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724: Medical Lectures > Systemic Lupus Erythematous > Flashcards

Systemic Lupus Erythematous Flashcards

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USMLE® Step 1 flashcards
1
Q

What can be defined as an inflammatory autoimmune disorder characterized by autoantibodies to nuclear atigens?

A

Systemic lupus erythematous

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2
Q

What are many of SLE symptoms secondary to what 2 things?

A
  • trapping of antigen-antibody complexes in capillaries of visceral structures
  • autoantibody-mediated destruction of host cells
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3
Q

What is the clinical course of SLE marked by?

A

spontaneous remission and relapses

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4
Q

What 3 factors influence the incidence of SLE?

A
  • gender
  • race
  • genetic inheritance
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5
Q

About __% of SLE patients are women and __% are men

A

85

15

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6
Q

When do the majority of cases begin in women?

A

After menarche and before menopause

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7
Q

SLE occurs in 1:____ white women and 1:_____ black women

A

1: 1000
1: 250
* More common in black women

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8
Q

If one identical twin has SLE there is a __-__% chance the other twin will as well

A

25-70

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9
Q

If a mother has SLE what are her daughter’s risks of developing the disease? What are her son’s?

A

1 in 40

1 in 250

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10
Q

What disorders are seen in asymptomatic relatives of those with SLE?

A

Rheumatic diseases (aggregation of serologic abnormalities)

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11
Q

Before making a diagnosis of SLE it is imperative to ascertain the symptoms are not secondary to what?

A

drug induced

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12
Q

What 3 drugs are considered to induce this type of lupus?

A
  • procainamide
  • hydralazine
  • isoniazid
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13
Q

What are the 4 features that separate drug-induced lupus from SLE?

A

1) the sex ratio is nearly equal
2) nephritis and CNS symptoms typically aren’t present
3) hypocomplementemia and antibodies to double-stranded DNA are absent
4) the clinical features and lab abnormalities usually revert to normal after the drug is withdrawn

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14
Q

When should the diagnosis of SLE be suspected?

A

In patients having a multisystem disease with a positive test for antinuclear antibodies

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15
Q

What are 8 differential diagnoses for SLE?

A
  • Rheumatoid arthritis
  • Systemic vasculitis
  • Scleroderma
  • Inflammatory myopathies
  • Viral hepatitis
  • Sarcoidosis
  • Acute drug reactions
  • Drug-induced lupus
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16
Q

The diagnosis of SLE can be made with reasonable probability if _ or the following 11 criteria are found.

  • Malar rash
  • Discoid rash
  • Photosensitivity
  • Oral ulcers
  • Arthritis
  • Serositis
  • Kidney disease
  • Neurologic disease
  • Hematologic disease
  • Immunologic abnormalitis
  • Positive ANA in serum
A

4

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17
Q

What are the systemic features of SLE?

A
  • Fever
  • Anorexia
  • Malaise (generalized feeling of discomfort)
  • Weight loss
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18
Q

What are the cutaneous manifestations of SLE?

A
  • Malar (butterfly) rash
  • Panniculitis: (inflammation of subcutaneous fat)
  • Discoid lupus
  • Fingertip lesions
  • Periungual erythema
  • Nail fold infarcts
  • Splinter hemorrhages
  • Alopecia (hair loss)
  • Raynaud phenomenon
  • Mucous membrane lesions
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19
Q

Raynaud phenomenon is present in __% of patient’s with SLE

A

20

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20
Q

When do mucous membrane lesions tend to occur?

A

during periods of exacerbation

21
Q

Joint symptoms occur in over __% of patients and are often the _____ manifestation

A

90

earliest

22
Q

Arthritis associated with SLE leads to what?

A

reversible swan-neck deformity

23
Q

What are the ocular manifestations of SLE?

A
  • Conjunctivitis (pink eye)
  • Photophobia
  • Transient or permanent monocular blindness
  • Blurred vision
24
Q

What do cotton-wool spots on the retina represent?

A

Degeneration of nerve fibers due to occlusion of retinal blood vessels

25
Q

What are the pulmonary manifestations of SLE?

A
  • Pleurisy
  • Pleural effusion
  • Bronchiopneumonia
  • Pneumonitis
  • Interstitial lung disease (rare)
  • Restrictive lung disease
  • Alveolar hemorrhage (rare)
26
Q

What layer covering the heart is affected in the majority of patients?

A

pericardium

27
Q

Heart failure associated with SLE may result from what?

A
  • myocarditis

- hypertension

28
Q

What are the neurological complications of SLE?

A
  • Psychosis (delusions and hallucinations are very common)
  • Cognitive impairments
  • Seizures
  • Peripheral and cranial neuropathies
  • Transverse myelitis
  • Stroke
29
Q

What 5 things can lead to SLE flare-ups?

A
  • Stress (most common cause)
  • Exposure to the sun
  • Infections
  • Surgery
  • Pregnancy
30
Q

Antinuclear antibody (ANA) tests are positive in virtually all SLE patients, but are also positive in what 4 nonlupus conditions?

A
  • RA
  • autoimmune thyroid disease
  • sclerodoma
  • Sjögren’s Syndrome
31
Q

What are the 2 ways in which ANA is tested?

A
  • Immunofluorescence (IFR)

- Enzyme Immunoassay

32
Q

The IFR test is considered positive for lupus if the blood sample to diluting sample is ____ than 1:40

A

greater

33
Q

What are the 3 types of antiphospholipid antibodies?

A
  • Syphilis False Positive
  • Lupus Anticoagulant
  • Anti-Cardiolipin
34
Q

Ultimately SLE lab studies should include data from what 3 parameters?

A
  • renal
  • hematological
  • immunological
35
Q

All SLE patients should wear SPF__ or greater when going outside

A

55

36
Q

What do skin lesions associated with SLE often respond to?

A

local corticosteroid use

37
Q

What are minor joint symptoms usually treated with?

A

rest and NSAIDs

38
Q

What specific drug assists with treating the rashes, joint symptoms, and severity of symptoms?

A

Hydroxychloroquine (an anti-malarial drug)

39
Q

What complex symptoms usually require systemic corticosteroids (prednisone)?

A
  • glomerulonephritis
  • hemolytic anemia
  • pericarditis / myocarditis
  • alveolar hemorrhage
  • CNS involvement
  • thrombotic thrombocytopenic purpura
40
Q

When are immunosuppressants used?

A

when the SLE is resistant to corticosteroid treatment

41
Q

What is the treatment of choice for pateints with the antiphospholipid syndrome?

A

anticoagulants (Warfarin)

42
Q

The 5 year survival rate is __%

The 10 year survival rate is __%

A

90

85

43
Q

True or False

SLE follows a relapsing and remitting course.

A

True

44
Q

What are the leading cause of death in the early years?

What are the leading cause of death in the later years?

A

infections

accelerated atherosclerosis

45
Q

Patients with SLE have an incidence rate _ times higher than normal people for a myocardial infarction.

A

5

46
Q

True or False

SLE patients have a higher risk of developing malignancy.

A

True

47
Q

Appropriate diagnosis and management of SLE requires the active participation of what HCP?

A

A rheumatologist

48
Q

When should you admit a person with suspected lupus?

A

When they show signs of:

- Rapidly progressive glomerulonephritis
- Pulmonary hemorrhage
- Transverse myelitis
- Severe infection
- Other severe manifestations

724: Medical Lectures (42 decks)

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