investigations/diagnostic criteria Flashcards
DMS initial Invx
-admission, histo-(LE interface mucin ), DIF(-ve vs LE),
CK aldolase, EMG/muscle bx
DMS diagnostic criteria
amyopathic
clinical+histo+/- myositis(proximal weakness, CK/aldolase
6 mo provisional, 2 y definitive, monitor, anti P155/MDA5
DMS full Invx - overlap, Cx, malignancy
a)CTD:ANA, ENA, dsDNA(overlap) U1RNP
b)Cx: pulm: CXR, anti Jo1(50-70% ILD), PFT(Werth 2010 routine PFT-abn-HRCT)
cardiac: ECG ,antiSRP-cardiac, fulminant
c)malignancy: FBC(Fe def), LFT, UECR/UFEME, CXR,
paraneoplastic screen
paraneoplastic screen
1.Refer ENT(PNS exam/Bx)
2.breast testicular exam/
mammogram/PAP/ US; ca125(ovarian)/PSA,
3. SOBx 3(>45y) AFP(hepatoma), CEA, ca 19-9,
SSc invx
1.Bx- histo
2. gen: FBC, ESR(activity), UEC/UFEME, LFT,
3. spec: SSc: ANA(50%morphea-chronic; 90% scleroderma-nucleolar*speckled homogenous), anti scl70(20%,DNA topoisomerase1) anti centromere(CREST)
4.Cx: CK, aldolase(myositis) CXR, PFT, MDTreferral
Overlap MCTD- +U1 RNP, antifibrillin, antiPMScl
Special site linear facial Invx i.e. en coup de sabre, parry romberg-
eye screen 3m: uveitis, episcleritis,pseudopapilledema/MRI( headache seizures NL-neuropathy malformation vasculitis infarct atrophy); salivary gland/tongue hemiatrophy
scleromyxedema Invx:
Bx, serum protein electrophoresis;TFT
Cx: ILD, myositis, dysphagia/cardiac(HT,AMI),polyarthritis,
renal crisis, dermatoneural syndrome(dysarthria,seizures/flu like illness)
LP invx
Drugs(HCTZ,Antimalarial,NSAID,Gold,Pencillamine,Captopril)/contact(color developer/amalgam);
Infx-HepC(+)/B(weak);
Histo,DIF-cytoid bodies IgM/c3/shaggy fibrinogen @BMZ
PRP Invx
Biopsy( vs psoriasis),
FBC, UECR, LFT,
HIV testing-malignancy screen(age-appropriate/symptom directed),
hepatosplenomegaly, LN
PPK Acquired work up
workup: scrape-scabies/fungal; bx(PRP); drug hx, urine PCR CT; FBC(nutritional, hematinic)+PBF(MF), UEC/LFT CXR; TFT; paraneoplastic- DMS, bazex
photoderm
FBC, ANA, CK/aldolase,porphyrins(plasma stool urine) HIV test ; skin bx(CTD)
phototesting(MED; buttock univolved topicals/sytemics, AH 1w), photoprovocation testing(if phototest inconclusive, CPC)
invx immunoderm
biopsy- histo
DIF(perilesional)salt split skin
IIF
ELISA:BP180/230/COL7/p200/antidsg1/3Ab-PF/mucosal/mucocutaneous(1+3)/antiendomysial IgA+antiTTG IgA/desmoplakin/plakophilin/plakoglobin immunoblot EBA,p200;IgA pemphigus,PNP
which Drug? induced- immunobullous
penicillamine, ACE i, thiol group-dsg1/3 interaction; BP+frusemide
dz associations DH
hashimoto/IDDM, Addison, MG)
Recurrent Oral/genital ulcerations/desquamative gingvitis invx
Inx FBC(Differential-cyclic neutropenia-AD,fever infx,LN, anemia), hematinic workup- Fe ferritin, TIBC B12, folate, zinc, HIV, HSV IF c/s, dsg1/3/G6PD, SLE
clinical suspicion: biopsy+DIF( EM,LP, immunobullous, malignancy,oral+skin(behcet’s EN)
GI(IBD)/eye referral(Behcet’s)
EM
Invx: FBC(TW, ESR,) Bx, DIF - TSST, HSV PCR; ASOT, CMV, EBV coxsackie, HCV
FDE drugs
Tetracyclines, penicillins, sulfamethoxazole, trimethoprim, macrolides, fluoroquinolones, metronidazole, griseofulvin, anticonvulsants ,NSAID
FDE invx
temporal relationship,+-Bx/Systemic provocation(>4w gold standard (single sub/therapeutic dose increased q12-24h/PT(generalized bFDE) old FDE(+)&normal back skin(-ve)
LV invx
1.prothrombotic- APS/proteinC/S,factor V leiden/MTHFR;antithrombin111def/PT gene mutation; ↑homocysteminemia/plasminogen activator inhibitor 2. CTD
vasculitis gen screen
gen FBC(?CTD, infective,eosinophilia-drug/Churg strauss), UEC/UFEME/BP( systemic) LFT; ESR
vasculitis Infective-
hep B/C, TB spot, SVV ASOT bacteremia blood c/s 2decho
vasculitis malignancy-
serum urine electrophoresis/myeloma/B2 microglobulin;
vasculitis ANCA
cANCA/PR3(wegener), pANCA(MPA), churg strauss(pANCA) , CXR, sinusitis
CTD screen-,
ANA,ENA, anti dsDNA, C3/4/c1q(SLE, HUVS), RF, scleroderma, MCTD
