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BioScience II > Test #2 autoimmune PPt-Josh > Flashcards

Test #2 autoimmune PPt-Josh Flashcards

1
Q

Autoimmunity:

is a disturbance in the immunologic tolerance of ________

A

Self antigens

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2
Q

Autoimmunity:

occurs when the immune system reacts against self-antigens to such a degree that a persons own tissues are damaged by _________ or autoreactive ___ cells

A

autoantibodies

t-cells

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3
Q

Autoimmunity:

what is the most common chronic inflammatory arthritis?

A

rheumatoid arthritis

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4
Q

Rheumatoid Arthritis:

course is multifactoral and is characterized by periods of _____ and ____

A

exacerbation and remission

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5
Q

Rheumatoid Arthritis:

etiology

A

exact cause unk

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6
Q

Rheumatoid Arthritis:

what may precipitate it

A
  • impaired immunity
  • stress
  • enviromental factors
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7
Q

Rheumatoid Arthritis:

what do they propose could be the etiology

A

viral or bacterial infection that alters the immune system in genetically suscetible host

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8
Q

Rheumatoid Arthritis:

circulating autoantibodies called _____ ______ are detectable in 70-80% of pts w/ RA

A

rheumatoid factors

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9
Q

Rheumatoid Arthritis: clinical manifestations

Inflammation and destruction of the ______ joints are responsible for most of the symptoms and chronic disability associated w/ RA

A

synovial joints

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10
Q

Rheumatoid Arthritis: clinical manifestations

what is teh onset like

A
  • insidiuos onset
  • over a period of weeks to months
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11
Q

Rheumatoid Arthritis: clinical manifestations

what are the most common sites

A
  • hands
  • wrists
  • feet
    *
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12
Q

Rheumatoid Arthritis: clinical manifestations

is the joint involvement symmetrical or asymmetrical

A

symmetrical

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13
Q

Rheumatoid Arthritis: clinical manifestations

what are the s/s associated with the inflammatory process

A
  • warmth
  • pain
  • swelling
  • weight loss
  • fatigue
  • Morning stiffness
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14
Q

Rheumatoid Arthritis: clinical manifestations

the joint invlvement progresses in 3 main stages what are they

A
  1. inflammation of synovial jointmembrane
  2. rapid division and growth of cells in joint
  3. Liberation of enzymes, which damages small blood vessels, cartilage, ligaments, tendons, and bones
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15
Q

Rheumatoid Arthritis: clinical manifestations

can it cause permanent damage to ROM

A

yeppers

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16
Q

Rheumatoid Arthritis: clinical manifestations

s/s of late stages

A
  • severe pain
  • joint instability
  • crippling deformities
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17
Q

Rheumatoid Arthritis: clinical manifestations

what can nerve entrapment cause

A

Carpal tunnel syndrome

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18
Q

Rheumatoid Arthritis: clinical manifestations

what synovial joint in the head can be affected

A

Synovitis in TMJ

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19
Q

Rheumatoid Arthritis: clinical manifestations

what affect on the cervical spine can occur

A
  • Atlantoaxial (C1-2) instability and subluxation
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20
Q

Rheumatoid Arthritis: clinical manifestations

what part of the larynx may be effected

A

cricoarytenoid joint

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21
Q

Rheumatoid Arthritis: clinical manifestations

s/s of cricoarytenoid joint arthritis

A

tenderness of larynx

hoarsness

pain w/ swallowing

radiatio to ear

dyspnea

Stridor

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22
Q

Rheumatoid Arthritis: clinical manifestations

w/ cricoarytenoid joint arthritis what may u see on DL

A
  • red swollen arytenoids
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23
Q

Rheumatoid Arthritis: CV

what are S/S

A

pericardial thickening

myocarditis

coronary arteritis

conduction defects

vasculitis cardiac valve fibrosis

CAD

cardiomyopathy

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24
Q

Rheumatoid Arthritis: Pulmonary

S/S

A
  • pleural effusions
  • pulmonary nodules
  • pulmonary fibrosis
  • Costochondral involvement
  • Restrictive lung changes
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25
Q

Rheumatoid Arthritis: Hematology

S/S

A
  • Anemia
  • Platelet dysfunction (ASA therapy)
  • thrombocytopenia
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26
Q

Rheumatoid Arthritis: Endocrine

s/s

A

Adrenal insufficiency

impaired immune system

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27
Q

Rheumatoid Arthritis: Dermatological

S/S

A
  • thin atrophic skin
  • rheumotoid nodules
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28
Q

Rheumatoid Arthritis: Treatments

what are some treatments?

A
  • NSAIDs
  • Corticosteroids
  • DMARDs
  • Biologic agents
  • Antimetabolite
  • Surgical intervention
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29
Q

Rheumatoid Arthritis: Anesthesia

best mode of anesthesia

A

No mode safer than the other

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30
Q

Rheumatoid Arthritis: Anesthesia

airway assessment

A
  • TMJ
  • Cervical spine
  • Cricoarytenoid joints
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31
Q

Rheumatoid Arthritis: Anesthesia

what to avoid w/the neck

A
  • flexion
  • extension
  • rotation
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32
Q

What is a chronic d/o characterized by immunologically mediated lacrimal and salvirary gland destruction

A

Sjogren’s Syndrome

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33
Q

Sjogren’s Syndrome

it presents with sicca symptoms, what the fuck is that?

A
  • Xeropthalmia (dry eyes)
  • Xerostomia (dry mouth)
  • Parotid gland enlargement
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34
Q

Sjogren’s Syndrome

is often associated w/ what 2 other Autoimmune d/o

A

SLE

RA

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35
Q

what is a disease associated w/ immune dysregulation and several antibodies, basically sclerosis of the skin!

A

Scleroderma

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36
Q

Scleroderma:

is characterized by inflammation, vascular sclerosis, and fibrosis of the skin and _____

A

Viscera

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37
Q

Scleroderma:

patho

A
  • injury to vascular endothelial cells
  • leakage of serum proteins
  • tissue edema
  • lymphatic obstruction
  • fibrosis
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38
Q

Scleroderma:

is associated w/ what syndrome

A

CREST syndrome

Calcinosis
 Raynaud's syndrome
 Esophageal dysmotility
 Sclerodactyly
 Telangiectasia
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39
Q

Scleroderma:

what is the prognosis?

A

Poor

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40
Q

Scleroderma:

what drugs or treatments are effective in treatment

A

No (you gonna die)

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41
Q

Scleroderma:

what can accelerate the progression in 50% of pt’s

A

Pregnancy

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42
Q

Scleroderma: S/S

skin/musculoskeletal

A
  • Thick skin
  • myopathy
  • weakness of muscles
  • increased plasma CK
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43
Q

Scleroderma: S/S

Nervous system

A
  • peripheral or cranial neuopathy
  • trigeminal neuralgia
  • Keratoconjunctivitis sicca
44
Q

Scleroderma: S/S

cardiac/vascular

A
  • Dysrhythmias
  • Conduction
  • CHF
  • Pulm HTN
  • Cor pulmonale
  • Pericarditis
  • Pericardial effusion
  • Raynauds
  • oral/nasal telangiectasias
45
Q

Scleroderma: S/S

pulmonary

A
  • Pulmonary fibrosis
  • Arterial hypoxemia
46
Q

Scleroderma: S/S

renal

A
  • Renal artery Stenosis/ HTN
  • renal failure
47
Q

Scleroderma: S/S

GI

A
  • Xerostomia
  • hypomotility of Lower esophagus & SI
  • dysphagia
  • reflux
  • malabsorption syndrome
48
Q

Scleroderma: Anesthesia implications

how to intubate

A

prepare for difficult airway

possible FOI

49
Q

Scleroderma: Anesthesia implications

what about nasal intubation/trumpets??

A

hmm be careful telangiectasias may bleed profusely

50
Q

Scleroderma: Anesthesia implications

why may IV/ a-line be difficult?

A

Thick skin

51
Q

Scleroderma: Anesthesia implications

whu may these individuals get hypotensive

A

Contracted Intravascular volumes

52
Q

Scleroderma: Anesthesia implications

why may the need higher pressures to ventilate?

A

Decreased pulm compliance

53
Q

Myasthenia Gravis:

receptor binding antibodies are present in more than 80% of Pts w. MG, the origin of the antibodies are unk, but there is a relationship with the _____ gland

A

Thymus

54
Q

Myasthenia Gravis:

how many classes are there?

A

4 (but 2 II’s) so really 5

55
Q

Myasthenia Gravis: S/S

muscle strength may be _____ with well-rested pts, but ______ occurs promptly w/ exercise

A

Normal

weakness

56
Q

Myasthenia Gravis: S/S

what is the most common initial complaint?

A
  • ptosis
  • diplopia
57
Q

Myasthenia Gravis: S/S

weakness of the pharyngeal and laryngeal muscles cause what complications?

A
  • dysphagia
  • dysarthria
  • difficulty w/ saliva
  • high risk of aspiration
58
Q

Myasthenia Gravis: S/S

arm, leg, or trunck weakness is usually symetrical or asymmetrical?

A

Asymmetrical

59
Q

Myasthenia Gravis: S/S

does muscle atrophy occur?

A

Nope

60
Q

Myasthenia Gravis: S/S

myocarditis can result in ____, ____. or ____

A
  • a-fib
  • heart block
  • cardiomyopathy
61
Q

Myasthenia Gravis: S/S

what can exacerbate it

A
  • infection
  • electrolyte abnormalities
  • pregnancy
  • emotional stress
  • surgery
62
Q

Myasthenia Gravis: S/S

antibiotics especially _______ can aggravate muscle weakness

A

aminoglycosides

63
Q

Myasthenia Gravis: Treatments

what are 5 main treatments

A
  1. Anticholinesterase drugs
  2. Immunosupressive therapy
  3. Plasmapheresis
  4. thymectomy
  5. IV immunoglobulin
64
Q

Myasthenia Gravis: Treatments

what is teh 1st line of treatment?

A

Anticholinesterase drugs

65
Q

Myasthenia Gravis: Treatments

what is the main anticholinesterase drug used

A

pyridostigmine

66
Q

Myasthenia Gravis: Treatments

what is used for immunosuppresive theapy

A
  • corticosteroids
  • azathioprine
  • cyclosporine
  • mycophenolate
67
Q

Myasthenia Gravis: Treatments

when is plasmapheresis used

A

myastenic crisis

prep for thymectomy

68
Q

Myasthenia Gravis: Treatments

what is teh point of plasmapheresis

A

Removes antibodies from circulation

69
Q

Myasthenia Gravis: Treatments

thymectomy- what is the incision sites

A

median sternotomy

Medianstinoscopy

70
Q

Myasthenia Gravis: Treatments

what levels are often decreased following thymectomy

A

ACh

71
Q

Myasthenia Gravis: Treatments

prior to thymectomy plasmapheresis is indcated if VC is < what?

A

< 2 L

72
Q

Myasthenia Gravis: Treatments

IV immunoglobulin therapy is reserved for when

A

acute exacerbations and myasthenic crisis

73
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one is from underdosing of anticholinesterase

A

MC

74
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

whch one os from overdosing

A

CC

75
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one has S/S of extreme weakness plus muscarinic SE of abd cramping, diarrhea, salivation, bradycardia, miosis?

A

CC

76
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one has S/S of sever exacerbation of MG symptoms

A

MC

77
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one has S/S of extreme quadriparesis or quadraplegia, resp insuficiency, extremly difficul swallowing, danger of resp arrest

A

MC

78
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one occurs 3-4 hours after taking medication

A

MC

79
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

CC occurs how long after giving meds

A

30-60 min

80
Q

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

what is the test for CC? and what will you see?

A

tensilon test

  • accenuated muscle weakness after administration of edrophonium
81
Q

Myasthenia Gravis: Anesthesia implications

what does teh data suggest about cont’s periop use of pyridostigmine

A

unclear

82
Q

Myasthenia Gravis: Anesthesia implications

what type of anesthesia is reccomended if poss

A

regional

83
Q

Myasthenia Gravis: Anesthesia implications

what about depolarizing MR (SCh)

A
  • response unpredictable
  • Untreated pt’s 2-3x’s more resistant to SCh
  • Treated pt’s- normal or prolonged response to SCh
84
Q

Myasthenia Gravis: Anesthesia implications

Non-Depolarizing MR

A
  • typically all pt’s have increased sensitivity
  • require decreased doses
  • wil have prolonged recovery
  • TOF essential
85
Q

Myasthenia Gravis: Anesthesia implications

reversal should be performes cautiously why?

A
  • can precipitate cholnergic crisis
86
Q

Myasthenia Gravis: Anesthesia implications

what is the best way to intubate these pt’s

A

VAAs

– b/c of intrinsic muscle weakness, intubation can be accomplished w/ VAA alone

87
Q

what d/o resembles MG and is sometimes called Myasthenic syndrome

A

Eaton-Lambert syndrome

88
Q

Eaton-Lambert Syndrome:

is associated w/ SCC of what organ

A

lung

89
Q

Eaton-Lambert Syndrome:

S/S is proximal limb weakness,muscle pain, decreased or absent reflexes. But what is teh main difference from MG

A

EXERCISE IMPROVES STRENGTH

90
Q

Eaton-Lambert Syndrome:

what is teh response to anticholinesterases

A

Poor

91
Q

Eaton-Lambert Syndrome:

is it sensitive to NDMR DMR or both?

A

Both

92
Q

what d/o is from thyrotoxicosis (a state of thyroid hormone excess)?

A

Graves’ Disease

93
Q

Graves’ Disease

is caused by thyroid-stimulating antibodies that bind to TSH receptors in the thyroid and you get an increased level of circulating what?

A

T4 and T3

94
Q

Graves’ Disease

is the thyroid usually enlarged?

A

yes 2-3xs

95
Q

Graves’ Disease

s/s?

A
  • Increased BP
  • Increased CO
  • Increased HR
  • MVP
  • A-fib
96
Q

Graves’ Disease

diagnosis is based off what lab interpertations w/ TSH, T3, T4

A

TSH low

T4 high

T3 high

97
Q

Graves’ Disease

is a disease of thyroid hormone excess or deficit?

A

excess

98
Q

Graves’ Disease

what is a funny s/s of it

A

Big ass bug eyes

OPTHALMOPATHY

99
Q

Graves’ Disease

what is a d/o that can arise form this d/o

A

thyroid storm

100
Q

Graves’ Disease

what is Thyroid storms s/s

A
  • Tachycardia
  • Hyperthermia
  • hTN
  • A-fib
  • sweating
  • Tremor
  • Vomiting
  • weakness
  • agitation
  • shock
  • CHF
  • Met acidosis
101
Q

Graves’ Disease

thyroid storm in an emergency!!!! what is its treatment

A
  • Antithyroid meds
  • Beta blockers
  • Potassium iodide
  • Hydrate w/ glucose containing solutions
  • Tylenol
  • O2
102
Q

what d/o is the most common form of HYPOTHYROIDISM

A

Hasimoto’s thyroiditis

103
Q

Hasimoto’s thyroiditis

is characterized by autoimmune mediated destruction of the ____ gland

A

Thyroid

(that was a gimme)

104
Q

Hasimoto’s thyroiditis

w/ this the formation of what is common?

A

Goiter

105
Q

Hasimoto’s thyroiditis

what happens to metabolim

A

sloooooooooowwwwsss

106
Q

Hasimoto’s thyroiditis

s/s

A
  • Dry skin
  • cold intolerance
  • paresthesias
  • slowedmental fxn
  • ataxia
  • puffy face (myxedema) aka fat mexican
  • constipation
107
Q

thats all folks

A

sweet

BioScience II (39 decks)

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