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on 20-Jun-2015 (Sat)

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Flashcard 150896706

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#medicine #rheumatology
Question
What is Ankylosing spondylitis ?
Answer
a chronic inflammatory disease of the spine and sacroiliac joints, of unknown aetiology


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Flashcard 150896713

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Question
What gene is commonly present in Ankylosing Spondylitis ?
Answer
HLA B27


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Flashcard 150896720

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Question
What is the prevalence of Ankylosing Spondylitis ? (Who do we most commonly see it in)
Answer
Men present earlier ≈ 6:1 at 16 yrs old, and ~ 2:1 at 30 yrs old


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Flashcard 150896727

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Question
What is the classical Ankylosing Spondylitis presentation ?
Answer
a man <30 yrs old with gradual onset of low back pain, worse at night, with spinal morning stiff ness relieved by exercise. Pain radi ates from sacroiliac joints to hips/buttocks, and usually improves towards the end of the day. There is progressive loss of spinal movement.


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Flashcard 150896734

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Question
What are the extra-articular manifestations of Ankylosing Spondylitis ?
Answer
  • Acute iritis
  • osteoporosis (up to 60 %),
  • aortic valve incompetence ( <3 %)
  • pulmonary apical fibrosis
  • Psoriasiform Rashes
  • Oral Ulcers
  • Inflammatory Bowel Disease


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Flashcard 150896750

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Question
What is a bamboo spine associated with ?
Answer
Ankylosing Spondylitis


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Flashcard 150896757

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Question
What are the Spondyloarthropathies ? (4)
Answer
  1. Ankylosing Spondylitis
  2. Enteropathic Spondylitis
  3. Psoriatic Arthritis
  4. Reactive Arthritis


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Flashcard 150896764

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Question
What are the steps of Treatment in Ankylosing Spondylitis ?
Answer
  • Exercise and Physiotherapy
  • NSAIDs (TNF alpha blockers are second line)
  • Local Steroid Injection
  • Consider Bisphosphonates (Increased Osteoporotic Spinal Fractures)


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Flashcard 150896771

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Question
What conditions are associated with Enteric Arthropathy ?
Answer
  • Inflammatory bowel disease
  • GI bypass
  • Coeliac Disease
  • Whipple’s disease


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Flashcard 150896778

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Question
What is Reiter's Syndrome
Answer
A triad of urethritis, arthritis, and conjunctivitis


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Flashcard 150896791

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Question
What often proceeds Reactive Arthritis ?
Answer
  • Urethritis (Chlamydia or Ureaplasma sp.)
  • Dysentery (Campylobacter, Salmonella, Shigella, or Yersinia sp.)


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Flashcard 150896798

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Question
What is a Reactice Arthritis ?
Answer
A sterile arthritis


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Flashcard 150896805

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Question
How long after infection does Reactive Arthritis Present ?
Answer
1 – 4 weeks


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Flashcard 150896812

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Question
What other conditions may be associated with Reactive Arthritis ?
Answer
  • Iritis
  • Keratoderma blenorrhagica (brown, raised plaques on soles and palms)
  • Circinate balanitis (painless penile ulceration secondary to Chlamydia)
  • Mouth ulcers
  • Enthesitis


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Flashcard 150896819

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Question
What are the important investigations in Reactive Arthritis ?
Answer
  • FBC
  • ESR & CRP
  • Culture stool if diarrhoea
  • Infectious serology
  • Sexual health review


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Flashcard 150896826

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Question
What is Dactylitis
Answer
Inflammation of an entire digit (‘sausage digit’), due to soft tissue oedema, and tenosynovial and joint inflammation.


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Flashcard 150896833

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Question
What is Enthesitis ?
Answer
Inflammation of the site of insertion of tendon or ligament into bone. (eg plantar fasciitis, Achilles tendonitis, costochondritis)


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Flashcard 150896840

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Question
What are the common features of Spondyloarthropathies ? (7)
Answer
  1. Seronegativity ( = rheumatoid factor – ve).
  2. HLA B27 association
  3. ‘Axial arthritis’: pathology in spine (spondylo-) and sacroiliac joints.
  4. Asymmetrical large-joint oligoarthritis (ie <5 joints) or monoarthritis.
  5. Enthesitis
  6. Dactylitis
  7. Extra-articular manifestations


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Flashcard 150896847

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Question
What are the Autoimmune connective tissue diseases ?
Answer
  • SLE
  • Systemic sclerosis
  • Primary Sjögren’s syndrome
  • Idiopathic inflammatory myopathies
  • Mixed connective tissue disease
  • Relapsing polychondritis
  • Behçet’s disease


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Flashcard 150896854

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Question
What parts of the body does Limited cutaneous systemic sclerosis affect ?
Answer
face, hands and feet


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Flashcard 150896861

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Question
What antibody is associated with Limited cutaneous systemic sclerosis ?
Answer
anticentromere antibodies


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Flashcard 150896868

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Question
What are the clinical features of Limited cutaneous systemic sclerosis ?
Answer
(CREST syndrome)
  • Calcinosis (subcutaneous tissues)
  • Raynaud’s
  • Esophageal and gut dysmotility
  • Sclerodactyly (swollen tight digits)
  • Telangiectasia


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Flashcard 150896875

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Question
What is often present in Limited cutaneous systemic sclerosis as a subclinical condition ?
Answer
Pulmonary hypertension


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Flashcard 150896882

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Question
What antibodies are associated with Diffuse cutaneous systemic sclerosis ?
Answer
Antitopoisomerase- 1 [Scl 70 ] antibodies and anti- RNA polymerase


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Flashcard 150896889

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Question
What conditions are associated with Relapsing polychondritis
Answer
  • aortic valve disease
  • polyarthritis
  • vasculitis


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Flashcard 150896896

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Question
Where does a Relapsing polychondritis typically affect ?
Answer
  • The pinna (floppy ears)
  • Nasal septum,
  • Larynx (hence stridor)
  • Joints


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Flashcard 150896903

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Question
How is Systemic Sclerosis Treated ?
Answer
  • Immunosuppressive regimens
  • Monitor BP and renal function
  • Regular ACE - i or A2RB
  • Raynaud's Treatment


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Flashcard 150896916

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Question
How does Polymyositis and Dermatomyositis present ?
Answer
insidious onset of progressive symmetrical proximal muscle weakness and autoimmune-mediated striated muscle inflammation (myositis), associated with myalgia ± arthralgia.


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Flashcard 150896923

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Question
What are the extra muscular signs of Polymyositis and Dermatomyositis ?
Answer
  • Fever
  • Arthralgia
  • Raynaud’s
  • Interstitial lung fibrosis
  • Myocardial involvement (myocarditis, arrhythmias).


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Flashcard 150896930

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Question
What are the skin signs in Dermatomyositis ?
Answer
  • Macular rash (shawl sign is + ve if over back & shoulders)
  • Lilac-purple (heliotrope) rash on eyelids often with oedema
  • Nailfold erythema (dilated capillary loops)
  • Gottron’s papules
  • Subcutaneous calcifications


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Flashcard 150896937

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Question
What antibodies are associated with Polymyositis and dermatomyositis ?
Answer
  • anti- Mi2
  • ​anti- Jo1


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Flashcard 150896944

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Question
What are the Muscle enzymes ?
Answer
ALT, AST, LDH, CK & aldolase


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Flashcard 150896951

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Question
How is Polymyositis and Dermatomyositis treated ?
Answer
Prednisolone


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Flashcard 150896958

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Question
What is Systemic lupus erythematosus ?
Answer
a multisystemic autoimmune disease in which autoantibodies are made against a variety of autoantigens


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Flashcard 150896965

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Question
Who does SLE Typically affect ?
Answer
Women of child-bearing age


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Flashcard 150896972

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Question
How is disease activity in SLE monitored ?
Answer
  1. Anti-ds DNA antibody titres
  2. Complement: C3. C4 (Decreased)
  3. ESR (Increased).


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Flashcard 150896982

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Question
ESR is raised in SLE. What happens to the CRP ?
Answer
CRP normal. If raised consider infection and arthritis


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Flashcard 150896989

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Question
What are the clinical features of Antiphospholipid Syndromes ?
Answer
CLOTS: Coagulation defect, Livedo reticularis, Obstetric (recurrent miscarriage), Thrombocytopenia ( Decreased platelets).


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Flashcard 150896996

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Question
How many of the revised criteria for Diagnosing SLE must be present to diagnose ?
Answer
≥ 4 out of 11 criteria


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Flashcard 150897003

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Question
What are the CNS disorders of SLE ?
Answer
  • Seizures
  • Psychosis


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Flashcard 150897016

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Question
What are the features of Renal Disease to diagnose SLE ?
Answer
  1. Persistent proteinuria >0 . 5 g/d (or >3+ on urinalysis) OR
  2. Cellular casts — may be red cell, granular, or mixed.


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Flashcard 150897023

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Question
What is the Malar rash (butterfly rash) seen in SLE ?
Answer
Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds


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Flashcard 150897030

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Question
What are the conditions of serositis seen with SLE ?
Answer
  1. Pleuritis (presents as pleuritic pain or dyspnoea due to pleural effusion — 80 % have lung function abnormalities) OR
  2. Pericarditis (chest pain, ECG, pericardial rub or signs of pericardial effusion)


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Flashcard 150897037

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Question
Describe a Discoid rash ?
Answer
Erythematous raised patches with adherent keratotic scal es and follicular plugging ± atrophic scarring


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Flashcard 150897044

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Question
What are the haematological changes seen with SLE ?
Answer
  • Haemolytic Anaemia
  • Leukopenia <4≈10 9 /L on ≥ 2 occasions
  • Lymphopenia <1 . 5 ≈ 10 9 /L on ≥ 2 occasions
  • Thrombocytopenia <100≈10 9 /L, in the absence of a drug effect


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Flashcard 150897051

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Question
what are the 11 Revised criteria (serial or simultaneous) for diagnosing SLE ?
Answer
  1. Malar rash (butterfly rash)
  2. Discoid Rash
  3. Photosensitivity
  4. Oral Ulcers
  5. Non - erosive arthritis
  6. Serositis
  7. Renal Disorders
  8. CNS Disorders
  9. Haematological Disorders
  10. Immunological Disorder
  11. Antinuclear Antibody


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Flashcard 150897058

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Question
What type of Vasculitis affects Large Vessels ?
Answer
  • Giant cell arteritis
  • Takayasu’s arteritis


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Flashcard 150897065

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Question
What types of vasculitis affects Medium sized vessels ?
Answer
  • Polyarteritis nodosa
  • Kawasaki disease


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Flashcard 150897072

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Question
What is Vasculitis ?
Answer
an inflammatory disorder of blood vessel walls, causing destruction (aneurysm/rupture) or stenosis. It can aff ect the vessels of any organ, and presentation depends on which organs are involved.


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Flashcard 150897079

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Question
What are the ANCA negative vasculitis of small vessels ?
Answer
  • Henoch-Schönlein purpura
  • Goodpasture’s syndrome
  • Cryoglobulinaemia


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Flashcard 150897089

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Question
What are the ANCA positive vasculitis of small vessels ?
Answer
p- ANCA
  • Microscopic polyangiitis
  • Glomerulonephritis
  • Churg – Strauss syndrome
c- ANCA
  • Wegener’s granulomatosis


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Flashcard 150897096

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Question
What are the investigation findings with Vasculitis ?
Answer
  • ESR/CRP Increase.
  • ANCA may be positive
  • Increased Creatinine if renal failure.
  • Urine: proteinuria, haematuria, casts on microscopy.
  • Angiography ± biopsy may be diagnostic


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Flashcard 150897106

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Question
What are the symptoms of Giant Cell Arteritis ?
Answer
  • Headache
  • Temporal artery and scalp tenderness (eg when combing hair)
  • Jaw claudication
  • Amaurosis fugax
  • Sudden blindness, typically in one eye.


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Flashcard 150897113

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Question
What are the Extracranial symptoms of Giant Cell Arthritis ?
Answer
  • dyspnoea
  • morning stiffness
  • unequal or weak pulses


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Flashcard 150897120

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Question
How long does Giant Cell Arteritis usually last ?
Answer
Typically a 2 -year course, then complete remission.


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Flashcard 150897127

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Question
What is the appropriate immediate treatment if suspecting Giant Cell Arteritis ?
Answer
Do ESR and start oral prednisolone immediately.


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Flashcard 150897134

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Question
What is a consequence of Giant Cell Arteritis ?
Answer
Irreversible bilateral visual loss


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Flashcard 150897141

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Question
How is Small/Medium artery vasculitis treated ?
Answer
  • Steroids
  • IV cyclophosphamide


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Flashcard 150897148

Tags
#medicine #rheumatology
Question
Within what time period should a biopsy be done if suspecting Giant Cell Arteritis ?
Answer
Temporal artery biopsy within 7 days of starting steroids. Skip lesions occur, so don’t be put off by a negative biopsy


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Flashcard 150897155

Tags
#medicine #rheumatology
Question
What is Polyarteritis nodosa ?
Answer
A necrotizing vasculitis that causes aneurysms and thrombosis in medium- sized arteries, leading to infarction in affected organs, with severe systemic symptoms.


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Flashcard 150897162

Tags
#medicine #rheumatology
Question
What are the clinical features of Microscopic polyangiitis
Answer
  • Rapidly progressive glomerulonephritis
  • Pulmonary haemorrhage


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Flashcard 150897169

Tags
#medicine #rheumatology
Question
What is the important antibody in Microscopic Polyangiitis ?
Answer
pANCA Positive


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Flashcard 150897176

Tags
#medicine #rheumatology
Question
What drugs are used in treating Polyangiitis Nodosa and Microscopic Polyangiitis ?
Answer
  • Corticosteroids
  • Cyclophosphamide


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