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Rezi > Reumato > Flashcards

Reumato Flashcards

1
Q

Gene care influenteaza susceptibilitatea la SA

A

IL-1
IL-23
CYP2D6
ERAP-1

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2
Q

Criterii lombalgie SA

A

Varsta diagnostic < 45 ani
Debut insidios
Ameliorare la efort
Lipsa ameliorare la repaus
Durere nocturna cu ameliorare la ridicare
4/5 = Sb 80%

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3
Q

Manifestari extraarticulare in SpA

A

Uveita
Leziuni cutanate identice histologic cu psoriazis pustulos - ARe
Distrofie unghiala - APs, ARe
Aortita - SA, ARe

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4
Q

Ce masoara testul Schober

A

Rigiditatea spinala

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5
Q

Manifestari uveita anterioara acuta

A

Durere oculara severa
Fotofobie
Vedere incetosata

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6
Q

Ce evalueaza scorul BASDAI

A

Oboseala
Durerea spinala
Artralgia
Tumefactia articulara
Sensibilitatea localizata
Tendinita/entezita
Durata si severitatea redorii matinale

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7
Q

Cum apare coloana de bambus pe Rx

A

Calcificarea lig intervertebrale
Fuziunea articulatiilor dintre apofizele spinoase
Sindesmofite

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8
Q

Ce determina entezita de la nivelul insertiei ligamentelor intervertebrale?

A

Formare de sindesmofite
Anchiloza osoasa
Rigidizare permanenta

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9
Q

Blocanti TNF-alfa utili in SA

A

Infliximab
Etanercept
Adalimumab
Golimumab
Certolizumab

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10
Q

Variante de antiinflamatoare in SA

A

AINS
Blocanti de TNF-alfa
Blocanti de IL-17
Sulfasalazina (doar pentru artrita periferica; nu are efect pe artrita axiala)

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11
Q

DMARDs utile in APs

A

Blocanti de TNF-alfa - etanercept, golimumab
Inhibitori de IL-17 - secukinumab, ixekizumab
Inhibitori de IL-12/23 - ustekinumab
Inhibitori de PDE4 - apremilast
Inhibitori de JAK - tofacitinib

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12
Q

Ce determina artrita psoriazica mutilanta?

A

Osteoliza periarticulara marcata
Scurtarea oaselor (degete telescopate)

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13
Q

Frecventa HLA DR4 la cei cu PAR

A

50-75%

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14
Q

Frecventa FR la cei cu PAR

A

75-80%

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15
Q

Ce citokine sunt sintetizate dupa depunerea de complexe imune in membrana sinoviala?

A

Macrofagele -> IL-1, IL-8, TNF-alfa, GM-CSF
Fibroblastele -> IL-6

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16
Q

Ce molecule prezinta fibroblastele sinoviale si ce faciliteaza ele?

A

VCAM-1 - sustin supravietuire si diferentierea LB
DAF - previne liza celulara indusa de C
Caderina II - mediaza interactiunile celulare

Aceste molecule faciliteaza formarea de tesut limfoid ectopic in membrana sinoviala

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17
Q

Ce produc LTh17

A

IL-17
IL-21
IL-22
TNF-alfa

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18
Q

Ce autoantigene se citrulineaza in organism? (Care sunt factorii declansatori pentru formarea de ACPA)

A

Filagrina
Vimentina
Colagen tip 2

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19
Q

Semnificatia unui titru FR persistent crescut in boala precoce

A

Sinovita persistent activa
Implicarea mai multor articulatii
Dizabilitate mai importanta

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20
Q

Factori de prognostic negativ in PAR

A

Varsta inaintata
Sex F
Fumat
Comorbiditati
Redoare matinala > 30 min
> 4 articulatii tumefiate
Afectare simetrica a articulatiilor mici
PCR > 20 g/dL
FR, ACPA +

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21
Q

DDx PAR precoce

A

SpA
PMR
Artroza nodulara acutizata
Artita postvirala: rubeola, eritrovirus, VHB

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22
Q

Ce articulatii afecteaza PAR precoce?

A

Frecvent IFP, MCF, MTF
Posibil si carp, cot, umar, glezna, genunchi
IFD crutate de obicei

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23
Q

Prezentare rara a PAR (10% cazuri)

A

Monoartrita genunchi/umar/STC

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24
Q

Tipuri de afectare clinica in PAR

A

Palindromica
Tranzitorie
Remisiva
Cronica
Rapid progrsiva

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25
Q

Cum se prezinta compresia medulara in PAR constituita?

A

Dificultate de mers care nu poate fi explicata prin boala articulara
Slabiciunea picioarelor
Pierderea controlului sfincterian

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26
Q

Ce alte articulatii mai sunt afectate in PAR?

A

Coloana cervicala
ATM
Acromio-claviculara
Sterno-claviculara
Crico-aritenoida
Orice alta articulatie sinoviala

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27
Q

Factori de risc pentru vasculita in PAR

A

FR titruri mari
Manifestari extra-articulare active in alte parti

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28
Q

Frecventa HLA DR4 in sindrom Felty

A

95%

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29
Q

Complicatii sindrom Felty

A

Ulcere picioare
Sepsis

30
Q

Cand trimitem un pacient cu PAR la reumato?

A

Afectarea articulatiilor mici (maini/picioare)
Afectarea a >1 articulatie
Debut > 3 luni

31
Q

Ce determina osteoporoza juxta-articulara in timpul sinovitei active?

A

Citokinele locale (de la nivelul membranei sinoviale)
Imobilizarea articulatiei

32
Q

Manifestari non-articulare in PAR

A

Sclerita/Episclerita
Scleromalacie
Sindrom Sjogren - xeroftalmie, xerostomie
Limfadenopatie
Bursita olecraniana, noduli subcutanati
Tenosinovita flexorilor
Tumefactia tecii tendonului extensor al degetelor
STC
Neuropatie senzitivo-motorie
Subluxatie atlanto-axiala -> rar determina compresie medulara
Leziuni de vasculita unghiala
Ulcere gambiere
Edem de glezne
Amiloidoza
Pericardita
Pleurezie, BIP, sindrom Caplan, noduli reumatoizi, bronsiolita obliteranta (boala de cai aeriene mici)
Sindrom Felty (splenomegalie + neutropenie)
Anemie

33
Q

Anticorpi umani (bDMARDs)

A

Adalimumab
Golimumab

34
Q

Anticorpi umanizati (bDMARDs)

A

Etanercept
Certolizumab

35
Q

bDMARDs cu administrare s.c

A

Etanercept
Certolizumab
Adalimumab
Golimumab
Tocilizumab
Sarilumab

36
Q

bDMARDs cu administrare i.v

A

Infliximab
Rituximab
Abatacept
Tocilizumab

37
Q

RA Anti-TNF

A

Reactii la locul injectarii
Reactii de HS
Sindrom lupus-like
Infectii
IC
Demielinizare, sindroame autoimune (rar)

38
Q

Ce biologice au biosimilare?

A

Infliximab
Etanercept
Adalimumab
Rituximab

39
Q

Tintele chirurgiei in PAR

A

Profilactice - previne distrugerea articulara si deformarea
Reconstructive - restabileste functia articulara

40
Q

Optiuni chirurgicale in PAR

A

Sinovectomie
Refacerea tendoanelor
Osteotomie de realiniere a suprafetelor portante
Artrodeza (fuziunea articulatiei) - pentru articulatiile deteriorate care nu sunt usor de inlocuit
Artroplastie de implant al articulatiilor mici (MCF)
Artroplastie de excizie ale capetelor metatarsiene - reduce durerea metatarsiana
Artroplastie totala - umar, cot, carp, sold, genunchi, glezna - reduce durerea si imbunatateste functia articulara

41
Q

Modalitatile prin care HLA B27 creste riscul de ARe

A

Selectarea receptorilor LT
Mimetism molecular
Modul de prezentare a peptidelor derivate din bacterii catre LT

42
Q

Ce artrita poate fi reactiva sau septica?

A

Poststreptococica
Gonococica
Bruceloza

43
Q

Manifestari clinice ale ARe

A

Conjunctivita sterila
Ulceratie orala
Uretrita
Balanita circinata
Artrita de genunchi
Sinovita de MTF
Dactilita
Entezita -> fasceita plantara, tendinoza ahiliana
Keratoderma blenorrhagica plantara

44
Q

Hiperuricemie patologica

A

> 6,86 mg/dL
Sau
408 mcmoli/L

45
Q

AUS creste cu

A

Varsta
Greutatea
O dieta occidentala
Dislipidemie mixta + DZ
BCI
HTA

46
Q

Ce transportori sunt responsabili de excretia renala de acid uric?

A

Antiporter anion-urat (reabsorbtie)
Transportor de reabsorbtie a uratului
Transportoare de anioni secretori
Proteine transportoare de fosfat de sodiu
Pompa secretorie cu motor ATP

47
Q

Ce transportor de urat este prezent si in rinichi si in intestin?

A

Transportorul secretor ABCG2

48
Q

Cauze de hiperuricemie - afectarea excretiei acidului uric

A

BCR
HTA
HPTH primar, hipotiroidism
Saturnism
Medicamente - diuretice tiazidice, aspirina (doze mici)
Cresterea productiei de acid lactic - alcool, exercitii fizice, infometare
Deficit de glucozo-6-fosfataza

49
Q

Cauze de hiperuricemie - cresterea productiei

A

Deficit de HGPRT - Lesch Nyhan (X linkata)
Deficit de glucozo-6-fosfataza - glicogenoza tip 1
Hiperactivitatea fosforibozil-pirofosfat sintazei

50
Q

Cauze de hiperuricemie - metabolism crescut al purinelor

A

Boli mieloproliferative - policitemia vera
Boli limfoproliferative - leucemie
Carcinoame
Psoriazis sever

51
Q

Caracteristici guta cronica tofacee poliarticulara

A

Artralgii cronice
Limitarea activitatii
Leziuni articulare structurale
Atacuri frecvente

52
Q

Ce poate precipita un atac de guta?

A

Exces alimentar
Alcool
Deshidratare
Diuretice

53
Q

Punctul de saturatie al acidului uric

A

6,05 mg/dL
Sau
360 mcmoli/L

54
Q

Scopul tratamentului in guta

A

AUS < 360 mcmoli/L SAU 6.05 mg/dL la toti
SAU
AUS < 300 mcmoli/L SAU 5.04 mg/dL la cei cu guta severa (tofi/atacuri frecvente)

55
Q

Cele mai frecvente RA la alopurinol

A

Eruptii cutanate
Intoleranta GI

56
Q

RA grave, dar rare ale alopurinolului

A

HS
Supresie medulara

57
Q

Unde se formeaza tofi?

A

Periarticular
Pe ureche
Pe degete
La nivelul tendonului ahilian

Sunt depozite subcutanate, albe, netede

58
Q

Prevalenta condrocalcinozei creste cu

A

Varsta
Prevalenta artrozei
Prevalenta traumatismelor/leziunilor articulare
Prevalenta bolilor metabolice - HPTH, hemocromatoza, hipoMg-emie

59
Q

Locuri preferentiale de debut in guta, condrocalcinoza

A

Guta - MTF 1
Condrocalcinoza - genunchi, carp

60
Q

Diferenta microscopica guta vs condrocalcinoza

A

Guta - cristale in forma de ac, fara birefringenta - UMS
Condrocalcinoza - cristale romboidale, cu birefringenta - PFCD

61
Q

Cum determina leziuni articulare cristalele de FCB

A

Induce proliferarea fibroblastelor
Citokine proinflamatorii - IL-1beta, TNF alfa
Oxid nitric
Metaloproteinaze

62
Q

DDx boala prin depunere de FCB

A

Guta
Condrocalcinoza
Artrita septica
Celulita

63
Q

Coloratie specifica pentru Calciu

A

Alizarin rosu S

64
Q

Medicamente care pot induce LES

A

Hidralazina
Izoniazida
Procainamida
Penicilamina

Forme usoare
NU dau afectare neurologica/renala

65
Q

Cand creste PCR in LES?

A

Pleurezie lupica
Peritonita
Artrita
Infectie coexistenta

66
Q

Markeri predictivi pentru puseu de LES

A

VSH mare
Ac anti-ADNdc crescuti
C3 mic

67
Q

Manifestari neurologice in LES

A

Depresie usoara
Psihoza
Boli cerebrovasculare
Hemiplegie
Epilepsie
Ataxie cerebeloasa
Polineuropatie
Afectarea NC
Migrene
Meningita septica

68
Q

Manifestari clinice in LES + procente

A

Articulatii (90%) - artrita de articulatii mici, rar NACF
Tegument (85%) - eritem in fluture, fotosensibilitate, vasculita, purpura, urticarie
Hematologic (75%) - anemie (Ncr, Nc sau hemolitica Coombs+), leuco/limfopenie, trombocitopenie
SN - vezi flashcard manifestari neuro
General - fatigabilitate (75%), febra (50%), scadere ponderala (50%), depresie
Torace (50%) - pleurezie/efuziune, disfunctie respiratorie restrictiva (rar)
Renal (30%) - glomerulonefrita
Cord - pericardita, endocardita Libman Sacks, leziuni de valva aortica, miocardita cu aritmii
Raynaud (20%)
Dureri abdominale (20%)
Ochi - Sjogren (15%), episclerita, conjunctivita, nevrita optica
Miozita (<5%)

69
Q

Sindrom lupic neonatal - clinica

A

Eruptii
Hepatita
Bloc cardiac fetal

70
Q

Ce manifestari din LES raspund la antimalarice?

A

Artralgii
Fatigabilitate
Afectare cutanata

71
Q

Ce manifestari din LES raspund la AINS in doze standard?

A

Artralgii
Artrita
Serozita
Febra

Rezi (15 decks)

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