Rheumatology Exam Three Study Guide

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Questions and Answers

What is a notable symptom of active synovitis?

Improved range of motion in the morning

Warm, swollen, and tender joints (correct)

Stable joint alignment

Asymmetrical joint involvement

Which deformity is associated with ulnar deviation of the fingers?

Boutonniere deformity (correct)

Hammer toe

Claw hand

Swan neck deformity (correct)

What is a common clinical criterion for diagnosing rheumatoid arthritis?

Elevated levels of cholesterol

Presence of morning stiffness lasting more than an hour (correct)

Score of 4 or more on a pain questionnaire

Asymmetrical joint involvement

Which of the following is an extra-articular manifestation of rheumatoid arthritis?

Anemia of chronic disease Signup and view all the answers

What is the first line treatment for rheumatoid arthritis?

Disease modifying anti-rheumatic drugs like methotrexate Signup and view all the answers

Which of the following is characteristic of CREST syndrome?

Calcinosis Signup and view all the answers

What radiological finding is not typically associated with osteoarthritis?

Severe joint displacement Signup and view all the answers

What distinguishes septic arthritis from other types of arthritis?

Presence of purulent synovial fluid with WBC > 50,000 Signup and view all the answers

What is one of the key characteristics of rheumatoid arthritis in terms of joint involvement?

Symmetrical involvement of joints of the hands Signup and view all the answers

What is the primary role of anti-nuclear antibodies (ANA) in the assessment of connective tissue diseases?

To screen for various connective tissue diseases Signup and view all the answers

Which of the following antibodies is specifically monitored to assess disease activity in systemic lupus erythematosus (SLE)?

Anti-dsDNA antibody Signup and view all the answers

What environmental factors are associated with the development of rheumatoid arthritis?

Smoking and viral infections Signup and view all the answers

Which of the following statements regarding rheumatoid arthritis is accurate?

It can lead to systemic complications such as vasculitis. Signup and view all the answers

What is citrullination, and why is it relevant to rheumatoid arthritis?

A modification that can lead to autoantibody development. Signup and view all the answers

In rheumatoid arthritis, what is primarily attacked by autoantibodies?

Synovial membranes Signup and view all the answers

What distinguishes rheumatoid arthritis from osteoarthritis in terms of disease progression?

Rheumatoid arthritis is characterized by systemic effects. Signup and view all the answers

What is the primary function of the conducting zone in the respiratory system?

Provides conduit for air to flow into lungs. Signup and view all the answers

Which structure is directly involved in gas exchange in the respiratory system?

Alveoli. Signup and view all the answers

Which component of the respiratory system is responsible for producing mucus?

Goblet cells. Signup and view all the answers

What characterizes bronchospasm in the respiratory system?

Sudden tightening of airway smooth muscles. Signup and view all the answers

How does acetylcholine affect airway smooth muscle?

Activates cholinergic and muscarinic receptors causing bronchoconstriction. Signup and view all the answers

During inhalation, what happens to the diaphragm?

It contracts and moves downward. Signup and view all the answers

What anatomical feature differentiates the left lung from the right lung?

The left lung has a cardiac notch. Signup and view all the answers

What role do the pleural membranes serve in the respiratory system?

Creating a lubricated environment for lung expansion and contraction. Signup and view all the answers

Which process helps to equalize air to body temperature as it enters the respiratory tract?

Warming and humidification through the nasal cavity. Signup and view all the answers

What is the primary mechanism leading to recurrent episodes of gout in most patients?

Inadequate excretion of uric acid from the kidneys Signup and view all the answers

Which of the following treatments is appropriate for acute gout attacks?

Colchicine Signup and view all the answers

Which characteristic rash is associated with Systemic Lupus Erythematosus (SLE)?

Butterfly rash Signup and view all the answers

In which scenario is IV Vancomycin typically administered?

For nongonococcal septic arthritis Signup and view all the answers

What is the primary protein deficiency observed in Duchenne Muscular Dystrophy?

Dystrophin Signup and view all the answers

Which condition is characterized by an autoimmune response targeting postsynaptic acetylcholine receptors?

Myasthenia gravis Signup and view all the answers

Which of the following signs is indicative of progressive muscular dystrophy, particularly Duchenne Muscular Dystrophy?

Gowers' sign Signup and view all the answers

What is the most common infectious agent associated with septic arthritis in a sexually active young patient?

Neisseria gonorrhoeae Signup and view all the answers

What is the goal serum uric acid level in the treatment of chronic gout?

Less than 6 mg/dL Signup and view all the answers

Which of the following is a treatment option to increase urinary uric acid excretion?

Uricase Signup and view all the answers

What is a primary characteristic of Acute Respiratory Distress Syndrome (ARDS)?

Severe hypoxemia and reduced pulmonary compliance Signup and view all the answers

Which of the following causes can lead to direct lung injury in ARDS?

Pneumonia Signup and view all the answers

Which symptom is NOT associated with pneumonia?

Expiratory high pitched wheeze Signup and view all the answers

In assessing pediatric asthma, which question is least relevant?

Has the child experienced night sweats? Signup and view all the answers

What factor would determine the severity of ARDS in relation to PaO2/fiO2 ratio?

A ratio between 200-300 indicates moderate ARDS Signup and view all the answers

Which response does NOT describe a role of neutrophils in ARDS?

They directly improve pulmonary compliance. Signup and view all the answers

Which statement regarding wheezing in pediatric patients is accurate?

A wheeze heard during exhalation is typical for asthma. Signup and view all the answers

Which is NOT a typical clinical assessment question for wheezing in children?

Has the child experienced recent weight gain? Signup and view all the answers

Which of the following is a characteristic of chronic asthma?

Element of irreversible disease leading to chronic dyspnea Signup and view all the answers

What indicates a status asthmaticus condition?

Life-threatening state with no instant response to treatment Signup and view all the answers

Which factor is NOT a predisposing factor for asthma?

Regular steroid use Signup and view all the answers

In COPD patients, which symptom is typically associated with chronic bronchitis?

Low volume, dirty looking sputum Signup and view all the answers

Which of the following is a diagnostic tool for confirming asthma?

Spirometry showing obstructive changes before and after treatment Signup and view all the answers

What distinguishes a 'Blue Bloater' phenotype in COPD?

Cyanosis with chronic type 2 respiratory failure Signup and view all the answers

What is a common characteristic of cough variant asthma?

Presence of a mild cough without wheeze Signup and view all the answers

Which of the following is true regarding the pathology of COPD?

Involves chronic inflammation and pathological changes over time Signup and view all the answers

What is the primary cause of tuberculosis?

Mycobacterium tuberculosis Signup and view all the answers

Which of the following lung function changes is characteristic of asthma diagnosis?

Diurnal variation in peak expiratory flow rate recordings Signup and view all the answers

Which of the following accurately describes a characteristic of chronic asthma?

It typically presents a chronic dyspnea and low FEV1. Signup and view all the answers

What defines Status Asthmaticus?

A life-threatening condition with no instant response to treatment. Signup and view all the answers

Which of the following factors is NOT a predisposing factor for asthma?

Advanced age. Signup and view all the answers

Which of the following is a primary symptom of COPD?

Chronic productive cough with dirty sputum. Signup and view all the answers

Which method is commonly used to confirm the diagnosis of asthma?

Spirometry showing obstructive changes. Signup and view all the answers

What is a distinguishing feature of 'Brittle Asthma'?

Very rapid exacerbation and severe attacks. Signup and view all the answers

How is COPD primarily differentiated from asthma?

By a significant history of smoking or inhaled irritants. Signup and view all the answers

Which symptom would most likely be associated with pneumonia rather than asthma?

Rusty colored sputum. Signup and view all the answers

What sign might indicate cor pulmonale in a patient with COPD?

Ankle edema and morning headaches. Signup and view all the answers

Which age group is least likely to have asthma as a primary diagnosis for wheezing?

Ages 10-12. Signup and view all the answers

Which of the following factors is NOT part of Virchow’s triad concerning venous thromboembolism (VTE)?

Presence of air in the bloodstream Signup and view all the answers

What is the primary method used to assess the probability of pulmonary embolism?

Modified Wells criteria Signup and view all the answers

In the evaluation of pulmonary embolism, a negative D-dimer test indicates what?

Effectively rules out VTE in low-risk and moderate-risk cases Signup and view all the answers

Which ECG finding is considered pathognomonic for right heart strain due to pulmonary embolism?

S1Q3T3 pattern Signup and view all the answers

What is a common characteristic of primary spontaneous pneumothorax?

Typically seen in tall and slim patients aged 20-30 years Signup and view all the answers

Which laboratory finding is likely to be elevated in patients with moderate-to-large pulmonary emboli?

D-dimer levels Signup and view all the answers

Which condition would NOT typically contribute to the elevation of D-dimer levels?

Hypoglycemia Signup and view all the answers

What distinguishes traumatic pneumothorax from spontaneous pneumothorax?

Traumatic pneumothorax results from external trauma to the chest Signup and view all the answers

What is the typical room-air oxygen saturation level indicating hypoxemia?

Less than 95% Signup and view all the answers

Which of the following statements about respiratory alkalosis is correct?

It can occur with low arterial blood gas CO2 levels Signup and view all the answers

What is the primary mechanism by which reactivated disease occurs in individuals?

Smoking, age, and HIV infection Signup and view all the answers

Which condition is NOT a likely cause for unilateral wheezing?

Asthma Signup and view all the answers

What genetic mutation is most commonly seen in cystic fibrosis patients?

Deletion of amino acid 508 Signup and view all the answers

In which situation is a chest X-ray least likely to be indicated?

Assessment of acute abdominal pain Signup and view all the answers

Which of the following conditions is most closely associated with chronic inflammation of the lungs?

Cystic fibrosis Signup and view all the answers

What factor most significantly increases the risk of lung cancer?

Smoking history and pack-years Signup and view all the answers

Which characteristic is indicative of Type 1 respiratory failure?

PaO2 less than 60 with normal or low PaCO2 Signup and view all the answers

Which of the following findings is typically NOT associated with cystic fibrosis?

Low serum calcium Signup and view all the answers

What is the main cause of airway secretions becoming extremely thick in cystic fibrosis?

Genetic defect in CFTR protein Signup and view all the answers

Which of the following does NOT typically contribute to respiratory failure?

Inadequate fluid intake Signup and view all the answers

What is the most immediate treatment for a tension pneumothorax in an unstable patient?

Needle decompression Signup and view all the answers

Which criterion is NOT a characteristic of stable patients with pneumothorax?

Ability to perform high-intensity exercise Signup and view all the answers

What is the primary initial step in managing a primary spontaneous pneumothorax?

Catheter aspiration Signup and view all the answers

In which scenario would surgical management be indicated for pneumothorax?

Recurrence of primary spontaneous pneumothorax Signup and view all the answers

What is the main consequence of a tension pneumothorax on venous return?

Reduced venous return to the heart Signup and view all the answers

What is the anatomical site for needle decompression in a tension pneumothorax?

2nd intercostal space in the midclavicular line Signup and view all the answers

Which of the following is an indication for video-assisted thoracic surgery (VATS) in managing pneumothorax?

Pneumothorax unresponsive to chest tube placement Signup and view all the answers

Which of the following is considered a potential complication of untreated tension pneumothorax?

Cardiopulmonary collapse Signup and view all the answers

Study Notes

Connective Tissue Diseases and Rheumatology

Labs for Assessing Connective Tissue Diseases (CTDs): Includes anti-nuclear antibody (ANA) testing; clinical diagnosis is crucial as labs are not definitive.
ANA (Antinuclear Antibody): Broadly screens for CTDs, excluding RA; a positive result may indicate aging or various diseases, including HIV and malignancies.
SLE: Involves specific antibodies like dsDNA. Disease activity is monitored via titers; Anti-smith has decreased sensitivity.
RA vs. OA:
- Rheumatoid Arthritis (RA): Features symmetrical joint involvement, especially in hands. Characterized by cartilage loss, bone erosion, and involves synovium.
- Osteoarthritis (OA): Involves complex risk factors including obesity and age, with x-ray findings showing narrowed joint space and osteophytes.
Rheumatoid Arthritis Symptoms: Morning stiffness lasting over an hour, symmetrical swelling in joints, potential for complications like Felty’s syndrome.
Environmental Triggers for RA: Smoking and infections can exacerbate the condition.
Extrarticular Manifestations of RA: Include cardiovascular issues, various forms of vasculitis, and systemic effects like anemia.
RA Treatment: NSAIDs as first-line; DMARDs like methotrexate, glucocorticoids for symptom management, and biologics for severe cases.

CREST Syndrome

Definition: Limited scleroderma characterized by calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia.
Complications: Can lead to pulmonary hypertension affecting heart and respiratory functions.

Gout

Pathophysiology: Caused by uric acid accumulation, often due to renal excretion issues; acute, inflammatory arthritis defined by hyperuricemia (>6.8 mg/dL).
Chronic Gout Treatment: Includes allopurinol; target serum uric acid less than 6 mg/dL. Tophi formation signifies aggravated condition.

Systemic Lupus Erythematosus (SLE)

Key Features: Autoantibody disease with symptoms like butterfly rash, oral ulcers, and potential vasculitis presenting with purpura.
Demographics: More common in women, especially African Americans.
Lupus Treatment: IV/oral steroids, NSAIDs, hydroxychloroquine for arthritis, and cytotoxic immunosuppressants for severe organ damage.

Myasthenia Gravis

Pathophysiology: Autoimmune disorder targeting acetylcholine receptors; characterized by muscle weakness, especially bulbar symptoms like ptosis and dysphagia.
Presentation: Fatigue, respiratory failure; differentiated into generalized and ocular forms.

Duchenne Muscular Dystrophy

Characteristics: Genetic condition affecting dystrophin; manifests with progressive weakness, often wheelchair dependence by ages 10-12.
Diagnosis: Identified by elevated serum creatine kinase levels, presents with muscle fiber necrosis, and Gowers' sign.

Respiratory System Overview

Breathing Control: Involves the pulmonary, musculoskeletal, and cardiac systems’ coordination; structures include conducting and respiratory zones.
Bronchospasm and Inflammation: Inflammation can cause constriction of airway smooth muscle; role of acetylcholine in promoting bronchoconstriction via muscarinic receptors.
Acute Respiratory Distress Syndrome (ARDS): Characterized by severe hypoxemia, bilateral infiltrates, and cytokine release; arises from pulmonary or extrapulmonary indirect injury.
Pneumonia Symptoms: Includes systemic symptoms like fever, cough, and purulent sputum; physical examination reveals crackles and pleural rubs.

Asthma and COPD

Asthma: Chronic inflammatory disease characterized by reversible airways obstruction; common triggers include allergens and irritants.
COPD: Includes conditions like chronic bronchitis and emphysema, characterized by chronic inflammation leading to airway obstruction; symptoms include dyspnea and chronic cough.
Diagnosis: Utilizes lung function tests such as spirometry; distinctions between “pink puffer” (emphysema) and “blue bloater” (bronchitis) based on clinical presentation.

Pediatric Considerations

Wheezing Assessment: Age of onset, episodic nature, and response to treatment are crucial in assessing wheezing in children; common causes vary with age group.### Asthma Clinical History
Most prevalent chronic lung disease globally characterized by chronic airway inflammation and hyperactivity.
Airway obstruction is typically reversible but can progress to irreversible if poorly managed.
Predisposing factors include family history, specific genetic markers (e.g., ADAM33 gene), atopy, premature birth, obesity, and exposure to secondhand smoke, recreational drugs, and smoking.

Asthma Subtypes

Chronic asthma leads to irreversible changes, low FEV1 levels, and dyspnea in older patients.
Exacerbations are acute worsens triggered by specific stimuli.
Status Asthmaticus represents a life-threatening state with poor response to treatment.
Bronchospasm results in increased airway constriction.
Brittle asthma features rapid, severe exacerbations.
Steroid-resistant asthma does not respond to corticosteroids.
Cough variant asthma presents primarily with a mild cough, lacking wheezing.
Occupational asthma results from inhaling allergens at work.

Diagnosis of Asthma

Confirmed by showing reversible airway obstruction through treatment response, PEFR recordings, and spirometry before and after bronchodilators.
Blood tests may reveal eosinophilia and elevated specific IgE levels.
Chest X-rays can be normal or show hyper-expansion during acute attacks.
Expiratory obstruction is typically worse than inspiratory, leading to air trapping.

Chronic Obstructive Pulmonary Disease (COPD)

Second most common lung disease, primarily caused by inhaled irritants leading to airway inflammation and changes over time.
Common symptoms include progressive dyspnea, chronic productive cough (often with sputum), wheezing, and manifestations of cor pulmonale (e.g., edema, headaches).
Clinical signs include tachypnea, use of accessory muscles, barrel chest, and decreased bilateral lung expansion.
Distinction between types:
- Blue Bloater: primarily airway obstruction, chronic type 2 respiratory failure, cyanosis, and edema.
- Pink Puffer: emphysema dominant, muscle wasting, increased respiratory effort, no cyanosis or edema.

Diagnosing COPD

Diagnosis relies on spirometry, demonstrating obstructive and irreversible changes.
PEFR often indicates low variability during exacerbations.
FEV1 decline over time is common; additional assessments may include the PSI risk stratification tool.

Tuberculosis (TB)

10% of latent infections may reactivate, primarily caused by Mycobacterium tuberculosis.
Infection occurs through droplet transmission and primarily affects alveolar macrophages.
TB presents in pulmonary or extrapulmonary forms, with a Ghon focus indicating infection in the lungs.
50% transmission risk occurs even with exposure to an infected individual; key reactivation risk factors include age, immunosuppression (HIV), malnutrition, and smoking.

Wheezing Evaluation

Bilateral wheezing indicates conditions like asthma and COPD.
Unilateral wheezing may result from foreign body aspiration, tumors, bronchial compression, or lymphadenopathy.

Chest X-ray Indications

Used to evaluate conditions associated with various pulmonary diseases, aiding diagnosis.

Cystic Fibrosis

Affects 4% of Caucasians; autosomal recessive gene causing CFTR mutations leading to thick secretions and lung inflammation.
Common complications: recurrent infections (notably by Pseudomonas aeruginosa), pancreatic insufficiency, and infertility in males.
Clinical signs include clubbed fingers, barrel chest, and failure to thrive in infants.
Diagnosis confirmed via sweat test showing elevated chloride levels.

Lung Cancer Risk Factors

Strongly linked to smoking, with risk correlating with exposure intensity over time.
Environmental factors include secondhand smoke, air pollutants (asbestos, radon), and certain pre-existing lung diseases.

Chronic Hypoxemia and Hypercapnia

Hypoxemia denotes insufficient blood oxygen, while hypercapnia indicates elevated blood carbon dioxide (CO2).
Respiratory failure is categorized into:
- Type 1 (Hypoxemic): Characterized by low PaO2, common in acute lung diseases.
- Type 2 (Hypercapnic): High PaCO2, potentially coexisting with hypoxemia, often seen in COPD or drug overdose cases.

CPAP Therapy for OSA

Continuous Positive Airway Pressure (CPAP) machines maintain airway patency during sleep by providing air pressure.

Pulmonary Embolism (PE) Origins and Evaluation

PE results from thrombus or other substances obstructing pulmonary arteries, with venous stasis, hypercoagulability, and vascular damage as contributing factors (Virchow’s triad).
Diagnosis often utilizes imaging alongside clinical assessment, pretest probability, and D-dimer levels.

Pneumothorax Types and Management

Traumatic pneumothorax can be closed (blunt trauma) or open (penetrating injury); spontaneous pneumothorax arises from ruptured blebs.
Tension pneumothorax is a life-threatening condition requiring immediate chest tube placement to alleviate pressure.
Stable patients can often be monitored while unstable patients require urgent intervention to stabilize respiratory function.

Treatment Protocols for Pneumothorax

Small, asymptomatic pneumothoraces can be monitored; large pneumothoraxes may require chest tube placement.
Surgical interventions may be necessary for recurrent or unresponsive cases, including VATS for pleurodesis and management of underlying conditions.

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Description

Prepare for your rheumatology exam with this comprehensive study guide focusing on labs to assess connective tissue diseases. Explore the complexities of diagnosing conditions such as SLE, RA, and Sjogren's, as well as the significance of anti-nuclear antibodies in clinical diagnosis. Ensure you're well-prepared with key insights into symptoms and differential diagnoses.