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Rheum Clin Lab Flashcards

1
Q

workup for monoarticualr joint pain

A

imaging
arthrocentesis w/ synovial fluid analysis
+/- labs

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2
Q

labs: hemarthrosis w/o trauma

A

PT/INR, PTT, CBC

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3
Q

labs: evidence of joint inflammation without infection or crystals

A

ESR/CRP, CMP, CBC
testing for systemic rheumatic disease IF suspicion for that disease
testing for lyme disease if suspicion is high

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4
Q

labs: synovial biopsy - rare

A

fungal infections
sarcoidosis

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5
Q

differential dx for monoarticular joint pain

A

OA
injury
septic arthritis
crystal induced
neoplasms

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6
Q

workup for polyarticular w/ synovitis

A

CBC, CMP, urinalysis
athrocentesis w/ synovial fluid analysis
labs based on suspicion
- ESR/CRP
suspected systemic illness
viral antibodies
imaging - rarely needed
synovial biopsy - rare

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7
Q

differential dx for polyarticular w/ synovitis

A

infection
reactive arthritis
psoriatic arthritis
rheumatic arthritis
crystal induced
systemic rheumatic illness
other system illness or malignancy
juvenile idiopathic arthritis

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8
Q

workup for polyarthritis w/o synovitis

A

CMP
TSH/PTH
imaging - x-ray
screening for depression

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9
Q

differential dx for polyarthritis w/o synovitis

A

fibromyalgia
OA
neuropathic pain
depression
metabolic bone disorder
endocrine disorder
plasma cell myeloma

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10
Q

arthocentesis indications

A

joint effusion/pain - diagnosis of underlying pathology
- infection
- arthritis
- crystalline arthritis (gout, pseudogout)
- synovitis
- neoplam

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11
Q

arthocentesis technique

A

local anesthetic given
fluid collected from joint space with sterile technique

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12
Q

therapeutic indications for arthocentesis

A

injection of anti-inflammatory medications into the joint

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13
Q

normal fluid analysis

A

viscosity - high
color - colorless to straw
clarity - translucent
WBC - <200
PNM - <10%
culture - negative
protein - 1-3

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14
Q

noninflammatory fluid analysis

A

viscosity - high
color - straw to yellow
clarity - translucent
WBC - 200-3K
PNM - <10%
culture - negative
protein - 1-3

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15
Q

inflammatory fluid analysis

A

viscosity - low
color - yellow
clarity - translucent-opaque
WBC - 2k-50k
PMN - Often >50%
culture - negative
protein - 3-5

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16
Q

septic fluid analysis

A

viscosity -variability
color - variable
clarity - opaque
WBC >50K
PNM - >75%
culture - often positive
protein - 3-5

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17
Q

CI athrocentesis

A

artificial joint/replacement joint
lesions on skin overlying injection site

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18
Q

gout clinical picture

A

hyperuricemia
age - 40+
sex: male>female

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19
Q

signs and symptoms of gout

A

sudden onset
monoarticular - small joints
severe pain
swelling, erythema, warmth,
+/- tophi

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20
Q

calcium pyrophosphate dihydrate deposition (CPPD)

A

aka pseudogout
female/eldery predominance
knee is most common joint

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21
Q

s/sx of calcium pyrophosphate dihydrate deposition (CPPD)

A

acute, subacute, chronic
monoarticular or polyarticular
mild or moderate pain
mimics other types of arthritis
high recurrence
+/- chondrocalcinosis

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22
Q

workup: gout

A
  • podegra - great toe
  • monosodium urate crystals
  • yellow negative birefringent
  • needle shaped
    serum uric level
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23
Q

workup: calcium pyrophosphate dihydrate deposition (CPPD)

A
  • calcium pyrophosphate dihydrate crystals
  • blue-positively birefringement
  • rhomboid shape
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24
Q

what must you rule out when diagnosis gout

A

septic arthritis

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25
Tophi - firm yellow or white papules or nodules commonly seen in gout
26
gout - yellow-negative birefringent
27
CPPD or pseudogout - positive birefringent
28
rhumatoid arthritis clinical picutre
etiology - autoimmine age - 35-50 sex -female
29
exam for rhematoid arthritis
ulnar deviation swan neck deformity boutonniere deformity
30
work up: rheumatoid arthritis
polyarticular, symmetric arthritis labs RF + Anti-CCP + ESR/CRP ↑ imaging - bony erosions - deformities
31
rheumatoid factor (RF) indications
patients with clinical symptoms of RA
32
Rhematoid Factor (RF) explanation
IgM antibodies made against IgG present in ~70% of patients with RA
33
Which lab marker is associated with RA but is not specific?
Rhematoid Factors can be elevated in other systemic rheumatic disorders, granulomatous disease, chronic infections, and cancer
34
indications for anti-cyclic citrullinated peptide antibodies (anti-CCP or ACPAs)
patients with clinical symptoms consistent with RA patients with undifferentiated arthritis prognostic marker in patients diagnosed with RA
35
explanation of anti-CCP
autoantibodies against citrullinated proteins citrullination is a post-translational modification of arginine to citrulline
36
Which lab marker is the most specific for rheumatoid arthritis (RA)?
anti-CCP
37
erythrocyte sedimentation rate (ESR)
to assess inflammatory state NOT specific
38
C-Reactive Protein (CRP)
to assess inflammatory state NOT specific
39
Normal hand XR
40
hand XR with RA
41
psoriatic arthritis clinical picture
must have a diagnosis of psoriatic arthritis
42
which populations is the prevalance psoriatic arthritis increased in?
HIV Human Leukocyte Antigen B27 (HLA-B27)
43
s/sx of psoriatic arthritis
can affect all size joints - commonly the DIP of fingers and toes manifests in many different patterns may occur before or after dermatologic findings
44
workup for psoriatic arthritis
- suspect in patients with psoriasis + arthritis RF (mild) Anti-CCP (rare)
45
what are the main distinguishing factors between Psoriatic arthritis and RA
dactylitis - sausage digits joint asymmetry DIP and sacroiliac involvement
46
Psoriatic Arthritis - "pencil in cup"
47
juvenile idiopathic arthritis
group of chornic, non-infectious arthropathies that occur in children
48
juvenile idiopathic arthritis clinical picture
age of onset - <16 years sex - depends on variant
49
s/sx of juvenile idiopathic arthritis
Vague joint pain Daily low-grade fever
50
expected labs for juvenile idiopathic arthritis
CBC- WBCs and plts ↑ ESR & CRP ↑ Ferritin ↑↑↑ RF and Anti-CCP neg
51
reactive arthritis clinical picture
usually develops 1-4 weeks after infection - typically GI or GU sex after GU - male >female after GI - equally common
52
s/sx of reactive arthritis
Preceding infection Asymmetric large joint Reiter’s - urethritis, arthritis, conjuctivitis
53
when to suspect reactive arthritis
should suspect in patients with acute, asymmetric arthritis affecting large joint in lower extremity after GI/GU infection
54
expected labs for reactive arthritis
ESR & CRP ↑ Arthrocentesis c/w inflammatory synovitis
55
Systemic Lupus Erythematosus (SLE) clinical picture
etiology - autoimmune w/ multisystem involvement age - any but more prevalent in the 40s sex - females > males race - black/asain
56
SLE s/sx
multisystem involvement malar rash
57
workup for SLE
ANA + Anti-dsDNA + Anti-Sm + Anti-chromatin + Anti-histone + (drug induced)
58
antinuclear antibodies (ANA) indications
initial test if SLE is suspected also often ordered as part of the work up in AKI and CKD
59
explanation of ANA
- detects autoantibodies against nuclear components - reported as a titer - higher titer indicates more active disease
60
what does negative ANA mean
helps to r/o SLE - highly sensitive
61
what does positive ANA mean
does not diagnose SLE - low specificity - can be positive in people without an autoimmune disorder
62
Anti-double stranded DNA (anti-dsDNA)
indications - positive ANA - diagnosis for SLE - monitoring SLE activity
63
explanation of Anti-dsDNA
high titers associated with SLE low titers can be found in other diseases and w/ certain drugs levels change with disease activity
64
extractable nuclear antigen antibody panel
can be ordered as a panel and can include generally 4-6 autoantibodies
65
anti-smith (anti-sm) indications
positive ANA diagnosis of SLE
66
explanation for anti-sm
high specificity for SLE low sensitivity - titers will remain positive after disease activity has subsided
67
anti-ribonucleoprotein (anti-RNP) indications
positive ANA concern for mixed connective tissue disease
68
importance of anti-RNP
hallmark of mixed connective tissue disease - nearly 100% sensitive - if negative, MCTD is highly unlikely
69
Anti-Ro/SSA indications
positive ANA concern for sjogrens sundrome
70
explanation of anti-Ro
autoantobodies that recognize one of two cellular proteins primarly found in sjogren syndrome can be positive ANA - negative SLE
71
Anti-La indications
Positive ANA concern for sjogrens syndrome
72
Anti-La/SSB explanation
autoantibodies that target a protein in the nucleus that goes back and forth between cytoplasm and nucleus
73
what does positive Anti-La/SSB indicate
usually positive in Sjogren's syndrome - high sensitive and specific negative in SLE
74
anti-chromatin indications
positive ANA concern for SLE - drug induced
75
What is the significance of anti-chromatin
- Common in SLE - Present in nearly all drug-induced SLE -Correlate with lupus-related kidney damage -Form immune complexes deposited in glomeruli
76
anti-histone indications
positive ANA suspicion for drug-induced lupus
77
what is the significance of anti-histone
autoantibodies target protein portions of nuclesomes - present in virtually all cases of drug induced lupus
78
common drugs that cause drug-induced SLE
isoniazid hydralazine procainamide anti-seizure meds
79
anti-phospholipid syndrome (APS)
- Syndrome causing arterial, venous, or microvascular thrombosis - Can also cause recurrent pregnancy loss - Triggered by antibodies against phospholipid-bound proteins
80
what is the connection between SLE and APS
APS can occur as a primary condition or secondary to SLE A subset of SLE patients have APS All SLE patients should be screened for APS
81
What labs are used to diagnose APS?
Anti-cardiolipin antibodies Anti-β2 glycoprotein antibodies Lupus anticoagulant
82
When should you screen for APS?
During initial SLE diagnosis In patients with recurrent pregnancy loss After unprovoked thrombotic events
83
sjogren syndrome clinical picture
etiology - infiltration of salivary ducts and other exocrine glands age - 40-55 sex - Females > Male race - predominantly Caucasian
84
s/sx of sjogren syndrome
dry mouth (xerostomia) dry eyes (xerophthalmia) dry skin dryness of pretty much all mucous membranes
85
workup for sjogrens syndrome
Anti-Ro/SSA + Anti-La/SSB + ANA and RF often + ESR + CBC-Hgb & WBCs ↓
86
tests for sjogrens sydrome
schirmer test sialometry salivary gland biopsy
87
systemic sclerosis clinical picture
aka scleroderma age - 20-50 y/o sex: females > male
88
classifications of systemic sclerosis
- limited cutaneous systemic sclerosis (CREST) - diffuse cutaneous systemic sclerosis - systemic sclerosis sine scleroderma
89
limited cutaneous systemic sclerosis (CREST)
Calcinosis cutis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiestasia
90
what labs should you expect with CREST
+ ANA + anti-centromere Ab
91
what labs should you expect with diffuse cutaneous systemic sclerosis
ANA + Anti-Scl70 + (Diffuse) Anti-RNA polymerase + (Diffuse) - correlated with disease severity
92
mixed connective tissue disorder (MCTD) clinical picture
typically evolves into systemic sclerosis or SLE age - adolescence sex - female > male
93
s/sx of mixed connective tissue disorder
Raynaud’s phenomenon Diffuse hand swelling Polyarthralgia Associated w/ lung disease
94
work up for MCTD
+ ANA + Anti-RNP + RF - Anti-Sm/Anti-dsDNA
95
ankylosing spondylitis clincal picture
age - 20s-30s sex - men > women appears to have a genetic component
96
s/sx of ankylosing spondylitis
back pain can have extra-articular manifestations: - anterior uveitis - psoriasis - IBD
97
work up of ankylosing spondylitis
+/- HLA B27 - positive increases likelihood imaging - look for sacroilitis
98
ankylosing spondylitis - "Bamboo spine"
99
Polymyositis clincal picture
age - 40-60 Female > Men
100
s/sx of polymyositis
Progressive proximal muscle weakness
101
work up for polymyositis
Anti-Jo + CPK ↑ Aldolase ↑ ESR & CRP - muscle biopsy
102
dermatomyositis
age - 40-60 female > men
103
s/sx dermatomyositis
Progressive proximal muscle weakness Skin findings -Heliotrope rash -Gottron papules -Shawl sign Increased incidence ILD
104
workup for dermatomyositis
Anti-Jo + CPK ↑ Aldolase ↑ ESR & CRP imaging - CXR to r/o ILD invasive dx - muscle biopsy
105
Polymyalgia Rheumatica clincal picture
age - 50+ Female > Male
106
polymyalgia rheumatica s/sx
back pain and stiffness in neck, shoulders, and hip girdle
107
workup for polymyalgia rhematica
labs - ESR & CRP ↑ - ANA – - CPK nml imaging - MRI - may see muscle edema invasive dx - EMG, eval for GCA
108
heiotrope rash - dermatomyositis
109
shawl sign - dermatomyositis
110
Gottron papules - dermatomyositis
111
giant cell arteritis
age - 70s Female > Male medium and large arteries off aortic arch
112
workup for giant cell arteritis
+ ESR/CRP MRI/CT narrowing of subclavian U/S temporal artery Temporal artery bx
113
polyarteritis nodosa
age - 50-70 Medium arteries Spares lungs
114
workup of polyarteritis nodosa
Labs - ESR & CRP usually ↑ - Screen for Hep B&C Biopsy
115
Granulomatosis w/ Polyangiitis (GPA)
age - 40s Small to medium vessels +Granuloma formation
116
work up for granulomatosis w/ polyangiitis (GPA)s
labs - c-ANCA PR3 + - ESR & CRP ↑ - Hematuria imaging - CT Chest assess lung involvement biopsy affected organ
117
Microscopic polyangiitis
Small vessels No granuloma
118
workup for Microscopic polyangiitis
labs - p-ANCA MPO + - ESR & CRP ↑ - Hematuria imaging - CT Chest assess lung involvement biopsy of affected organ
119
fibromyalgia
age - young-middle age Female > Male
120
fibromyalgia s/sx
Non-articular, non-inflammatory generalized aching Muscle tenderness Muscle stiffness Fatigue Mental cloudiness Poor sleep
121
workup for fibromyalgia
diagnosis of exclusion - Hep C - thyroid - ESR/CRP - - CBC
122
what is the do not miss consideration for giant cell arteritis
temporal arteritis can lead to blindness

Clin Lab (3 decks)

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