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S7- Differential Diagnosis > Week 12- Screening for Immunologic Disease > Flashcards

Week 12- Screening for Immunologic Disease Flashcards

1
Q

PART 1

A

PART 1

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2
Q

Immunology:

  • Response to defend against attacks by “_______ _______”.
  • Immunity is provided by _______ cells.
  • Immune disorders are classified as what (4) things?
A
  • “foreign invaders”
  • lymphoid cells
  • Autoimmune*, immunodeficiency, hypersensitivity, and immunoproliferative disorders
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3
Q

What are some questions to ask during the patient interview if immune disorder is suspected?

A
  • How long have you had this problem? (chronic and repetitive)
  • Has the problem gone away then recurred? (cyclical pattern)
  • Have additional symptoms developed or have other areas become symptomatic over time?
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4
Q

_________ may be the only risk factor for immunologic disease.

A

Family Hx

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5
Q

Immunologic Disease S/Sx. (7)

A
  • Soft tissue/joint pain***
  • Stiffness***
  • Swelling***
  • Generalized weakness***
  • Constitutional symptoms***
  • Raynaud’s phenomenon***
  • Sleep disturbances***
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6
Q

Soft Tissue/Joint Pain:

  • Specific joints affected.
  • What joints are affected with RA?
  • What joints are affected with Psoriatic Arthritis?
A
  • RA = wrist and proximal small joints of hands and feet

- Psoriatic Arthritis = distal joints of hands and feet

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7
Q

Stiffness:

  • Marked by prolonged stiffness >_____.
  • What is the gel phenomenon?
A
  • > 1 hour

- Gel phenomenon = Symptoms relieved with activity but recurs after sitting and then attempting to continue activity.

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8
Q

What would we do if we note a cluster of S/Sx associated with immunologic disease?

A
  • Immunologic ROS

- Rheumatologic ROS

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9
Q

PART 2: IMMUNE SYSTEM PATHOLOGIES

A

PART 2: IMMUNE SYSTEM PATHOLOGIES

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10
Q

Immune System Pathologies. (11)

A
  • Fibromyalgia
  • Rheumatoid Arthritis (RA)
  • Polymyalgia Rheumatica
  • Scleroderma
  • Systemic Lupus Erythematosus (SLE)
  • Ankylosing spondylitis (AS)
  • Reiter’s syndrome or reactive arthritis (ReA)
  • Psoriatic arthritis (PsA)
  • Multiple Sclerosis (MS)
  • Guillain-Barre Syndrome (GBS)
  • Myasthenia Gravis (MG)
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11
Q

Autoimmune Disorders Overview:

  • When do autoimmune disorders occur?
  • Body manufactures _________ directed against the body’s own cellular components or specific organs.
  • What does this result in?
  • Is the exact cause known?
A
  • Occurs when the immune system fails to distinguish self from non-self and misdirects immune response against body’s own tissues.
  • autoantibodies
  • Results in abnormal tissue reaction and tissue damage.
  • Exact cause not well understood.
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12
Q

Fibromyalgia:

  • What is fibromyalgia?
  • Is it more common in men or women?
  • Recent evidence suggests that chronic pain is _______ _______.
  • The new set of diagnostic criteria to diagnose fibromyalgia focuses on measuring ____________ rather than relying on tender point examination alone.
  • ___/___ tender points to diagnose as fibromyalgia.
A
  • Noninflammatory condition appearing with generalized MSK pain with associated tenderness to palpation in a large number of specific areas.
  • Women > Men
  • CENTRALLY MEDIATED
  • symptom severity
  • 11/18***
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13
Q

Fibromyalgia S/Sx. (5)

A
  • Aches and pains
  • Stiffness
  • Swelling in soft tissue
  • Tender points
  • Muscle spasms or nodules

-Fatigue, morning stiffness, and sleep disturbances may be present but not necessary for diagnosis.

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14
Q

Rheumatoid Arthritis (RA):

  • _______, _______, _______ disorder.
  • Is it more common in men or women?
  • Most common between ages ___-___.
  • What is the cause?
  • Affects various organs but predominantly ________ tissues of _______ joints.
A
  • Chronic, systemic, inflammatory disorder.
  • Women > Men (2-3x)
  • 20-40
  • Unknown cause (support for genetic predisposition)
  • synovial tissues of synovial joints
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15
Q

RA S/Sx. (7)

A
  • Swelling in 1 or more joints
  • Early morning stiffness (>1hr)
  • Recurring pain/tenderness in any joint (MTP, MCP)
  • Inability to move joint normally
  • Obvious redness and warmth in joint
  • Unexplained weight loss, fever, or weakness combined w/ joint pain
  • Symptoms lasting >2 weeks
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16
Q

What is a mnemonic to remember RA S/Sx?

A

SERIOUS

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17
Q

RA Referral/Diagnosis:

  • Why is early referral/diagnosis important in RA?
  • What are some early inflammatory symptoms of RA? (3)
A

-Studies show 70-90% of people with RA have SIGNIFICANT JOINT EROSION 2 YEARS AFTER ONSET.

  1. ) Significant discomfort with compression of metacarpal and metatarsal joints.
  2. ) Presence of 3 or more swollen joints.
  3. ) More than 1hr of morning stiffness.
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18
Q

RA Hands/Feet:

  • ________ pain often first complaint.
  • ________-____ deformities.
  • ______ ________ of MCP joint and ulnar deviation.
  • _____ ______ and __________ deformities may also be present.
A
  • Forefoot pain
  • Hammer-toe
  • Volar subluxation
  • Swan Neck and Boutonniere Deformities
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19
Q

RA Cervical Spine:

  • _________ may be reported in early onset of disease.
  • ___-___ laxity secondary to inflammation of ligaments. (Occurs more often _____ in disease)
  • Could result in _________ _________ with resultant spinal cord compression.
A
  • Neck stiffness
  • C1-C2 laxity (late in disease)
  • atlantoaxial subluxation
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20
Q

RA Shoulder:
-Chronic synovitis may result in limitations of shoulder ROM, dislocation, or spontaneous tears of the ___________ or ________________.

RA Elbow:
-Destruction or articulation may result in ________ contracture, loss of ________/_______, subluxation or _______ nerve neuropathy.

RA Wrist:
-Frequently affected and may result in _________ muscle atrophy, _______ or __________ (due to volar synovitis).

A
  • rotator cuff or adhesive capsulitis
  • flexion contracture, loss of supination/pronation, subluxation, or ulnar nerve neuropathy
  • interosseous muscle atrophy, ankylosis or carpal tunnel syndrome
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21
Q

What are some extraarticular manifestations of RA? (6)

A
  • Rheumatoid nodules
  • Arteritis (inflammation of artery walls)
  • Neuropathy
  • Scleritis (inflammation of sclera)
  • Pericarditis
  • Splenomegaly
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22
Q

Diagnosis is made if the patient has __/__ of what criteria?

A

-4/7

  1. ) Morning stiffness
  2. ) Arthritis of 3 or more joints
  3. ) Arthritis of hands
  4. ) Symmetric arthritis
  5. ) Rheumatoid nodules
  6. ) Serum rheumatoid factor
  7. ) Radiographic changes
23
Q

Polymyalgia Rheumatica:

  • _______, rheumatic inflammatory disorder with unknown cause.
  • Occurs almost exclusively in people >___.
  • Is it more common in men or women?
  • What patient population is it predominantly in?
  • Characterized by severe ______ and _________ primarily in the _______ as opposed to the joints.
A
  • Systemic
  • > 50
  • Women > Men (2x)
  • Caucasian population
  • severe aching and stiffness primarily in muscles
24
Q

Polymyalgia Rheumatica S/Sx. (8)

A
  • Muscle pain or aching (proximal muscle groups)***
  • Stiffness upon arising in the morning or after rest***
  • Weakness, fatigue, malaise
  • Low-grade fever, sweats
  • HA
  • Weight loss
  • Depression
  • Vision changes
25
Q

Polymyalgia Rheumatica:

  • Condition is _____-________.
  • Typically lasts __-__ years.
  • What is used to suppress inflammation, treat symptoms and provide remission but does not cure?
  • Important for PTs to be aware of the possibility of _______-_______ osteopenia and _______.
  • Most pts with this condition do not have lasting effects with medical intervention.
A
  • self-limiting
  • 2-3 years
  • oral corticosteroids
  • steroid-induced osteopenia and DM
26
Q

Scleroderma:

  • Chronic _________ disease.
  • Characterized by _________ and _______ of many body parts including skin, blood vessels, synovium, skeletal muscle, and certain internal organs.
  • What are the (2) main categories of scleroderma?
  • Who is it more common in?
A
  • multisystem
  • inflammation and fibrosis
  • limited cutaneous scleroderma, diffuse cutaneous scleroderma
  • young/middle-aged women
27
Q

Limited Scleroderma:

  • Characterized by long hx of _________ phenomenon.
  • Skin thickening is limited to _____.
  • Esophageal ________ is common.
A
  • Raynaud’s phenomenon
  • limited to hand
  • esophageal dysmotility
28
Q

Diffuse Scleroderma:

  • More _______ onset.
  • Many constitutional symptoms, arthritis, carpal tunnel and marked swelling of hands and legs.
  • Wide-spread skin thickening occurs and progresses from ________ to _______.
  • _____________ problems are common (GI effects and pulmonary fibrosis common, severe life-threatening involvement of heart/kidneys occurs)
A
  • acute onset
  • from fingers to trunk
  • internal organ
29
Q

Limited Cutaneous Scleroderma S/Sx. (5)

A
  • Calcinosis
  • Raynaud’s Phenomenon
  • Esophageal dysmotility, dysphagia, heartburn
  • Sclerodactyly (thickening of skin of digits of hands and feets)
  • Telangiectasia (dilated/broken blood vessels near surface of skin)

CREST***

30
Q

Diffuse Cutaneous Sclerosis S/Sx. (6)

A
  • Raynaud’s Phenomenon
  • Trunk and extremity skin changes
  • Ulceration of fingers
  • Polyarthralgia
  • Flexion contractures of large and small joints
  • Visceral involvement
31
Q

Systemic Lupus Erythematosus (SLE):

  • In family of _________ _______ disease.
  • Chronic, systemic, inflammatory condition affecting skin, joints, kidneys, heart and blood-forming organs, nervous system and mucous membranes.
  • What is the most common characteristic of SLE?
  • What are the (2) primary forms of SLE?
A
  • autoimmune rheumatic diseases
  • butterfly rash across cheeks/nose
  • discoid lupus, systemic lupus
32
Q

SLE Risk Factors:

  • Appears to be result of ___________ disturbance caused by interplay of genetic, hormonal, chemical, and environmental factors.
  • ___________ factors that may trigger include infections, antibiotics/other medications, exposure to UV (sun) light and extreme physical/emotional stress.
  • There is a known genetic predisposition but no known gene associated with SLE.
  • Most common in ___-___ years of age. (can occur at any age)
  • Are men or women affected more?
A
  • immunoregulatory disturbance
  • environmental factors
  • 15-40 years
  • Women > Men (10-15x)
33
Q

SLE S/Sx. (12)

A

-Arthralgia*
-Arthritis*
-Constitutional symptoms (low-grade fever & fatigue)
-Skin rash (malar)
-Pulmonary involvement
-Anemia
-Kidney involvement
-Sun or light sensitivity
-Hair loss
-Raynaud’s phenomenon
-Nervous system involvement
Mouth, nose, or vaginal ulcers

34
Q

Spondyloarthropathy:

  • Group of __________, _________, _________ rheumatic diseases.
  • What does it target?
  • Is it more common in men or women?
  • What are the (3) main types?
A
  • noninfectious, inflammatory, erosive rheumatic diseases
  • Targets SI, bony insertion of annulus fibrosis of IV discs and facet joint
  • Men > Women
  • ankylosing spondylitis, Reiter’s syndrome, Psoriatic arthritis
35
Q

What are the (3) main types of spondyloarthropathy?

A
  • Ankylosing Spondylitis
  • Reiter’s Syndrome
  • Psoriatic Arthritis
36
Q

Ankylosing Spondylitis:

  • _______, _________ inflammatory disorder of undetermined cause.
  • Inflammation of fibrous tissue affected insertions of _______/______/_______ into bone resulting in what?
  • What areas are primarily affected? (3)
A
  • chronic, progressive, inflammatory
  • ligaments/tendons/capsules, results in fusion over time
  • SI, spine, and large peripheral joints
37
Q

Ankylosing Spondylosis Early Stage S/Sx. (5)

A
  • Intermittent LBP***
  • Sacroiliitis***
  • Spasm of paravertebral muscles***
  • Loss of normal lumbar lordosis***
  • Painful limitation of cervical joint motion***
38
Q

Ankylosing Spondylosis Advanced Stage S/Sx. (4)

A
  • Constant LBP***
  • Loss of normal lumbar lordosis***
  • Ankylosis of SI joints and spine***
  • Muscle wasting in shoulder and pelvic girdle***
39
Q

What are some complications of ankylosing spondylitis? (6)

A
  • Prone to fracture from even minor trauma
  • Most common fracture site is lower cervical spine
  • Myelopathy
  • Spondylodiscitis (erosive & destructive lesions of vertebral bodies)
  • Cauda-equina syndrome
  • Spinal stenosis
40
Q

Reiter’s Syndrome:

  • Characterized by what triad?
  • Type of ________ arthritis.
  • Occurs mainly in young adult _____ ages ___-___.
A
  • Triad of arthritis, conjunctivitis, and nonspecific urethritis
  • reactive arthritis
  • young adult men ages 20-40
41
Q

Reiter’s Syndrome S/Sx. (11)

A
  • Plantar fasciitis***
  • Polyarthritis
  • SI joint changes
  • Low back and buttock pain
  • Small joint involvement
  • Low-grade fever
  • Urethritis
  • Conjunctivitis and iritis, bilaterally
  • Skin involvement (resembling psoriasis)
  • May be preceded by bowel infection
  • Anorexia and weight loss
42
Q

What are the (3) ways we can differentiate Reiter’s Syndrome from Ankylosing Spondylitis?

A
  1. ) Presence of urethritis and conjunctivitis.
  2. ) Prominent involvement of distal joints.
  3. ) Presence of asymmetric radiologic changes in SIJ and spine.
43
Q

Psoriatic Arthritis (PsA):

  • ________, _________, erosive, inflammatory arthritis.
  • Associated with skin disease _________.
  • Does it affect men or women more?
  • Can occur at any age but usually ___-___.
  • Arthritis is usually preceded by _____ condition.
  • Causes and risk factors are unknown.
A
  • Chronic, recurrent, erosive, inflammatory
  • skin disease psoriasis
  • Affects both genders equally
  • 20-30
  • skin condition
44
Q

Psoriatic Arthritis S/Sx. (6)

A
  • Fever
  • Fatigue
  • Polyarthritis
  • Psoriasis
  • Sore fingers
  • Unique clinical features of PsA (DIP joint involvement, nail changes, dactylitis, spondylitis, iritis)
45
Q

Multiple Sclerosis (MS):

  • Most common _________ ___________ disease of the CNS.
  • Affects areas of brain and spinal cord.
  • Symptoms appear between ___-___ years.
  • Does it affect men or women more?
  • __________ increases risk 10x.
  • 5x more prevalent in ______ climates of NA and EU.
  • Characterized by _________ _______ lesions that form scars (plaques) scattered in CNS white matter.
A
  • inflammatory demyelinating disease of the CNS
  • 20-40
  • Women > Men (2x)
  • Family Hx
  • colder climates
  • inflammatory demyelinating lesions
46
Q

MS S/Sx. (16)

A

Symptoms (highest to lowest occurrence)

  • Unilateral visual impairment
  • Paresthesias
  • Ataxia
  • Vertigo
  • Fatigue
  • Muscle weakness
  • Bowel/bladder dysfunctions
  • Speech impairment

Signs (highest to lowest occurrence)

  • Optic neuritis
  • Nystagmus
  • Spasticity or hyperreflexia
  • Babinski’s sign
  • Absent abdominal reflexes
  • Dysmetria or intention tremor
  • Labile or changed mood
  • Lhermitte’s sign (shock-like sensation in flexion)
47
Q

Guillain-Barre Syndrome (GBS):

  • AKA _____ _________ _________
  • _____, _______ autoimmune disorder.
  • Demyelination of _______.
  • Characterized by abrupt onset of _______.
  • Not related to race, sex, or age.
  • Exact cause unknown but frequently occurs after an _______.
A
  • Acute Idiopathic Polyneuritis
  • acute, acquired
  • PNS
  • paralysis
  • illness
48
Q

GBS S/Sx. (5)

A
  • Muscular weakness (bilateral, progressing from legs and arms to chest and neck)
  • Diminished DTR
  • Paresthesias (w/o loss of sensation)
  • Fever, malaise
  • Nausea
49
Q

Myasthenia Gravis (MG):

  • Develops when antibodies produced by immune system block receptors in muscles that receive signals of _______.
  • What does this result in?
  • What are the two peaks of onset?
A
  • ACh (acetylcholine)
  • Impaired muscle function
  • 20-30 years, after 50 years
50
Q

MG S/Sx. (9)

A

Muscle fatigue and proximal muscle weakness aggravated by exertion***

  • Respiratory failure
  • Ptosis
  • Diplopia
  • Dysarthria
  • Alteration in voice quality
  • Dysphagia
  • Nasal regurgitation
  • Choking, difficulty in chewing
51
Q

Clues to Immune System Dysfunction:

  • Insidious onset of episodic back pain in patient younger than 40 with family history of spondyloarthropathy. (_________)
  • Joint pain preceded or accompanied by burning and urinary frequency (urethritis) and/or accompanied by eye irritation. (_________)
  • Joint pain preceded or accompanied by a skin rash or lesions. (___________)
  • Development of neurological symptoms 1-3 weeks after infection. (___________)
A
  • ankylosing spondylitis
  • Reiter’s syndrome
  • Psoriatic Arthritis
  • GBS
52
Q

Guidelines for immediate medical attention? (3)

A
  • Dusky blue discoloration or erythema with exquisite tenderness in a joint
  • Evidence of spinal cord compression
  • Presence of incontinence in pt with AS
53
Q

Guidelines for MD referral? (3)

A
  • New onset of joint pain within 6 weeks of surgery accompanied by constitutional symptoms.
  • Symmetric swelling and pain in peripheral joints.
  • Development of progressive neurologic symptoms within 1-3 weeks of previous infection or recent vaccination.

S7- Differential Diagnosis (15 decks)

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