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Block 3: MSK > Clin Lab: MSK 1 > Flashcards

Clin Lab: MSK 1 Flashcards

1
Q

Signs that are evidence of synovitis

A

swelling, warmth, tenderness

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2
Q

burning” pain, or accompanied by numbness/tingling is more likely…

A

neuropathic pain

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3
Q

Pain accompanied by weakness is more likely…

A

muscle or nerve issue

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4
Q

Worse after inactivity is more likely…

A

inflammatory disorder (RA, psoriatic arthritis, lupus, etc)

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5
Q

Worse with activity, better with rest is more likely…

A

osteoarthritis
(tends to be worse on one side)

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6
Q

Symmetric joint involvement more likely…

A

systemic illness

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7
Q

Duration of pain that is associated with a viral/reactive cause…

A

< 3weeks

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8
Q

Duration of pain that is less likely to be a viral/reactive cause…

A

> 6 weeks

*think more long term chronic things like RA

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9
Q

Symptoms more associated with systemic illness

A
  • fever
  • night sweats
  • skin manifestations (lupus or scleroderma)
  • adenopathy
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10
Q

An younger/middle aged patient w/ joint pain think…

A

Lupus

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11
Q

An older patient w/ joint pain think…

A

OA

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12
Q

Monoarticular conditions

A
  • OA
  • Injury
  • Septic arthritis*
  • Crystal-induced (gout, CPPD)
  • Neoplasms
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13
Q

What is so important about septic arthritis?

A

It is a MEDICAL EMERGENCY

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14
Q

Polyarticular w/ synovitis conditions

A
  • Inflammatory joint dz
    –> Infx (often viral)
    –> Reactive arthritis
    –> Psoriatic arthritis
    –> RA
    –> Crystal-induced
    –> Systemic rheumatic illness**
    –> Other systemic illness or malignancy (IBD)
    –> Juvenile idiopathic arthritis
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15
Q

What bacterial infx can causes polyarticular w/ synovitis?

A
  • Lyme Dz
  • Gonococcal
  • Staph
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16
Q

What viral infx can causes polyarticular w/ synovitis?

A
  • Hep B or C
  • Parvovirus
  • Dengue virus
  • Alphaviruses (chikungunya, equine encephalitis),
  • HIV
  • Mumps
  • CMV
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17
Q

List rheumatic illnesses that can cause polyarticular w/ synovitis.

A
  • lupus
  • vasculitis
  • systemic sclerosis
  • polymyositis
  • dermatomyositis
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18
Q

Polyarticular w/o synovitis conditions

A
  • Fibromyalgia
  • OA
  • Neuropathic pain
  • Depression
  • Metabolic bone dz
  • Endocrine disorder – hypothyroid, hyperparathyroid
  • Plasma cell myeloma
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19
Q

Workup for Monoarticular

A
  • Imaging
  • Arthrocentesis w/ analysis
  • Labs (if needed)
  • Synovial biopsy (RARE)
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20
Q

Do you usually order imaging for monoarticular?

A

YES
we tend to get imaging when one joint is involved

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21
Q

When would you want an arthrocentesis w/ synovial fluid analysis?

A

diagnose septic arthritis or gout

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22
Q

Labs for Hemarthrosis w/o trauma

A

PT/INR, PTT, CBC

(checking for coag disorders like hemophilia)

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23
Q

Labs for evidence of joint inflammation w/o infx (septic) or crystals

A
  • ESR/CRP, CBC, CMP
  • Testing for systemic rheumatic dz IF suspicion of that dz
  • Testing for Lyme dz IF suspicion is high
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24
Q

When would you do synovial biopsy?

A
  • Fungal infx
  • Sarcoidosis
  • Lymphoma of the synovial joint
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25
Q

Workup for polyarticular w/ synovitis (red swollen joint)

A
  • CBC, CMP, UA (uric acid crystals, Ca++ crystals)
  • Arthrocentesis w/ synovial fluid analysis
  • Labs based on clinical suspicion
    –> ESR/CRP
    –> Suspected systemic illness (RA, Lupus, Other systemic dz (IBD))
    –> Viral antibodies (Hep B, C, Parvovirus B19)
    –> Imaging – rarely needed
  • Synovial biopsy - rare
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26
Q

Workup for Polyarticular w/o synovitis

A
  • CMP
  • TSH / PTH
  • Imaging – x-ray
  • Screening for depression
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27
Q

Arthrocentesis w/ Synovial Fluid Analysis Indications

A
  • joint effusion/pain - dx of underlying pathology
  • therapeutic
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28
Q

Arthrocentesis w/ Synovial Fluid Analysis Indications: example of underlying pathology

A
  • Infx (Septic arthritis)
  • Arthritis
  • Crystalline arthritis (gout, pseudogout)
  • Synovitis (inflammation)
  • Neoplasm
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29
Q

Arthrocentesis w/ Synovial Fluid Analysis Indications: therapeutic

A

Injection of anti-inflammatory meds into the joint

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30
Q

What does a synovial fluid analysis include?

A
  • Color & clarity
  • Viscosity

These are ordered separately & must tell the lab
- Gram stain & culture
- Cell count & differential
- Crystal analysis
- Cytology

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31
Q

Synovial Fluid Analysis: NORMAL
Clarity:
Color:
Viscosity:
WBC/mm3:
PMNs% (neutrophils):

A

Clarity: Transparent
Color: Clear
Viscosity: High
WBC/mm3: < 200
PMNs% (neutrophils): < 25%

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32
Q

Synovial Fluid Analysis: Non-inflammatory
Clarity:
Color:
Viscosity:
WBC:
PMNs% (neutrophils):

A

Clarity: Translucent
Color: Yellow
Viscosity: High
WBC: 200 - 2,000
PMNs% (neutrophils): <25%

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33
Q

Synovial Fluid Analysis: Inflammatory
Clarity:
Color:
Viscosity:
WBC:
PMNs% (neutrophils):

A

Clarity: Translucent
Color: Yellow
Viscosity: Low
WBC: 2000 - 10,000 (up to 100,000)
PMNs% (neutrophils): >50%

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34
Q

Synovial Fluid Analysis: Septic
Clarity:
Color:
Viscosity:
WBC:
PMNs% (neutrophils):

A

Clarity: Opaque
Color: Dirty Yellow
Viscosity: Variable
WBC: >80,000
PMNs% (neutrophils): >75%

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35
Q

Synovial Fluid Analysis: Hemorrhagic
Clarity:
Color:
Viscosity:
WBC:
PMNs% (neutrophils):

A

Clarity: Bloody
Color: Red
Viscosity: Variable
WBC: 200 - 2,000
PMNs% (neutrophils): 50 - 75%

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36
Q

Arthrocentesis w/ Synovial Fluid Analysis Contraindications

A
  • Artificial joint/joint replacement
  • Lesions of skin overlying injection site
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37
Q

What is gout?

A

a build up uric acids crystals in the joint space
(very painful during gout attack)

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38
Q

Describe Tophaceous gout

A

pt has gout–> develop nodules called tophi–> can cause ulcerations (can occur anywhere on the body)

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39
Q

Gout testing:

A
  1. Have to distinguish from septic (infected) joint
  2. Crystal analysis of synovial fluid
    monosodium urate crystals (look like needles)
    –> “yellow” – negatively birefringent
  3. Uric acid level
    –> Hyperuricemia can cause crystalline arthropathy
    –> Not sensitive or specific
    –> Can be low/normal during a gout attack
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40
Q

Immediate Tx for Gout

A

Prednisone 1st line
NSAID (indomethacin) 2nd line
Pain meds
Colchicine 4th line

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41
Q

Prevention of Gout Meds

A
  • Allopurinol
  • Probenecid
  • Colchicine
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42
Q

What does CPPD stand for?

A

Calcium Pyrophosphate Dihydrate Deposition

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43
Q

CPPD is also known as…

A

pseudogout

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44
Q

Testing for CPPD diagnosis

A
  • Crystal analysis of synovial fluid
    –> CPPD crystals (square – rectangular)
    —-> “Blue” – positively birefringent
  • Chondrocalcinosis on imaging
    –> Calcium deposits in cartilage
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45
Q

What is a physiological sign that can be seen & is indicative of RA?

A

Ulnar deviation of the fingers

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46
Q

What meds can help prevent ulnar deviation in RA?

A

DMARDs

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47
Q

Lab Diagnostics for RA

A
  • ESR/CRP
  • Rheumatoid factor (RF)
  • Anti-citrullinated peptide antibodies (ACPA)
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48
Q

What will be seen on imaging in RA

A

joint erosions & deformities (seen in longstanding RA)

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49
Q

Indications to order an RF factor

A

Patients with clinical symptoms consistent with RA

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50
Q

Classic symptoms that make you think RA

A

Symmetrical joint pain, inflammation, fingers & knees, hurts more in the morning & better w/ movement

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51
Q

Is the RF a screening test?

A

NO

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52
Q

RF Explanation

A
  • IgM Ab are made against the constant region of IgG Ab (antibodies attacking antibodies)
  • Associated w/ RA, but non-specific –> (+) in other conditions (i.e., SLE, scleroderma)
    ~ 70-80% of pts w/ RA will be RF+
    –> Some pts may become RF+ at later date
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53
Q

Is RF specific or non-specific?

A

non-specific

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54
Q

What are the two Anti-citrullinated Peptide Abs (ACPA)?

A
  • Anticyclic-citrullinated Ab (anti-CCP)
  • Anti-mutated citrullinated vimentin Ab (anti-MCV)
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55
Q

What is Citrulline?

A

an amino acid

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56
Q

How does Citrulline form?

A

it is a derivative of arginine; post-translation modification

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57
Q

Are the Anti-citrullinated Peptide Abs (ACPA) specific or non-specific?

A

More specific for RA

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58
Q

How is Anti-citrullinated Peptide Abs (ACPA) used in relation to RA?

A

biomarker for dz progression

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59
Q

How do you diagnose RA?

A
  • Clinical Dx
  • Scoring system used (labs are one component)
  • (+) RF & (+) ACPA highly specific for RA
  • Also need to rule out other systemic rheumatologic dz like SLE
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60
Q

What PE findings are consistent w/ psoriasis?

A

Pitting of nails, silvery plaques that bleed

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61
Q

Labs for Psoriatic arthritis

A
  • No definitive labs
  • Lab testing mostly done to rule out other arthritises
  • Some assoc. w/ HLA-B27 genotype
    –> HLA = human leukocyte antigen
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62
Q

Psoriatic arthritis imaging changes

A
  • “pencil-in-cup”
    –> aka “Symmetric bone erosions of the margin”
  • Joint ankylosis (fusing) & joint destruction
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63
Q

Diagnostics for JIA

A
  • Clinical dx
    –> Childhood (average age 7yo)
64
Q

How will a child present w/ suspected JIA?

A

Recurrent daily fever & polyarthritis

65
Q

Expected Labs for JIA if done

A
  • RF (-), ACPA (-)
  • Elevated WBC & platelet counts
  • Elevated ESR / CRP
  • Very elevated ferritin
    Most time it will go away after a few years
66
Q

Prognosis of JIA

A

Most time it will go away after a few years

67
Q

What is reactive arthritis?

A
  • Arthropathy associated w/ other dz/disorders
    –> GI infx, UTI, STI
68
Q

Reactive arthritis Triad: Reiter’s syndrome

A
  • urethritis (dysuria)
  • arthritis
  • conjunctivitis (red eyes)
69
Q

When does reactive arthritis usually occur?

A

1-4 weeks after triggering infx

70
Q

Reactive arthritis workup

A
  • Clinical dx
  • Rarely will have evidence of current infx
  • (+/-) elevated ESR/CRP
  • Arthrocentesis, if done = inflammatory synovitis
  • Tx: Steroids
71
Q

How does lupus manifest throughout the body?

A

It is multi-system

72
Q

Describe the various effects of Lupus on each system.

A

Skin
- Rash worse w/ sunshine
- Butterfly rash
- Spares nasolabial folds
MSK
- Arthritis
Bone marrow
Renal
- Lupus Nephritis
Cardiac/Pulm
- Pericarditis
- Chest pain better when leaning fwd
- Pericardial friction rub
- Diffuse ST seg elevation

73
Q

SLE Testing

A

Testing for autoantibodies
- Anti-nuclear antibodies (ANA) – initial test
- Anti-double stranded DNA Ab
- Anti-Smith (anti-extractable nuclear antigen) Ab
- Anti-chromatin Ab
- Anti-phospholipid Ab (cardiolipin, lupus anticoagulant, beta-2-glycoprotein)
–> Anti-phospholipid syndrome (prone to clotting; need lifelong anticoag)

74
Q

Anti-nuclear Antibodies pathophys

A

Many autoimmune rheumatologic diseases have autoantibodies against nucleic acid (DNA/RNA) antigens == anti-nuclear antibodies

75
Q

Is Anti-nuclear antibodies (ANA) specific for any one dz?

A

NO

76
Q

Explain ANA testing

A

Test = titer (dilutional conc)
Initial test is a specific dilution, usually (1:40).
- If (+), serial dilution is done until no longer p(+).
–> Highest dilution that is still (+) is reported
- Higher numbers = higher dz activity
- Test is done using indirect immunofluorescence
–> Pattern of fluorescence can help differentiate b/t diseases, but less specific

77
Q

ANA Interpretation

A
  • (-) ANA helps to rule out SLE (high sensitivity)
  • Can be (+) in ppl w/o autoimmune disorder (~5% of adults) (low specificity)
  • Not used for screening
  • Once (+), will usually remain (+)
78
Q

Anti-double stranded DNA Antibody Indications

A

Dx & follow-up of help support SLE

79
Q

Anti-double stranded DNA Antibody Explanation

A
  • High titers assoc. with SLE
  • Low titers can be found in other dz (hep C)
  • Levels change w/ dz activity
    –> Monitor treatment
    —> Diagnose flares
80
Q

Anti-extractable Nuclear Antigen (Anti-Smith & anti-RNP) Indicaitons

A

dx of SLE & mixed CT dz (MCTD)

81
Q

Anti-extractable Nuclear Antigen (Anti-Smith & anti-RNP) Explanation

A

Most common anti-ENA Ab are anti-Smith (SM) & anti-ribonucleoprotein (RNP)
- Anti-SM Ab is present in SLE & MCTD.
–> Present only 30% in SLE, 8% in MCTD.
- Anti-RNP present in 99%+ pts w/ MCTD

82
Q

If I suspect a pt to have SLE, which Anti-extractable Nuclear Antigen would I order?

A

Anti-SM Ab

83
Q

If I suspect a pt to have MCTD, which Anti-extractable Nuclear Antigen would I order?

A

Anti-RNP

84
Q

Anti-Ro/SSA is primarily found in…

A

Sjogren’s syndrome

85
Q

Anti-La/SSB is usually positive in….

A

Sjogren’s syndrome

86
Q

When can Anti-Ro/SSA be positive?

A
  • rare cases of ANA-negative SLE
    –> Anti-La/SSB negative in SLE
87
Q

Antichromatin Antibody indications

A

Important marker in renal dz in SLE

88
Q

Antichromatin Antibody explanation

A

Levels show direct correlation w/ renal damage assoc. w/ SLE

Prognosis of renal damage

89
Q

Anti-histone antibody indications

A
  • Important marker in drug-induced lupus erythematosus
  • Drug-induced SLE –> usually (-) for anti-double stranded DNA antibodies
90
Q

Common meds related to anti-histone antibody

A
  • isoniazid
  • Hydralazine
  • Procainamide
  • Minocycline
  • TNF blockers
  • Anti-seizure meds
  • Methyldopa
  • Sulfasalazine
91
Q

Why is Anti-phospholipid syndrome and SLE important?

A

If (+), it predisposes to unprovoked arterial/venous clot formation

92
Q

Test all SLE patients for…

A

anti-phospholipid syndrome

93
Q

What are the 3 things we look for in Anti-phospholipid syndrome.

A
  • Anti-cardiolipin Ab
  • anti-beta 2 glycoprotein
  • lupus anticoagulant

only 1 (+) means (+) for syndrome

94
Q

Sjögren’s Syndrome dz process:

A
  • lymphocytic infiltration of the exocrine glands (salivary & lacrimal (tears))
    Results in dry mouth (xerostomia) & dry eyes (keratoconjunctivitis sicca).
95
Q

Two type of Sjögren’s Syndrome

A

Primary & secondary

96
Q

Testing for Sjögren’s Syndrome

A
  • Labs
  • Schirmer Test
  • Sialometry
  • salivary gland biopsy
97
Q

Describe the labs for Sjogren’s Syndrome

A
  • Anti-SS-A (anti-Ro) & Anti-SS-B (anti-La) are (+) in about 50% pts w/ primary Sjögren’s
  • Can help to separate primary from secondary Sjogren’s
  • Often ANA+ (>1:320) & RF+
  • Elevated ESR/CRP
  • CBC – anemia of Chronic Dz, leukopenia
  • Low iron, high ferritin
  • CMP – elevated PRO (polyclonal gammopathy)
    –> A lot of different ab that are elevated
98
Q

Describe Schirmer test

A
  • Normal 15 mm in 5 mins
  • Sjogren’s = 5mm
99
Q

What is the most diagnostic test for Sjogren’s Syndrome?

A

Salivary gland biopsy

100
Q

Categories of Systemic sclerosis (Scleroderma)

A
  • Limited systemic sclerosis (CREST syndrome)
  • Diffuse systemic sclerosis
  • Systemic sclerosis sine scleroderma
101
Q

Describe diffuse systemic Sclerosis

A
  • Xerostomia (Dry)
  • interstitial lung dz
  • pulm HTN
  • Barrett’s esophagus
  • gastroparesis
  • joint contractures
  • uclers
  • Raynaud’s

Basically a lot of fibrosis going on

102
Q

Diffuse systemic sclerosis Testing

A
  • ANA+ in 90-95%
  • Anti-topoisomerase I (anti-Scl-70) Ab
  • Anti-U3 RNP (fibrillarin) Ab
  • anti-RNA polymerase Ab
103
Q

What is the antibody of choice to test in diffuse systemic sclerosis?

A

Anti-topoisomerase I (anti-Scl-70) Ab

104
Q

What is the antibody is correlated w/ dz severity in diffuse systemic sclerosis?

A

anti-RNA polymerase Ab

105
Q

What does CREST syndrome stand for?

A
  • Calcinosis
  • Raynaud phenomenon
  • esophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
106
Q

Describe Calcinosis Cutis

A

Calcium deposits under the skin (everywhere)
can look like tophaceous gout but diffuse

107
Q

What can you order to differentiate calcinosis cutis from tophaceous gout?

A

uric acid level

108
Q

What is Raynaud Phenomenon?

A

When you go out in the cold something turns white, blue, red or mixed

109
Q

Describe esophageal dysmotility

A

Dysfunction of the esophagus leading to dysphagia, heartburn, choking

110
Q

Describe Sclerodactyly

A
  • Resorption of the distal phalanx
  • Swelling of fingers (sausage fingers), skin is shiny, contractures, loss distal joint
111
Q

Describe telangiectasias

A

enlarged capillaries under the skin

“spider veins”

112
Q

Testing for SSc (CREST)

A
  • ANA+
  • Anticentromere Ab
113
Q

MCTD is most common in…

A
  • women
  • teenagers to 20s
114
Q

MCTD S/S:

A
  • Overlapping features of Sjogren’s, SLE, Systemic sclerosis (maybe GI problems), polymyositis
  • Raynaud syndrome, diffuse hand swelling, polyarthralgias, lung dz (ILD, pulm HTN)
115
Q

MCTD Testing

A
  • ANA+
  • U1 RNP+ (99%)
  • RF+; anti-Sm & anti-dsDNA (-)
116
Q

What is happening in Ankylosing spondylitis?

A

Calcification of ligaments & joints

117
Q

Ankylosing Spondylitis S/S

A

stiffness & pain

118
Q

Ankylosing spondylitis Testing

A

Imaging
- Fusion of SI joint, “bamboo spine”
Labs
- HLA-B27 testing
- (when patients has clinical picture but no proof on imaging)

119
Q

What is polymyositis?

A
  • autoimmune inflammation of skeletal muscle tissue
    –> progressive proximal muscle weakness
120
Q

What is dermatomyositis?

A
  • muscle weakness plus skin involvement
    –> can be due to occult malignancy & poss. interstitial lung dz
121
Q

Which cancers should you check for in women w/ dermatomyositis?

A

breast uterine, cervical & GI cancers

122
Q

Which cancers should you check for in men w/ dermatomyositis?

A

Prostate & GI cancer

123
Q

Polymyositis hits which joints?

A

shoulders & hips

124
Q

Testing for Myositis

A
  • Anti-Jo-1 (antihistidyl transfer synthase) Ab
  • CPK (creatine kinase)
    –> Elevated w/ inflammation or destruction of muscle cells
  • Aldolase
    –> Alt to CPK, often tested when CPK is (-)
  • ESR/CRP – usually not elevated
125
Q

Where does creatine kinase found?

A

found inside muscles

126
Q

How is Polymyalgia rheumatica usually diagnosed?

A

largely a clinical dx
- proximal joint pain/stiffness

127
Q

Testing for Polymyalgia rheumatica

A
  • Elevated ESR/CRP
  • Assoc. w/ HLA-DR4
  • EMG
  • MRI – muscle edema
  • Muscle biopsy (definitive)
128
Q

What is the definitive diagnostic test for polymyalgia rheumatica?

A

muscle biopsy

129
Q

Polymyalgia rheumatica is often associated with…

A

giant cell arteritis (vasculitis)
(30-35%)

130
Q

Is fibromyalgia inflammatory or non-inflammatory?

A

Non-inflammatory

131
Q

Testing for fibromyalgia

A
  • Clinical dx
  • Rule out other dz
    –> Hep C
    –> Thyroid disorders
    –> ESR/CRP
    –> CBC
    –> Only order testing for rheumatic dz if hx/PE or lab findings suggest it
132
Q

What are Vasculitides?

A

Inflammation of BVs

133
Q

List multiple types of Vasculitides

A
  • Large vessels – Takayasu arteritis, giant cell arteritis
  • Medium vessels – Polyarteritis nodosa, Kawasaki dz (peds)

Small vessels – ANCA-assoc. (polyangiitis), Immune complex (IgA, cryoglobulins)

134
Q

Vasculitides labs is largely based on…

A

ruling out other dz

135
Q

Labs to order for Vasculitides

A
  • CBC, CMP, ESR/CRP
  • Hepatitis panel (Hep B)
  • Blood cultures
  • decr complement levels
  • ANA
136
Q

How are Vasculitides definitely diagnosed?

A

Tissue biopsy or angiography

137
Q

Giant cell arteritis affects…

A

large vessels
- aorta, carotids, extracranial branches

138
Q

Who do we see giant cell arteritis in?

A

those >50 yo

139
Q

Giant cell arteritis is assoc. w/…

A

polymyalgia rheumatica

140
Q

Testing for giant cell arteritis

A
  • Elevated ESR/CRP – usually very high
  • Artery biopsy (often temporal artery)
141
Q

Describe polyarteritis nodosa (PAN)

A

Rare, necrotizing vasculitis of medium-sized arteries

142
Q

List medium-sized arteries affected by polyarteritis nodosa (PAN)

A
  • Kidneys (not glomeruli)
  • skin,
  • joints
  • muscles
  • GI tract
143
Q

Polyarteritis nodosa (PAN) is associated with…

A

Hep B & C

144
Q

Polyarteritis nodosa (PAN) is seen in what population

A

Middle-aged adults

145
Q

Polyarteritis nodosa (PAN) S/S

A
  • systemic (fever, fatigue, etc)
  • arthralgias & myalgias
  • asymmetric sensory & motor issues in same area (multiple mononeuropathy)
  • abd pain
  • rapidly worsening HTN
  • skin ulcers
146
Q

Testing for Polyarteritis nodosa (PAN)

A
  • Biopsy (focal)
  • Hep B & Hep C
147
Q

What is Granulomatosis w/ polyangiitis?

A
  • Old name = Wegener’s granulomatosis
  • Necrotizing vasculitis of small/medium vessels w/ granuloma formation
148
Q

Granulomatosis w/ polyangiitis S/S

A
  • Systemic sx
  • Respiratory sx – upper (nosebleeds) & lower (hemoptysis)
  • EENT sx (nasal congestion)
  • Myalgias & arthralgias
  • GN & AKI
  • Multiple mononeuropathy
149
Q

Testing for Granulomatosis w/ polyangiitis

A
  • ESR/CRP
  • UA (PROs & RBCs)
  • CMP
  • c-ANCA & p-ANCA — will be c-ANCA (+) to proteinase-3
  • Imaging (CT chest) - shows granulomas
  • Biopsies
150
Q

What is Eosinophilic granulomatosis with polyangiitis?

A
  • Old name = Churg-Strauss syndrome
  • Necrotizing vasculitis of small vessels w/ eosinophilic granulomas
151
Q

Eosinophilic granulomatosis w/ polyangiitis S/S

A
  • Adult onset asthma / allergies
  • Systemic sx
  • Skin – extensor surface nodules
  • Nerve – multiple mononeuropathy
  • MSK – arthralgias/myalgias
  • Heart – HF/myocarditis
152
Q

Testing for Eosinophilic granulomatosis w/ polyangiitis

A
  • CBC – eosinophilia
  • ANCA – p-ANCA (+) for myeloperoxidase
  • ESR/CRP
  • Echo
  • Biopsy
153
Q

What is Microscopic polyangiitis?

A

Necrotizing vasculitis of small vessels WITHOUT granulomas

154
Q

Microscopic polyangiitis S/S

A
  • Systemic sx
  • GN & AKI
  • Resp sx – lower (hemoptysis)
  • Myalgias & arthralgias
155
Q

Testing for Microscopic polyangiitis

A
  • ANCA – p-ANCA (+) for myeloperoxidase
  • ESR/CRP
  • Imaging (CT chest)
  • Biopsy

Block 3: MSK (10 decks)

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