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Clinical Medicine LAB - Professor Sample > MS III > Flashcards

MS III Flashcards

1
Q

Antinuclear Antibody: Anti-scleroderma , disease ?

A

Scleroderma

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2
Q

Antinuclear Antibody: Anti-Smith , disease ?

A

SLE

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3
Q

Culture: Non-inflammatory ?

A

Negative

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4
Q

Total protein, g/dL: NL ?

A

1-2

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5
Q

Viscosity: Hemorrhagic ?

A

Variable

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6
Q

When is a DEXA used: Men / Women ?

A

with hyperparathyroidism - leaks Ca out

with long term steroid use

being monitored during osteoporosis treatment for someone already dx

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7
Q

Clarity: Hemorrhagic ?

A

Bloody

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8
Q

Clarity: Non-inflammatory ?

A

Transparent

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9
Q

Color: Inflammatory ?

A

yellow to opalescent

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10
Q

Antinuclear Antibody: Anti-ss-A (Ro), Anti-ss-B (La) , disease ?

A

Sjogren syndrome

SLE

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11
Q

WBC , per mm3: Septic ?

A

> equal to 50,000

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12
Q

Arthroscopy contraindications ?

A

Pts with ankylosis
things fuse and anatomy changes

Overlying infections
dont want to put infection in the joint - cellulitis over the knee, or even like a rash or bad psoriasis )

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13
Q

Viscosity: Non-inflammatory ?

A

High

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14
Q

Anti-DNA antibody decreases with ?

A

Will decrease with treatment or in dormant disease. ( lower ABS - makes it more difficult to dx someone with intermittent sxs. )

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15
Q

Anticardiolipin Antibody own notes ?

A

part of the antiphospholipid ABS syndrome - not really to antiphospholipids , they creates ABS to plasma proteins that are involved in the clotting process anf they end u with a hyper coagulable state ( making more blood clots) the mechanism of this is not well understood

many theories but not well understood

2016 in Jan

Lupus anticoagulant and this anti-cardiolipin ( we talk about this one) - tested for th most with antiphospholipid ABS’s

it was first found in animal hearts and it has nothing to do with he heart - it is found in the inner mitochondria membrane

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16
Q

Synovial fluid: glucose ?

A

Within 10 ml/dL of the serum glucose

Falls with severity of inflammation

Lowest in septic arthritis (<50% of serum glucose)

**usually low with bacterial infection - septic arthritis **

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17
Q

Total protein, g/dL: Non-inflammatory ?

A

1-3

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18
Q

When is ANCA used?

A

Dx Wegener’s granulomatosis

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19
Q

Anti-DNA antibody increases ?

A

Increases with active disease.

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20
Q

Clarity: Septic ?

A

Opaque

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21
Q

Antinuclear Antibody: Anticentromere , disease ?

A

CREST syndrome

CREST - calci, esophagela dismoitility, raynauds, scleroderma, telangectiasias

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22
Q 
Color: straw
Clarity: turbid ( cloudy)
Viscosity: low
WBC: 65,000
PMN: 80%
Glucose: 15 ( low)

What is the dx?

A

septic arthtisis - pain with passive ROM - big sign ( you moving it and it still hurts them - passive)

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23
Q

Clarity: Inflammatory ?

A

Translucent to opaque

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24
Q

Glucose, mg/dL: NL ?

(glucose is very low in septic arthritis
)

A

nearly equal to blood

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25
Q 
Color: straw
Clarity: turbid ( cloudy)
Viscosity: low
WBC: 65,000
PMN: 80%
Glucose: 15 ( low)

What is the next best step in treating?

A

get blood cultures before ABS to r/o disseminated infection

figure out why it happened? IV drugs user, STD, seeded from somewhere
Surgery

vanco and ceftriaxone

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26
Q

When is RF used?

A

Diagnosis of Rheumatoid Arthritis

80% of pts with RA have + RF titers

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27
Q

Culture: NL?

A

Negative

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28
Q

Compartment Pressure, what is it ?

A

Test to evaluate for compartment syndrome

**test to evaluate for compartment syndrome

one compartment of increased pressure typically from crush injury or a direct blow -the muscle actually swells ( the fascia the tight fibrouss layer doesn’t stretch much and with a injury the muscle swells and it cannot go beyond the fascia and more and more swelling swelling and the muscle starts to die and people get really sick and rlly fast

injury with pain out of portions to what the injury looks like - it is cause the injury and the muscle is dying**

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29
Q

ESR /CRP own notes ?

A

used in MS for a marker of “ is this disease processs happening right now or not , are they having an acute flare”

malar rash, joint ache, fever - acute flare of lupus - ESR/CRP - elevated = yes this is an acute flare and can be treated with medications

and you can follow levels back down when treatment is initiated - recheck esr / crp ( may never go back to normal but they can be close)

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30
Q

T-score: Is units of SD and shows whether the bones are more or less dense than ________

A

“normal”

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31
Q

What is ESR/CRP ?

A

Nonspecific marker of inflammation

Reliable indicator of course of autoimmune diseases

Elevated with worsening of disease and better with improvements

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32
Q 
Color: straw
Clarity: turbid ( cloudy)
Viscosity: low
WBC: 65,000
PMN: 80%
Glucose: 15 ( low)

what is the next best test?

A

culture and sensitivity

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33
Q

Antinuclear Antibody (ANA): patterns ?

A

positive ANA test - not exactly dx cause they will run other tests -

postive ANA —doesnt means ABS are doing anything to it

actue flare or sxs. AI disease with a positive ANA they will do other tests like ELISA (immunoflourcesnce - it shows a pattern and certain patterns fall into certain categories)

peripheral pattern - stain is only collect around the perimeter of the cell then they probably have lupus and anti-DNA ( these are the subclasses or ANA)

positive ANA with speckled pattern is for scleroderma

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34
Q

PMN %: Septic ?

A

> equal to 75

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35
Q

Synovial fluid: cell counts should be low: WBC NL?

A

<200 WBCs/mm3

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36
Q

When is arthroscopy used?

A

Evaluates for meniscus/cartilage injury

Minor corrective surgery

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37
Q

Uric Acid own notes ?

A

purines in DNA - adenine & Guanine

Why Allopurinol causes an acute GOUT flare up when it lowered uric acid levels ( never A in a acute flare cause it can worsen)

undissociated Urica AAcid ( waste product) - is not water soluble and not excreted very readily but it is not a problem unless the Ca is high or urine is acidic - cause decrease in being able to excrete it

A and G have a common intermediate “xanthine stage” before they are completely broken down

G through deamination you get ammonia ( NH3) and gets transferred over to the liver - as glutamineand the liver excretes it down by urea ( how G is broken down)

Xanthine - uses oxygen and X oxidase (XO) gets catalyzed to urate

allopurinol - is a synthetic xanthine that binds to XO (irriversible process) and does not allow the break down of xanthine and does not allot the urate by product reaction so no urate - stopping production of uric acid

GOUT - from high purine diets - meat ( shellfish) - alot of DNA

undissociated UA can bind to the ca and cause stone and crystals in the joint

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38
Q

Color: NL?

A

Straw-colored

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39
Q

Viscosity: NL

A

High

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40
Q

Synovial Fluid: adding acetic acid does what ?

A

“Rope’s test” : good – enough hyaluronic acid - sort of a clot or lime ( lift it up and it forms a rope) - it gets thicker

Reduced viscosity indicates inflammation - if it does not get thick - cause the inflammatory markers decrease viscosity

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41
Q

Glucose, mg/dL: Septic ?

A

<25

much lower than blood

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42
Q

Glucose, mg/dL: Hemorrhagic ?

A

nearly equal to blood

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43
Q

Z-score uses?

A

What is expected for your size, age, race, sex

idea of how dense your bones are compared to other people your size, shape, race, gender

does not give us a good idea of how thin our bones are to what they are supposed to be

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44
Q

Striated muscle - LDH isoenzyme ?

A

isoenzyme 5

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45
Q

Antinuclear antibody (ANA) what is it ?

A

Autoantibodies directed at the nucleus of cells.

Sensitive for detecting autoimmune disease (95% of pts with SLE are positive)

Not specific for SLE

Tests are IFA or ELISA that are reported as a titer with a specific immunoflourescence pattern

**careful caus etiters change with lupus - high and low so it is very difficult to dx someone whose titer fluxuate frequenctly

not specific for lupus itself **

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46
Q

What are the 2 major staining patterns ?

A

c-ANCA:Ab to proteinase 3 (PR3)

p-ANCA: Ab to myeloperoxidase (MPO)
DISTRACTER ON TEST IT IS PROBABLY NOT THIS ONE

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47
Q

NL Synovial fluid ?

A

Clear

Straw-colored - light yellow
color

Good mucin clot

No crystals - duh - if so

GOUT pseduogout

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48
Q

Antinuclear Antibody: RA Precipitin , disease ?

A

RA

Sjogren syndrome

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49
Q

Pattern: Nucleolar / anti-nucleolar ?

A

SLE

PSS

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50
Q

T-score, peak bone density is reached by age ?

A

30

** “our bone density compared to a average normally health 30 year old”**

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51
Q

DEXA: T-score ?

A

“normal”

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52
Q

Color: Septic ?

A

yellow to green

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53
Q

Aldolase is mostly used for identifying ________ or _______ cellular injury or destruction

A

muscular

hepatic

**muscles and liver where it is most heavily found

used to ID muscle damage to tissue destruction - not as much for liver damage much more used for muscle damage **

54
Q

When is Synovial fluid used?

A

Consider dx of:

Joint infection
Arthritis
Gout
Pseudogout
Synovitis
Neoplasms involving the joint spacce
55
Q

WBC , per mm3: NL ?

A

<200

56
Q

Pattern: Homogeneous (diffuse) / anti-DNA, anti-histone, anti-DNP (nucleosomes) ?

A

RA

SLE

misc. disorders (anti-ssDNA)

57
Q

Anticardiolipin Antibody: Pts are at higher risk for: clots

?

A

Venous and arterial thrombosis

Recurrent spontaneous abortion - not well understood = part of the workup of if women is unable to carry fetus long term - it binds to the trophoblast in the placenta and this causes abort ( will give heparin during the pregnancy and it can help)

Thrombocytopenia

Strokes in young people

58
Q

What is Anticardiolipin Antibody ?

A

Antiphospholipid antibody

Found in ~40% of patients with SLE

Pts are at higher risk for: clots

59
Q

Uric Acid increased: decreased excretion of uric acid ?

A

Idiopathic

Chronic renal disease

Acidosis - decrease UA scretion

Alcoholism
-Accelerates breakdown of —ATP in the liver which increases uric acid production
Chronic acidosis

**pic - lots of tophi

cruises - because alcohol and shell fish

Alcohol does both — two fold process
decrease the excretion - chronically acidotic
and what ?**

60
Q

A 54 yr old male presents with foot pain x 2 days. He is an alcoholic and states he gets this “twice every year”.

A

GOUT - test urine acid - first time gout maybe arthorcentisis to look for crystals, xray - changes consist with gout, deposits around the joint space

this is padagra

just treat him and send hime home but if it is the first time get a detail hx, xray and uric acid level ( but not all elevateion have gout so sometimes they are not helps in acute presentation or acute flare)

UA - 6 - still can have GOUT but not high serum levels

first time - not sure about cellulitis or GOUT but arthrocyntesis is diagnostic ( this is what is indicated) (not esr, crp, UA , xray)

61
Q

When is Anticardiolipin Antibody used ?

A

Increased in SLE

**many of these patient have the syndrome as well

“ type of ABS that people with lupus have that cause increase risk of clots in children “**

62
Q

DEXA aka ?

A

Dual-Energy Absorptiometry

63
Q

PMN %: Inflammatory ?

A

> equal to 50

64
Q

What is uric acid ?

A

Nitrogenous compound that is found after breakdown of purine (found in DNA)

75% excreted by kidney, 25% excreted by GI

65
Q

PMN %: Hemorrhagic ?

A

50-75

66
Q

WBC , per mm3: Hemorrhagic ?

A

200-2,000

67
Q

PMN %: Non-inflammatory ?

A

<25

68
Q

RF own notes ?

A

within the joint capsule the body creates an AI process and it attack the joints and you get these abnormal IgG ABS inside the joint capsule itself

norma IgG IgM ABS in the serum which start to attack the IgG

the normal IgM is the RF - so if we can find normal IgM ABS that are specific to the abnormal IgG in the joint capsule so we can tell if there is a predisposition to RA

had to dx AI diseases cause titers goes up and down if in flare or not ( how high are the titters - or how much ABS is circulating)

69
Q

Pattern: Centromere / anti-centromere ?

A

PSS (CREST)

70
Q

LDH increased with ?

A

Recent strenuous exercise

Skeletal muscle injury

Muscular dystrophy

Trauma to the muscle
any kind of muscle injury

71
Q

Total protein, g/dL: Septic ?

A

3-5

72
Q

When is HLA B-27 used?

A

HLA compatibility is used with tissue or organ transplantation and paternity testing

73
Q

What is Lactic/Lactate Dehydrogenase (LDH) ?

A

Intracellular enzyme

When disease or injury affects the cells that contain LDH, cells lyse and spill LDH into the serum

Found in many tissues of the body

Use isoenzymes to break down where the particular injury/disease is occurring.

look up isoenzymes

74
Q

Antinuclear Antibody: Anti-ENA , disease ?

A

SLE

MCTD

75
Q

Aldolase decreased with ?

A

Hereditary fructose intolerance (cause AB is used to break down fructose)

Decreased muscle mass

76
Q

Total protein, g/dL: Inflammatory ?

A

3-5

77
Q

Compartment Pressure results ?

A

≥30mmHg in the compartment suggests fasciotomy

78
Q

Total protein, g/dL: Hemorrhagic ?

A

4-6

79
Q

Review other topics ?

A

Alkaline Phosphatase

Calcium/Phosphorus

Myoglobin

ESR

CRP

CK

and the facial X-rays

**CAs multiple myeloma - how the play into other disorders **

80
Q

Aldolase increased: Hepatocellular disease ?

A

Hepatitis

Cirrhosis

cause aldolase B - primarily the liver aldolase

81
Q

Glucose, mg/dL: Inflammatory ?

A

> 25

lower than blood

82
Q

A patient is positive for Ab to proteinase-3. What is the most likely diagnosis?

A

wegners

83
Q

HLA B-27 own notes ?

A

B and B-27 - genetic passed down tends to have more AI diseases than other people

( the way the antigen is position on the outside of the tissue and it can essential recognize its own self as a forgone body and it creates an AI response)

PAIR

  • P - psoriasis
  • A - ankylosing spondylitis ( most consistent with HLA - B-27)
  • I - IBD - consist of crohns and celiacs
  • R - active arthritis
84
Q

Synovial Fluid: Mucin clot test ?

A

Correlates with the viscosity

Hyaluronic acid in the fluid acts as a lubricant therefore, fluid is usually viscous

Add acetic acid to fluid

85
Q

When is uric acid used?

A

Dx of stones - Can supersaturate the urine and build up in the kidney as stones

Dx of gout - Can deposit crystals in periarticular tissue

**test UA when someone comes in with stone or GOUT

Padagra

MTP usually first affect in GOUT then ankles ( bigger joints) **

86
Q

Synovial fluid: crystals analysis ?

A

Observe for uric acid crystals (gout)

Calcium pyrophosphate crystals (pseudogout)

87
Q

When is Anti-DNA antibody used?

A

Subtype of ANA

88
Q

DEXA own notes ?

A

lower you go - the less dense the bones are - osteopenia ( between -1 and -2.5) - still treat this to prevent osteoporosis

-2.5 or below is dx or osteoporosis ( ass. with alot of pathologic fractures)

morbidity and mortality for hip fracture is high cause they are bedridden, etc etc -

89
Q

Color: Non-inflammatory ?

A

yellow

90
Q

DEXA: Z-score ?

A

“age-matched”

91
Q

WBC , per mm3: Non-inflammatory ?

A

200 - 2,000

92
Q

Pattern: Speckled / anti Sm & RNP, anti - Ro /La, anti-Jo-1 & Mi-2, anti - Sci-70 ?

A

SLE

SS

PM/DM

PSS (systemic)

93
Q

When is Aldolase used ?

A

Differentiate between neurologic causes of weakness and muscular causes of weakness.

94
Q

Aldolase increased: Muscular disease ?

A

Muscular dystrophy ( earlier stage)

Dermatomyositis -AI condition that destroys muscular tissue

95
Q

Culture: Septic ?

A

often positive

96
Q

HLA B-27 is associated with certain autoimmune diseases (pts will be positive) ?

A

Reiter syndrome - reactive arthritis

Ankylosing spondylitis

Anterior uveitis

Graves disease

97
Q

42 yr old female with positive ANA (rimmed pattern), anti-ds-DNA, and anticardiolipin antibody. What is the most likely diagnosis?

A

lupus

98
Q

Uric Acid increased: Increased uric acid production ?

A

↑ ingestion of purines

Genetic error in purine metabolism

Hemolysis - break down of cells releases DNA

Rhabdomyolysis

99
Q

What is HLA B-27?

A

Human Lymphocytic Antigen B27

Exists on the surface of WBCs and all nucleated cells in other tissues

100
Q

RF results: titers less then ___ indicates other possible AI disease,

A

1:80

Indicates:

SLE
Scleroderma
Sjogren disease

101
Q

PMN %: NL ? (polymorphic neutrophils )

A

<25

102
Q

Elevated Aldolase levels are seen with primarily ?

A

muscular disorders

**neuro - luegerigs versu muscular dystrophy ( aldolase help differenciate these cause it tells use the different)

when muscle tissue break down or are damaged then elevated aldolase in the serum **

103
Q

Aldolase decreased: Decreased muscle mass ?

A

Late muscular dystrophy ( be cause so much muscle damaged or wasting towards the end then we dont have the muscle there to release the aldosae that we did earlier in the disease process)

Other muscle wasting diseases causing decreased muscle mass

104
Q

HLA B-27: presence or absence of these antigens is determined by genes on chromosome __ ?

A

6

4 genes that control the presence of HLA A,B,C, and D

**all of the bodies cells have antigens on them and it help immune system tells use that they are good cells

one of these antigens is HLA B-27

(HLA compatible for a kidney match - so body thinks it is his and it wont reject it ) **

105
Q

Synovial Fluid what is it ?

A

Synovial fluid is obtained through arthrocentesis and analyzed.

106
Q

WBC , per mm3: Inflammatory ?

A

2,000-50,000

107
Q

Glucose, mg/dL: Non-inflammatory ?

A

nearly equal to blood

108
Q

What is Aldolase ?

A

Enzyme used in the breakdown of glucose

Present in most tissues in the body

109
Q

When do you want to use a DEXA?

A

Women > 65 yo

Postmenopausal women with at least one addtl’ risk factor for osteoporosis

Women who have received hormone replacement for prolonged periods

**screening exam

long term steroids, petite women who are thin ( tiny people), chemo or radiation or certain estrogens or hormone therapy = tend to have lower bone densities

any weight bearing exercise create increasing bone density - building bone **

110
Q

Pattern: peripheral / anti-DNA (not seen on HEp-2) ?

A

SLE

111
Q

What is RF?

A

Abnl IgG Ab are produced in the synovial fluid and act as “antigens” in RA

Normal IgG and IgM Abs then react to the abnl IgG “antigens” activating the complement system and inflammatory systems (creates joint damage)

Reactive IgM (NL) is what makes up the RF

112
Q

Dx Wegener’s granulomatosis

: Autoantibodies to PR3 ?

A

Highly specific for WG (95-99%)

auto ABS to PR# then it is probably wegeners

113
Q

Anti-DNA antibody: anti-ss-DNA?

A

Positive in other autoimmune diseases

114
Q

Color: Hemorrhagic ?

A

rusty brown to red

115
Q

Antinuclear Antibody: Antinucleolar , disease ?

A

Scleroderma

SLE

116
Q

Synovial fluid: cell counts should be low: RBC NL?

A

<2000 RBCs/mL

117
Q

What is a DEXA scan ?

A

Measures bone mineral density with low exposure radiation

Uses thin slices of xray beams to measure bone density

**uses low levels or xray technology to examine typically the spine and there hip - look at how dense the bone is **

118
Q

Aldolase increased: Muscular injury ?

A

Muscular trauma

Ischemic process

119
Q

Anti-DNA antibody: anti-ds-DNA ?

A

more sensitive and specific for SLE

esr/crp = elevated

**lupus suspicion - ANA - positive then look at staining pattern then subtyping and ds then deff lupus and esr/crp - elevated as well and can see is they have the syndrome or if they have raynauds

nothing with these AI tests are 100% ( not all cut and dry) but you can make a greta case **

120
Q

Viscosity: Septic ?

A

Variable

121
Q

Clarity: NL ?

A

Transparent

122
Q

How are uric acid serum levels determined ?

A

Serum level determined by rate of production (liver) and rate of excretion (primarily kidney)

123
Q

When is LDH used?

A

Diagnose injury or disease involving the heart, liver, blood cells, kidneys, skeletal muscle, brain or lungs.

124
Q

Antinuclear Antibody: Anti-Jo-1 antihistadyl , disease ?

A

Polymyositis

dermatomyositis

125
Q

Arthroscopy potential complications ?

A

Infection

Hemarthrosis - bleeding

Swelling

Thrombophlebitis
inflammation of the vasculature - clots in superficial venous system

Joint injury

Synovial membrane rupture

126
Q

Dx Wegener’s granulomatosis: Causes regional systemic vasculitis ?

A

Small arteries in the kidneys, lungs, and upper resp tract are damaged by granulomatous inflammation

127
Q

what is Arthroscopy ?

A

Procedure used to examine the joint interior using an endoscope

128
Q

RF results: titers greater than _____ is positive ?

A

1: 80

pos. for RA

129
Q

What is Antineutrophil Cytoplasmic Antibody?

A

ANCAs are Ab directed against cytoplasmic components of neutrophils

130
Q

Viscosity: Inflammatory ?

A

Low

131
Q

Culture: Inflammatory ?

A

Negative

132
Q

Culture: Hemorrhagic ?

A

Negative

Clinical Medicine LAB - Professor Sample (36 decks)

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