Rheumatology

Question 1

How are diagnosis made

Answer 1

Arthrocentesis and joint fluid analysis

Question 2

Common sites for joint aspiration

Answer 2

Shoulder
Elbow
Wrist
Hip
Knee
Ankle

Question 3

Characteristics of normal synovial fluid

Answer 3

Highly viscous (hyaluronic acid)
Clear
Acellular
Protein and Gluose (not specific)

Question 4

Categories of joint effusions

Answer 4

noninflammatory
inflammatory
septic
hemorrhagic

Question 5

What are you looking for on joint fluid analysis

Answer 5

Gross appearance
Microscopic exam
Gram stain & culture
Presence of crystals

Question 6

Non inflammatory disease states

Answer 6

OA
Traumatic arthritis
Osteonecrosis
Charcot arthropathy

Question 7

Inflammatory disease states

Answer 7

RA
SLE
Poly/Dermatomyositis
Systemic sclerosis

Question 8

Septic disease states

Answer 8

Bacterial

Fungal

Question 9

Hemorrhagic disease states

Answer 9

Traumatic tap
Trauma
Neoplasia
Coagulopathy

Question 10

WBC

Answer 10

Normal

Question 11

WBC

Answer 11

Non-inflammatory

Question 12

WBC > 100000

Answer 12

Septic (until proven otherwise)

Question 13

50000 - 100000

Answer 13

Make sure you rule out sepsis

Answer 14

Non inflammatory

Question 15

Gout

Answer 15

Monosodium urate crystals
Negatively birefringent; needle shape
intra/extra cellular

Question 16

Pseudogout

Answer 16

Calcium pyrophosphate
Positive birefringent; rhomboid shape
Intra/extracellular

Question 17

How is birefringence determined

Answer 17

Polarized light microscopy

Question 18

What is the gold standard for evaluating crystals

Answer 18

Polarized light microscopy

Question 19

What is birefringence

Answer 19

Ability to refract light rays (use compensator filters)`

Question 20

What is the down side of Rheumatoid factor

Answer 20

Poor specificity (autoimmune, rheumatic and non-rheumatic dz)

Question 21

What does a positive ANA (Anti Nuclear Antibodies) consist of

Answer 21

Titer and staining pattern (outline, speckled, homogenous, nucleolar)

Question 22

Diseases w/ positive ANA

Answer 22

RA
SLE
Scleroderma
CREST
Poly/Dermamyositis

Question 23

Anti-dsDNA

Answer 23

SLE (malar rash)

Titer decreases w/ successful therapy and increases w/ exacerbation or meds

Question 24

Anti-Smith (Anti-Sm)

Answer 24

SLE

Question 25

Anti-Ro/SSA, Anti-La/SSB

Answer 25

Sjorgen (diagnostic)

Titers decrease as it becomes less active

Question 26

Anti-scleroderma-70 aka Antitopoisomerase I antibody

Answer 26

Systemic sclerosis (Scleroderma)
Absence of antibody doesnt rule out scleroderma

Question 27

Anticentromere (ACA)

Answer 27

CREST

Question 28

ESR/CRP

Answer 28

ESR ≥ 40 (forty) diagnostic fo polymyalgia rheumatica

Elevated ESR; think Giant cell temporal arteritis and cn cause blindness

Question 29

Human Leukocyte Antigen (HLA-b27)

Answer 29

Ankylosising spondylitis

Also seen in : Reactive arthritis, psoriatic arthritis, arthritis/spondylitis associated w/ IBD

Question 30

Antiphospholipid antibodies

Answer 30

Antiphospholipid syndrome
primary condition or secondary to underlying diseases usu SLE
Female recurrent fetal loss w/ Hx of thrombosis

Question 31

Chronic symmetric polyarthritis, positive RF, +/- anti CCP

Answer 31

RA

Question 32

Polyarthritis, rash, nephritis, serositis, +ve ANA, anti-DS DNA +/- anti-Smith

Answer 32

SLE

Question 33

Acute onset of proximal myalgia, morning stiffness, >55yo, high ESR, Prompt improvement with low dose corticosteroids

Answer 33

Polymyalgia rheumatica

Question 34

Tender points, non-restorative sleep, normal test results

Answer 34

Fibromyalgia

Question 35

Sicca complex, anti-Ro/SSA, Anti-La/SSB

Answer 35

Sjorgens

Question 36

CREST syndrome, anti SCL-70, ACA

Answer 36

Systemic sclerosis (scleroderma)