Test #2 autoimmune PPt-Josh Flashcards Preview

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Flashcards in Test #2 autoimmune PPt-Josh Deck (107):
1

Autoimmunity:

is a disturbance in the immunologic tolerance of ________

Self antigens

2

Autoimmunity:

occurs when the immune system reacts against self-antigens to such a degree that a persons own tissues are damaged by _________ or autoreactive ___ cells

autoantibodies

t-cells

3

Autoimmunity:

what is the most common chronic inflammatory arthritis?

rheumatoid arthritis

4

Rheumatoid Arthritis:

course is multifactoral and is characterized by periods of _____ and ____

exacerbation and remission

5

Rheumatoid Arthritis:

etiology

exact cause unk

6

Rheumatoid Arthritis:

what may precipitate it

  • impaired immunity
  • stress
  • enviromental factors

7

Rheumatoid Arthritis:

what do they propose could be the etiology

viral or bacterial infection that alters the immune system in genetically suscetible host

8

Rheumatoid Arthritis:

circulating autoantibodies called _____ ______ are detectable in 70-80% of pts w/ RA

rheumatoid factors

9

Rheumatoid Arthritis: clinical manifestations

Inflammation and destruction of the ______ joints are responsible for most of the symptoms and chronic disability associated w/ RA

synovial joints

10

Rheumatoid Arthritis: clinical manifestations

what is teh onset like

  • insidiuos onset
  • over a period of weeks to months

11

Rheumatoid Arthritis: clinical manifestations

what are the most common sites

  • hands
  • wrists
  • feet
  •  

12

Rheumatoid Arthritis: clinical manifestations

is the joint involvement symmetrical or asymmetrical

symmetrical

13

Rheumatoid Arthritis: clinical manifestations

what are the s/s associated with the inflammatory process

 

  • warmth
  • pain
  • swelling
  • weight loss
  • fatigue
  • Morning stiffness

 

14

Rheumatoid Arthritis: clinical manifestations

the joint invlvement progresses in 3 main stages what are they

  1. inflammation of synovial jointmembrane
  2. rapid division and growth of cells in joint
  3. Liberation of enzymes, which damages small blood vessels, cartilage, ligaments, tendons, and bones

15

Rheumatoid Arthritis: clinical manifestations

can it cause permanent damage to ROM

yeppers

16

Rheumatoid Arthritis: clinical manifestations

s/s of late stages

  • severe pain
  • joint instability
  • crippling deformities

17

Rheumatoid Arthritis: clinical manifestations

what can nerve entrapment cause

Carpal tunnel syndrome

18

Rheumatoid Arthritis: clinical manifestations

what synovial joint in the head can be affected

Synovitis in TMJ

19

Rheumatoid Arthritis: clinical manifestations

what affect on the cervical spine can occur

  • Atlantoaxial (C1-2) instability and subluxation

20

Rheumatoid Arthritis: clinical manifestations

what part of the larynx may be effected

cricoarytenoid joint

21

Rheumatoid Arthritis: clinical manifestations

s/s of cricoarytenoid joint arthritis

tenderness of larynx

hoarsness

pain w/ swallowing

radiatio to ear

dyspnea

Stridor

22

Rheumatoid Arthritis: clinical manifestations

w/ cricoarytenoid joint arthritis what may u see on DL

  • red swollen arytenoids

23

Rheumatoid Arthritis: CV

what are S/S

pericardial thickening

myocarditis

coronary arteritis

conduction defects

vasculitis cardiac valve fibrosis

CAD

cardiomyopathy

24

Rheumatoid Arthritis: Pulmonary

S/S

  • pleural effusions
  • pulmonary nodules
  • pulmonary fibrosis
  • Costochondral involvement
  • Restrictive lung changes

25

Rheumatoid Arthritis: Hematology

S/S

  • Anemia
  • Platelet dysfunction (ASA therapy)
  • thrombocytopenia

26

Rheumatoid Arthritis: Endocrine

s/s

Adrenal insufficiency

impaired immune system

27

Rheumatoid Arthritis: Dermatological

S/S

  • thin atrophic skin
  • rheumotoid nodules

28

Rheumatoid Arthritis: Treatments

what are some treatments?

  • NSAIDs
  • Corticosteroids
  • DMARDs
  • Biologic agents
  • Antimetabolite
  • Surgical intervention

29

Rheumatoid Arthritis: Anesthesia

best mode of anesthesia

No mode safer than the other

30

Rheumatoid Arthritis: Anesthesia

airway assessment

  • TMJ
  • Cervical spine
  • Cricoarytenoid joints

31

Rheumatoid Arthritis: Anesthesia

what to avoid w/the neck

  • flexion
  • extension
  • rotation

32

What is a chronic d/o characterized by immunologically mediated lacrimal and salvirary gland destruction

Sjogren's Syndrome

33

Sjogren's Syndrome

it presents with sicca symptoms, what the fuck is that?

  • Xeropthalmia (dry eyes)
  • Xerostomia (dry mouth)
  • Parotid gland enlargement

34

Sjogren's Syndrome

is often associated w/ what 2 other Autoimmune d/o

SLE

RA

35

what is a disease associated w/ immune dysregulation and several antibodies, basically sclerosis of the skin!

Scleroderma

36

Scleroderma:

is characterized by inflammation, vascular sclerosis, and fibrosis of the skin and _____

Viscera

37

Scleroderma:

patho

  • injury to vascular endothelial cells
  • leakage of serum proteins
  • tissue edema
  • lymphatic obstruction
  • fibrosis

38

Scleroderma:

is associated w/ what syndrome

CREST syndrome


    Calcinosis
    Raynaud's syndrome
    Esophageal dysmotility
    Sclerodactyly
    Telangiectasia

39

Scleroderma:

what is the prognosis?

 

 

Poor

40

Scleroderma:

what drugs or treatments are effective in treatment

No  (you gonna die)

41

Scleroderma:

what can accelerate the progression in 50% of pt's

Pregnancy

42

Scleroderma: S/S

skin/musculoskeletal

  • Thick skin
  • myopathy
  • weakness of muscles
  • increased plasma CK

43

Scleroderma: S/S

Nervous system

  • peripheral or cranial neuopathy
  • trigeminal neuralgia
  • Keratoconjunctivitis sicca

44

Scleroderma: S/S

cardiac/vascular

  • Dysrhythmias
  • Conduction
  • CHF
  • Pulm HTN
  • Cor pulmonale
  • Pericarditis
  • Pericardial effusion
  • Raynauds
  • oral/nasal telangiectasias

45

Scleroderma: S/S

pulmonary

  • Pulmonary fibrosis
  • Arterial hypoxemia

46

Scleroderma: S/S

renal

  • Renal artery Stenosis/ HTN
  • renal failure

47

Scleroderma: S/S

GI

  • Xerostomia
  • hypomotility of Lower esophagus & SI
  • dysphagia
  • reflux
  • malabsorption syndrome

48

Scleroderma: Anesthesia implications

how to intubate

prepare for difficult airway

possible FOI

49

Scleroderma: Anesthesia implications

what about nasal intubation/trumpets??

hmm be careful telangiectasias may bleed profusely

50

Scleroderma: Anesthesia implications

why may IV/ a-line be difficult?

Thick skin

51

Scleroderma: Anesthesia implications

whu may these individuals get hypotensive

Contracted Intravascular volumes

52

Scleroderma: Anesthesia implications

why may the need higher pressures to ventilate?

Decreased pulm compliance

53

Myasthenia Gravis:

receptor binding antibodies are present in more than 80% of Pts w. MG, the origin of the antibodies are unk, but there is a relationship with the _____ gland

Thymus

54

Myasthenia Gravis:

how many classes are there?

4 (but 2 II's) so really 5

55

Myasthenia Gravis: S/S

muscle strength may be _____ with well-rested pts, but ______ occurs promptly w/ exercise

Normal

weakness

56

Myasthenia Gravis: S/S

what is the most common initial complaint?

  • ptosis
  • diplopia

57

Myasthenia Gravis: S/S

weakness of the pharyngeal and laryngeal muscles cause what complications?

  • dysphagia
  • dysarthria
  • difficulty w/ saliva
  • high risk of aspiration

58

Myasthenia Gravis: S/S

arm, leg, or trunck weakness is usually symetrical or asymmetrical?

Asymmetrical

59

Myasthenia Gravis: S/S

does muscle atrophy occur?

Nope

60

Myasthenia Gravis: S/S

myocarditis can result in ____, ____. or ____

  • a-fib
  • heart block
  • cardiomyopathy

61

Myasthenia Gravis: S/S

what can exacerbate it

  • infection
  • electrolyte abnormalities
  • pregnancy
  • emotional stress
  • surgery

62

Myasthenia Gravis: S/S

antibiotics especially _______ can aggravate muscle weakness

aminoglycosides

63

Myasthenia Gravis: Treatments

what are 5 main treatments

  1. Anticholinesterase drugs
  2. Immunosupressive therapy
  3. Plasmapheresis
  4. thymectomy
  5. IV immunoglobulin

64

Myasthenia Gravis: Treatments

what is teh 1st line of treatment?

Anticholinesterase drugs

65

Myasthenia Gravis: Treatments

what is the main anticholinesterase drug used

pyridostigmine

66

Myasthenia Gravis: Treatments

what is used for immunosuppresive theapy

  • corticosteroids
  • azathioprine
  • cyclosporine
  • mycophenolate

67

Myasthenia Gravis: Treatments

when is plasmapheresis used

myastenic crisis

prep for thymectomy

68

Myasthenia Gravis: Treatments

what is teh point of plasmapheresis

Removes antibodies from circulation

69

Myasthenia Gravis: Treatments

thymectomy- what is the incision sites

median sternotomy

Medianstinoscopy

70

Myasthenia Gravis: Treatments

what levels are often decreased following thymectomy

ACh

71

Myasthenia Gravis: Treatments

prior to thymectomy plasmapheresis is indcated if VC is < what?

< 2 L

72

Myasthenia Gravis: Treatments

IV immunoglobulin therapy is reserved for when

acute exacerbations and myasthenic crisis

73

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one is from underdosing of anticholinesterase

MC

74

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

whch one os from overdosing

CC

75

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one has S/S of extreme weakness plus muscarinic SE of abd cramping, diarrhea, salivation, bradycardia, miosis?

CC

76

 

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one has S/S of sever exacerbation of MG symptoms

MC

77

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one has S/S of extreme quadriparesis or quadraplegia, resp insuficiency, extremly difficul swallowing, danger of resp arrest

MC

78

 

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

which one occurs 3-4 hours after taking medication

MC

79

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

CC occurs how long after giving meds

30-60 min

80

Myasthenia Gravis: Myasthenic crisis VS Cholinergic Crisis

what is the test for CC? and what will you see?

tensilon test

- accenuated muscle weakness after administration of edrophonium

81

Myasthenia Gravis: Anesthesia implications

what does teh data suggest about cont's periop use of pyridostigmine

unclear

82

Myasthenia Gravis: Anesthesia implications

what type of anesthesia is reccomended if poss

regional

83

Myasthenia Gravis: Anesthesia implications

what about depolarizing MR (SCh)

  • response unpredictable
  • Untreated pt's 2-3x's more resistant to SCh
  • Treated pt's- normal or prolonged response to SCh

84

Myasthenia Gravis: Anesthesia implications

Non-Depolarizing MR

  • typically all pt's have increased sensitivity
  • require decreased doses
  • wil have prolonged recovery
  • TOF essential

85

Myasthenia Gravis: Anesthesia implications

reversal should be performes cautiously why?

  • can precipitate cholnergic crisis

86

Myasthenia Gravis: Anesthesia implications

what is the best way to intubate these pt's

VAAs

-- b/c of intrinsic muscle weakness, intubation can be accomplished w/ VAA alone

87

what d/o resembles MG and is sometimes called Myasthenic syndrome

Eaton-Lambert syndrome

88

Eaton-Lambert Syndrome:

is associated w/ SCC of what organ

 

lung

89

Eaton-Lambert Syndrome:

S/S is proximal limb weakness,muscle pain, decreased or absent reflexes. But what is teh main difference from MG

EXERCISE IMPROVES STRENGTH

90

Eaton-Lambert Syndrome:

what is teh response to anticholinesterases

Poor

91

Eaton-Lambert Syndrome:

is it sensitive to NDMR DMR or both?

Both

92

what d/o is from thyrotoxicosis (a state of thyroid hormone excess)?

Graves' Disease

93

Graves' Disease

is caused by thyroid-stimulating antibodies that bind to TSH receptors in the thyroid and you get an increased level of circulating what?

T4 and T3

94

Graves' Disease

is the thyroid usually enlarged?

yes 2-3xs

95

Graves' Disease

s/s?

  • Increased BP
  • Increased CO
  • Increased HR
  • MVP
  • A-fib

96

Graves' Disease

diagnosis is based off what lab interpertations w/ TSH, T3, T4

TSH low

T4 high

T3 high

97

Graves' Disease

is a disease of thyroid hormone excess or deficit?

excess

98

Graves' Disease

what is a funny s/s of it

Big ass bug eyes

OPTHALMOPATHY

99

Graves' Disease

what is a d/o that can arise form this d/o

thyroid storm

100

Graves' Disease

what is Thyroid storms s/s

  • Tachycardia
  • Hyperthermia
  • hTN
  • A-fib
  • sweating
  • Tremor
  • Vomiting
  • weakness
  • agitation
  • shock
  • CHF
  • Met acidosis

101

Graves' Disease

thyroid storm in an emergency!!!! what is its treatment

  • Antithyroid meds
  • Beta blockers
  • Potassium iodide
  • Hydrate w/ glucose containing solutions
  • Tylenol
  • O2

102

what d/o is the most common form of HYPOTHYROIDISM

Hasimoto's thyroiditis

103

Hasimoto's thyroiditis

is characterized by autoimmune mediated destruction of the ____ gland

Thyroid

(that was a gimme)

104

Hasimoto's thyroiditis

w/ this the formation of what is common?

Goiter

105

Hasimoto's thyroiditis

what happens to metabolim

sloooooooooowwwwsss

106

Hasimoto's thyroiditis

s/s

  • Dry skin
  • cold intolerance
  • paresthesias
  • slowedmental fxn
  • ataxia
  • puffy face (myxedema) aka fat mexican
  • constipation

107

thats all folks

sweet