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YEAR 1 MED > Investigations > Flashcards

Investigations Flashcards

1
Q

What does an FBC (full blood count) measure?

A
  • haemoglobin
  • platelets
  • white cell count (WCC)
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2
Q

What does haemoglobin lvls tell us in an FBC?

A
  • low Hb is anaemia: found in chronic inflammation or blood loss
  • microcytic anaemia (small Hb): suggests iron deficiency
  • macrocytic anaemia (big Hb): suggests auto-immune disease
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3
Q

What do platelet levels tell us in an FBC?

A
  • low platelets (thrombocytopenia): suggests problem with bone marrow (seen in SLE and APLS)
  • high platelets (thrombocytosis): often occurs in active inflammatory disease (reactive thrombocytosis)
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4
Q

What does white cell count (WCC) tell us in an FBC?

A
  • high lvls: suggests infection, inflammation, or due to steroid use
  • leukopenia (low lymphocytes): feature of SLE, connective tissue disease, or due to anti-rheumatic drugs
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5
Q

What do ESR (erythrocyte sedimentation rate) lvls tell us?

A
  • Inflammatory marker: seen more in chronic inflammation/infection
  • increased levels with increased levels of plasma proteins (eg. immunoglobulins and fibrinogen)
  • (ESR= rate at which RBCs sediment over an hour)
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6
Q

What do CRP (C-reactive protein) lvls tell us?

A
  • CRP is an acute phase protein made in the liver
  • Inflammatory marker: lvls rise in a non-specific way (typically takes 6-10 hrs after an inflammatory event to increase)
  • note: CRP responds more rapidly than ESR to changes in inflammation
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7
Q

What do U&Es (urea and electrolytes) tell us?

A
  • raised urea suggests renal failure or dehydration
  • note: chronic NSAIDs use can cause interstitial nephritis (inflammation of kidneys)
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8
Q

What do LFTs (liver function tests) tell us? (in regards to MSK related conditions) and what MSK drug used for RA treatment is hepatotoxic?

A
  • raised alkaline phosphatase is seen in Pagets disease
  • (alkaline phosphatase is found in both the liver and bone)
  • note: some drugs used for MSK problems (eg. methotrexate) are hepatotoxic
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9
Q

What do uric acids lvls tell us?

A
  • lvls are high in many patients with gout (but not a differential)
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10
Q

What do calcium levels tell us?

A
  • hypocalcaemia: occurs in osteomalacia and vitamin D deficiency
  • hypercalcaemia: may suggest malignancy, sarcoid, and excess PTH production
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11
Q

What do creatine kinase (CK) lvls tell us?

A
  • creatine kinase (CK) is a muscle enzyme
  • lvls increase in response to muscle injury (eg. trauma, inflammation)
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12
Q

What do complement protein lvls tell us?

A
  • complement proteins are activated in response to injury/inflammation
  • they bind to vessel walls and tissue when activated, this can lead to low serum lvls of C3 and C4 (seen in SLE)
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13
Q

What do antiphospholipid antibodies tell us and what are they associated with?

A
  • lupus anticoagulant and anticardiolipin antibodies are found in antiphospholipid syndrome (APLS)
  • associatiated with thrombosis (VT/AT) and recurrent miscarriages
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14
Q

Why would a blood film be requested?

A
  • to look at specific cells (RBCs, WBCs, platelets, leukaemia, malaria)
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15
Q

What does rheumatoid factor tell us?

A
  • around 75% of patients with RA have a +ve rheumatoid factor antibody
  • Rf is an antibody directed against Fc fragment of IgG
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16
Q

What does anti-CCP (cyclic citrullinated peptide antibody) tell us?

A
  • anti-CCP is found in patients with RA
  • note: more specific than rheumatoid factor
17
Q

What does procalcitonin lvls tell us?

A
  • Inflammatory marker (more specific for bacterial infections)
  • note: often used for an acute hot joint
18
Q

What does antineutrophil cytoplasmic antibodies (ANCA) tell us?

A
  • c-ANCA (cytoplasmic) bind to PR3: found in patients with granulomatosis with polyangiitis (Wegeners granulomatosis)
  • p-ANCA (perinuclear) bind to MPO: found in patients with microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
  • (PR3 and MPO are neutrophil enzymes)
19
Q

What are the antinuclear antibodies (ANAs) associated with specific diseases? (there are 8)

A
  • note: anti-Scl-70 (topoisomerase)
20
Q

What are the 3 things you can do with synovial fluid analysis?

A
  • look at macroscopic appearance (colour)
  • gram stain and culture (if suspected septic arthritis)
  • polarised light microscopy (to assess the presence of crystals in fluid)
21
Q

What does the macroscopic appearance (colour) of synovial fluid tell us? (yellow and clear, blood-stained, cloudy, frank pus, chalky)

A
  • yellow and clear: normal
  • blood-stained: haemarthrosis or trauma from aspiration
  • cloudy: increased WCC from infection/inflammation
  • frank pus: infection
  • chalky: gout crystals, occasionally cholesterol crystals
22
Q

Why would we do a gram stain/culture on synovial fluid and what might make it more difficult to detect organisms?

A
  • if suspected septic arthritis (or infection of the joint)
  • note: may be more difficult to detect organisms if antibiotics have been given before an aspirate has been obtained
23
Q

You perform polarised light microscopy on a synovial fluid sample, what would the appearance of the crystals look like in gout and what would it look like in pseudogout?

A
  • Gout: negatively birefringent needle-shaped (monosodium urate crystals)
  • Pseudogout (CPPD): weakly positive birefringent rhomboid-shaped (calcium pyrophosphate dihydrate crystals)
24
Q

Why would a biopsy be taken?

A
  • important in assessment of bony lesions in suspected cancer
  • muscle biopsies are sometimes needed for suspected myositis
25
Q

What are x-rays useful for and how many views should you take?

A
  • used to view bone (mainly to assess fractures and arthritis)
  • two views (usually AP and lateral)
26
Q

Why would ultrasound be used?

A
  • to investigate soft tissue injuries (eg. tears and effusions)
  • advantages: safe, cheap, portable, allows a dynamic assessment
27
Q

When would a CT (computed-tomography) scan be used?

A
  • can give a 3D view
  • sometimes used for complex fractures
28
Q

When would an MRI (magnetic resonance imaging) be used?

A
  • gives a very detailed view of soft tissues and bone marrow
29
Q

How does an isotope bone scan work and what can it tell us?

A
  • radioactive tracers are injected into body and taken up physiologically by bone
  • image shows areas of increased uptake: usually growth plates, arthritis, fractures, metastases, infection, and Paget disease
  • note: isotope bone scans are sensitive but not specific (not used for diagnosis)
30
Q

What is a DEXA (dual energy x-ray absorptiometry) scan used for?

A
  • measures bone density
  • used to diagnose osteoporosis and osteopenia
  • (T-score <-2.5 is osteoporosis, T-score <-1 is osteopenia)
31
Q

What is a PET (positron emission tomography) and what is it used for?

A
  • nuclear medicine scanning technique that can be used to observe metabolic activity within the body
  • can be useful for identifying active inflammation in specific tissues (eg. large vessel vasculitis, occult infections)

YEAR 1 MED (49 decks)

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