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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
Q

recommendations for the treatment of lupus nephritis

A

Cyclophosphamide or mycophenolate mofetil

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26
Q

Treatment. Renal biopsy show ISN grade III or IV disease

A

glucocorticoids + cyclophosphamide

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27
Q

side effects myophenolate mofetil

A

diarrhea

28
Q

toxicity. cyclophosphamide

A

amenorrhea, leukopenia, nausea

29
Q

Treatment. Severe lupus nephritis

A

cyclophosphamide 500-100 mg/m2 BSA monthly for 6 months then azathioprine/ myocphenolate mofetil

30
Q

common side effect of cyclophosphamide and how lessened

A

ovarian failure; reduced by treatment with gonadotropin releasing hormone agonist such as leuprolide 3.75 mg IM

31
Q

SLE flares reduced by maintenance therapy with what drugs

A

azathioprine 1- 2.5 mg/kg/day OR

myophenolate mofetil 1.5- 2 g/daily

32
Q

True or false. both azathioprine and mycophenolate mofetil are teratogenic

A

True. stopped 3 months prior to conceiving

33
Q

What can be given to pregnant SLE patient to control active disease

A

azathioprine

34
Q

in SLE with APAS patient, what is the target INR if with one previous venous clotting? if with recurring clots or arterial clotting

A

one previous venous clotting: 2.0-2.5

recurrent venous clotting or with arterial clotting: 3.0-3.5

35
Q

what is the SPF factor of sunscreens of SLE patients

A

SPF 30

36
Q

drugs commonly associated with Lupus like disease

A

procainamide, disopyramide propafenone
hydralazine
ACEI, and Beta blockers
PTU

37
Q

Best differentiate lupus arthritis from rhematoid arthritis

A

absence of erosions in lupus

38
Q

genetic signature in peripheral blood cells of 50-80% of SLE patients

A

upregulation of the genes induced by IFN

39
Q

lowest prevalence of SLE

A

white men

40
Q

why are women more prone to SLE

A

estradiol binds to receptors on the T and B lymphocytes increasing the activation and survival of cells with autoreactive subsets

41
Q

how does UV lead to SLE flares

A

exposure to ultraviolet light causes increased apoptosis in skin or by altering DNA

42
Q

True or false. Exposure to ultraviolet light leads to flares in SLE in about 70% of cases

A

True.

43
Q

one infectious agent that may trigger SLE in susceptible individuals

A

EBV

44
Q

most common vasculitis pattern in SLE

A

leukocytoclastic vasculitis

45
Q

True or false. ANA is postiive in more than 98% of patient during the course of illness

A

True.

46
Q

True or false. Permanent complete remissions in SLE is rare

A

True.

47
Q

considered in a patient with SLE who complaints of pain persisting in a single joint, such as the knee, shoulder or hip

A

ischemic necrosis of the bone

48
Q

scaly red patches similar to psoriasis or circular flat red rimmed lesions in patient with SLE

A

subacute cutaneous lupus erythematosus

49
Q

subacute cutaneous lupus erythematosus

A

infection and nephritis

50
Q

most important autoantibodies to detect

A

ANA

51
Q

True or false. 90% of people affected with SLE are women in child bearing years

A

True or false. 90% of people affected with SLE are women in child bearing years

52
Q

syndrome of hemolysis, thrombocytopenia, microvascular thrombosis in kidneys, brain and other tissues carries a high mortality rate in individuals with lupus

A

syndrome of hemolysis, thrombocytopenia, microvascular thrombosis in kidneys, brain and other tissues carries a high mortality rate in individuals with lupus

53
Q

useful laboratory test for microvascular thrombotic crisis

A

schistocytes on peripheral blood smears, elevated serum levels of LDH, antibodies to ADAMS13

54
Q

treatment for microvascular thrombotic crisis

A

plasma exchange or extensive plasmapheresis

55
Q

plasma exchange or extensive plasmapheresis

A

cyclosphosphamide or Mycophenolate mofetil should be off for 3 months prior

56
Q

maintenance medication for SLE

A

mycophenolate mofetil, azathioprine

57
Q

can be given to pregnant women with SLE

A

??

58
Q

in SLE patients with APAS, what is the treatment?

A

warfarin.

59
Q

INR goal in patients with SLE and APAS

A

one episode of venous clotting INR 2-2.5; with recurring clots or arterial clotting in the CNS INR 3.0-3.5

60
Q

in patietns with SLE. What is the SPF of sunscreen

A

SPF 30

61
Q

what may be given in patients with lupus dermatitis

A

topical glucocorticoids, hydroxycholoquine

62
Q

cancers with increased incidence in SLE

A

NHL, cancers of thyroid, lung, liver, vulvar/vaginal tissues

63
Q

medications that can lead to drug induced lupus

A

procainamide, disopyramide, propafenone, hydralazone, ACEI, beta blockers, PTU, chlorphromazine, llithium, carbamazepine, phenytoin, sulfasalazine, hydrochlorothiazide, lovasatin, simvastatin

64
Q

affected by intermittent polyarthritis in SLE

A

hands, wrists, knees

65
Q

most common system involved in SLE

A

musculoskeletal

66
Q

how to differential CNS lupus and GC induced psychosis

A

GC psychosis: 1st week of therapy, at doses more than 40 mg of prednisone or equivalent

67
Q

GC psychosis: 1st week of therapy, at doses more than 40 mg of prednisone or equivalent

A

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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