Term
What is Sjogren's syndrome? |
|
Definition
autoimmune disorder in which immune cells attack and destroy exocrine glands affecting the glands that form saliva and tears |
|
|
Term
Who is more commonly affected by Sjogren's syndrome, males or females? |
|
Definition
|
|
Term
What is the average age of diagnosis for Sjogren's syndrome? |
|
Definition
|
|
Term
What is the 2nt most common autoimmune rhematological disease? |
|
Definition
|
|
Term
What does Sjogren's syndrome cause? |
|
Definition
|
|
Term
What test is used to diagnose Sjogren's syndrome? |
|
Definition
Schirmer test
measures the amount of tear production over 5 minutes with a filter strip that is held in the lower eye lid and then the moisture is measured with a ruler
producing less than 5 mm is indicative of Sjogren's |
|
|
Term
What imaging modalities can be used in Sjogren's syndrome to detect calculi and other duct problems? |
|
Definition
ultrasound radiographs with contrast dye (stenson duct) |
|
|
Term
Who is scleroderma more common in, men or women? |
|
Definition
|
|
Term
What is the most commonly diagnosed age group for scerloderma? |
|
Definition
|
|
Term
|
Definition
systemic autoimmune disease characterized by fibrosis, vascular alteration, and autoantibodies
kills the arterioles of the epithelial cells and they are replaced by collagen and other fibrotic material |
|
|
Term
What do 90% of patients with scleroderma present with? |
|
Definition
|
|
Term
What is scleroderma associated with? |
|
Definition
CREST
calcinosis Raynaud's phenomenon esophageal dysfunction sclerodactyly telangiectasia |
|
|
Term
What internal organs are most commonly affected by scleroderma? |
|
Definition
kidneys heart lungs esophagus |
|
|
Term
Is there a cure for scleroderma? |
|
Definition
no (only treat organ systems it affects) |
|
|
Term
What complications cause most of the deaths due to scleroderma? |
|
Definition
renal and pulmonary complications |
|
|
Term
|
Definition
abnormal collection of inflammatory cells form as nodules in many organs of the body |
|
|
Term
What do the granulomas associated with sarcoidosis most often affect? |
|
Definition
lungs and lymph nodes (but can affect any organ) |
|
|
Term
Sarcoidosis is usually ___________. |
|
Definition
|
|
Term
What condition can cause lung scarring and infection which can lead to respiratory failure and death? |
|
Definition
|
|
Term
What condition has a higher prevalence in non-smokers? |
|
Definition
|
|
Term
What condition is a diagnosis of exclusion? |
|
Definition
|
|
Term
What is the treatment for sarcoidosis if treatment is needed? |
|
Definition
corticosteroids DMARDs cyclophasphomide |
|
|
Term
What is first line treatment for sarcoidosis? |
|
Definition
corticosteroids (azathiopine, methotrexat also used) |
|
|
Term
What annual exams need to be done in a patient with sarcoidosis? |
|
Definition
EKG ocular evaluation LFTs serum calcium 24 hour urine calcium thyroid evaluations |
|
|
Term
Most patients with sarcoidosis are cured in ___ years. |
|
Definition
|
|
Term
What is Reiter's syndrome? |
|
Definition
reactive arthritis in response to an infection elsewhere in the body
seronegative spondyloarthropathy |
|
|
Term
What are the only autoimmune conditions discussed that are more common in men than women? |
|
Definition
Reiter's syndrome polyarteritis nodosa |
|
|
Term
What gene is present in 75% of patients with Reiter's syndrome? |
|
Definition
|
|
Term
What is the triad of symptoms associated with Reiter's syndrome? |
|
Definition
-inflammatory arthritis (usually polyarticular and asymmetric) -inflammation of the eye (conjunctivitis, uveitis) -urethritis/cervicitis |
|
|
Term
What types of infections are usually the cause of Reiter's syndrome? |
|
Definition
genitourinary or gastrointestinal |
|
|
Term
What is the most common trigger for Reiter's syndrome? |
|
Definition
chlamydia
also gonorrhea, salmonella, shigella, and camphylobacter |
|
|
Term
If you suspect Reiter's syndrome, what must you get a good history on? |
|
Definition
|
|
Term
What is keratoderma blenorrhagica and what condition is it associated with? |
|
Definition
Reiter's syndrome
visco-pustular waxy lesion with a yellow-brown color
less frequent on palms |
|
|
Term
What must you think about in a patient who presents with balanitis (inflammation of the glans penis)? |
|
Definition
|
|
Term
What type of discharge may be present in a patient with Reiter's syndrome? |
|
Definition
fowl smelling or purulent |
|
|
Term
How long does Reiter's syndrome last? |
|
Definition
|
|
Term
What is the treatment for Reiter's syndrome? |
|
Definition
treat underlying organism NSAIDs methotrexate (reduce joint destruction) |
|
|
Term
|
Definition
connective tissue disease related to polymyositis that is characterized by inflammation of the muscles and skin |
|
|
Term
What do many patients have a history of with dermatomyositis? |
|
Definition
|
|
Term
How does polymyositis present? |
|
Definition
bilateral proximal muscle weakness, usually in the upper legs
first c/o fatigue with walking
also occurs in the upper arms |
|
|
Term
What are patients with dermatomyositis and polymyositis at risk for? |
|
Definition
interstitial lung disease |
|
|
Term
How is dermatomyositis and polymyositis diagnosed? |
|
Definition
increased creatine kinase (not specific) muscle biopsy |
|
|
Term
What might x-rays show in a patient with dermatomyositis and polymyositis? |
|
Definition
calcifications in the muscles |
|
|
Term
What antibodies are present in >65% of diagnosed patients with dermatomyositis and polymyositis if there is also lung disease present? |
|
Definition
|
|
Term
What is the treatment for dermatomyositis and polymyositis? |
|
Definition
high dose corticosteroids strength usually improves in 4-6 weeks
if unresponsive, then immunosuppressants |
|
|
Term
What is death associated with dermatomyositis and polymyositis usually due to? |
|
Definition
|
|
Term
What is polymyalgia rheumatica? |
|
Definition
inflammatory disorder that present as pain and stiffness in the hips and shoulders |
|
|
Term
How does polymyalgia rheumatica present? |
|
Definition
quickly over a few days
symptoms worse with increased inactivity or first thing in the morning
low grade fever, depression, fatigue, unintentional weight loss, loss of appetitie |
|
|
Term
What condition is associated with giant cell arteritis? |
|
Definition
|
|
Term
What condition can cause headache, jaw pain, scalp tenderness, and vision impairment? |
|
Definition
|
|
Term
Patients with what condition may find it hard to do simple activities like put on a coat or tend to simple activities of daily living? |
|
Definition
polymyalgia rheumatica
hygiene may be poor |
|
|
Term
What is the treatment for polymyalgia rheumatica? |
|
Definition
low dose corticosteroids
pt. usually improves in a few days (if not, think about another diagnosis) |
|
|
Term
How is polymyalgia rheumatica diagnosed? |
|
Definition
normal creatine kinase level negative RF negative muscle biopsy normochromic normocytic anemia (50%) elevated ESR mild elevated LFTs nonspecific mild synovitis |
|
|
Term
|
Definition
group of disorders characterized by inflammatory destruction of blood vessels |
|
|
Term
What vessels are involved in vasculitis? |
|
Definition
|
|
Term
What conditions are consider vasculitis? |
|
Definition
Buerger's disease Kawasaki disease polyarteritis nodosa Behcet's syndrome Henoch-Schonlen purpura |
|
|
Term
What is another name for Buerger's disease? |
|
Definition
thromboangiitis obliterans |
|
|
Term
What vessels are obstructed in Buerger's disease? |
|
Definition
|
|
Term
What demographic is primarily affected by Buerger's disease? |
|
Definition
male smokers between 20 and 40 |
|
|
Term
What are the signs and symptoms of Buerger's disease? |
|
Definition
pain in hands and feet (esp. arches) claudication in legs ulcers in the digits pale, red, bluish hands and feet symptoms worse with cold/stress |
|
|
Term
What is the treatment for Buerger's disease? |
|
Definition
control the symptoms smoking cessation amputation if gangrene sets in |
|
|
Term
How can Buerger's disease be prevented? |
|
Definition
don't smoke (especially patients with hx of Raynaud's) |
|
|
Term
What condition can cause inflammation of blood vessels in children? |
|
Definition
|
|
Term
What characterizes the 1st phase of Kawasaki disease? |
|
Definition
2 weeks persistent fever >104 for 5 days |
|
|
Term
What characterizes the 2nd phase of Kawasaki disease? |
|
Definition
skin on hands and feet may peel in large pieces |
|
|
Term
What are signs and symptoms of Kawasaki disease? |
|
Definition
joint pain, abdominal pain, nausea, vomiting
strawberry tongue
swollen lymph nodes
rash on trunk and genitals
bilateral conjunctivitis without exudate |
|
|
Term
If treatment if delayed beyond ____ days of the start of the fever associated with Kawasaki disease, heart problems may ensue. |
|
Definition
|
|
Term
What is the treatment for Kawasaki disease? |
|
Definition
IV gamma globulin ASA to reduce heart problems |
|
|
Term
What vessels are affected by polyarteritis nodosa? |
|
Definition
small and medium sized vessels spares the aorta and its bronches and the small vessels including the capillaries and arterioles |
|
|
Term
Where do the microaneurysms associated with polyarteritis nodosa occur? |
|
Definition
bifurcations or branch points of vessels |
|
|
Term
What organs are affected by polyarteritis nodosa? |
|
Definition
skin heart kidneys nervous system musculoskeltal system GU eyes brain GI |
|
|
Term
What condition is associated with necrotizing inflammatory lesions in the blood vessels? |
|
Definition
|
|
Term
What are the complications of polyarteritis nodosa? |
|
Definition
organ infarction gangrene of a limb aneurysm rupture causing intra-organ bleeding |
|
|
Term
How many of the 10 criteria must be present to diagnose polyarteritis nodosa? |
|
Definition
|
|
Term
How is polyarteritis nodosa treated? |
|
Definition
corticosteroids
severe disease--cyclophosphamides surgery for bowel complications
need multi-specialty involvement with multi-organ involvement |
|
|
Term
What vessels are affected by Behcets syndrome? |
|
Definition
small (capillaries, arterioles, venules) |
|
|
Term
What is the triple symptom complex associated with Behcets syndrome? |
|
Definition
recurrent oral apthous ulcers genital ulcers uveitis |
|
|
Term
What is the most common vasculitis in children and teens? |
|
Definition
|
|
Term
What causes Henoch-Schonlein purpura? |
|
Definition
deposition of IgA in the skin and kidneys |
|
|
Term
What is the classic triad associated with Henoch-Schonlein purpura |
|
Definition
purpura (palpable hemorrhages in the skin) joint pain abdominal pain |
|
|
Term
What is the prognosis/treatment for Henoch-Schonlein purpura? |
|
Definition
usually self-limiting most of the time just treat symptoms
1/3 may develop kidney problems which can lead to ESRF |
|
|
Term
How is the diagnosis of Henoch-Schonlein purpura made? |
|
Definition
|
|
Term
What is there a risk of in children under 10 who have Henoch-Schonlein purpura? |
|
Definition
1/3 chance of recurrence within 4 months of the first attack
recurrence is more common in older children and adults |
|
|
Term
Who is end stage renal failure more common in with patients who have Henoch-Schonlein purpura? |
|
Definition
|
|
Term
What is chronic myofascial pain syndrome? |
|
Definition
painful condition affecting the muscle and fascia |
|
|
Term
What is a common presentation of chronic myofascial pain syndrome? |
|
Definition
trigger points twitching of the muscle referred pain
sleep disturbance muscle weakness tingling stiffness |
|
|
Term
What sign might a patient with chronic myofascial pain syndrome exhibit? |
|
Definition
"jump sign" upon trigger point palpation |
|
|
Term
What is the treatment for chronic myofascial pain syndrome? |
|
Definition
NSAIDs PT massage trigger point injections (-caine, Botox, dry needle) correcting posture, leg length, workplace ergonomics, depression/anxiety |
|
|
Term
What does fibromyalgia stem from? |
|
Definition
dysfunction of neurotransmitters and hormones that transfer information from tissue to tissue |
|
|
Term
What condition produces general aching? |
|
Definition
|
|
Term
How does fibromyalgia differ from chronic myofascial pain? |
|
Definition
fibromyalgia--tender points myofascial pain--trigger points with radiating pain |
|
|
Term
How is a diagnosis of fibromyalgia made? |
|
Definition
3 months of widespread pain and tenderness at 11 of the 18 tender points |
|
|
Term
What are components of treatment for fibromyalgia? |
|
Definition
gentle exercise and stretching support groups patient education balanced diet acupuncture no high impact aerobics/weight lifting medications |
|
|
Term
What medications can be used for the treatment of fibromyalgia? |
|
Definition
Lyrica Cymbalta Savella anti-inflammatories |
|
|