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Clinical Medicine > The Spondyloarthropathies > Flashcards

The Spondyloarthropathies Flashcards

1
Q

Four examples of spondyloarthropathies:

A

ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis

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2
Q

spondyloarthropathies CM

A

spine/SI joint pain; chronic inflammation = new bone formation; peripheral arthritis (asymmetrical and lower extremities); inflammation at tendon insertion = enthesitis; ocular inflammation = acute anterior uveitis

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3
Q

spondyloarthropathies are associated with which gene marker

A

HLA-B27

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4
Q

spondyloarthropathies diagnostic criteria

A

sacroiliitis on imaging plus 1+ SpA feature OR HLA-B27 plus 2+ other SpA features

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5
Q

SpA features

A

inflammatory back pain, arthritis, enthesitis (heel), dactylitis, psoriasis, Crohn’s/colitis, good response to NSAIDs, FH, HLA-B27, elevated CRP

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6
Q

Radiographic sacroiliitis criteria for SpA

A

grade 2+ bilaterally or grade 3-4 unilaterally

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7
Q

Treatment of spondyloarthropathies

A

patient education, exercise, medicine (NSAID, corticosteroids, sulfasalazine, methotrexate, maybe abx, anti-TNF therapy)

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8
Q

HLA association for RA

A

DR4

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9
Q

HLA association for ankylosing spondylitis

A

B27

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10
Q

HLA association for for enteropathic arthritis

A

B27 (axial)

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11
Q

HLA association for psoriatic arthritis

A

B27 (axial)

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12
Q

HLA association for reactive arthritis

A

B27

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13
Q

joint pattern for RA

A

symmetrical, peripheral

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14
Q

joint pattern for ankylosing spondylitis

A

axial

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15
Q

joint pattern for enteropathic arthritis

A

axial and peripheral

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16
Q

joint pattern for psoriatic arthritis

A

axial and asymmetrical, peripheral

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17
Q

joint pattern for reactive arthritis

A

axial and asymetrical, peripheral

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18
Q

Sacroiliac for RA

A

NA

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19
Q

Sacroiliac for ankylosing spondylitis

A

symmetrical

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20
Q

Sacroiliac for enteropathic arthritis

A

symmetrical

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21
Q

Sacroiliac for psoriatic arthritis

A

asymmetrical

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22
Q

Sacroiliac for reactive arthritis

A

asymmetrical

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23
Q

syndesmophyte for RA

A

NA

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24
Q

syndesmophyte for ankylosing spondylitis

A

smooth, marginal

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25
Q

syndesmophyte for enteropathic arthritis

A

smooth, marginal

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26
Q

syndesmophyte for psoriatic arthirits

A

coarse, non-marginal

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27
Q

syndesmophyte for reactive arthirits

A

coarse, non-marginal

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28
Q

eye manifestations for RA

A

scleritis

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29
Q

eye manifestations for ankylosing spondylitis

A

iritis

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30
Q

eye manifestations for enteropathic arthritis

A

+/-

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31
Q

eye manifestations for psoriatic arthritis

A

none

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32
Q

eye manifestations for reactive arthritis

A

iritis and conjunctiviits

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33
Q

skin manifestations for RA

A

vasculitis

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34
Q

skin manifestations for ankylosing spondylitis

A

none

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35
Q

skin manifestations for enteropathic arthritis

A

none

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36
Q

skin manifestations for psoriatic arthritis

A

psoriasis

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37
Q

skin manifestations for reactive arthritis

A

keratoderma

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38
Q

What’s the most common axial skeleton inflammatory disorder?

A

ankylosing spondylitis

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39
Q

Are men or women more affected by ankylosing spondylitis?

A

men

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40
Q

who does ankylosing spondylitis most commonly affect?

A

white males 15-40

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41
Q

onset of ankylosing spondylitis

A

young adulthood; sometimes juvenile

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42
Q

S/S of ankylosing spondylitis

A

persistent LBP >3 months; SI joint; possible radiation to buttock; early morning stiffness; pain that wakes patient up from sleep; fatigue; asymmetrical polyarthritis (most common in LE); enthesitis (achilles tendinitis and/or heel pain); extra-articular features

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43
Q

PE ankylosing spondylitis

A

TTP; spinal decreased ROM; stooped posture; Schober test; possible FABER test; chest expansion; peripheral joints

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44
Q

What test do you use to test for ankylosing spondylitis

A

Schober Test, FABER test

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45
Q

Labs for ankylosing spondylitis

A

RF (negative), ANA (negative), SED, CRP, HLA-B27

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46
Q

Imaging for ankylosing spondylitis

A

plain films (lumbar spine and SI joint) , MRI

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47
Q

What will you see on plain films of ankylosing spondylitis

A

bamboo spine

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48
Q

Tx for ankylosing spondylitis

A

patient education, exercise (PT, OT, AT), meds (NSAIDs, corticosteroids, sulfasalazine, MTX, DMARDs, anti-TNF therapy)

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49
Q

What’s reactive arthritis?

A

aseptic arthritis-synovitis

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50
Q

when does reactive arthritis develop?

A

after systemic infection; 1-3 weeks

51
Q

offending agents of reactive arthritis?

A

salmonella typhimurium, erisinia enterocolitica, shigella flexneri, chlamydia trachomatis

52
Q

reactive arthritis is associated with what genetic marker

A

HLA-B27

53
Q

are males or females more impacted by reactive arthritis?

A

men

54
Q

S/S of reactive arthritis

A

LE asymmetrical polyarthritis; sacroiliitis; malaise, fatigue, fever; enthesitis (achilles tendon or plantar fasciitis), dactylitis (sausage fingers); Reiter’s Syndrome

55
Q

Reiter’s Syndrome

A

urethritis/cervicitis; arthritis; conjunctivitis “can’t see, can’t pee, can’t climb a tree”

56
Q

PE of reactive arthritis:

A

dactylitis, asymmetric arthritis (LE), mucocutaneous lesions, papulosquamous eruptions on palms and soles; conjunctivitis; cervicitis/urethritis/ diarrhea

57
Q

Imaging for reactive arthritis

A

plain films; MRI

58
Q

labs for reactive arthritis

A

CBC with diff, ESR, CRP, HLA-B27, synovial fluid analysis

59
Q

Course for reactive arthritis

A

initial onset 2-3 months with synovitis lasting up to a year

60
Q

Treatment of reactive arthritis

A

treat symptoms, NSAIDs, possible intra-articular injection, systemic infections, extra articular manifestations

61
Q

What’s psoriatic arthrits?

A

papulosquamous disease with keratinocyte proliferation

62
Q

onset of psoriatic arthritis?

A

30-35

63
Q

Are men or women more impacted by psoriatic arthritis?

A

M=F

64
Q

Genetic markers associated with psoriatic arthritis?

A

HLA-Cw6 (dominant); HLA-B39 and HLA-B27 (sacroiliitis and axial involvement)

65
Q

What does psoriatic arthritis not produce?

A

immunoglobulin or RF

66
Q

In regards to psoriatic arthritis, what additional condition can cause higher prevalence for joint destruction?

A

HIV

67
Q

S/S of psoriatic arthritis

A

insidious onset of pain and stiffness; possible skin lesions

68
Q

PE of psoriatic arthritis

A

asymmetrical polyarthritis in large and small joints and dactylitis; DIP joints with nail dystrophy (onycholysis, subungual keratosis, pitting, oil drop staining), symmetrical polyarthritis (no nodules), spondylitis

69
Q

Imaging for psoriatic arthritis

A

plain films

70
Q

treatment for psoriatic arthritis

A

pain control; anti-TNF

71
Q

What’s enteropathic arthritis?

A

Arthritis associated with Crohn’s disease/Ulcerative Colitis; more commonly Crohn’s

72
Q

Presentation of enteropathic arthritis?

A

non-erosive, asymmetric polyarthritis of large joints; lower extremities–peripheral arthritis not associated with HLA-B27, spondylitis/sacroiliitis associated with HLA-B27; inflammation of joint follows inflammation of GI

73
Q

What’s systemic sclerosis?

A

chronic autoimmune connective tissue disease; thickening of skin with internal organ involvement

74
Q

3 cardinal processes of scleroderma

A

1) autoimmunity and inflammation; 2) vascular injury and obliteration 3) fibrosis and matrix deposition

75
Q

Patho of scleroderma

A

capillary loss; obliterative vasculopathy (intimal proliferation in small and medium vessels); acellular fibrosis (deposition of connective tissue matrix); findings based on tissue biopsied

76
Q

What skin findings can you find on biopsied tissue of scleroderma?

A

collage deposits in hair follicles; atrophic epidermis

77
Q

Lung findings in biopsy of scleroderma

A

thickened alveolar septae

78
Q

x-ray finding of lungs in scleroderma

A

honeycombing

79
Q

GI biopsy findings in scleroderma

A

fibrosis of lamina propria and submucosa; muscle atrophy

80
Q

Classification of scleroderma

A

systemic sclerosis (diffuse cutaneous vs. limited cutaneous); mixed connective tissue disorder; localized scleroderma

81
Q

Describe limited cutaneous systemic sclerosis

A

fingers, toes, distal extremities and face; associated with Raynaud, CREST syndrome. Impacts periphery.

82
Q

Describe diffuse cutaneous systemic slcerosis

A

involves skin proximal to elbows and knees, trunk and distal extremities; rapid progression; early pulmonary fibrosis and acute renal failure

83
Q

What is CREST syndrome associated with?

A

limited cutaneous systemic sclerosis

84
Q

CREST syndrome:

A

calcinosis cutis; Raynaud’s phenomenon; esophageal dysmotility; sclerodactyly; telangiectasia

85
Q

What’s Raynaud’s phenomenon?

A

episodic vasoconstriction

86
Q

Describe a Raynaud’s attack

A

vasoconstriction (pallor), ischemia (cyanosis), reperfusion (erythema)

87
Q

Raynaud’s triggers

A

cold, emotional stress

88
Q

What’s primary Raynaud’s phenomenon?

A

benign condition, exposure to cold, more frequent in women

89
Q

What’s secondary Raynaud’s phenomenon?

A

result of other diseases (scleroderma, other CT diseases, hematologic and endocrine); medications (beta blockers, chemotherapy, cisplatin, bleomycin)

90
Q

Mixed Connective Tissue Disorder

A

overlap of symptoms of SLE, systemic sclerosis, myositis

91
Q

CM of mixed connective tissue disorder

A

Raynaud with hand edema, other findings of CT disease, late stage: renal crisis

92
Q

What genetic marker is associated with mixed connective tissue disorder?

A

autoantibody against U1-ribonuclear protein (U1-RNP_

93
Q

Who does localized scleroderma primary effect?

A

kids

94
Q

CM of localized scleroderma

A

morphea (reddish/purple lesions of the skin); skin induration (asymmetrical distribution; spares the digits; common on lower extremities); no Raynaud; no systemic involvement

95
Q

Scleroderma etiology

A

unknown; attributed to: infectious agents (CMV, parvovirus B19), silica, epoxy resins, dietary, drugs (bleomycin, HRT, cocaine, appetite suppressants), lifestyle exposures, genetic susceptibility

96
Q

Which gender is impacted more by scleroderma?

A

females

97
Q

what age group is impacted most by scleroderma?

A

females in childbearing years and decreases after menopause

98
Q

age for systemic sclerosis

A

30-50

99
Q

Diffuse cutaneous scleroderma CM

A

soft tissue swelling, erythema, pruritus, fatigue, stiffness, malaise, Raynaud

100
Q

Limited cutaneous scleroderma CM

A

history of raynaud’s, possible ischemic ulcerations, indolent and delayed onset of other signs (CREST), more prevalent vascular manifestations (digital ischemia; telangiectasia; pulmonary HTN)

101
Q

Skin involvement of scleroderma

A

thickening, symmetrical and bilateral, starts and fingers and works proximal, hyperpigmentation, vitiligo, decrease sweating and dry skin, masklike facies, calcium deposits (finger pads, extensor surfaces, forearms, bursae)

102
Q

GI tract scleroderma manifestations

A

periodontal disease, GERD (possible Barrett’s esophagus), gastroparesis, impaired small intestinal motility (chronic diarrhea), malabsorption of fat and protein; vitamin B12 and D deficiency, constipation, rectal prolapse

103
Q

lung involvement of scleroderma

A

interstitial lung disease (exertional dyspnea, fatigue and decreased exercise tolerance); pulmonary hypertension

104
Q

RF for interstitial lung disease from scleroderma

A

male, AA, diffuse skin involvement, severe GERD, presence of topoisomerase-I autoantibodies

105
Q

What’s pulmonary hypertension?

A

mean pulmonary arterial pressure >25 mmHg and pulmonary cap pressure <15 mmHg

106
Q

RF for pulmonary hypertension from scleroderma?

A

limited cutaneous disease, late disease onset, large number of cutaneous telangiectasias, presence of anticentromere autoantibodies

107
Q

Kidney manifestations of scleroderma

A

scleroderma renal crisis–uncommon but life threatening; chronic kidney disease

108
Q

When does scleroderma renal crisis occur?

A

within 4 years of onset

109
Q

What’s scleroderma renal crisis?

A

obliterative vasculopathy and luminal narrowing = decreased blood flow; abrupt onset HTN and progressive renal insufficiency

110
Q

RF of scleroderma renal crisis?

A

rapidly progressive sin involvement, tendon rubs, AA, male, autoantibodies to RNA polymerases I and III

111
Q

cardiac manifestations of scleroderma

A

associated with diffuse cutaneous systemic sclerosis; tachycardia, conduction abnormalities, valvular regurgitation, diastolic heart failure, pericardial effusion; poor prognosis

112
Q

MSK manifestations of scleroderma

A

carpal tunnel syndrome, decreased joint mobility, tendon friction rubs

113
Q

Scleroderma “other” manifestations

A

dry eyes, dry mouth, hypothyroidism, CNS usually spared (trigeminal nerve fibrosis can occur)

114
Q

Labs for scleroderma

A

cbc with diff (anemia), sed rate and CRP are usually normal, RF negative, ANA negative, vitamin deficiencies (folate, vitamin B12, vitamin D); nailfold capillaroscopy

115
Q

Scleroderma treatment

A

corticosteroids (treats stiffness and aching), cyclophosphamide (decreased progression of symptomatic interstitial lung disease), methotrexate (skin manifestations), antifibrotic therapy–D-penicillamine (improves skin induration; prevents new internal organ involvement; improved survival); ACE inhibitors (sclerodermal renal crisis)

116
Q

How to treat pulmonary arterial hypertension?

A

endothelin-1 receptor antagonist or 5-phosphodiesterase inhibitor

117
Q

Which form of scleroderma has worst prognosis?

A

diffuse cutaneous systemic sclerosis

118
Q

which symptom of scleroderma has the most rapid progression?

A

organ involvement

119
Q

what happens 2-4 years after scleroderma onset?

A

inflammatory symptoms fatigue/edema/arthralgia subside, skin thickening plateau, organ involvement progresses

120
Q

Ten-year survival rate for diffuse cutaneous systemic scleroderma

A

55%

121
Q

ten-year survival rate for limited cutaneous systemic scleroderma

A

75%

122
Q

leading cause of scleroderma death

A

pulmonary fibrosis, PAH, GI involvement, cardiac disease

123
Q

poorer prognosis in scleroderma if

A

male, AA, older age of disease onset, low BMI, extensive skin thickening with truncal involvement, presence of antibodies topoisomerase-I or RNA polymerase III, absence of anticentromere antibodies

Clinical Medicine (13 decks)

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