SLE Flashcards
Which antibody has the highest prevalence in patients with systemic lupus erythematosus (SLE)?
A. Anti-dsDNA
B. Antinuclear antibodies (ANA)
C. Anti-Sm
D. Anti-Ro (SS-A)
B. Antinuclear antibodies (ANA)
Rationale: ANA is present in 98% of SLE cases and is the best screening test for SLE. A negative test makes SLE unlikely.
What is the clinical significance of anti-dsDNA antibodies in SLE?
A. Associated with Sjögren syndrome
B. Predisposes to neonatal lupus with congenital heart block
C. Correlates with disease activity and nephritis
D. Highly specific for drug-induced lupus
C. Correlates with disease activity and nephritis
Rationale: Anti-dsDNA antibodies are highly specific for SLE and correlate with disease activity, especially lupus nephritis.
Which antibody is strongly associated with lupus nephritis and often coexists with anti-dsDNA?
A. Anti-C1q
B. Anti-Sm
C. Antiphospholipid
D. Anti-RNP
A. Anti-C1q
Rationale: Anti-C1q antibodies are present in 63% of lupus nephritis cases and are particularly associated with active nephritis when anti-dsDNA is also positive.
What is the clinical relevance of antiphospholipid antibodies in SLE?
A. Correlates with CNS lupus
B. Predisposes to clotting, fetal loss, and thrombocytopenia
C. Specific marker for drug-induced lupus
D. Associated with neonatal lupus
B. Predisposes to clotting, fetal loss, and thrombocytopenia
Rationale: Antiphospholipid antibodies increase the risk of thrombosis, pregnancy complications, and thrombocytopenia in SLE.
Which antibody is tested by the Coombs test in SLE patients?
A. Antierythrocyte
B. Antiplatelet
C. Anti-Sm
D. Anti-Ro (SS-A)
A. Antierythrocyte
Rationale: Antierythrocyte antibodies are measured using a direct Coombs test, and a small proportion of patients develop hemolysis.
Antiribosomal P antibodies are associated with which clinical manifestation in SLE?
A. Lupus nephritis
B. CNS lupus with psychosis or depression
C. Subacute cutaneous lupus
D. Thrombocytopenia
B. CNS lupus with psychosis or depression
Rationale: Positive antiribosomal P antibodies in serum correlate with depression or psychosis due to CNS involvement in SLE.
What is the hallmark feature of Class I lupus nephritis?
A. >90% of glomeruli globally sclerosed without residual activity
B. Normal glomeruli by light microscopy but mesangial immune deposits
C. Diffuse global endocapillary proliferative lesions
D. Subendothelial deposits with mesangial hypercellularity
B. Normal glomeruli by light microscopy but mesangial immune deposits
Rationale: Class I LN is minimal mesangial lupus nephritis characterized by normal glomeruli on light microscopy with mesangial immune deposits detected by immunofluorescence.
Which class of lupus nephritis involves <50% of glomeruli with segmental or global glomerular lesions?
A. Class III
B. Class IV
C. Class V
D. Class VI
A. Class III
Rationale: Class III LN (focal lupus nephritis) involves <50% of glomeruli with segmental or global endo- or extracapillary glomerulonephritis, often associated with subendothelial immune deposits.
Class IV lupus nephritis is defined by which of the following criteria?
A. Mesangial immune deposits without hypercellularity
B. >50% of glomeruli with diffuse endo- or extracapillary glomerulonephritis
C. Segmental glomerular scars involving <10% of glomeruli
D. >90% of glomeruli globally sclerosed
B. >50% of glomeruli with diffuse endo- or extracapillary glomerulonephritis
Rationale: Class IV LN is diffuse lupus nephritis involving >50% of glomeruli with segmental or global lesions, often with diffuse subendothelial deposits.
Class V lupus nephritis primarily involves which pathological feature?
A. Diffuse subendothelial deposits with segmental sclerosis
B. Subepithelial immune deposits and thickened capillary walls
C. Endocapillary hypercellularity and subendothelial deposits
D. Mesangial proliferation with subendothelial immune deposits
B. Subepithelial immune deposits and thickened capillary walls
Rationale: Class V LN (membranous lupus nephritis) is characterized by global or segmental subepithelial immune deposits and morphologic changes resembling membranous nephropathy.
Which class of lupus nephritis involves >90% of glomeruli being globally sclerosed without residual activity?
A. Class II
B. Class IV
C. Class V
D. Class VI
D. Class VI
Rationale: Class VI LN (advanced sclerotic lupus nephritis) is defined by >90% of glomeruli being globally sclerosed with no residual activity, often representing end-stage renal disease.
A patient presents with symptoms suggestive of SLE. Initial tests (ANA, CBC, platelets, and urinalysis) are normal, and symptoms subside. What is the most appropriate next step?
A. Order anti-dsDNA and anti-Ro antibodies
B. Diagnose as SLE and begin treatment
C. Repeat ANA test
D. Rule out SLE
D. Rule out SLE
Rationale: If all tests are normal and symptoms resolve, the patient is not diagnosed with SLE as per the algorithm.
If a patient with symptoms suggestive of SLE has a positive ANA test and meets three diagnostic criteria for SLE, what is the diagnosis?
A. Not SLE
B. Possible SLE
C. Definite SLE
D. Drug-induced lupus
B. Possible SLE
Rationale: Patients with <4 diagnostic criteria (per Table 356-3) are considered to have “possible SLE” rather than definite SLE.
Which initial treatment is appropriate for SLE that is not life- or organ-threatening with acceptable quality of life?
A. High-dose glucocorticoids
B. Cyclophosphamide
C. Conservative management
D. Mycophenolate mofetil
C. Conservative management
Rationale: For non-life- or organ-threatening SLE with acceptable quality of life, conservative management is recommended.
In a patient with life- or organ-threatening SLE, what is the first-line treatment?
A. High-dose glucocorticoids with an additional agent
B. Belimumab
C. Low-dose glucocorticoids only
D. Conservative management
A. High-dose glucocorticoids with an additional agent
Rationale: For severe, life-threatening manifestations of SLE, high-dose glucocorticoids are initiated with an additional immunosuppressive agent like cyclophosphamide or mycophenolate mofetil.
What is the maximum recommended duration for cyclophosphamide therapy in SLE?
A. 3 months
B. 6 months
C. 9 months
D. 12 months
B. 6 months
Rationale: Cyclophosphamide therapy for SLE should not exceed 6 months to limit toxicity while maintaining efficacy.
Which treatment is recommended for lupus nephritis if the patient responds poorly to mycophenolate mofetil?
A. Belimumab or rituximab
B. Cyclophosphamide
C. Hydroxychloroquine
D. Low-dose glucocorticoids
A. Belimumab or rituximab
Rationale: For lupus nephritis with poor response to standard therapies, experimental or alternative therapies such as belimumab or rituximab are considered.
After achieving a response to cyclophosphamide in severe SLE, which maintenance therapy is recommended?
A. High-dose glucocorticoids alone
B. Mycophenolate mofetil or azathioprine
C. Rituximab
D. Continue cyclophosphamide
Mycophenolate mofetil or azathioprine
Rationale: Once remission is achieved with cyclophosphamide, maintenance therapy with mycophenolate mofetil or azathioprine is recommended to prevent relapse
Which is the most common type of chronic lupus dermatitis?
A. Subacute cutaneous lupus erythematosus (SCLE)
B. Acute lupus erythematosus
C. Discoid lupus erythematosus (DLE)
D. Lupus panniculitis
C. Discoid lupus erythematosus (DLE)
Rationale: DLE is the most common chronic dermatitis in lupus, characterized by circular, scaly, hyperpigmented lesions with atrophic centers.
What is a hallmark feature of discoid lupus erythematosus (DLE) lesions?
A. Bullae and panniculitis
B. Atrophic centers with destroyed dermal appendages
C. Scaly red patches resembling psoriasis
D. Butterfly-shaped rash on the cheeks and nose
B. Atrophic centers with destroyed dermal appendages
Rationale: DLE lesions are distinguished by their hyperpigmented rims, depigmented and atrophic centers, and permanent destruction of dermal appendages.
Subacute cutaneous lupus erythematosus (SCLE) is commonly associated with which feature?
A. Urticarial lesions
B. Positive antibodies to Ro (SS-A)
C. Deep, scarring lesions resembling lichen planus
D. Bullae and panniculitis
B. Positive antibodies to Ro (SS-A)
Rationale: SCLE often presents with scaly red patches or annular lesions and is strongly associated with antibodies to Ro (SS-A).
What are the leading causes of mortality in the first decade of SLE?
A. Cardiovascular disease and stroke
B. Nephritis and infection
C. Pulmonary embolism and hypertension
D. Thrombocytopenia and anemia
B. Nephritis and infection
Rationale: Nephritis and infection are the primary causes of mortality in the early stages of SLE, highlighting the importance of monitoring and managing these complications.
What is the purpose of renal biopsy in patients with lupus nephritis?
A. To confirm the diagnosis of SLE
B. To monitor disease progression without additional testing
C. To classify the type of nephritis and guide therapy
D. To assess the risk of cardiovascular disease in lupus
C. To classify the type of nephritis and guide therapy
Rationale: Renal biopsy helps determine the class of lupus nephritis (e.g., ISN III or IV) and is critical in planning treatment and its duration.
Which classes of lupus nephritis are considered proliferative and most dangerous?
A. Class I and II
B. Class III and IV
C. Class V and VI
D. Class II and V
B. Class III and IV
Rationale: ISN III (focal lupus nephritis) and ISN IV (diffuse lupus nephritis) are proliferative forms associated with significant glomerular damage, posing a serious risk to patients.
What is the most common manifestation of diffuse CNS lupus?
A. Psychosis
B. Seizures
C. Cognitive dysfunction
D. Myelopathy
C. Cognitive dysfunction
Rationale: Cognitive dysfunction, including difficulties with memory and reasoning, is the most common CNS manifestation in lupus.
How can psychosis caused by lupus be distinguished from glucocorticoid-induced psychosis?
A. Lupus psychosis is always associated with headaches.
B. Glucocorticoid-induced psychosis occurs during the first weeks of therapy at high doses and resolves after dose reduction.
C. Glucocorticoid-induced psychosis is more resistant to treatment.
D. Lupus psychosis is not affected by immunosuppressive therapies.
B. Glucocorticoid-induced psychosis occurs during the first weeks of therapy at high doses and resolves after dose reduction.
Rationale: Psychosis from glucocorticoids typically arises early in therapy (≥40 mg of prednisone or equivalent daily) and resolves over days when the dose is decreased or stopped, unlike lupus-induced psychosis.
What is the most common pulmonary manifestation of systemic lupus erythematosus (SLE)?
A. Pulmonary fibrosis
B. Pleuritis with or without pleural effusion
C. Pulmonary hypertension
D. Acute respiratory distress syndrome (ARDS)
B. Pleuritis with or without pleural effusion
Rationale: Pleuritis, which may occur with or without pleural effusion, is the most common pulmonary manifestation of SLE. Other pulmonary issues, such as fibrosis and pulmonary hypertension, are less frequent.
What is the most frequent cardiac manifestation of systemic lupus erythematosus (SLE)?
A. Myocarditis
B. Pericarditis
C. Libman-Sacks endocarditis
D. Arrhythmias
B. Pericarditis
Rationale: Pericarditis is the most frequent cardiac manifestation in SLE and typically responds well to anti-inflammatory therapy, rarely leading to complications like tamponade.
What type of endocarditis is associated with systemic lupus erythematosus?
A. Infective endocarditis
B. Non-bacterial thrombotic endocarditis (Libman-Sacks)
C. Rheumatic endocarditis
D. Marantic endocarditis
B. Non-bacterial thrombotic endocarditis (Libman-Sacks)
Rationale: Libman-Sacks endocarditis is a characteristic non-bacterial endocarditis in SLE, often leading to valvular insufficiencies or embolic events.
Which heart valves are most commonly affected by endocardial involvement in SLE?
A. Tricuspid and pulmonary valves
B. Mitral and aortic valves
C. Mitral and tricuspid valves
D. Aortic and pulmonary valves
B. Mitral and aortic valves
Rationale: Endocardial involvement in SLE often leads to valvular insufficiencies, most commonly affecting the mitral and aortic valves.
What is the most frequent hematologic manifestation of systemic lupus erythematosus (SLE)?
A. Thrombocytopenia
B. Normochromic normocytic anemia
C. Hemolytic anemia
D. Leukopenia
Normochromic normocytic anemia
Rationale: The most frequent hematologic manifestation of SLE is anemia, typically normochromic normocytic, due to chronic illness and impaired iron utilization.
What type of leukopenia is most commonly seen in SLE patients?
A. Granulocytopenia
B. Neutropenia
C. Eosinopenia
D. Lymphopenia
D. Lymphopenia
Rationale: Leukopenia in SLE most commonly consists of lymphopenia, which typically does not predispose patients to infections or require therapy.
What is the first-line treatment for severe thrombocytopenia or hemolysis in SLE?
A. Rituximab
B. Splenectomy
C. High-dose glucocorticoid therapy
D. Platelet transfusion
C. High-dose glucocorticoid therapy
Rationale: Severe thrombocytopenia or hemolysis in SLE is initially treated with high-dose glucocorticoid therapy, such as 1 mg/kg per day of prednisone or equivalent.
What additional strategies may be used for recurring or refractory hematologic complications in SLE?
A. Cyclophosphamide and methotrexate
B. Rituximab, platelet growth factors, and/or splenectomy
C. Low-dose glucocorticoids and hydroxychloroquine
D. IV iron infusions and erythropoietin
B. Rituximab, platelet growth factors, and/or splenectomy
Rationale: For recurring or refractory hemolytic anemia or thrombocytopenia, or when high glucocorticoid doses are not feasible, additional therapies such as rituximab, platelet growth factors, or splenectomy may be considered.
What is the preferred medication for controlling active systemic lupus erythematosus (SLE) during pregnancy?
A. Methotrexate
B. Hydroxychloroquine
C. Cyclophosphamide
D. Mycophenolate mofetil
B. Hydroxychloroquine
Rationale: Hydroxychloroquine is the preferred medication for controlling active SLE in pregnant women due to its safety profile and efficacy.
In pregnant women with SLE and antiphospholipid syndrome (APS) with prior fetal losses, what combination therapy has been shown to significantly increase the proportion of live births?
A. Aspirin and hydroxychloroquine
B. Heparin and hydroxychloroquine
C. Low-molecular-weight heparin (LMWH) and low-dose aspirin
D. Warfarin and aspirin
C. Low-molecular-weight heparin (LMWH) and low-dose aspirin
Rationale: Prospective controlled trials have shown that LMWH plus low-dose aspirin significantly improves live birth rates in pregnant women with antiphospholipid antibodies and prior fetal losses.
The presence of maternal anti-Ro antibodies during pregnancy requires vigilant monitoring because they can cause which life-threatening fetal condition?
A. Fetal anemia
B. Neonatal lupus with congenital heart block
C. Severe intrauterine growth restriction
D. Fetal arrhythmias
B. Neonatal lupus with congenital heart block
Rationale: Maternal anti-Ro antibodies are associated with neonatal lupus, which may include a rash or congenital heart block that can be life-threatening.
Which of the following is the most appropriate recommendation for a patient with lupus dermatitis regarding ultraviolet (UV) light exposure?
A) Avoid sun exposure only between 10 AM and 2 PM.
B) Use sunscreen with a minimum SPF of 15 and limit sun exposure for 30 minutes a day.
C) Minimize exposure to UV light by wearing appropriate clothing and using sunscreen with an SPF of at least 30.
D) UV light exposure is beneficial for patients with lupus dermatitis and should be encouraged to improve their symptoms.
C) Minimize exposure to UV light by wearing appropriate clothing and using sunscreen with an SPF of at least 30.
