Lupus

Question 1

Lupus is a (definition)

Answer 1

complex multi-systemic autoimmune disease characterized by presence of autoreactive B & T cells and production of heterogenous group of autoantibodies

Question 2

The most characteristic antibody production of lupus is

Answer 2

antinuclear (anti DNA) antibody

can also include nucleic acids, RBCs, phospholipids, lymphocytes, platelets

Question 3

These three factors combined make up the pathogenesis of lupus:

Answer 3

genetic predisposition & environmental exposures
loss of self-tolerance
immune activation

Question 4

Explain how loss of self-tolerance precludes people to lupus development

Answer 4

leads to production of autoantibodies without regulation

Question 5

Explain how immune activation causes lupus

Answer 5

T & B cells are hyperactive, & innate immune systems are programmed towards inflammation leading to tissue damage and clinical manifestation of disease

Question 6

Describe the patient population most likely affected by lupus.

Answer 6

Women 15-44
People of color- African Americans, Asian Americans, Hispanic/Latinos, Native American, or Pacific Islander
50 genes are associated with SLE
UV light, infection, virus, & stress
estrogen is thought to coontribute

Question 7

List the testing that might be performed to diagnose lupus.

Answer 7

CBC, Complement test, blood clotting tests, urine tests, biopsies, antibody tests- ANA & anti dsDNA antibody

Question 8

Describe the criteria for classification.

Answer 8

serial or simultaneous presence of at least four of these indicators:
malar rash, photosensitivity, oral or nasopharyngeal ulcers, discoid rash, renal disorder, serositis, neurologic disorders, hematologic disorders, immunologic disorders, nonerosive arthritis of at least two peripheral joints, presence of antinuclear antibody

Question 9

Types of lupus include:

Answer 9

systemic lupus erythematous, drug-induced lupus erythematosus, cutaneous lupus erythematosus, neonatal lupus

Question 10

Central nervous system symptoms of systemic lupus include:

Answer 10

vasculitis, anxiety, depression, psychosis, seizures, stroke

Question 11

Blood involvement of systemic lupus involves:

Answer 11

thrombocytopenia, anemia, leukopenia
antiphospholipid syndrome (acquired hypercoagulability)--> embolism

Question 12

Cardiac symptoms of systemic lupus include:

Answer 12

pericarditis, pericardial effusions, CHF, HTN

Question 13

Joint involvement symptoms of lupus include:

Answer 13

arthritis (hands, wrists, elbows, & knees)
avascular necrosis (femur head) due to use of steroids

Question 14

Renal symptoms of lupus include

Answer 14

nephritis, proteinuria, hypoalbuminemia, hematuria, & renal failure

Question 15

Pulmonary symptoms of lupus include

Answer 15

pleural effusions, restrictive disease, atelectasis

Question 16

Airway symptoms of lupus include

Answer 16

mucosal ulceration, cricoarytenoid arthritis, recurrent laryngeal nerve palsy

Question 17

Drug-induced lupus can be caused by

Answer 17

hydralazine, procainamide, isonazid

Question 18

Drug induced lupus is a

Answer 18

lupus-like disease that mimics lupus

Question 19

Signs & symptoms of drug-induced lupus

Answer 19

usually disappear 6 months after drugs are stopped

more often cutaneous manifestations

Question 20

Cutaneous lupus is affected by

Answer 20

sunlight & fluorescent light

Question 21

Cutaneous lupus causes

Answer 21

rashes, discoid lesions of the face, arms, neck, shoulders, & trunk, pigment change, hair loss (due to lesions)
Raynaud’s occurs in some individuals
10% will develop into SLE

Question 22

Patients with lupus who become pregnant may have

Answer 22

pre-eclampsia, flare, pre-term delivery, miscarriages, intrauterine growth restrictions
-patient’s with lupus need to consult their physician prior to getting pregnant

Question 23

Neonatal lupus affects

Answer 23

infants in the womb in lupus women

Question 24

Neonatal lupus is caused by

Answer 24

mom’s antibodies

Question 25

Babies with neonatal lupus are born with

Answer 25

skin rash, liver problems, low blood counts (disappear after some months), congenital heart block (need pacemaker)

Question 26

Treatment for lupus includes

Answer 26

Tylenol, NSAIDs, immunosuppressants, corticosteroids, antimalarial, anticoagulants, monoclonal antibodies, & repository corticotropin injections

Question 27

Preop testing for patients with lupus

Answer 27

is influenced by the magnitude of organ system dysfunction

preop testing may include PFTs, echo, EKG, renal function labs, etc.

Question 28

Drugs used to treat SLE that may have an affect on anesthesia include

Answer 28

corticosteroids, immunosuppressants, and anticoagulants

Question 29

Anesthetic implications of SLE include

Answer 29

laryngeal function (pre & postop)
cricoarytenoid arthritis--> hoarseness