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(1) MS: Orthopedic and Rheumatic Conditions 🩺 > S3_L2: Rheumatoid Arthritis and Systemic Lupus Erythematosus > Flashcards

S3_L2: Rheumatoid Arthritis and Systemic Lupus Erythematosus Flashcards

1
Q

This is an idiopathic inflammatory arthropathy characterized by autoimmune attack to the joints, although it also affects periarticular and extra-articular tissues

A

Rheumatoid Arthritis

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2
Q

TRUE OR FALSE: Rheumatoid Arthritis is a acute inflammatory, systemic disease that produces its most common and most prominent manifestations in the synovial joint

A

False

It is chronic.

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3
Q

Rheumatoid Arthritis is characterized by (1)_____ waxing and waning inflammation, predominantly affecting the small joints of the (2)_______ and (3)_______

A
  1. symmetric
  2. hands
  3. feet
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4
Q

TRUE OR FALSE: Rheumatoid Arthritis can affect any synovial joint of the body. Its peak incidence is between 4th and 6th decades

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

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5
Q

Choose the statement that is TRUE about Rheumatoid Arthritis:

A. Men > Women
B. Unilateral
C. Higher incidence in Japanese and Chinese
D. Etiology: unknown; autoimmune
E. None of the above

A

D. Etiology: unknown; autoimmune

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6
Q

Match the following Classification of Functional Status in Rheumatoid Arthritis.

  1. Completely able to do ADL
  2. Limited to ADL
  3. Able to do self care but limited vocational and avocational activities

A. Class I
B. Class II
C. Class III
D. Class IV
E. Class V

A
  1. A
  2. D
  3. C

NOTE: There is no Class V

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7
Q

Determine the condition.

  1. Joints painful but without swelling
  2. Morning stiffness lasts less than 1 hour
  3. Whole body symptoms are not present
  4. Affects women more than men
  5. NSAIDs for tx

A. Osteoarthritis (OA)
B. Rheumatoid Arthritis (RA)
C. Both
D. Neither

A
  1. A
  2. A
  3. A
  4. B
  5. C
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8
Q

Determine the condition.

  1. Occurs at any time in life
  2. Symptoms occur in isolation, with no systemic symptoms
  3. Relatively rapid, over weeks to months
  4. Frequent fatigue and a general feeling of being ill are present
  5. Uses X-ray for diagnosing

A. Osteoarthritis (OA)
B. Rheumatoid Arthritis (RA)
C. Both
D. Neither

A
  1. B
  2. A
  3. B
  4. B
  5. A
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9
Q

Determine the condition.

  1. Normal wear and tear
  2. Autoimmune
  3. Symmetrical affectation
  4. Frequent feelings of “being sick inside”, with fevers, weight loss, or involvement of other organ systems
  5. Begin on one side of the body and may spread to the other side

A. Osteoarthritis (OA)
B. Rheumatoid Arthritis (RA)
C. Both
D. Neither

A
  1. A
  2. B
  3. B
  4. B
  5. A
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10
Q

In Rheumatoid Arthritis, the onset of joint pain and swelling is ______

A

insidious (subtle)

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11
Q

What is the hallmark symptom of RA?

A

Morning stiffness is more than an hour

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12
Q

In Rheumatoid Arthritis, constitutional symptoms such as low grade fever, fatigue, malaise, myalgia, decrease appetite and weight loss are due to _______

A

systemic inflammation

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13
Q

TRUE OR FALSE: In Rheumatoid Arthritis, nodules may appear in the elbow and achilles tendon. Shortness of breath or chest pain may be reported in pt hx due to pleuropulmonary involvement.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

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14
Q

Histologically, the midzone of a rheumatoid nodule is/are the:

A. necrotic material (NC)
B. macrophages (MM)
C. granulation tissue (OG)

A

B. macrophages (MM)

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15
Q

Histologically, the outer zone of a rheumatoid nodule is/are the:

A. necrotic material (NC)
B. macrophages (MM)
C. granulation tissue (OG)

A

C. granulation tissue (OG)

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16
Q

Histologically, the central zone of a rheumatoid nodule is/are the:

A. necrotic material (NC)
B. macrophages (MM)
C. granulation tissue (OG)

A

A. necrotic material (NC)

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17
Q

In Rheumatoid Arthritis, in what gender is pleuropulmonary manifestation
more common?

A

Men

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18
Q

Rheumatoid scleritis is most common in the ______ decade of life

A

sixth

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19
Q

TRUE OR FALSE: Rheumatoid scleritis is often bilateral. it affects men more frequently than women.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

C. Only the 1st statement is true

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20
Q

FILL IN THE BLANKS: The following are clinical signs and symptoms of patients with RA.

  1. _______ in one or more joints
  2. Early morning stiffness (> 1hr)
  3. Recurring pain or ________ in any joint
  4. Inability to move a joint normally
  5. Obvious redness and warmth in a joint
  6. Unexplained weight loss, fever or weakness combined with joint pain
  7. Symptoms last for more than ________
A
  1. Swelling
  2. tenderness
  3. 2 weeks
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21
Q

In order to diagnose RA, there must be at least ______ joint areas simultaneously have had soft tissue swelling or fluid observed by a physician.

A

3

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22
Q

In order to diagnose RA, there must be subcutaneous ________, over bony prominences, or extensor surfaces, or in juxta-articular regions, observed by a physician.

A

nodules

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23
Q

In order to diagnose RA, there must be a demonstration of abnormally elevated amounts of _________ by any method for which the result has been positive in <5% of normal control subjects

A

serum rheumatoid factor

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24
Q

In order to diagnose RA, an X-ray result must include (1)_____ or unequivocal bony (2)_______ localized in or most marked adjacent to the involved joints

A
  1. erosions
  2. decalcification
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25
Q

This is a distal hyperextensibility that happens when there is a subluxations at the 1st MCP and IP joints

A

hitchhiker deformity

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26
Q

According to the 1987 Revised Criteria for Classification of Rheumatoid Arthritis:

  1. A diagnosis of RA is now established upon the presentation of ______ of the seven listed criteria.
  2. The joint signs and symptoms described in criteria must have lasted for at least ________
A
  1. four
  2. 6 weeks
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27
Q

According to the 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis, a score of ______ is needed for classification of a patient as having definite RA.

A

≥6/10

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28
Q

TRUE OR FALSE: Every patient with a point total of 6 or higher is unequivocally classified as an RA patient, provided he has synovitis in at least one joint and given that there is no other diagnosis better explaining the synovitis.

A

True

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29
Q

In RA, antibodies against ___________ are present in many patients with RA.

A

autologous immunoglobulin G

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30
Q

In RA, what is structure is specifically affected?

31
Q

TRUE OR FALSE: RA in the cervical spine is a common cause of C1-C2 subluxation

32
Q

What deformity and condition arises when the elbow is affected by RA?

A

Flexion deformity and Ulnar compression neuropathy

33
Q

Determine the hand deformity.

  1. floating ulnar head
  2. no ulnar nerve problem
  3. stretched radioulnar ligaments allow the ulna to drift upward
  4. telescoping appearance of the digits
  5. rupture or destruction of the ulnar collateral ligament

A. Piano-Key Sign
B. Pseudobenediction sign
C. Mutilan deformity

34
Q

Determine the hand deformity.

  1. Most serious arthritic involvement
  2. Resorptive arthropathy
  3. Digits are shortened and phalanges appear retracted with skin folds
  4. Indicates ulnar head subluxation
  5. Inability to fully extend 4th and 5th digit

A. Piano-Key Sign
B. Pseudobenediction sign
C. Mutilan deformity

35
Q

This refers to the combination of seropositive rheumatoid arthritis and a characteristic pattern of fibrosis

A

Caplan’s syndrome

NOTE: It is a combination of pulmonary nodules + RA and is also known as rheumatoid pneumoconiosis

36
Q

What is the most common peripheral entrapment neuropathy that may arise from RA?

A

Carpal Tunnel Syndrome

37
Q

What hematological syndrome is a combination of splenomegaly, leukopenia and leg ulcers that arises from RA?

A

Felty’s Syndrome

38
Q

TRUE OR FALSE: There is no laboratory test, histologic or radiographic finding that conclusively indicates a definitive diagnosis of RA

39
Q

The following are the most common joints affected by RA, EXCEPT:

A. DIP of the fingers
B. PIP of the fingers
C. MCP
D. MTP
E. None

A

A. DIP of the fingers

40
Q

TRUE OR FALSE: Cytokines does not play a key role in the perpetuation of synovial inflammation.

41
Q

TRUE OR FALSE: RA may occur in the TMJ.

42
Q

When the wrist is affected with RA, a (1)______ contracture and decrease in ability to execute power (2)_____ occurs

A
  1. Flexion
  2. grasp
43
Q

In which direction does the distal row of the carpals deviate in RA?

A

radial side

44
Q

What deformity of the foot arises from RA?

A

Cock-up deformity of MTP/Hammer toe

45
Q

What respiratory joints may be inflamed in RA and cause laryngeal pain and dysphonia?

A

cricoarythenoid joint

46
Q

TRUE OR FALSE: There are no specific GI symptom in RA.

47
Q

RA is a (1)______mild disease with partial/complete periods of remission . It is a (2)_____ disease with either rapid or slow but relentless (3)______

A
  1. Intermittent
  2. Progressive
  3. Deterioration
48
Q

What does it mean to be in a period of remission in RA?

A

when the patient is not “under attack”

49
Q

A 32 y/o female comes in a PT clinic dx with RA. HPI indicates persistent sustained disease of more than 1 year duration. Lab tests observe a high RF and (+) HLA-DR4 haplotype. Upon PE, PT notes of (+) rheumatoid nodules.

What is the prognosis of the patient?

50
Q

In RA, joints are painful, (1)_____, and (2)_____. Morning stiffness lasts (3)_____ than 1 hour

A
  1. swollen
  2. stiff
  3. longer/ more
51
Q

This is a heterogeneous disease characterized by autoimmune attack on multi-body system, causing widespread inflammation and tissue damage in the affected organs

A

Systemic lupus erythematosus (SLE)

52
Q

Systemic lupus erythematosus (SLE) is predominantly a disease of which gender?

53
Q

The following may be observed in a PT IE for a SLE pt, EXCEPT:

A. Skin rashes
B. Diabetes
C. Abnormal urine findings
D. History of thrombophlebitis and Raynaud’s disease
E. None

54
Q

The following may be observed in a PT IE for a SLE pt, EXCEPT:

A. Hypertension
B. Difficulty swallowing
C. Abdominal pain
D. Nasal sores
E. None

A

A. Hypertension

55
Q

The following may be observed in a PT IE for a SLE pt, EXCEPT:

A. scleritis
B. pregnancy
C. visual loss
D. pleural effusion
E. None

A

B. pregnancy

NOTE: severe preeclampsia is often seen in women.

56
Q

TRUE OR FALSE: Smoking is a risk factor for SLE.

57
Q

Which of the following laboratory test result should NOT be seen in a pt dx with SLE?

A. anemia
B. leukopenia
C. thrombocytopenia
D. low ESR
E. None

A

D. low ESR

NOTE: this is non specific but can be elevated in SLE pts.

58
Q

What 2 antibodies are specific for lupus?

A
  1. anti-dsDNA (anti-double stranded DNA)
  2. anti-SM (anti-Smith)
59
Q

These are autoantibodies that target normal proteins within in the nucleus of a cell and signal the body to begin attacking itself

A

antinuclear antibodies

60
Q

The following may be seen in a Chest x ray with a SLE patient, EXCEPT:

A. pleural effusion
B. pulmonary fibrosis
C. pulmonary hypertension
D. acute pneumonitis
E. none

61
Q

The following may be seen in a cardiac echocardiogram with a SLE patient, EXCEPT:

A. pericardial inflammation and effusion
B. myocardial hypertrophy
C. ventricular dysfunction
D. myocardial infarction
E. none

A

D. myocardial infarction

62
Q

The following may be seen in a Joint x-ray with a SLE patient, EXCEPT:

A. soft tissue swelling
B. peri-articular osteoporosis
C. narrow joint space
D. deformities due to ligamentous laxity and muscle contracture
E. none

A

C. narrow joint space

NOTE: joint spaces are often normal

63
Q

The following may be seen in a with a SLE patient, EXCEPT:

A. cerebral atrophy
B. ischemic stroke
C. intra-cerebral hemorrhage
D. cerebral vasculitis
E. none

64
Q

Enumerate the 11 criteria in diagnosing SLE.

HINT: Use the mnemonic “DOPAMINE RASH”

A
  1. Discoid rash
  2. Oral ulcers
  3. Photosensitivity
  4. Arthritis
  5. Malar rash
  6. Immunologic disorder
  7. Neurologic disorder
  8. Renal disorder
  9. Antinuclear antibody
  10. Serositis
  11. Hematologic
65
Q

Choose the SLE criteria that corresponds to the statement

Skin rash as a result of unusual reaction to sunlight, by patient history or physical observation

A Discoid rash
B. Oral ulcers
C. Photosensitivity
D. Arthritis
E. Malar rash
F. Immunologic disorder
G. Neurologic disorder
H. Renal disorder
I. Antinuclear antibody
J. Serositis
K. Hematologic

A

C. Photosensitivity

NOTE: This choice criteria will be eliminated in the next question.

66
Q

Choose the SLE criteria that corresponds to the statement

Erythematous raised patches with adherent keratotic scaling and follicular plugging

A Discoid rash
B. Oral ulcers
D. Arthritis
E. Malar rash
F. Immunologic disorder
G. Neurologic disorder
H. Renal disorder
I. Antinuclear antibody
J. Serositis
K. Hematologic

A

A Discoid rash

NOTE: This choice criteria will be eliminated in the next question.

67
Q

Choose the SLE criteria that corresponds to the statement

Most common cause of death in SLE

B. Oral ulcers
D. Arthritis
E. Malar rash
F. Immunologic disorder
G. Neurologic disorder
H. Renal disorder
I. Antinuclear antibody
J. Serositis
K. Hematologic

A

H. Renal disorder

68
Q

Choose the SLE criteria that corresponds to the statement

Fixed erythema, flat or raised over malar eminences, tending to spare the nasolabial folds.

B. Oral ulcers
D. Arthritis
E. Malar rash
F. Immunologic disorder
G. Neurologic disorder
H. Renal disorder
I. Antinuclear antibody
J. Serositis
K. Hematologic

A

E. Malar rash

NOTE: This choice criteria will be eliminated in the next question.

69
Q

Choose the SLE criteria that corresponds to the statement

Persistent proteinuria greater than .5g/day or greater than 3+

B. Oral ulcers
D. Arthritis
F. Immunologic disorder
G. Neurologic disorder
H. Renal disorder
I. Antinuclear antibody
J. Serositis
K. Hematologic

A

H. Renal disorder

70
Q

A Malar rash is also known as?

A

Butterfly rash

71
Q

How much of the 11 criteria is required to be present before diagnosing a pt with SLE?

72
Q

Determine whether the descriptions are for RA, SLE, both, or neither

  1. Female > Male
  2. Non-erosive arthritis
  3. Autoimmune
  4. Multisystemic
  5. (-) photosensitivity

A. RA
B. SLE
C. Both
D. Neither

73
Q

TRUE OR FALSE: Both RA and SLE presents with rashes

(1) MS: Orthopedic and Rheumatic Conditions 🩺 (13 decks)

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