Prep 2 Flashcards
What are the most common autoantibodies found in lupus?
anti nuclear antibodies anti ds DNA anti smith anti ro anti jo
How do symptoms arise in lupus?
Antinuclear antibody-antigen complex deposit in different tissues around the body (common in kidneys, skin, joints, and heart) triggering local inflammation and complement activation (type 3 hypersensitivity)
What are the common triggers for lupus (cause the initial cell damage that exposes nuclear components for ANAs to bind to)
Sunlight infections smoking medications oestrogen (more common in women)
Why can SLE give false positive for syphilis?
sub type of antiphospholipid antibody (anticardiolipin is found in syphilis)
Dactylitis
inflammation of digit
what investigation in a male with sternal pain and multiple lytic bone lesions?
urine electrophoresis (look for bence jones proteins/M spike) multiple myeloma
What is multiple myeloma?
clonal proliferation of plasma cells (all secrete the same ABs most commonly IgG type)
What is MGUS?
monoclonal gammopathy of undetermined significance
<10% plasma cells on bone marrow biopsy
M spike present (monoclonal ABs)
patient is asymptomatic
Symptoms of multiple myeloma?
CRAB hyperCalcaemia Renal failure Anaemia Bone pain (fractures, neuropathy - weakness of bone due to bone marrow proliferation and plasma cells secrete osteoclast activating factor)
What age group is multiple myeloma common in?
70s
What is amyloidosis
Misfolded proteins (amyloids) build up and excreted out of cell forming clumps that deposit throughout the body can be localised or systemic about 30 different types due to different proteins
What is AL amyloidosis and when is it commonly seen?
Plasma cells produce abnormal light chains (component of AB). Light chains accumulate and clump
seen in multiple myeloma
What are bence jones proteins
abnormal light chains in the urine
What is a roleaux formation?
RBCs attached in chains (attached by the light chains secreted by plasma cells in multiple myeloma)
soap bubble appearance on bone xray
multiple myeloma (lytic lesions)
What does bone marrow biopsy in multiple myeloma show?
> 10% plasma cells
Management of MGUS?
watch and wait
risk of multiple myeloma
What is smoldering myeloma?
M spike and >10% plasma cells but assymtpomatic (watch and wait as increased risk of multiple myeloma)
Management of myeloma?
chemotherapy
marrow transplant
What type of therapy is beck’s triad?
CBT
What food interacts with warfarin?
green veg (high in vit K)
What is freudian theory?
psychoanalytical theory (personality develops in stages characterised by internal conflicts
What food interferes with statins?
grapefruit
Common side effect of amoxicillin
n&v
Surfer with gradual unilateral hearing loss
exostosis (surfer’s ear)
prolonged and repeated exposure to cold water cause the bone surrounding ear canal to develop spurs that constrict the ear canal (one side often worse as one striking the wave or wind)
Woman with permanent complete unilateral hearing loss in pregnancy
otosclerosis (pregnancy accelerates it)
abnormal growth of bones in inner ear, stapes thickens and becomes fixed at oval window
otitis media effusion
glue ear (non infective) usually due to eustachian tube defect
Hearing loss after getting off a plane
tympanic perforation
Bird beak appearance barium swallow
achalasia
Female with dysphagia and anaemia
Patterson kelly brown syndrome (iron deficiency anaemia, atrophic glossitis, oesophageal webs)
Management of mild dyskarosis on smear?
repeat test in 6 months
Management of severe dyskarosis on smear?
colposcopy
Pulseless VT
amioderone 300mg