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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
CREST stand for
``` Calcinosis Raynaud’s Esophageal dysfunction Sclerodactyly: thickening and tightening of skin on hands+face Telangiectasias ```
26
CREST aka
limited systemic sclerosis
27
Systemic sclerosis antibodies
Anticentromere antibodies (ACA) (95%) Anti-Scl-70 antibody (Scleroderma, anti-topoisomerase I)
28
Anticentromere antibodies (ACA)
Used to support diagnosis of limited systemic sclerosis, also found in other conditions
29
Anti-Scl-70 antibody (Scleroderma, anti-topoisomerase I)
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
ACR Criteria for Systemic Lupus Erythematosus diagnosis
``` >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
Diseases associated with rheumatoid factor
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
Synovial fluid
viscous fluid, egg white consistency, reduces friction between articular cartilage of synovial joints
33
Arthrocentesis + Synovial fluid analysis uses
Evaluating effusion or signs/symptoms of inflammation within the joint Diagnose Relieve pressure Inject medications: glucocorticoid, local anesthetic, or both
34
Arthrocentesis + Synovial fluid analysis indications
New onset monoarthritis Suspected crystal-induced arthritis Suspected infection/septic arthritis Unexplained joint, bursa, or tendon sheath swelling
35
Arthrocentesis + Synovial fluid analysis complications
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
Synovial fluid analysis
Gross inspection: clarity, color, viscosity Microscopic inspection: gram stain+culture, cell count, crystal detection
37
Noninflammatory joint effusion
Osteoarthritis, trauma, avascular necrosis
38
Inflammatory joint effusion
septic arthritis, rheumatoid arthritis, spondyloarthritis, lyme, crystal-induced monoarthritis
39
Septic joint effusion
bacterial, fungal, mycobacteria
40
Hemorrhagic joint effusion
hemophilia, trauma (+/- fracture), tumor, anticoagulation
41
Monosodium urate crystals
Gout Negatively birefringent → yellow when parallel to the compensator Needle shaped
42
Calcium pyrophosphate dihyrate (CPPD)
Pseudogout Positively birefringent → blue when parallel to the compensator Rhomboid shape
43
Gout vs pseudogout: crystal color
Gout: Negatively birefringent→ yellow Pseudogout: Positively birefringent→ blue
44
Gout vs pseudogout: crystal shape
Gout: needle Pseudogout: rhomboid
45
Birefringent
ability to refract light rays→ changes the direction of the light rays
46
Normal synovial fluid values
``` Volume: <3.5 ml Clarity: Transparent Color: Clear Viscosity: High WBC per mm^3: <200 PMNs (neutrophils): <25% Culture: Negative ```
47
Noninflammatory synovial fluid values
``` Volume: >3.5 ml Clarity: Transparent Color: Yellow Viscosity: High WBC per mm^3: <200 PMNs (neutrophils): <25% Culture: Negative ```
48
Septic synovial fluid values
``` 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
Inflammatory synovial fluid values
``` Volume: >3.5 ml Clarity: Translucent-opaque Color: Yellow Viscosity: Low WBC per mm^3: >2000 PMNs (neutrophils): >50% Culture: Negative ```
50
Hemorrhagic synovial fluid values
``` Volume: >3.5 ml Clarity: Bloody Color: Red Viscosity: Variable WBC per mm^3: Variable PMNs (neutrophils): 50-75% Culture: Negatively ```
51
Osteoarthritis vs Rheumatoid arthritis vs Septic: Color
Osteoarthritis: yellow Rheumatoid arthritis: yellow Septic: yellow green
52
Osteoarthritis vs Rheumatoid arthritis vs Septic: WBCs
Osteoarthritis: <2,000 Rheumatoid arthritis: <2,000 Septic: >20,000-100,000
53
Osteoarthritis vs Rheumatoid arthritis vs Septic: PMNs
Osteoarthritis: <25% Rheumatoid arthritis: >50% Septic: >75%
54
Osteoarthritis vs Rheumatoid arthritis vs Septic: Culture
Osteoarthritis: negative Rheumatoid arthritis: negative Septic: positive
55
Osteoarthritis is...
noninflammatory
56
Rheumatoid arthritis is...
inflammatory
57
Gold standard for evaluating crystals
Polarized light microscopy→ microscope + polarizing filters + red quartz compensator→ birefringent?
58
Anticardiolipin antibody
Antiphospholipid syndrome
59
Beta 2 glycoprotein antibody
Antiphospholipid syndrome
60
Lupus anticoagulant
Antiphospholipid syndrome

Unit 3 Clin Lab Med (5 decks)

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