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Clin Lab Med > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

polyarthralgias, discoid or malar rash, nephritis, serositis, neuro disorders, and heme disorders are all sx of what disease?

A

SLE

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2
Q

What serology would most likely be positive in pt w/ SLE?

A

ANA
Anti-dsDNA
Anti-Sm
Anti-phospholipid Ab

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3
Q

What is the cardinal features of SLE disease?

A

+ ANA (be aware test is not specific for just SLE)

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4
Q

How are ANA lab results reported?

A

2 parts:

  1. Titer of Ab w/ serial dilution (1:640)
  2. Staining pattern of Ab (homogenous, speckled, nucleolar, centromere)
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5
Q

Does a positive ANA always mean SLE?

A

No

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6
Q

If pt w/ suspected SLE has positive ANA what is the next step?

A

Review ANA Ab subtypes: Ant-dsDNA and Anti-smith

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7
Q

What ANA Ab subtypes is most specific to SLE?

A

Anti-dsDNA

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8
Q

What ANA Ab subtypes will remain positive even if pt is in remission?

A

Anti-smith (once positive, it is always positive)

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9
Q

Anti-phospholipid Abs are seen in pts with what disease?

A

Anti-phospholipid syndrome

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10
Q

What are the sx of antiphospholipid syndrome?

A

Arterial/VTE, recurrent fetal loss

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11
Q

Pt presents with chronic morning stiffness lasting about 2 hrs and states that OTC NSAIDs provide little improvements. On exam you find erythema and STS of PIP and MCPs (DIPs are spared). You also note an ulnar deviation at MCPs. What disease are you concerned about?

A

RA

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12
Q

What tests should you order if concerned about RA? (4)

A

RF, ANA, ESR, Anti-CCP

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13
Q

Is RF very specific for RA? What other test should you order to help confirm suspicion of RA?

A

No. Only moderate specificity (can be associated with rheumatic or non rheumatic disease).

Order w/ Anti-CCP

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14
Q

Is Anti-CCP specific for RA?

A

Yes. Specificity is high

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15
Q

Positive Anti-Ro/SSA, Anti-La/SSB and ANA associated w/ what disease?

A

Sjogren’s syndrome

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16
Q

If you suspected systemic sclerosis in a pt, what Abs will be positive?

A

ANA, Anticentromemere (ACA), Anti-scleroderma-70

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17
Q

Acute onset of proximal aching and stiffness to shoulders and hips, elevated ESR/CRP is concerning for what disease?

A

PMR

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18
Q

Giant cell temporal arteritis is associated w/ what disease?

A

PMR

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19
Q

Pt presents w/ diffuse generalized pain, fatigue and feeling “foggy”. Exam is unremarkable. What is your suspected DX?

A

Fibromyalgia

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20
Q

In a pt w/ suspected fibro. What general trend do you expect to see in their labs?

A

All normal

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21
Q

PT presents w/ ongoing LBP and progressive stiffness that he states is worse in the morning and with rest, but improves with activity. Review of pt’s medical hx revels plantar fasciitis. What disease are you concerned about?

A

Ankylosing spondylitis

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22
Q

PT presents w/ thickening and tightening of their skin and pain in their fingers when exposed to cold temperatures. On exam you observe difficulty swallowing and talangiectasias on the skin. What disease are you concerned about?

A

Systemic sclerosis

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23
Q

CREST, associated w/ systemic sclerosis, stands for what?

A

Calcinosis, raynauds, esophageal dysfunctions, sclerodactyly, talangiectasias

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24
Q

ANA is positive in what % of pts w/ systemic sclerosis?

A

95%

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25
Q

SICCA complex is associated with what disease?

A

Sjogren’s

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26
Q

HLA-B27 and bamboo spine are concerning for what?

A

Ankylosing spondylitis (AI)

27
Q

When would you consider performing an arthrocentesis?

A

If pt w/ effusion or signs of inflammation/ infection of the joint

28
Q

What is the most feared complication of an arthrocentesis?

A

Septic joint

29
Q

A glucocorticoid injection into the joint can cause what potential SEs? (3)

A

Tendon rupture, nerve damage, osteonecrosis

30
Q

What are minor atrophies associated w/ an arthrocentesis? (2)

A

Skin atrophy, hypopigmentation

31
Q

Gross inspection of synovial fluid will evaluate what? (3)

A

Clarity, color, viscosity

32
Q

Microscopic assessment of synovial fluid will look at what? (3)

A

Gram stain and culture, cell count, crystal detection

33
Q

What are the 4 categories of joint effusions?

A

Noninflammatory, inflammatory, septic, hemorrhagic

34
Q

What are the 3 causes of noninflammatory joint effusions?

A

OA, trauma, avascular necrosis

35
Q

What are the 5 potential causes of inflammatory joint effusion?

A

Septic arthritis, RA/SLE, spondyloarthritis, lyme disease, crystal induced mono-arthritis

36
Q

What can cause a septic joint?

A

Bacterial, fungal or mycobacterial infection

37
Q

Hemorrhagic joint effusion can result for what? (4)

A

Hemophilia, trauma (+/- fx), tumor (malignant or benign), anticoagulation

38
Q

What synovial fluid WBC count will tell you if a pt’s joint effusion is inflammatory or noninflammatory?

A

> 2000 WBC/mm = inflammatory

39
Q

Is joint fluid that is transparent, clear, highly viscous, w/ WBC < 200 (PMN < 25%) concerning or normal?

40
Q

How is noninflammatory joint fluid different from normal joint fluid?

A

Yellow in color, 0-2000 WBC/mm

41
Q

Joint fluid that is translucent-opaque, yellow, thick, and has WBCs > 2000 (PMNs ≥50%) is concerning for what cause of joint effusion?

A

Inflammatory

42
Q

Joint fluid that is opaque, yellow/green, WBCs > 20,000-100,000 (PMN ≥ 75%) and has a positive culture is concerning for what cause of joint effusion?

43
Q

Joint fluid that is bloody and red is concerning for what cause of joint effusion?

A

Hemorrhagic

44
Q

Is it possible to have a septic joint if WBC is <100,000?

A

Yes! There is not a specific WBC cut off for septic arthritis.
(BUT the likelihood of septic arthritis increases at synovial fluid WBC count increase)

45
Q

If joint fluid w/ WBC count > 100,00 how should it be treated?

A

Tx as septic until proven otherwise

46
Q

If neutrophils (PMNs) are <25% what does this mean?

A

Non-inflammatory

47
Q

If neutrophils (PMNs) are ≥ 75% what does this mean?

48
Q

What does the joint fluid look like for a pt with OA?

A

yellow, WBCs < 2,000, PMNs < 25%, negative culture

49
Q

What does the joint fluid look like for a pt with RA?

A

yellow, WBCs >2,000, PMNs ≥50%%, negative culture

50
Q

What is the definitive dx for pt w/ septic arthritis?

A

Synovial fluid arthrocentesis

51
Q

Is a septic joint an urgent condition?

A

Yes! If not treated, it will result in further joint destruction

52
Q

Consuming large amounts or meat and drinking alcohol can trigger flares of what disease?

53
Q

How will synovial fluid aspirated rom a gouty joint appear?

54
Q

Detection of what during microscopic exam of fluid aspirated from a gout joint will help make a dx?

A

Crystal detection

55
Q

What crystals are associated with gout?

A

Monosodium urate crystals (MSU)

56
Q

XR of a joint shows chonedrocalcinosis (cartilage calcification). What disease are you concerned about? What type of crystal would you expect to see on arthrocentesis crystal analysis?

A

Pseudogout. Calcium pyrophosphate dihydrate (CPPD)

57
Q

What is the gold standard for evaluating crystals?

A

Polarized light microscopy (uses “red compensator”)

58
Q

What term refers to a particular material’s ability to refract light rays?

A

Birefringent

59
Q

If a specimen contains birefringent material, what happens to the light rays?

A

Changes their direction (refracts)

60
Q

If on light microscopy you note yellow (negatively birefringent) crystals, what is the likely cause?

A

Monosodium urate (MSU)

61
Q

If on light microscopy you note blue (positively birefringent) crystals, what is the likely cause?

A

Calcium pyrophosphate deposition (CPPD)

62
Q

Negatively birefringent and needle shaped crystals are indicative of what disease?

63
Q

Positively birefringent and prism (rhomboid) shaped crystals are indicative of what disease?

A

Pseudogout

Clin Lab Med (4 decks)

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