Approach To Malaise And Generalized Pain Flashcards by Mashaal Zahid

What clinical markers are present in Lupus like syndrome/drug-induced

+ANA

+Anti histone antibody

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What causes a drug induced SLE?

Sulfa drugs 
Hydralazine
Isoniazid 
Minocycline 
TNF Inhibitors
Quinidine
Chlorpromazine
Methyldopa
Procainamide

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What antibodies is neonatal lupus associated with?

Anti Ro or La Abs

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What is the treatment for SLE?

Avoid sun
NSAIDS
Corticosteroids
Hydroxychloroquine

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What causes mortality in the early years after diagnosis of SLE?

Later years?

Infections - opportunistic
Kidney or CNS

Accelerated atherosclerosis - MI
Thromboembolic events

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How do you manage SLE patients?

Minimize other conventional risk factors for atherosclerosis
Avoid smoking
Flu vaccines
Pneumococcal vaccines
Cancer screenings (increased risk of malignancy)
Consider avascular necrosis of the bone due to corticosteroid use

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What type of hypersensitivity is SLE?

TYPE III

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What is the treatment of discoid lupus?

Photo protection + topical anti-inflammatory agents of systemic antimalarial drugs

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What is the hallmark of scleroderma?

Thickening and hardening of the skin (fibrosis of the skin and visceral organs)

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What causes the dry itchy skin in scleroderma?

Obliteration of eccrine sweat and sebaceous glands

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What are the three forms of scleroderma?

Diffuse

Limited (Crest syndrome)

Localized

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What is a manifestation of limited scleroderma?

Pulmonary HTN

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What is a manifestation of diffuse scleroderma?

Interstitial lung disease

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What does CREST stand for?

Calcinosis cutis 
Raynauds 
Esophageal dysmotility 
Sclerodactylyl 
Telangectasia

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Is renal crisis common in limited scleroderma?

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What is the primary cause of morbidity and mjortality in scleroderma?

Pulmonary disease

Interstitial lung disease seen in diffuse
Pulmonary artery hypertension seen in limited

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How do you diagnose PAH?

A mean pulmonary arterial pressure of 25 mmHG OR GREATER

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How do you confirm diagnosis of PAH?

Right heart catheter

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Which cancer shows an increased incidence in scleroderma?

Bronchoalveolar carcinoma

Esophageal adenocarcinoma

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What is the diagnostic work up for scleroderma?

Blood pressure 
ESR 
ANA 
UA 
CXR 
Barium swallow 
Echo
PFT 
Skin biopsy 
Serology

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What is the serology for Scc (diffuse and limited)?

Diffuse - anti Scl 70, anti RNA polymerase III

Limited - +anti centromere

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How do we treat Scc?

Treat the symptoms

CCB 
ACE inh 
Anti reflux 
Glucocorticoids 
Cyclophosphamide 
PDE inh

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What is an adverse affect of high dose corticosteroids?

Renal crisis

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What is the limited Scc characterized by?

Benign skin condition of discreet areas of discolored skin induration

Morphea (patches)

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What are the manifestations of sjogren?

``` Dry eyes Dry mouth Vaginal dryness Tracheobronchial dryness Parotid enlargement ```

What is keratoconjunctivitis sicca?

Inadequate tear production causing a foreign body sensation

What cancer is sjogrens associated with?

B Cell NHL (Maltoma)

What is the serology work up for sjogrens?

``` +anti SSA/Ro +anti SSB/La Low C4 Hypergammaglobulinemia High ESR +RF +ANA ```

Treatment of sjogrens?

Treat symptoms Eye lubricants Frequent water Hydrdoxychloroquine Glucocorticoids Avoid atropine drugs and decongestants

how do you characterize the muscle involvement in inflammatory myopathies?

Symmetrical proximal muscle weakness

What are the four key skin features of dermatomyositis?

Gottron’s patches Heliotrope rash Periungual erythema V neck Erythema

What is the muscle biopsy finding in dermatomyositis?

Perimysial and perivascular inflammation, perifascicular atrophy

What is seen in labs for Dermatomyositis?

Elevated CK and aldolase

What is seen on serology of dermatomyositis?

Anti Jo 1 Anti Mi2 Anti MDA5 Anti P155/P140

What malignancies are associated with dermatomyositis?

``` Ovarian (check CA 125) Lung Pancreatic Stomach Colorectal NHL ```

What is seen on the biopsy for polymyositis?

Endomysial inflammation with invasion of non necrotic muscle fibers

What is seen on labs for polymyositis?

Elevated CK

What is seen on serology for polymyositis?

Anti Jo1

What is the treatment for dermatomyositis and polymyositis? **

Corticosteroids

What is the characteristic muscle weakness in inclusion body myositis?

Finger flexion or quadriceps weakness

What is seen on biopsy of inclusion body myositis?

Endomysial inflammation, rimmed vacuoles, invasion of non necrotic muscle fibers

What is seen on labs of IBM?

Elevated CK

What is seen on serology of IBM?

Anti cN1A autoantibodies

What is the treatment of IBM?

Supportive

How do you diagnose Henoch schonlein purpura?

IgA deposits on biopsy

How do you treat HSP?

Glucocorticoids

How do you diagnose Goodpastures?

Biopsy shows anti basement membrane autoantibodies in basement membrane

What causes the hypertension in Takayasu arteritis?

Renal artery stenosis

How do you diagnose takayasu arteritis?

MRI or CT angiography | Biopsy shows granulomas with giant cells

How do you treat takayasu arteritis?

Glucocorticoids

What is the triad in Behcet syndrome?

Recurrent mouth ulcers Genital ulcers Uveitis

What HLA for Behcet syndrome ?

HLA B51

What is the treatment of Behcet?

Low dose GC

What is polyarteritis nodosa characteristically assoc. with?

Hep B virus

What is seen on biopsy for PAN?

FIBRINOID NECROSIS

What is seen on serology for PAN?

P ANCA

Tx of PAN ?

Corticosteroids

What do patients die from in Kawasaki disease?

Coronary involvement | Aneurysm or MI

What is the tx of Kawasaki disease?

IVIG and high dose ASA

What is seen on serology for Wegeners granulomatosis?

C ANCA

What is the hallmark of Wegeners?

Granulomatous inflammation

What is the tx of Wegeners?

Cyclophosphamide and high dose GC or rituximab

What are the hallmarks of Churg Strauss syndrome?

Asthma + eosinophilia -> vasculitis with granulomas

How do you make the diagnosis of Churg Strauss?

MPO ANCA

How do you treat Churg Strauss?

Who is affected by Buerger disease?

Smokers

How do you make the diagnosis of Buerger disease?

Angiography corkscrew appearance

Treatment of Buerger disease?

Smoking cessation

How does temporal(giant cell) arteritis present?

Headache, jaw claudication, visual abnormalities (amaurosis fugax or diplopia)

What HLA is associated with temporal arteritis?

HLA DR4

How do you diagnose temporal arteritis?

Temporal artery bx 1.0 cm segment biopsy will show segmental granulomatous vasculitis with multinucleated giant cells

How do you treat temporal arteritis?

Corticosteroids therapy before biopsy

What is polymyalgia rheumatica (PMR) associated with?

Temporal/giant cell arteritis

How do you diagnose PMR?

Elevated ESR and CRP

How do you treat PMR?

Corticosteroids

How do you diagnose secondary raynauds?

Nailfold capillaroscopy

What serology marker can we use to identify an autoimmune disease?

+ANA

What is the clinically significant ratio of ANA?

1:160

What are the four ANA patterns?

Homogenous Speckled Centromere Nucleolar

What staining pattern does CREST show?

Centromere pattern

Which staining pattern does drug induced SLE show?

Homogenous

Which staining pattern does Sjögren’s syndrome show?

Speckled mostly but can also be homogenous

What staining pattern does diffuse systemic sclerosis show?

Nucleolar pattern (more than the others) can also be speckled

What do the sx of malaise, malar rash, photosensitivity, symmetric inflammatory arthritis, thrombosis, pancytopenia, pericarditis, seizures and psychosis indicate ?

SLE

Antibodies in SLE include what? (3)

ANA, anti-ds DNA, anti Sm (smith)

Which antibody present in SLE correlates with disease activity?

Anti-ds DNA

What happens to complement levels in SLE?

Decreased C3 and C4

Which type of APA syndrome can cause biological false positive tests for syphilis?

Type one

Which type of APA syndrome can cause lupus anticoagulant and is a risk factor for venous and arterial thrombosis and miscarriage ?

Type two

Which type of APA syndrome can cause anti cardiolipin antibodies?

Type three

What are anti cardiolipin antibodies directed at?

Beta 2 GPI

What is the treatment for APA syndrome?

Anticoagulation

Approach To Malaise And Generalized Pain Flashcards

(92 cards)