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Rheumatology > 349 SLE > Flashcards

349 SLE Flashcards

1
Q 
A 24F presents with 3 weeks on and off fever with myalgia, and poor appetite. She has mouth sores and hair fall. PE BP 90/60 mmHg, HR 108 bpm,  RR 19 cpm, Temp 36.8, rash on the face, pale dry lips, oral ulcers on the hard palate, macular lesions on both upper and lower extremities and bipedal edema. What serologic test will confirm your diagnosis?
A. Anti Sm
B. ANA antibody
C. Anti ribosomal P
D. Anti DsDNA
A

D. Anti DsDNA

ANA is screening

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2
Q 
A 25F present with polyarthritis, photosensitivity and recurrent oral ulcers. ANA positive. Normal urinalysis. What is your initial treatment?
A. Hydroxycholoquine
B. Methotrexate
C. Prednisone
D, Mycophenolate mofetil
A

C. Prednisone

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3
Q

True or false: exposure to ultraviolet light causes flares of SLE in 70% of patient

A

True

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4
Q

Auto antibodies in SLE. Best screening test

A

Antinuclear antibodies

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5
Q

Auto antibodies in SLE. More specific but no definite clinical correlation

A

Anti Sm

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6
Q

Auto antibodies in SLE. Correlate with disease activity L, nephritis and vasculitis

A

Anti DsDNA

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7
Q

Auto antibodies in SLE. More frequent in drug induced lupus than in SLE

A

Antihistone

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8
Q

Auto antibodies in SLE. Positive correlates with depression or psychosis due CNS lupus

A

Antiribosomal P

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9
Q

Most common chronic dermatitis in SLE

A

Discoid lupus erythema toss (DLE)

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10
Q

Treament for discoid lupus erythematosus (DLE)

A

Topical or locally injected glucocorticoids and systemic antimalarials

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11
Q

Most common acute SLE rash

A

Photosensitive

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12
Q

Most serious manifestation of SLE

A

Nephritis

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13
Q

Most common manifestation of diffuse CNS lupus

A

Cognitive dysfunction including difficulty with memory and reasoning

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14
Q

In SLE, the primary manifestation of accelerated atherosclerosis

A

Myocardial infractions

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15
Q

Most common pulmonary manifestation of SLE

A

Pleuritis with or without pleural effusion

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16
Q

Most frequent cardiac manifestation of SLE

A

Pericarditis

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17
Q

Most common valves involved in SLE

A

Mitral and aortic valves

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18
Q

Most frequent hematologic manifestation of SLE

A

Normochromic normocytic anemia

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19
Q

permissive for SLE

A

female sex

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20
Q

True or false. Prevalence of TIA, stroke and MI is increased in SLE

A

true. due to associated hypercoagulable state for SLE with APAS

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21
Q

True or false. There is no cure for SLE and sustained remissions are rare

A

True.

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22
Q

mainstay in the treatment of SLE

A

analgesics and antimalarial

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23
Q

True or false. SLE patients are increased risk for NSAID induced asceptic meningitis

A

True

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24
Q

mainstay treatment for inflammatory life threatening or organ threatening manifestation

A

systemic glucocorticoids 0.5-1 mg/kg/day or 500- 1000 mg methylprednisolone IV daily for 3 days then 0.5-1 mg/kg daily of prednisone or equivalent

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25
recommendations for the treatment of lupus nephritis
Cyclophosphamide or mycophenolate mofetil
26
Treatment. Renal biopsy show ISN grade III or IV disease
glucocorticoids + cyclophosphamide
27
side effects myophenolate mofetil
diarrhea
28
toxicity. cyclophosphamide
amenorrhea, leukopenia, nausea
29
Treatment. Severe lupus nephritis
cyclophosphamide 500-100 mg/m2 BSA monthly for 6 months then azathioprine/ myocphenolate mofetil
30
common side effect of cyclophosphamide and how lessened
ovarian failure; reduced by treatment with gonadotropin releasing hormone agonist such as leuprolide 3.75 mg IM
31
SLE flares reduced by maintenance therapy with what drugs
azathioprine 1- 2.5 mg/kg/day OR | myophenolate mofetil 1.5- 2 g/daily
32
True or false. both azathioprine and mycophenolate mofetil are teratogenic
True. stopped 3 months prior to conceiving
33
What can be given to pregnant SLE patient to control active disease
azathioprine
34
in SLE with APAS patient, what is the target INR if with one previous venous clotting? if with recurring clots or arterial clotting
one previous venous clotting: 2.0-2.5 | recurrent venous clotting or with arterial clotting: 3.0-3.5
35
what is the SPF factor of sunscreens of SLE patients
SPF 30
36
drugs commonly associated with Lupus like disease
procainamide, disopyramide propafenone hydralazine ACEI, and Beta blockers PTU
37
Best differentiate lupus arthritis from rhematoid arthritis
absence of erosions in lupus
38
genetic signature in peripheral blood cells of 50-80% of SLE patients
upregulation of the genes induced by IFN
39
lowest prevalence of SLE
white men
40
why are women more prone to SLE
estradiol binds to receptors on the T and B lymphocytes increasing the activation and survival of cells with autoreactive subsets
41
how does UV lead to SLE flares
exposure to ultraviolet light causes increased apoptosis in skin or by altering DNA
42
True or false. Exposure to ultraviolet light leads to flares in SLE in about 70% of cases
True.
43
one infectious agent that may trigger SLE in susceptible individuals
EBV
44
most common vasculitis pattern in SLE
leukocytoclastic vasculitis
45
True or false. ANA is postiive in more than 98% of patient during the course of illness
True.
46
True or false. Permanent complete remissions in SLE is rare
True.
47
considered in a patient with SLE who complaints of pain persisting in a single joint, such as the knee, shoulder or hip
ischemic necrosis of the bone
48
scaly red patches similar to psoriasis or circular flat red rimmed lesions in patient with SLE
subacute cutaneous lupus erythematosus
49
subacute cutaneous lupus erythematosus
infection and nephritis
50
most important autoantibodies to detect
ANA
51
True or false. 90% of people affected with SLE are women in child bearing years
True or false. 90% of people affected with SLE are women in child bearing years
52
syndrome of hemolysis, thrombocytopenia, microvascular thrombosis in kidneys, brain and other tissues carries a high mortality rate in individuals with lupus
syndrome of hemolysis, thrombocytopenia, microvascular thrombosis in kidneys, brain and other tissues carries a high mortality rate in individuals with lupus
53
useful laboratory test for microvascular thrombotic crisis
schistocytes on peripheral blood smears, elevated serum levels of LDH, antibodies to ADAMS13
54
treatment for microvascular thrombotic crisis
plasma exchange or extensive plasmapheresis
55
plasma exchange or extensive plasmapheresis
cyclosphosphamide or Mycophenolate mofetil should be off for 3 months prior
56
maintenance medication for SLE
mycophenolate mofetil, azathioprine
57
can be given to pregnant women with SLE
??
58
in SLE patients with APAS, what is the treatment?
warfarin.
59
INR goal in patients with SLE and APAS
one episode of venous clotting INR 2-2.5; with recurring clots or arterial clotting in the CNS INR 3.0-3.5
60
in patietns with SLE. What is the SPF of sunscreen
SPF 30
61
what may be given in patients with lupus dermatitis
topical glucocorticoids, hydroxycholoquine
62
cancers with increased incidence in SLE
NHL, cancers of thyroid, lung, liver, vulvar/vaginal tissues
63
medications that can lead to drug induced lupus
procainamide, disopyramide, propafenone, hydralazone, ACEI, beta blockers, PTU, chlorphromazine, llithium, carbamazepine, phenytoin, sulfasalazine, hydrochlorothiazide, lovasatin, simvastatin
64
affected by intermittent polyarthritis in SLE
hands, wrists, knees
65
most common system involved in SLE
musculoskeletal
66
how to differential CNS lupus and GC induced psychosis
GC psychosis: 1st week of therapy, at doses more than 40 mg of prednisone or equivalent
67
GC psychosis: 1st week of therapy, at doses more than 40 mg of prednisone or equivalent
activation of innate immunity, T and B cell hyperactivity, ineffective CD4 and CD8 T cells, impaired phagocytosis and clearance of cellular debris

Rheumatology (15 decks)

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