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MSKJaz > CT diseases > Flashcards

CT diseases Flashcards

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1
Q

SLE areas it can affect in the body?

A

anywhere!

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2
Q

SLE:
F:M
which ethnicities have a higher prevalence

A 
F9:1M
Asain 
African Americans
Afro-caribbean
hispanic americans
Asain indians in the UK
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3
Q

aetiology factors of SLE

A

gentic
hormonal - high oestrogen increases incidence
EBV, UV, silica dust
immunological

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4
Q

pathogenesis of SLE:

__+__ apoptosis > ___ released by necrotic cells act as ___ => __ as extended exposure to these >+ stimulated > ___

A 
increased and defective
nuclear material
auto Ig
AI
B and T
auto Igs
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5
Q

why renal disease in SLE?

A

immune complexes deposited in mesangium > activate complement > leucocyte attracted and release cytokines => perpetuates inflam => necrosis and scarring

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6
Q

mucocutaneous features of SLE =

A 
malar rash
photosensitive rash (devs 2-3 days after exposure)
discoid LE
subacute cutaneous lupus
painless mouth ulcers
non-scarring alopecia
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7
Q

constitutional features of SLE

A 
fever 
malaise
decreased appetite
wt loss
fatigue
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8
Q

MSK features of SLE

A

non deforming polyarthritis/algia (RA distribution but no erosion)
deforming arthropathy - Jaccoud’s arthritis
erosive arthritis (rare)
myopathy
myalgia
myositis

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9
Q

serositis in SLE can cause

A

pericarditis
pleurisy
pleural/pericardial effusion

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10
Q

renal involvement in SLE =

A

proteinuria >500mg in 24hrs

red cell casts

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11
Q

neuro features of SLE

A 
seizures
psychosis/depression
migraine
mononeuritis multiplex
cranial/peripheral neuropathy
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12
Q

haematological features of SLE

A

lymphadenopathy, leucopenia (susceptible to infections), haem anaem, thrombocytopenia

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13
Q

SLE is often ass with ___ syndrome => (5)

A 
anti-phospholipid
arterial and venous thrombosis
recurrent miscarriage
livedo reticularis
thrombocytopenia
prolonged APTT
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14
Q

Ix for diagnosis of SLE

A

autoIgs

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15
Q

screening in SLE for organ involvement test = (8)

A 
CXR
PFT
CT chest
urinalysis
renal biopsy
echocardiogram
nerve conduction studies
brain MRI
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16
Q

autoIgs in SLE (5)

A

ANA (+ve in 95% but not v specific)
anti-dsDNA (+ve in 60%, highly specific and titre correlates to disease activity)
anti-ENA (cutaneous manifestations) = anti -Ro +La
anti-Sm (in 10%, highly specific)
anti-RNP (30%)

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17
Q

autoIg highly specific for SLE and its titre correlates to disease activity =

A

anti dsDNA

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18
Q

anti phospholipid autoIgs (3)

must be ___ for diagnosis

A

anti-cardiolipin Ig
lupus anticoagulant
anti β2 glycoprotein
+ve 2x 12 wks apart

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19
Q

monitor activity of SLE by: (3)

A

clinical assessment eg. bp, FBC, biochem, urine for protein, cells and casts
anti dsDNA Ig
C3/4 levels (increase if activity decreases)

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20
Q

treatment for SLE

A 
limit sun exposure
pregnancy support
NSAIDs and analgesia
hydroxychloroquine
steroids
IS
biologics
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21
Q

biologics used for SLE

Study These Flashcards
A

anti-CD20 (rituximab)

anti B Igs (belimumab)

22
Q

low dose steroids <15mg/d of prednisolone is used if ++_ features of SLE

Study These Flashcards
A

skin rashes
arthritis
serositis

23
Q

mod dose steroids 0.5mg/kg/d used if these features of SLE (3)

Study These Flashcards
A

resistant serositis
haematological
class V glomerulonephritis

24
Q

high dose steroids 1mg/kg/d used if these features of SLE (3)

Study These Flashcards
A

major organ involvement
severe/resistant haematological
diffuse glomerulonephritis

25
mild SLE drugs =
hydroxychloroquine topical steroids NSAIDs
26
moderate SLE drugs (no major organ involvement)
PO steroids azathioprine methotraxate
27
severe SLE drugs
IV steroids glycophosphamide rituximab
28
Rx of anti-phospholipid syndrome
lifelong anticoagulation aspirin and heparin during pregnancy decrease vascular risk factors
29
Diagnosis of antiphospholipid syndrome is by 1 lab + 1 clinical feature : clinical features =
arterial/ venous thrombosis unexplained preg loss 10-34wks in/ 3 losses unexplained <10wks / prem <34wk due to eclampsia, severe pre eclampsia or placental insufficency
30
Diagnosis of antiphospholipid syndrome is by 1 lab + 1 clinical feature : lab =
anti cardiolipin Ig +/ lupus anticoagulant +/ antiβ2 glycoprotein on two occasions at least 12 wks apart
31
F:M for anti phospholipid syndrome
F3.5:1M
32
s+s of anti-phospholid syndrome
``` superficial thrombophlebitis livedo reticularis moderate thrombocytopenia migraine transverse myelitis Libman-Sachs endocarditis ```
33
AI lymphocyte infiltration of exocrine glands => ___+___ = ___ syndrome
xerostomia keratoconjunctivitis sicca Sjogrens
34
diagnosis of Sjogrens is dependent on
``` 4/6 of: ocular / oral sympts (daily >3months) ocular dryness salivary gland involved anit Ro +/La PLUS lymphocytic infiltrate on biopsy ```
35
test to test ocular dryness
Schirmer test
36
s+s of Sjogrens (11)
``` fatigue arthralgia Raynauds salivary swelling lymphadenopathy skin and vaginal dryness ILD neuropathy lymphoma (40x risk) renal tubular acidosis neonatal complete heart block (anti-Ro) ```
37
primary Sjogrens age, M:F | rarely have __
40-60yo F9:1M rarely have serious complications
38
Rx of Sjogrens
``` eye drops punctal plugs saliva replacement pilocarpine hydroxychloroquine steroids and IS CV risk factors ```
39
systemic sclerosis 4 types =
localised scleroderma limited systemic sclerosis diffuse systemic sclerosis systemic sclerosis sine scleroderma
40
AI that causes vasculopathy (__), inflam and fibrosis - excess deposition of collagen in skin and organs =
Raynauds | Systemic sclerosis
41
signs of localised scleroderma =
morphoea (skin patches/plaques) linear scleroderma (long narrow thickening of skin) only affects the SKIN
42
s+s of limited systemic sclerosis
CREST Calconosis, Raynauds, Esophageal dysmotility, Sclerodactyly, Telangiectasia 30% = pulmonary hbp
43
limited systemic sclerosis is ass with ____ Igs
anti-centromere
44
diffuse systemic sclerosis ass. with ___ Igs early ___ involvement __ changes within 1 yr of Raynauds __+__ skin involvement
anti- Scl 70 significant organ involvement (lungs, kidneys, gut, muscle, joints, heart) skin truncal and acral
45
treatment of systemic sclerosis
``` CCBs prostacyclin (Iloprost) ACEI prednisolone IS bosentan sildenafil ```
46
Mixed CT disease (MCTD) | major features -
``` severe myositis pulmonary involvement Raynauds swollen hands sclerodactyly anti U1 RNP > 1:10000 ```
47
minor features of Mixed CT disease (MCTD)
``` alopecia lecuopenia anaemia pleuritis pericarditis arthritis trigeminal neuralgia malar rash thrombocytopenia mild myositis Hx of swollen hands ```
48
auto Igs in Sjogrens =
Anti Ro and La
49
auto Igs in systemic sclerosis
anti centromere | anti Scl 70
50
MCTD auto IG
anti RNP
51
polymyositis auto Ig =
anti Jo1

MSKJaz (28 decks)

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