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BRS 1b > Rheumatology Diagnostics > Flashcards

Rheumatology Diagnostics Flashcards

1
Q

What basic tests are performed in patients in rheumatology?

A 
FBC
U&E
Liver function tests
Bone profile
Erythrocyte sedimentation rate (ESR)
C-reactive protein (CRP)
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2
Q

In inflammatory arthritis, what type of anaemia is present?

A

Normocytic anaemia

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3
Q

What is the mean cell volume in patients with inflammatory arthritis?

A

Normal

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4
Q

What is the WCC in patients with inflammatory arthritis?

A

Normal

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5
Q

What is the platelet count in patients with inflammatory arthritis?

A

Normal or increased

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6
Q

In osteoarthritis, what blood abnormalities exist?

A

Nil

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7
Q

In septic arthritis, what can be said regarding WCC?

A

Increased due to leukocytosis

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8
Q

In septic arthritis, what can be said regarding platelet count?

A

Normal or increased

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9
Q

A high creatinine count in patients with rheumatoid disorder can suggest what?

A

Impaired renal clearance, and suggestive of renal failure.

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10
Q

Which rheumatological disorder is strongly concerned with renal failure?

A

SLE can manifest as lupus nephritis

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11
Q

How does vasculitis affect the kidneys?

A

Can cause nephritis

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12
Q

What type of protein is elevated and deposited within the kidney due to chronic inflammation?

A

Serum amyloid (A) SAA protein

This causes AA amyloidosis

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13
Q

Which four main parameters are examined under a liver function test?

A

Bilirubin
Alkaline aminotransferase (ALT)
Alkaline phosphatase (ALP)
Albumin

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14
Q

What side effect can DMARDs have, and what tests should be done to monitor, and how often?

Provide an example of DMARDs

A

DMARDs can cause liver damage
LFTs every 8 weeks

Methotrexate

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15
Q

How often are LFTs conducted in patients on methotrexate?

A

LFTs and blood tests are conducted every 8 weeks.

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16
Q

What type of plasma protein is albumin (concerning inflammation)?

A

Negative acute phase protein

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17
Q

What three main parameters are examined in a bone profile?

A

Calcium
Phosphate
Alkaline phosphatase (ALP) - produced by bone or liver

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18
Q

Which enzyme is elevated in Paget’s disease?

A

Alkaline phosphatase (ALP), since there is an abnormally high bone turnover

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19
Q

Which is ALP elevated in Paget’s disease?

A

Due to an abnormally high bone turnover

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20
Q

What are the clinical features associated with Paget’s disease?

A

Bone pain
Excessive pain growth
Fracture through area of pathological bone

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21
Q

What can cause an elevated ESR (4)?

A

Elevated immunoglobulin level
Paraprotein (myeloma)
Anemia
Tends to rise with age

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22
Q

Which marker is specific for inflammation?

A

C-reative protein

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23
Q

In SLE, what happens to CRP?

A

CRP is normal

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24
Q

Which factor is elevated in SLE?

A

ESR

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25
Q

Under what circumstance is ESR and CRP elevated in patients with SLE?

A

Synovitis (Infection)

Inflammatory pleural or pericardial effusion

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26
Q

Which type of autoantibodies are typical for patients with SLE?

A

Anti-nuclear antibodies (ANA)

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27
Q

What happens to ANA concentrations after an infection?

A

Increases transiently following infection

28
Q

What are the common autoimmune tissue diseases?

A

SLE
Sjogren’s syndrome
Scleroderma

29
Q

What ANA dilution suggests a weak concentration?

A

1:320

30
Q

What ANA dilution ratio suggests a strong concentration of ANA?

A

1:1280

31
Q

A negative test of ANA rules out which disorder?

A

SLE

32
Q

Does a positive ANA test confirm a diagnosis of SLE?

A

NO, other clinical and lab features support diagnosis

33
Q

What are the five common antinuclear autoantibodies?

A 
Ro
La
RNP
Smith
Jo-I
34
Q

An RNP positive autoantibodies suggests what?

A

Lupus or mixed connective tissue disease

35
Q

Which ANA antibodies are associated with Sjogrens?

A

Ro and La

36
Q

Which antibodies other than ANA are highly specific for lupus and are useful for monitoring SLE activity?

A

Double stranded DNA (dsDNA) antibodies

37
Q

What happens to complement levels in a patient with lupus?

A

C3 and C4 may decrease in active lupus

38
Q

What is the diagnostic purpose of a synovial fluid analysis?

A

To obtain synovial fluid for analysis

39
Q

What is the therapeutic objective of a synovial fluid analysis?

A

To relieve symptoms (+/- concurrent steroid injections).

40
Q

What diagnostic investigation is conducted in a patient with septic arthritis?

A 
Joint aspiration 
(Gold standard)
41
Q

What happens after a joint aspiration is conducted?

A

Sent for microscopy and sensitivity
Enables the causative organism to be identified
Sensitivities from culture guide antibiotic choice

42
Q

How is gout diagnosed in terms of crystal analysis?

A

Needle shaped crystals with negative birefringence

43
Q

What composes gout crystals?

A

Monosodium urate

44
Q

How is pseudogout diagnosed in terms of crystal analysis?

A

Rhomboid shaped crystals with positive birefringence

45
Q

A synovial fluid culture in reactive arthritis reveals what result?

A

Sterile

46
Q

What is the ultimate treatment goal for septic arthritis once a joint aspiration is conducted, and is positive?

A

Joint lavage for large joints

47
Q

What is the first-line of imaging in rheumatoid disorders?

A

X-rays

48
Q

What is the purpose of CT scan imaging?

A

To identify detailed bony imaging

49
Q

What doe MRIs provide?

A

Provides maximal visualisation of soft tissue structures including tendons and ligaments

50
Q

Which type of imaging is optical for spinal disorders?

A

MRI

51
Q

What is the disadvantage to using MRIs?

A

Expensive and time consuming

52
Q

What types of structures are visualised using ultrasound?

A

Soft tissue structures, good for smaller joint structures

53
Q

What is the most useful imaging test used in osteoarthritis?

A

Radiographic (X-ray)

54
Q

What are four main radiographic features associated with osteoarthritis?

A

Joint space narrowing
Subchondral bony sclerosis
Osteophytes
Subchondral cysts

55
Q

What radiographic features are evident in patients with rheumatoid arthritis?

A 
Soft tissue swelling
Peri-auricular osteopenia
Bony erosions
Joint space narrowing 
Ulnar deviation
56
Q

Ulnar deviation is associated with which type of arthritis?

A

Rheumatoid arthritis

57
Q

What is the treatment aim of rheumatoid arthritis in view of erosions?

A

Treat early before erosions occur

58
Q

What is an appropriate investigation to detect for synovitis?

A

Ultrasound

59
Q

What utlrasound changes are visible in RA?

A

Synovial hypertrophy (thickening)
Increased blood flow (as seen as Doppler signal)
May detect erosions not seen on plain X-ray

60
Q

Why does joint space narrowing occur in rheumatoid arthritis?

A

Indicates articular cartilage loss (Secondary damage due to synovitis)

61
Q

Where are osteophytes prevalent in osteoarthritis?

A

Distal inter-phalangeal joints

62
Q

What are Heberden’s nodes?

A

Osteophytes and IPJS

63
Q

What are Bouchard’s nodes?

A

Osteophytes at PIPs

64
Q

Juxta-articular osteopenia is an early radiographic sign of what type of arthritis?

A

Inflammatory arthritis of any cause

65
Q

What is the ‘bare area’ in arthritis?

A

Erosions occur initially at the margins of the join where the synovium is in direct contact with the bone.

BRS 1b (62 decks)

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