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Clin Med Exam 3 (Lauren) > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the labs like on scleroderma/systemic sclerosis?

A

Anti-centromere antibodes

Anti-SCL-70 (scleroderma antibody aka anti-topoisomerase)

CBC: Mild anemia

UA: proteinurua if renal involvement

ANA+ in 95%

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2
Q

Who is most likely to get PAN?

A

50yo men

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3
Q

What are the main features of Sjogrens?

A

Keratoconjunctivitis sicca (dry eyes)

Xerostomia

Arthralgia/arthritis*****

Fatigue

Parotid gland enlargement

Dryness of other surfaces

Tons of other extraglandular shit - raynaud, lymphadenopathy, pulmonary disease, vasculitis, nephritis, lymphoma

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4
Q

Do you have to order tons of different labs for SLE/

A

Yes because it can affect ANY tissue/organ

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5
Q

What is dermatomyositis?

A

It is polymyositis with cutaneous eruptions.

Frequently associated with occult malignancy

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6
Q

7-10% of patients with dermatomyositis also have what?

A

Occult malignancy!!

cervix, lung, ovary, stomach.
Ask them when their last PAP was

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7
Q

What other conditions are associated with polymyositis?

A

Interstitial Lung Disease***

Raynaud phenomenon

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8
Q

Are antinuclear antibodies associated with lupus?

A

Yes

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9
Q

How does lupus affect the kidney?

A

Nephritis with proteinuria (one of the things that kills SLE pts)

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10
Q

What are the specific ANA antibodies that will be present in primary Sjögren’s syndrome?**

A

Anti-sjogren’s syndrome:

Anti-Ro

Anti-La

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11
Q

Name it:

May involve interstitial lung disease

A

Polymyositis/dermatomyositis

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12
Q

Which antibody do you see with drug=induced SLE? Which ones don’t you see?

A

Positive Antihistone antibody*****

Negative anti-dsDNA, anti-Sm ab

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13
Q

What is the first line treatment for SLE?

A

daily Hydroxychloroquine (Plaquenil)

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14
Q

What is the test for tear production in Sjögren’s syndrome?

A

Schirmer test

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15
Q

What is the treatment for raynaud phenomenon

A

Calcium channel blocker

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16
Q

What will the labs look like for PAN?

A

Antinetirophil cytoplasmic antibodies (ANCA) will be NEGATIVE!!!!

Negative ANCA

If it’s positive, you don’t have PAN. You have another type of vasculitis

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17
Q

How will a pt with PAN present?

A

Cutaneous nodules, ulcers, and purpura

Renal manifestations

Malaise, neuropathy, arthralgia

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18
Q

Name it:

Autoimmune disorder that causes diffuse fibrosis (tightening and thickening) of the skin and internal organs

A

Systemic sclerosis (scleroderma)

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19
Q

What is the treatment for PAN

A

Steroids

Hepatitis treatment if they also have that

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20
Q

“I have difficulty arising from a chair” or “I have trouble reaching a high shelf”

A

Polymyositis

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21
Q

What is the universal symptom of lupus?

A

Fatigue

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22
Q

Name it:
Chronic dysfunction of exocrine glands, affecting the lacrimal and salivary glands.
Extra-glandular sx: a ton of other vague shit

A

Sjogrens

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23
Q

What are the cutaneous eruptions seen with dermatomyositis?

A

Heliotrope rash

Gottron’s papules

Shawl sign

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24
Q

What is the discoid rash?

A

Erythematous patches w/ keratotic scaling in sun exposed areas

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25
Q

If you get a positive ANCA, does that mean you have PAN?

A

No. Never. ANCA is always negative in PAN.

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26
Q

Name it:
Idiopathic, progressive, inflammatory condition causing symmetric proximal muscle weakness

(Weakness not pain)

A

Polymyositis

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27
Q

Does an ANA result over 40 mean you have lupus?

A

No, lots of healthy people have this, but 95% of SLE patients have an ANA over 40.

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28
Q

Can you see the calcifications of the skin on an x ray in a scleroderma patient?

A

Yes

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29
Q

Who usually gets systemic sclerosis (scleroderma)

A

20-50yo females

30
Q 
Name it:
Chronic multi-organ autoimmune disorder 
Autoantibodies to nuclear antigens (ANA)
Anti-dsDNA, anti-Sm ab
Malar butterfly rash
Discoid rash
Can affect any organ
Hydroxychloroquine 1st line tx
A

SLE

31
Q

Name it:
Transmural inflammation of muscular arteries, causing a narrowing of the lumen.

Veins unaffected.

Results in thrombosis, ischemia, or infarct*

A

Polyarteritis Nodosa (PAN)

32
Q

Name it:
Anti-Ro/SSA, Anti-La/SSB

Schirmer’s test

Sicca complex

A

Sjögren’s syndrome

33
Q

How will lupus present?

A

Fatigue

Butterfly rash 50%

Discoid lupus in sun exposed areas

Painless** ulcers in mouth or nose

Alopecia

Raynaud phenomenon 30%

34
Q

How is SLE diagnosed?

A

Clinical judgement

The American College of Rheum. has identified 11 criteria, and most pts will have 4 or more

35
Q

What is the progression of the sclerodactyly that comes along with scleroderma

A

Hands and fingers start puffy

Then get shiny as skin thickens

36
Q

What labs will be elevated with polymyositis and dermatomyositis?

A

Muscle enzymes: CK and aldolase***

ANA will be positive in 80%

37
Q

What are the 11 criteria of SLE that the typical patient has 4 or more of?

(Just look at it)

A

Photosensitivity

Malar rash

Discoid rash

Mucosal ulcers

+ANA (anti nuclear antibody)

+Anti ds-DNA, +anti-sm +anti phospholipid abs

Polyarthritis

Serositis

Renal disorders

Neuro disorders

Hematologic disorders

38
Q

What is the difference between limited and diffuse scleroderma?

A

Diffuse has all the same stuff as limited, but the sclerotic skin is also on chest, trunk, arms, and shoulders. They also have an increased risk of internal organ involvement.

39
Q

What will you find if you biopsy skin lesions of a PAN patient?

A

Leukocytoclastic vasculitis*****

“WBC debris”

40
Q

What are the 3 ANA subtypes that are associated with lupus?

A

Anti-dsDNA

Anti-Sm

Antiphospholipid

41
Q

Which muscles are commonly affected by polymyositis?

A

Deltoids

Hip flexors

42
Q

What is sicca complex?

A

Combo of xeropthalmia and xerostomia

(Dry eyes and mouth)

43
Q

What drugs commonly cause drug-induced SLE?

A

Procainamide

Isoniazid

Hydralazine
***

44
Q

Is polymyositis painful?

A

No its usually just weakness

45
Q

What illness can sometimes trigger PAN?

A

Hepatitis B and C

Test them for hepatitis

46
Q

Name it:
ACA (anticerntromere Ab)

Anti-SCL-70 (anti-topoisomerase Ab)

A

Systemic sclerosis (scleroderma)

47
Q

What is an autoimmune disorder causing diffuse fibrosis?

A

Systemic sclerosis

48
Q

Does PAN represent a spectrum of disease rather than a single entity?

A

Yes

49
Q

Name it:

ANCA negative

A

Polyarteritis Nodosa (PAN)

50
Q

What is CREST syndrome?

A

Calcinosis- Ca+ deposits in skin

Raynaud’s phenomenon

Esophageal dysfunction

Sclerodactyly- tightening of fingers

Telangiectasias

51
Q

Do low complement levels indicate active or latent lupus?

A

Active

52
Q

What is really important for your SLE patient to do if you give them hydroxychloroquine?

A

Regular ophthalmology follow-ups!!****

Retinal toxicity possible

53
Q

What is it:

Fixed erythema over nasal bridge that spares nasolabial folds

A

Malar rash

54
Q

What are the treatments for Sjogren’s syndrome?

A

See the dentist and eye doctor

Eye drops

Saliva substitute

Drink water

Sugarless candy

NSAIDs

Steroids for severe

Refer to rheumatology

55
Q

What are some of the main treatments (non pharm) for SLE

A

Sun protection

Stop smoking**

Diet/exercise

Immunizations

Contraception- anti-phospholipid ab associated with fetal loss

56
Q

What happens to the lumen of the arteries affected by PAN?

A

Narrowed due to inflammation

57
Q

What is the first line treatment for polymyositis and dermatomyositis?

A

Steroids

58
Q

What is so important to do if your pt has dermatomyositis?

A

Rule out occult malignancy

59
Q

What is the treatment for systemic sclerosis?

A

Symptomatic care, no effective therapy for underlying process:

Warm clothing, 
stop smoking, 
Ca+ channel blockers for raynauds
GERD drugs for esophagus
ACE-inhibitors for renal involvement
Immunosuppressive drugs for severe cases
60
Q

Name it:

Heliotrope rash, shawl sign, gottrons papules

A

Dermatomyositis

61
Q

What will the initial ANA report tell you?

A
  1. Titer dilution
  2. Staining pattern

(Not specific. You need to order the 3 subtypes separately)

62
Q

What is the risk of plaquenil/hydroxychloroquine?

A

Retinal toxicity

63
Q

What is raynaud phenomenon?

A

Episodic vasospastic** disease of the extremities

Fingers turn red white and blue in cold weather

64
Q

Who is most likely to get lupus?

A

Black females in childbearing years

65
Q

What are the two types of systemic sclerosis?

A
  1. Limited cutaneous-80%

2. Diffuse cutaneous- 20%

66
Q

What mediates clinical manifestations of lupus?

A

Antibody formation and creation of immune complexes

**

67
Q

What is the treatment for drug-induced SLE?

A

Stop the offending drug

Procainamide, isoniazid, hydralazine

68
Q

Name it:

Anti-histone antibody

A

Drug induced SLE

69
Q

What is a cause of chronic cough to consider in a pt with polymyositis?

A

Interstitial lung disease

70
Q

Who is most likely to get Sjogrens Syndrome?

A

40-60yo women

71
Q

Where are Gottron’s papules seen?

A

On the dorsal aspect of the hand joints

Clin Med Exam 3 (Lauren) (7 decks)

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