Answer: A
Rationale: Patients with AS should exercise after pain and stiffness are managed. Postural control is important to minimize spinal deformity. The exercise regimen should include back, neck, and chest stretches. You should teach the patient with AS about regular exercise and attention to posture, local moist heat applications, and knowledgeable use of drugs. Discourage excessive physical exertion during periods of active disease flare-ups. Proper positioning at rest is essential. The mattress should be firm, and the patient should sleep on the back with a flat pillow, avoiding positions that encourage flexion deformity. Postural training emphasizes avoiding spinal flexion (e.g., leaning over a desk), heavy lifting, and prolonged walking, standing, or sitting.
Answer: D
Rationale: SLE is characterized by the production of a large variety of autoantibodies against nucleic acids (e.g., single- and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (ANAs), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response.
Answer: B, C, D, E
Rationale: Systemic sclerosis, or scleroderma, is a disorder of connective tissue characterized by fibrotic, degenerative, and occasionally inflammatory changes in the skin, blood vessels, synovium, skeletal muscle, and internal organs. You should include the following in the teaching plan: perform daily oral hygiene (neglect may lead to increased tooth and gingival problems); protect hands and feet from cold exposure and possible burns or cuts (wounds heal slowly); avoid emotional stress and cold ambient temperatures (aggravate Raynaud's phenomenon); perform isometric exercises for arthropathy (no joint movement occurs); use assistive devices as appropriate; organize activities to preserve strength and reduce disability; and practice mouth excursion (yawning with an open mouth), which helps maintain temporomandibular joint function.
Answer: B
Rationale: There are several commonalities between fibromyalgia syndrome and chronic fatigue syndrome (CFS). Both occur in previously healthy, young, and middle-aged women. Causes for both include an infectious trigger, dysfunction in hypothalamic-pituitary-adrenal axis, or an alteration in central nervous system. Common clinical manifestations are malaise and fatigue, cognitive dysfunction, headaches, sleep disturbances, depression, anxiety, fever, and generalized musculoskeletal pain. The disease course for both syndromes includes symptoms that vary in intensity and fluctuate over time. Because there are no definitive laboratory tests or joint and muscle examinations, they are mainly diagnoses of exclusion. Treatment for both disorders is symptomatic and may include antidepressant drugs. Other therapeutic measures are heat, massage, regular stretching, biofeedback, stress management, and relaxation training.
Arthritis is inflammation of the joints. The two most common and clinically relevant forms of
arthritis are osteoarthritis (OA, also known as degenerative joint disease or DJD), a primarily degenerative, or 'wear-and-tear' disease primarily related to age, obesity, and/or trauma, and rheumatoid arthritis (RA), a systemic autoimmune arthritis.
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There are many other types of arthritis including infections,
crystal deposition diseases, and more rare autoimmune diseases. Most of these will be discussed subsequently in "Non- neoplastic Joint Diseases," and you should continue to compare OA and RA to these other etiologies.
RA; Primary Path -> autoimmune rxn via ____ T-cell activity -> pannus formation & autoantibodies *anti-CCP/RF test
JNTS: ___ & PIP of hands 1st, then prox involvement
Gross/micro: inflam pannus (___ tissue in synovium w/
inflammation cells -> papillary synovitis w/ lots of plasma cells /lymph) -> cartilaginous destruction & scarring -> ultimately ____ (jnt fusion) & inflamed soft tissue-> pain/swell/warm,
Lab tests? + ACPA (95%)!!, + RF (70-90%), elevated ESR/CRP, increased total serum prot bc of Iggs -> ___gammopathy, mild anemia synovial fluid: ___-___ WBC/uL, >50% neutrophils, low glucose, no crystals, negative bacterial culture
SONE (S= swelling of soft tiss, O= osteo___, N= narrowing of JNt ___w/ ankylosing JNT fusion/symetric, E = erosion of ____)
Identify the major risk factors for seropositive rheumatoid arthritis?
- female gender (3: 1),
-prevalence in 1% of pop, ages 30-50
-HLA- ___ haplotype (Involved in intracellular signaling and production of synovial citrullinated proteins; Correlates with ___-positive RA)
-like many AI teases, related to nonspecific viral, bacterial infection (ex: EBV, parvovirus B19,
Mycoplasma etc) via molecular ___!
-Other microbes suggested as contributing causes due to __activity
-~50-60% of the risk of developing RA is related to this inherited ___ susceptibility
- tobacco use, obesity, silicosis: pneumoconiosis- chronic lung diseases from inhalation of silica dust (sandblast, road construction, manufacture of glass, ceramic, concrete, tile - RA + silicosis = ___)
Clinical features of RA:
Symetric polyarticular (>3
joint) involvement of MCP & PIP; spares __
- acute: jnt pain/swell, warm vs. chronic: acute stuff + jnt laxity, ___ (ex: swan neck: DIP ___, PIP ___ or boutonniere: extend DIP, ___ PIP, muscle imbalance
- Bilateral ulnar deviation at ___ joints & radial deviation at the wrists
- Morning stiffness> 1 hr, ___ with use
-Cervica lspine, shoulders,___, hips, knees, & feet
Cervical spine involvement increases risk of ____ joint subluxation
o Popliteal (Baker) cyst ___
knee joint is a frequent complication; Caused by extension of bursae into posterior joint space
Distinguish from DVT or popliteal artery aneurysm by ___
Diagnostic criteria for hip, hand, and knee OA:
Hip: Hip pain+2 or more of: Radiographic joint space narrowing,
Radiographic femoral or acetabular ____, ESR <20
Hand: Hand pain, aching, or stiffness, + 3 or more of: Hard tissue enlargement (HTE) of 2 or > of 10 selected joints or HTE of ___
or more DIP joints, <3 swollen MCP joints, Deformity of 1 or more of 10 selected joints
o Knee: Knee pain + 1 or more of: Age > 50 years, Stiffness <__ minutes; Crepitus (crackling of joints); Osteophytes