MSK and CT dos

Question 1

*Define SLE

Answer 1

multisyst auto immune CT do characterized by numerous autoantibodies, circ immune complexes, with widespread immunologically determined tissue damage

Question 2

______ decent is most common afflicted by LSE

Answer 2

african american descent

Question 3

90% of SLE cases are ______gender of _____(age)

Answer 3

female; child bearing

Question 4

age reange of SLE diagnosis?

Answer 4

15-45 (after menarche and before menopause)

Question 5

what are enviro triggers for SLE (4)

Answer 5

UV light, smoking,microrganisms, and likely estrogen

Question 6

what are the two ways SLE causes tissue damage?

Answer 6

1) formation/deposition of immune complexes at dermal/epidermal jxn and at renal tissue
2) damage of specific cells resulting inflammation activated PMNs, and release of lysozymes and ROS – t lymphocyte dominant

Question 7

exacerbations of SLE are common with _____ or when taking _____; in addition there is an inc incidence in males with _________

Answer 7

pregnancy or taking OCP

inc incidence in males with kleinfelters

Question 8

SLE can be induced by various _____; these pts still have positive _____ tests

Answer 8

drugs

pos ANAs

Question 9

*Name the 3 primary clinical features of SLE

Answer 9

arthritis, arthralgia(polyarthralgia), and fever(fever and rash) (raynauds is also common)

Question 10

*_______ is the most common constitutional sx in SLE

Answer 10

fatigue(>90%)

Question 11

SLE arthritis is often _____ and _________

Answer 11

transitory and migratory

Question 12

SLE pts present with vasculitis, purpura, malar butterfly rash and _____ lesions

Answer 12

discoid (and painful oral ulcers)

Question 13

_______ involvement can affect up to 60% of SLE pts and can include: chorea, depression, epilepsy and peripheral neuropathy.

Answer 13

CNS

Question 14

females with SLE often have a normal rate of conception but a 1.5-3x higher rate of ________

Answer 14

miscarriage

Question 15

_______ is positive in 98% of SLE cases but low titer has a low predictive value… conversely high titer….

Answer 15

ANA

higher titer =SLE more liekly

Question 16

Tx for SLE includes NSAIDs, sun protection, exercise and smoking cessation
________ is the mainstay drug treatment -moniter for retinal toxcicity
________ is prescribed if the above drug is inneffective

Answer 16

antimalarials

corticosteroids– very bad side effects

Question 17

If SLE pt is pregnant perscribe _______/_______

Answer 17

prednisone/prednisolone

Question 18

what are the 5 critical comorbidities for SLE

Answer 18

accel atherosclerosis
Pul HTN
antiphospholipid syndrome
osteopenia/porosis
non-hodgkins lymphoma

Question 19

Name the 6 ways to prevent SLE

Answer 19

sun protection
vaccination
caution with live attenuated vaccine and immunosupp
supress reccurent UTIs
prevent osteoporosis
prevent/control obesity and CVD risk

Question 20

what’s the difference between SLE and sjogren’s dz?

Answer 20

SLE- widespread destruction

Sjo-focal/specific destruction

Question 21

what is sjogren’s syndrome?

Answer 21

autoimm do where the salivary and lacrimal glands are destroyed(exocrine glands)

Question 22

Sjogren’s is most common in _______(age) _______(gender)

Answer 22

middle-aged females(9-1)

related to other autoimmune dos, can be a 2ry complication

Question 23

_______ cells infiltrate glands in sjogren’s

Answer 23

b lymphocytes — hyperreactive

Question 24

exocrine malfxn(sjogrens’) can lead to _____, _________, and ________

Answer 24

dry mouth(xerostomia)
dry eyes(xeropthalmia)
enlargement of parotid gland

Question 25

name the 4 constitutional sx of sjogren's

Answer 25

fever, wt loss, fatigue, lymphadenopathy

Question 26

name 2 critical diagnostic criteria for sjogrens

Answer 26

histopath of salivary glands(biopsy) | reactive autobodies for RO/SS-A or LA/SS-b

Question 27

how do you treat sjogrens

Answer 27

treat sx, often with lubricants for eyes, mouth, vagina, etc also try to inc PO intake

Question 28

2 drugs used to treat sjogrens

Answer 28

NSAIDS for arthralgia | antimalarials/methotrexate (also corticosteroids for sx relief)

Question 29

what is scleroderma

Answer 29

multi-syst autoimmune do with vasculopathy and excess collagen deposits leading to fibrosis and degen skin changes and organ damage - presents with high circ autoantibodies

Question 30

name 2 early manifestations of scleroderma

Answer 30

raynaud's phenomenon and skin calcinosis

Question 31

scleroderma is 4.6:1 ___ to___(gender) with onset b/w _____and _____yo

Answer 31

f:m | 30-50

Question 32

______ damage occurs in scleroderma as a result of _____ activation and vasoconstrictors such as_____ -- this leads to ulcerations, ischemia, and gangrene of digits and skin

Answer 32

endothelial platelet activation endothelin

Question 33

what are the 2 types of scleroderma

Answer 33

diffuse -affects the organs and skin (arthralgias more prononced(crepetis present) limited cutaneous - CREST syndrome (skin of face neck and elbows; pulm htn, and raynaouds/gangrene of fingers)

Question 34

name 4 cardinal features of scleroderma

Answer 34

skin involvement(95%) Raynauds(85%) arthralgias, and esoph dysfxn tendon/bursal friction rubs often seen prior to thickening of skin

Question 35

Systemic and bilat skin changes result in scleroderma, name 5

Answer 35

``` non-pitting edema sausage fingers shiny skin(atrophy) dec facial pigment, face becomes taut beaking of nose and tight mouth loss of adipose tissue ```

Question 36

In limited cutaneous scleroderma, what does CREST stand for\?

Answer 36

``` calcinosis raynauds esophageal dysfxn sclerodactyly -tight skin over fingers telangiectasia ```

Question 37

scleroderma can result in _____ and ______ failure

Answer 37

cardiac(restrictive pericarditis) | renal

Question 38

sclerodermal dx is mainly ____; but labs reveal pos _____, and anti-______ antibody in limited type

Answer 38

ANA | anti-centromere

Question 39

treatment for scleroderma?

Answer 39

no curative tx | treat organ-specific sx

Question 40

what is kawasaki's dz?

Answer 40

acute systemic do of childhood that resembles viral exanthem

Question 41

who is more suceptible to kawasaki? name the 4 complications

Answer 41

boys 3x more likely | coronary anuerysms, MI, Pericarditis, and effusions

Question 42

whta is polymyalgia rheumatica

Answer 42

PMR is an inflam rheumatic condition with aching and a.m. stiffness in shoulders, hip girdle, neck and torso.

Question 43

_________ may be assoc with PMR in 15% of pts

Answer 43

temporal arteritis (aka giant cell arteritis) which presents with jaw pain anemia, elvated ESR, headache and visual sx

Question 44

PMR is typically seen in those +_____yo; and is assoc with the HLA-_____ type

Answer 44

50 | DR4

Question 45

In PMR pain/stiffness is most common in the _______(time), and after ______. stiffness may last more than 30 minutes

Answer 45

morning | after rest

Question 46

In PMR swelling and tendnosynovitis can be seen in apendages. Swelling is typically ____(UL or BL), ______(prox vs dist), and _____(symet vs asymmet)

Answer 46

BL proximal symmetrical

Question 47

________ are usually used to treat PMR which is dosed for 2 yrs and must be tapered. _____not freq used as 1ry tx.

Answer 47

corticosteroids | NSAIDs not used typically

Question 48

what is fibromyalgia

Answer 48

controvesial chronic pain syndrome with widespread pain and tenderness to palpation at defined soft tissue structures/points --- can be associated with mood disorders

Question 49

pain of fibromyalgia is...(3)

Answer 49

non-articular, diffuse, and poorly localized "pain all over"

Question 50

with fibromyalgia you must r/o _________and _________

Answer 50

inflamm condition and articular pathology

Question 51

where are the 7 trigger points for fibromyalgia? what constitutes a diagnosis(# and duration of pain)

Answer 51

the neck, along the lev scapulae, central ant chest, near lat epicondyle of arm, hips, lowerback/butt, medial knee need at least 11 points of pian for >3months

Question 52

tx for fibromyalgia(4)

Answer 52

NARCOTICS ARE NOT INDICATED amytriptyline - sedating for sleep SSRIs and Exercise