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DM II > autoimmune > Flashcards

autoimmune Flashcards

1
Q

autoimmune disease

A

pathologic condition caused by an adaptive autoimmune response

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2
Q

rheumatic disease

A

up to 25% of patients with rheumatic disease with systemic symptoms cannot be definitively diagnosed

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3
Q

arthralgia

A

joint pain

symptom of injury, infection, illness (arthritis) or allergic rxn to medication

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4
Q

sensitivity

A

proportion of patients with a disease who have had a + test result

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5
Q

specificity

A

proportion of patients without the disease who have had a - test result

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6
Q

high positive predictive value

A

patient with a + result most likely has the disease

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7
Q

high negative predictive value

A

patient with a - result most likely doesn’t have the disease

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8
Q

+ rheumatologic test

A

predictive value of a + rheum test in patients with poly-arthralgia is likely to be higher in a rheum practice than in a family physician’s office

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9
Q

evaluative tests

A

monitor disease over time

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10
Q

ESR and CRP

A

non specific inflammatory markers

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11
Q

RF

A

rheumatoid factor

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12
Q

ANA

A

antinuclear antibody

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13
Q

ACPA

A

anti-citrullinated peptide antibodies ; also known as anti-CCP

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14
Q

anti dsDNA

A

antibody to native double strand DNA

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15
Q

anti-Sm

A

anti-Smith antibody

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16
Q

ANCA

A

antineutrophil cystoplasmic antibody

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17
Q

aPLs

A

antiphospholipid antibodies

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18
Q

lyme serologies

A

ELISA and western block

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19
Q

SLE

A

anti ds DNA

anti Smith Ag

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20
Q

Drug induced SLE

A

Anti-Histone

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21
Q

CREST syndrome

A

Anticentromere

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22
Q

Mixed connective disease

A

Anticentromere

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23
Q

Scleroderma

A

Anti SCL 70

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24
Q

Dermatomyositis

A

Anti Jo1

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25
Q

Sjorgen’s syndrome

A 
Anti Ro (anti-SS-A)
anti La (anti-SS-B)
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26
Q

Wegener’s granulomatosis

A

ANCA

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27
Q

<2000 WBC joint fluid analysis

A

non-inflammatory

OA, viral infection

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28
Q

> 2000 - 10,000 WBC joint fluid analysis

A

inflammatory

gout, pseudogout

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29
Q

> 100,000 WBC joint fluid analysis

A

septic

even less than 100,000 with fever, consider septic unless proven otherwise

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30
Q

red fluid WBC joint fluid analysis

A

hemorrhagic

trauma, tumor, coagulopathy

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31
Q

PMN

A

polymorphonuclear leukocytes

32
Q

> 75% PMN

A

inflammatory

33
Q

analysis of synovial fluid should include

A
  • % PMNs
  • crystal anaylsis
  • gram staining and culture
  • arthrocentesis - mandatory if infection is suspected
  • warfarin is not contraindication
34
Q

acute arthritis

A

acute - less than 6 weeks
arthritis - inflammation localized to the articular structures,
swelling, warmth, discomfort, redness
distinct from arthralgia, peri-arthritis, tendinitis, bursitis

35
Q

MSK emergencies

A

infection
-septic arthritis, septic emboli, osteomyelitis
fracture
operable full/partial tendon/ligament tears
compartment syndrome
entrapment neuropathy/mononeuritis multiplex
myelopathy/myelitis
primary or secondary bone tumors
vascular - DVT or arterial insufficiency

36
Q

goals for initial evaluation of joint complaints

A 
articular vs nonarticular
inflamm vs noninflamm
triage MS emergencies
assess systemic rheum disease
obtain appropriate necessary testing
short term &amp; long term plan
when to refer
37
Q

acute monoarthritis

A

if there is bacterial infection -> it may cause rapid joint destruction and eventual sepsis

38
Q

septic arthritis

A

hematogenous seeding of synovium can be extension from site trauma or osteomyelitis
knee and hip especially susceptible
also abnormal synovial joints previously damaged by trauma, inflammation or degenerative process are also more susceptible

39
Q

acute monoarthritis

differential diagnosis

A

infection

  • bacteria
  • –gonoccocal vs non-gonococcal
  • viruses
  • fungi/spirochetes/mycobacteria
  • –coccidiodomycosis, lyme, spirotrichosis, blastomycosis

crystal induced arthropathies

  • gout, pseudogout (CPPD)
  • gout is risk factor for septic arthritis

trauma
hemarthrosis
osteonecrosis

40
Q

early monoarticular presentations of polyarticular diseases

A 
RA
Reiter's syndrome
ankylosing spondylitis
psoriatic arthritis
sarcoidosis
arthritis of IBD
41
Q

infection

A

common cause of acute pain and swelling in a single joint

42
Q

myelodysplastic and leukemic disorders

A

also can cause arthralgias and arthritis

43
Q

gonococcal monoarthritis

infectious inflamm monoarthritis

A 
incidence decreasing
sexually active young adults
female > male
polyarthralgia can precede but monoarthritis in 50%
fever
tenosynovitis, especially in wrist 68%
minimal joint effusion
skin lesions 75%
anogenital infection often asymptomatic

+blood culture
sterile joint fluid

44
Q

septic joint stage

A

monoarticular vs polyarticular symptoms with marked joint swelling and effusion
can recover organism from joints in 50% of patients

45
Q

bacterial septic arthritis
NON GONOCOCCAL
infectious inflamm monoarthritis

A

gram + 80% of time
S. Aureus predominates

gram - 20%
E. coli, proteus, klebsiella, Enterobacter
very young, elderly, injection drug use, immunocompromised

anerobes uncommon, diabetes risk factor

prodrome of malaise and fever
mild fever

large joint predilection

requires aggressive management
-serial aspiration, parenteral antibiotics, splinting and PT

46
Q

Monoarthritis - lyme

infectious inflamm monoarthritis

A

features dependent on phase of disease

early disseminated lyme
-poly arthralgia, ELISA may be negative very early

late lyme
weeks to months after infection
ELISA +
mono,oligo, poly arthritis
tends to be asymmetric
large effusion in a single knee in most
47
Q

infectious inflamm monoarthritis

OTHER infectious organisms

A

mycobacterial infection
HIV patients are at risk

HIV infection: at onset of HIV syndrome, look for acute monoarticular or oligoarticular arthritis

48
Q

noninfectious inflammatory monoarthritis

A 
acute gout
pseudo gout
immunologic disease::::
-RA
-Reiter's
-ankylosing spondylitis
-psoriatic arthritis
-arthritis associated with IBD
49
Q

noninflamm monoarthritis

A

acute trauma: meniscus, fracture extending into joint space, trauma resulting in hemoarthrosis

osteoarthritis: degeneration of hyaline articular cartilage with adjacent bony sclerosis proliferation (may be painful and inflamed)

50
Q

monoarthritis history

A

review for septic cause
review for acute trauma

ask about prior attacks - thinking of gout

review alcohol use - thinking gout, trauma, infection

ask about back pain/stiffness - spondyloarthropathies

in younger patients - Reiter’s , ankylosing spondyltis, GC

co-morbidities - IBD, psoriasis, hypothyroidism, h/o gout

meds

SH - work / travel

FH - connective tissue disease, psoriasis, IBD, gout

51
Q

rapid onset vs slow/insidious

A

rapid: trauma, septic, crystalline
slow: systemic rheum or non-inflamm process like osteoarthritis

52
Q

AM vs PM

A

AM: prolonged in systemic rheum disease
PM: sprain/strain/non-inflamm process

53
Q

worse with activity or rest

A

activity: tendinitis/bursitis/non-inflamm
rest: systemic rheum diseases

54
Q

rapid from no symptoms to maximal intensity

A

trauma
septic
crystalline

55
Q

confined to joints vs inter-articular

A

localized to joints: arthritis/arthralgia

inter-articular: diffuse pain syndromes

56
Q

mono vs oligo vs polyarticular

A

poly articular less likely to be septic arthritis

monoarticular can still be early presentation of a systematic rheum disease

57
Q

0-10 pain scale /touch me not

A

often septic or crystalline

58
Q

stiffness > pain

A

systemic rheum diseases

59
Q

vague, deep ache

A

hyperparathyroidism
osteomalacia
bone lesions: night pain

60
Q

burning/numbness/tingling

A

neurogenic

61
Q

claudication

A

vascular vs spinal stenosis

62
Q

constitutional / prodromal symptoms

A

infection or systemic rheum diseases, occasionally crystalline

63
Q

prior similar episodes

A

less likely infectious

intercritical return to complete normality: crystalline arthritis

64
Q

special indicators of systemic rheum diseases

A

cutaneous manifestations:
psoriasis, photosensitivity, skin thickening, purpura etc

swollen glands
Raynaud's
oral/nasal ulcers
pleurisy/pericarditis
eye inflammation
nail changes
dry eyes/mouth
proximal muscle weakness
sinusitis
hearing loss
65
Q

physical exam re: articular

A

inspection
range of motion
palpation:
-warmth, erythema, swelling, effusion, tenderness, deformity, crepitus, stability

66
Q

tendinitis/bursitis

A

symmetry: uncommon
inflammation: over tendon/bursa
tenderness: focal
instability: uncommon
locking: unusual - expect with tears
multi-system disease: no

67
Q

non-inflammatory

A

symmetry: occasional
inflammation: unusual
tenderness: unusual
instability: occasional
locking: possible
multi-system disease: no

68
Q

systemic rheumatic disease

A

symmetry: common
inflammation: common
tenderness: over entire joint space
instability: uncommon
locking: uncommon
multi-system disease: often

69
Q

fever

A

+ septic arthritis

+/- low grade -> gout /RA

70
Q

necrotic lesions

A

GC

71
Q

splinter hemorrhages

A

endocarditis

HIV/IVDA - needle tracks

72
Q

pitting of nails

A

psoriasis

73
Q

erythema nodosum

A

sarcoidosis;

IBD

74
Q

keratoderma blenorhagicum/

cirinate balanitis

A

Reiter’s syndrome

75
Q

spine: restriction of motion; tenderness

A

spondylitis

76
Q

labs for monoarthritis

A

no standard - mostly H&P
CBC, blood cultures, coag studies, X-rays
elevated uric acid does not exclude septic arthritis

CT or MRI if you suspect osteomyelitis or soft tissue abscesses

77
Q

evaluation of polyarthritis

A

are symptoms ARTICULAR or NON-ARTICULAR (periarticular - occuring around the joint)

INFLAMM OR DEGENerative
(red, warm, swollen, or boggy)

local or systemic

DM II (4 decks)

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