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40 Cards in this Set

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What is the significance of ANA- anti-nuclear antibodies?
If present in higher than normal numbers it suggests autoimmune disease.

The ANA test measures the pattern and amount of autoantibody which can attack the body's tissues as if they were foreign material
Describe Rheumatoid Arthritis
a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints.

It can also affect the skin, blood vessels, heart, lungs, and muscle.
This disease presents with morning stiffness longer than 1 hour and is usually relieved with exercise
RA
This is a chronic autoimmune disease that results in inflammation and tissue damage. It can affect any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys and nervous system.

Its more common in women and often presents with a malar rash
SLE
What are hematological manifestations of SLE?
Anemia
Leukopenia
Iron deficiency
What are cardiac manifestations of SLE?
pericarditis
myocarditis
endocarditis
What are the renal symptoms of SLE?
Painless hematuria or proteinuria

Can casue membraneous glomerulonephritis
What are some test done to diagnose SLE?
ANA: antinuclear antibodies
anti-ENA: anti-extractable nuclear antigen
Antiphospholipid antibodies: can predispose to thrombosis
anti-smith antibodies
anti-dsDNA antibodies
What is the criteria to diagnose SLE?
Must meet 4 out of the 11 criteria

SOAP BRAIN MD:
Serositis: pleuritis, pericarditis

Oral ulcers

Arthritis

Photosensitivity: UV causes rash

Blood Changes: anemia, leukopenia, thrombocytopenia

Renal involvement (proteinuria or casts)

ANA Positive

Immunological changes: Positive anti-Sm DNA, anti-ds DNA, anti-phospholipid antibody and/or false positive serological test for syphilis

Neurological signs (seizures, frank psychosis)

Malar Rash

Discoid lupus: red, scaly patches on skin which cause scarring
This disorder presents with dry eyes and dry mouth
Sjögren's syndrome: its an autoimmune disorder in which immune cells attack and destroy the exocrine glands that produce tears and saliva
Which antibodies are typically present in Sjogren's syndrome?
SSA/Ro
SSB/La (more specific)
What are some test used to Dx Sjogren's?
Schirmer's test- measures the production of tears

Salivary gland function test

Lip biopsy- to look for lymphocytes around the gland that may be damaging it.
A rare, chronic disease characterized by excessive deposits of collagen in the skin or other organs
Scleroderma
What are some signs and symptoms of scleroderma?
CREST

Calcinosis
Reynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia
What are Heberden's nodes and Bouchard's nodes
Osteophytes on the fingers and toes associated with Osteoarthritis. Heberden's nodes are hard bony enlargements on the distal interphalangeal joints and Bouchard's nodes on the proximal interphalangeal joints
Swan neck and boutonniere deformities are characteristic of what disease?
Rheumatoid Arthritis

Boutonniere deformity: Hyperflexion at the proximal interphalangeal joint with hyperextension at the distal interphalangeal joint

Swan neck deformity: Hyperextension at the proximal interphalangeal joint, hyperflexion at the distal interphalangeal joint
This is a group of related inflammatory joint disease associated with the MHC class I molecule HLA-B27
Spondyloarthropathies

They include:
Ankylosing Spondylitis
Reiter's syndrome (reactive arthritis)
Enteropathic arthritis
Psoriatic arthritis
Which blood test can be done to diagnose RA?
RF: Not very specific

ACPA: Anti-Citrullinated Protein Antibody (98%specific)
Fusion of the sacroiliac joints, elevated ESR, negative RF, positive HLA-B27
Ankylosing Spondylitis
This condition usually follows dysentery or a sexually transmitted infection; 80% are HLA-B27 positive
Reiter's syndrome
Septic bursitis is almost always caused by this organism
Staph aureus
Which bursa are more commonly affected by Septic bursitis
olecranon
prepatellar
How cam you differentiate on phys exam between acute osteomyelitis and septic arthritis
range of joint motion is preserved in osteomyelitis
What are the responsible pathogens that cause folliculitis?
Staphylococci
Yeast
Pseudomonas
What organisms cause impetigo
Group A streptococci
S. aureus
vesicles on the skin of a child that rapidly become pustular and leave a golden crust
Impetigo
Who gets malignant otitis externa and what's the organism?
Diabetes Mellitus, most commonly caused by pseudomonas and affects the mastoid bone
Who are at risk of getting osteomyelitis?
People with:

Sickle cell disease
IV Drug users
Elderly
What organism is the likely cause of osteomyelitis with sickle cell patients? IV Drug users?
Sickle cell: Salmonella
Drug users: S.aureus, Pseudomonas, serratia
What organisms cause osteomyelitis that has spread from soft tissue infections (contiguous)
Staph aureus
Staph epidermidis
How do you treat osteomyelitis?
FQ 4-6 wks
If caused by S.aureus add rifampin
What are some meds to treat gout
NSAIDS- Piroxicam
Indomethacine
Colchicine
Steroids- for acute attack
Triaminolone- intra articular
What are some causes of hyperurecemia?
Chemotherapy
Alcohol
Leukemia
Chronic hemolysis
How does IgA nephropathy (Berger's) present?
Frank hematuria which usually starts within a day of an upper respiratory tract infection
What are some side effects of steroid therapy?
Cushing's
Hyperglycemia
Immunosuppression
Osteoporosis
Weight gain
Anovulation
Slippage of the vertebrae
Spondylolisthesis: usually with L3-L5, slips forward most of the time
How does Felty's syndrome present?
Rheumatoid arthritis
Splenomegaly
Leukopenia
Fever
Name some drugs that can give you a positive ANA
hydralazine
procainamide
isoniazid
dilantin
methyldopa
Alpha blockers
What condition presents with erythema multiforme (bull's eye lesions)
SJS
mouth sores, genital sores, inflammation inside of the eye, and skin problems (alopecia) suggest?
Behcet's disease