5 Written questions
5 Matching questions
- What is tx for Takayasu's arteritis?
- What are the different types of systemic vasculitis?
- What are the Diagnostic Criteria for Churg-Strauss Syndrome?
- A pt comes in with ptosis, diplopia, difficulty in chewing and swallowing, respiratory difficulties and limb weakness. The muscle weakness increases with activity and improves after periods of rest. What do they have?
- What has an ESR >50, is ANCA-negative, has low titers of ANA or RF?
- a Myasthenia Gravis (chronic autoimmune neuromuscular disorder with varying degrees of weakness of skeletal (voluntary) muscles of body)/ mya - muscles, anticholinesterase, acetylcholine receptor antibodies
- b P M & M: Prednisone 1 mg/kg/d tapered to < 20 in 8-20 wks with maintenance at 10 mg; Methotrexate 25 mg/wk and mycophenolate mofetil 1500 mg bid for those who are refractory
- c PE MEAT: Paranasal sinus abnormalities, Eosinophilia > 10% on diff, Mononeuropathy, Extravascular eosinophils positive biopsy, Asthma, Transient pulmonary infiltrates
- d Polyarteritis Nodosa
- e PoG -> Wegman's for Japanese + German food = Polyarteritis Nodosa, Giant Cell Arteritis, Wegener's Granulomatosis, Takayasu's arteritis, Churg-Strauss Syndrome
5 Multiple choice questions
- Wegener's Granulomatosis (fatal if not treated)
- High dose prednisone 40-60 mg/d tapered slowly after 1 month; immunosuppressive agents
- urgently with prednisone 60 mg/d immediately -> bx to confirm/ then low dose ASA 81 mg/d/ continue prednisone 1 month before tapering
- it is abnormal (thymoma = thymic hyperplasia)/ it has clusters of immune cells indicative of lymphoid hyperplasia/ autoimmunity and production of the acetylcholine receptor antibodies setting the stage for attack on neuromuscular transmission -> skel muscle weakness
- nose, soft palate, petechiae, gums, GI and CNS; good
5 True/False questions
What Ig is involved with ITP? Which cell lines are affected? → autoimmune do where IgG antibody formed that binds to platelets; destruction in spleen; isolated thrombocytopenia (other cell lines normal)
What is a vasculitis that presents in pts over 50 with a warning headache, visual symptoms, jaw claudication, throat pain, dry cough, and a fever? It affects medium and large arteries. There is an asymmetry of pulses in arms, murmur of aortic regurgitation and bruits near the clavicle. → Giant Cell Arteritis (blindness if untreated)
What should you screen for in pt's with polyarteritis nodosa? → high dose corticosteroids (60 mg Prednisone daily), Methylprednisolone 1 g IV daily for 3 days if critically ill, immunosuppressive agents like Cyclophosphamide; Hep B responds to short course of prednisone + lamivudine 100 mg/d and plasmapheresis 3 wk for 6 weeks
How do you treat polyarteritis nodosa? → high dose corticosteroids (60 mg Prednisone daily), Methylprednisolone 1 g IV daily for 3 days if critically ill, immunosuppressive agents like Cyclophosphamide; Hep B responds to short course of prednisone + lamivudine 100 mg/d and plasmapheresis 3 wk for 6 weeks
How do you dx myasthenia gravis? → NAP: (since it improves with rest)/ otherwise CT
Anticholinesterase drugs give symptomatic relief
i.e. Neostigmine 15 mg qid and Pyridostigmine 60 mg qid; thymectomy; failure of above - corticosteroids