Rheumatology

Question 1

when should joint aspiration not be done?

Answer 1

if skin infection is suspected

Question 2

what should normal synovial fluid look like?

Answer 2

clear and colorless

Question 3

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

Answer 3

septic
crystals

Question 4

An inflammatory process of multiple joints indicates … (1)

Answer 4

rheumatoid arthritis

Question 5

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

Answer 5

osteoarthritis
trauma

Question 6

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

Answer 6

osteoarthritis

Question 7

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

Answer 7

bursitis
tendonitis

Question 8

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

Answer 8

fibromyalgia

Question 9

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

Answer 9

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

Question 10

what do elevated levels of ESR indicate?

Answer 10

inflammation

Question 11

what does the ESR test measure?

Answer 11

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

Question 12

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

Answer 12

c-reactive protein

Question 13

what does an elevated CRP indicate?

Answer 13

significant inflammatory process

Question 14

what is the high-sensitivity CRP used for?

Answer 14

cardiovascular processes

Question 15

what does rheumatoid factor look for?

Answer 15

antibodies against IgG

Question 16

what is rheumatoid factor most commonly associated with?

Answer 16

rheumatoid arthritis

Question 17

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

Answer 17

autoimmune disorder
inflammatory disease
infection
cancer

Question 18

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

Answer 18

seronegative

Question 19

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

Answer 19

anticitrullinated protein antibodies (ACPA)

Question 20

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

Answer 20

ACPA (anticitrullinated protein antibodies)

Question 21

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

Answer 21

immunoglobulins (antibodies)

Question 22

immunoglobulin secreted into mucous, saliva, tears, and colostrum

Answer 22

IgA

Question 23

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

Answer 23

IgD

Question 24

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

Answer 24

IgE

Question 25

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

Answer 25

IgG

Question 26

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

Answer 26

IgM

Question 27

related to fluid accumulation around, not inside the joint space

Answer 27

non-articular

Question 28

what are 3 misleading factors of an ESR?

Answer 28

pregnancy menses obesity

Question 29

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

Answer 29

when used in cardiovascular risk assessment

Question 30

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

Answer 30

older smokers

Question 31

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

Answer 31

ACPA

Question 32

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

Answer 32

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

Question 33

5 rheumatic diseases that would give a positive RF

Answer 33

Sjogren syndrome RA Systemic Sclerosis SLE Mixed connective tissue disease

Question 34

5 non-rhematic conditions that would give a positive RF

Answer 34

mononucleosis hepatitis malaria/TB subacute bacterial endocarditis chemo/radiation

Question 35

heterogenous autoantibodies directed against cellular nucleic acids and nucleoproteins

Answer 35

antinuclear antibodies

Question 36

when is ANA not suitable as a screening test?

Answer 36

if asymptomatic

Question 37

a high ANA level is suspicious for what?

Answer 37

autoimmune disorder

Question 38

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

Answer 38

Double-stranded DNA (Anti-dsDNA)

Question 39

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

Answer 39

Smith (Anti-Sm)

Question 40

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

Answer 40

nucleosome (anti-histone)

Question 41

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

Answer 41

Anti-Ro/SSA and Anti-La/SSB

Question 42

autoantibodies directed against neutrophil cytoplasmic antigens

Answer 42

antineutrophil cytoplasmic antibodies (ANCAs)

Question 43

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

Answer 43

vasculitic syndromes

Question 44

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

Answer 44

complement (C3 & C4)

Question 45

which is the most abundant complement protein?

Answer 45

C3

Question 46

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

Answer 46

C4

Question 47

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?

Answer 47

high levels

Question 48

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

Answer 48

low levels

Question 49

why does complement depletion occur?

Answer 49

due to activation of the immune system

Question 50

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

Answer 50

human leukocyte antigen B27

Question 51

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

Answer 51

ankylosing spondylitis reiter syndrome anterior uveitis

Question 52

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

Answer 52

not clinically significant