Sjögren's Syndrome

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Sjögren's syndrome is named after

a) the gland responsible for salivary secretion
b) a Greek god with perpetually teary eyes
c) a Swedish ophthalmologist
d) an American autoimmunologist

2. The definition of Sjögren's syndrome requires the presence of

a) keratoconjunctivitis sicca (KCS)
b) xerostomia (dry mouth)
c) rheumatoid arthritis (RA)
d) at least two of the above
e) all of the above

3. Most patients with a diagnosis of SS are

a) males.
b) females.
c) equally distributed between the sexes.

4. A connective tissue disease, usually rheumatoid arthritis, generally ______ the onset of SS.

a) precedes
b) follows

5. Patients who have the salivary, ocular, and extraglandular components in addition to a connective tissue disease are classified as having

a) primary SS.
b) secondary SS.

6. The diagnosis of Sjögren's syndrome requires the establishment of criteria that clearly identifies the three components of SS. Of the three, which presents the most difficulty to a clinician?

a) KCS
b) rheumatoid arthritis (RA)
c) xerostomia

7. The use of symptoms or signs of hyposalivation in diagnosing the salivary component of Sjögren's Syndrome presents many problems. Select from the following the correct response:

a) Only a small proportion of SS patients have a completely dry mouth.
b) Symptoms of dry mouth are subjective and common to many conditions.
c) Since salivary flow rates vary so widely among individuals it is difficult to differentiate between normal and abnormal flow.
d) Flow rates are reduced by many commonly prescribed drugs and by other diseases.
e) all of the above

8. Most patients would not complain of dry mouth until the salivary output has decreased by approximately _____ percent.

a) 10
b) 25
c) 50
d) 75

9. A person complaining of dry mouth may not necessarily have a diminished salivary function.

a) True
b) False

10. Patient's subjective complaints are not always helpful in the diagnosis of salivary dysfunction. However, certain complaints correlate well with decreased salivary function. Which of the following is not associated with decreased glandular function?

a) difficulty swallowing
b) need to sip liquids to swallow dry foods
c) perception of too little saliva in the mouth
d) oral dryness when eating
e) sleep disruption

11. In the diagnosis of xerostomia, one of the following statements is unTrue:

a) Complaint of dry mouth is sufficient to establish the diagnosis of salivary dysfunction.
b) The absence of a complaint of dry mouth is not a guarantee of adequacy of salivary function.
c) Most patients do not feel dry mouth until the salivary output has decreased by approximately 50%.
d) Often xerostomia is caused by cognitive alteration or psychological reasons.

12. There are over 400 medications which have been demonstrated to cause diminished salivary function.

a) True
b) False

13. Patient history is one method of evaluating salivary function. Which of the following history data is least likely to have an effect on salivary glands?

a) primary Sjögren's syndrome with connective tissue disease
b) radiation therapy to the head and neck region
c) cystic fibrosis
d) medications

14. Using the measurement of whole saliva in the diagnosis of Sjögren's syndrome, for a female patient which of the following rates is indicative of the disease?

a) resting flow rate 0.3 mL/min, stimulated flow rate 1 mL/min
b) resting flow rate 0.1 mL/min, stimulated flow rate 0.5 mL/min
c) resting flow rate 0.4 mL/min, stimulated flow rate 2 mL/min

15. In the multicenter trial testing the effectiveness of pilocarpine tablets for the treatment of dry mouth and dry eyes in patients with Sjögren's syndrome, the onset of subjective benefits for various symptoms in patients took

a) 3-5 days
b) 2-3 weeks
c) 4-5 weeks
d) 6-12 weeks

16. Patients with Sjögren's syndrome and those diagnosed with fibromyalgia exhibit very similar symptoms and it is important to differentiate between the two since the treatments are often quite different. Which of the following provides the differential

a) dryness of the mouth and eyes
b) damaged salivary glands
c) fatigue
d) memory loss
e) aching muscles

17. With respect to Sjögren's syndrome, select the correct statement from below:

a) Sjögren's syndrome is not fatal.
b) There is no cure for Sjögren's syndrome.
c) The risk for passing this disease on to family members is extremely low.
d) This disease is an "autoimmune" disorder.
e) all of the above

18. Schirmer test is used to determine

a) dry mouth
b) dry eyes

19. The symptoms of Sjögren's syndrome were first reported in

a) 1868
b) 1898
c) 1933
d) 1957

20. In an individual with Sjögren's syndrome, there are no or few lymphocytes in the salivary glands.

a) True
b) False

21. Differential diagnosis of Sjögren's syndrome requires ruling out

a) scleroderma
b) polymyositis
c) rheumatoid arthritis (RA)
d) systemic lupus erythematosus (SLE)
e) acquired immunodeficiency disease

22. In the early stages of Sjögren's syndrome, patients experience maximum dryness of the mouth

a) while eating
b) during the night

23. This is evidence that a virus sets off the autoimmune response that results in Sjögren's syndrome. The most suspected candidate for this is

a) human immunodeficiency virus (HIV)
b) Epstein-Barr virus (EBV)
c) hepatitis B virus (HBV)
d) hepatitis C virus (HCV)

24. Patients with fibromyalgia and Sjögren's syndrome share symptoms such as fatigue, aching muscles, dryness of the eyes and mouth.

a) True
b) False

25. Several toothpastes and mouth rinses have been developed for the patient with a dry mouth. These products typically contain alcohol as a liquid preservative.

a) True
b) False

26. Pilocarpine (Salagen) is contraindicated for dryness of the mouth in patients with prior radiation therapy of the head and neck muscles.

a) True
b) False

27. In patients who require the frequent use of artificial tears to relieve dry eyes symptoms, which of the following is recommended?

a) "preserved" tears
b) "preservative-free" tears

28. Which of the following drugs have been identified for their anticholinergic side effects?

a) tricyclic antidepressants
b) decongestants
c) some Chinese herbal remedies
d) a and b
e) a, b and c

29. A common and often-used procedure for dry eyes is partial tarsorrhaphy (sewing the lateral portion of the eyelids together.)

a) True
b) False

30. Sjögren's syndrome patients do not get a higher frequency of sinusitis infections than other individuals.

a) True
b) False

31. Estrogen replacement therapy in postmenopausal Sjögren's patients is not recommended as it worsens the condition.

a) True
b) False

32. Obstetrical authorities report slightly higher rates of recurrent fetal death and congeni- tal heart block in those pregnancies complicated by maternal autoimmune disease.

a) True
b) False

33. Causes of sleep disruption in Sjögren's syndrome patients can be traced to

a) nocturnal myoclonus (spontaneous muscle cramping)
b) sleep apnea
c) joint or muscle pain
d) Sjögren's patients drink a great deal of water during the day because of dry mouth and throat
e) all of the above

34. Sjögren's syndrome patients often suffer from depression. Which class of anti-depressants is recommended in such patients?

a) tricyclics
b) monoamine oxidase (MAO)
c) trazodone
d) none of the above

35. The role of the diet and nutrition in either causing Sjögren's syndrome or treating it is not well known. Which of the following, however, can safely be recommended to Sjögren's patients?

a) yogurt
b) fish oil tablets
c) vitamin A
d) zinc sulfate

36. For the management of dry mouth and discomfort caused by it, the best advice for the patient is to use

a) water
b) fruit juices
c) soft drinks
d) mouthrinses

37. Anti-yeast medication for Sjögren's patients for the treatment of oral Candida mucositis should be in one of the following forms for maximum effectiveness:

a) mouthrinse
b) tablet-form designed to be absorbed into the bloodstream
c) topical
d) they all work equally well

38. Nystatin and clotrimazole are two anti-yeast medications commonly used for the treatment of oral Candida mucositis. These medications, however, have one drawback:

a) adverse drug reaction
b) taste
c) ineffectiveness
d) expensive

39. Tetracycline, the antibiotic used for bacterial infection, is very effective against yeast infections in Sjögren's patients.

a) True
b) False

40. The most common adverse experience of 5 mg. pilocarpine tablets administered 4 times daily is

a) sweating
b) headache
c) flu syndrome
d) nausea
e) urinary frequency