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Infection Related Rheumatic Disorders > MISC > Flashcards

MISC Flashcards

1
Q

MC arthritogenic enteric and GU bacteria

A

Yersinia
Salmonella
Shigella
Campylobacter
Chlamydia trachomatis

Less common
Chlamydia pneumo
M pneumo
C difficile

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2
Q

ReA gender predilection

A

M

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3
Q

Organisms responsible for ReA at all ages

A

Enteric infections

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4
Q

T/F significant prop of patients with ReA are HLA-B27 neg

A

T

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5
Q

BErlin dx criteria for ReA

A

Pg 614 box

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6
Q

In ReA: Symptoms of infection usually precede arthritis, enthesitis, or extraarticular disease by

A

1-4 weeks

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7
Q

Active period of ReA

A

Weeks to months

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8
Q

T/F Chlamydia GU infection is usually asymptomatic

A

T

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9
Q

T/F ReA is typically red and warm

A

T

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10
Q

T/F ReA is typically oligoart

A

T

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11
Q

Eye finding in ReA occuring in 2/3 of patients

A

Conjunctivitis

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12
Q

Organism that may cause severe purulent conjunc in ReA

A

Yersinia

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13
Q

T/F ReA is difficult to distinguish from septic arth

A

T, do culture

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14
Q

T/F Clincial and lab confirmation of an infectious trigger in children with ReA is often made

A

F

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15
Q

Usual distinguishing clinical cxs of ReA compared to JIA

A

More painful
Assoc with erythema of overlying skin

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16
Q

Usual distinguishing clinical cxs of septic arth compared to ReA

A

Fever and usual monoarticular involvement

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17
Q

Among all rheumatic disease of childhood, this is the only one potentially preventable

A

ReA

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18
Q

Circinate balanitis (shallow painless ulcers on glans) is seen in what ReA

A

Chlamydia-triggered ReA

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19
Q

Skin lesions of ReA difficult to distinguish from Psoriasis

A

Keratoderma blenorrhagicum

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20
Q

T/F Treatment of enteric infection with abx impacts the course of ReA

A

F

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21
Q

Abx therapy for this organism may be beneficial for altering course ofReA

A

Chlamydia trachomatis

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22
Q

1st line tx for ReA

A

NSAIDs

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23
Q

Usual duration of ReA

A

3-6m

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24
Q

Tx for Keratoderma blenorrhagicum

A

MTX

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25
Q

Tx for uveitis from ReA

A

Topical steroids

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26
Q

Most children with ReA achieve within

A

6-12m

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27
Q

Recurrent arthritis may occur in ReA

A

T

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28
Q

ARF latency

A

2-3 weeks

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29
Q

MC clinical presentation of RF

A

Carditis

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30
Q

Most specific clinical presentation of RF

A

Carditis

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31
Q

Most serious presentation of RF

A

Carditis

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32
Q

RF: Patholgocial process underlying inflammatory reaction in various organs

A

Vasculitis mediated by immune reaction to the strep antigen

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33
Q

Prevention of RF

A

Timely and appropriate treatment of strep pharyngitis

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34
Q

Peak incidence of RF

A

6-15years

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35
Q

Low incidence ARF is defined as

A

2 or fewer new cases per 100,000 children per year

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36
Q

Low prevalence ARF is defined as

A

1:1000 cases or fewer in the whole population

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37
Q

Strains of strep primarily associated with ARF

A

Serotype 3 and 18, particularly those that produced mucoid colonies when cultured on blood agar

38
Q

Susceptibility genes for ARF

A

HLA-DR 4,2,1,3,7
DRB1*16
Allotype D8/17

39
Q

Measure neutralizing Abs to purified streptolysin O

A

ASO

40
Q

Assays for antibodies to the most ubiquitous of 4 deoxyribonuclease isozymes produced by group A strep

A

Anti-DNAse B

41
Q

Antibodies against GAS peak approx ___ after acute infection

A

2-3 weeks

42
Q

Only about ___% of patient with ARF mount an ASO response

A

83

43
Q

RF: Structures that share cross-reactive antigenic determinants

A

1) Components of M protein and myocardial sarcolemma
2) Cell-wall carbohydrate and valvular glycoprotein
3) Strep protoplast membrane and neuronal tissue of subthalamic and caudate nuclei
4) Hyaluronate capsule and articular cart

44
Q

MCC of morbidity and mortality in patients with ARF

A

Carditis

45
Q

Older vs younger children with RF: More likely to develop moderate and severe carditis

A

Young

46
Q

WAS considered the hallmark of RHD

A

Pancarditis

47
Q

Main target and site responsible for pathological and clinical manif of RHD

A

Endocardium

48
Q

Hallmark lesion of rheumatic carditis

A

Valvular insuff

49
Q

Valves MC affected by RF in order

A

Mitral > aortic

50
Q

Murmur of mitral insuff/regurg

A

High-freq, smooth, holosystolic, apical, radiating to the left axilla, best heard while the patient is in left lat decubitus

51
Q

Murmur of mitral stenosis

A

Carey coombs murmur: Mid- to late-diastolic flow murmur

52
Q

Pulse of AI

A

Corrigan pulse: Increased pulse pressure asociated with bounding peripheral pulses

53
Q

Arthritis occurs in about ___% of patients with ARF

A

70

54
Q

RF: Most severe clinical manif at presentation

A

Arthritis

55
Q

RF clinical manif: Takes the longest to resolve

A

Chorea and erythema marginatum

56
Q

RF clinical manif: Rarest

A

Erythema marginatum

57
Q

RF clinical manif: Develops last

A

Chorea

58
Q

MCC of misdiagnosis of ARF

A

Arthritis

59
Q

T/F Arthritis of RF is usually initially monoartic

A

T

60
Q

Most prominent symptom of RF arthritis

A

Pain

61
Q

T/F Pain of RF arthritis occurs at rest and accentuated by active or passive mvt

A

T

62
Q

T/F ARF arthritis treated with NSAIDs may be monoarticu and not follow migratory pattern

A

T

63
Q

Sydenham chorea is a manif of involvement of

A

Basal ganglia and caudate nucleus

64
Q

Latency period between strep infxn and chorea

A

2-4 months, sometimes as long as 12 months

65
Q

T/F involuntary mvts in sydenham chor is usually asymm and disappear during sleep

A

F, symmetrical, disappear during sleep

66
Q

T/F Sydenham chor resolves spont

A

T, in 2-3 weeks, but may persist for months, sometimes, years

67
Q

PANDAs vs sydenham chorea

A

Carditis is highly prevalent in SC and not associated with PANDAs

68
Q

MC loc of erythema marginatum

A

Trunk and proximal inner aspects of the limbs

69
Q

T/F ERythema marginatum is accentuated by cold

A

F, warmth

70
Q

Usual location of SC nodules of RF

A

Extensor surface of joints

71
Q

T/F Overlying skin of SC nodules RF is often discolored

A

F, also firm, freely movable, painless, and nontender

72
Q

T/F Trop I is typically elevated in ARF

A

F

73
Q

Pathognomonic pathologic finding of rheumatic carditis and occurse MC in patients with subacute or chronic carditis

A

Aschoff body

74
Q

Pathologic appearance of SC nodules of RF

A

CEntral area of fibrinoid necrosis surrounded by loosely demarcated zones of scattered mononuclear cells

75
Q

An elevated ASO or anti-DNAse B is present in about ___% of patients with ARF

A

85

76
Q

Jones criteria

A

Pg 626 box

77
Q

Primary agent of choice for eradication of strep

A

Penicillin IM as single dose (as ben pen g) or orally for 10 days

78
Q

Tx for mild to moderate RF carditis

A

Aspirin 80-100mkday in 4 divided doses given for 4-8 weeks depending on clinical response then discontinued gradually in the next 4 weeks

79
Q

Tx for severe RF carditis and CHF

A

CS:
Pred 2mkday OD, tapered and withdrawn during the next 2-3 weeks

80
Q

T/F MPPT is inferior to oral pred in the treatment of RF

A

T

81
Q

Should be given prior to termination of oral pred therapy in RF severe carditis

A

Aspirin, to avoid rebound symptoms and of acute phase reactants

82
Q

Inflamm marker that is more reliable in monitoring response to antiinflam therapy for RF carditis

A

CRP

83
Q

T/F Complete bed rest for patients with acute carditis of RF should be discouraged

A

T, lead to prolonged confinement and cardiac neurosis

84
Q

Primary and secondary prevention of RF, regimens

A

Pg 627 table

85
Q

Duration of RF arthritis in any one joint

A

Rarely >1 week

86
Q

Hallmark of RF arthritis

A

Exquisite sensitivity to salicylates

87
Q

Dose of aspirin for RF arthritis

A

50-75mkday in 3-4 doses, no more than 2 weeks, gradually withdrawn

88
Q

T/F Mild manifestations of sydenham chorea require only bed rest and avoidance of physical and emotional stress

A

T

89
Q

T/F antiinflam agents are need for treatment of RF chorea

A

F

90
Q

Major morbidity in RF

A

Exclusively associated with degree of cardiac damage

91
Q

Rare form of nonerosive but deforming arthropathy ascribed to RF

A

Jaccoud arthritis

92
Q

T/F SC and erythema marginatum in RF are self-ltd with no permanent residua

A

T

Infection Related Rheumatic Disorders (3 decks)

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