Test #2 autoimmune PPt-Josh Flashcards by Josh Newby

Autoimmunity:

is a disturbance in the immunologic tolerance of ________

Self antigens

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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

autoantibodies

t-cells

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Autoimmunity:

what is the most common chronic inflammatory arthritis?

rheumatoid arthritis

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Rheumatoid Arthritis:

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

exacerbation and remission

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Rheumatoid Arthritis:

etiology

exact cause unk

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Rheumatoid Arthritis:

what may precipitate it

impaired immunity
stress
enviromental factors

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Rheumatoid Arthritis:

what do they propose could be the etiology

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

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Rheumatoid Arthritis:

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

rheumatoid factors

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Rheumatoid Arthritis: clinical manifestations

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

synovial joints

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Rheumatoid Arthritis: clinical manifestations

what is teh onset like

insidiuos onset
over a period of weeks to months

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Rheumatoid Arthritis: clinical manifestations

what are the most common sites

hands
wrists
feet
*

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Rheumatoid Arthritis: clinical manifestations

is the joint involvement symmetrical or asymmetrical

symmetrical

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Rheumatoid Arthritis: clinical manifestations

what are the s/s associated with the inflammatory process

warmth
pain
swelling
weight loss
fatigue
Morning stiffness

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Rheumatoid Arthritis: clinical manifestations

the joint invlvement progresses in 3 main stages what are they

inflammation of synovial jointmembrane
rapid division and growth of cells in joint
Liberation of enzymes, which damages small blood vessels, cartilage, ligaments, tendons, and bones

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Rheumatoid Arthritis: clinical manifestations

can it cause permanent damage to ROM

yeppers

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Rheumatoid Arthritis: clinical manifestations

s/s of late stages

severe pain
joint instability
crippling deformities

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Rheumatoid Arthritis: clinical manifestations

what can nerve entrapment cause

Carpal tunnel syndrome

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Rheumatoid Arthritis: clinical manifestations

what synovial joint in the head can be affected

Synovitis in TMJ

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Rheumatoid Arthritis: clinical manifestations

what affect on the cervical spine can occur

Atlantoaxial (C1-2) instability and subluxation

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Rheumatoid Arthritis: clinical manifestations

what part of the larynx may be effected

cricoarytenoid joint

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Rheumatoid Arthritis: clinical manifestations

s/s of cricoarytenoid joint arthritis

tenderness of larynx

hoarsness

pain w/ swallowing

radiatio to ear

dyspnea

Stridor

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Rheumatoid Arthritis: clinical manifestations

w/ cricoarytenoid joint arthritis what may u see on DL

red swollen arytenoids

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Rheumatoid Arthritis: CV

what are S/S

pericardial thickening

myocarditis

coronary arteritis

conduction defects

vasculitis cardiac valve fibrosis

CAD

cardiomyopathy

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Rheumatoid Arthritis: Pulmonary

S/S

pleural effusions
pulmonary nodules
pulmonary fibrosis
Costochondral involvement
Restrictive lung changes

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Rheumatoid Arthritis: Hematology S/S

* Anemia * Platelet dysfunction (ASA therapy) * thrombocytopenia

Rheumatoid Arthritis: Endocrine s/s

Adrenal insufficiency impaired immune system

Rheumatoid Arthritis: Dermatological S/S

* thin atrophic skin * rheumotoid nodules

Rheumatoid Arthritis: Treatments what are some treatments?

* NSAIDs * Corticosteroids * DMARDs * Biologic agents * Antimetabolite * Surgical intervention

Rheumatoid Arthritis: Anesthesia best mode of anesthesia

No mode safer than the other

Rheumatoid Arthritis: Anesthesia airway assessment

* TMJ * Cervical spine * Cricoarytenoid joints

Rheumatoid Arthritis: Anesthesia what to avoid w/the neck

* flexion * extension * rotation

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

Sjogren's Syndrome

Sjogren's Syndrome it presents with sicca symptoms, what the fuck is that?

* Xeropthalmia (dry eyes) * Xerostomia (dry mouth) * Parotid gland enlargement

Sjogren's Syndrome is often associated w/ what 2 other Autoimmune d/o

SLE RA

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

Scleroderma

Scleroderma: is characterized by inflammation, vascular sclerosis, and fibrosis of the skin and \_\_\_\_\_

Viscera

Scleroderma: patho

* injury to vascular endothelial cells * leakage of serum proteins * tissue edema * lymphatic obstruction * fibrosis

Scleroderma: is associated w/ what syndrome

CREST syndrome Calcinosis Raynaud's syndrome Esophageal dysmotility Sclerodactyly Telangiectasia

Scleroderma: what is the prognosis?

Poor

Scleroderma: what drugs or treatments are effective in treatment

No (you gonna die)

Scleroderma: what can accelerate the progression in 50% of pt's

Pregnancy

Scleroderma: S/S skin/musculoskeletal

* Thick skin * myopathy * weakness of muscles * increased plasma CK

Scleroderma: S/S Nervous system

* peripheral or cranial neuopathy * trigeminal neuralgia * Keratoconjunctivitis sicca

Scleroderma: S/S cardiac/vascular

* Dysrhythmias * Conduction * CHF * Pulm HTN * Cor pulmonale * Pericarditis * Pericardial effusion * Raynauds * oral/nasal telangiectasias

Scleroderma: S/S pulmonary

* Pulmonary fibrosis * Arterial hypoxemia

Scleroderma: S/S renal

* Renal artery Stenosis/ HTN * renal failure

Scleroderma: S/S GI

* Xerostomia * hypomotility of Lower esophagus & SI * dysphagia * reflux * malabsorption syndrome

Scleroderma: Anesthesia implications how to intubate

prepare for difficult airway possible FOI

Scleroderma: Anesthesia implications what about nasal intubation/trumpets??

hmm be careful telangiectasias may bleed profusely

Scleroderma: Anesthesia implications why may IV/ a-line be difficult?

Thick skin

Scleroderma: Anesthesia implications whu may these individuals get hypotensive

Contracted Intravascular volumes

Scleroderma: Anesthesia implications why may the need higher pressures to ventilate?

Decreased pulm compliance

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

Thymus

Myasthenia Gravis: how many classes are there?

4 (but 2 II's) so really 5

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

Normal weakness

Myasthenia Gravis: S/S what is the most common initial complaint?

* ptosis * diplopia

Myasthenia Gravis: S/S weakness of the pharyngeal and laryngeal muscles cause what complications?

* dysphagia * dysarthria * difficulty w/ saliva * high risk of aspiration

Myasthenia Gravis: S/S arm, leg, or trunck weakness is usually symetrical or asymmetrical?

Asymmetrical

Myasthenia Gravis: S/S does muscle atrophy occur?

Nope

Myasthenia Gravis: S/S myocarditis can result in \_\_\_\_, \_\_\_\_. or \_\_\_\_

* a-fib * heart block * cardiomyopathy

Myasthenia Gravis: S/S what can exacerbate it

* infection * electrolyte abnormalities * pregnancy * emotional stress * surgery

Myasthenia Gravis: S/S antibiotics especially _______ can aggravate muscle weakness

aminoglycosides

Myasthenia Gravis: Treatments what are 5 main treatments

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

Myasthenia Gravis: Treatments what is teh 1st line of treatment?

Anticholinesterase drugs

Myasthenia Gravis: Treatments what is the main anticholinesterase drug used

pyridostigmine

Myasthenia Gravis: Treatments what is used for immunosuppresive theapy

* corticosteroids * azathioprine * cyclosporine * mycophenolate

Myasthenia Gravis: Treatments when is plasmapheresis used

myastenic crisis prep for thymectomy

Myasthenia Gravis: Treatments what is teh point of plasmapheresis

Removes antibodies from circulation

Myasthenia Gravis: Treatments thymectomy- what is the incision sites

median sternotomy Medianstinoscopy

Myasthenia Gravis: Treatments what levels are often decreased following thymectomy

ACh

Myasthenia Gravis: Treatments prior to thymectomy plasmapheresis is indcated if VC is \< what?

\< 2 L

Myasthenia Gravis: Treatments IV immunoglobulin therapy is reserved for when

acute exacerbations and myasthenic crisis

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis which one is from underdosing of anticholinesterase

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis whch one os from overdosing

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?

## Footnote Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis which one has S/S of sever exacerbation of MG symptoms

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

## Footnote Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis which one occurs 3-4 hours after taking medication

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis CC occurs how long after giving meds

30-60 min

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis what is the test for CC? and what will you see?

tensilon test - accenuated muscle weakness after administration of edrophonium

Myasthenia Gravis: Anesthesia implications what does teh data suggest about cont's periop use of pyridostigmine

unclear

Myasthenia Gravis: Anesthesia implications what type of anesthesia is reccomended if poss

regional

Myasthenia Gravis: Anesthesia implications what about depolarizing MR (SCh)

* response unpredictable * Untreated pt's 2-3x's more resistant to SCh * Treated pt's- normal or prolonged response to SCh

Myasthenia Gravis: Anesthesia implications Non-Depolarizing MR

* typically all pt's have increased sensitivity * require decreased doses * wil have prolonged recovery * TOF essential

Myasthenia Gravis: Anesthesia implications reversal should be performes cautiously why?

* can precipitate cholnergic crisis

Myasthenia Gravis: Anesthesia implications what is the best way to intubate these pt's

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

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

Eaton-Lambert syndrome

Eaton-Lambert Syndrome: is associated w/ SCC of what organ

## Footnote lung

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

EXERCISE IMPROVES STRENGTH

Eaton-Lambert Syndrome: what is teh response to anticholinesterases

Poor

Eaton-Lambert Syndrome: is it sensitive to NDMR DMR or both?

Both

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

Graves' Disease

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?

T4 and T3

Graves' Disease is the thyroid usually enlarged?

yes 2-3xs

Graves' Disease s/s?

* Increased BP * Increased CO * Increased HR * MVP * A-fib

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

TSH low T4 high T3 high

Graves' Disease is a disease of thyroid hormone excess or deficit?

excess

Graves' Disease what is a funny s/s of it

Big ass bug eyes OPTHALMOPATHY

Graves' Disease what is a d/o that can arise form this d/o

thyroid storm

Graves' Disease what is Thyroid storms s/s

* Tachycardia * Hyperthermia * hTN * A-fib * sweating * Tremor * Vomiting * weakness * agitation * shock * CHF * Met acidosis

Graves' Disease thyroid storm in an emergency!!!! what is its treatment

* Antithyroid meds * Beta blockers * Potassium iodide * Hydrate w/ glucose containing solutions * Tylenol * O2

what d/o is the most common form of HYPOTHYROIDISM

Hasimoto's thyroiditis

Hasimoto's thyroiditis is characterized by autoimmune mediated destruction of the ____ gland

Thyroid (that was a gimme)

Hasimoto's thyroiditis w/ this the formation of what is common?

Goiter

Hasimoto's thyroiditis what happens to metabolim

sloooooooooowwwwsss

Hasimoto's thyroiditis s/s

* Dry skin * cold intolerance * paresthesias * slowedmental fxn * ataxia * puffy face (myxedema) aka fat mexican * constipation

thats all folks

sweet