pathology - autoimmune Flashcards

1
Q

rash
joint pian
fever
female of repro and african

A

SLE

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2
Q

how si the heart invovled in lupus

A
leibman sacks endocarditis - nonbacterial, wart liek vegetations on both sides of valve
and pericarditis (serositis)
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3
Q

how are the kidneys affected in SLE

A

nephritis- diffuse prolfierative glomerulonpehtiris

neprhotic - membranous gomerulonephtirits

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4
Q

tyep of hypersensitiveit e of SLE

A

type III @ skin, glomeruli/tubules, goints and small vessels

type II @ cytopenias

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5
Q

common causes of :( in SLE

A

cardivascular disease
infections
renal dsiease

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6
Q

why susceptible to infetions?

A

autoimmune hemolytic anaemia - warm IgG extravascular hemoysis
and cytopenais

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7
Q

RASH or PAIN of SLE pease

A
rash - malar or discoid
arhtirits
soft tissues/seoritis - leuritis and pericarditis
hematogolicy disorders - cytopenias
oral/nasopharyngeal ulcres
renal dsiease
raynouad pneomenon
phostosensitivity
positive VDRL/RPR
antinuclear antibdoies
immunosppressants 
neuslrog - seizures an spsyxhosis
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8
Q

lab findings in sle

A

antinuclear antiboids - senstive but not specific = SCREENING
antidsDNA - renal invovlement and specific - DIAGNOSIS
antiSMith - specifis - DIAGNOSIS
decreased C3 C4 and Ch50 due to immune complex formation

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9
Q

decreased CH50 in SLE?

A

deacreased c3 and c4 due to type III vrs skin, glomeruli/tubules, joitns and small vessels

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10
Q

antibodies foudn in drug induced lupus

A

anti histone

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11
Q

drugs that cause drug induced lupus

A

procainamide

hydralazine

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12
Q

diff in cxpx of drug induced lupus and sle

A

drug induced - seriosits in lugns and heart
arthralgias
fever
anti histone abs
NO ab dsDNA
NO decrease C’
rarely CNS and renal involvment (no dsRNA for renal)

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13
Q

where woudl ics be deposited in skin for sle

A

band liek deposition of IC at the dermal epidermal fuction

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14
Q

how to treat sle

A

nsaids, steroids, immunsupprestants, hydroxychloroquine

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15
Q

what is antiphospholipid syndrome

A

primary or secondary autoimmune disorder in SLE

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16
Q

what is antiphospholipid syndrome asociated with

A

SLE or RA, sjogrens ITP and HIV

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17
Q

dzs associated with:

a) RA
b) OA
c) SLE

A

ra - sjogrens
OA - pseudogout
SLE - antiphospholipid

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18
Q

how to diagnose antiphospholipid syndrome?

A

dx based on history of thromobosis in arterial and venous
spotnarous abortion
and lupus anticoagulat, anticardiolip and anti beta2 glycoprotein

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19
Q

if i say anticardiolipid, anti beta glycoprotein and lupus anticoagulant you think?

A

antiphospholipid syndrome

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20
Q

how to treat antiphospholipid syndrome

A

systemic anticoagulation

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21
Q

how to lupus anticoagulat and cardiolipid abs affect test results in antiphospholipid syndrome

A

lupus anticogulation - increased PTT outside body but acutally cause thrombosis in vivp
cardiolipin - false positive VDRL

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22
Q

where are thrombi foudn in antiphospholipid syndrome

A

venous at calf > renal, ehpatic, axiallry, subclavian, retinal, vena canca, placenta
areterial - can cause strokes

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23
Q
widespread noncaseating granulomas
increase ACE elvels
increased CD4/CD8 ratio
hypercalcemia
african american women between 20-39
A

saarrrccooiiddoossiiisss

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24
Q

cxpx of sarcoidosis

A

often asymptomatic

enlarged lms

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25
Q

CXR of sarcoidosis

A

bilateral adenopathy and coarse reticular opaticies

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26
Q

ct of sarcoidossi

A

extensive hilar and mediatstinal adenopathy

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27
Q

miscropic sarcoidosis

A

schaumann bodies - laminated ca concretions

asteroid bodies - stellate infiltrates

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28
Q

schaumann bodies

A

sarcoidosis

laimnated ca concretions

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29
Q

asteroid bodies

A

stellate infiltrates

sarcoidosis

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30
Q

what causes hypercalcemia in sarcoidosis

A

increased 1 alpha-hydroxylase from vitamin D activation in macropahges

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31
Q

treatmetn of sarcoidosis

A

steroids

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32
Q

complications fo sarcoidosis

A

restrictive lung disease
lupus pernio
erythema nodosum
bell palsy

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33
Q

restrictive lung dsiease
lupus pernio
erythema nodosum
bell palsy

A

sarcoidosis

34
Q

pain and stiffness in shoulders and hips

A

polymylagia rheumatica

35
Q

fever
malaise
stiffness
pain and stiffness in shoulders and hips

A

polymylagia rheumatica

36
Q

musclar weakness in polylagia rheumatica?

A

nope. fever, malaise, stiffness and pain in shoulders and hips

37
Q

labs in polymylagia rheumatica

A

increased ESR
increased CRP
normal CK (no mustcular weakness)

38
Q

what is polymylagia rheumatica associated with

A

temporal arterities

39
Q

dzs associated wtih:

a) RA
b) OA
c) polymylagia rheumatica
d) SLE

A

a) ra - sjogren
b) oa - pseudogout
c) sle - antiphospholipid
d) polymylagia rheumatica - temporal arteritis

40
Q

hwo to treat polymylagia rheumatica

A

rapid response to low dose corticosteroids

41
Q

age fo patient with fibromyalgia?

A

females 20-50 yaers old

42
Q

chornic widespread musculoskeletal pain associated with stiffness, paresthesias, poor sleep, fatigue

A

fibromyalgia

43
Q

cxpx fo fibromylagia

A

chronic widespread msuculoskeletal pain associated with stiffness, paresthesias, poor sleep and fatigue

44
Q

treat fibromyalgia

A

regular exercise
antidepressnats - TCAs and SNRIs
anticonvulsants

45
Q

labs of polymyositis and dermatomyositis

A
increased CK (not in polymyalgia rheumatica)
positive ANA
positive anti Jo-1
positive anti SRP
poaisitve anti Mi2 abs
jooo srp,  me 2
yooo wassup,  me 2
46
Q

yoo wassup? me 2

A
abs for polymyositis and dermatomyositis
anti jo
anti srp
anti mi2
ana
47
Q

how to treat polymyositis and dermatomyositis

A

steroids and then long term immunosuppresant tearphy - methotrexate

48
Q

cxpx fo polymyositis

A

progressive symmetric proximal muscle weakness

49
Q

pathogen of polymyositis

A

CD8 T cells
endomysial inflammation
most often in shoulders

50
Q

cxpx for dermatomyositis

A

progressive symmetric proximal muscle weakness
malar rash (liek sle ish)
GOTTRON PAPULES, HELIOTROPE/erythematous periorbital rash
shawal and face rash
mechanis hands

51
Q

what are gottron papules

A

reddish purple plaques over knuckes and pip

dermatomyositis

52
Q

what are heiotrope eyelids

A

purplish red eyelid discolouration

dermatomyositis

53
Q

skin deltas seen at dermatomyositis

A

gottron papules at hands
heliotrope at heyes
malar rash
shawl and face rash

54
Q

pathogenesis of dermatomyositis?

A

CD4 and perimysial infllmation

ATROPHY

55
Q

atrophy

A

dermatomyositis

56
Q

no atrophy

A

polymyositis

57
Q

what is dermatomyositis associated wtih?

A

increased risk of occult malignancy

58
Q

what has increased risk of osteogenic sarcoma?

A

paget disease

59
Q

dzs associated with

a) pagets
b) RA
c) OA
e) polymylagia rheumatica
f) dermatomyositis
g) SLE

A

pagets - osteogenic sarcoma
ra - sjogren
soa - pseudogout
polymylagia rheumatica - temporal arteritis
dermatomyositis - increas risk of occult malignancy
SLE - antiphospholipid syndrome

yaya! good job brain

60
Q

what is the most common NMJ disease

A

myasthenai gravis

61
Q

pathophsy of MG

A

autoabs vrs ach receptor

type II

62
Q

cxpx of myasthenai gravis

A

ptosis, diplopia, weakness that worsens with muscle use

63
Q

what is myasthenai gravis associated with

A

thymom and thymic hyperplasia bc abs made there

64
Q

a) pagets
b) RA
c) OA
e) polymylagia rheumatica
f) dermatomyositis
g) SLE
h) myasthenia gravis
i) lambert eaton

A

pagets - osteogenic sarcoma
RA - sjogrens
OA - pseudogout
polymyalgia rheumatica - tempral arteritis
dermatomyositis - occult maligincnacy risk increases
sle - antiphospholipid syndrome
myasthenia gravis - thymoma/thymic hyperplasia
lambert eaton - small cell lung cam

65
Q

what effect does achase inhibitor have on myasthenia gravis

A

reversal of symptoms

66
Q

pathophys of lamber eaton

A

autoabs vrs presynaptic CA channels - decreased ach realse

67
Q

cxpx of lambert eaton

A

proximal muscle weakness (polymyositis and dermatomyositis), autnomic symptoms - dry mout and impotennce that imptove with mucls use

68
Q

what is lambert eaton associated with

A

small cell of llung

69
Q

effect of achase inhibitor on lambert eaton

A

little effect

70
Q

what is myositis ossificans

A

metaplasia of skeletal muscle into bone following muscular truama

71
Q

where do you most often see metaplasia of skeletal muscle into bone following muscular trauma

A

myositis ossificans

upper and lower extremity

72
Q

how does myositis ossifican spresent

A

suspicious mass at site of known trauma or as an incidental finding on radiogtapy

73
Q

what is scleroderma

A

systemic sclerosis

triad or a) autoimmunity b) noninflammatory vasculopathy and c( collagen deposition with firbosiss

74
Q

sclerosis of skin wtih puffy taut skin without wrinkles
dingertip pitting
what organs do you worry about?

A
systemic sclerosis/scleroderma
renal
PULMONARY - cause do f :(
cardiovascular
git
75
Q

autoabs foudn in diffuse scleroderma

A

anti scl-70 = anti DNA topoisomerase I

76
Q

what aubt ab found in limited scleroderma

A

anti-centromere abs

77
Q

how does diffuse scleroderma present

A

widespread skin invovlement
rapid progression
early viscearl (pulmonary, renal, cardio git) invovlement
anti scl-90/anti topoisomerase I abs

78
Q

how does limited scleroderma present

A
limited skin at fingers and face and wtih CREST
calcinosis
raynaoud phenomenon
esophageal dysmotility
sclerodactyly
telangiectasia
more beigin
anti-centromere abs
79
Q

CREST

A

limited scleroderma
anti centromere
Calcinosis, raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia.

80
Q

what is most common cause of :( in scleroderma

A

resp failure