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Flashcards in WEEK 5 Deck (59)
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1
Q

What does Infectious Spondylitis present as?

A

Deep back pain, and insomnia due to pain

2
Q

What does Infectious Spondylitis have a history of?

A

Infection, intravenous drug use, diabetes

3
Q

How will the patient present with Infectious Spondylitis ?

A

Antalgic, and Febrile

4
Q

What is the cause of Infectious Spondylitis?

A

Infection of disc and vertebral body (adults)

Discitis in (children)

5
Q

Pyogenic Infectious Spondylitis =

A

Staph, strep, gram negative

6
Q

Nonpyogenic Infectious Spondylitis =

A

TB, Brucella, fungal infection

7
Q

What is the protrusion of the spine called with infectious spondylitis?

A

Gibbs deformity

8
Q

With IS, pain is worsened by _____

A

Compression and percussion

9
Q

What are lab findings for IS?

A

Elevated ESR, increase leukocytes

10
Q

Mantoux test for TB is for what disease?

A

Infectious Spondylitis

11
Q

Radiographic findings take _____ for IS

A

3-4 weeks

12
Q

What will you see with AS?

A

No rheumatoid factor or nodules

13
Q

Is AS more common in males or females?

A

Males 5:1, 15-35 y.o.

14
Q

What is primary complaint with AS?

A

Primarily complaint is LBP, aching, stiffness, especially after rest

15
Q

Is AS aggravated by physical activity?

A

NO

16
Q

What is the onset of AS?

A

Insidious episodic onset

17
Q

What does 75% of AS patients have?

A

Some form of sciatica (unilateral, alternating, or bilateral) usually occurring during early phases

18
Q

What can AS be associated with?

A

Iritis

19
Q

What is (+) in more than 90% of patients?

A

HLA B27

20
Q

What is mildly elevated in AS?

A

ESR & C-Reactive proteins

21
Q

What are the first 3 findings of AS?

A
  • Paraspinal spasm
  • Flattening of lumbar lordosis
  • Painful palpating/percussion of SI joint
22
Q

What are the last 3 findings of AS?

A
  • Eventful flattening of lower thoracic spine
  • Restriction of C-spine
  • X rays: Initially bilateral sacroilitis, then enthesopathy at thoracolumbar spine which descends & ascends from there
23
Q

What does Reactive arthritis (Reiter’s Syndrome) present as?

A

Low back pain after the can’t see, pee, dance with me triad

24
Q

What is the cause of Reactive Arthritis (Reiter’s Syndrome)?

A
  • Seronegative arthropathy post infection

- HLA-B27 marker; more prone to reactive arthritis

25
Q

What is the evaluation of Reactive Arthritis (Reiter’s) ?

A
  • Arthritis affecting knees, ankles unilaterally
26
Q

What is MC place for Reiter’s ?

A

SI joint

27
Q

What is Multiple Myeloma a cancer of?

A

The plasma cell, incurable but treatable

28
Q

What is the estimated frequency of Multiple Myeloma?

A

5-6 new cases per 100,000 per year

29
Q

In the USA _______ new cases are expected to be diagnosed in ______

A

15,980 & year 2005*

30
Q

How many people in the US are living with Multiple Myeloma?

A

50,000 people

31
Q

What is Multiple Myeloma aka?

A

“Myeloma” or “Plasma cell Myeloma”

32
Q

What is multiple Myeloma the cancer of?

A

The plasma cell, part of the immune system that produces immunoglobulins (antibodies)

33
Q

What are you gonna see in the blood with Multiple Myeloma?

A

Excessive # of abnormal plasma cells in the bone marrow and overproduction of intact monoclonal immunoglobulin (IgG, IgA, IgD, or IgE) or Bence Jones protein

34
Q

What is the MC monoclonal spike seen in the IG profile of Multiple Myeloma?

A

IgG (55%)

35
Q

What is the 2nd MC IG profile found in multiple myeloma?

A

IgA

36
Q

Bence Jones proteins are ____

A

Free monoclonal k and alpha light chains

37
Q

40% of patients with IgG/IgA will express ______ in their urine?

A

Bence Jones proteins

38
Q

What are the clinical manifestations of MM?

A

Hypercalcemia, anemia, renal damage, increased susceptibility to bacterial infection, and impaired production of normal immunoglobulin are common

39
Q

What are clinical manifestations also characterized by?

A

Diffuse osteoporosis, usually in the pelvis, spine, ribs, and skull

40
Q

What is the pathophysiology of MM?

A

Cells destined to become immune cells, like all blood cells, arise in the bone marrow from stem
cells (see figure). Some stem cells develop into the small white blood cells called lymphocytes.
The two major classes of lymphocytes are B cells (B lymphocytes) and T cells (T lymphocytes).
Plasma cells develop from B cells.

41
Q

In MM, the B cell is ______

A

damaged and gives rise to too many
plasma cells (myeloma cells). These malignant cells do not function
properly and their increased numbers produce excess
immunoglobulins of a single type that the body does not need along
with reduced amounts of normal immunoglobulins.

42
Q

Myeloma plasma cells have:

A

Specific adhesion molecules on their surface allowing them to target bone marrow where they attach to structural cells called stromal cells

43
Q

Cytokines are produced by:

A

Both myeloma cells and stromal cells

44
Q

What do cytokines stimulate?

A

The growth of myeloma cells and inhibit (prevent) natural cell death (apoptosis), leading to proliferation of myeloma cells and ultimately resulting in bone destruction

45
Q

Myeloma cells produce growth factors that promote:

A

Angiogenesis, the creation of new blood vessels. These new blood vessels provide the oxygen and nutrients that promote tumor growth

46
Q

How does Angiogenesis affect MM?

A

It encourages reproduction of myeloma cells, which increase in # and begin to infiltrate the bone marrow, eventually compromising more than 10% of cells present, which is 2 times the normal percentage of normal plasma cells

47
Q

Mature myeloma cells fail to activate:

A

The immune system and may produce substances that decrease the body’s normal immune response to a foreign body

48
Q

Levels of functional IG are _____ in individuals with myeloma?

A

Depressed

49
Q

What do Bence Jones proteins do?

A

They may deposit in the kidney and clog tiny tubules, this can cause kidney changes and damage

50
Q

What is the test that detects the exact amount of immunoglobulins in urine and blood?

A

Immunoelectrophoresis

51
Q

What do you use for Bence Jones protein detection?

A

Acidic urine sample 40-60 degrees Celsius

52
Q

What is the 2nd most prevalent blood cancer?

A

Multiple myeloma after #1 non-Hodgkin’s Lymphoma

53
Q

What does Multiple Myeloma represent?

A

Approximately 1% of all cancers and 2% of all cancer deaths

54
Q

Avg death of MM?

A

68 years

55
Q

MM is more common in men or women?

A

MEN

56
Q

What race has the highest prevelance of MM?

A

Blacks and native Pacific Islanders

Asians have lowest

57
Q

What is the Prostate, Mets Carcinoma called?

A

Batson’s Plexus

58
Q

Mets Carcinoma Lytic:

A

Increase serum calcium

59
Q

Mets Carcinoma Blastic:

A

Alkaline Phosphatase