CT Diseases Flashcards
What is a normal titer of ANA and what level do we say it’s clinically significant?
Less than 1:40
1:160
When I say the following staining pattern for ANA what disease comes to mind? Homogenous/diffuse? Speckled? Centromere? Nucleolar?
Drug Induced Lupus
Sjogren
CREST
Diffuse systemic sclerosis
Characterize SLE? What type of hypersensitivity run? Gender and Race more commonly affected? 6 clinical signs? 4 lab markers?
Autoimmune inflammatory disorder with autoantibodies against uncle antigens with B and T cells kick A
3 because its immune complex
Female and AA and Hispanics
Heart problems, plural effusions, lupus nephritis, arthritis, raynauds, butterfly rash
ANA, anti DS DNA, Smith, c3 and c4 down because of consumption
1/3 of patients with SLE can also have secondary what?
What are the 3 antibodies of this condition?
Antiphospholipid syndrome
- Causes biologic false positive for syphlysis
- Lupus anticoagulant which is a risk factor for clots
- Anti cardiolipin antibodies against beta 2 GP1
What remains the standard of care for antiphospholipid syndrome?
What do we do for pregnant ladies?
Start LMW heparin first then bridge to vitamin K antagonists (warfarin/Coumadin)
LMW heparin (enoxaparin) + aspirin.
What is a clinical sign she wants us to know for SLE/APS?
Retinopathy shows by cotton wool spots
What are the two antibodies for drug induced lupus and what antibiotics cause SLE flare ups?
ANA and anti histone antibodies
Sulfa
What two antibodies do we identify with neonatal lupus and what clinical condition does the neonate have permanently?
Anti RO (ssa) or LA (SSB) Permanent complete heart block
4 things to treat SLE?
Sun screen
NSAIDS
Corticosteroids
Hydroxychloroquine
3 causes of death in the early years for SLE?
2 common causes of death in later years of SLE?
Infections, kidney and CNS
Atherosclerosis, leading to MI, and thromboembolic events
Lifestyle mod these SLE people need to make?
3 cancers associated with SLE?
What is one conditions she said is responsible for substantial morbidity in SLE?
No smoking
Lymphoma, lung cancer, cervical cancer
Avascular necrosis of bone.
What is one of the most common heart related manifestations of lupus?
Libman-Sacks endocarditis, which is non bacterial.
Most commonly affects the mitral valve.
What two conditions does discoid lupus look like?
Ring worm and psoriasis
What are the two hallmark of scleroderma?
6 areas of the body that are affected?
What secondary condition is seen in almost all patients?
Why do they present with dry skin?
Thickening and hardening of skin, so systemic sclerosis AND microangiopathy and fibrosis of skin and visceral organs.
Skin, lungs, GI, heart, MSK, kidney.
Raynauds
Loss of sweat and sebaceous glands.
What are the 3 types of scleroderma and explain the importance of each?
- Diffuse: all over including proximal limbs and trunk. Early internal organ involvement. Worse prognosis.
- Limited: distal limbs, face and neck. Raynauds usually first symptom. CREST: calcium in skin, raynauds, esophageal problems, sclerodactyly, telangiectasia. Pulmonary HTN. Good prognosis.
- Localized: children, no raynauds, no systemic, morphea patches.
