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Clinical Laboratory Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

The following presentation is concerning for…

Symmetric polyarthritis
Pleuritic CP
Raynaud’s
Malar Rash/Discoid rash

A

SLE

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2
Q

Active SLE is indicated with what level of C3/C4?

A

low complement levels

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3
Q

What SLE specific dx labs would you order for a suspected case of SLE?

A

ANA

Anti-dsDNA Abs

Anti-Smith Abs

Anti-phospholipid Abs

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4
Q

Which ANA subtype typically remains positive even in SLE remission, and is detected in 10-50% of patients?

A

Anti-Sm

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5
Q

Which ANA subtype is specific for SLE, and levels fluctuate with activity of SLE…

A

Andi-dsDNA

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6
Q

A patient presenting with the following hx is concerning for…

aching

redness and swelling of hands, fingers, knees

2 hr morning stiffness

A

RA

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7
Q

A physical exam showing the following is concerning for…

Erythema/swelling of PIP and MCPs

Ulnar deviation at MCP

A

RA

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8
Q

With RA, ESR and CRP are…

A

elevated

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9
Q

What are two 1st line labs to get with RA?

A

RF, CBC

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10
Q

What Ab test is specific for RA?

A

Anti-CCP

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11
Q

A patient with the following presentation is concerning for…

  • dry mouth/eyes
  • diffuse joint and muscle pain
  • increased dental cavities
A

Sjogren syndrome

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12
Q

What Ab tests should be ordred for suspected sjogren’s cases?

A

Anti-ro, anti-la Abs

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13
Q

A patient with the following presentation is concerning for…

  • limited shoulder ROM bilaterally
  • morning stiffness and on car rides
  • recent onset UE/LBP/Hip/thigh pain
A

PMR

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14
Q

Elevated _______ is characteristic in PMR and is associated with what condition?

A

ESR

giant cell temporal arteritis

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15
Q

Is ESR/CRP specific for PMR?

A

no

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16
Q

What lab results would you expect for each of the following for fibromyalgia?

CBC
ANA
RF
CRP
ESR
A

all normal

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17
Q

A patient with the following is concerning for…

  • LBP and progressive stiffness
  • worse in AM
  • LBP worse with inactivity
  • Hx of plantar fascitis
A

ankylosing spondylitis

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18
Q

Bamboo spine and sacroiliitis on imaging is concerning for…

A

ankylosing spondylitis

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19
Q

What lab is strongly associated with ankylosing spondylitis?

A

HLA-b27

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20
Q

CREST syndrome is associated with…

A

Systemic sclerosis

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21
Q

CREST stands for…

A 
calcinosis
reynauds
esophageal dysfunction
sclerodactyly
telangiectasia
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22
Q

ANA is _____ in 95% of systemic sclerosis patients…

A

positive ANA

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23
Q

Which antibody is associated with diffuse, cutaneous systemic sclerosis?

A

Anti-Scl-70

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24
Q

Anti-dsDNA Ab

A

SLE

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25
Anti-Sm Ab
SKE
26
Anti-Ro/SSA
Sjogren
27
Anti-La/SSB
Sjogren
28
Anti-Scl-70
systemic sclerosis
29
Anticentromere (ACA)...
Crest/limited systemic sclerosis
30
Ab positive in RA...
ANA, RF, Anti-CCP
31
Chronic, symmetric polyarthritis positive RF positive anti-CCP
RA
32
polyarthritis, rash, nephritis, serositis + ANA + Anti-dsDNA + Anti-Sm
SLE
33
Acute onset proximal myalgia morning stiffness age > 55 High ESR improvement w/ CS
Polymyalgia rheumatica
34
Tender points, non-restorative sleep/fatigue, normal labs...
fibromyalgia
35
Sicca Complex (dry glands) + Anti-Ro + Anti-La
Sjogren's
36
CREST syndrome + Anti-SCL-70 + ACA
Systemic Sclerosis
37
Back pain/stiffness Bamboo spine + HLA-b27
ankylosing spondylitis
38
The below are 5 indications for... new onset monoarthritis crystal-induced arthritis infx/septic arthritis inflamm/non-inflamm arthritis unexplained swelling
arthrocentesis/synovial fluid analysis
39
What is the most feared complication of arthrocentesis?
septic joint
40
What are three concerns for GC injection...
tendon rupture nerve damage osteonecrosis
41
What are 2 derm complications from joint aspiration/injection
skin atrophy | hypopicmentation
42
On gross inspection of synovial fluid, what should you look for?
Clarity Color Viscosity
43
On microscopic assessment of synovial fluid, what three things are normal?
high viscosity clear acellular
44
What are the 4 categories of joint effusions?
non-inflammatory inflammatory septic hemorrhagic
45
3 causes of _______ joint effusion... OA Trauma Avascular necrosis
noninflammatory
46
5 causes of ______ joint effusion... ``` septic arthritis RA/SLE spondy lyme disease crystals/gout ```
inflammatory
47
3 causes of septic joint effusion...
bacteria, fungi, mycobacteria
48
4 causes of _______ joint effusion... hemophilia trauma tumor anticoagulation
hemorrhagic
49
WBC > ________ is typically inflammatory...
2000
50
What type of effusion... - yellow color - high viscosity - 0-2000 WBCs - < 25% PMNs
Noninflammatory
51
What type of effusion... - opaque/translucent - yellow - low viscosity - PMNs 50+ %
inflammatory
52
What type of effusion... - opaque - yellow/green - 20,000-100,000 WBCs - PMNs 75% +
septic
53
WBCs > _______ should be considered septic until proven otherwise...
100k
54
PMNs 75+ considered...
septic
55
Can you have septic arthritis if WBC < 100k?
yes
56
Cx of joint fluid is positive in...
septic
57
A patient with the following hx is concerning for... - swollen, painful, red joint - hot to touch - mild fever
septic arthritis
58
Joint fluid that is turbin, WBC 88k, 90% neutrophils, pos Cx.. this indicates...
septic arthritis
59
Patient presents with joint pain at base of 1st toe after eating prime rib, cocktails, dancing. What type of crystals confirm dx of gout
MSU, negatively-birefringent needle shaped
60
A patient presents with... - joint pain, swelling, redness - no fever - X-Ray shows chondrocalcinosis. What type of crystals would indicate pseudogout?
Calcium pyrophosphate dihydrate (CPPD), positively birefringent, rhomboid shape
61
What is the gold standard for analyzing crystals...
polarized light microscopy
62
This measure is a material's ability to refract light rays
birefringence
63
Which crystals appear yellow when parallel to the compensator of the microscope?
mono-sodium urate (MSU) negative birefringent
64
Which crystals appear blue when parallel to the compensator?
CPPD positive birefringent

Clinical Laboratory Medicine (9 decks)

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