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OPT 537 > Exam 1 -- Rheumatology #2 > Flashcards

Exam 1 -- Rheumatology #2 Flashcards

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1
Q

True or false: rheumatoid arthritis is the most common type of autoimmune arthritis

A

True.

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2
Q

True or false: rheumatoid arthritis presents bilaterally and symmetrically

A

True.

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3
Q

Does RA present peripherally or axially?

A

Peripherally

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4
Q

True or false: RA leads to destruction of bone, cartilage, and tendons, but not of ligaments.

A

False; it leads to destruction of all of these.

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5
Q

What percentage of the US population is affected with rheumatoid arthritis (RA)?

A

1%

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6
Q

Which gender has a higher incidence of RA?

A

Women (3:1)

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7
Q

What is the most common age of onset for RA?

A

45-75 years

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8
Q

True or false: pregnancy can be protective against RA.

A

True.

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9
Q

Which populations have a higher incidence of RA? Which have a lower incidence?

A

White and hispanic; African American and Chinese

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10
Q

True or false: RA is genetically associated with HLA-B27

A

False; HLA-B27 is associated with the spondyloathrothopy conditions, not RA.

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11
Q

True or false: smoking, obesity, and heavy coffee drinking are all considered risk factors for RA

A

True.

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12
Q

How many joints must be affected in order to diagnose a condition as RA?

A

More than 3

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13
Q

Which joint(s) of the fingers are affected by RA?

A

MCP and PIP, not DIP (the proximal two joints, but not the distal joint)

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14
Q

What symptoms may be indicative of RA?

A

Pain, stiffness, swelling, and limited movement of small joints. Less common: weight loss, fever, fatigue, malaise

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15
Q

The symptoms of RA can be similar to the symptoms of an infection. How long do the symptoms of RA last?

A

More than 6 weeks (longer than symptoms from an infection)

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16
Q

True or false: the pain from RA is worse in the morning and gets better with activity.

A

True.

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17
Q

How quickly can arthritis manifest from the onset of RA (not diagnosis, but onset)?

A

Within 3-6 months

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18
Q

What is citrullination? What effect does it have in terms of inflammation?

A

The conversion of an arginine to a citrulline. In the synovial fluid, the citrullinated site fits into the antigen binding site of HLA. This starts an inflammatory response.

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19
Q

Part of testing for RA can involve testing for Anti-Citrullinated Protein Antibodies (ACPAs). What percentage of RA patients have ACPAs?

A

50-70%

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20
Q

Rheumatoid factor is associated with what Ig? Which portion of which other Ig does it target?

A

IgM; Fc portion of IgG

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21
Q

What percentage of RA patients have rheumatoid factor?

A

70%

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22
Q

Rheumatoid factor is found in what percentage of healthy patients over the age of 70?

A

25%

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23
Q

What term is used to indicate a lack of rheumatoid factor?

A

Seronegative

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24
Q

If a patient tests positive for both RF and ACPA, what is the likelihood that they have RA?

A

80-97%

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25
Which Ig is the largest?
IgM
26
Which Ig is the fastest responder?
IgM
27
Which Ig can cross the placenta?
IgG
28
Which Ig is the most common?
IgG (75% of all Ig)
29
Which Ig is found in bodily fluids (tears, saliva, breast milk, etc.)?
IgA
30
Which Ig is involved in allergic responses?
IgE
31
Rheumatoid factor can be associated with viral infections. Can ACPA also be associated with viral infections?
No
32
True or false: about 25% of patients in the advanced stages of RA have rheumatoid nodules.
True.
33
Where can rheumatoid nodules be found?
Toes, elbows, knuckles, spine, lungs, heart, liver, skin
34
True or false: rheumatoid nodules are tender to the touch
False; they are non-tender
35
What medication can cause rheumatoid nodules?
Methotrexate
36
What is a normal value for a CRP?
Less than 1.0 mg/dL (less than 10 mg/L)
37
What is a normal value for an ESR?
For males: less than half their age in years; for females, less than half of (their age in years + 10)
38
True or false: mild anemia is present in nearly all rheumatoid conditions
True.
39
Systemic effects are present in what percentage of RA patients?
40%
40
What systemic effects may be present in the lungs of a patient with RA?
Difficulty breathing, fibrosis, cough, nodules
41
What systemic effects may be present in the heart of a patient with RA?
Coronary artery disease (CAD), myocarditis (inflammation of muscles around the heart), atrial fibrillation (abnormal heartbeat)
42
What systemic effects may be present in the kidneys of a patient with RA?
Chronic kidney disease (CKD)
43
What is amyloidosis?
Incorrectly folding proteins that can cause nodules inside the body
44
True or false: RA is the #1 cause of secondary amyloidosis
True.
45
What neurologic effects may be present in a patient with RA?
Peripheral neuropathy
46
What is the most common ocular effect of RA?
Dry eye (occurs in 15-25% of RA pts)
47
What ocular effects can occur with RA?
Dry eye, episcleritis, scleritis, scleromalacia perforans, PUK (peripheral ulcerative keratitis; abnormal bacterial ulcers)
48
True or false: uveitis is more common in Juvenile RA than in RA.
True.
49
What are possible treatment options for a patient with RA?
Physical therapy, NSAIDs, corticosteroids, DMARDs
50
True or false: Juvenile Idiopathic Arthritis (JIA) is the exact same condition as RA, just in younger patients
False.
51
Juvenile Idiopathic Arthritis presents with symmetric or asymmetric joint pain?
Symmetric
52
How old must a patient be in order for their condition to be considered Juvenile Idiopathic Arthritis, assuming all other symptoms match?
Under age 16 years
53
For how long must a patient have symptoms in order to be diagnosed with Juvenile Idiopathic Arthritis?
More than 3-6 weeks
54
What symptoms may be indicative of Juvenile Idiopathic Arthritis?
Symmetric joint pain, fever, rash
55
Patients with Juvenile Idiopathic Arthritis are at risk for what ocular conditions?
Chronic uveitis and band keratopathy
56
There are five forms of Juvenile Idiopathic Arthritis. Which is most common?
Oligoarticular/pauciarticular (50-60%)
57
How many joints are affected in oligoarticular Juvenile Idiopathic Arthritis?
Four or fewer
58
True or false: oligoarticular Juvenile Idiopathic Arthritis affects girls and boys equally
False; girls are more affected than boys
59
True or false: patients with oligoarticular Juvenile Idiopathic Arthritis are RF (-)
True.
60
What is the peak onset age for oligoarticular Juvenile Idiopathic Arthritis?
3 years
61
How many patients with oligoarticular Juvenile Idiopathic Arthritis also suffer from uveitis?
25%
62
True or false: oligoarticular Juvenile Idiopathic Arthritis usually doesn't cause lasting harm.
True.
63
How many joints are affected in polyarticular Juvenile Idiopathic Arthritis?
More than four
64
Polyarticular Juvenile Idiopathic Arthritis is more common in what gender and age groups?
Girls age 2-5 or 10-14
65
True or false: polyarticular Juvenile Idiopathic Arthritis usually shows up RF (+)
False; it can show up RF (+) or RF(-) depending on the age of diagnosis
66
True or false: polyarticular Juvenile Idiopathic Arthritis usually doesn't cause lasting harm.
False; it is progressive and destructive
67
True or false: systemic Juvenile Idiopathic Arthritis affects girls and boys equally
True, up to age 5, then girls are more affected than boys
68
What symptoms accompany systemic Juvenile Idiopathic Arthritis?
Fever and a rash that doesn't itch
69
Fill in the blank: patients with systemic Juvenile Idiopathic Arthritis usually have ______ (high/low) CRP, _____ (high/low) ESR, and are RF ______ (positive/negative)
High, high, negative
70
What are symptoms of psoriatic Juvenile Idiopathic Arthritis?
Multiple rashes, sausage digits, nail pitting
71
What is another term for "sausage digits?"
Dactylitis
72
Patients with psoriatic Juvenile Idiopathic Arthritis are typically RF ______________(positive or negative)?
Negative
73
Enthesis-related Juvnile Idiopathic Arthritis is sometimes referred to by what other name?
Pediatric spondyloarthropathy
74
The symptoms of enthesis-related Juvnile Idiopathic Arthritis are usually seen in which portion of the skeleton?
Axial
75
Enthesis-related Juvnile Idiopathic Arthritis is most common in what gender and age group?
Boys age 8-12 years
76
True or false: patients with enthesis-related Juvnile Idiopathic Arthritis can be HLA B27 (+)
True.
77
True or false: patients with enthesis-related Juvnile Idiopathic Arthritis are usually RF (+)
False; they are usually RF (-)
78
What are treatment options for Juvenile Idiopathic Arthritis? Which one should be used with caution?
NSAIDs, DMARDs, TNF modulators, oral steroids with caution (interfere with bone growth)
79
Which biologic drug can be used to treat Juvenile Idiopathic Arthritis?
Tocilizumab
80
Acute rheumatic fever occurs most commonly in what age group?
5-15 years
81
What causes acute rhematic fever?
Streptococcal pharyngitis infection followed 2-4 weeks later by migratory arthritis
82
True or false: migratory arthritis is the earliest manifestation of acute rheumatic fever
True.
83
Describe migratory arthritis
Affects several joints in quick succession for 1-3 days each
84
What symptoms might accompany acute rheumatic fever?
Carditis, CNS involvement (psychosis), subcutaneous nodules, multiple skin rashes
85
Rheumatic heart disease involves calcification of what structure in the heart?
The mitral valve (and the aortic valve, to a lesser degree)
86
If acute rheumatic fever is left untreated, it can lead to rheumatic heart disease. How much time can pass before the onset of the rheumatic heart disease?
10-20 years
87
How would you treat rheumatic heart disease?
Antibiotics* (penicillin, amoxicillin, azithromycin), aspirin*, anti-inflammatories
88
What is lyme arthritis?
Arthralgia (joint pain) secondary to late stage lyme disease
89
What joints are most commonly involved in lyme arthritis?
Knee, ankle, elbow, wrist
90
True or false: lyme arthritis typically presents bilaterally
False; it typically presents unilaterally
91
80% of lyme disease patients get what sort of sign?
Bull's eye rash at site of tick bite
92
Lyme arthritis is accompanied by what symptoms?
Joint swelling, bursitis, tendonitis, fatigue, fever, HA, weight loss
93
What would you test for in a patient you suspect of having lyme disease?
B. burgdorferi, ESR, CRP
94
How would you treat a patient with lyme arthritis?
Oral doxycycline or amoxicillin for a month, followed by another month if needed. If those fail, treat with IV ceftriaxone

OPT 537 (21 decks)

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