inflammation

Question 1

RA: Early pathologic change is

Answer 1

rheumatoid synovitis. Synovium becomes inflamed. Lymphocytes and plasma cells increase.

Question 2

RA: Over time, ____________ occurs, and ______________ grows across the cartilage surface (pannus) from the edges of the joint. Joint surface shows loss of _______ beneath the extending pannus, most marked at joint margins.

Answer 2

articular cartilage destruction

vascular granulation tissue

cartilage

Question 3

RA: Inflammatory pannus causes focal destruction of _______. Osteolytic destruction of ______ occurs at joint edges, causing erosions seen on x-rays. This phase is associated with _________.

Answer 3

bone

bone

joint deformity

Question 4

RA onset

Answer 4

young/middle age

Question 5

RA is more common in _____ than _____

Answer 5

women

Question 6

RA weight is

Answer 6

lost or maintained

Question 7

RA is a ________ disease with exacerbations and remissions.

Answer 7

systemic

Question 8

RA affected joints

Answer 8

Small joints typically affected first (PIPs, MCPs, MTPs), wrists, elbows, shoulders, knees. Usually bilateral, symmetric joint involvement.

Question 9

RA pain characteristics

Answer 9

Stiffness lasts 1 h to all day and may ↓ with joint use. Pain is variable, may disrupt sleep.

Question 10

RA effusions are _______

Answer 10

common (loss of fluid)

Question 11

RA Nodules are present, especially on _____ surfaces

Answer 11

extensor

Question 12

RA synovial fluid WBC count

Answer 12

5000–60,000/μL (could be high) with mostly neutrophils; decreased viscosity.

Question 13

RA x rays show

Answer 13

Joint space narrowing and erosion with bony overgrowths, subluxation with advanced disease. Osteoporosis related to decreased activity, corticosteroid use.

Question 14

most likely lab findings for RA

Answer 14

RH (Rheumatoid factor) positive

increased ANAs (antinuclear antibodies)

positive anti-CCP (anti-citrullinated peptide)

increased ESR (Erythrocyte Sedimentation Rate) /CRP (C-Reactive Protein)

Question 15

typical RA deformities

Answer 15

(A) Ulnar drift. (fingers bend toward pinky)

(B) Boutonnière deformity. (middle joint bends down, distal joint extends up)

(C) Hallux valgus. (big toe deviates toward other toes)

(D) Swan neck deformity. (distal joint bent toward palm, proximal joint bent away from palm)

Question 16

RA can affect nearly every ____________

Answer 16

body system

Question 17

Atherosclerosis (narrow, hard arteries) can result from

Answer 17

chronic inflammation that damages endothelial cells within blood vessels. More cholesterol plaques may be formed. When plaques break loose, they can lead to heart attack or stroke.

Question 18

Sjögren syndrome

Answer 18

dried up

Question 19

Felty syndrome

Answer 19

enlarged spleen and low white blood cell (WBC) count

increased risk of lymphoma

Question 20

RA stages

Answer 20

1) no destruction

2) slight destruction, no deformities

3) joint deformity without joint fusion

4) joint fusion

Question 21

A RA patient-specific treatment plan considers

Answer 21

disease activity, joint function, age, sex, family and social roles, and response to previous treatment

Question 22

DMARDs stands for

Answer 22

disease-modifying antirheumatic drugs

Question 23

BRMs - Biologic response modifiers (also called biologics or immunotherapy) are used to

Answer 23

slow disease progression

BRMs can be used to treat patients with moderate to severe RA who have not responded to DMARD

Question 24

synovectomy

Answer 24

removal of joint lining

Question 25

arthroplasty

Answer 25

total joint replacement

Question 26

Gout is a type of arthritis characterized by

Answer 26

elevation of uric acid (hyperuricemia) and the deposit of uric acid crystals in 1 or more joints. marked by painful flares lasting days to weeks followed by long periods without symptoms.

Question 27

Uric acid is the major end product of purine catabolism. It is excreted by the ______

Answer 27

kidneys

Question 28

Gout occurs when either the kidneys cannot excrete enough ______ or there is too much being made for the kidneys to handle effectively.

Answer 28

uric acid

Question 29

Primary hyperuricemia

Answer 29

genetic. Accumulation of uric acid may be due to a lack of uricase.

Question 30

Uricase breaks down ______ into water-soluble products for elimination in urine. A lack of uricase then leads to __________

Answer 30

uric acid uric acid retention

Question 31

Secondary hyperuricemia may be caused by

Answer 31

conditions that increase uric acid production or decrease uric acid excretion or drugs that inhibit uric acid excretion

Question 32

Persons with other forms of inflammatory arthritis (e.g., RA, PsA) are more likely to develop

Answer 32

gout

Question 33

Not everyone with high uric acid levels develops gout. Two processes are essential for a person to develop gout:

Answer 33

crystallization (excess urate coalesces into crystals) triggering inflammation

Question 34

The gold standard for diagnosis of gout is

Answer 34

synovial fluid aspiration

Question 35

Acute gout is treated with

Answer 35

oral colchicine (Colcrys, Mitigare, antiinflamatory but not analgesic) and NSAIDs (for pain)

Question 36

Systemic lupus erythematosus (SLE) is a

Answer 36

multisystem inflammatory autoimmune disease

Question 37

lupus clinical manifestations

Answer 37

butterfly rash skin lesions erurythmia kidney, renal, cardiac, psychological, nervous system problems oral ulcers siezures photosensitivity arthritis

Question 38

lupus treatment

Answer 38

NSAIDs and Antimalarial agents, such as hydroxychloroquine and chloroquine Also Steroid sparing Methotrexate as well as Corticosteroids, anticoagulants, immunosuppressive drugs

Question 39

Fibromyalgia (FMS) is a

Answer 39

chronic central pain syndrome marked by widespread, nonarticular musculoskeletal pain and fatigue with multiple tender points. It is a common musculoskeletal disorder and a major cause of disability

Question 40

FMS involves abnormal central processing of _________________ in the CNS

Answer 40

nociceptive pain input

Question 41

FMS clinical manifestations

Answer 41

widespread burning pain that fluctuates through the course of a day may have pain in response to a stimulus that does not typically cause pain (allodynia)

Question 42

neurological manifestations of SLE

Answer 42

stroke, siezures, psychosis

Question 43

Articulation

Answer 43

Joint Or Being able to pronounce things clearly

Question 44

Swelling, pain, heat, redness, loss of mobility

Answer 44

Local manifestations of inflammation

Question 45

Fever, leukocytosis (increases WBC), malaise, fatigue

Answer 45

Systematic manifestations of inflammation

Question 46

Allopurinol (a xanthine oxidase inhibitor) treats for _____ but not ______

Answer 46

Treats for gout flare-ups (by reducing uric acid) but not pain

Question 47

Diet education for gout requires refraining from foods high in _____

Answer 47

Purine (liver, beer, anchovies, wine)

Question 48

Lupus patients should limit their ______ exposure

Answer 48

Sun

Question 49

Use cold for _____ and heat for ______

Answer 49

Cold for gout, heat for lupus

Question 50

FMS can be treated with ____ and _____

Answer 50

Anticonvulsants and antidepressants