SLE, polyarteritis, polymyositis

Question 1

Treatment

NSAIDS

Hydroxychloroquine

Steroids

Answer 1

lupus

Question 2

SLE

def

age

race

Answer 2

autoimmune disorder characterized by positive ANAs and inflammation. involves multiple organs. affects women of childbearing age; mostly blacks

Question 3

SLE labs

Answer 3

CBC, BUN, creatine, UA, ESR, serum complement C3 or C4, ANA

Anti nuclear antibody (ANA) in SLE this is present 100% of the time, but it is not specific to SLE

Question 4

what are the markers for the progression of SLE

Answer 4

antibodies to smith antigen, double stranded DNA, and depressed levels to the serum complement

Question 5

tx of SLE

Answer 5

regular exercise, sun protection. NSAIDs, antimalarials, corticosteroids, methotrexate(at low does)

Question 6

polymositis definition

Answer 6

dermatomyositis. inflammatory disease of striated muscle affecting proximal limbs, neck, and pharynx

symmetric

Question 7

sx of polymyositis

Answer 7

heliotrope, malar rash, insidious, painless, proximal muscle weakness, muscle atrophy, polyarthalgias

Question 8

how to dx polymyositis

Answer 8

CPK, anti-Jo-1 antibodies, and aldolase elevated. muscle bx.

Question 9

tx of polymyosis

Answer 9

high dose steroids, methotrexate, azathioprine

Question 10

what is polymyalgia rheumatica

Answer 10

pain and stiffness in neck, shoulder, pelvic girdle with constitutional sx. temporal arteritis 30% of cases

Question 11

Rule out what in polymyalgia rheumatica

Answer 11

giant cell(temporal) arteritis. presents with scalp tenderness, jaw claudication, HA, artery tenderness. can lead to vision loss!

Question 12

describe the stiffness in polymyalgia rheumatica

Answer 12

severe stiffness after rest and in the morning

Question 13

labs in polymyalgia

Answer 13

ESR marked elevated (>50mm/hr)

Question 14

tx of polymyalgia rheumatica

Answer 14

low dose corticosteroids.

Question 15

causes of polymyositits, polymyalgia rheumatica, and polyarteritis nodosa

Answer 15

unknown

Question 16

polyarteritis nodosa definition, gender, age of onset

Answer 16

small to medium artery inflammation involving skin, kidney, peripheral nerves, muscle, gut. male 3:1, 40-60 yrs old.

Question 17

what can polyarteritis nodusa associated with

Answer 17

hep B in 30% of pts

Question 18

palpable purpura and livedo reticularis

Answer 18

polyarteris nodosa

Question 19

4 sx of pts with polyarteritis nodosa with renal impairment

Answer 19

HTN, edema, oliguria, uremia

Question 20

ANCA

Answer 20

antineutrophil cytoplasmico antibody suggestive but not diagnostic of polyarteritis nodosa

Question 21

labs to dx polyarteritis nodosa

Answer 21

vessel bx or angiography! also elevated ESR and CRP, positive hep B surface antigen(HBsAG)

Question 22

tx of polyarteritis nodosa

Answer 22

high dose corticosteroids initially. cytotoxic drugs and immunotherapy may be used.

Question 23

I came in to see my physician assistant today because of…

Joint pain – hands, wrists and knees most commonly

Malaise

Fever

Chest pain

Fatigue

Skin rash

Mouth sores

Sensitivity to light

Answer 23

lupus

Question 24

other organ systems affected with polymyositis

Answer 24

joints, lungs, heart, GI tract

Question 25

I came in to see my physician assistant because of…

Insidious onset of proximal muscle weakness

Difficulty going up stairs

Difficulty getting up from a chair

Dysphagia

Butterfly facial rash

Labs, studies

Answer 25

polymyositis

Question 26

dermatomyositis 3 rashes

Answer 26

heliotrope: violaceous periorbital rash

shawl sign: rash involving shoulders, upper chest, and back

gottron papules: papular rash with scales on dorsa of hands over bony prominences

Question 27

increased serum creatinine kinase and anti-jo antibodies

Answer 27

polymyositis

Question 28

felty syndrome

Answer 28

RA, splenomegaly, neutropenia

Question 29

DIP joint spared in what

Answer 29

RA but involved in OA

Question 30

RA, splenomegaly, neutropenia

Answer 30

felty syndrome

Question 31

hydroxychloroquine causes what

Answer 31

retinal toxicity

Question 32

strong association with malignancy

Answer 32

polymyositis

Question 33

concomitant tx of hep B may be required with what

Answer 33

polyarteritis nodosa

Question 34

A patient presents with the triad of an eye infection, urethritis and knee pain. What is the most likely diagnosis?

Answer 34

reactive arthritis

Question 35

Butterfly rash should make you think of what diagnosis?

Answer 35

lupus

Question 36

Describe a swan neck deformity

Answer 36

PIP hyperextension with DIP flexion

Question 37

A question includes the term negatively birefringent crystals. What disease must be in your differential?

What medication do you use to control uric acid in a patient with a history of gout?

Aside from lupus what is another disease which may have a butterfly facial rash?

Which is used to treat polyarteritis nodosa, high or low dose steroids?

Answer 37

A question includes the term negatively birefringent crystals. What disease must be in your differential?

Gout

What medication do you use to control uric acid in a patient with a history of gout?

Allopurinol

Aside from lupus what is another disease which may have a butterfly facial rash?

Polymyositis

Which is used to treat polyarteritis nodosa, high or low dose steroids?

High