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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{TS}}
|QuestionAuthor= {{TS}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Immunology, Pharmacology, Internal medicine
|MainCategory=Immunology, Pharmacology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Immunology, Pharmacology, Internal medicine
|MainCategory=Immunology, Pharmacology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Immunology, Pharmacology, Internal medicine
|MainCategory=Immunology, Pharmacology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Immunology, Pharmacology, Internal medicine
|MainCategory=Immunology, Pharmacology
|MainCategory=Immunology, Pharmacology, Internal medicine
|MainCategory=Immunology, Pharmacology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|MainCategory=Immunology, Pharmacology
|MainCategory=Immunology, Pharmacology, Internal medicine
|SubCategory=Musculoskeletal/Rheumatology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|MainCategory=Immunology, Pharmacology
|MainCategory=Immunology, Pharmacology, Internal medicine
|SubCategory=Musculoskeletal/Rheumatology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|MainCategory=Immunology, Pharmacology
|MainCategory=Immunology, Pharmacology, Internal medicine
|SubCategory=Musculoskeletal/Rheumatology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|MainCategory=Immunology, Pharmacology
|MainCategory=Immunology, Pharmacology, Internal medicine
|SubCategory=Musculoskeletal/Rheumatology
|MainCategory=Immunology, Pharmacology, Internal medicine
|MainCategory=Immunology, Pharmacology
|SubCategory=Musculoskeletal/Rheumatology, Allergy/Immunology
|MainCategory=Immunology, Pharmacology
|Prompt=A 65 year old female comes with complaints of breathlessness and a sharp chest pain on right side which increases on deep inspiration and cough from one week. She is also suffering from joint pain, generalized muscle ache and mild on and off fever from few weeks. On examination, there is a pleural rub at 4th intercostal space on right side. Her vital signs are blood pressure 130/100, pulse 90/min and respiratory rate 22/min. She is on a medication for irregular heart beat from one year. Her other medications include lisinopril, simvastatin and over the counter analgesics. Which of the following is the most common lab finding in this patient?  
|SubCategory=Musculoskeletal/Rheumatology
|Explanation=Drug-induced lupus erythematosus is a side-effect of long-term use of certain medications. The most commom medications that cause drug-induced lupus erythematosus are procainamide, hydralazine and quinidine. Symptoms of drug-induced lupus erythematosus are similar to systemic lupus erythematosus.  It presents commonly with non inflammatory arthritis, myalgia, fever and serositis. Cutaneous manifestations are less common. After stopping the medication that caused the condition, most patients may recover.  
|Prompt=A 65-year-old woman presents to emergency department with complaints of breathlessness, sharp pleuritic chest pain, and cough for the past week. She also reports mild joint pain and intermittent fever. On physical examination, a right-sided pleural rub is appreciated. Her blood pressure is 110/60 mm Hg, heart rate is 92/min, respiratory rate is 21/min, and temperature is 36.7 ᵒC (98 ᵒF). Upon further questioning, the patient explains that she has been receiving a medication for an irregular heart beat for the past year, whose name she cannot recall. Which of the following antibodies are likely to be present in this patient?
|AnswerA=Anti ds-DNA antibodies
|Explanation=Drug-induced lupus erythematosus is a side-effect of long-term use of certain drugs namely procainamide, hydralazine, isoniazid, quinidine, and anti-TNF alpha drugs. Common symptoms closely resemble those of systemic lupus erythematousus and include non-inflammatory arthritis, myalgia, fever and serositis. Drug-induced lupus is usually dose-dependent, taking months to years of exposure to develop. Approximately all (95%) of patients with drug-induced lupus have anti-histone antibodies detected in the serum. A large proportion of patients may also have detectable antibodies but no clinically apparent manifestations. Discontinuation of the drug leads to the resolution of the associated symptoms. This both a diagnostic and therapeutic step in the management of suspected drug-induced lupus.
|AnswerAExp=Anti ds-DNA antibodies are more specific to idiopathic SLE
|AnswerA=Anti-ds-DNA antibodies
|AnswerB=Anti nuclear antibodies
|AnswerAExp=Anti-ds-DNA antibodies are more specific to idiopathic SLE.
|AnswerBExp=Anti nuclear antibodies are the non specific antibodies present in SLE.  
|AnswerB=Anti-nuclear antibodies
|AnswerC=Anti- mitochondrial antibodies
|AnswerBExp=Anti-nuclear antibodies are non-specific and may be present in most forms of SLE. They are less common in drug-induced lupus.
|AnswerCExp=Anti mitochondrial antibodies are found in primary billiary cirrhosis
|AnswerC=Anti-mitochondrial antibodies
|AnswerD=Anti-histone antibodies  
|AnswerCExp=Anti-mitochondrial antibodies are found in patients with primary biliary cirrhosis.
|AnswerDExp=Anti-histone antibodies are present in 90% of patients with drug induced lupus  
|AnswerD=Anti-histone antibodies
|AnswerE=Anti smooth muscle antibodies
|AnswerDExp=Anti-histone antibodies are present in 95% of patients with drug-induced lupus.
|AnswerEExp=Anti smooth muscle antibodies are present autoimmune hepatitis
|AnswerE=Anti-smooth muscle antibodies
 
|AnswerEExp=Anti-smooth muscle antibodies are present autoimmune hepatitis.
 
|EducationalObjectives=Drug-induced lupus erythematosus is a side-effect of long-term use of procainamide. Approximately 95% of patients have a positive anti-histone antibody assay.
|References=Katz U, Zandman-goddard G. Drug-induced lupus: an update. Autoimmun Rev. 2010;10(1):46-50.
|RightAnswer=D
|RightAnswer=D
|WBRKeyword=Drug Induced Lupus Erythematosus, Anti histone antibodies, Anti smooth muscle antibodies
|WBRKeyword=Drug-induced lupus erythematosus, Anti-histone antibodies, Anti-smooth muscle antibodies, Lupus, Procainamide, Hydralazine
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:24, 28 October 2020

 
Author [[PageAuthor::Twinkle Singh, M.B.B.S. [1] (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Immunology, MainCategory::Pharmacology
Sub Category SubCategory::Musculoskeletal/Rheumatology
Prompt [[Prompt::A 65-year-old woman presents to emergency department with complaints of breathlessness, sharp pleuritic chest pain, and cough for the past week. She also reports mild joint pain and intermittent fever. On physical examination, a right-sided pleural rub is appreciated. Her blood pressure is 110/60 mm Hg, heart rate is 92/min, respiratory rate is 21/min, and temperature is 36.7 ᵒC (98 ᵒF). Upon further questioning, the patient explains that she has been receiving a medication for an irregular heart beat for the past year, whose name she cannot recall. Which of the following antibodies are likely to be present in this patient?]]
Answer A AnswerA::Anti-ds-DNA antibodies
Answer A Explanation AnswerAExp::Anti-ds-DNA antibodies are more specific to idiopathic SLE.
Answer B AnswerB::Anti-nuclear antibodies
Answer B Explanation AnswerBExp::Anti-nuclear antibodies are non-specific and may be present in most forms of SLE. They are less common in drug-induced lupus.
Answer C AnswerC::Anti-mitochondrial antibodies
Answer C Explanation AnswerCExp::Anti-mitochondrial antibodies are found in patients with primary biliary cirrhosis.
Answer D AnswerD::Anti-histone antibodies
Answer D Explanation AnswerDExp::Anti-histone antibodies are present in 95% of patients with drug-induced lupus.
Answer E AnswerE::Anti-smooth muscle antibodies
Answer E Explanation AnswerEExp::Anti-smooth muscle antibodies are present autoimmune hepatitis.
Right Answer RightAnswer::D
Explanation [[Explanation::Drug-induced lupus erythematosus is a side-effect of long-term use of certain drugs namely procainamide, hydralazine, isoniazid, quinidine, and anti-TNF alpha drugs. Common symptoms closely resemble those of systemic lupus erythematousus and include non-inflammatory arthritis, myalgia, fever and serositis. Drug-induced lupus is usually dose-dependent, taking months to years of exposure to develop. Approximately all (95%) of patients with drug-induced lupus have anti-histone antibodies detected in the serum. A large proportion of patients may also have detectable antibodies but no clinically apparent manifestations. Discontinuation of the drug leads to the resolution of the associated symptoms. This both a diagnostic and therapeutic step in the management of suspected drug-induced lupus.

Educational Objective: Drug-induced lupus erythematosus is a side-effect of long-term use of procainamide. Approximately 95% of patients have a positive anti-histone antibody assay.
References: Katz U, Zandman-goddard G. Drug-induced lupus: an update. Autoimmun Rev. 2010;10(1):46-50.]]

Approved Approved::Yes
Keyword WBRKeyword::Drug-induced lupus erythematosus, WBRKeyword::Anti-histone antibodies, WBRKeyword::Anti-smooth muscle antibodies, WBRKeyword::Lupus, WBRKeyword::Procainamide, WBRKeyword::Hydralazine
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