MSK 2 > McGowan > Flashcards

McGowan Flashcards

(44 cards)

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1
Q

what titer level of ANA is normal/negative

A

-<1:40 . .. so higher ration like 1:160 is +

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2
Q

Homogenous ANA staining

A

Drug induced SLE

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3
Q

Speckled staining pattern of ANA

A

Sjogren’s

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4
Q

Centromere ANA staining pattern

A

-Limited systemic sclerosis (CREST)

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5
Q

Nucleolar ANA staining pattern

A

-Diffuse Systemic sclerosis

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6
Q

multisystem involvement of SLE

A
  • butterfly rash
  • Pleural effusions
  • Heart problems
  • Lupus nephritis
  • arthritis
  • Raynaud’s
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7
Q

Serology of SLE?

which correlates with disease activity

A
  • ANA
  • Anti-ds DNA (DISEASE ACTIVITY)
  • Sm
  • low C3 and C4: increased consumptions
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8
Q

SLE and anti-phospholipid antibody syndrome (APS)

A
  • 1/3 of SLE pts have APS

- treat with anticoagulation

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9
Q

what are the 3 types of antiphospholipid antibodies

A
  • type 1: causes biologic false + syphilis test
  • type 2: Lupus anticoagulant- risk factor for venous and arterial thrombosis and miscarriage, prolongs aPTT, presence confirmed by an abnormal Russel viper venom time (RVVT)
  • Type 3: anti cardiolipin antibodies (beta2GPI)
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10
Q

Cotton wool spots

A

SLE/APS retinopathy

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11
Q

serology for drug induced lupus like syndrome

A
  • ANA

- Anti-histone antibodies

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12
Q

Neonatal lupus affects children born of mothers with what Abs

A
  • Ro (SSA)

- La (SSB)

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13
Q

major complication of Neonatal Lupus

A

-permanent complete heart block

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14
Q

Treatment of SLE

A
  • Avoid sun exposure, wear sunscreen
  • NSAIDs
  • Corticosterioids
  • Hydroxychloroquine
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15
Q

what type of hypersensivity is SLE

A
  • type 3

- immune complex mediated

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16
Q

hallmark of Scleroderma (systemic sclerosis)

A
  • thickening and hardening of the skin

- microangiopathy and fibrosis of the skin and visceral organs

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17
Q

3 types of scleroderma

A
  • Diffuse
  • Limited (CREST: calcinosis cutis, Raynauds secondary, esophageal dysmotility, sclerodactyly, telangiectasia)
  • Localized
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18
Q

Serology for Diffuse scleroderma

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A
  • Anti-Scl 70 aka anti DNA topoisomerase I

- Anti-RNA polymerase III

19
Q

Serology for Limited cutaneous scleroderma

Study These Flashcards
A

-Anti-centromere

20
Q

GI effects of scleroderma

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A
  • malnutrition: fat, protein, B12, and vitamin D deficiency
  • GERD –>Barrett Esophagus –> increased risk of esophageal adenocarcinoma
  • GAVE aka watermelon stomach
21
Q

pulmonary effects of scleroderma

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A
  • primary cause of morbifity and mortality
  • interstitial lung disease: diffuse . .dry Velcro crackles
  • Pulmonary artery HTN: limited
  • right heart cath to confirm dx
  • increased incidence of bronchoalveolar carcinoma
22
Q

Renal effects of scleroderma

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A
  • Chronic kidney disease
  • Renal crisis uncommon but life threatening: abrupt onset of malignant HTN, hemolytic anemia, and progressive renal insufficiency
  • more common in DIFFUSE scleroderma
  • Treatment: avoid high dose corticosteroids
23
Q

MSK and other effects of scleroderma

Study These Flashcards
A
  • Carpal tunnel syndrome

- Hypothyroid from thyroid fibrosis

24
Q

highlights for Sjogren

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A
  • Sicca symptoms (immune mediated dysfunction of lacrimal and salivary glands
  • Keratoconjunctivitis sicca (foreign body sensation-inadequate tear production)
  • Strone association with B cell non Hogkin lymphoma
25
Lip biopsy in Sjogren
- characteristic lymphoid foci in accessory salivary glands | - essential for diagnosis
26
Serology for Sjogren-
- ANA - RF - Hypergammaglobulinemia - anti SSA/Ro: may lead to newborn complete heart block - Anti SSB/La: never present without Ro
27
Highlights for inflammatory myopathies
- Symmetrical bilateral proximal muscle weakness: difficulty rising from chair or bathtub or climbing stairs - elevated CK and aldolase - characteristic muscle biopsy
28
Highlights for Dermatomyositis
- Heliotrope rash - "shawl sign": erythema over neck/shoulders, upper chest and back - increased risk of occult MALIGNANCY - Dx: biopsy-perimysial and perivascular inflammation . . Perifascicular atrophy
29
serology for Dermatomyositis
- Elevated CK, aldolase | - Anti Jo-1, anti-Mi2, and anti-MDA5, anti-P155/140
30
Malignancies and Dermatomyositis
- Ovarian most common | - check transvaginal US, CT abd/pelvis, CA-125
31
highlights for polymyositis
- NO skin changes like Dermatomyositis - elevated CK - Anti-Jo-1 - muscle bx: endomysial inflammation
32
management of dermatomyositis and polymyositis
Corticosteroids
33
highlights for inclusion body myositis
- Males more - Finger flexion and quad weakness - CK is mild elevation or normal - Muscle bx: endomysial inflammation, RIMMED VACUOLES, invasion of non-necrotic muscle fibers, ANTI-cN1A autoantibodies
34
highlights for Takayasu Arteritis
- Asian less than 40 - Large vessel - long smooth tapered stenosis - "pulseless disease": obliterate UE peripheral pulses, collaterals so limb loss from ischemia is rare - Diagnosis: MRI or CT angiography - Histology: granuloma with some giant cells - Tx: Glucocorticoids
35
highlights for Behcet Syndrome
- Silk route: Turkey, Asia, Mid East - HLA-B51 - Triad: recurrent mouth ulcers, genital ulcers, eye inflammation (uveitis) - Large vessel=aneurysm - Venous involvement: DVT - Pathergy: pustules at site of sterile needle pricks - 50% pulmonary involvement - Retinopathies
36
highlights for Polyarteritis Nodosa
- associated with HBV - males more - 80% have vasculitis neuropathy . .foot drop - LUNGS SPARED - Bx: infiltration and destruction of blood vessels by inflammatory cells-->fibrinoid necrosis, NO granulomas - Angiogram: micro aneurysm - ANCA negative, check HBsAg and HBeAg
37
highlights for Kawasaki
- <5yr - Asian - "mucocutaneous lymph node syndrome" - "strawberry tongue" - Death: from coronary involvement (aneurysm or MI-can occur years later) - Tx: IVIG w/in 10 days of sxs and high dose ASA . . YES ASPIRIN in a pediatric pts
38
highlights for Granulomatosis with polyangiitis: aka Wegener's Granulomatosis
- C-ANCA aka PR3-ANCA - respiratory tract (Saddle nose) - Chest XR: cavitary lesions - kidney involvement - Hallmarks: Granulomatous inflammation, Necrotizing vasculitis, Segmental Glomerulonephritis
39
highlights for Eosinophilic Granulomatosis with polyangiitis aka Churg-Strauss Syndrome
- ANCA + in 50% . .typically MPO-ANCA - Granulomas with eosinophilia - Hallmarks: asthma + eosinophilia
40
Highlights for Thromboangiitis Obliterans aka Buerger Disease
- young males <35 - only occurs in smokers - Dx: angiography-"corkscrew" appearance - Tx: STOP SMOKING
41
Secondary Raynaud
- more severe than primary . .ischemia - unilateral (primary is bilateral) - Nailfold Capillaroscopy: distorted with widened and irregular loops, dilated lumen and areas of vascular "dropout" . . normal in primary
42
what frequently occurs with polymyalgia Rheumatica
Giant cell arteritis aka Temporal Arteritis
43
highlight for Giant Cell arteritis aka Temporal Arteritis
- Cranial arteries (temporal/facial/ophthalmic) - Aortic arch - Headache, Jaw claudication, visual abnormalities - super high ESR . . >50 mm/h - HLA-DR4 - associated with polymyalgia rheumatic - Temporal artery bx (gold standard for dx: need a 1 cm segment) - multinucleated giant cells - Start corticosterioids before biopsy .. if no treatment then blindness
44
highlights for polymyalgia Rheumatica
- Associated with giant cell arteritis - Stiffness, soreness and pain - weakness as result of pain - NO inflammation on muscle bx - muscle enzymes and EMG normal - elevated ESR and CRP
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