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BRS Y2 > Rheumatology Diagnostics > Flashcards

Rheumatology Diagnostics Flashcards

1
Q

What are the 3 main diagnostic pathways in rheumatology?

A

Blood tests
Joint fluid analysis
Imaging tests

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2
Q

How often are blood tests needed in rheumatology? If they are, how are they ordered?

A

They may not be needed if the diagnosis is clear from the history and examination, if they are start with simple ones before ordering fancy ones

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3
Q

What do basic rheumatology blood tests include?

A 
FBC
Urea and electrolytes
Liver function tests
Bone profile
ESR
CRP
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4
Q

Describe expected Hb, MCV, WCC and PLT in inflammatory arthrtis

A 
Hb= low if anaemic or normal
MCV= normal
WCC= usually normal
PLT= normal or raised
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5
Q

Describe expected Hb, MCV, WCC and PLT in osteoarthritis

A

Hb=normal
MCV=normal
WCC=normal
PLT=normal

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6
Q

Describe expected Hb, MCV, WCC and PLT in septic arthritis

A

Hb= usually normal
MCV=normal
WCC= high due to leucocytosis
PLT= normal or high

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7
Q

What is encompassed in urea and electrolytes?

A

Creatinine
Sodium
Potassium

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8
Q

What does high creatinine indicate?

A

Worsening renal clearance

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9
Q

Why are urea and electrolytes relevant in rheumatology diagnostics?

A

Rheumatological disease can effect the kidneys
NSAIDs can cause kidney impairment
Chronic inflammation can lead to serum amyloid a deposits in the kidney

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10
Q

What do LFTs encompass?

A

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

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11
Q

Why are LFTs relevant in rheumatology diagnostics?

A

DMARDs can cause liver damage

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12
Q

What do patients on methotrexate need regularly?

A

Blood tests every 8 weeks (to check LFTs and ensure there isnt liver damage)

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13
Q

What can low albumin indicate?

A

Problem of synthesis (in liver) or problem of leak from kidney (eg in lupus nephritis)

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14
Q

What does bone profile encompass?

A

Calcium
Phosphate
Alkaline phosphotase

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15
Q

What diagnostic component is present in both the LFT and bone profile?

A

ALP

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16
Q

What will ALP levels be in Paget’s disease?

A

High

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17
Q

What is Paget’s disease?

A

Disease caused by abnormality of high bone turnover

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18
Q

Describe calcium, phosphate and ALP levels in someone with osteomalacia

A

Calcium low or normal
Phosphate low or normal
ALP high or normal

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19
Q

What are clinical features of Paget’s disease

A

Bone pain, excessive pain growth, fracture through area of abnormal bone

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20
Q

Describe calcium, phosphate and ALP levels in someone with osteoporosis

A

All normal

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21
Q

What are ESR and CRP useful markers of?

A

Inflammation

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22
Q

What are reasons beside inflammation ESR could be up?

A

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

23
Q

What are ESR and CRP in SLE?

A

ESR is usually high, CRP is usually normal

24
Q

When may CRP be high in SLE?

A

If there is significant synovitis or there is an inflammatory pleural or pericardial effusion

25
Q

What are the 3 main types of arthritis?

A

Osteoarthritis
Inflammatory
Septic

26
Q

What are the 2 autoantibodies in RA?

A 
Rheumatoid factor (RF)
Cyclic citrullinated peptides (CCP) antibodies
27
Q

What are anti nuclear antibodies?

A

Antibodies directed at nuclear component of the cell

28
Q

Other than in RA, when might ANAs be high?

A

They increase with age

Sometimes high after infection

29
Q

When is ANA used in rheumatology?

A

When you suspect an autoimmune condition and to support the diagnosis, its not helpful if used only to diagnose as a lot of people will have a high ANA

30
Q

What are clinical manifestations of SLE?

A 
Arthritis
Skin rash
Mouth ulcers
Kidney disease
Pleural effusion
Pericardial effusion
31
Q

What are clinical manifestations of Sjorgen’s syndrome?

A

Dry eyes
Dry mouth
Extra articular features

32
Q

What are clinical manifestations of polymyositis?

A

Muscle inflammation
Weakness
High CK

33
Q

What are clinical manifestations of scleroderma?

A

Vasculopathy eg Reynaud’s
Skin thickening
Organ fibrosis

34
Q

How is strength of ANA reported?

A

As the maximal dilution at which its still detectable

35
Q

What does a negative ANA mean?

A

SLE can be ruled out

36
Q

What does a positive ANA mean?

A

Doesn’t necessarily mean SLE can be diagnosed but means it is more likely if other clinical features are present

37
Q

What is done after ANA comes out positive?

A

Other more specific antibody tests are ordered to see what condition the patient has

38
Q

What are double stranded DNA antibodies specific to?

A

Lupus

39
Q

What antibodies are useful for tracking lupus over time?

A

Double stranded DNA

40
Q

What will C3 and C4 levels be in lupus?

A

Low

41
Q

What are indications for joint aspiration?

A

Diagnostic: to obtain synovial fluid for analysis
Therapeutic: to relief symptoms

42
Q

Why is synovial fluid analysis useful for septic arthritis?

A

It enables the causative organism to be identified and can guide antibiotic choice

43
Q

What is synovial fluid analysis used to diagnose?

A

Crystal arthritis

44
Q

Is joint lavage used for septic arthritis and reactive arthritis?

A

It is for septic arthritis but not for reactive

45
Q

What is the first line imaging in rheumatology

A

X rays

46
Q

When is MRI useful for imaging in rheumatology?

A

When looking at soft tissue in small joints, but its not useful for large joints

47
Q

What are some radiographic features of osteoarthritis?

A

Joint space narrowing
Subchondral bony sclerosis
Osteophytes
Subchondral cysts

48
Q

At what point do erosions occour in RA?

A

In established disease, the aim is to treat early before erosions occour

49
Q

What is ultrasound useful for in RA?

A

Detecting synovitis

50
Q

Do RA or osteoarthritis have joint space narrowing?

A

Yes they both do

51
Q

Do RA or osteoarthritis have subchondral sclerosis?

A

RA doesnt osteo does

52
Q

Do RA or osteoarthritis have osteophytes?

A

RA doesnt osteo does

53
Q

Do RA or osteoarthritis have osteopenia?

A

RA does psteo doesn’t

54
Q

Do RA or osteoarthritis have bony erosions?

A

RA does, osteo doesn’t

BRS Y2 (85 decks)

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