Flashcards in Quiz 6 - MS I Deck (77)
What parts of the body do MS disorders arise?
muscles, joints, tendons, ligaments and nerves
What are the three actions of synovial fluid?
reduction of friction via lubrication
shock absorption - becomes VISCOUS under pressure**
Nutrient and waste transportation - provides O2 and allows the movement of CO2 out
Any acute mono arthritis (involving one joint) is ______ until proven otherwise
what does pauciarticular mean?
MS disease involving 2-4 joints
meaning polyarticular is 5+ joints.
what is the name for "swelling of a tendon sheath causing 'triggering'"
when you have synovitis with a large effusion of non purulent fluid you have..
what are the 8 carpal bones of the hand
Some Lovers Try Positions That They Can't Handle
when discussing the onset and progression of disease with MS patients - what is important?
Speed of onset!
What is one of the most important questions to ask specifically to MS patients?
Do you have morning stiffness and how long does it last?
This is important because it helps differentiate functional abnormalities vs pathology.
- AI inflammatory arthridities last >1 hr.
Does pain occur at rest?
Travel? Where and when?
What joints, where, swelling?
What patterns are seen on the hand that should help differentiate specific AIs?
OA - DIPS, PIPs, wrist (rarely MCP)
RA - PIPs, MCPs, writest (rarely DIPs)
PA - nails, asymm, sausage fingers (MCP, PIP and DIP - all affected)
Scleroderma - skin is thickened, flexion contractors, Raynaud's is common
Sarcoidosis - DIP, PID, MCP all affected
what does ESR assess?
indicates systemic inflammatory response.
can increase in: cancer, pregnancy, infection
what does CRP assess?
acute phase reactant - more sensitive measure of disease activity and progression
*** BEST OBJECTIVE MEASURE of DISEASE ACTIVITY in RA, even though it's non-specific
what lab value increases for gout - but is associated with these other conditions
serum uric acid
also increases with low dose
ASA, Diuretics, other drugs and alcohol
what does Rheumatoid Factor tell us?
RF is antibodies directed agains the Fc portion of an IgG antibody.
May be representative of previous microbe interaction with antibodies
therefore indicated CHRONIC INFECTION (perhaps asx)
85% positive when disease is established.
NOT SPECIFIC FOR RA
what is anti-CCP and what is this lab value good for?
anti-cyclic citrullinated peptide antibody
> 90% SPECIFIC FOR RA!!!
as sensitve, but more specific than IgM RF.
May be present prior to RA symptoms.
Sjogren's and TB can also show positives in this one
can predict increased risk for erosive disease
HLA-B27 is associated with which 3 conditions?
reactive arthritis (RA)
psoriatic arthritis (PA)
Which vitamin is definitely associated with many MS disease?
Vitamin D deficiency
When there is any suspicion of septic arthritis (acute monoarthritis), immediate what must be carried out?
immediate aspiration of synovial fluid must be carried out
What is the broad differential to know for most any autoimmune disorder?
What are common etiologies of Rheumatoid Arthritis? What is the clinical picture? What joints are commonly affected? What labs would you order?
What are MMPs and why are they important?
Matrix metalloproeinases (MMPs)
implicated in many diseases of MS
what are the steps in the general approach to the MS patient?
first, listen. second, listen.
provide a differential
make a plan
Recent GU/GI infection suggests which AI?
Bloody Diarrhea suggests?
When you have an individual present with Photosensitive rash, seizures, hallucinations, renal disease, what is suggested?
if patient presents with painful red eye, what does this suggest?
Dry as a desert.. Dry eyes, mouth, vagina..
Which condition present swift severe morning stiffness, amaurosis fugal and jaw claudation
Rash in the gluteal fold suggests which condition