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Old 05-26-2012
tyagee's Avatar
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Question lupus patient...next step in mx...EXPLN PLZ

A 25-year-old woman is evaluated during a routine follow-up visit. Four months ago, she was
diagnosed with systemic lupus erythematosus that manifested as fatigue, malar rash, oral
ulcers, pleuritis, and arthralgia. At that time, she began treatment with hydroxychloroquine
and a 1-month course of low-dose prednisone.
On physical examination today, she states that her symptoms have resolved somewhat but
that she still has slight fatigue and mild arthralgia in her hands, feet, and knees. Temperature
is 36.4C (97.6F), blood pressure is 130/92 mm Hg, pulse rate is 84/min, and respiration
rate is 18/min. She has a mild malar flush, a painless ulcer on the hard palate, and trace
bilateral ankle edema. The remainder of the examination is normal.
Hemoglobin 10 g/dL (100 g/L)
Leukocyte count 2300/μL (2.3 109/L)
Platelet count 132,000/μL (132 109/L)
Erythrocyte
sedimentation rate 45 mm/h
Serum creatinine 1.0 mg/dL (88.4 μmol/L)
Albumin 3.1 g/dL (31 g/L)
Serum complement (C3
and C4) Decreased
Urinalysis 2+ protein; 3+ blood; 5-10 leukocytes, 15-20 erythrocytes, and 1
erythrocyte cast/hpf
Which of the following is the next best step in this patient's treatment?
(A) Amlodipine
(B) High-dose prednisone
(C) Ibuprofen
(D) Low-dose prednisone
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  #2  
Old 05-26-2012
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B, high dose prednisone

her symptoms havenot resolved. theres some resolution of sysmptoms tho. so we need to increase the dose of presdnisone till theres complete resolution of symptoms
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Old 05-26-2012
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LOW dose steroids are for maintenance

HIgh dose for Rx.

she has active Glomerular disease.. for which steroids are the best line of Rx.

although you MUST do a biopsy before that.. so if biopsy was a choice that is better than Rx with steroids for NEXT BEST STEP
TO determine if u need steroids alone or with mycophenolate/cyclophosphamide

pg- 185 MTB
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Old 05-26-2012
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(B) High-dose prednisone
She has Lupus nephritis ............wonder why Amlodipine is even among the choices.........it should be MMF/Cyclophosphamide & High dose steroids.
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Old 05-26-2012
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wow.u so confident. if i be pd, would have given u residency seat by now...lolz
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