B3.020 - Lupus

Question 1

What joints does RA spare

Answer 1

DIPs

Question 2

What can lupus cause in the lymph nodes

Answer 2

inflammation

Question 3

On an H&E stain what would indicate lupus

Answer 3

Mesangial proliferation

Question 4

What is full house staining

Answer 4

Indirect immunofluorescence for IgG, IgA, IgM, C3, C1q, Kappa, and lambda

Question 5

What is the most common presenting symptom for lupus

Answer 5

joint pain

Question 6

What disease feature non destructive arthritis

Answer 6

Lupus

Question 7

What is jaccouds arthropathy

Answer 7

Ligament laxity, looks like a deformity but can correct on exam

Question 8

What can constitute serositis

Answer 8

Pleural effusion
Pericardial effusion
Pleurisy/pleuritic chest pain

Question 9

What is something unique about oral ulcers associated with lupus

Answer 9

Can involve hard palate and typically not painful

Question 10

What are the 3 types of rash associated with lupus

Answer 10

Butterfly
Subacute cutaneous lupus rash
Discoid lupus rash

Question 11

Differentiate between the 3 types of rash

Answer 11

1. butterfly is due to photosensitivity, appearing days after exposure
2. Subacute cutaneous is ornate and not due to photosensitivity
3. Discoid is scarring that doesnt heal fully

Question 12

What are hematologic manifestations of lupus

Answer 12

Anemia
Thrombocytopenia
Leukopenia

Question 13

What are the renal manifestations of lupus

Answer 13

Glomerulonephritis, aka lupus nephritis

Question 14

What are symptoms of lupus nephritis

Answer 14

Hematuria, proteinuria, hypertension, edema

Question 15

What type of hypersesitivity leads to lupus nephritis

Answer 15

3 - antibody/antigen complexes form in blood and deposit in tissues

Question 16

What can be measured to loo for lupus nephritis and why

Answer 16

C3 and C4, because IgG containin immune complexes activate complement in tissues leading to damage

Question 17

What are the cardiac manifestations of lupus nephritis

Answer 17

Pericarditis

Libman-sacks endocarditis (noninfectious vegetations)

Question 18

What neurologic clinical manifestations are there for lupus

Answer 18

Seizures

Psychosis

Question 19

What is Antinuclear antibody

Answer 19

Antibody with specificity to components of nucleus

Question 20

How do you test for antinuclear antibodies and what does it test for

Answer 20

ANA - indirect immunofluorescence

Reflects dilution

Question 21

What are limitations of ANA

Answer 21

False positives
Variability in results
quantitative value doesn’t have clinical significance

Question 22

What is a positive of ANA diagnostics for lupus

Answer 22

Its sensitive

Question 23

What are anti double stranded DNA antibodies

Answer 23

Specific to lupus, felt to be pathogenic, trend with disease activity

Question 24

What are specific antinuclear antibodies

Answer 24

Anti-Smith
Anti-RNP
Anti-SSA
Anti-SSB

Question 25

What are antiphospholipid Abs

Answer 25

Anti cardiolipin Ab IgM and IgG | Anti beta 2 glycoprotein 1 IgM and IgG

Question 26

Activation of which complement pathway is associated with Lupus flares and what Cs does it lead to a decline in

Answer 26

Classical - C1, C2, C3, C4

Question 27

Which Igs participate in the classical pathway

Answer 27

IgM and IgG

Question 28

What are Anti-Histone Antibodies associated with

Answer 28

Drug induced lupus

Question 29

What are common medications that can cause drug induced lupus

Answer 29

Hydralazine Procainamide Isoniazid Minocycline

Question 30

How long before disease clinically do autoantibodies present

Answer 30

5 years

Question 31

What is the mnemonic for diagnosing lupus

Answer 31

``` SOAP MD BRAIN Serositis Oral Ulcers Arthritis Photosensitivity Malar rash Discoid rash Blood abnormalities Renal abnormalities Positive ANA Immunologic abnormalities Neurologic ```

Question 32

what age is lupus most commonly diagnosed

Answer 32

16-55

Question 33

What are the 3 general steps leading to lupus

Answer 33

1. Inefficient clearance of apoptotic debris 2. Breach of tolerance 3. Immune complex deposition and complement activation

Question 34

What is the increase in mortality of lupus patients

Answer 34

3 fold

Question 35

What does Hydroxychloroquine do

Answer 35

Interferes with antigen processing as a result of peptide-MHC protein complexes

Question 36

What does Belimumab do

Answer 36

Blocks binding of soluble B Cell activating factor

Question 37

What does Azathioprine do

Answer 37

Inhibits purine synthesis leading to inhibition of DNA and RNA leading to reduced cellular proliferation

Question 38

What does Mycophenolate mofetil do

Answer 38

Inhibits inosine monophosphate dyhedrogenase which leads to reduced B and T cell proliferation

Question 39

What does cyclophosphamide do

Answer 39

Attaches to an alkyl group to DNA which leads to apoptosis | Classic chemo drug

Question 40

What are consequences of corticosteroids like prednisone

Answer 40

``` Weight gain Bone health DM Infection Mood ```

Question 41

What drugs are contraindicated for pregnancy

Answer 41

Cyclophosphamide | mycophenolate mofetil