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4.11 Antibody Review
Rheumatology review for the USMLE Step 1 Exam.
ANA Principles
ANA (Anti-Nuclear Antibody): Non-specific antibody. Reacts against nuclear antigens, including proteins, DNA, RNA, and nucleic acid-protein complexes. Includes a group of antibodies such as anti-dsDNA, anti-histone, SSA/Ro, SSB/La, Scl-70, anti-aminoacyl-tRNA synthetase (Jo-1). Found in 20-30% of the general public without connective tissue disorder symptoms. ANA+ individuals may or may not have a rheumatologic disorder. Further workup is needed in ANA+ cases to determine the specific disorder.Antibodies by Disease Process
Systemic Lupus Erythematosus (SLE)
Anti-dsDNA antibody. Anti-Smith antibody.Drug-Induced Lupus
Anti-histone antibody.Diffuse vs. Limited Scleroderma
Diffuse: Anti-Scl-70 (anti-topoisomerase I). Limited: Anti-centromere (often called CREST syndrome, with CREST standing for centromere).Sjogren's Syndrome
Anti-SSA (Ro). Anti-SSB (La), which usually occurs in the presence of SSA. SSA is considered the Sjogren-specific antibody, leading to the presence of SSB.Rheumatoid Arthritis (RA)
Anti-CCP (Cyclic Citrullinated Peptide). RF (Rheumatoid Factor) is non-specific.Thanks for listening!
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4.10 Gout and Pseudogout
Rheumotology review for the USMLE Step 1 Exam.
Gout
Caused by uric acid crystal deposition due to purine metabolism. Triggers inflammation when crystals precipitate in cooler joint fluid. Presents with severe, red, and swollen monoarticular joints, often in the big toe. Diagnosis through synovial fluid analysis. Acute treatment: colchicine, NSAIDs, and glucocorticoids. Preventive treatment: allopurinol, febuxostat, probenecid, and lifestyle changes.Pseudogout
Resulting from calcium pyrophosphate crystal deposition, often due to ATP breakdown. Manifests with painful, swollen joints, typically affecting multiple upper extremity joints, especially the knee. Diagnosis through synovial fluid analysis. Acute treatment resembles gout management. No direct preventive treatment to lower calcium pyrophosphate levels.Thanks for listening!
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4.09 Rheumatologic Emergencies
Rheumatology review for USMLE Step 1 Exam
Giant Cell Arteritis (GCA)
A large vessel vasculitis, mainly in older individuals. Symptoms: headache, jaw claudication, vision loss. Ischemia from granulomas in large vessels causes vision loss. Immediate high-dose corticosteroids are crucial.Scleroderma Renal Crisis
A complication of scleroderma. Symptoms: finger edema, skin tightening, sudden hypertension, rising creatinine. Renal artery fibrosis leads to high blood pressure. Treat with IV ACE inhibitor, not steroids.Acute Transverse Myelitis in SLE
Inflammation of the spinal cord in lupus. Symptoms: bilateral numbness, tingling, weakness. Treat with corticosteroids.Catastrophic Antiphospholipid Syndrome (CAPS)
A rare, life-threatening form of APS. Symptoms: unexplained miscarriages, unexplained clots, multiorgan failure. Treat with anticoagulation followed by immune suppression -
1.06 Systolic Heart Murmurs
Cardiovascular system review for the USMLE STEP 1 Exam
Heart murmurs are caused by turbulent blood flow in the heart
There are 4 different types of systolic murmurs: ventricular septal defect (VSD), patent ductus arteriosus (PDA), aortic stenosis, and mitral or tricuspid regurgitation
PDA produces a constant, machine-like murmur
VSD produces a harsh holosystolic murmur
Aortic stenosis produces a crescendo-decrescendo systolic ejection murmur
Mitral and tricuspid regurgitation produce a holosystolic high pitched "blowing" murmur
Mitral valve prolapse produces a mid-systolic click followed by a late systolic murmur
Aortic regurgitation produces a decrescendo diastolic murmur
Mitral stenosis produces a rumbling diastolic murmur
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5.13 OCD and Related Disorders
Psych review for the USMLE Step 1 Exam
Obsessive Compulsive Disorder (OCD): Unwanted thoughts (obsessions) and repetitive behaviors (compulsions). Treat with CBT + SSRIs/SNRIs. Tic Disorders: Tourette Syndrome involves multiple motor and at least one vocal tic. Treat with Habit Reversal Therapy. Body Dysmorphic Disorder: Preoccupation with minor flaws, treat with SSRIs and CBT. Trichotillomania: Hair pulling disorder, treat with Habit Reversal Training and sometimes SSRIs. PANDAS: Pediatric disorder after strep infection, sudden OCD-like symptoms. Treat with antibiotics, CBT, and SSRIs. -
5.12 Anxiety Related Disorders
Psychiatry review for the USMLE Step 1 Exam
Anxiety is a normal response to threats or stressors in the environment Anxiety disorders occur when anxiety causes significant distress or impairment in functioning Generalized Anxiety Disorder (GAD) involves persistent and excessive worry about various aspects of daily life for at least 6 months, accompanied by physical symptoms Treatment for GAD typically involves a combination of cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) Panic Disorder is diagnosed in individuals who experience spontaneous panic attacks and fear future attacks Panic attacks are acute episodes of intense anxiety and physical symptoms Treatment for Panic Disorder involves CBT and SSRIs, with SSRIs being the first-line medication Agoraphobia is the fear of being in public places where escape may be difficult and often follows a traumatic event CBT and SSRIs are the recommended treatment for Agoraphobia Social Anxiety Disorder (Social Phobia) involves fear of scrutiny or embarrassment in social situations Public speaking can be a significant trigger for individuals with social anxiety disorder Beta blockers can be used to treat social anxiety disorder by reducing physical symptoms Treatment for social anxiety disorder usually involves CBT, SSRIs, or beta blockers. -
5.11 Eating and Feeding Disorders
Psychiatry Review for the USMLE Step 1 Exam
Eating Disorders:
Main disorders: bulimia nervosa, anorexia nervosa, and binge eating disorder. Bulimia and anorexia share anxiety and compensatory behaviors. Anorexia: low body weight, fear of gaining weight, treatment involves slow refeeding. Bulimia: normal weight, signs of forced vomiting, treated with CBT and SSRIs. Binge Eating Disorder: uncontrollable eating, negative emotions, SSRIs and CBT for treatment.Feeding Disorders:
Occur in children, not related to body image. Common disorders: avoidant/restrictive food intake disorder, rumination disorder, and pica. Avoidant/Restrictive Food Intake Disorder: avoidance or restriction of food intake. Pica: eating non-nutritious substances, common in young children. Rumination Disorder: regurgitation without associated symptoms. -
5.10 Mood Disorders (Depression and Bipolar)
Psychiatry Review for the USMLE Step 1 exam
Mood disorders are persistent disruptions in emotion, categorized into bipolar disorders and depressive disorders. Bipolar disorders are characterized by manic or hypomanic episodes, while depressive disorders feature periods of depression. Major Depressive Disorder (MDD) is characterized by feelings of sadness, guilt, worthlessness, and anhedonia lasting for at least two weeks. SIG E CAPS is an acronym used to remember the symptoms of depression: Sleep changes, Interest loss, Guilt, Energy loss, Concentration difficulties, Appetite changes, Psychomotor retardation, and Suicidal ideation. In MDD, at least 5 of the SIG E CAPS symptoms must persist for more than 2 weeks. Persistent Depressive Disorder (dysthymia) is a chronic, low-grade form of MDD that lasts for at least two years. Mania is a symptom common to all bipolar disorders, characterized by elevated or irritable mood and increased activity or energy. Mania lasting for at least 1 week is called a manic episode, while hypomania is a less severe form lasting longer than 4 days. The symptoms of mania can be remembered using the mnemonic DIG FAST: Distractibility, Irritable mood/insomnia, Grandiosity, Flight of ideas, Agitation/increased activity, Speedy thoughts/speech, and Thoughtlessness. Bipolar I involves manic episodes, and bipolar II involves hypomanic episodes and major depressive episodes. Bipolar I requires at least one manic episode, while bipolar II requires depressive episodes. Mood stabilizers such as lithium, valproate, carbamazepine, and lamotrigine are used to treat bipolar disorders. Litium is the best (notable exeptions however). Antidepressants are contraindicated for bipolar patients due to the risk of flipping into mania. The risk of suicide is high in bipolar patients, with 25-50% attempting suicide and 10-15% dying by suicide. Cyclothymia is a less common form of bipolar disorder characterized by cycling between hypomania and mild depression over many years. -
5.09 Schizophrenia
Psychiatry review for the USMLE Step 1 Exam
Epidemiology: Slight male predilection (1.4:1 male to female ratio). Men present between 18-25, women between 28-35. Affects about 0.5% of the population. Symptoms: Positive symptoms: hallucinations, delusions, disorganized behavior and speech. Negative symptoms: flat affect, anhedonia, apathy, alogia, lack of interest in socialization. Cognitive symptoms: impairments in attention, executive function, working memory. Diagnosis: Criteria: two or more symptoms lasting over a month. Schizophreniform disorder if symptoms last less than 1 month. Pathophysiology: Excess dopamine in prefrontal cortical pathway (negative symptoms). Excess dopamine in mesolimbic pathway (positive symptoms). Other neurotransmitters may also play a role (especially serotonin excess). Treatments: Antipsychotics (D2 receptor antagonists). First-generation antipsychotics: haloperidol, chlorpromazine (more side effects). Second-generation antipsychotics (atypical antipsychotics): aripiprazole, olanzapine, quetiapine, risperidone (lower extrapyramidal side effects, higher metabolic side effects). Outcomes: Rule of thirds: one-third full recovery, one-third improved with mild symptoms, one-third require high-level care. -
5.08 Cluster C Personality Disorders
Psychiatry review for the USMLE Step 1 Exam
Introduction:
Cluster C personality disorders = anxious/worried. Disorders: avoidant, obsessive-compulsive, dependent. Distinguish from normal traits.Avoidant Personality Disorder:
Inhibited, introverted, anxious. Fear of rejection, low self-esteem. Characteristics: avoidance, preoccupation with criticism/rejection, social ineptness. Treatment: Anti-anxiety drugs may help temporarily.Obsessive-Compulsive Personality Disorder:
Perfectionism, inflexibility, diligence. Not OCD; need for control, not obsessions/compulsions. Characteristics: details, work focus, rigidity. Example: Mark, unemployed with attention to detail.Dependent Personality Disorder:
Excessive reliance on others for support/decisions. Linked to early medical/psychiatric conditions. Characteristics: decision-making, fear of disapproval, reliance. Example: Bob, farm laborer dependent on mother.Conclusion:
Cluster C = anxiety-driven. Understand characteristics, not specific diagnoses. Examples show impact on lives. -
5.07 Cluster B Personality Disorders
Psychiatry review for USMLE Step 1 Exam
Cluster B personality disorders are the highest yield among all personality disorders. The cluster B disorders include borderline personality disorder, histrionic personality disorder, narcissistic personality disorder, and antisocial personality disorder. Substance abuse and comorbid mood disorders, particularly major depressive disorder (MDD), are commonly associated with cluster B disorders. Personality disorders are distinguished from normal personality traits by their negative impact on daily life, lack of awareness of the problem, and deviation from cultural expectations. Borderline personality disorder is characterized by unstable emotions, impulsivity, disturbed relationships, and potential psychotic features. Criteria for diagnosing borderline personality disorder include frantic efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, recurrent suicidal behavior, affective instability, chronic feelings of emptiness, inappropriate anger, and paranoid ideation or dissociative symptoms under stress. Borderline personality disorder has a high risk of suicide, especially in women, and is often treated with dialectical behavior therapy (DBT). Histrionic personality disorder involves excessive attention-seeking, inappropriate sexually seductive behavior, shallow emotional expression, and self-dramatization. Diagnostic criteria for histrionic personality disorder include discomfort when not the center of attention, sexually provocative behavior, emotional instability, attention to physical appearance, impressionistic speech, self-dramatization, and susceptibility to influence. Histrionic personality disorder is more common in women and is associated with the defense mechanism of regression. Narcissistic personality disorder is characterized by grandiosity, a need for admiration, lack of empathy, and a sense of entitlement. Diagnostic criteria for narcissistic personality disorder include a grandiose self-importance, fantasies of unlimited success, a belief in being unique, excessive need for admiration, sense of entitlement, exploitation of others, lack of empathy, envy, and arrogant behavior. Narcissistic personality disorder is exemplified by individuals who exhibit characteristics similar to a former president (not mentioned by name), including being grandiose, preoccupied with success, and envious of others. Antisocial personality disorder, often referred to as sociopathy, involves a disregard for others' rights, lack of remorse, criminal behavior, hostility, and manipulation. Antisocial personality disorder is more common in males, has a high prevalence in incarcerated individuals, and is usually preceded by childhood conduct disorder. Diagnostic criteria for antisocial personality disorder include failure to conform to social norms, deceitfulness, impulsivity, aggressiveness, disregard for safety, irresponsibility, and lack of remorse. -
5.06 Cluster A Personality Disorders
Psychiatry review for the USMLE Step 1 Exam.
The cluster A personality disorders include paranoid, schizoid, and schizotypal. These disorders are characterized by individuals who are perceived as weird, awkward, and quiet. Personality disorders differ from normal personality quirks based on their negative impact on daily life, lack of awareness of the problem, and deviation from cultural expectations. Paranoid Personality Disorder: Patients are chronically suspicious and distrustful of others, without persistent fixed delusions. Key characteristics include unwarranted suspicions, doubts about loyalty, reluctance to confide, reading hidden meanings, holding grudges, perceiving attacks on reputation, and suspicion of infidelity. Schizoid Personality Disorder: Individuals prefer isolation and have difficulty forming relationships. Criteria for diagnosis include a lack of interest in close relationships, solitary activities, indifference to praise or criticism, emotional coldness, and flattened affectivity. Schizotypal Personality Disorder: Considered a less severe form of schizophrenia, with odd behavior, speech, thinking, and mild perceptual experiences. Notable features include social isolation, "magical" beliefs, mild paranoia, constricted affect, and social anxiety. -
5.05 Hallucinogens (Types, Intoxication, and Withdrawal)
Psychiatry review for the USME STEP 1 Exam.
Hallucinogens are a diverse class of drugs that cause hallucinations and other symptoms. Common hallucinogens discussed in the podcast are LSD, marijuana, PCP, and ketamine. LSD activates serotonin receptors, causing visual and auditory hallucinations, time and reality distortions, mood elevation, and dilation of the pupils. No notable withdrawal symptoms. Marijuana acts as a depressant, stimulant, and hallucinogen. THC binds to cannabinoid receptors, increasing neurotransmitters like dopamine and serotonin. Intoxication symptoms include red eyes, anxiety, euphoria, increased appetite, dry mouth, paranoid delusions, and perceived slowed time. Mild withdrawal symptoms include irritability, depression, sleep problems, and decreased appetite. Heavy cannabis use in adolescence is linked to an increased risk of schizophrenia. PCP antagonizes NMDA glutamate receptors and activates dopaminergic neurons. Intoxication symptoms include increased pain threshold, agitation, hallucinations, nystagmus, ataxia, and tachycardia. No notable withdrawal symptoms. Ketamine is structurally similar to PCP and acts as a milder version. It causes hallucinations and dissociation and is used medically for analgesia. -
5.04 Depressants (Types, Intoxication, and Withdrawal)
Psychiatry review for the USMLE Step 1 exam.
Depressants decrease neuronal activity in the brain. They can work by stimulating GABAergic neurons or binding to opiate receptors. Common GABA-promoting depressants: alcohol, benzodiazepines, barbiturates, and inhalants. Opioid depressants include heroin and morphine derivatives. Alcohol enhances GABA receptor effects, inhibits glutamate activity, and causes intoxication symptoms such as disinhibition, slurred speech, impaired motor control, lethargy, respiratory depression, and coma. Alcohol withdrawal symptoms include anxiety, agitation, insomnia, nausea/vomiting, tremors, autonomic dysfunction, seizures, and can be life-threatening (delirium tremens). Benzodiazepines bind to the benzodiazepine receptor, enhance GABA effects, and cause intoxication symptoms similar to alcohol. Benzodiazepine withdrawal symptoms include anxiety, agitation, insomnia, and seizures, which are treated with a gradual tapering of the drug. Inhalants depress brain activity and cause symptoms such as disinhibition, paranoia, lethargy, dizziness, ataxia, slurred speech, and high doses can lead to respiratory depression and brain damage. Opioids bind to opioid receptors, reduce pain, improve mood, and cause intoxication symptoms like drowsiness, constricted pupils, seizures, and respiratory depression. Opioid overdose can be reversed with naloxone, an opioid receptor antagonist. Opioid withdrawal symptoms include dysphoria, anxiety, weakness, sweating, dilated pupils, and diarrhea, and can be managed with medications like methadone and buprenorphine. Alcohol withdrawal is an emergency and requires prompt treatment with benzodiazepines. -
5.03 Stimulants (Types, Intoxication, and Withdrawal)
Psychiatry review for the USMLE Step 1 Exam.
Stimulants increase CNS activity and activate the sympathetic nervous system. They can block reuptake of neurotransmitters or stimulate their release. Intoxication symptoms include agitation, dilated pupils, sweating, euphoria, hallucinations, and increased norepinephrine, epinephrine, dopamine, and serotonin levels. Prescribed stimulants: amphetamine, dextroamphetamine, and methylphenidate (used for ADHD). Recreational stimulants: methamphetamine, cocaine, MDMA, nicotine, and caffeine. Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, and can cause hallucinations, paranoia, chest pain, and potentially cardiac death. Methamphetamine can cause tactile hallucinations where patients feel like bugs are crawling on their skin. MDMA can induce feelings of connectedness, heightened emotions, and hallucinations. Withdrawal from stimulants, particularly cocaine and methamphetamine, is characterized by depression, headache, malaise, fatigue, hypersomnolence, anhedonia, constricted pupils, vivid dreams, and flu-like symptoms. Withdrawal symptoms are opposite to the effects experienced during intoxication. -
5.02 Classical and Operant Conditioning
Psychiatry review for the USMLE Step 1 Exam
Classical Conditioning:
Pavlovian conditioning discovered by Ivan Pavlov, a Russian physiologist known for his experiments with dogs. Learning through association. Example: Conditioning dogs to respond to a noise the way they would respond to meat. Involves associating an unconditioned stimulus with a new conditioned stimulus to elicit the same response.Process of Classical Conditioning:
Start with a stimulus that produces a response (e.g., smelling pizza makes you hungry). Pair the stimulus and response with an unconditioned stimulus (e.g., receiving a text indicating pizza delivery). Eventually, the conditioned stimulus (the text notification) alone elicits the conditioned response (mouth watering).Extinction and Spontaneous Recovery in Classical Conditioning:
If the conditioned stimulus (text notification) is presented without the unconditioned stimulus (pizza), the conditioned response (mouth watering) will weaken and eventually extinguish. Spontaneous recovery may occur, where the conditioned behavior briefly reappears after a period of extinction.Terms in Classical Conditioning:
Unconditioned stimulus (US): Triggers a response unconditionally. Unconditioned response (UR): The response elicited by the unconditioned stimulus. Conditioned stimulus (CS): Initially neutral stimulus that becomes associated with the unconditioned stimulus. Conditioned response (CR): The response elicited by the conditioned stimulus.Operant Conditioning:
Developed by B.F. Skinner. Learning occurs through rewards and punishments for behavior. Three types of responses: neutral operants, reinforcers, and punishers.Examples of Operant Conditioning:
Positive reinforcement: Giving a child candy for good behavior. Negative reinforcement: Taking away a child's phone until homework is done to increase desired behavior. Positive punishment: Using physical force as punishment (not recommended). Negative punishment: Taking away a child's phone to decrease unwanted behavior.Different Schedules of Reinforcement:
Continuous Reinforcement: Positive reinforcement every time a specific behavior occurs. Fixed Ratio Reinforcement: Reinforcement after a specified number of correct responses. Fixed Interval Reinforcement: Reinforcement after a fixed time interval with at least one correct response. Variable Ratio Reinforcement: Reinforcement after an unpredictable number of responses. Variable Interval Reinforcement: Reinforcement after an unpredictable amount of time.Summary:
Classical conditioning involves learning through association of stimuli. Operant conditioning involves learning through rewards and punishments for behavior. -
5.01 Ego Defenses
Psychiatry review for the USMLE Step 1 Exam
Defense mechanisms protect the unconscious part of our personality from anxiety caused by unacceptable thoughts or feelings. Ego defenses are categorized into three groups: mature, neurotic, and immature. Immature defense mechanisms include projection, regression, denial, acting out, and splitting. Projection involves attributing objectionable thoughts or emotions to others. Regression is behaving in an age-inappropriate way to avoid tension associated with the current phase of development. Denial is not accepting or believing something to protect one's ego. Acting out involves giving in to socially inappropriate impulses to avoid anxiety. Splitting is viewing people as either all good or all bad, without considering the middle ground. Neurotic defense mechanisms include intellectualization, isolation of affect, displacement, rationalization, reaction formation, and repression. Intellectualization is overanalyzing situations or focusing on irrelevant details to avoid negative feelings. Isolation of affect is unconsciously limiting the experience of emotions associated with a stressful event. Displacement involves shifting emotions from one thing to another, which is deemed more acceptable. Rationalization is justifying one's behavior or negative feelings through rational explanations. Reaction formation is unconsciously acting opposite to an unacceptable impulse. Repression involves preventing thoughts or feelings from entering consciousness to avoid negative emotions. Mature defense mechanisms include humor, altruism, suppression, and sublimation. Humor is used to relieve anxiety and negative thoughts. Altruism involves performing beneficial acts for others to experience pleasure and relieve anxiety. Suppression is consciously blocking undesirable ideas, thoughts, or impulses. Sublimation is transforming anxiety or emotions into socially valued pursuits. Sublimation involves channeling negative emotions into productive and socially desirable actions. -
4.08 Myasthenia Gravis and Lambert Eaton Syndrome
MSK/Rheumatology review for the USMLE Step 1 Exam
Introduction: Review of neuromuscular junction and its components: presynaptic part, postsynaptic part, synaptic cleft. Cascade of events leading to the release of acetylcholine into the synaptic cleft. Myasthenia Gravis: Autoimmune neuromuscular junction disease. Fluctuating muscle weakness, especially ocular and eyelid weakness, distal limb weakness. Antibodies target nicotinic acetylcholine receptors (n-AChR's). Association with thymic hyperplasia and enlarged thymus. Treatment: Acetylcholinesterase inhibitors (AChE inhibitors), immunosuppressants. Lambert Eaton Syndrome: Autoimmune neuromuscular junction disease associated with cancer. Fluctuating muscle weakness, autonomic dysfunction, decreased reflexes. Antibodies target presynaptic calcium channels on nerve terminals. Autonomic manifestations due to calcium channels also present in smooth muscle. Around 50% of cases associated with an underlying malignancy. Treatment: Immunosuppression, addressing underlying malignancy if present. -
This high yeild podcast covers schizophrenia type disorders for the USMLE Step 1 exam.
I cover the following topics:
Defining psychotic symptoms: hallucinations, delusions, and disorganized thoughts/speech Example of a delusional belief about a small being inside the body Schizophrenia spectrum disorders: schizophrenia, schizophreniform, and brief psychotic disorder Differentiating the disorders based on the duration of symptoms: brief (6 months) Progression from brief psychotic disorder to schizophreniform to schizophrenia Schizoaffective disorder: combination of schizophrenia and a mood disorder (MDD) Highlighting the importance of episodes with only schizophrenia symptoms in schizoaffective disorder Delusional disorder: focusing on delusions without hallucinations, disorganized thoughts/behavior, or mood disorders Contrasting delusions in delusional disorder with those in schizophrenia Litigious tendencies observed in delusional disorder cases Mood disorders with psychotic features: exploring MDD as an example Psychotic symptoms in MDD appear only during depressive episodes Clarifying the distinction between psychotic symptoms in MDD and schizoaffective disorder Summary: Understanding the different disorders and their symptom overlap. -
4.07 Polymyositis and Dermatomyositis
MSK/Rheum review for the USMLE Step 1 Exam
Polymyositis and dermatomyositis are autoimmune inflammatory myopathies. They are caused by abnormal activation of T cells that attack skeletal muscle and both cause proximal muscle weakness, especially of the shoulders and pelvic girdle muscles. Polymyositis develops when there is abnormal activation of CD8 T cells, while dermatomyositis is primarily attacked by CD4 T cells. Both are diagnosed through a muscle biopsy and the presence of elevated CK levels and several different autoantibodies. Dermatomyositis includes dermatologic manifestations, such as gottron papules, heliotrope rash, and shawl rash. Both are associated with MI, interstitial lung disease, and various types of cancer (dermatomyositis more so). Both diseases require prompt treatment with steroids and immunosuppressive agents. - Näytä enemmän
