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MSK > Rheumatology Investigations > Flashcards

Rheumatology Investigations Flashcards

1
Q

what is included in a full blood count

A

haemoglobin, MCV, neutrophil count, lymphocyte count, eosinophil count, platelet count

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2
Q

what is the relevance of haemoglobin

A

may be low in most inflammatory conditions

may be an indicator of disease activity

may get iron deficiency anaemia with NSAIDs

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3
Q

what is the relevance of MCV

A

may be high in patients on sulfasalazine, methotrexate or azathiprine

low in iron deficiency

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4
Q

when is MCV of no significance

A

of Hb stable and B12 folate and TFTs normal

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5
Q

what is the relevance of neutrophil count

A

may be low in CTD (especially SLE and sjogrens)

neutropenia can be adverse effect of most DMARDs

occasionally raised in inflammatory arthritis

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6
Q

what is the relevance of lymphocyte count

A

may be low in CTD (especially SLE and sjogrens)

reduced by immunosuppressants

indicator of disease activity

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7
Q

what is the relevance of eosinophil count

A

raised in eosinophilic granulomatous with polyangiitis (churg-strauss)

indicator of disease activity

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8
Q

what is the relevance of plasma viscosity

A

high in inflammatory conditions

indicator of disease activity

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9
Q

why is there a risk of toxicity in renal impairment with methotrexate

A

as it is excreted renally

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10
Q

what rheumatological disease can cause renal impairment

A

CTD

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11
Q

what is the relevance of LFTs

A

DMARDS, allopurinol and NSAIDs can cause hepatitis

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12
Q

what is the relevance of corrected calcium

A

hyperparathyroidism may cause pseudogout/ calcium pyrophosphate arthropathy (CPPD)

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13
Q

what is the relevance of ferritin

A

low in iron deficiency
high in anaemia of chronic disease

in presence of iron deficiency can be artificially high in inflammatory disease as also acts as an acute phase reactant

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14
Q

what is the relevance of creatine kinase

A

raised in myositis

indicator of disease activity

may also be raised in muscle trauma and strenuous exercise

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15
Q

what is the relevance of uric acid

A

raised in gout

normal in about 30% of cases of acute gout

may get asymptomatic hyperuricaemia

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16
Q

what is the relevance of urine protein/ creatine ratio

A

may get glomerulonephritis as part of connective tissue disease or vasculitis

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17
Q

when do you do a synovial fluid microscopy and culture

A

suspected septic arthritis or crystal arthritis

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18
Q

what is very unlikely if RF negative

A

extra-articular manifestations of RA

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19
Q

who has a worse prognosis: sero negative or positive for RF in RA

A

sero negative

20
Q

how sensitive and specific is RF for RA

A

70% sensitive

85% specific

21
Q

how sensitive and specific is anti- CCP for RA

A

70% sensitive

98% specific

22
Q

who has a worse prognosis: sero negative or positive for anti-ccp in RA

A

negative

23
Q

how sensitive and specific is anti- nuclear antibody for SLE

A 
98% sensitive 
non specific (13% of adults +ve titre of 1:80- positive in a wide range of diseases inc. RA)
24
Q

what is anti-dsDNA specific for and how specific

A

95% specific for SLE

25
Q

can anti-dsDNA be used to monitor disease activity

A

yes

26
Q

what does ENA stand for

A

extractable nuclear antigens

27
Q

what can anti-RNP be positive in

A

usually in mixed connective tissue disease

can be in SLE

28
Q

what can anti-centromere be positive in

A

limited systemic sclerosis

29
Q

what can anti-Scl 70 be positive in

A

diffuse systemic sclerosis

30
Q

what can anti-Ro and anti:La be positive in

A

primary sjogrens syndrome

31
Q

what can anti-Jo-1 be positive in

A

inflammatory myositis

32
Q

what can anti-Sm be positive in

A

very specific for lupus but in UK only in 3% of cases

33
Q

what can anti-cardiolipin antibiodies (ACLA) be positive in

A

anti-phospholipid syndrome

34
Q

what is there an increased risk of when ACLA is positive

A

thrombosis or pregnancy loss

35
Q

what is c-ANCA/ anti- PR3 sensitive and specific for

A

granulomatosis with polyangitis (wegeners granulomatosis)

36
Q

can ANCA be used to monitor disease activity

A

yes

37
Q

how specific is p-ANCA/ anti-MPO and what is it associated with

A

less specific than c-ANCA/ anti-PR3

associated with microscopic polyangitis and churg strauss syndrome

fluctuates, used to monitor disease activity

38
Q

what is the relevance of complement

A

low in immune complex vasculitis esp lupus nephritis

low in active lupus, used to monitor disease activity

39
Q

what is the baseline imaging for early inflammatory arthritis- what would you expect to see

A

Xray hands and feet

expect to be normal- erosions may indicate poor prognosis

40
Q

what is x ray of hands and feet used to diagnose

A

OA

41
Q

what imaging for neck pain, especially in RA

A

cervical spine X ray

42
Q

what is a cervical spine x ray looking for in RA flexion and extension views

A

atlanto-axial instability/ subluxation

43
Q

why might a thoracic and lumbar spine x ray be done

A

to look for spondyloarthropathy changes

44
Q

why would you do a High resolution CT chest

A

if suspect ILD as part of CTD/ RA

45
Q

why would you do a joint ultrasound

A

to diagnose inflammatory arthropathy if not convinced by clinical synovitis

46
Q

why would you do a MRI of the spine

A

non radiographic spondyloarthropathy- will show changes earlier than x ray

MSK (71 decks)

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