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Unit 3 Clin Lab Med > L9: Rheum > Flashcards

L9: Rheum Flashcards

1
Q

Symmetric polyarthritis
Pleuritic chest pain
Malar Rash
Raynaud’s

A

SLE

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2
Q

SLE Labs

A

CBC: anemia, leukopenia, thrombocytopenia
UA: proteinuria, cellular casts, hematuria
Elevated serum creatinine
Elevated ESR, CRP
LFTs
Low complement: C3, C4

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3
Q

+Anti-dsDNA

A

SLE

Specific, fluctuates with dsiease activity

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4
Q

+Anti-Sm (smith)

A

SLE

remains (+) even with remission

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5
Q

Antinuclear antibody

A

Cardinal sign of SLE but not specific, also seen in RA, Sjogren,
2 parts:
1. Titer of antibodies with serial dilution
2. Staining pattern: homogeneous/diffuse, speckled, nucleolar, centromere

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6
Q

Antiphospholipid syndrome

A

Primary condition or secondary to underlying disease (usually lupus)
Arterial and venous thromboembolic events
Recurrent fetal loss

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7
Q

Antiphospholipid syndrome antibodies

A

Anticardiolipin antibody
Beta 2 glycoprotein antibody
Lupus anticoagulant

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8
Q

RF

A

Rheumatoid factor, but only moderately specific for rheumatoid arthritis

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9
Q

RA antibodies

A

ANA, RF, Anti-CCP

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10
Q

Anti-CCP

A

cyclic citrullinated peptides

Most commonly used for RA, high specificity

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11
Q

RA

A

Redness and swelling of hands, fingers, knees. Spares DIP.
Ulnar deviation at MCPs.
Morning stiffness lasts >2 hours

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12
Q

RA labs

A

Elevated ESR, CBC
Mild thrombocytosis
Check serum uric acid

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13
Q

Sjogren Syndrome

A 
Fatigue
Sicca complex: Dry mouth, eyes
Caries
Diffuse muscle and joint aches
Primary or secondary, associated with other autoimmune diseases
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14
Q

Sicca complex

A

Sjogren: dry eyes, dry mouth

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15
Q

Sjogren Syndrome antibodies

A

ANA
Anti-Ro/SSa antibody
Anti-La/SSB antibody

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16
Q

Anti-Ro/SSa antibody

Anti-La/SSB antibody

A

Sjogren Syndrome antibodies, 1 or both are positive in 60-80% of patients with primary sjogren

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17
Q

Polymyalgia Rheumatica labs

A

Elevated ESR and/or CRP

Characteristic finding=Giant cell temporal arteritis

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18
Q

Polymyalgia Rheumatica

A 
>55 years 
Proximal aching and stiffness
Upper arms, low back, hips, thighs
Morning stiffness
Stiffness with long car rides
ROM decreased bilaterally 
Improves with low dose corticosteroids
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19
Q

Fibromyalgia

A

Exhaustion, fogginess (“non-restorative sleep)
Myalgias and arthralgias
Multiple tender points

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20
Q

Fibromyalgia labs

A

NORMAL

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21
Q

Ankylosing spondylitis

A

Low back pain
Progressive stiffness
Worst in mornings, with inactivity
Emphysitis: inflammation of tendon insertion

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22
Q

Ankylosing spondylitis labs

A

Imaging: bamboo spine, sacroilitis

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23
Q

Ankylosing spondylitis antibodies

A

Human Leukocyte antigen (HLA)- B27

Strong association

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24
Q

Human Leukocyte antigen (HLA)- B27

A

Ankylosing spondylitis

Also seen with other spondyloarthropathies: reactive arthritis, psoriatic arthritis, IBD

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25
Q

CREST stand for

A 
Calcinosis
Raynaud’s
Esophageal dysfunction
Sclerodactyly: thickening and tightening of skin on hands+face
Telangiectasias
26
Q

CREST aka

A

limited systemic sclerosis

27
Q

Systemic sclerosis antibodies

A

Anticentromere antibodies (ACA) (95%)

Anti-Scl-70 antibody (Scleroderma, anti-topoisomerase I)

28
Q

Anticentromere antibodies (ACA)

A

Used to support diagnosis of limited systemic sclerosis, also found in other conditions

29
Q

Anti-Scl-70 antibody (Scleroderma, anti-topoisomerase I)

A

Diffuse cutaneous systemic sclerosis, higher risk of severe interstitial lung disease

Specific but seen in other conditions

Absence of antibody doesn’t exclude diagnosis of scleroderma

30
Q

ACR Criteria for Systemic Lupus Erythematosus diagnosis

A 
>4 of the following: 
Rash: malar, photosensitivity, discoid
Mucosal ulcers
Polyarthritis
Serositis: pleuritis or pericarditis 
Neurological disorders: HA, seizures
Labs: renal disorders (proteinuria, cellular casts), hematologic disorders (anemia, leukopenia, thrombocytopenia)	
Antibodies: Anti-DNA, Anti-Sm, Anti-nuclear (ANA)
31
Q

Diseases associated with rheumatoid factor

A

Rheumatic diseases: rheumatoid arthritis, Sjogren, Lupus, Polymyositis, dermatomyositis, mixed connective tissue disease

Nonrheumatic diseases: bacterial endocarditis, Hep B+C, TB, Sarcoidosis, malignancy, primary biliary cholangitis

32
Q

Synovial fluid

A

viscous fluid, egg white consistency, reduces friction between articular cartilage of synovial joints

33
Q

Arthrocentesis + Synovial fluid analysis uses

A

Evaluating effusion or signs/symptoms of inflammation within the joint

Diagnose

Relieve pressure

Inject medications: glucocorticoid, local anesthetic, or both

34
Q

Arthrocentesis + Synovial fluid analysis indications

A

New onset monoarthritis

Suspected crystal-induced arthritis

Suspected infection/septic arthritis

Unexplained joint, bursa, or tendon sheath swelling

35
Q

Arthrocentesis + Synovial fluid analysis complications

A

Septic joint: most feared complication
With or without glucocorticoid injection
1/3000

Minor atrophies: skin, hypopigmentation

Glucocorticoids: tendon rupture, nerve damage, osteonecrosis (ischemic or avascular necrosis of bone, rare)

36
Q

Synovial fluid analysis

A

Gross inspection: clarity, color, viscosity

Microscopic inspection: gram stain+culture, cell count, crystal detection

37
Q

Noninflammatory joint effusion

A

Osteoarthritis, trauma, avascular necrosis

38
Q

Inflammatory joint effusion

A

septic arthritis, rheumatoid arthritis, spondyloarthritis, lyme, crystal-induced monoarthritis

39
Q

Septic joint effusion

A

bacterial, fungal, mycobacteria

40
Q

Hemorrhagic joint effusion

A

hemophilia, trauma (+/- fracture), tumor, anticoagulation

41
Q

Monosodium urate crystals

A

Gout
Negatively birefringent
→ yellow when parallel to the compensator
Needle shaped

42
Q

Calcium pyrophosphate dihyrate (CPPD)

A

Pseudogout
Positively birefringent
→ blue when parallel to the compensator
Rhomboid shape

43
Q

Gout vs pseudogout: crystal color

A

Gout: Negatively birefringent→ yellow

Pseudogout: Positively birefringent→ blue

44
Q

Gout vs pseudogout: crystal shape

A

Gout: needle
Pseudogout: rhomboid

45
Q

Birefringent

A

ability to refract light rays→ changes the direction of the light rays

46
Q

Normal synovial fluid values

A 
Volume: <3.5 ml
Clarity: Transparent
Color: Clear 
Viscosity: High
WBC per mm^3: <200 
PMNs (neutrophils): <25%
Culture: Negative
47
Q

Noninflammatory synovial fluid values

A 
Volume: >3.5 ml
Clarity: Transparent
Color: Yellow 
Viscosity: High
WBC per mm^3: <200 
PMNs (neutrophils): <25%
Culture: Negative
48
Q

Septic synovial fluid values

A 
Volume: >3.5 ml
Clarity: opaque
Color: yellow/green 
Viscosity: variable
WBC per mm^3: >20,000, >100,00 is septic until proven otherwise
PMNs (neutrophils): >75%
*Culture: positive*
49
Q

Inflammatory synovial fluid values

A 
Volume: >3.5 ml
Clarity: Translucent-opaque
Color: Yellow 
Viscosity: Low
WBC per mm^3: >2000 
PMNs (neutrophils): >50%
Culture: Negative
50
Q

Hemorrhagic synovial fluid values

A 
Volume: >3.5 ml
Clarity: Bloody
Color: Red
Viscosity: Variable
WBC per mm^3: Variable
PMNs (neutrophils): 50-75%
Culture: Negatively
51
Q

Osteoarthritis vs Rheumatoid arthritis vs Septic: Color

A

Osteoarthritis: yellow
Rheumatoid arthritis: yellow
Septic: yellow green

52
Q

Osteoarthritis vs Rheumatoid arthritis vs Septic: WBCs

A

Osteoarthritis: <2,000
Rheumatoid arthritis: <2,000
Septic: >20,000-100,000

53
Q

Osteoarthritis vs Rheumatoid arthritis vs Septic: PMNs

A

Osteoarthritis: <25%
Rheumatoid arthritis: >50%
Septic: >75%

54
Q

Osteoarthritis vs Rheumatoid arthritis vs Septic: Culture

A

Osteoarthritis: negative
Rheumatoid arthritis: negative
Septic: positive

55
Q

Osteoarthritis is…

A

noninflammatory

56
Q

Rheumatoid arthritis is…

A

inflammatory

57
Q

Gold standard for evaluating crystals

A

Polarized light microscopy→ microscope + polarizing filters + red quartz compensator→ birefringent?

58
Q

Anticardiolipin antibody

A

Antiphospholipid syndrome

59
Q

Beta 2 glycoprotein antibody

A

Antiphospholipid syndrome

60
Q

Lupus anticoagulant

A

Antiphospholipid syndrome

Unit 3 Clin Lab Med (5 decks)

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