Autoimmune

Question 1

Define sarcoidosis
Give signs in the following in sarcoidosis:
- General (3)
- Pulmonary (2)
- Musc (1)
- Eyes (2)
- Skin (2)
- Cardio (2)

Answer 1

• Multisystem granulomatous inflammatory disorder characterised by presence of non-caseating granulomas.
• Fever, malaise, weight loss
• SOB, cough
• Arthralgia
• Uveitis, keratoconjunctivits
• Lupus pernio (pathognomic), erythema nodosum
• Arrhythmia, HF.

Question 2

Give 3 blood test findings in sarcoidosis.
Give 2 CXR findings
Give biopsy finding.
Give 3 medical managements.

Answer 2

• high calcium, high ESR, high ACE
• Bihilar lymphadenopathy, pulmonary infiltration/ fibrosis.
• Non-caseating granuloma
• Steroids, NSAIDs, Steroid-sparing agents.

Question 3

Give the symptoms of SLE according to mnemonic SOAP BRAIN MD

Answer 3

• Serositis
• Oral ulcers
• Arthritis
• Photosensitivity
• Bloods- low counts
• Renal- proteinuria, casts
• ANA antibodies
• Immunological: anti-dsDNA
• Neurological- psychosis, seizures.
• Malar rash
• Discoid rash

Question 4

Give 3 blood tests for SLE.

Give 3 autoantibodies in SLE

Answer 4

• High ESR, U&E, FBC

- Autoantibodies: ANA, anti-dsDNA, anti-Cardiolipin.

Question 5

What is anti-phospholipid syndrome a complication of?
What is the triad of symptoms?
Which autoantibody is present?

Answer 5

• Complication of SLE
• Thromboembolism, recurrent miscarriage, thrombocytopenia.
• anti-cardiolipin autoantibody.

Question 6

Diffuse cutaneous systemic sclerosis (diffuse scleroderma). Give 3 signs
- Give antibody present.

Answer 6

• Raynaud’s phenomenon
• Trunk skin changes
• Tendon friction.
  Also have GI, heart and renal and early lung disease.
• Autoantibody: anti-topoisomerase II (anti-scl-70)

Question 7

In Limited Cutaneous Systemic Sclerosis (limited scleroderma) what are the CREST symptoms?

What autoantibody is present?

Answer 7

• Calcinosis
• Raynaud’s phenomenon
• Esophageal dysmotility
• Sclerodactyly- thickening of finger skin
• Telangiectasia

Anti-centromere.

Question 8

Which condition is Giant Cell arteritis (Temporal arteritis) associated with?
What type of vasculitis is it?

Answer 8

• Associated with polymyalgia rheumatica: shoulder/ pelvic girdle pain
• Large vessel vasculitis.

Question 9

Give 5 symptoms of giant cell arteritis

Answer 9

• Unilateral headache
• Jaw claudication
• Scalp tenderness
• Loss of vision
• Systemic upset.

Question 10

Give 2 investigations for temporal arteritis.

What is medical management of temporal arteritis.

Answer 10

• Raised ESR- check ESR before steroids.
• Temporal artery biopsy- not 100% sensitive.
• High dose oral prednisolone.

Question 11

Give 2 symptoms of polymyalgia rheumatica
Give 2 blood test findings
What is the management?

Answer 11

• Bilateral shoulder or pelvic pain
• Morning stiffness
  NB: no weakness, chronic.
• Raised ESR/ CRP
• oral steroids.

Question 12

What infection is polyarteritis nodosa associated with?
What type of vasculitis is PN?
Give up to 6 symptoms.
What sign is seen on angiogram?

Answer 12

• Associated with hepatitis B
• Medium vessel vasculitis.
• Constitutional upset
• Skin rash
• Abdominal pain
• Rectal bleeding
• Peripheral neuropathy
• Renal failure and HTN.

Rosary sign on angiogram.

Question 13

Give the triad of symptoms of granulomatosis with polyangiitis (Wegener’s)
What happens to the face?

Answer 13

• Upper respiratory tract: rhinitis, nose bleeds
• Lower respiratory tract: haemoptysis
• Kidneys: glomerulonephritis
• Destruction of the face: saddle nose

Question 14

Give antibody found in granulomatosis with polyangiitis (Wegener’s).
What is seen on CXR?

Answer 14

• cANCA

- Cavitating lesions.

Question 15

Give the triphasic signs of Eosinophilic Granulomatosis with Polyangiitis- Churg-Strauss syndrome.

Answer 15

• Allergic: asthma/ rhinits
• Eosinophilic: high eosinophils, mainly lungs and GIT
• Vasculitic: can lead to organ damage and death.

Other symptoms: haemoptysis, rash, focal neuropathy, kidney damage.

Question 16

What antibody is found in Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)?

Answer 16

• pANCA

Question 17

Which HLA is associated with Behcet’s disease.
What is the triad of symptoms for Behcet’s disease.
Give 2 other symptoms.

Answer 17

• HLA- B51
• Recurrent oral ulcers, genital ulcers, Uveitis
• Rash, arthritis, pericarditis, colitis.

Question 18

Give investigation for behcet’s disease.

Answer 18

Pathergy test- needle prick becomes inflamed and sterile pustule develops in 48 hours.

Question 19

What is Takayasu’s arteritis?

What are the two phases?

Answer 19

• Large vessel vasculitis
• Targets branches of the aortic arch
  Affects Asian women 20-40yrs.
• Inflammatory phase: FLAWS
• Pulseless phase: weak/ absent limb pulses. Claudication.

Question 20

What population is affect by Henoch-Schönlein Purpura?
What type of vasculitis is it?
What is the triad of symptoms?

Answer 20

Affects 3-15yr old children. IgA vasculitis.
- Purpuric rash on buttocks and LL extensor surface
- Abdominal pain
- Arthralgia
Oedema

Question 21

Which antibody is found in Goodpasture’s syndrome?

What is the triad of Goodpasture’s syndrome.

Answer 21

Anti-GBM antibodies.

• Glomerulonephritis
• Haemoptysis- pulmonary haemorrhage.
• Anti-GBM antibodies.