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Self-Assessment Questions


Systemic Lupus Erythematosus: Review Questions

Janet Burkholder-Krommes, MD

Dr. Burkholder-Krommes is in private practice with Rheumatology Associates, Mercerville, NJ.

Choose the single best answer for each question.

1. A 23-year-old woman was diagnosed with systemic lupus erythematosus (SLE) at age 13 years when she presented with polyarticular joint swelling. On a regimen of methotrexate and hydroxychloroquine, her joint pain and swelling have been relatively well controlled. The patient’s fingers exhibit both boutonnière and swan-neck deformities, but she is able to make a normal closed fist. What will radiographs of the patient’s hands likely reveal?
  1. Bone fragmentation
  2. Carpal fusion
  3. Erosions in the proximal joints
  4. Marked subchondral cysts
  5. Normal joints
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2. A 32-year-old woman with longstanding SLE presents with severe headache. Her blood pressure is 200/110 mm Hg, the cardiac examination is remarkable for an S4, and a new heart murmur is noted at the left sternal border. Her medical history includes 3 spontaneous abortions and multiple episodes of pleurisy, arthritis, and thrombocytopenia. Dipstick urinalysis is positive for protein and trace blood. Microscopic examination shows 3 to 5 erythrocytes per high power field and an occasional granular cast. Serum creatinine level is 4.0 mg/dL. What is a renal biopsy likely to show?

  1. Diffuse proliferative glomerulonephritis
  2. Focal segmental glomerulonephritis
  3. IgA deposits
  4. Mesangial deposits (seen by electron microscopy only)
  5. Thrombotic microangiopathy
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3. A 20-year-old man with SLE presents to the emergency department with chest pain that started 10 days ago. He has become increasingly dyspneic over the last 48 hours and has been too exhausted to make meals. He will not lay flat on the examination table and insists on leaning slightly forward. Blood pressure is 94/50 mm Hg and heart rate is 100 bpm. The heart sounds are quiet, and tubular breath sounds are heard at the left scapular border. There is 1+ peripheral edema. Chest radiograph shows a possible cardiomegaly. What is the next step in this patient’s management?

  1. Arterial blood gas
  2. Diuresis with intravenous furosemide
  3. Echocardiogram
  4. High-dose nonsteroidal medication
  5. Infusion of stress dose steroids
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4. What is the most specific indicator of Raynaud’s phenomenon commonly associated with SLE or a related connective tissue (CT) disease?
  1. Alopecia
  2. Diffuse myalgias and arthralgias
  3. Dilated capillary loops on capillary microscopy
  4. History of a first-degree relative with SLE
  5. Onset of severe fatigue in the last 2 months
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5. A 31-year-old man with a history of lupus nephritis in remission is seen in the office for routine follow-up. Medications include hydroxychloroquine and naproxen. Laboratory tests are performed, and the hemoglobin level is noted to have dropped to 9.0 mg/dL since the last testing 3 months ago. Platelet counts, leukocyte counts, and renal function are normal. The erythrocyte sedimentation rate is 45 mm/h. Other than being more tired than usual, the patient has no complaints. What will the evaluation of anemia most likely show?

  1. Cold agglutinins
  2. Elevated haptoglobin
  3. Negative Coomb’s testing
  4. Normal total bilirubin
  5. Spherocytes on peripheral smear
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