Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
|
Cardinal signs of rheumatology
|
1. heat in joint
2. redness of joint 3. swelling 4. paint 5. loss of function 6. stiffness |
|
|
11 S's of RA
|
1. synovitis
2. swelling 3. sex (F>M) 4. synovial effusions 5. stiffness 6. symmetry 7. serology 8. sed rate 9. subQ ndules at various joint junctions 10. systemic involvement 11. spinal involvement |
|
|
psoriatic synovitis
|
erythema
soft tissue swelling sausage digits nail changes -- not severe psoriasis, but very crippling |
|
|
gout
|
hyperurecemia
podagra = foot/ankle tophaceous = chronic |
|
|
pustular synovitis
|
- infection of synovial space
- joint pain - vesicles & pustules - can spread to become bactermia & septicemia - gonococcal dermatitis arthritis syndrome |
|
|
septic olecranon bursitis
|
- not in joint; in bursa
- mosquito bite that is persistently scratched can be contaminated w/ Staphylococcus - low glucose in joint fluid (due to bacT in bursa eating up sugar in joint fluid) indx bacT infection - high sed rate indx of sev inflamm infxn |
|
|
septic prepatellar bursitis
|
- inflamm of pre-patellar bursa
- needle placement during tap important - wrong space = septic arthritis |
|
|
synovitis of DJD
|
bony enlargement
Bouchard's nodes Heberden's nodes |
|
|
Bouchard's nodes
|
PIP
|
|
|
Heberden's nodes
|
DIP
|
|
|
sources of rheumatic symptoms
|
soft tissue disorders:
- outside joint - bursitis/tendinitis arthritis: - w/in joint - non-inflamm vs. inflamm bone disorders: - traumatic/ metabolic ** all 3 can co-exist (having one doesn't r/o the rest) |
|
|
features of arthritis (characteristics)
|
inflammation, to varying degrees
all motion causes pain pain generalized around joint decreased ROM |
|
|
inflamm vs/ non-inflamm arthritis
|
non-inflamm: OA
inflamm: RA, SLE, psoriatic arthritis |
|
|
HPE for pts w/ arthritis
|
- duration of pain
- trauma - possible sepsis - rusty nail - accident - STDs - ROS (diabetes, thyroid, fam hx) |
|
|
clinical exam
|
examine:
- bursa - tendon - alignment - symmetry - fingers/palm (nodes, thumb opposition, fist formation) - patella (fluid in bursa) - ankle (alignment) - synovitis - calcaneous - calcaneal bursa - achilles bursa - swelling - gout - OA - metatarsa fracture - stress fracture - ROM |
|
|
Acute phase reactants
- ESR - C-RP (c-reactive protein) |
- ESR = measures rate at which RBCs settle to bottom of test tube (inc mean inflammation; non-specific)
- C-RP = indicates tissue damage in body or severe inflamm |
|
|
RF (rheumatoid factor)
|
85% of adults w/ RA have +RF
children w/ juvenile RA are -RF |
|
|
ANA patterns of disease:
diseases a/w ANA |
- SLE
- progressive systemic sclerosis - Sjogren's syndrome - Felty's syndrome - Juvenile arthritis |
|
|
nL sed rates in M and F
1. 0-50 2. 51-85 3. >85 |
0-50: M <15mm/h; F <20mm/h
51-85: M <20mm/h; F <30mm/h >85: M <30mm/h; F <42mm/h |
|
|
routine lab studies
|
CBC - different anemias point to different disorders; meds can cause anemia
Chemistries - CU GLUE CPK, uric acid Glucose, LFT, urinalysis, electrolytes |
|
|
special arthritis tests
|
- complement levels
- CHLA testing - ANCA - cryoglobulins - lyme titers |
|
|
complement levels
|
- CH50; C3/C4
--if pt using up complement, they are being subjected to immune complexes --pt has special Ab floating in blood --these form complexes that deplete C3, C4, CH50 |
|
|
HLA testing
|
B27; D locus allelles
-- some types of HLA indx genetic predisposition to arthropathies |
|
|
ANCA
|
dx of vasculitis
|
|
|
2 main types of dx procedures
|
- arthrocentesis
- arthroscopy |
|
|
arthrocentesis
- in knee - naked eye (looking for what) |
- under patella at medial aspect
- determine turbidity, viscosity & color |
|
|
blood in fluid (hemarthrosis) can indicate
|
- trauma
- bleedig disorders - Willonodular synovitis - pyrophosphate arthropathy - charcot joint - resolving infxn - contaminated sample |
|
|
classification of synovial effusions:
type; features; leukocytes |
1. nL; clear/colorless/viscous; <200
2. non-inflamm; clear/yellow/viscous; 200-2,000 3. inflamm; cloudy/yellow/watery/low gluc; 2000-100000 ***septic; purulent/v low gluc; >80000 |
|
|
types of synovial effusions:
group I |
OA
early RA trauma osteochorditis dissecan osteonecrosis sickle cell chronic/subsiding crystal synovitis lupus vasculitis scleroderma amylodosis hypothyroidism |
|
|
types of synovial effusions:
group II |
RA
Reiter's acute crystal synovitis psoriatic arthritis arthritis of IBD ankylosing spondylitis viral arthritis rheumatic fever juvenile chronic arthritis behcat's syndrome infection |
|
|
types of synovial effusions:
group III |
bacteria
fungal mycobacterial acute crystal synovitis |
|
|
crystals found in synovial fluid:
1. monosodium urate monohydrate 2. calcium pyrophosphate dihydrate 3. basic calcium phosphate 4. calcium oxalate 5. lipid 6. cholesterol |
1. acute/tophaceous gout; asymptomatic
2. acute pseudogout; destructive arthropathy; asymptomatic 3. acute calcific periarthritis; acute arthritis; destructive arthropathy 4. acute/subacute arthritis; asymptomatic 5. acute arthritis 6. asymptomatic |
|
|
arthroscopy
|
- biospy must be done carefully
- ideal in most functional joints |
|
|
key to diagnosis is clinical suspicion (ex of multiple systems involved)
|
- rash
- anemia - thrombocytosis - diastolic HTN - testicular p - ischemia - proteinuria |
|
|
symptoms and signs are varied and non-specific (ex of systemic)
|
- fevers
- malaise - weight loss |
|
|
symptoms per vessel size:
- large - medium - small |
- pulseless, blindness, CVA, syncope
- CAD, renal atery, CVA, mononeuritis (wrist/foot drop) - palpable purpura, Raynaud's/ gangrene |
|
|
vasculitis classifications:
large |
Takayasu
Temporal arteritis |
|
|
vasculitis classifications:
medium |
polyarteritis nodosa
|
|
|
vasculitis classifications:
small (also MC) |
- churg-strauss syndrome
- wegener's granulomatosis - Henoch-schonlein purpura - hypersensitivity/ cutaneous vasculitis - CVD associated vasculitis - Goodpasture's syndrome - Behcet disease |
