Approach To Malaise And Generalized Pain Flashcards

1
Q

What clinical markers are present in Lupus like syndrome/drug-induced

A

+ANA

+Anti histone antibody

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2
Q

What causes a drug induced SLE?

A
Sulfa drugs 
Hydralazine
Isoniazid 
Minocycline 
TNF Inhibitors
Quinidine
Chlorpromazine
Methyldopa
Procainamide
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3
Q

What antibodies is neonatal lupus associated with?

A

Anti Ro or La Abs

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4
Q

What is the treatment for SLE?

A

Avoid sun
NSAIDS
Corticosteroids
Hydroxychloroquine

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5
Q

What causes mortality in the early years after diagnosis of SLE?

Later years?

A

Infections - opportunistic
Kidney or CNS

Accelerated atherosclerosis - MI
Thromboembolic events

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6
Q

How do you manage SLE patients?

A

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

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7
Q

What type of hypersensitivity is SLE?

A

TYPE III

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8
Q

What is the treatment of discoid lupus?

A

Photo protection + topical anti-inflammatory agents of systemic antimalarial drugs

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9
Q

What is the hallmark of scleroderma?

A

Thickening and hardening of the skin (fibrosis of the skin and visceral organs)

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10
Q

What causes the dry itchy skin in scleroderma?

A

Obliteration of eccrine sweat and sebaceous glands

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11
Q

What are the three forms of scleroderma?

A

Diffuse

Limited (Crest syndrome)

Localized

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12
Q

What is a manifestation of limited scleroderma?

A

Pulmonary HTN

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13
Q

What is a manifestation of diffuse scleroderma?

A

Interstitial lung disease

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14
Q

What does CREST stand for?

A
Calcinosis cutis 
Raynauds 
Esophageal dysmotility 
Sclerodactylyl 
Telangectasia
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15
Q

Is renal crisis common in limited scleroderma?

A

No

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16
Q

What is the primary cause of morbidity and mjortality in scleroderma?

A

Pulmonary disease

Interstitial lung disease seen in diffuse
Pulmonary artery hypertension seen in limited

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17
Q

How do you diagnose PAH?

A

A mean pulmonary arterial pressure of 25 mmHG OR GREATER

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18
Q

How do you confirm diagnosis of PAH?

A

Right heart catheter

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19
Q

Which cancer shows an increased incidence in scleroderma?

A

Bronchoalveolar carcinoma

Esophageal adenocarcinoma

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20
Q

What is the diagnostic work up for scleroderma?

A
Blood pressure 
ESR 
ANA 
UA 
CXR 
Barium swallow 
Echo
PFT 
Skin biopsy 
Serology
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21
Q

What is the serology for Scc (diffuse and limited)?

A

Diffuse - anti Scl 70, anti RNA polymerase III

Limited - +anti centromere

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22
Q

How do we treat Scc?

A

Treat the symptoms

CCB 
ACE inh 
Anti reflux 
Glucocorticoids 
Cyclophosphamide 
PDE inh
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23
Q

What is an adverse affect of high dose corticosteroids?

A

Renal crisis

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24
Q

What is the limited Scc characterized by?

A

Benign skin condition of discreet areas of discolored skin induration

Morphea (patches)

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25
Q

What are the manifestations of sjogren?

A
Dry eyes 
Dry mouth 
Vaginal dryness 
Tracheobronchial dryness 
Parotid enlargement
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26
Q

What is keratoconjunctivitis sicca?

A

Inadequate tear production causing a foreign body sensation

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27
Q

What cancer is sjogrens associated with?

A

B Cell NHL (Maltoma)

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28
Q

What is the serology work up for sjogrens?

A
\+anti SSA/Ro 
\+anti SSB/La
Low C4 
Hypergammaglobulinemia 
High ESR 
\+RF 
\+ANA
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29
Q

Treatment of sjogrens?

A

Treat symptoms

Eye lubricants
Frequent water
Hydrdoxychloroquine
Glucocorticoids

Avoid atropine drugs and decongestants

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30
Q

how do you characterize the muscle involvement in inflammatory myopathies?

A

Symmetrical proximal muscle weakness

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31
Q

What are the four key skin features of dermatomyositis?

A

Gottron’s patches
Heliotrope rash
Periungual erythema
V neck Erythema

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32
Q

What is the muscle biopsy finding in dermatomyositis?

A

Perimysial and perivascular inflammation, perifascicular atrophy

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33
Q

What is seen in labs for Dermatomyositis?

A

Elevated CK and aldolase

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34
Q

What is seen on serology of dermatomyositis?

A

Anti Jo 1
Anti Mi2
Anti MDA5
Anti P155/P140

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35
Q

What malignancies are associated with dermatomyositis?

A
Ovarian (check CA 125) 
Lung 
Pancreatic 
Stomach 
Colorectal 
NHL
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36
Q

What is seen on the biopsy for polymyositis?

A

Endomysial inflammation with invasion of non necrotic muscle fibers

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37
Q

What is seen on labs for polymyositis?

A

Elevated CK

38
Q

What is seen on serology for polymyositis?

A

Anti Jo1

39
Q

What is the treatment for dermatomyositis and polymyositis? **

A

Corticosteroids

40
Q

What is the characteristic muscle weakness in inclusion body myositis?

A

Finger flexion or quadriceps weakness

41
Q

What is seen on biopsy of inclusion body myositis?

A

Endomysial inflammation, rimmed vacuoles, invasion of non necrotic muscle fibers

42
Q

What is seen on labs of IBM?

A

Elevated CK

43
Q

What is seen on serology of IBM?

A

Anti cN1A autoantibodies

44
Q

What is the treatment of IBM?

A

Supportive

45
Q

How do you diagnose Henoch schonlein purpura?

A

IgA deposits on biopsy

46
Q

How do you treat HSP?

A

Glucocorticoids

47
Q

How do you diagnose Goodpastures?

A

Biopsy shows anti basement membrane autoantibodies in basement membrane

48
Q

What causes the hypertension in Takayasu arteritis?

A

Renal artery stenosis

49
Q

How do you diagnose takayasu arteritis?

A

MRI or CT angiography

Biopsy shows granulomas with giant cells

50
Q

How do you treat takayasu arteritis?

A

Glucocorticoids

51
Q

What is the triad in Behcet syndrome?

A

Recurrent mouth ulcers
Genital ulcers
Uveitis

52
Q

What HLA for Behcet syndrome ?

A

HLA B51

53
Q

What is the treatment of Behcet?

A

Low dose GC

54
Q

What is polyarteritis nodosa characteristically assoc. with?

A

Hep B virus

55
Q

What is seen on biopsy for PAN?

A

FIBRINOID NECROSIS

56
Q

What is seen on serology for PAN?

A

P ANCA

57
Q

Tx of PAN ?

A

Corticosteroids

58
Q

What do patients die from in Kawasaki disease?

A

Coronary involvement

Aneurysm or MI

59
Q

What is the tx of Kawasaki disease?

A

IVIG and high dose ASA

60
Q

What is seen on serology for Wegeners granulomatosis?

A

C ANCA

61
Q

What is the hallmark of Wegeners?

A

Granulomatous inflammation

62
Q

What is the tx of Wegeners?

A

Cyclophosphamide and high dose GC or rituximab

63
Q

What are the hallmarks of Churg Strauss syndrome?

A

Asthma + eosinophilia -> vasculitis with granulomas

64
Q

How do you make the diagnosis of Churg Strauss?

A

MPO ANCA

65
Q

How do you treat Churg Strauss?

A

GC

66
Q

Who is affected by Buerger disease?

A

Smokers

67
Q

How do you make the diagnosis of Buerger disease?

A

Angiography corkscrew appearance

68
Q

Treatment of Buerger disease?

A

Smoking cessation

69
Q

How does temporal(giant cell) arteritis present?

A

Headache, jaw claudication, visual abnormalities (amaurosis fugax or diplopia)

70
Q

What HLA is associated with temporal arteritis?

A

HLA DR4

71
Q

How do you diagnose temporal arteritis?

A

Temporal artery bx

1.0 cm segment biopsy will show segmental granulomatous vasculitis with multinucleated giant cells

72
Q

How do you treat temporal arteritis?

A

Corticosteroids therapy before biopsy

73
Q

What is polymyalgia rheumatica (PMR) associated with?

A

Temporal/giant cell arteritis

74
Q

How do you diagnose PMR?

A

Elevated ESR and CRP

75
Q

How do you treat PMR?

A

Corticosteroids

76
Q

How do you diagnose secondary raynauds?

A

Nailfold capillaroscopy

77
Q

What serology marker can we use to identify an autoimmune disease?

A

+ANA

78
Q

What is the clinically significant ratio of ANA?

A

1:160

79
Q

What are the four ANA patterns?

A

Homogenous
Speckled
Centromere
Nucleolar

80
Q

What staining pattern does CREST show?

A

Centromere pattern

81
Q

Which staining pattern does drug induced SLE show?

A

Homogenous

82
Q

Which staining pattern does Sjögren’s syndrome show?

A

Speckled mostly but can also be homogenous

83
Q

What staining pattern does diffuse systemic sclerosis show?

A

Nucleolar pattern (more than the others) can also be speckled

84
Q

What do the sx of malaise, malar rash, photosensitivity, symmetric inflammatory arthritis, thrombosis, pancytopenia, pericarditis, seizures and psychosis indicate ?

A

SLE

85
Q

Antibodies in SLE include what? (3)

A

ANA, anti-ds DNA, anti Sm (smith)

86
Q

Which antibody present in SLE correlates with disease activity?

A

Anti-ds DNA

87
Q

What happens to complement levels in SLE?

A

Decreased C3 and C4

88
Q

Which type of APA syndrome can cause biological false positive tests for syphilis?

A

Type one

89
Q

Which type of APA syndrome can cause lupus anticoagulant and is a risk factor for venous and arterial thrombosis and miscarriage ?

A

Type two

90
Q

Which type of APA syndrome can cause anti cardiolipin antibodies?

A

Type three

91
Q

What are anti cardiolipin antibodies directed at?

A

Beta 2 GPI

92
Q

What is the treatment for APA syndrome?

A

Anticoagulation