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MSK Week 2 2017/18 > 4: Connective tissue diseases 1 > Flashcards

4: Connective tissue diseases 1 Flashcards

1
Q

Most connective tissue diseases are ___ diseases.

A

autoimmune

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2
Q

Connective tissue diseases often affect multiple ___.

A

systems

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3
Q

What are some examples of CTDs?

A

SLE

Sjogren’s syndrome

Systemic sclerosis

Dermatomyositis

Polymyositis

Anti-phospholipid syndrome

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4
Q

Do connective tissue diseases affect connective tissue?

A

No

autoimmune disease - antibodies

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5
Q

In connective tissues diseases, the immune system attack cells (in one place / all over the body).

A

all over the body

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6
Q

Connective tissue diseases are more common in (men / women).

A

women

as with all autoimmune diseases

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7
Q

What four factors are thought to cause connective tissue diseases?

A

Genetics

Environment

Faulty immune system

Hormones

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8
Q

Which hormone is linked to the onset of CTDs?

A

Oestrogen

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9
Q

Which virus is associated with lupus?

A

Epstein-Barr virus

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10
Q

What environmental factors are linked to lupus?

A

UV exposure

Cigarette smoking

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11
Q

Although lupus is less common in men, it tends to be more ___.

A

severe

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12
Q

Which immune cells are antigens presented to?

A

T cells

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13
Q

In lupus, apoptotic cells aren’t cleaned up and their contents float around for longer than normal.

What is the consequence of this?

A

Immune system recognises nuclear material as foreign antigen

Nuclear material presented to T cells, which activate B cells

Production of autoantibodies

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14
Q

In lupus, the immune system treats self nuclear material as an antigen.

Which processes occur?

A

Cytokines released

Complement released

Inflammation

Necrosis

Scarring

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15
Q

Which system is asymptomatic when it’s being messed up by lupus?

A

Renal

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16
Q

What are deposited in the kidneys and the skin in lupus?

A

Immune complexes

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17
Q

In lupus, immune complexes get lodged in endothelial walls - what happens next?

A

Immune response - complement released, acute inflammation

Endothelial damage

Leaky vessels

Oedema

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18
Q

What is a very common symptom of lupus?

A

Rash

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19
Q

What are general symptoms of lupus?

A

Fever

Weight loss

Fatigue

Anorexia

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20
Q

What does a malar rash look like?

A

Butterfly rash on face associated with UV exposure

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21
Q

What aspect of the face is spared by lupus?

A

Naso-labial folds

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22
Q

___ - the tendency to burn easily - is a skin symptom of SLE.

A

Photosensitivity

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23
Q

What hair condition is associated with lupus?

A

Alopecia

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24
Q

Which lesions appear in the oral and nasal mucosa in some cases of SLE?

25
An MSK symptom of lupus is ___ \_\_\_ with no actual joint damage.
**joint pain**
26
What is serositis?
**Inflammation of a lining** e.g pleura, pericardium...
27
Serositis secondary to lupus often presents as what?
**Pericarditis / Pericardial effusion** **Pleurisy / Pleural effusion**
28
What is a renal **sign** of lupus?
**Proteinuria** elevated levels of protein in the urine
29
After a **positive urinalysis**, what is done to **confirm** that someone has renal disease secondary to lupus?
**Renal biopsy**
30
Lupus can also cause what brain-related disease?
**Neurological disease**
31
Name three **haematological** signs of lupus you might see on a FBC.
**Anaemia** - low RBCs **Thrombocytopaenia** - low platelets **Leukopaenia** - low white blood cells (i.e immune cells)
32
Which structures are often enlarged in lupus?
**Lymph nodes**
33
Which syndrome, associated with lupus, causes hypercoagulability and may result in thrombosis and recurrent miscarriage?
**Anti-phospholipid syndrome**
34
People with lupus are more susceptible to \_\_\_. Why?
**infection** through the haem effects of the disease itself AND the immunosuppressive drugs used to treat it
35
How is suspected SLE diagnosed?
**Autoantibody tests**
36
Most people with lupus are positive for which antibody?
Anti-nuclear antibody (ANA)
37
ANA is a **(specific / non-specific)** antibody for lupus.
**non-specific** found in other autoimmune diseases, RA, HIV, Hep C....
38
Apart from ANA, what other autoantibodies are associated with lupus?
**Anti-dsDNA** (anti double stranded DNA antibody) **Anti-Sm** **Anti-Ro** (non-specific for lupus but uncommon) **Anti-RNP**
39
Which antibodies are **highly** specific for lupus?
**Anti-dsDNA** **Anti-Sm**
40
The higher the titre of anti-dsDNA, the more **(active / inactive)** the disease.
**active**
41
Babies of mothers who are anti-Ro positive may present with what?
**Neonatal lupus** of which **heart block** is a significant feature
42
Which autoantibodies are found in anti-phospholipid syndrome?
**Anti-cardiolipin antibody** **Lupus anticoagulant** **Anti-beta 2 glycoprotein**
43
Once you've diagnosed someone with lupus, what must you do?
**Screen every other system**
44
What's the most appropriate first screening test in someone newly diagnosed with lupus?
**Urinanalysis** for renal disease
45
What are the two **inflammatory markers** which rise in people with **rheumatoid** conditions?
**CRP** **PV**
46
Does CRP rise in flare ups of lupus?
**NO**
47
When may CRP be raised in a lupus patient?
**Infection** **Co-existing inflammatory disease** e.g RA
48
Which changes in two markers indicate a flare up of lupus?
**INCREASED anti-dsDNA** (antibody associated with active disease) **DECREASED in C4** (complement being used up)
49
In a flare up of lupus, the level of anti-dsDNA **(increases / decreases)**.
increases
50
In a flare up of lupus, the level of complement **(increases / decreases)**.
**decreases**
51
SLE tends to get **(better / worse)** during pregnancy.
**worse**
52
Patients with lupus are advised to avoid excessive __ \_\_.
**sun exposure** because it causes photosensitivity
53
Which drugs are used to treat lupus?
**1. NSAIDs, analgesics, HYDROXYCHLOROQUINE** **2.** **Steroids** **Immunosuppressants** (mycophenolate mofetil, cyclophosphamide, methotrexate, azathioprine) **Biologic agents**
54
If all your drugs aren't controlling lupus symptoms, which drugs can you use?
**Biologic agents**
55
Which DMARD is used first to treat lupus?
**Hydroxychloroquine**
56
What are the immediate tests for someone who has suspected SLE?
**Urinalysis** **Antibodies and complement**
57
Does a positive ANA guarantee lupus?
**No**
58
What is the **most common presentation of SLE** and who has it?
**Fever, joint pain and a rash** In a **woman of childbearing age**
59
What is the typical distribution of **joint pain** seen in **SLE?**
**Symmetrical polyarthritis affecting the small joints of hands and feet**

MSK Week 2 2017/18 (11 decks)

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