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Reumato Flashcards

1
Q

Gene care influenteaza susceptibilitatea la SA

A

IL-1IL-23CYP2D6ERAP-1

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2
Q

Criterii lombalgie SA

A

Varsta diagnostic < 45 aniDebut insidiosAmeliorare la efortLipsa ameliorare la repausDurere nocturna cu ameliorare la ridicare4/5 = Sb 80%

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3
Q

Manifestari extraarticulare in SpA

A

UveitaLeziuni cutanate identice histologic cu psoriazis pustulos - AReDistrofie unghiala - APs, AReAortita - 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 severaFotofobieVedere incetosata

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6
Q

Ce evalueaza scorul BASDAI

A

ObosealaDurerea spinalaArtralgiaTumefactia articularaSensibilitatea localizataTendinita/entezitaDurata si severitatea redorii matinale

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7
Q

Cum apare coloana de bambus pe Rx

A

Calcificarea lig intervertebraleFuziunea articulatiilor dintre apofizele spinoaseSindesmofite

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8
Q

Ce determina entezita de la nivelul insertiei ligamentelor intervertebrale?

A

Formare de sindesmofiteAnchiloza osoasaRigidizare permanenta

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9
Q

Blocanti TNF-alfa utili in SA

A

InfliximabEtanerceptAdalimumabGolimumabCertolizumab

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10
Q

Variante de antiinflamatoare in SA

A

AINSBlocanti de TNF-alfaBlocanti de IL-17Sulfasalazina (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, golimumabInhibitori de IL-17 - secukinumab, ixekizumabInhibitori de IL-12/23 - ustekinumabInhibitori de PDE4 - apremilastInhibitori de JAK - tofacitinib

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12
Q

Ce determina artrita psoriazica mutilanta?

A

Osteoliza periarticulara marcataScurtarea 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-CSFFibroblastele -> IL-6

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16
Q

Ce molecule prezinta fibroblastele sinoviale si ce faciliteaza ele?

A

VCAM-1 - sustin supravietuire si diferentierea LBDAF - previne liza celulara indusa de CCaderina II - mediaza interactiunile celulareAceste molecule faciliteaza formarea de tesut limfoid ectopic in membrana sinoviala

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17
Q

Ce produc LTh17

A

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

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18
Q

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

A

FilagrinaVimentinaColagen tip 2

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19
Q

Semnificatia unui titru FR persistent crescut in boala precoce

A

Sinovita persistent activaImplicarea mai multor articulatiiDizabilitate mai importanta

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20
Q

Factori de prognostic negativ in PAR

A

Varsta inaintataSex FFumatComorbiditatiRedoare matinala > 30 min> 4 articulatii tumefiateAfectare simetrica a articulatiilor miciPCR > 20 g/dLFR, 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, MTFPosibil si carp, cot, umar, glezna, genunchiIFD 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

PalindromicaTranzitorieRemisivaCronicaRapid 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 articularaSlabiciunea picioarelorPierderea controlului sfincterian

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26
Q

Ce alte articulatii mai sunt afectate in PAR?

A

Coloana cervicalaATMAcromio-clavicularaSterno-clavicularaCrico-aritenoidaOrice alta articulatie sinoviala

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27
Q

Factori de risc pentru vasculita in PAR

A

FR titruri mariManifestari 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 picioareSepsis

30
Q

Cand trimitem un pacient cu PAR la reumato?

A

Afectarea articulatiilor mici (maini/picioare)Afectarea a >1 articulatieDebut > 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/EpiscleritaScleromalacieSindrom Sjogren - xeroftalmie, xerostomieLimfadenopatieBursita olecraniana, noduli subcutanatiTenosinovita flexorilorTumefactia tecii tendonului extensor al degetelorSTCNeuropatie senzitivo-motorieSubluxatie atlanto-axiala -> rar determina compresie medularaLeziuni de vasculita unghialaUlcere gambiereEdem de glezneAmiloidozaPericarditaPleurezie, BIP, sindrom Caplan, noduli reumatoizi, bronsiolita obliteranta (boala de cai aeriene mici)Sindrom Felty (splenomegalie + neutropenie)Anemie

33
Q

Anticorpi umani (bDMARDs)

A

AdalimumabGolimumab

34
Q

Anticorpi umanizati (bDMARDs)

A

EtanerceptCertolizumab

35
Q

bDMARDs cu administrare s.c

A

EtanerceptCertolizumabAdalimumabGolimumabTocilizumabSarilumab

36
Q

bDMARDs cu administrare i.v

A

InfliximabRituximabAbataceptTocilizumab

37
Q

RA Anti-TNF

A

Reactii la locul injectariiReactii de HSSindrom lupus-likeInfectiiICDemielinizare, sindroame autoimune (rar)

38
Q

Ce biologice au biosimilare?

A

InfliximabEtanerceptAdalimumabRituximab

39
Q

Tintele chirurgiei in PAR

A

Profilactice - previne distrugerea articulara si deformareaReconstructive - restabileste functia articulara

40
Q

Optiuni chirurgicale in PAR

A

SinovectomieRefacerea tendoanelorOsteotomie de realiniere a suprafetelor portanteArtrodeza (fuziunea articulatiei) - pentru articulatiile deteriorate care nu sunt usor de inlocuitArtroplastie de implant al articulatiilor mici (MCF)Artroplastie de excizie ale capetelor metatarsiene - reduce durerea metatarsianaArtroplastie 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 LTMimetism molecularModul de prezentare a peptidelor derivate din bacterii catre LT

42
Q

Ce artrita poate fi reactiva sau septica?

A

PoststreptococicaGonococicaBruceloza

43
Q

Manifestari clinice ale ARe

A

Conjunctivita sterilaUlceratie oralaUretritaBalanita circinataArtrita de genunchiSinovita de MTFDactilitaEntezita -> fasceita plantara, tendinoza ahilianaKeratoderma blenorrhagica plantara

44
Q

Hiperuricemie patologica

A

> 6,86 mg/dLSau> 408 mcmoli/L

45
Q

AUS creste cu

A

VarstaGreutateaO dieta occidentalaDislipidemie mixta + DZBCIHTA

46
Q

Ce transportori sunt responsabili de excretia renala de acid uric?

A

Antiporter anion-urat (reabsorbtie)Transportor de reabsorbtie a uratuluiTransportoare de anioni secretoriProteine transportoare de fosfat de sodiuPompa 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

BCRHTAHPTH primar, hipotiroidismSaturnismMedicamente - diuretice tiazidice, aspirina (doze mici)Cresterea productiei de acid lactic - alcool, exercitii fizice, infometareDeficit 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 1Hiperactivitatea fosforibozil-pirofosfat sintazei

50
Q

Cauze de hiperuricemie - metabolism crescut al purinelor

A

Boli mieloproliferative - policitemia veraBoli limfoproliferative - leucemieCarcinoamePsoriazis sever

51
Q

Caracteristici guta cronica tofacee poliarticulara

A

Artralgii croniceLimitarea activitatiiLeziuni articulare structuraleAtacuri frecvente

52
Q

Ce poate precipita un atac de guta?

A

Exces alimentarAlcoolDeshidratareDiuretice

53
Q

Punctul de saturatie al acidului uric

A

6,05 mg/dLSau360 mcmoli/L

54
Q

Scopul tratamentului in guta

A

AUS < 360 mcmoli/L SAU 6.05 mg/dL la totiSAUAUS < 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 cutanateIntoleranta GI

56
Q

RA grave, dar rare ale alopurinolului

A

HSSupresie medulara

57
Q

Unde se formeaza tofi?

A

PeriarticularPe urechePe degeteLa nivelul tendonului ahilianSunt depozite subcutanate, albe, netede

58
Q

Prevalenta condrocalcinozei creste cu

A

VarstaPrevalenta artrozeiPrevalenta traumatismelor/leziunilor articularePrevalenta bolilor metabolice - HPTH, hemocromatoza, hipoMg-emie

59
Q

Locuri preferentiale de debut in guta, condrocalcinoza

A

Guta - MTF 1Condrocalcinoza - genunchi, carp

60
Q

Diferenta microscopica guta vs condrocalcinoza

A

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

61
Q

Cum determina leziuni articulare cristalele de FCB

A

Induce proliferarea fibroblastelorCitokine proinflamatorii - IL-1beta, TNF alfaOxid nitricMetaloproteinaze

62
Q

DDx boala prin depunere de FCB

A

GutaCondrocalcinozaArtrita septicaCelulita

63
Q

Coloratie specifica pentru Calciu

A

Alizarin rosu S

64
Q

Medicamente care pot induce LES

A

HidralazinaIzoniazidaProcainamidaPenicilaminaForme usoareNU dau afectare neurologica/renala

65
Q

Cand creste PCR in LES?

A

Pleurezie lupicaPeritonitaArtritaInfectie coexistenta

66
Q

Markeri predictivi pentru puseu de LES

A

VSH mareAc anti-ADNdc crescutiC3 mic

67
Q

Manifestari neurologice in LES

A

Depresie usoaraPsihozaBoli cerebrovasculareHemiplegieEpilepsieAtaxie cerebeloasaPolineuropatieAfectarea NCMigreneMeningita septica

68
Q

Manifestari clinice in LES + procente

A

Articulatii (90%) - artrita de articulatii mici, rar NACFTegument (85%) - eritem in fluture, fotosensibilitate, vasculita, purpura, urticarieHematologic (75%) - anemie (Ncr, Nc sau hemolitica Coombs+), leuco/limfopenie, trombocitopenieSN - vezi flashcard manifestari neuroGeneral - fatigabilitate (75%), febra (50%), scadere ponderala (50%), depresieTorace (50%) - pleurezie/efuziune, disfunctie respiratorie restrictiva (rar)Renal (30%) - glomerulonefritaCord - pericardita, endocardita Libman Sacks, leziuni de valva aortica, miocardita cu aritmiiRaynaud (20%)Dureri abdominale (20%)Ochi - Sjogren (15%), episclerita, conjunctivita, nevrita opticaMiozita (<5%)

69
Q

Sindrom lupic neonatal - clinica

A

EruptiiHepatitaBloc cardiac fetal

70
Q

Ce manifestari din LES raspund la antimalarice?

A

ArtralgiiFatigabilitateAfectare cutanata

71
Q

Ce manifestari din LES raspund la AINS in doze standard?

A

ArtralgiiArtritaSerozitaFebra

Rezi FC (29 decks)

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