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MSK > Other ANA+ Diseases > Flashcards

Other ANA+ Diseases Flashcards

1
Q

What are the other ANA+ diseases

A

Sjogren’s
Systemic Sclerosis
Mixed Connective Tissue Disease
Undifferentiated connective tissue disease

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2
Q

Characteristics of ANA tests

A

Reported in a titer
Tested with other antibodies
very sensitive not very specific
High false positive rate

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3
Q

What medications can effect ANA test

A

IVIG, sulfasalazine, TNF-alpha inhibitors

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4
Q

What other things can lead to false ANA+ test

A

Infections, inflammatory liver diseases, cancer
Aging
Vit D deficiency
Tobacco smoke, silica, organic pollutants
dense fine speckled 70 (DSF70) associated with allergic disease

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5
Q

Other diseases associated with ANA+

A 
Hashimoto's thyroiditis
Type I diabetes
Addison's 
Autoimmune anemia
Psoriasis
Lichen planus
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6
Q

What are Sjogren’s demographics/characteristics

A

Female»male (9:1)
Chief concern: dry eyes, dry mouth

Primary - no other underlying autoimmunity
Secondary - also have things like RA (15-20%)

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7
Q

What are the eye symptoms of Sjogren’s

A

Significant eye dryness - gritty sensation, burning eyes, worse thru the day

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8
Q

What are the mouth symptoms of Sjogren’s

A

Oral dryness - frequently drink water, increased dental carries, taste change, burning mouth, difficulty swalowing
Parotid/submandibular gland swelling

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9
Q

Other symptoms of Sjogren’s

A 
Vaginal dryness
Fatigue
Arthralgias/arthritis
Raynaud's phenomenon
Dysphagia/esophageal dysfunction
lymphadenopathy

less:
SOB, leg swelling, urinary changes, numbness/tingling/weakness, rash, B symptoms (fevers, night sweats, weight loss)

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10
Q

Other diseases that cause dryness

A 
Diabetes mellitus
dehydration
blepharitis (eye inflammation)
hepatitis C, HIV/AIDS
depresssion/anxiety
cystic fibrosis
radiation to the head/neck
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11
Q

Medications that cause dryness

A 
Antihistamines
Tricyclic antidepressants
benzodiazepines
clonidine
diuretics
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12
Q

Sjogren’s HEENT exam findings

A

Ocular injections, corneal damage, swelling of eye lids
Oral dryness, decreased salivary pooling, dental decay
Swelling in submandibular glands

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13
Q

Other Sjogren’s exam findings

A

Lymph: examine for adenopathy
MSK: arthritis
Skin: vasculitic lesions
Neuro: muscle strength and sensation

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14
Q

Sjogren’s labs

A 
ANA+ (85-90%)
SSA (50-70%), SSB (30-50%)
Rheumatoid factor (sometimes)
Elevateed Sed Rate
Polyclonal hypergammaglobulinemia
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15
Q

What tests do you do to diagnose Sjogren’s

A 
Schrimer's filter paper
Fluorescein dye/lissamine green to eval conjunctiva
Unstimulated salivary flow
Ultrasound or MRI to eval parotid 
Minor salivary gland biopsy
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16
Q

Sjogren’s glandular symptoms treatment

A 
Eye and dental care
Humidifier, hydration, artificial saliva
Eye drops, lubricants
punctual plugs
Meds: Pilocarpine, Cevimeline
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17
Q

Sjogren’s extra glandular treatment

A

Fatigue - rule out other medical cause
Arthritis - similar to RA: methotrexate, hydroxychloroquine, DMARD
Severe disease - rituximab, cyclophosphamide

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18
Q

Sjogren Pregnancy complications

A

SSA/SSB + = risk for neonatal lupus

19
Q

Sjogrens complications for cancer

A

Increased 5-44 fold

median 8 years after diagnosis

20
Q

Systemic Sclerosis demographics and characteristics

A

Female>Male
Age 35-64
High rates in Native American Tribes (esp. Choctaw)
Chief complaint: Skin thickening and tightening, severe Raynaud’s, fingertip ulcerations

21
Q

Skin changes in SS

A 
Limited or diffuse
Tightening, thickening
Distal arms, face, neck
Early signs are puffiness or swelling
Telangiectasias
Raynaud's
22
Q

Systemic Sclerosis Pulmonary signs

A

SOB, dry cough, leg swelling
Interstitial lung disease, more associated with generalized SCL 70 ab
Pulmonary hypertension - more associated with limited anticentromere ab

23
Q

Systemic sclerosis GI symptoms

A

Severe GERD
Dysphagia
Decreased GI motility, small bowel bacterial overgrowth
GI bleeding/iron deficiency anemia (Gastric antral vascular ectasia aka watermelon stomach)

24
Q

Systemic sclerosis MSK symptoms

A

Muscle weakness

Arthritis

25
Q

Systemic sclerosis Renal symptoms

A

scleroderma renal crisis: RNA pol III

26
Q

CREST syndrome

A 
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia
27
Q

SS Physical exam

A

Vitals: hypertension
HEENT: tightening around face
Cardio: elevated JVP, loud S2, RV heave, TR murmur
Pulmonary: crackles/rales
Skin: thickening, sclerodactyly etc.
MSK: inflammatory arthritis/synovitis, acrolysis

28
Q

SS Labs

A

ANA+ (85%)
ABs: ANA, anticentromere, Scl 70, RNA pol III
CXR, High res CT
Echocardiogram: pulmonary hypertension
Endoscopy or wallow evaluation for GI dysfunction

29
Q

Tx SS Raynaud’s

A

Calcium channel blockers, topical nitroglycerin, sildenafil, pentoxifylline, fluoxetine

30
Q

Tx SS GERD

A

PPI, H2 blockers

31
Q

Tx SS Skin Dz

A

Methotrexate, cyclophosphamide, mycophenolate

32
Q

Tx SS Lung dz

A

Mycophenolate, cyclophosphamide, antifibrotics, stem cell transplant

33
Q

Tx SS Pulmonary hypertension

A

calcim channel blockers, diuretics, oxygen, prostacyclins, oral endothelin receptor antagonists, PDE inhibitors

34
Q

Mixed Connective Tissue Disease demographics and characteristics

A

Femal > Male

Chief complaint: arthritis, Raynaud’s, puffy swollen hands, etc.

35
Q

MCTD clinical symptoms

A 
Arthritis
SOB, chest pain, cough
Rashes
Muscle weakness
Skin changes/severe Raynaud's
9rare to see Kidney disease)
36
Q

MCTD Labs and Dx

A 
ANA + (100%)
High titer U1 RNP antibody (100%)
Sometimes positive for RF, other ab
CBC: may see anemia, leukopenia
SPEP hypergammaglobulinemia
Muscle symptoms  = elevated creatinine kinase, aldolase
rarely have low compliments
37
Q

MCTD treatment

A

SLE-like: NSAIDS, Hydroxychloroquine, low dose steroids, methotrexate, azathioprine
SS-like: symptomatic Rx, ILD, mycophenolate, cyclophosphamide
Myositis: methotrexate, azathioprine, mycophenolate, steroids
PAH treatment (pulmonary vasodilators)

38
Q

MCTD prognosis

A

58% stay diagnosed with MCTD, others evolve to SS, SLE, RA
Low mortality overall
Pulmonary hypertension is the highest risk

39
Q

Undifferentiated Connective Tissue Disease Demographics and characteristics

A

25% of rheum patients do not meet criteria for difinable illness
Women 30-40 years old
Chief complaint: joint pain, others

40
Q

UCTD most common symptoms

A

Joint pain
Raynaud’s
Rash/oral ulcers
SICCA symptoms

41
Q

UCTD symptoms suggestive of other pathology

A

Fever, serositis, anti-dsDNA/Smith - SLE
abnormal nail capillaries, nuclear ANA - SS
Xerostomia, SSA/SSB - Sjogren’s

42
Q

UCTD exam findings

A

Not enough to clearly suggest other pathology

43
Q

UCTD Labs

A

ANA+

Other antibodies may be present (my indicate further progression)

44
Q

UCTD treatment

A

Hydroxychloroquine
NSAIDs
low dose prednisone
Monitor - 25% progress to other pathology

MSK (6 decks)

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