?

A

Oligoarthritis/Pauciarticular JIA

68
Q

are joints in oligoartheritis/pauciarticular JIA erythematous?

A

no

joints are warm, swollen and tender to palpation, but NOT RED

69
Q

what is a big concern involving oligoarthritis/pauciarticular JIA

A

Iridocyclitis
Uveiti is the most serious complication

ANA is also, often positive

70
Q

which condition presents bimodally and which joints are affected?

A

Psoriatic JIA

preschool girls, late childhood (bimodal); oligoarthritis, adult psoriatic arthritis (respectively)

71
Q

Patient presents with dactylitis (sausage digit), involving the small joints of the hands and feet

or they may present with a single inflamed joint (knee most likely)

what joint involvement is more indicative of this disease?

A

psoriatic JIA

if DIPs are involved, dx of PsJIA is more likely

72
Q

this condition is commonly misdiagnosed with recurrent sprains or strains?

A

enthesis JIA

primarily involves joints of the lower extremities, pauciarticular, asymmetric

73
Q

This lab value is present in 90% of children with …

A

ankylosing spondylitis

74
Q

what is a unique manifestation of JIA?

A

ocular involvement

chronic uveitis
- blindness may be painless, slit lamp recommended quarterly

75
Q

what would be your comprehensive workup of a child suspect of JIA?

A

3 hour lactulose (SIBO)
lactulose/mannitol (intestinal permeability)
comprehensive stool analysis (large intestine ONLY)
IgG/IgA food sensitivity testing
Anti-endomysial/TTG-IgA/total IgA

76
Q

what is xerostomia?

A

difficulty swallowing food, cotton mouth, dry foods need liquid

dental caries on the gum line

77
Q

obstructive lung disease in the absence of smoking is..

A

sjogren’s

keratoconjunctivitis
xerophthalmia (also common)

CPD Spring Term (6 decks)

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