The Zebra King
An Antibody is Born
The Rise of Doppelgangers
How to Train Your Internist
End Game
100
Multisystem autoimmune disorder that results in autoantibody-mediated tissue damage
What is SLE?
100
Useful as an initial screening test, however non-specific
What is ANA?
100
Malaise, fever, arthritis, rash; positive ANA and antihistone antibodies
What is Drug-induced Lupus Erythematosus?
100
Three triggers for SLE flare
What are stress, environmental factors and infection?
100
Most common cause of death among older patients with SLE
What is CAD?
200
In SLE, there is an abnormal activation of __ cells and __ cell
What are T and B cells?
200
Antibodies tested during SLE flares
What is C3, C4, dsDNA, and ESR?
200
Fever, rash, arthritis with quotidian fevers
What is Adult Still's Disease?
200
Initiated in every patient because it reduces disease-associated damage, prevents disease flares, and improves kidney and overall survival
What is Hydroxychloroquine?
200
fever, cough, dyspnea, hypoxemia, pleuritic chest pain and infiltrates in SLE patient
What is Acute lupus pneumonitis?
300
Criteria for Classification of SLE
What are malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, Kidney disorder, Neurologic disorder, Hematologic disorder, Immunologic disorder, ANA
300
Specific for SLE, often associated with more severe disease
What is Anti-Smith, anti-dsDNA?
300
Gottron rash, heliotrope rash, shawl sign, malar erythema with insidious onset of symmetric proximal muscle weakness.
What is Dermatomyositis?
300
Mainstay of SLE management, particularly in acute disease
What are Glucocorticoids?
300
32-y/o woman evaluated for an 8-week h/o fatigue and low-grade fever. She also reports swelling and tenderness of han joints, along with morning stiffness lasting 2 hours. Over the past 2 weeks, she has been taking naproxen with relief. Last week, she developed swelling of the legs and gained 4.5 kg (10 lbs).
On PE, BP 152/96; other VS are normal. Malar rash is present. Active tenderness and swelling of multiple joints of hands are noted. There is pitting edema of the lower extremities. Remainder of PE is normal.
ESR: 88
Hct 38%
C3,C4 Low
Crea 1.1
ANA 1:320
Anti-Smith +; anti-dsDNA +
UA: 3+ protein
Urine protein 4000/24h
_______ should be performed next.
What is Kidney Biopsy?
400
A 21 y/o woman is evaluated for an 8-week history of fatigue and low-grade fever. Last week she developed a facial rash. She takes a multivitamin.
On PE, VS are normal. Remainder of exam is normal.
Appearance of rash is as follows:
______ is the most likely diagnosis for the rash.
What is Acute cutaneous lupus erythematosus?
400
Associated with photosensitive rashes, DLE, and neonatal lupus erythematosus
What is Anti-Ro/SSA?
400
Joint swelling and morning stiffness that improves with activity
What is RA?
400
A 25 y/o woman is hospitalized for a 4-week h/o swelling of the legs, weight gain, and SOB on exertion. She was diagnosed with SLE 1 year ago when she presented with polyarthritis, rash and alopecia. She was initially treated with hydroxychloroquine and prednisone with a good response.
On PE, BP is 142/96; other VS are normal. There is pitting edema of the lower extremities extending to the knees. The remainder of the PE is normal.
ESR: 68
Hct 38%
C3, C4 low
Crea 1.0
Anti-Sm +
Anti-dsDNA +
UA 3+ protein
Urine Protein 6000/24h
___ is the most appropriate treatment of kidney disease.
What is Mycophenolate mofetil?
400
Unexplained hip pain with reduced range of motion
What is Osteonecrosis?
500
The ACR has published 11 criteria for the classification of patients with SLE. ____ is the number of criteria required to be fulfilled in order for a patient to be classified as having SLE when all other reasonable diagnoses have been excluded.
What is 4?
500
21 y/o woman is evaluated for a 2-week h/o worsening rash and arthritis as well as intermittent low-grade fever. She has a 5-yr h/o SLE. She has been doing well w/o active disease for the past 3 yrs and has been adherent to hydroxychloroquine.
On PE, temperature is 100.0F, and BP 150/86; other VS are normal. A malar rash is present. Diffuse tenderness and swelling of multiple small joints of the hands are present. New dependent edema is present.
Lab studies show low C3 and C4. Serum crea is 1.8; a urine protein-creatinine ratio of 3200 mg/g, active urine sediment on microscopic examination.
_______ is the following lab study that should be done next.
What is anti-double-stranded DNA antibodies?
500
Typical clinical features of this condition include Raynaud phenomenon, arthritis, puffy fingers, sclerodactyly, serositis, esophageal dymotility, myositis, interstitial lung disease, PAH with positive anti-U1-RNP antibodies
What is Mixed connective tissue disease?
500
A 26-year old woman is evaluated for a rash on her scalp and polyarthritis associate with SLE. She was diagnosed with SLE 8 years ago with an initial presentation of photosensitivity, malar and discoid rashes, pleuropericarditis, and arthritis. She was initially treated with hydroxychloroquine, azathioprine, and glucocorticoids with a good response, but she has had intermittent flare-ups of arthritis and rash. She developed lupus nephritis 3 years ago and had a 6- month course of cyclophosphamide followed by mycophenolate mofetil. She is currently on MMF, hydroxychloroquine and prednisone, but continues to have joint and skin disease. MTX and leflunomide were tried but she was not able to tolerate them. Her kidney disease is well controlled without any active nephritis.
On PE, VS are normal. Several hyperkeratotic, dyspigmented, discoid plaques are present on the scalp. Multiple joints of the hands are tender and swollen. Remainder of exam is normal.
ESR: 56
Hct 38%
C3, C4 low
Creatinine 1.5
Anti-dsDNA high
UA normal
CXR normal
___ is the most appropriate tx to consider.
What is Belimumab?
500
SLE patient with embolic strokes
What is Verrucous (Libman-Sacks) endocarditis?