MBB ABIM IM Board Review updated 2022.08.07
Acute cutaneous lupus erythematosus (ACLE)
-photosensitive malar rash sparing the nasolabial folds
-other sun exposed area can be involved
-almost all pts have systemic symptoms and positive serologic
results (ANA, anti-Ro/SSA, anti-La/SSB)
Three primary patterns of lupus specific skin rashes
1. Acute cutaneous lupus erythematosus (ACLE)
2. Subacute cutaneous lupus erythematosus
3. Chronic cutaneous lupus erythematosus
Lupus pernio disease association and characteristics
Sarcoidosis
Face and head rash - not chest and arms
Not photosensitive
Rosacea
Most common cause of an red malar rash
More likely to be pustular
May have telangiectasias
Does not spare the nasolabial fold
Subacute cutaneous lupus erythematosus
Occurs as two variants - annular and polycyclic
Photosensitive plaques on the back, chest, ext
May be psoriasiform scaly plaques
Fewer than 1/4 of pts with SCLE have SLE
Many cases are drug induced
Ganaxolone (ZTALMY)
-Indication: seizures a/w cyclin dependent kinase-like 5 def
disorder
-first treatment for seizures a/w CCD
-first treatment specifically for CCD patients
Dextromethorphan and fluoxetine
,Antitussive agents such as dextromethorphan have limited
efficacy in treating cough and should be avoided in patients taking
SSRIs, particularly fluoxetine, because of the possibility of
increased serotonergic effects, including serotonin syndrome.
Serotonin syndrome is a hyperthermic reaction triggered by
simultaneous use of two or more medications that affect release
or reuptake of serotonin; it is usually associated with hyperreflexia
and myoclonus
Benzonatate MOA
1. Inhibits cough by anesthetizing stretch receptors of vagal
afferent fibers in the bronchi, alveoli, and pleura.
2. Suppresses transmission of the cough reflex at the level of the
medulla where the afferent impulse is transmitted to the motor
nerves.
Dextromethorphan
1. Retains only the antitussive activity of other morphinan
derivatives
2. Acts centrally on the respiratory center in the medulla and
nucleus tractus solaris to increase the cough threshold
3. About equal to codeine in depressing the cough reflex and has
no expectorant action
Treatment for Chronic cough
1. Multimodality speech pathology intervention
2. Antitussive therapy
3. Trial of gabapentin - a neuromodulatory agent that may
dampen the enhanced neural sensitization that is a key
component of unexplained cough
4. Continue gabapentin after 6 months only after re-evaluation
Common causes of hemoptysis
1. Acute bronchitis - mild hemoptysis which is self-limited
2. Bronchiectasis
3. Cancer
4. TB
5. PE
6. LV failure
, rare causes of hemoptysis
1. Anti-GBM disease (Goodpasture syndrome)
2. Granulomatosis with polyangiitis (Wegener's granulomatosis)
Gabapentin S/E
1. Dizziness
2. Disequilibrium
3. Somnolence
4. Weight gain
5. Peripheral edema
6. Cognitive difficulties
7. Use with caution in pt's >=65
First generation anti-histamines
Dyphendrdramine (Benadryl), chlorpheniramine maleate,
brompheniramine (dimetane) promethazine (Phenergan)
Non-asthmatic eosinophilic bronchitis (NAEB)
1. Assess with sputum analysis for eosinophils or FeNO testing
2. Treat with ICS
Common causes of chronic cough
Smoking
ACE inhibitor use
UACS
GERD
Asthma
NAEB
Dizziness evaluation - 4 group classification facilitates
establishing a formal diagnosis and tx strategy
Vertigo
Presyncope
Disequilibrium
Nonspecific dizziness
Classification of vertigo
1. Peripheral
2. Central
Major causes of acute vertigo
Acute cutaneous lupus erythematosus (ACLE)
-photosensitive malar rash sparing the nasolabial folds
-other sun exposed area can be involved
-almost all pts have systemic symptoms and positive serologic
results (ANA, anti-Ro/SSA, anti-La/SSB)
Three primary patterns of lupus specific skin rashes
1. Acute cutaneous lupus erythematosus (ACLE)
2. Subacute cutaneous lupus erythematosus
3. Chronic cutaneous lupus erythematosus
Lupus pernio disease association and characteristics
Sarcoidosis
Face and head rash - not chest and arms
Not photosensitive
Rosacea
Most common cause of an red malar rash
More likely to be pustular
May have telangiectasias
Does not spare the nasolabial fold
Subacute cutaneous lupus erythematosus
Occurs as two variants - annular and polycyclic
Photosensitive plaques on the back, chest, ext
May be psoriasiform scaly plaques
Fewer than 1/4 of pts with SCLE have SLE
Many cases are drug induced
Ganaxolone (ZTALMY)
-Indication: seizures a/w cyclin dependent kinase-like 5 def
disorder
-first treatment for seizures a/w CCD
-first treatment specifically for CCD patients
Dextromethorphan and fluoxetine
,Antitussive agents such as dextromethorphan have limited
efficacy in treating cough and should be avoided in patients taking
SSRIs, particularly fluoxetine, because of the possibility of
increased serotonergic effects, including serotonin syndrome.
Serotonin syndrome is a hyperthermic reaction triggered by
simultaneous use of two or more medications that affect release
or reuptake of serotonin; it is usually associated with hyperreflexia
and myoclonus
Benzonatate MOA
1. Inhibits cough by anesthetizing stretch receptors of vagal
afferent fibers in the bronchi, alveoli, and pleura.
2. Suppresses transmission of the cough reflex at the level of the
medulla where the afferent impulse is transmitted to the motor
nerves.
Dextromethorphan
1. Retains only the antitussive activity of other morphinan
derivatives
2. Acts centrally on the respiratory center in the medulla and
nucleus tractus solaris to increase the cough threshold
3. About equal to codeine in depressing the cough reflex and has
no expectorant action
Treatment for Chronic cough
1. Multimodality speech pathology intervention
2. Antitussive therapy
3. Trial of gabapentin - a neuromodulatory agent that may
dampen the enhanced neural sensitization that is a key
component of unexplained cough
4. Continue gabapentin after 6 months only after re-evaluation
Common causes of hemoptysis
1. Acute bronchitis - mild hemoptysis which is self-limited
2. Bronchiectasis
3. Cancer
4. TB
5. PE
6. LV failure
, rare causes of hemoptysis
1. Anti-GBM disease (Goodpasture syndrome)
2. Granulomatosis with polyangiitis (Wegener's granulomatosis)
Gabapentin S/E
1. Dizziness
2. Disequilibrium
3. Somnolence
4. Weight gain
5. Peripheral edema
6. Cognitive difficulties
7. Use with caution in pt's >=65
First generation anti-histamines
Dyphendrdramine (Benadryl), chlorpheniramine maleate,
brompheniramine (dimetane) promethazine (Phenergan)
Non-asthmatic eosinophilic bronchitis (NAEB)
1. Assess with sputum analysis for eosinophils or FeNO testing
2. Treat with ICS
Common causes of chronic cough
Smoking
ACE inhibitor use
UACS
GERD
Asthma
NAEB
Dizziness evaluation - 4 group classification facilitates
establishing a formal diagnosis and tx strategy
Vertigo
Presyncope
Disequilibrium
Nonspecific dizziness
Classification of vertigo
1. Peripheral
2. Central
Major causes of acute vertigo
