1humoral immunity
in body fluids
2cell-mediated immunity
in cells
3articular swelling =
arthritis... swelling within the joint
4periarticular swelling =
tenosynovitis... structure around the joint
5entire limb swelling =
lymphedema
6Seropositive arthropathy symmetry for stiffness=
symmetrical (RA)
7seronegative arthropathy symmetry for stiffness =
asymmetrical (PsA)
8What is the gel phenomenon?
stiffness that is relieved with activity, but when the person sits down, they stiffen back up again
9Seropositve blood marker
+RF... present in 80% of ppl with RA
10Seronegative blood marker
-RF... Present in Ankylosing spondylitis (AS), Reactive arthritis (ReA), Psoriatic arthritis (PsA)
11what is ANA positive in
lupus, RA, and other autoimmune diseases
12what are the nail bed changes and hand deformities present in pts with immune system involvement?
dystrophic nail changes, bouchard's nodes, sclerodactyly
13pt presents with dystrophic nail changes... what two immune diags?
psoriasis and RA
14Pt presents with sclerodactly... what immune diag?
scleroderma
15pt presents with bouchard's nodes.. what immune diag?
RA, OA
16What is type 1 hypersensitivity?
anaphylatic... releases histamines and cytotoxins
17What is type 2 hypersensitivity?
Cytolytic or Cytotoxic
Drug reaction
Antigen-antibody
Drug induced anemia
Blood transfusion
18What is type 3 hypersensitivity?
Immune complex
Antigen-antibody
Vasculitis
19What is type 4 hypersensitivity?
Cell- mediated (delayed)
After 24-48 hrs
Cytokine and GF release
Dermatitis
20Pt presents with decreased muscle mass, LBP and postural changes. They also have been experiencing night sweats and fevers. They dont use condoms and they liked to use needles around 10 years ago for things they wont tell you. What diag is likely?
HIV/AIDS
21What are Sx of HIV?
often asymptomatic for 10 years, night sweats, fever, wt loss, mm mass decreased, postural changes, LBP, neuro involvement
22T/F kaposi Sarcoma lesions are painful and contagious
false! WRONG NO! they are NON painful and NOT contagious
23your patient has kaposi sarcoma lesions.. what other two tracts may be involved
GI and resp
24what type of hypersensitivity disorder? allergies, anaphylaxis, releases histamine and cytokines
type 1: immediate/anaphylaxis
25what type of hypersensitivity disorder? antigen-antibody, blood transfusion reaction, ach receptors (MYASTHENIA GRAVIS)
type 2: cytotoxic reactions
26what type of hypersensitivity disorder? antigen-antibody, vasculitis, jt arthritis, nephritis
type 3: immune complex reactions
27what type of hypersensitivity disorder? develops after 24-48 hrs, releases cytokines and growthfactor, dermatitis
type 4: delayed-type/cell mediated
28T/F Fibromyalgia is an inflammatory condition
FALSE YOU LOSER
29T/F: Fibromyalgia is seen more frequently in men than women.
FALSE... more in women
30name the diag: pain hypersensitivity due to central sensitization !!!!!!!!!!!!
fibromyalgia
31fibromyalgia is a non-inflammatory condition T/F
true :)
32pt presents with Generalized MSK pain with tenderness to touch in specific areas of the body, Fatigue, sleep disturbance, cognitive dysfunction.. diag?
fibromyalgia
33T/F fibromyalgia is autoimmune?
false... its is not autoimmune but is common in ppl with autoimmune diseases
34whats the diagnostic criteria for fibromyalgia
1) Presence of generalized pain, in > 4/5 defined regions
2_ Symptoms present at a similar level for at least 3 months
3) WPI > 7 and SSS >5 OR WPI 4-6 and SSS>9
35Systemic problem with multiple tender points... Cluster of associated signs and symptoms
fibromyalgia
36does myofascial pain have associated S&S?
no
37whats the three risk factors for polymyalgia rheumatics?
women, >55, caucasian
38what is the diagnostic criteria for polymyalgia rheumatics?
1)BILATERAL aching in 2/3 areas (Torso, UE, LE)
2) Sudden onset
3) Morning stiffness >1 hr
4) 1 mth duration
5)High ESR (>40mm/h) measures inflamm in the body
39pt presents with bilateral aching in torso and LE that started a month ago suddenly. They have morning stiffness that lasts over an hour. They have pitting edema and lo grade fever..diag?
polymyalgia rheumatics
40what are associated sx of polymyalgia rheumatics?
low grade fever, fatigue, malaise, pitting edema, jt pain
41whats the red flag for polymyalgia rheumatics?
Can progress to Giant Cell or Temporal Arteritis (GCA)
42localized or systemic scleroderma: benign, confined to skin and underlying tissues and has morphea
localized
43localized or systemic scleroderma: multiorgan involvement, high mortality rate, hand function impaired, GERD and raynauds
systemic
44is RF factor + or - in axial spondylitis
negative
45pt says their pmhx consist of "scleroderma, GERD and raynauds" what can you tell them about those three things?
GERD and raynauds are early sings of systemic scleroderma
46SIJ inflamm and arthritis =
HALLMARK SIGN OF AXIAL SPONDYLITIS
47WHAT IS THE HALLMARK SIGN OF AXIAL SPONDYLITIS
SIJ inflamm and arthritis
48women and men are equally at risk for psoratic arthritis T/F
true bitch
49dactylitis =
HALLMARK SIGN OF PSORIATIC ARTHRITIS
50pt presents with psoriasis in medical hx, dactylitis, is between the age of 20 and 30. They have flat and scaly lesions on their body.. diag
psoriatic arthritis
51women are more likey to get myasthenia gravis at age
20-30
52men are more likey to get myasthenia gravis at age
over 50
53pt presents with symmetrical and proximal Muscle weakness of eyes, chewing, swallowing, facial expressions, limb, axial muscles.. diag?
myasthenia gravis
54Antibodies destroy acetylcholine receptors at the neuromuscular junction... diag?
myasthenia gravis
55t/f SLE can affect skin, joints, kidneys, nervous system, mucous membranes
true
56pt presents with coin shaped lesions that are raised red and scaly but dont itch.. diag?
cutaneous lupus (discoid lupus)
57what age is more liekly to develop SLE
15-40
58pt presents with a malar (butterfly rash), raynauds, arthalgia and + ANA... diag?
SLE
59is SLE a graudal or sudden onset
gradual
60risk factors for RA
Women 2-3x > Men
Ages 40-60
+ RF, genetic marker
Smoking
61what are the three presentations of RA/criteria for referral
Morning stiffness > 60 min
Pain with compression of MCP/MTP joints
Presence of > 3 swollen joints
62pt presents with dry mouth and dry eyes... diag
sjogrens syndrome
63What is Sjogren's syndrome associated with the development of
non-hodgkin lymphoma
6450% of pts with sjogrens have what
another autoimmune disease
65what age and gender is sjogrens
women 10x>men and age 40-60
66what is important to note about lyme disease
Arthritis appears several months later (monoarticular/oligoarticular)