Systemic Lupus Erythematous

Systemic Lupus Erythematous

Q. 1

Commonest cutaneous eruption in Systemic Lupus Erythmatosus is:

 A Palmar erythema
 B Discoid lesions
 C Erythema of light exposed area
 D Diffuse morbiliform erythema
Q. 1

Commonest cutaneous eruption in Systemic Lupus Erythmatosus is:

 A Palmar erythema
 B Discoid lesions
 C Erythema of light exposed area
 D Diffuse morbiliform erythema
Ans. C

Explanation:

Erythema of light exposed area


Q. 2

All are included in the criteria for diagnosis of systemic lupus erythematosus, except:

 A

Photosensitivity

 B

Malar rash

 C

Discoid rash

 D

Painful oral ulcers

Q. 2

All are included in the criteria for diagnosis of systemic lupus erythematosus, except:

 A

Photosensitivity

 B

Malar rash

 C

Discoid rash

 D

Painful oral ulcers

Ans. D

Explanation:

SLE produce painless oral ulcers.


Q. 3

What is the percentage of patients with disseminated discoid lupus erythematosus who develop SLE?

 A

2%

 B

22%

 C

52%

 D

82%

Q. 3

What is the percentage of patients with disseminated discoid lupus erythematosus who develop SLE?

 A

2%

 B

22%

 C

52%

 D

82%

Ans. B

Explanation:

The risk is higher in patients with disseminated DLE (22%) than in DLE confined to the head and neck (1.2%).

Females developing DLE before the age of 40 years,with HLA-B8 in their histocompatibility type, have an increasedrisk of ‘converting’ to SLE. Neither immunological nor biochemical abnormalities appear to alter the patient’s progress.

Note: Carpet tack/tin tack sign is positive in DLE lesions.
 
Ref: Rook’s textbook of dermatology, Edition-8, Page  51.20.

Q. 4

Which of the following autoantibodies is most suggestive of subacute cutaneous lupus erythematosus?

 A

anti ds DNA

 B

anti Ro

 C

anti La

 D

U1 RNP

Q. 4

Which of the following autoantibodies is most suggestive of subacute cutaneous lupus erythematosus?

 A

anti ds DNA

 B

anti Ro

 C

anti La

 D

U1 RNP

Ans. B

Explanation:

Antibodies to the Ro/SS-A antigen are usually always found in SCLE.

NB: anti ds DNA- SLE, anti La – Rowell’s & Sjogren’s syndrome, U1RNP- mixed connective disease
 
Ref: Rook’s textbook of dermatology, Edition-8, Page-51.22.

Q. 5

High titers of which of the following are considered to be highly specific for Systemic lupus erythematosus (SLE)?

 A

Anti dsDNA

 B

Anti Jo-1

 C

Anti SS-A

 D

Anti SS-B

Q. 5

High titers of which of the following are considered to be highly specific for Systemic lupus erythematosus (SLE)?

 A

Anti dsDNA

 B

Anti Jo-1

 C

Anti SS-A

 D

Anti SS-B

Ans. A

Explanation:

A wide variety of autoantibodies can be seen in systemic lupus erythematosus, including all of those listed. However, high titers of anti-double-stranded DNA and anti-Sm (not listed above) are considered to be the most specific for systemic lupus erythematosus.

MUST KNOW:

  • Anti-Jo-1 is associated with inflammatory myopathies.
  • Anti SS-A and anti-SS-B  are associated with Sjögren syndrome.
Ref: Costner M.I., Sontheimer R.D. (2012). Chapter 155. Lupus Erythematosus. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick’s Dermatology in General Medicine, 8e.

Q. 6

Which of the following is not a feature of neonatal lupus erythematosus?

 A

Cutaneous lesions

 B

Heart block

 C

Anti Ro positivity

 D

Thrombocytopenia

Q. 6

Which of the following is not a feature of neonatal lupus erythematosus?

 A

Cutaneous lesions

 B

Heart block

 C

Anti Ro positivity

 D

Thrombocytopenia

Ans. C

Explanation:

Neonatal lupus erythematosus (NLE) is a disorder caused by the transplacental passage of maternal antibodies.

 
The most frequent clinical manifestations are cutaneous lesions andcongenital heart block (CHB).
 Approximately 50% of NLE infants manifest skin lesions at birth or occur in the first few weeks of life as an erythematous eruption on the face and periorbital skin (raccoon sign/owl-eye/eye mask).
 Thrombocytopenia may occur in up to 20% ofcases and does not usually require treatment. The main antibody is Ro/SS-A.
 
Ref: Rook’s textbook of dermatology, Edition-8, Page-51.49.

Q. 7

Which of the following cardiac complications may develop in a 33 year old woman with systemic lupus erythematosus (SLE) because of her underlying condition?

 A

Hemorrhagic pericarditis

 B

Infective endocarditis

 C

Libman-Sacks endocarditis

 D

Mitral valve prolapse

Q. 7

Which of the following cardiac complications may develop in a 33 year old woman with systemic lupus erythematosus (SLE) because of her underlying condition?

 A

Hemorrhagic pericarditis

 B

Infective endocarditis

 C

Libman-Sacks endocarditis

 D

Mitral valve prolapse

Ans. C

Explanation:

Libman-Sacks endocarditis affects patients with systemic lupus erythematosus (SLE).
Small granular vegetations consisting of fibrin develop on the undersurface of the leaflets of mitral and aortic valves.
Fragments of vegetations may detach, resulting in embolism. Eventually, vegetations heal by organization of fibrin and subsequent fibrosis, leading to distortion of valve leaflets and resultant insufficiency or stenosis.
The pathogenesis is unclear but is probably related to thrombotic diathesis.
 
Hemorrhagic pericarditis is usually a consequence of tuberculosis or metastatic spread of cancer to the pericardium.
An exudate containing blood accumulates in the pericardial sac, producing pain and a characteristic auscultatory phenomenon known as a pericardial rub. SLE is associated instead with fibrinous pericarditis, which also manifests with chest pain and pericardial rub.
 
Infective endocarditis is prevalent in patients with damaged or prosthetic valves and in intravenous drug abusers.
It is associated with formation of bulky, friable vegetations that consist of masses of fibrin, neutrophils, and bacteria.
Such vegetations cause extensive destruction of valve leaflets and may release fragments into the bloodstream, with resultant septic embolism.
 
There is no association between SLE and mitral valve prolapse, which is a frequent, usually asymptomatic, valvular abnormality that occurs in 2% to 3% of the general population. Mitral valve prolapse is also associated with Marfan syndrome. Complications include sudden death, thromboembolism, and mitral regurgitation.
 
Ref: Kaul M.S., Tapson V.F., St. Clair E. (2011). Chapter 89. Rheumatologic Diseases and the Cardiovascular System. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst’s The Heart, 13e.

Q. 8

A 32-year-old woman with systemic lupus erythematosus (SLE) and chronic renal failure manifests rapidly progressive weakness. On physical examination, she appears pale and has slightly yellow sclerae and an enlarged spleen. Blood tests reveal severe anemia and mild, mostly unconjugated, hyperbilirubinemia. Coombs test is positive at 37 C but negative at 0-4 C. This patient developed anemia because of?

 A

Bone marrow aplasia

 B

IgG directed against red blood cells

 C

IgM directed against red blood cells

 D

Renal failure

Q. 8

A 32-year-old woman with systemic lupus erythematosus (SLE) and chronic renal failure manifests rapidly progressive weakness. On physical examination, she appears pale and has slightly yellow sclerae and an enlarged spleen. Blood tests reveal severe anemia and mild, mostly unconjugated, hyperbilirubinemia. Coombs test is positive at 37 C but negative at 0-4 C. This patient developed anemia because of?

 A

Bone marrow aplasia

 B

IgG directed against red blood cells

 C

IgM directed against red blood cells

 D

Renal failure

Ans. B

Explanation:

First, what type of anemia is it? It must be a hemolytic form, since it is associated with unconjugated hyperbilirubinemia (hence the yellow sclerae), resulting from increased destruction of red blood cells.

Increased erythrocyte destruction is the cause (not the effect) of splenomegaly.

Furthermore, a positive Coombs test implies that hemolysis is mediated by antibodies attached to red blood cells. Thus, the correct choice must be either IgG or IgM. Since the Coombs test is positive at warm temperature (37 C), the antibody is a warm agglutinin.

Warm agglutinins are virtually always of IgG type and may be triggered by a variety of disorders, including lymphomas, drugs, and autoimmune diseases such as SLE. IgG-coated red cells are then sequestered by the spleen, where hemolysis occurs, thus explaining splenomegaly.

By contrast, cold agglutinins are IgM and can be demonstrated by Coombs test at cold temperature (0-4 C).

Cold agglutinins are usually triggered by Mycoplasma pneumoniae infection or lymphomas.

Note:
Bone marrow aplasia is due to failure or suppression of myeloid stem cells, with decreased production of red blood cells, platelets, and leukocytes (pancytopenia). Most commonly, this condition is caused by chemical agents (especially drugs such as chloramphenicol, phenylbutazone, alkylating agents, and antimetabolites) or total body irradiation.
 
Renal failure causes normochromic, normocytic anemia because of decreased synthesis of erythropoietin. Erythropoietin administration is currently the standard treatment for this form of anemia. Although renal failure is a frequent consequence of SLE, there is no evidence that it plays a role in this patient’s anemia.
 
Ref: Reid M.E. (2010). Chapter 137. Erythrocyte Antigens and Antibodies. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds),Williams Hematology, 8e.

Q. 9

A patient with systemic lupus erythematosus very much wants to become pregnant. What should her physician tell her regarding pregnancy in lupus patients?

 A

There is no increased risk to the baby.

 B

There may be an increase in cardiovascular malformations

 C

There may be an increase in nervous system malformations.

 D

There may be an increase in spontaneous abortions and prematurity.

Q. 9

A patient with systemic lupus erythematosus very much wants to become pregnant. What should her physician tell her regarding pregnancy in lupus patients?

 A

There is no increased risk to the baby.

 B

There may be an increase in cardiovascular malformations

 C

There may be an increase in nervous system malformations.

 D

There may be an increase in spontaneous abortions and prematurity.

Ans. D

Explanation:

Systemic lupus erythematosus (SLE) predominantly affects younger women, and so the question of lupus and pregnancy may arise frequently in clinical practice. Patients with SLE have an increased incidence of spontaneous abortion, fetal death in utero, and prematurity. The mother may experience an exacerbation in the activity of her disease in the third trimester or peripartum period, and it may be difficult to distinguish between active SLE and preeclampsia. Therapy of pregnant patients with SLE is problematic, and the generalist should consult the literature or a specialist when such a patient is encountered.Congenital malformations (choices B, C, and D) are not a complication of pregnancies in patients with SLE.

Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 54. Connective-Tissue Disorders. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.


Q. 10

What is the most common histological type of nephritis seen in systemic lupus erythematosus (SLE) –

 A

Mesangial

 B

Focal proliferative

 C

Diffuse proliferative

 D

Membranous

Q. 10

What is the most common histological type of nephritis seen in systemic lupus erythematosus (SLE) –

 A

Mesangial

 B

Focal proliferative

 C

Diffuse proliferative

 D

Membranous

Ans. C

Explanation:

Ans. is ‘c’ i.e., Diffuse proliferative


Q. 11

Children born to mothers with systemic lupus erythematosis are likely to have one of the following anomalies –

 A

Atrial septal defect

 B

Tetralogy of fallot

 C

Transposition of great vessels

 D

Complete heart block

Q. 11

Children born to mothers with systemic lupus erythematosis are likely to have one of the following anomalies –

 A

Atrial septal defect

 B

Tetralogy of fallot

 C

Transposition of great vessels

 D

Complete heart block

Ans. D

Explanation:

Ans. is ‘d’ i.e., Complete heart block

o Maternal lupus erythmatosus has been associated with a high incidence of congenital heart block in offspring.


Q. 12

Characteristic feature of SLE is:

 A

Uveitis

 B

Joint deformity

 C

Polyserositis

 D

Cavitating lesion in lung

Q. 12

Characteristic feature of SLE is:

 A

Uveitis

 B

Joint deformity

 C

Polyserositis

 D

Cavitating lesion in lung

Ans. C

Explanation:

Answer is C (Polyserositis):

Polyserositis is included as a diagnostic criteria for SLE and is the most characteristic feature of SLE amongst the options provided.

Uveitis is not a characteristic feature of SLE

Ocular manifestation include sicca syndrome, non specific conjunctivitis, episcleritis, retinal vasculitis and optic neuritis. Uveitis is not mentioned as an ocular manifestation of SLE.

Ocular manifestations are not characteristic of SLE and are not included in the diagnostic criteria for SLE.

Joint Deformity is not a characteristic feature of SLE

Arthritis is included amongst the diagnostic criteria for SLE, however arthritis in SLE is typically nor erosive and does not lead to joint deformities.

Cavitatory Lesion in lungs are not characteristic of SLE 

Cavitatory Lesion in lungs are not characteristic of SLE

The most common pulmonary manifestation of SLE is pleuritis with or without pleural effusion.

Other Pulmonary manifestations include Interstitial fibrosis, intraalveolar hemorrhage and shrinking lung syndrome.

Diagnostic Criteria for Systemic Lupus Erythematous

Malar rash

Fixed erythema, flat or raised, over the malar eminences

Discoid rash

Erythematous circular raised patches with adherent keratitic scalling and follicular plugging; atrophic

scarring may occur

Photosensitivity

Exposure to ultraviolet light causes rash

Oral ulcers

Includes oral and nasopharyngeal ulcers, observed by physician

Arthritis

Nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion

Serositis

Pleuritis or pericarditis documented by ECG or rub or evidence of effusion

Renal disorder

Proteinuria >0.5g/d or >3+, or cellular casts

Neurologic

disorder

Seizures or psychosis without other causes

Hematologic

disorder

Hemolytic anemia or leucopenia (<4000/4) or lymphonia (<1500/4) or thrombocytopenia (<

100,000111AL) in the absence of offending drugs

Immunologic

disorder

Anti-ds DNA, anti-Sm, and /or anti-phospholipid

Antinuclear

antibodies

An abnormal titer of ANA by immunofluorescence or an equivalent assay at any point in time in the

absence of drugs known to induce ANAs

 


Q. 13

All of the following are true about SLE except:

 A

Autoimmune Hematolytic Anemia

 B

↑ed ANA

 C

Anti-ds DNA

 D

Joint deformity

Q. 13

All of the following are true about SLE except:

 A

Autoimmune Hematolytic Anemia

 B

↑ed ANA

 C

Anti-ds DNA

 D

Joint deformity

Ans. D

Explanation:

Answer is D (Joint Deformity)

SLE is characterized by non erosive arthritis. Joint deformities may occur but these are rare and limited to hands & feet.

Presence of joint deformities should rasie the suspicion of a non lupus inflammatory arthropathy like RA, and hence joint deformities is the single best answer amongst the options provided.


Q. 14

In SLE, characteristic kidney lesion is

 A

Mesangial proliferation

 B

Tubular fibrin deposits

 C

Wire loop lesions

 D

IgG deposits

Q. 14

In SLE, characteristic kidney lesion is

 A

Mesangial proliferation

 B

Tubular fibrin deposits

 C

Wire loop lesions

 D

IgG deposits

Ans. C

Explanation:

Answer is C (Wire loop lesions):

Wire loop lesions are characteristic of SLE

Wire loop lesions:

  • Wire loop lesions represent local PAS – Positive thickening of glomerular capillary walls and are characteristically sen in Lupus Nephritis (SLE)
  • These lesions result from subendothelial deposits between endothelium and basement membrane. When extensive and confluent, these subendothelial deposits create a homogenous thickening of the capillary wall which can be seen in light microscopy as ‘Wire loop lesion’
  • Wire loop lesions are most characteristic of Lupus Nephritis Class IV or Diffuse Lupus Nephritis These may however also be seen in Class III (Focal Lupus Nephritis) and Class V (membranous) Lupus Nephritis.

Q. 15

Indications of steroids in SLE are all except:

 A

Myocarditis

 B

Endocarditis

 C

Thrombocytopenia

 D

Neuropsychiatric symptoms

Q. 15

Indications of steroids in SLE are all except:

 A

Myocarditis

 B

Endocarditis

 C

Thrombocytopenia

 D

Neuropsychiatric symptoms

Ans. B

Explanation:

Answer is B (Endocarditis) :


Q. 16

SLE is which type of hypersensitivity reaction:

March 2005

 A

Type I hypersensitivity

 B

Type II hypersensitivity

 C

Type III hypersensitivity

 D

Type IV hypersensitivity

Q. 16

SLE is which type of hypersensitivity reaction:

March 2005

 A

Type I hypersensitivity

 B

Type II hypersensitivity

 C

Type III hypersensitivity

 D

Type IV hypersensitivity

Ans. C

Explanation:

Ans. C: Type III hypersensitivity

Type III hypersensitivity response (Immune-complex mediated response) Examples are:

  • Some form of glomerulonephritis
  • Serum sickness
  • Arthus reaction
  • SLE

Antinuclear antibody (ANA) testing and anti-extractable nuclear antigen (anti-EN A) form the mainstay of serologic testing for SLE.

Several techniques are used to detect ANAs. Clinically the most widely used method is indirect immunofluorescence. The pattern of fluorescence suggests the type of antibody present in the patient’s serum.

ANA screening yields positive results in many connective tissue disorders and other autoimmune diseases, and may occur in normal individuals.

Subtypes of antinuclear antibodies include anti-Smith and anti-double stranded DNA (dsDNA) antibodies (which are linked to SLE) and anti-histone antibodies (which are linked to drug-induced lupus).

Anti-dsDNA antibodies are highly specific for SLE; they are present in 70% of cases, whereas they appear in only 0.5% of people without SLE.

The anti-dsDNA antibody titers also tend to reflect disease activity, although not in all cases.


Q. 17

Onion skin spleen is seen in

 A

ITP

 B

Thalassemia

 C

SLE

 D

Scleroderma

Q. 17

Onion skin spleen is seen in

 A

ITP

 B

Thalassemia

 C

SLE

 D

Scleroderma

Ans. C

Explanation:

Ans. is ‘c’ i.e., SLE

The characterisitc histopathologic picture of the spleen in SLE is periaterial fibrosis or anion skin lesion.

  • First described by Libman and Sacks, this lesion is defined as the presene of 3 to as many as 20 seperated layers of the normally densely packed periarterial collagen of the penicillary or follicular arteries producing the appearance of concentric rings (anion peel).

Q. 18

Normal CRP with elevated ESR seen in

 A

RA

 B

SLE

 C

Scleroderma

 D

Polymyalgia rheumatica

Q. 18

Normal CRP with elevated ESR seen in

 A

RA

 B

SLE

 C

Scleroderma

 D

Polymyalgia rheumatica

Ans. B

Explanation:

Ans. is ‘b’ i.e., SLE

Both ESR and CRP are markers of inflammation

  • Erythrocyte sedimentation rate or ESR is used to separate inflammation from non-inflammation.
  • Another sign of inflammation is the rise in blood level of number of proteins called as acute phase proteins.
  • One of the proteins is C-reactive protein (CRP).
  • Like ESR and other acute phase proteins, CRP also goes up in inflammation.
  • In systemic lupus however the level does not rise unless there is infection associated.
  • The normal response to active inflammatory disease is an increase in plasma CRP concentration. o For reasons that remain unclear tht response is either significantly lower in magnitude or entirely absent in a few inflammatory conditions.
  • This has proven diagnostically useful because there are very few inflammatory conditions in which ESR is significantly raised (reflecting an inflammatory process) but plasma CRP is only slightly raised or even normal.
  • One ofthese conditions is systemic lupus erythematosus (SLE or lupus), a relatively common chronic autoimmune disease that predominantly affects women of child-bearing age.
  • When this inflammation occurs in the lupus patient it is accompanied as expected by a marked increase in ESR. However in contrst to most other inflammatory condition, the plasma CRP remains resolutely normal. The combination of raised ESR and normal CRP is a useful diagnostic feature of SLE.

Other disorders where CRP is not increased

  • Osteoarthritis, leukemia, anemia
  • Polycythemia, viral infection
  • Ulcerative colitis, pregnancy, estrogen

Q. 19

A study of skin biopsy of SLE patient using RTC labeled human IgG antiserum shows deposition of irregular particles at dermoepidermal junction. This means there is presence of

 A

Anti-nuclear antibody

 B

Anti-collagen antibody

 C

Anti-epithelial antibody

 D

Immune complex deposits

Q. 19

A study of skin biopsy of SLE patient using RTC labeled human IgG antiserum shows deposition of irregular particles at dermoepidermal junction. This means there is presence of

 A

Anti-nuclear antibody

 B

Anti-collagen antibody

 C

Anti-epithelial antibody

 D

Immune complex deposits

Ans. D

Explanation:

Ans. d. Immune complex deposits


Q. 20

True about SLE is‑

 A

Autoimmune disease

 B

Childhood SLE had poor prognosis than adult SLE

 C

Presence of ANA

 D

All are true

Q. 20

True about SLE is‑

 A

Autoimmune disease

 B

Childhood SLE had poor prognosis than adult SLE

 C

Presence of ANA

 D

All are true

Ans. D

Explanation:

Ans. is ‘d’ i.e., All are true

SLE (sytemic lupus Erythematosus)

  • Autoimmune disorder
  • Inflammation of blood vessel
  • Childhood SLE had poor pnognosis than adult SLE

Hall mark of SLE is presence of antinuclean antibody (ANA)

  • More common in female.
  • Malar rash in pathognomic of SLE
  • Non – erosive arthritis
  • Nephritis
  • Encephalopathy
  • Pleuritis / Pericarditis
  • Cytopenia

Q. 21

Which of the following can cause both cicatricial as well as noncicatrical alopecia ‑

 A

Alopecia areata

 B

Telogen effluvium

 C

SLE

 D

Hypothyroidism

Q. 21

Which of the following can cause both cicatricial as well as noncicatrical alopecia ‑

 A

Alopecia areata

 B

Telogen effluvium

 C

SLE

 D

Hypothyroidism

Ans. C

Explanation:

Ans. is ‘c’ i.e., SLE 


Q. 22

Band test is done in ‑

 A

RA

 B

SLE

 C

Scleroderma

 D

PAN

Q. 22

Band test is done in ‑

 A

RA

 B

SLE

 C

Scleroderma

 D

PAN

Ans. B

Explanation:

Ans. is ‘b’ i.e., SLE 

Band test (Lupus band test)

  • Lupus band test is done upon skin biopsy, with direct immunofluorescence staining, in which, if positive, IgG and complement depositions are found at the dermoepidermal junction. This test can be helpful in distinguishing systemic lupus erythematosus (SLE) from cutaneous lupus, because in SLE the lupus band test will be positive in both involved and uninvolved skin, whereas with cutaneous lupus only the involved skin will be positive.
  • The minimum criteria for positivity are:
  • In sun-exposed skin : Presence of a band of deposits of IgM along the epidermal basement membrane in 50% of the biopsy, intermediate (2+) intensity or more.
  • In sun protected skin : Presence of interrupted (i.e. less than 50%) deposits of IgM along the epidermal basement membrane, intermediate (2+) intensity or more.
  • The presence of other immunoglobulins (especially IgA) and/or complement proteins (especially C4) increases the specificity of a positive test.

Q. 23

According to WHO, membranous glomerulo­nephritis seen in SLE, is ‑

 A

Class II

 B

Class III

 C

Class IV

 D

Class V

Q. 23

According to WHO, membranous glomerulo­nephritis seen in SLE, is ‑

 A

Class II

 B

Class III

 C

Class IV

 D

Class V

Ans. D

Explanation:

Ans. is ‘d’ i.e., Class V 

KIDNEY INVOLVEMENT IN SLE (LUPUS NEPHRITIS)

A. Glomerular disease

T1. here are several versions of WHO classification of lupus nephritis ‑

  • Minimal or no detectable abnormalities (class 1) 
  • It occurs in less than 5% of patients.
  • Has best prognosis.

2. Mesangial lupus glomerulonephritis (class II)

  1. Focal proliferative glomerulonephritis (class III)
  2. Diffuse proliferative glomerulonephritis (class IV)
  3. Membranous glomerulonephritis (class V) 

B. Tubulointerstitial disease

  • Though glomeruli are involved primarily in lupus nephritis, interstitium and tubules can also be involved especially in association with diffuse proliferative glomerulonephritis.
  •  Granular deposition of immunoglobulin and complement in tubular basement membrane are seen.

Anti-DNA antibodies is usually associated with active lupus nephritis 

Also know

  • Nephritis is the most serious manifestation of SLE.
  • Most common cause of death is renal failure due to nephritis.

Q. 24

Antinuclear antibody specific for SLE is ‑

 A

Anti ds DNA

 B

Anti nuclear antibodies

 C

Anti centromere antibody

 D

Anti histone Ab

Q. 24

Antinuclear antibody specific for SLE is ‑

 A

Anti ds DNA

 B

Anti nuclear antibodies

 C

Anti centromere antibody

 D

Anti histone Ab

Ans. A

Explanation:

Ans. is ‘a’ i.e., Anti ds DNA 


Q. 25

According to WHO, membranous glomerulo­nephritis seen in SLE, is ‑

 A

Class II

 B

Class III

 C

Class IV

 D

Class V

Q. 25

According to WHO, membranous glomerulo­nephritis seen in SLE, is ‑

 A

Class II

 B

Class III

 C

Class IV

 D

Class V

Ans. D

Explanation:

Ans. is ‘d’ i.e., Class V


Q. 26

Which antibodies in mother with SLE is responsible for congenital heart disease in child‑

 A

Anti-histone

 B

Anti-Ro & Anti-LA

 C

Anti ds DNA

 D

Anti-centromere

Q. 26

Which antibodies in mother with SLE is responsible for congenital heart disease in child‑

 A

Anti-histone

 B

Anti-Ro & Anti-LA

 C

Anti ds DNA

 D

Anti-centromere

Ans. B

Explanation:

Ans. is ‘b’ i.e., Anti-Ro & Anti-LA 

Most sensitive                         Antinuclear antibody (ANA)

Most specific                            Antidouble stranded anitbody and the antibody against smith (Sm)

Associted with neonatal            Anti Ro, AntiLA antibody

lupus and congenital

heart block

Associated with lupus               Anti P antibody

psychosis


Q. 27

Limbman Sack’s endocarditis is seen in ‑

 A

RA

 B

SLE

 C

Rheumatic fever

 D

PAN

Q. 27

Limbman Sack’s endocarditis is seen in ‑

 A

RA

 B

SLE

 C

Rheumatic fever

 D

PAN

Ans. B

Explanation:

Ans. is ‘b’ i.e., SLE 



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