Approach To Malaise And Generalized Pain Flashcards
What clinical markers are present in Lupus like syndrome/drug-induced
+ANA
+Anti histone antibody
What causes a drug induced SLE?
Sulfa drugs Hydralazine Isoniazid Minocycline TNF Inhibitors Quinidine Chlorpromazine Methyldopa Procainamide
What antibodies is neonatal lupus associated with?
Anti Ro or La Abs
What is the treatment for SLE?
Avoid sun
NSAIDS
Corticosteroids
Hydroxychloroquine
What causes mortality in the early years after diagnosis of SLE?
Later years?
Infections - opportunistic
Kidney or CNS
Accelerated atherosclerosis - MI
Thromboembolic events
How do you manage SLE patients?
Minimize other conventional risk factors for atherosclerosis
Avoid smoking
Flu vaccines
Pneumococcal vaccines
Cancer screenings (increased risk of malignancy)
Consider avascular necrosis of the bone due to corticosteroid use
What type of hypersensitivity is SLE?
TYPE III
What is the treatment of discoid lupus?
Photo protection + topical anti-inflammatory agents of systemic antimalarial drugs
What is the hallmark of scleroderma?
Thickening and hardening of the skin (fibrosis of the skin and visceral organs)
What causes the dry itchy skin in scleroderma?
Obliteration of eccrine sweat and sebaceous glands
What are the three forms of scleroderma?
Diffuse
Limited (Crest syndrome)
Localized
What is a manifestation of limited scleroderma?
Pulmonary HTN
What is a manifestation of diffuse scleroderma?
Interstitial lung disease
What does CREST stand for?
Calcinosis cutis Raynauds Esophageal dysmotility Sclerodactylyl Telangectasia
Is renal crisis common in limited scleroderma?
No
What is the primary cause of morbidity and mjortality in scleroderma?
Pulmonary disease
Interstitial lung disease seen in diffuse
Pulmonary artery hypertension seen in limited
How do you diagnose PAH?
A mean pulmonary arterial pressure of 25 mmHG OR GREATER
How do you confirm diagnosis of PAH?
Right heart catheter
Which cancer shows an increased incidence in scleroderma?
Bronchoalveolar carcinoma
Esophageal adenocarcinoma
What is the diagnostic work up for scleroderma?
Blood pressure ESR ANA UA CXR Barium swallow Echo PFT Skin biopsy Serology
What is the serology for Scc (diffuse and limited)?
Diffuse - anti Scl 70, anti RNA polymerase III
Limited - +anti centromere
How do we treat Scc?
Treat the symptoms
CCB ACE inh Anti reflux Glucocorticoids Cyclophosphamide PDE inh
What is an adverse affect of high dose corticosteroids?
Renal crisis
What is the limited Scc characterized by?
Benign skin condition of discreet areas of discolored skin induration
Morphea (patches)
What are the manifestations of sjogren?
Dry eyes Dry mouth Vaginal dryness Tracheobronchial dryness Parotid enlargement
What is keratoconjunctivitis sicca?
Inadequate tear production causing a foreign body sensation
What cancer is sjogrens associated with?
B Cell NHL (Maltoma)
What is the serology work up for sjogrens?
\+anti SSA/Ro \+anti SSB/La Low C4 Hypergammaglobulinemia High ESR \+RF \+ANA
Treatment of sjogrens?
Treat symptoms
Eye lubricants
Frequent water
Hydrdoxychloroquine
Glucocorticoids
Avoid atropine drugs and decongestants
how do you characterize the muscle involvement in inflammatory myopathies?
Symmetrical proximal muscle weakness
What are the four key skin features of dermatomyositis?
Gottron’s patches
Heliotrope rash
Periungual erythema
V neck Erythema
What is the muscle biopsy finding in dermatomyositis?
Perimysial and perivascular inflammation, perifascicular atrophy
What is seen in labs for Dermatomyositis?
Elevated CK and aldolase
What is seen on serology of dermatomyositis?
Anti Jo 1
Anti Mi2
Anti MDA5
Anti P155/P140
What malignancies are associated with dermatomyositis?
Ovarian (check CA 125) Lung Pancreatic Stomach Colorectal NHL
What is seen on the biopsy for polymyositis?
Endomysial inflammation with invasion of non necrotic muscle fibers