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72 Cards in this Set
- Front
- Back
Who is Lupus most common in?
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Young women
-15-40 y/o F:M ration of 5-9:1 |
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Most common manifestations of lupus?
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Rash
Joint pain |
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When should you consider SLE?
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any time an organ is involved and don't know why - it is systemic
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What type of dz is lupus?
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chronic inflammatory autoimmune dz
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Lupus Ab are made to?
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components of cell nucleus
ANA |
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What HLA types is Lupus assoc. w/
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DR2 and DR3
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What diffeciency may increase risk Lupus and why?
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inherited complement deficiencies
ie: C4a, C1q, C1r/s, C2 b/c interferes w/ normal clearance apoptotic cells |
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What can trigger SLE?
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enviro or exog factors like
-infections -stress (phys/emotional) -toxins (drugs) -physical agents (sunlight) -hormones |
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What is teh central immune disturbance of SLE?
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autoantibody production
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Where could autoantibodies be directed at self-molecules?
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found in nucleus
cytoplasm cell surface |
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What can measurably see w/ regard to immune system that may suggest lupus?
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B-cell hyperactivity
-Hypergammaglobulinemia -increased # ab producing cells -heightened response to ag, both self and foreign increased helpert T cell activity Decreased # and function suppressor t-cells |
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Why might C1q def. lead to lupus?
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if C1q absent, apoptotic cells inefficiently cleared
- this is proinflammatory |
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Why is SLE referred to sometimes as a "dz of waste disposal"
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-abnormal apoptosis could be factor in SLE
(ie: large blebs like Ro, La, Sm, RNP, Mi2 and small blebs like Ro Jo-1 and RNP produced) |
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Is SLE a constant DZ?
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no, periods of exacerbations and remissions
-malaise (wt. loss, fatigue, fever may affect patients at some point in dz) |
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How detect autoantibodies lupus (ANAs)?
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Indirect immunofluorescence Ab
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Of SLE Classification criteria below, how many must be present for SLE?
-Malar Rash -Discoid rash -Photosensitivity -Oral Ulcers -Arthritis -Serositis -Renal disorder -Neurological disorders -hematological disorder -immunological disorder -Antinuclear antibody (ANA) |
4/11 criteria
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SLE Criteria 10 (Immunological Disorder) of Lupus requires?
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-antibodies to dsDNA
-anti-Sm (Smith antibodies) -anti-phospholipid antibodies |
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What is the most specific test for Lupus?
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anti-Sm
(S, for specific) |
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What does SLE criteria 11 test for?
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Antinuclear Ab Test
-positive ANA is non-specific |
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What percent of SLE patients have ANAs?
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95%
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Does ANA titer levels correlate w/ dz activity?
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No
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What titer levels do correlate w/ SLE dz activity?
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dsDNA
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What are the SLE specific autoantibodies?
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Anti-dsDNA
Anti-Sm (smit) |
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Once someone is Anti-Sm positive, does it need to be checked again?
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No- this is an expensive test and level don't correlate w/ dz progression (unlike anti-dsDNA ab, which do)
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anti-APL (antiphospholipid ab) put patient at increased risk for?
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Arterial and/or venous thrombosis
*can be manifested by recurrent miscarriages |
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how does Lupus cause tissue damage?
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ab bind to ags resulting in circulating immune complexes (CICs)
-CICs deposit in tissues -consumes and activates complement-->inflammatory response **sometimes serum complement levels can assist in determining dz activity |
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What ab titer can correlate w/ SLE dz activity?
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=anti-dsDNA
- complement C3 and C4 can follow |
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How many criteria rq'd for dx lupus?
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4 of 11
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name 2 criteria for dx?
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ANA
inflammation/rash (there are 11) |
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Example of Ab mediated cell lysis?
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Hemolytic anemia (anti-PLP)
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What can measurably see w/ regard to immune system that may suggest lupus?
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B-cell hyperactivity
-Hypergammaglobulinemia -increased # ab producing cells -heightened response to ag, both self and foreign increased helpert T cell activity Decreased # and function suppressor t-cells |
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Why might C1q def. lead to lupus?
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if C1q absent, apoptotic cells inefficiently cleared
- this is proinflammatory |
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Why is SLE referred to sometimes as a "dz of waste disposal"
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-abnormal apoptosis could be factor in SLE
(ie: large blebs like Ro, La, Sm, RNP, Mi2 and small blebs like Ro Jo-1 and RNP produced) |
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Is SLE a constant DZ?
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no, periods of exacerbations and remissions
-malaise (wt. loss, fatigue, fever may affect patients at some point in dz) |
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How detect autoantibodies lupus (ANAs)?
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Indirect immunofluorescence Ab
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Of SLE Classification criteria below, how many must be present for SLE?
-Malar Rash -Discoid rash -Photosensitivity -Oral Ulcers -Arthritis -Serositis -Renal disorder -Neurological disorders -hematological disorder -immunological disorder -Antinuclear antibody (ANA) |
4/11 criteria
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SLE Criteria 10 (Immunological Disorder) of Lupus requires?
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-antibodies to dsDNA
-anti-Sm (Smith antibodies) -anti-phospholipid antibodies |
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What is the most specific test for Lupus?
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anti-Sm
(S, for specific) |
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What does SLE criteria 11 test for?
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Antinuclear Ab Test
-positive ANA is non-specific |
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What percent of SLE patients have ANAs?
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95%
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Two ways SLE autoantibodies can cause tissue damage?
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1. ab bind directly to ag on cells --> cell lysis
2. ab can "tag" cell for uptake in the reticulo-endothelial system |
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Does butterfly rash (malar) cause scarring?
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no
*it is itchy **may be generalized ***Most photosensitive |
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Malar rash associated w/
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UV sensitivity
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Does discoid rash scar?
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yes
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Is discoid rash always associated w/ lupus?
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no, can be independent
*may have associated alopecia (hair loss) |
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Where are common locations of SLE in mucous membranes?
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Mouth ulcers (4)
Nasal septal ulcers vaginal ulcers |
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w/ regard to the skin, where does inflammation and degeneration occur with SLE?
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dermal/epidermal junction
**Band-like pattern of granular deposits IgG and complement |
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Is lupus pain symmetrical or one-sided?
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symmetrical
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Where does SLE typically impact joints?
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Small and large joints (knees, hands, wrists)
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What are the most common presentations of joint pain w/ SLE?
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intermittent, migratory, chronic
-50% stiffness -myositis and fibromyalgia common |
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Does lupus typically have deformities or erosions?
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Typically deformites
-unlike rheumatoid arthritis, typically not erosions |
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Most common serositis manifestations?
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-Pleurisy
-Pericarditis sometimes peritonitis *usually bilateral and may have exudate (fluid) |
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Most common heart involvement w/ lupus?
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Pericarditis
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Note, Gi, pulmonary manifestions, and cardiac manifestions not tested, nor are premature vasc. dz,s
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any important points mentioned about these in her review ?'s will be covered later
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History of someone w/ pleurisy?
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chest pain w/ deep breath
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2 SLE criteria that affect the skin?
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Discoid, malar, photosensitivity, ulceritis, mucous membranes
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Skin lesions that result in scarring?
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Discoid (NOT malar)
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Most common joint presentation SLE?
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Symmetrical stiffness/ aching (amy mimic rheumatoid arthritis)
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Are SLE renal manifestations usually symptomatic or assymptomatic?
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assymptomatic
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Clinical renal dz
-proteinuria? |
>500mg/24hrs
>5 RBC/hpf in uinarlysis >5WBC/hpf w/o infection **elevated serum creatinine in blood |
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What are renal lupus biopsies examined for?
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basic histology
-immunofluorescence for Ig and complement -electron microscopy for immune deposits |
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when doing renal SLE biopsy, what do you need to determine?
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Type and
Severity of kidney involvement *graded in terms of activity and chronicity |
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What parts of the nervous system can be affected w/ SLE?
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any parts
-classify as nervous system vs peripheral nervous system, or as -neurological vs psychiatric |
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What are some things observed w/ CNS lupus
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seizures, psychosis, chorea, stroke
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what are some things observed w/ Peripheral nervous system SLE?
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cranial neuropathies (visual defects), motor/sensory or mixed peripheral neuropathies
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What are a few hemolytic abnormalities that occur w/ SLE?
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-autoimmune Hemolytic anemia
-leukopenia (2,500-4000/mm3) common w/ active dz |
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Thrombocytopenia and Lymphopenia are also associated w/ SLE and what are their levels?
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-Thrombocytopenia (<100,000/mm3) normal 150,000
-Lymphopenia <1,500/mm3):usually associated w/ antibodies to lymphocytes and active SLE |
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If patient has hemolytic anemia and thrombocytopenia, how many SLE criteria need to fulfill?
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1
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CNS manifestions SLE?
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seizures, strokes, psychosis
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2 ways renal DZ may present SLE?
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-assymptomatic usually so
*proteinuria *increased creatinine *hypertension *RBCs in urine |
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2 clinical findings drug induced lupus?
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-lung involvement and rash, fluid in lungs
*antihistone Ab **anti-dsDNA ab and renal dz not found |
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Is drug-induced lupus as severe as normal lupus?
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usually less severe
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