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28 Cards in this Set
- Front
- Back
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85. Note: 20% of pts w/Scleroderma have Sjögren’s
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85. Note: 20% of pts w/Scleroderma have Sjögren’s
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86. What should you search for in a pt w/Sjogren’s?!?
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a. An occult lymphoma (Look for lymphadenopathy and hepatosplenomegaly)!
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87. Sjogren’s syndrome pathophys?
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a. Sjogren’s is an autoimmune disease most commonly seen in women
b. Lymphocytes infiltrate and destroy the lacrimal and salivary glands. c. There is both primary and secondary Sjogren’s. |
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88. What else can be affected by Sjogren’s syndrome?
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a. A multiorgan disease:
1. Skin 2. Lungs 3. Thyroid 4. Vessels 5. Liver |
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89. Primary Sjogren’s syndrome?
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a. Dry eyes and dry mouth
b. Along w/lymphocytic infiltration of the minor salivary glands (on hist) c. Pts do not have another rheumatologic disease |
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90. Secondary Sjogren’s syndrome?
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a. Dry eyes and mouth along w/a connective tissue disease (RA, Systemic Sclerosis, SLE, polymyositis)
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91. Risk of what disease is associated w/ Sjogren’s syndrome?
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a. Non-Hodgkin’s lymphoma.
b. Malignancy is the most common cause of death. |
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92. Clinical features of Sjogren’s syndrome?
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a. Dry eyes- Burning, redness, Blurred vision
b. Dry mouth c. Arthralgias, arthritis, fatigue d. Many Extraglandular manifestations (more common in primary disease), such as chronic arthritis, interstitial nephritis, and vasculitis. |
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93. Lab values in diagnosis of Sjogren’s syndrome?
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a. ANAs are present in 95% of pts
b. RF is present in 50-75% of pts w/2° disease. c. Ro (SS-A) in 55% d. La (SS-B) in 40%. e. Nonspecific findings: 1. ↑’d ESR 2. Normocytic normochromic anaemia 3. Leukopenia |
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94. Tx of Sjogren’s syndrome?
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a. Pilocarpine (enhances secretions)
b. Artificial tears for dry eyes c. Good oral hygiene d. NSAIDs, steroids for arthralgias, arthritis e. Pts w/2° Sjogren’s syndrome- Therapy for connective tissue disease. |
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95. What are pts w/antibodies to Ro (SS-A) at increased risk of in their offspring?
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a. Having a child w/neonatal SLE (w/congenital heart block).
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96. Mixed Connective Tissue Disease?
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a. Mixed Connective Tissue Disease is an “overlap” syndrome with clinical features similar to those of SLE, RA, Systemic Sclerosis, and polymyositis.
b. Finding consistent with each of these diseases do not necessarily occur simultaneously. c. It usually takes some time for pattern to be identified and the diagnosis of mixed connective tissue disease the made. |
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97. Clinical features of Mixed Connective Tissue Disease?
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1. Pulmonary involvement
2. esophageal dysfunction 3. polyarthritis 4. sclerodactyly 5. cutaneous manifestations 6. myopathy 7. Raynaud's phenomenon |
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98. What is a key laboratory finding in Mixed Connective Tissue Disease?
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a. Anti-U1-RNP Abs.
b. High ANA and RF may be present. |
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99. Treatment of Mixed Connective Tissue Disease?
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a. Varies according to which specific disease predominates.
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100. What are patients with antibodies to Ro (SS-A) at increased risk of having a child with?
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a. Neonatal SLE (with congenital heart block)
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101. Clinical Features of Rheumatoid arthritis?
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a. Systemic disease w/many extra-articular manifestations.
b. Usual age of onset is 20-40 yrs. c. F:M 3:1 d. Disease severity is variable- Some pts have moderate restrictions and are capable of performing ADLs, whereas others are confined to a wheelchair or bed. |
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102. Aetiology of Rheumatoid arthritis?
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a. Uncertain.
b. May be caused by an infection or a series of infections (most likely viral), but genetic predisposition is necessary. |
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103. Symptoms of Rheumatoid arthritis?
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a. Symmetrical inflammatory polyarthritis (symmetrical joint swelling is the most common sign) -it can involve every joint in the body EXCEPT THE DIP JOINTS.
b. Pain on motion of joints/tenderness of joints c. Constitutional symptoms can be present. d. Cervical spine involvement is common at C1-C2 (subluxation and instability). e. Cardiac involvement f. pulmonary involvement g. ocular involvement h. soft tissue swelling (rather than bony enlargement) i. dry mucous membranes (Sjogren's xerostomia) j. Subcutaneus rheumatoid nodules over extensor surfaces- may also occur in visceral structures! |
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104. What joints are commonly involved with Rheumatoid arthritis?
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a. Joints of the hand (PIP, MCP) and wrists!!!
b. Knees, ankles, elbows, hips, and shoulders |
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105. What are the characteristics and deformities of Rheumatoid arthritis?
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a. Ulnar deviation of the MCP joints
b. Boutonniere deformities of the PIP joints (PIP flexed, PIP hyperextended) c. Swan neck contractures (MCP flexed, PIP hyperextended, PIP flexed) |
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106. Constitutional symptoms of Rheumatoid arthritis?
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a. Morning stiffness!!!!! Present in all patients- improves as the day progresses
b. low-grade fever, weight loss c. Fatigue can be prominent because this is a systemic disease |
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107. Where is cervical spine involvement common in Rheumatoid arthritis?
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a. At C1 – C2! (Subluxation and instability)
b. it is less common lower cervical spine |
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108. What is the risk of cervical spine instability in patients with Rheumatoid arthritis?
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a. Instability of the cervical spine is a potentially life-threatening competition of RA.
b. Most patients do NOT have neurologic involvement-but if they do, it can be progressive and fatal if not treated surgically |
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109. How common is cervical spine involvement in Rheumatoid arthritis?
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a. 30 to 40% of patients!!
b. All patients with Rheumatoid arthritis should have cervical spine radiographs before undergoing any surgery (due to the risk of neurologic injury during intubation). |
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110. Cutaneous involvement with Rheumatoid arthritis?
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a. Skin becomes thin and atrophic and bruises easily.
b. Vasculitic changes/ulcerations involving fingers nail folds. c. Subcutaneous Rheumatoid nodules (elbow, sacrum, occiput)- Pathognomonic for RA. |
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111. How may cardiac involvement present in Rheumatoid arthritis?
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a. Pericarditis (40% of pts)
b. Pericardial effusions c. Conduction abnormalities. d. Valvular incompetence e. Rheumatic nodules in heart. |
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112. Significance of rheumatic nodules in heart?
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a. Can lead to conduction disturbances (heart block and BBB)
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