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Musculoskeletal Health > Systemic Lupus Erythematosus > Flashcards

Systemic Lupus Erythematosus Flashcards

1
Q

What are the causes of nephrotic syndrome?

A
  • Amyloidosis
  • SLE
  • Diabetes
  • Primary renal disorders e.g. membranous nephropathy, FSGS
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2
Q

What are the signs of nephrotic syndrome?

A
  • Peripheral oedema
  • Heavy proteinuria (>3-5g/24hrs)
  • Hypoalbuminaemia
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3
Q

What are the signs of nephritic syndrome?

A
  • Haematuria (macroscopic or microscopic)
  • Proteinuria (usually <2g/24hrs)
  • HTN (caused by salt and water retention)
  • Oedema (periorbital, leg or sacral)
  • Oliguria
  • Uraemia
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4
Q

What are features in a hx associated with CTD and SLE?

A
  • Raynaud’s
  • Hair loss
  • Mucosal ulcers
  • Fatigue
  • Weight loss
  • Systems review - cardiorespiratory or GI/GU
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5
Q

What are the common symptoms of SLE?

A
  • Systemic: fever, fatigue
  • Photosensitvity
  • Ulcers (mouth and nose)
  • Muscle aches
  • Arthritis
  • Raynaud’s phenomenon
  • Butterfly rash
  • Pleura and pericardial inflammation
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6
Q

What tests would be used to monitor SLE?

A
  • ESR
  • Complement levels (C3, C4) are low
  • Anti-dsDNA titre
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7
Q

What is used in the treatment of SLE?

A
  • NSAIDs
  • Sun block
  • Hydroxychloroquine
  • If internal organ involvement - prednisolone, cyclophosphamide
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8
Q

Why should pregnancy be managed in SLE?

A
  • Ensure immunosuppressants are changed if existing regime is not safe
  • Presence of Ro (SSA) and La (SSB) and antiphospholipid antibodies should be known
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9
Q

Why do Ro (SSA) and La (SSB) levels need to be known in pregnancy?

A

They can cross the placenta and result in neonatal lupus. This can include a lupus rash, complete heart block and blood abnormalities such as cytopaenias.

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10
Q

What is antiphospholipid syndrome?

A

A systemic autoimmune disease characterised by elevated antiphospholipid antibodies and an acquired thrombophilia or clotting tendancy.

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11
Q

How is antiphospholipid syndrome (APLS) diagnosed?

A

Positive antiphospholipid antibodies present (lupus anticoagulant and anti-cardiolopin antibody) on 2 or more occasions at least 12 weeks (3months) apart AND vascular thrombosis or pregnancy morbidity.

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12
Q

What is the classic presentation of SLE?

A
  • Fever
  • Joint pain
  • Rash
  • Woman of child-bearing age
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13
Q

What are the antibodies indicated in SLE?

A
  • Anti-Smith: targets ribonucleoproteins (high specificity, very low sensitivity)
  • Anti-dsDNA: targets double stranded DNA, seen during active disease (high specificity, less sensitive)
  • ANA (high sensitivity, low specificity)
  • Rheumatoid Factor (RF)
  • Also: anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)
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14
Q

What are the classifications of kidney involvement in SLE?

A
  1. Normal kidney
  2. Mesangial glomerulonephritis
  3. Focal (+segmental) proliferative glomerulonephritis
  4. Diffuse proliferative glomerulonephritis
  5. Diffuse membranous glomerulonephritis
  6. Sclerosing glomerulonephritis
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15
Q

What does class IV (diffuse proliferative glomerulonephritis) show on a renal biopsy?

A
  • Glomeruli shows endothelial and mesangial proliferation, ‘wire loop’ appearance
  • If severe, the capillary wall may be thickened secondary to immune complex deposition
  • Electron microscopy shows subendothelial immune complex deposits
  • Granular appearance on immunofluorescence
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16
Q

What is the management for kidney involvement in SLE?

A
  • Treat HTN
  • Initial therapy for focal (class III) or diffuse (class IV) lupus nephritis - glucocorticoids with either mycophenolate or cyclophosphamide
  • Subsequent therapy - mycophenolate generally preferred to azathioprine to decrease risk of end stage renal disease
17
Q

What is the epidemiology of SLE?

A
  • More common in females 9:1
  • More common in Afro-Caribbean’s and Asian communities
  • Onset is usually 20-40yrs
18
Q

What are the key features of antiphospholipid syndrome?

A
  • Prolonged APTT
  • Thrombocytopenia - low platelets
  • Venous/arterial thrombosis
  • Recurrent fetal loss
  • Livedo reticularis
  • Pre-eclampsia, pulmonary hypertension
  • Common secondary to lupus
19
Q

What are the complications of SLE?

A
  • CVD - HTN and CAD
  • Infection is more common
  • Anaemia - anaemia of chronic disease, autoimmune haemolytic anaemia, bone marrow suppression by meds or kidney disease, leucopenia, neutropenia, thrombocytopenia
  • Pericarditis
  • Pleuritis and ILD (leads to pulmonary fibrosis)
  • Lupus nephritis (leads to ESRF)
  • Neuropsychiatric SLE - optic neuritis, transverse myelitis or psychosis
  • Recurrent miscarriage, increased risk of IUGR, pre-eclampsia and pre-term labour
  • VTE due to antiphospholipid syndrome

Musculoskeletal Health (17 decks)

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