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Lab Med > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

when should joint aspiration not be done?

A

if skin infection is suspected

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2
Q

what should normal synovial fluid look like?

A

clear and colorless

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3
Q

An inflammatory process of 1 or 2 joints indicates … (2)

A

septic
crystals

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4
Q

An inflammatory process of multiple joints indicates … (1)

A

rheumatoid arthritis

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5
Q

A non-inflammatory process of 1 or 2 joints indicates … (2)

A

osteoarthritis
trauma

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6
Q

A non-inflammatory process of multiple joints indicates … (1)

A

osteoarthritis

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7
Q

A non articular process of 1 or 2 joints indicates … (2)

A

bursitis
tendonitis

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8
Q

A non-articular process of multiple joints indicates … (1)

A

fibromyalgia

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9
Q

which 2 tests should we start with when suspecting a rheumatologic problem?

A

erythrocyte sedimentation rate (ESR)
C-reactive protein (CRP)

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10
Q

what do elevated levels of ESR indicate?

A

inflammation

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11
Q

what does the ESR test measure?

A

how quickly RBCs fall to the bottom of tube in 1 hour

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12
Q

a plasma protein produced by the liver that is active in the complement pathway and cellular immune response

A

c-reactive protein

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13
Q

what does an elevated CRP indicate?

A

significant inflammatory process

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14
Q

what is the high-sensitivity CRP used for?

A

cardiovascular processes

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15
Q

what does rheumatoid factor look for?

A

antibodies against IgG

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16
Q

what is rheumatoid factor most commonly associated with?

A

rheumatoid arthritis

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17
Q

what do positive levels of rheumatoid factor indicate? (4)

A

autoimmune disorder
inflammatory disease
infection
cancer

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18
Q

what are RA patients with RF titers within the normal range called?

A

seronegative

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19
Q

which test finds autoantibodies against citrullinated proteins by binding to the amino acid citrulline?

A

anticitrullinated protein antibodies (ACPA)

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20
Q

which test, if positive, is a clinical feature of RA at 90-95% specificity?

A

ACPA (anticitrullinated protein antibodies)

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21
Q

Y-shaped proteins that recognize unique markers (antigens) on pathogens

A

immunoglobulins (antibodies)

22
Q

immunoglobulin secreted into mucous, saliva, tears, and colostrum

A

IgA

23
Q

immunoglobulin that is a B-cell receptor and stimulates release of IgM

A

IgD

24
Q

immunoglobulin that binds to mast cells and basophils. Active during allergies and act as an antiparasitic

A

IgE

25
Q

immunoglobulin that binds to phagocytes; is the main blood antibody for secondary responses and crosses the placenta

A

IgG

26
Q

immunoglobulin that is the main antibody of primary responses. Acts as a B-cell receptor and is active in immune system memory

A

IgM

27
Q

related to fluid accumulation around, not inside the joint space

A

non-articular

28
Q

what are 3 misleading factors of an ESR?

A

pregnancy
menses
obesity

29
Q

when should CRP be measured twice, 2 weeks apart and the values averaged?

A

when used in cardiovascular risk assessment

30
Q

in what type of healthy patients could RF be falsely positive? (2)

A

older
smokers

31
Q

which test is a predictor of RA in patients with undifferentiated arthritis?

A

ACPA

32
Q

what is the management of a patient who tests positive in an anticitrullinated protein antibody?

A

aggressive treatment early + close follow-up to control systemic inflammation

33
Q

5 rheumatic diseases that would give a positive RF

A

Sjogren syndrome
RA
Systemic Sclerosis
SLE
Mixed connective tissue disease

34
Q

5 non-rhematic conditions that would give a positive RF

A

mononucleosis
hepatitis
malaria/TB
subacute bacterial endocarditis
chemo/radiation

35
Q

heterogenous autoantibodies directed against cellular nucleic acids and nucleoproteins

A

antinuclear antibodies

36
Q

when is ANA not suitable as a screening test?

A

if asymptomatic

37
Q

a high ANA level is suspicious for what?

A

autoimmune disorder

38
Q

type of ANA antibody that is specific for SLE; rises when disease flares, falls when it subsides, and is helpful in disease management

A

Double-stranded DNA (Anti-dsDNA)

39
Q

type of ANA antibody that is specific for SLE and titers remain positive after disease has subsided and other antibodies have normalized, making it a useful diagnostic tool

A

Smith (Anti-Sm)

40
Q

type of ANA antibody that targets the protein portion of nucleosomes in DNA and is present in all cases of drug-induced lupus

A

nucleosome (anti-histone)

41
Q

type of ANA antibody that strongly supports the diagnosis of Sjogren if positive

A

Anti-Ro/SSA and Anti-La/SSB

42
Q

autoantibodies directed against neutrophil cytoplasmic antigens

A

antineutrophil cytoplasmic antibodies (ANCAs)

43
Q

a positive antineutrophil cytoplasmic antibody (ANCA) indicates what disease process?

A

vasculitic syndromes

44
Q

test that measures the amount of complement proteins (C1-C9) in the blood and their activity to identify and fight off disease

A

complement (C3 & C4)

45
Q

which is the most abundant complement protein?

A

C3

46
Q

which compliment protein is more sensitive and specific to smaller changes?

A

C4

47
Q

what levels of complement (C3 & C4) proteins reflect an inflammatory process like cancer, viral infection, non-alcoholic liver disease, obesity, diabetes, heart disease, and autoimmunity?

A

high levels

48
Q

what levels of complement (C3 & C4) proteins reflect systemic lupus erythematosus, rheumatoid arthritis, or alcoholic liver disease?

A

low levels

49
Q

why does complement depletion occur?

A

due to activation of the immune system

50
Q

antigen on the surface of WBCs encoded by the B locus - helps to differentiate self from foreign material

A

human leukocyte antigen B27

51
Q

what does a positive result in human leukocyte antigen B27 indicate? (3)

A

ankylosing spondylitis
reiter syndrome
anterior uveitis

52
Q

what does it mean when an asymptomatic patient tests positive for human leukocyte antigen B27, but does NOT have any family history?

A

not clinically significant

Lab Med (19 decks)

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