Rheumatology Diagnostics

Question 1

What basic tests are performed in patients in rheumatology?

Answer 1

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

Question 2

In inflammatory arthritis, what type of anaemia is present?

Answer 2

Normocytic anaemia

Question 3

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

Answer 3

Normal

Question 4

What is the WCC in patients with inflammatory arthritis?

Answer 4

Normal

Question 5

What is the platelet count in patients with inflammatory arthritis?

Answer 5

Normal or increased

Question 6

In osteoarthritis, what blood abnormalities exist?

Answer 6

Nil

Question 7

In septic arthritis, what can be said regarding WCC?

Answer 7

Increased due to leukocytosis

Question 8

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

Answer 8

Normal or increased

Question 9

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

Answer 9

Impaired renal clearance, and suggestive of renal failure.

Question 10

Which rheumatological disorder is strongly concerned with renal failure?

Answer 10

SLE can manifest as lupus nephritis

Question 11

How does vasculitis affect the kidneys?

Answer 11

Can cause nephritis

Question 12

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

Answer 12

Serum amyloid (A) SAA protein

This causes AA amyloidosis

Question 13

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

Answer 13

Bilirubin
Alkaline aminotransferase
Alkaline phosphatase
Albumin

Question 14

What effect doe DMARDs have on the kidneys, and provide an example?

Answer 14

DMARDs can cause liver damage

Methotrexate

Question 15

How often are LFTs conducted in patients on methotrexate?

Answer 15

LFTs and blood tests are conducted every 8 weeks.

Question 16

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

Answer 16

Negative acute phase protein

Question 17

What three main parameters are examined in a bone profile?

Answer 17

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

Question 18

Which enzyme is elevated in Paget’s disease?

Answer 18

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

Question 19

Which is ALP elevated in Paget’s disease?

Answer 19

Due to an abnormally high bone turnover

Question 20

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

Answer 20

Bone pain
Excessive pain growth
Fracture through area of pathological bone

Question 21

What can cause an elevated ESR (4)?

Answer 21

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

Question 22

Which marker is specific for inflammation?

Answer 22

C-reative protein

Question 23

In SLE, what happens to CRP?

Answer 23

CRP is normal

Question 24

Which factor is elevated in SLE?

Answer 24

ESR

Question 25

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

Answer 25

Synovitis (Infection) | Inflammatory pleural or pericardial effusion

Question 26

Which type of autoantibodies are typical for patients with SLE?

Answer 26

Anti-nuclear antibodies (ANA)

Question 27

What happens to ANA concentrations after an infection?

Answer 27

Increases transiently following infection

Question 28

What are the common autoimmune tissue diseases?

Answer 28

SLE Sjogren's syndrome Scleroderma

Question 29

What ANA dilution suggests a weak concentration?

Answer 29

1:320

Question 30

What ANA dilution ratio suggests a strong concentration of ANA?

Answer 30

1:1280

Question 31

A negative test of ANA rules out which disorder?

Answer 31

SLE

Question 32

Does a positive ANA test confirm a diagnosis of SLE?

Answer 32

NO, other clinical and lab features support diagnosis

Question 33

What are the five common antinuclear autoantibodies?

Answer 33

``` Ro La RNP Smith Jo-I ```

Question 34

An RNP positive autoantibodies suggests what?

Answer 34

Lupus or mixed connective tissue disease

Question 35

Which ANA antibodies are associated with Sjogrens?

Answer 35

Ro and La

Question 36

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

Answer 36

Double stranded DNA (dsDNA) antibodies

Question 37

What happens to complement levels in a patient with lupus?

Answer 37

C3 and C4 may decrease in active lupus

Question 38

What is the diagnostic purpose of a synovial fluid analysis?

Answer 38

To obtain synovial fluid for analysis

Question 39

What is the therapeutic objective of a synovial fluid analysis?

Answer 39

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

Question 40

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

Answer 40

``` Joint aspiration (Gold standard) ```

Question 41

What happens after a joint aspiration is conducted?

Answer 41

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

Question 42

How is gout diagnosed in terms of crystal analysis?

Answer 42

Needle shaped crystals with negative birefringence

Question 43

What composes gout crystals?

Answer 43

Monosodium urate

Question 44

How is pseudogout diagnosed in terms of crystal analysis?

Answer 44

Rhomboid shaped crystals with positive birefringence

Question 45

A synovial fluid culture in reactive arthritis reveals what result?

Answer 45

Sterile

Question 46

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

Answer 46

Joint lavage for large joints

Question 47

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

Answer 47

X-rays

Question 48

What is the purpose of CT scan imaging?

Answer 48

To identify detailed bony imaging

Question 49

What doe MRIs provide?

Answer 49

Provides maximal visualisation of soft tissue structures including tendons and ligaments

Question 50

Which type of imaging is optical for spinal disorders?

Answer 50

MRI

Question 51

What is the disadvantage to using MRIs?

Answer 51

Expensive and time consuming

Question 52

What types of structures are visualised using ultrasound?

Answer 52

Soft tissue structures, good for smaller joint structures

Question 53

What is the most useful imaging test used in osteoarthritis?

Answer 53

Radiographic (X-ray)

Question 54

What are four main radiographic features associated with osteoarthritis?

Answer 54

Joint space narrowing Subchondral bony sclerosis Osteophytes Subchondral cysts

Question 55

What radiographic features are evident in patients with rheumatoid arthritis?

Answer 55

``` Soft tissue swelling Peri-auricular osteopenia Bony erosions Joint space narrowing Ulnar deviation ```

Question 56

Ulnar deviation is associated with which type of arthritis?

Answer 56

Rheumatoid arthritis

Question 57

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

Answer 57

Treat early before erosions occur

Question 58

What is an appropriate investigation to detect for synovitis?

Answer 58

Ultrasound

Question 59

What utlrasound changes are visible in RA?

Answer 59

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

Question 60

Why does joint space narrowing occur in rheumatoid arthritis?

Answer 60

Indicates articular cartilage loss (Secondary damage due to synovitis)

Question 61

Where are osteophytes prevalent in osteoarthritis?

Answer 61

Distal inter-phalangeal joints

Question 62

What are Heberden's nodes?

Answer 62

Osteophytes and IPJS

Question 63

What are Bouchard's nodes?

Answer 63

Osteophytes at PIPs

Question 64

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

Answer 64

Inflammatory arthritis of any cause

Question 65

What is the 'bare area' in arthritis?

Answer 65

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