Flashcards in McGowen Deck (72):
Anti-dsDNA and anti-Sm
50 yesr old AF with fatigue and perioral lesions. Ant-dsDNA and positive ANA. Dx? Most likely cause of mortality in this?
atherosclerosis or renal
45 year old WF presents with CP. Hx of SLE. Recent resting has positive phospholipid antibodies. 2D echo reveals valvular thickening and verrucous valvular lesions. What is the condition called?
Nodules are ____, meanign w/o bacteria?
Libman Sacks endocarditis
sterile nodules (caused by inflammation)
MALT B cell lymphomas associated with?
Beta2GPI assoiated with?
37 year old AAF with hx of mood disorder. Cotton woll spots fundoscopically. Right leg venous doppler shows DVT. Diffuse LAD presents with aRF and chest pain that is work on respiration.
anti-phopholipid syndrome - think CLOTTING!
beta2GPI, anti-cardiolipin, or anti-phospholipid anitbody
anti-centromere antibodies. Dx? Definition?
CREST (limited scleroderma):
Esophageal dysmotolity (barrett's??)
anti-histone antibody. Dx?
drug induced SLE
45 year old white female with joint pain. Recently hospitalized for pyelonephritis with Cr of 1.7 on discharge. Discharged with hydralazine for BP and Cipro for infection. Develops malar rash on discharge as well as diffuse joint pain. What is most likely seen on serology.
anti-histone ab for drug induced lupus (dt hydralazine, isoniazid)
25 year old hispanic female with h/o SLE. Presents 16 weeks pregnant. Noticed swelling in legs and elevated BP. Fetal echo shows complete heart block in fetus. Serology possibly seen in mom?
(assoc with SLE in mom?)
Sx: swelling and elevated BP is preeclampsia
SJOGRENS with primary biliary cirrhosis
fetal complete heart block and fetal growth restriction, what ab?
45 year old presents with finger stiffness. She has hard white nodules on fingers and says at times fingers go blue. on PE she has perioral furrowing with red spots on lips and tongue. What is this?
CREST (limited scleroderma)
Pt has sx: calcinosis, raynauds, telangiectasias
Could also see: esophageal dysmotility
What disorder is associated with Pericarditis (sharp pain that gets better; assoc with diffuse ST elevation)
Type3 HS, HLADR4+, >40/50yo, Classic px: headache, trouble chewing/**jaw claudication**, ischemic optic neuropathy/blindness, ↑ESR, thoracic aneurysm (years later).
Temporal/giant cell arteritis
parotid gland enlargement
giant cell arteritis (hurts to chew)
43 year old F with dyspnea. Noted over last few mo gets SOA quickly. She has h/o GERD Raynaud's phenomenon and carpal tunnel syndrome. CXR reveals mediastinal LAD and honeycombing. Dry crackles heard on lung exam. Topoisomerase 1 ab positive. What is the cause of SOA?
she has diffuse scleroderma - interstitial lung disease is the most common cause of death
pulmonary artery HTN more commonly seen in limited or diffuse scleroderma?
how about interstitial lung disease?
dry crackles (velcro like) caused by?
wet crackles caused by?
interstitial lung disease (diffuse scleroderma)
asthma with eosinophils
EGPA - eospinophilic granulomatous poly angiitis (Churg strauss)
30 year old AAF c/o dry itchy skin. She is a coal miner. She says that her fingers and mouth feel tight and she is having difficulty eating. Noticed white patches on her skin. On ends of fingers she has developed sores. She has frequent heartburn. What is her dx and the most likely etiology of her dx?
Etiology: possibly silica (silicosis)
itchy skin ddx
These are possible etiologies of ___?
hormone replacement therapy, cocaine use, silica exposure, appetite suppressants, bleomycin (cancer)
30 year old AAM c/o fatigue, stiffness, and malaise. Mscle weakness, arthralgia. A h/o Raynaud's and CTS. Presents to ED with confusion and BP of 212/109. Protein, microscopic blood, and negative granular casts in urine. Anti-centromere Ab are negative. RNA polymerases 1 and 3 Ab are positive. What is his diagnosis?
diffuse scleroderma (RNA polymerases 1 and 3 Ab)
GAVE syndrome - Gastric Antral Vascular Ectasia
sinusitis, lung involvement, renal involvement
Granulomatosis with polyangitis (wegner's)
vasculitis more common in males, associated with Hep B.
what is hypertensive encephalopathy?
altered mental status (i.e. confusion) due to hypertension (i.e. malignant hypertension)
7 year old F with "spot on face". Healthy with no PMH. No h/o trauma. Spot hasn't gone away for several weeks. Dx?
Pediatric localized scleroderma - only cutaneous (morphea)
60 year old F with facial swelling. Last week increased dry mouth and eyes and today her face swollen.
What is this?
What is she at risk of developing?
40 year old female with chronic oral candidiasis, and multiple dental fillings presents with feeling that she has something in her eyes constantly and she can't stand to be around bright lights. Diffuse LAD is palpated on exam. She has positive ANA, anti Ro and La Ab. She was recently diagnosed with B cell NHL.
What is this?
What is most likely to be seen on serology.
Sjogren's (karatoconjuctivitis sicca - decreased lacrimal flow); anti- ro, anti-la
elevated IgG, decreased C4 levels
45 year old F c/o weakness progressing over last 2 mo in arms/legs and diffusely itchy skin. "Doc, I can't climb stairs." Labs show elevated CK and aldolase. PE shows violacious periorbital macular erythema and papules over dorsal MCP joints with "Shawl sign" (poikiloderma) noted.
What is the dx?
What cancer do you be wary of?
violacious periorbital macular erythema - what is this called?
Do Hep B serology if you suspect ___
Do esophagogastroduodenoscopy (EGD) if you suspect ___
Scleroderma (Barrett's esophagus, adenocarcinoma)
41 yo F with one week h/o muscle weakness. Elevated CK, muscle biopsy shows endomysial inflammation with invasion of non necrotic muscle fibers. PE normal except for 4/5 muscle strength an db/l UE and LE.
If biopsy was normal, what would it be? Why is there weakness in this?
polymalgia rheumatica if biopsy was normal - weakness is due to pain.
55 year old male with weakness in **finger flexors and quads**. Sx gradually developed over past year. Difficulty walking and knees sometimes buckle. CK level normal. Biopsy shows rimmed vacuoles on H&E stain.
What ab associated with dx?
Dx: inclusion body myositis
Ab: cN1A antibody (highly specific for this dx)
39 year old form India. Uncontrolled HTN 175/92. Adhering to anti-HTN meds. "Copper wire" retinal infarctions seen. Radial and pedal pulses difficult to palpate. Renal doppler US shows narrowing of renal arteries bilaterally. UA normal.
Pt is at highest risk of developing what?
Dx: Takayasu arteritis ("pulseless disease", large vessel/AORTA vasculitis, obliterating, aortic stenosis)
Risk of developing: Aortic rupture
#1 cause of b/l renal stenosis in india
Coronary artery aneurysm is a complication of what vasculitis?
55 year old Turk with mouth sores with recurrent mouth sores and genital sores. Herpes w/u negative. Joint pain in right shoulder and left knee and remote h/o DVT. Recent lab work HLA-B51 was present. Developed pustule at site of lab draw.
What is lab draw site pustule called?
Dx: Behcet Syndrome (**mouth sores**, genital sores, HLA-B51, aa/vv of ALL SIZES)
Lab draw site pustule: Pathergy
oral lesions, genital lesions, eye inflammation
palpable purpura, abdominal pain, arthralgias, renal
lung, renal, anti-GBM ab
dry mouth, dry eyes, parotid gland involvement, risk of MALT lymphoma, Ro and La ab
35 year old male with h/o chronic hep B and HTN. Concerns of fatigue and myalgias. Concerned about numbness in hands and feet. Shown livido reticularis (net or lace like skin discoloration).
What organ system is not affected by this dz?
Organ systems NOT involved: pulmonary (spares the lungs)
Organ systems involved:
-cardiac (CHF, MI)
-GI (intestinal angina/chronic abd pain)
-renal (HTN and renal infarcts)
4 year old Asian female with diffuse LAD. 102 fever for 2 days. Palmar erythema and some desquamation of finger tips. Rapid strep negative. Congested eyes, prominent tongue papillae.
Most likely mortality in late disease?
Dx: Kawasaki (aka mucocutaneous LN syndrome)
Mortality: Coronary artery aneurysm
Pulmonary embolism seen in what two syndromes?
phospholipid antibody syndrome
CHF associated with what vasculitis?
50 year old WF with rash on legs. H/o chronic sinusitis. CXR reveals lung nodules with necrotizing granulomas. Positive C-ANCA.
Dx: Wegner's (Granulomatosis with polyangiitis - GPA)
PE: saddle nose due to cartilage inflammation/collapse
30 yo F with h/o asthma, allergies, allergic rhinitis for 20 years. Rash, tingling on arms and legs. ANCA postiive. Rash shows necrotizing granulomas.
What is seen on lab work?
Dx: Churg Strauss (esoinophilic granulomatosis with polyangiitis - EGPA)
25 year old with finger ulcer that has been worsening. Smoker for 10 years.
Start colonoscopy at?
Dx: burger's disease (thromboangiitis obliterans)
Tx: stop smoking
Colonoscopy at: 40 years
Wegners, Churg strauss,
-possible: giant cell arteritis, takayasu
IgA deposition - what vasculitity?
Basement membrane Ab - what vaculitity?
Primary v. secondary raynauds
-Primary: no PMH/healthy person, just when in stress/cold weather fingers turn red/white/blue
-Secondary: SLE/CREST, digital ulcers (tx: CCB)
55 year old female with 2 day hx of acute intermittent vision changes and complete vision loss at times. Low grade fever and fatigue. Recalls "migraine" last week. Pain chewing food. ESR 55.
Dx: Giant cell arteritis (vision change, HA, jaw claudication, elevated ESR)
Tx: glucocorticoid steroids immediately BEFORE biopsy
50 year old female with constant, severe neck and shoulder pain and feeling weak. She reports weight loos of 15 pounds over the last 3 mo. She has difficulty standing from a seated position due to pain. Muscle biopsy reveals no inflammation and is considered normal.
Associated with hx of ___ and ___?
Associated with hx of Giant Cell arteritis and CTS
DVT associated with what two syndromes?
antiphospholipid and Behcets
55 year old female with persistent HA and can't sleep due to the pain for weeks. Constantly tired and 10 lb weight loss. Painful to chew food.
most common cause of death in SLE pts
What has a steroid response v. not: dermato/polymyositis v. inclusion body myositis
Y - dermato/polymyositis
N - inclusion body myositis
IVIg w/in 10 days and HD ASA --- this is tx of?
Kawasaki disease (mucocutaneous LN syndrome)
Tx of __: LD CS