Q4: High Yield PLAB 1 Exam Style Question
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A 35-year-old female presents to the clinic with generalized fatigue, hair loss, and pain in multiple joints, including her wrists, knees, and small joints of the hands. She also complains of frequent headaches and sensitivity to sunlight. Her past medical history is significant for recurrent mouth ulcers and a single episode of chest pain last year that was diagnosed as pleuritis. Physical examination reveals a malar rash extending over her nose and cheeks. Her laboratory results are as follows:
- Hb: 122 g/L
- Platelets: 98 × 10^9/L
- WBC: 3.2 × 10^9/L
- Anti-dsDNA antibodies: Positive
- Anti-Sm antibodies: Positive
Given the suspected diagnosis of systemic lupus erythematosus (SLE), which one of the following tests should be performed to assess for complement levels to monitor disease activity?
A. C1
B. C2
C. C3
D. C4
E. C5
Answer: D. C4
Background:
The patient is a 35-year-old female with multiple symptoms that align with the clinical picture of systemic lupus erythematosus (SLE). These symptoms include fatigue, hair loss, joint pain, malar rash, sensitivity to sunlight, and a history of pleuritis and mouth ulcers. Lab tests further support this diagnosis by showing reduced Hb, low platelets, and low WBC, along with positive anti-dsDNA and anti-Sm antibodies.
Understanding Complement Levels in SLE:
The complement system plays a crucial role in the immune response, and alterations in complement levels can be indicative of disease activity in SLE.
A. C1: This is generally not routinely assessed in SLE patients for disease activity.
B. C2: Levels of C2 are not typically utilized to monitor SLE disease activity
C. C3: While levels of C3 can be reduced in SLE and indicate disease activity, it's generally not as specific as C4.
D. C4: Low levels of C4 have been associated with SLE and are indicative of disease activity. Monitoring these levels can provide insights into the severity of the condition and help guide treatment decisions.
E. C5: This component is not typically monitored in the context of SLE.
Diagnostic Reasoning:
Given that we suspect SLE in this patient, and considering her multiple symptoms along with the positive anti-dsDNA and anti-Sm antibodies, it is important to monitor disease activity to guide treatment. C4 levels are known to be affiliated with an increased risk of SLE and serve as a marker for disease activity.
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Reference:
BSR guideline for the management of systemic lupus erythematosus in adults: This is a guideline from the British Society of Rheumatology (BSR) that sets out an evidence-based strategy for the diagnosis, assessment, and treatment of SLE in adults. It includes recommendations on clinical features, immunological tests, disease activity, organ involvement, and pharmacological and non-pharmacological interventions. It also provides a summary of the key points and a visual algorithm for the management of SLE.
Monitoring Systemic Lupus Erythematosus in Standard Clinical Care: This is an article from the journal Rheumatology that discusses the importance of monitoring SLE in standard clinical care. It covers the principles and methods of monitoring disease activity, damage, quality of life, and treatment adherence. It also reviews the available tools and biomarkers for monitoring SLE, such as complement levels, anti-dsDNA antibodies, and other novel markers.
Complement activation in patients with systemic lupus erythematosus: This is an article from the journal Lupus that explores the role of complement activation in SLE. It explains the mechanisms and pathways of complement activation, the clinical implications of complement deficiency and consumption, and the potential therapeutic targets for modulating complement activity in SLE.
