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WorksheetsPatho2 Week2
Total questions: 117
Worksheet time: 1hrs 12mins
"to make more violent, bitter or severe" best describes
exacerbation
pleura
C-structured proteins
The serous membrane that lines each half of the thorax in mammals and is folded back over the surface of the same side lung
pleura
diaphram
membrane
"A group of chronic disorders characterized by diffuse inflammatory vascular lesions and degenerative changes in connective tisse"
(a)
The conical sac of serous membrane that encloses the heart and roots of great blood vessels
pericardium
myocardium
epicardium
endocardium
Abnormal enlargement of the lymph nodes
lymphadenopathy
catchment enlargement
swollen nodes
The speed of red blood cells settling in a graduated tube of fresh whole blood best describes (ESR)
Erythocyte sedimation rate
Erythocyte seperation reflex
Erythocyte sedintary rule
A protein present in blood serum in various abnormal states such as inflammation or neoplasia
C-reactive protein
Proteases
Erythocyte
B12 Protein
A chronic system disorder effecting joints and CT throughout the body. Autoimmune disorder characterized with exacerbations and remissions
(a)
What can rheumatoid arthritis effect
synovial membranes of specific joints
synovial membrane of blood vessels
serous membrane of heart
serous membrane of lungs
serous membrane of eyes
What is the peak onset of rheumatoid arthritis
50-75 yrs
50-60 yrs
65-80 yrs
60-85 yrs
Women are effected 2.5x more than men in regards to rheumatoid arthritis
true
false
rheumatoid arthritis has an uncertain cause
true
false
Rheumatoid arthritis could have possible genetic predeposition through the alteration of human leukocyte antigen which is found on which major histocombatibility complex
MHC 2
MHC 1
70-80% of sufferers have rheumatoid factor (an antibody that reacts with a fragment of IgG to create immune complexes)
true
false
what can increase the severity of RA
smoking
diet
obesity
anti-coagulants
Cytokine production leading to the release of TNF and IL1 which eventually destroys articular carilege and underlying bone best describes the pathiogenesis of____ (rearding RA)
genetic predisposition
inflammatory response
immunological response
angiogenesis of synovium
Inflammatory response releases enzymes which then destroy articular cartilage and subchondral bone happens during which pathogenisis for RA
genetic predisposition
immunologic Response
The normal synovium is 2 layers. How many layers is it when there is inflammation
8-10
3-4
4-5
12-15
What occurs during synovitis
synovial cells attack synovium, causing it to swell
joint capsule stretches
ligaments, muscles, tendons are imbalanced
What occurs during pannus (a characteristic feature of RA)
synovial hyperplasia
angiogenesis
granulation tissue formation that extends to joint margins & articular surface
inflammatory cells within the pannus destroy cartilage and subchondral bone
Reduced joint motion during RA due to pain and generalized inflammation occurs during which stage
early
later
Reduced joint motion during RA due to pannus and disuse muscle atrophy occurs during which stage
early
late
Bony fusion and complete joint immobility defines
(a)
Progressive joint destruction, subluxation, instability and limited movement (clinical manifestations of RA) are caused from
stretching of ligaments and joint capsule
pannus
ankylosis
osteoporosis
Which of the following are true with regards to systemic and polyarticular articular manifestations of RA
Begins with smaller joints
Any synovial joint can be involved
degree of joint change depends on severity
difficulty with fine motor actions can occur
What occurs with Swan neck deformity (manifestation of RA)
PIP hyperextension
DIP flexion
inability to make a fist
wrist ulnar deviation
What occurs during boutonneirs deformity (manifestation of RA)
DIP hypextended
PIP flexed
inability to make a fist
wrist ulnar deviation
What causes ulnar deviation during the clinical manifestation of RA
MCP defomity
PIP hyperextended
extensor tendons slip to ulnar side of MC heads
What are some early common joints effeceted by RA
wrist
MCP
PIPs
IP of thumb
MTP of big toe with valgus bunion
What occurs from RA effecting the early joints (Wrist, PIP,MCP,IP of thumb, 1stMTP)
pain and difficult of fine motor actions
opening doors
opening jars
dressing
What joints would be effected in a later stage of RA
ankle
knee
shoulder/elbow
spinal involvement
wrist
What would happen from a client having knee RA
genu valgum
genu varum
visible edema
abnormal contour
quadricep atrophy
What are some early systemic manifestations of RA
fatigue/weakness/anorxeia
increased ESR
Increased anti-citrullinated peptide antibody
nodules
What do rheumatoid nodules contain
fibrin
degraded collagen
pus
What is a common location for a rheumatic nodule
extensor surface of ulna
1st MCP
radioulnar joint
flexor surface of radius
Vascilitis is the inflammation of small and medium vessels. What can it create?
skin ulcers
intestinal ulcers
Raynauds
ischemic area in the skin fold
What are some occular changes that can occur d/t a systemic manifestation of RA
blindness
decrease in vision
dry eye
inflammation of sclera
What is pulmonary fibrosis (systemic manifstation of RA)
infammation in pleural space
scar tissue formation in pleural space
thickening of pleural space
collagen build up in pleural space
What is splenomegaly
spleen enlargement
lymph node enlargement
spleen rupture
lumph node rupture
What does a physical exam look for when diagnosing RA
Inflammation and swelling
soft/boggy end feel (synovitis)
decreased ROM
pain that inhibits movement
posture to look for joint fusion
What are some treatment goals for clients with RA
decrease pain, swelling, stiffness
maintain mobility
client education
decrease lymphodema
What are some assitive devices to help with RA treatment
supportive shoes
splints
casts
slings
What are some surgical treatments for clients with RA
total joint repair
hyralunic injections
synovectemy
repair damaged tendons
Which of the following are NSAID's to help relieve clients with RA
ibuprofen
naproxan
emugul
voltaren
aceitominophen
Which drug class decreases the risk of stomach ulcers for clients with RA (eg. celebrex)
NSAID's
Cyclooxygenase-2 inhibitors
Corticosteroids
DMARD's
Which drug class for RA interrupts inflammatory response, is taken short term with a low dose to minimize side effects. Injections decrease synovitis
corticosteroids
NSAIDS
Salicylates
DMARD's
Which drug class for RA is fast acting to decrease S&S + slow progression of disease (eg. methotrexate).
corticosteroids
DMARDS
NSAIDS
Cyclooxygenase-2 inhibitors
"arthralgia" best describes
hair loss
inflammation of the myocardium
pain in one or more joints
"an antibody active against a tissue constituent of the individual producing it" would be called an
(a)
"the presence of excess protein in the urine" best describes
alopecia
arthralgia
proteinuria
The onset of lupas can be acute or insidious
true
false
"A chronic inflammatory disease that effects many different organs/tissues in the body. Characterized by the formation of autoantibodies and immune complexes" best describes
(a)
The exact cause of lupus is unknown, what are some resasons for the development of autoantibodies?
genetic predispoisiton
environmental
sex
hereditary
What are some examples of environmental triggers for lupus
UV light
foods
infectious agents
stress
medications
90% of those effected by Lupus are men
true
false
Lupus is related to the defective elimination of self reflective B-cells, reflecting a lack of apoptosis. What does this cause?
body is unable to remove autoantibodies
body is able to remove autontibodies
Which of the following are true with regards to the pathogenesis of lupus
exacerbations and remissions
complimenet activation
perpetrates inflammation
autoantibodies damage tissue/combine w antigens to create immune complexes
What are some of the inittal presentations of lupus
butterfly rash
joint pain
fever
muscle atrophy
Arthralgia and arthritis are present in ____% of sufferers with lupus. Often systemic, effecting any joint.
75
90
60
88
Client with lupus can suffer from arthralgia. What joints does it effect?
PIPs
MCPs
Wrists
Knees
C-Spine
T-Spine
L-Spine
Although rare, a clinical manifestation of lupus could effects the ligaments, tendons, and joint capsules. What type of contracture could these create?
flexor contracture
extensor contracture
Inflammation from lupus can cause edema in which joints
knees
shoulder
hips
MCP's
ankle
Lupus leading to tenosynovitis could cause which tendons to rupture
achillies
intrapetellar
common flexor tendon
sartorius
Where would an acute butterfly rash (falt and raise) from lupus typically be found
nose
cheeks
chest and neck
scalp
Sun sensitivity could cause a sun rash from lupus
true
false
Hives from lupus only happen in the acute stage
true
false
What would a mucous membrane lesion be as a result from lupus
mouth ulcer
lichen planus
oral candidiasis
hairy tongue
What percent of lupus sufferers experiences pleuritis
50
75
90
88
abnormal fluid accumulation which inhibits lung expansion and is a painful pulmonary manifstation of lupus best describes
pleuritis
pleural effusion
What are some cardiovascular manifestations of lupus
hypertension
pericarditis
myocarditis
DVT
Pericarditis effects what percentage of sufferers with lupus
50
75
90
88
The CNS is effected from lupus after strokes, hemmorages due to vasculitis/immune complexes attacking neurons. What can this cause?
depression
seizure
headaches
heart attack
What are some signs and symptoms of glomerulonephritis; a renal manifestation of lupus
hematuria
proteinuria
edema in legs and abdomen
edema in eyes
What are some GI clinical manifestations of lupus
nausea
abdominal pain
anorexia
hyperthyroidism
What are some hematologic clinical manifestations of lupus
leukopenia
lymphopenia
thrombocytopenia
anemia
How is lupus diagnosed
ultrasound
health hx.
blood work analysis
physical examination
What is being assessed when trying to diagnose lupus
decreased WBC's
antiautobodies
anemia
platelet count
systemic infection
What are some treatment aims for Lupus
decreasing exacerbations
prevent complications
manage acute and chronic symptoms
prevent progessive organ loss
decrease autoantibody count
What are some NSAIDs used for lupus. To help with arthritis, myaglia, and arthralgia
naproxen
advil
aleve
motrin
What drug class works as an immunosupressent to help with bolder symptoms of lupus (such as renal or CNS manifestations)
antimalarials
NSAID's
corticosteroids
immunosupressive drugs
What drug class for Lupus helps with rashes, pleuritic, and arthritic symptoms that wouldnt be relieved by NSAID's (eg. Plaquenil)
corticosteroids
antimalarials
immunosupressive drugs
What drug class is used when corticosteroids wont work (eg. cytoxin)
NSAID's
antimalarials
immunosupressive drugs
What Vitamin can help decrease lupus activity while also improving energy levels
Vitamin D
VItamin B12
Vitamin C
Vitamin K
What is the Lupus survival rate in the global north
5 years
10 years
15 years
20 years
What involvement can cause Lupus death within the first few years of active disease
CNS
Renal
Cardiovascular
Pulmonary
What parts of the body are mainly effected by ankylosing spondylitis
spine
hip
SI
AC
Ankylosing spondylitis is 3x more common in ____. The onset is more common in adolecense to early adulthood
men
women
The etiology of ankylosing spondylitis could be autoimmune. What cells are present
monocytes
lymphocytes
synovial cells
erythocytes
Which antigen on MHC is 90% present throughout cases of ankylosing sponylitis
(a)
What could be some environemntal factors that could contribute to the etiology of ankylosing spondylitis
stress
infection
ulcerative colitis
posture
Multisystem inflammatory joint disorders, mainly affecting axial skeleton best describes
spondylopathies
spondylitis
ankylosis
enthesitis
Stiffness or fixation of a joint by disease or surgery best describes
spondylopathies
spondylitis
ankylosis
enthesitis
The site where a tendon or ligament inserts into a bone is called a
enthesis
spondylosis
ankylosis
spondylopathy
Inflammation of the pigmented middle eye layer is called
uveitis
oclurlitis
Ankylosing spondylitis has exacerbations and remissions
true
false
Back pain from ankylosing spondylitis is worse with activity
true
false
ankylosing spondylitis can be misdiagnosed as a
sprain
strain
tear
spasm
When is back stiffness worse for people with ankylosing spondylitis
morning
post-rest
post-activity
prolonged standing
Pain with ankylosing spondylitis is localted in the lumbarsacral region. Where else can it refer pain/cause discomfort?
posterior thigh
buttocks
hips
knee
Ankylosing spondylitis begins bilaterally at the SI's. it moves ____ to smaller joints. Creating progressive spinal fushion
superiorly
posteriorly
inferiorly
anteriorly
Enthesitis occurs to the inf/sup facet joints + IVD attachements. What happens after?
pain
inflammation
calcification
posterior spinal fusion
eventual anterior fusion
What are the bony protuberances called at the site of ligament attachments
epicondyle
condyle
syndesmophytes
ankylosis
Ankylosing spondylitis can contribute to
thoracic kyphosis
lumbar lordosis
cervical lordosis
Which larger synovial joints could be effected by ankylosing spondylitis
shoulder
knee
hip
ankle
The spine during ankylosing spondylitis fuses in what position with the absense of joint movement
flexion
sideflexion
extension
rotation
What could occur as a result of ankylosing spondylitis
difficulty looking ahead and maintaining balance while walking
osteoporosis
increased fracture risk
hip degeneration/hip OA
Acute anterior uevitis, the most common extraskeletal manifestation of AS can create what problems for the client
blurred vision
dizziness
pain
reddness
What systemic clinical manifestations
weight loss
fever/fatigue
flexion contracture of diaphram
heart and lung constriction in thorax
What would an X-Ray of ankylosing spondylitis show
rigid bamboo like spine
crooked spine (mild scoliosis)
posterior projecting vertebrae
What are lab tests looking for when diagnosing ankylosing spondylitis
Increased ESR
C-Reactive Protein
osteophyte formation
If the nerve root is affected from ankylosing spondylitis. What is the name of the surgery to relieve it
lobotomy
laminectomy
DREZ procedure
What peripheral joint replacement would best help a client with ankylosing spondylitis
hip
knee
shoulder
ankle
What are some good treatments for clients with ankylosing spondylitis
swimming
diaphramatic breathing
ROM exercises
extensor streghtening
How should a client with ankylosing spondylitis sleep
supine
side lying
on hard mattress
small or no pillow
on soft mattress
Which medication class for clients with ankylosing spondylitis best decreases pain, inflammation, and spams
NSAID's
DMARD's
AntiTNF
What ankylosing spondylitis medication is best used for peripheral joint symptoms (eg. methotrexate)
NSAID's
DMARDs
Anti-TNF
What medication class for clients with ankylosing spondylitis is best used to help decrease axial and peripheral joint symptoms
NSAIDs
DMARDs
Anti-TNF
