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Final Year - Rheum > Tutorial 3 > Flashcards

Tutorial 3 Flashcards

1
Q

Titre meaning

A

How many times you have to dilute it

1 in 80

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2
Q

Give examples of ANA

A

dsDNA - LUPUS

Extranuclear antigens:

Ro, La, Sm, U1RNP - ribonuclear proteins
- can all be found in lupus
- Sm more specific for Lupus

  • Ro and La - Sjogren’s

-Scl70 - diffuse cutaneous sytemic sclerosis

  • centrometere - limited cutaneous systemic sclerosis -
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3
Q

What does Scl70 relate to?

A

Topiosmerase

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4
Q

Centromere

A

Limited cutaneous systemic sclerosis

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5
Q

ro and la

A

Sjogrens

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6
Q

Large cell arteritis

A

Takayasu - SE asian women
Giant cell arteritis

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7
Q

Medium vessel artertitis

A

Kawasaki
Polyarteritis nodosa - associated with hep B

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8
Q

Small vessel arteritis

A

ANCA associated vasculitis

  • microscopic GPA (wegner)
  • GPA
  • eGPA (churgh strauss)

Immune complex vasculitis

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9
Q

Mixed vessel arteritis

A

Behcet’s disease - veins as well as arterities

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10
Q

Infective causes of arteritis

A

Subacute bacterial endocarditis
Meningococcal septicemia
Syphillus
EBV, CMV, HIV, HepB/C

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11
Q
A

Auto-inflammatory = without antibodies

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12
Q

Autoinflammatory diseasese

A

see path slide

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13
Q

SLE symptoms

A

Oral ulcers
Hair loss
Raynaud’s
Swelling of glands

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14
Q

Lupus screening tests

A

FBC
Renal function - creatinine
LFT
CRP
ESR
ANA
dsDNA
ENA
COmpletement
Anti-cardiolipin

Urine dip - red cells and protein - to check for glomerulonephritis
Anti-dsDNA
ESR levels
urine dip and chest xray

Disease activity - c3 and c4 (c4 goes down first)

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15
Q

Mx of lupus

A

Less severe - methotrexate

Flare - steroids and hydroxychloroquine
Do a biopsy of the kidney

Mycophenolate if kidney disease
If no kidney disease - methotrexate

Rituximab to suppress the B cells

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16
Q

If there is anti-Ro, what is the consequence in pregnancy?

A

Foetal heart block
so monitor foetal

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17
Q

Hydroxychloroquine mx

A

Affects antigen presentation

18
Q

Alopecia

A

can be reversed with

19
Q

What are the stages of SLE?

A

Mild - skin, hair, joints, lymphadenopathy

Moderate disease =
Pleurisy, pleural effusion
Pericardial effusion

Moderate dsiease = lungs and heart
Severe disease = kidneys

20
Q

PMR is associated with?

A

Hip pain
Shoulder pain
Bursitis and humeral synovitis
Bilateral
Power in muscles are fine

GCA - temporal pain, pain brushing hair, jaw claudicaiton

21
Q

PMR screening work up

A

ESR and CRP
CK
RF and anti-ccp as this can
FBC, U and E, LFT

22
Q

PMR mx

A

15mg oral prednisolone
Bisphosphonate for bone protection
Calcium and vit D

Dramatic response within 1-2 days
Pain free
However they need to keep going with it

23
Q

GCA screening work up

A

GCA probability score
Temporal artery - look for a halo sign, aka the artery being inflamed
Axillary artery
Examine eyes

you only really biospy if the hx or uss isn’t clear that it might be GCA
CRP and ESR

24
Q

Mx of GCA

A

4-60mg pred for 18 months
60 esp if visual symptoms

Tociolizumab - steroid sparing - weekly, for 1 years

25
Q

Pale disc

A
26
Q

GCA is on a spectrum with three diseases, what is about?

A

GCA = temporal
Large vessel arteritis
PMR

27
Q
A

Systemically unwell
Over 50
Sweats, fevers
ESR

Large vessel GCA is diagnosed on a FDG PET scan

Mx with 40-60mgmgs pred or methotrexate

28
Q
A

Sjogren’s consequence
MALT lymphoma

29
Q
A

Tear management
??

30
Q

Features of diffuse cutaneous systemic sclerosis

A

Tightness, wooden, thickened skin
High blood pressure

Raynaud’s
Scl-70 positive

fibrotic element
ischemic element

Lupus is more proflierative infalmmatory neprhtiits

Narrowing of walls of kidneys - in diffuse cutaneous systemic sclerosis = renin release cos the kidney thinks it doesn’t have enough blood flow

31
Q

Limited cutaneous systemic sclerosis

A

Limited = limited to hands
CREST
Pulmonary HTN
Anti-centromere

32
Q
A

Inflammatory lung disease - give steroids
But if very high blood pressure - don’t give steroids

33
Q

Dermatomyositis screening

A

Creatnine kinase
ANA
MRI - shows oedema
Biopsy
PET scan - why?
EMGs

34
Q
A

Rash on dorsum of hands and knees

35
Q

Polymyositis

A

muscles only

Lymphocytic infiltartion of muscles
white = inflamed
proximal >distal msucles

Prognosis - difficulty swallowing,

36
Q

Dermatomyositis mx

A

Steroids -
hydroxycloroquine for rash
methotrex

37
Q

Idiopathic inflammatory myositis can be split into

A

Dermatomyositis
Polymyositis

38
Q

GPA

A

Upper
Lower resp
Kidney

39
Q

Antibodies for GPA

A

c-ANCA

MPA - pANCA

40
Q

What is another name for HSP

A

IgA vasculitis

41
Q

Symptoms of IgA vasculitis

A

Purpuric rash
Arthritis
Bowel disease

A proportion of patients

Final Year - Rheum (7 decks)

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