MS III Flashcards
Antinuclear Antibody: Anti-scleroderma , disease ?
Scleroderma
Antinuclear Antibody: Anti-Smith , disease ?
SLE
Culture: Non-inflammatory ?
Negative
Total protein, g/dL: NL ?
1-2
Viscosity: Hemorrhagic ?
Variable
When is a DEXA used: Men / Women ?
with hyperparathyroidism - leaks Ca out
with long term steroid use
being monitored during osteoporosis treatment for someone already dx
Clarity: Hemorrhagic ?
Bloody
Clarity: Non-inflammatory ?
Transparent
Color: Inflammatory ?
yellow to opalescent
Antinuclear Antibody: Anti-ss-A (Ro), Anti-ss-B (La) , disease ?
Sjogren syndrome
SLE
WBC , per mm3: Septic ?
> equal to 50,000
Arthroscopy contraindications ?
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 )
Viscosity: Non-inflammatory ?
High
Anti-DNA antibody decreases with ?
Will decrease with treatment or in dormant disease. ( lower ABS - makes it more difficult to dx someone with intermittent sxs. )
Anticardiolipin Antibody own notes ?
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
Synovial fluid: glucose ?
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 **
Total protein, g/dL: Non-inflammatory ?
1-3
When is ANCA used?
Dx Wegener’s granulomatosis
Anti-DNA antibody increases ?
Increases with active disease.
Clarity: Septic ?
Opaque
Antinuclear Antibody: Anticentromere , disease ?
CREST syndrome
CREST - calci, esophagela dismoitility, raynauds, scleroderma, telangectiasias
Color: straw Clarity: turbid ( cloudy) Viscosity: low WBC: 65,000 PMN: 80% Glucose: 15 ( low)
What is the dx?
septic arthtisis - pain with passive ROM - big sign ( you moving it and it still hurts them - passive)
Clarity: Inflammatory ?
Translucent to opaque
Glucose, mg/dL: NL ?
(glucose is very low in septic arthritis
)
nearly equal to blood
Color: straw Clarity: turbid ( cloudy) Viscosity: low WBC: 65,000 PMN: 80% Glucose: 15 ( low)
What is the next best step in treating?
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
When is RF used?
Diagnosis of Rheumatoid Arthritis
80% of pts with RA have + RF titers
Culture: NL?
Negative
Compartment Pressure, what is it ?
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**
ESR /CRP own notes ?
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)
T-score: Is units of SD and shows whether the bones are more or less dense than ________
“normal”
What is ESR/CRP ?
Nonspecific marker of inflammation
Reliable indicator of course of autoimmune diseases
Elevated with worsening of disease and better with improvements
Color: straw Clarity: turbid ( cloudy) Viscosity: low WBC: 65,000 PMN: 80% Glucose: 15 ( low)
what is the next best test?
culture and sensitivity
Antinuclear Antibody (ANA): patterns ?
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
PMN %: Septic ?
> equal to 75
Synovial fluid: cell counts should be low: WBC NL?
<200 WBCs/mm3
When is arthroscopy used?
Evaluates for meniscus/cartilage injury
Minor corrective surgery
Uric Acid own notes ?
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
Color: NL?
Straw-colored
Viscosity: NL
High
Synovial Fluid: adding acetic acid does what ?
“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
Glucose, mg/dL: Septic ?
<25
much lower than blood
Glucose, mg/dL: Hemorrhagic ?
nearly equal to blood
Z-score uses?
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
Striated muscle - LDH isoenzyme ?
isoenzyme 5
Antinuclear antibody (ANA) what is it ?
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 **
What are the 2 major staining patterns ?
c-ANCA:Ab to proteinase 3 (PR3)
p-ANCA: Ab to myeloperoxidase (MPO)
DISTRACTER ON TEST IT IS PROBABLY NOT THIS ONE
NL Synovial fluid ?
Clear
Straw-colored - light yellow
color
Good mucin clot
No crystals - duh - if so
GOUT pseduogout
Antinuclear Antibody: RA Precipitin , disease ?
RA
Sjogren syndrome
Pattern: Nucleolar / anti-nucleolar ?
SLE
PSS
T-score, peak bone density is reached by age ?
30
** “our bone density compared to a average normally health 30 year old”**
DEXA: T-score ?
“normal”
Color: Septic ?
yellow to green
Aldolase is mostly used for identifying ________ or _______ cellular injury or destruction
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 **
When is Synovial fluid used?
Consider dx of:
Joint infection Arthritis Gout Pseudogout Synovitis Neoplasms involving the joint spacce
WBC , per mm3: NL ?
<200
Pattern: Homogeneous (diffuse) / anti-DNA, anti-histone, anti-DNP (nucleosomes) ?
RA
SLE
misc. disorders (anti-ssDNA)
Anticardiolipin Antibody: Pts are at higher risk for: clots
?
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
What is Anticardiolipin Antibody ?
Antiphospholipid antibody
Found in ~40% of patients with SLE
Pts are at higher risk for: clots
Uric Acid increased: decreased excretion of uric acid ?
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 ?**
A 54 yr old male presents with foot pain x 2 days. He is an alcoholic and states he gets this “twice every year”.
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)
When is Anticardiolipin Antibody used ?
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 “**
DEXA aka ?
Dual-Energy Absorptiometry
PMN %: Inflammatory ?
> equal to 50
What is uric acid ?
Nitrogenous compound that is found after breakdown of purine (found in DNA)
75% excreted by kidney, 25% excreted by GI
PMN %: Hemorrhagic ?
50-75
WBC , per mm3: Hemorrhagic ?
200-2,000
PMN %: Non-inflammatory ?
<25
RF own notes ?
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)
Pattern: Centromere / anti-centromere ?
PSS (CREST)
LDH increased with ?
Recent strenuous exercise
Skeletal muscle injury
Muscular dystrophy
Trauma to the muscle
any kind of muscle injury
Total protein, g/dL: Septic ?
3-5
When is HLA B-27 used?
HLA compatibility is used with tissue or organ transplantation and paternity testing
What is Lactic/Lactate Dehydrogenase (LDH) ?
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
Antinuclear Antibody: Anti-ENA , disease ?
SLE
MCTD
Aldolase decreased with ?
Hereditary fructose intolerance (cause AB is used to break down fructose)
Decreased muscle mass
Total protein, g/dL: Inflammatory ?
3-5
Compartment Pressure results ?
≥30mmHg in the compartment suggests fasciotomy
Total protein, g/dL: Hemorrhagic ?
4-6
Review other topics ?
Alkaline Phosphatase
Calcium/Phosphorus
Myoglobin
ESR
CRP
CK
and the facial X-rays
**CAs multiple myeloma - how the play into other disorders **
Aldolase increased: Hepatocellular disease ?
Hepatitis
Cirrhosis
cause aldolase B - primarily the liver aldolase
Glucose, mg/dL: Inflammatory ?
> 25
lower than blood
A patient is positive for Ab to proteinase-3. What is the most likely diagnosis?
wegners
HLA B-27 own notes ?
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
Synovial Fluid: Mucin clot test ?
Correlates with the viscosity
Hyaluronic acid in the fluid acts as a lubricant therefore, fluid is usually viscous
Add acetic acid to fluid
When is uric acid used?
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) **
Synovial fluid: crystals analysis ?
Observe for uric acid crystals (gout)
Calcium pyrophosphate crystals (pseudogout)
When is Anti-DNA antibody used?
Subtype of ANA
DEXA own notes ?
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 -
Color: Non-inflammatory ?
yellow
DEXA: Z-score ?
“age-matched”
WBC , per mm3: Non-inflammatory ?
200 - 2,000
Pattern: Speckled / anti Sm & RNP, anti - Ro /La, anti-Jo-1 & Mi-2, anti - Sci-70 ?
SLE
SS
PM/DM
PSS (systemic)
When is Aldolase used ?
Differentiate between neurologic causes of weakness and muscular causes of weakness.
Aldolase increased: Muscular disease ?
Muscular dystrophy ( earlier stage)
Dermatomyositis -AI condition that destroys muscular tissue
Culture: Septic ?
often positive
HLA B-27 is associated with certain autoimmune diseases (pts will be positive) ?
Reiter syndrome - reactive arthritis
Ankylosing spondylitis
Anterior uveitis
Graves disease
42 yr old female with positive ANA (rimmed pattern), anti-ds-DNA, and anticardiolipin antibody. What is the most likely diagnosis?
lupus
Uric Acid increased: Increased uric acid production ?
↑ ingestion of purines
Genetic error in purine metabolism
Hemolysis - break down of cells releases DNA
Rhabdomyolysis
What is HLA B-27?
Human Lymphocytic Antigen B27
Exists on the surface of WBCs and all nucleated cells in other tissues
RF results: titers less then ___ indicates other possible AI disease,
1:80
Indicates:
SLE
Scleroderma
Sjogren disease
PMN %: NL ? (polymorphic neutrophils )
<25
Elevated Aldolase levels are seen with primarily ?
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 **
Aldolase decreased: Decreased muscle mass ?
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
HLA B-27: presence or absence of these antigens is determined by genes on chromosome __ ?
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 ) **
Synovial Fluid what is it ?
Synovial fluid is obtained through arthrocentesis and analyzed.
WBC , per mm3: Inflammatory ?
2,000-50,000
Glucose, mg/dL: Non-inflammatory ?
nearly equal to blood
What is Aldolase ?
Enzyme used in the breakdown of glucose
Present in most tissues in the body
When do you want to use a DEXA?
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 **
Pattern: peripheral / anti-DNA (not seen on HEp-2) ?
SLE
What is RF?
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
Dx Wegener’s granulomatosis
: Autoantibodies to PR3 ?
Highly specific for WG (95-99%)
auto ABS to PR# then it is probably wegeners
Anti-DNA antibody: anti-ss-DNA?
Positive in other autoimmune diseases
Color: Hemorrhagic ?
rusty brown to red
Antinuclear Antibody: Antinucleolar , disease ?
Scleroderma
SLE
Synovial fluid: cell counts should be low: RBC NL?
<2000 RBCs/mL
What is a DEXA scan ?
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 **
Aldolase increased: Muscular injury ?
Muscular trauma
Ischemic process
Anti-DNA antibody: anti-ds-DNA ?
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 **
Viscosity: Septic ?
Variable
Clarity: NL ?
Transparent
How are uric acid serum levels determined ?
Serum level determined by rate of production (liver) and rate of excretion (primarily kidney)
When is LDH used?
Diagnose injury or disease involving the heart, liver, blood cells, kidneys, skeletal muscle, brain or lungs.
Antinuclear Antibody: Anti-Jo-1 antihistadyl , disease ?
Polymyositis
dermatomyositis
Arthroscopy potential complications ?
Infection
Hemarthrosis - bleeding
Swelling
Thrombophlebitis
inflammation of the vasculature - clots in superficial venous system
Joint injury
Synovial membrane rupture
Dx Wegener’s granulomatosis: Causes regional systemic vasculitis ?
Small arteries in the kidneys, lungs, and upper resp tract are damaged by granulomatous inflammation
what is Arthroscopy ?
Procedure used to examine the joint interior using an endoscope
RF results: titers greater than _____ is positive ?
1: 80
pos. for RA
What is Antineutrophil Cytoplasmic Antibody?
ANCAs are Ab directed against cytoplasmic components of neutrophils
Viscosity: Inflammatory ?
Low
Culture: Inflammatory ?
Negative
Culture: Hemorrhagic ?
Negative
