Making a Diagnosis

Question 1

What is the system for describing a fracture x-ray?

Answer 1

1. Describe the qualities of the x-ray (RIPE)
2. Site of fracture (which bone and which part of the bone, examine entire cortex)
3. Type of fracture (transverse, oblique, spiral)
4. Simple or comminuted
5. Displaced or not
6. Angulated or not
7. Is the bone of normal consistency or not?

Question 2

What are the x-ray features of osteoarthritis?

Answer 2

• Loss of joint space
• Osteophytes
• Subchondral cysts
• Subchondral sclerosis

Question 3

What do you need to look out for in rheumatology?

Answer 3

Single red, hot, swollen and tender joint&raquo_space;> septic arthritis

Question 4

How would you check for septic arthritis?

Answer 4

Joint aspiration, send for a gram stain, microscopy and culture.

Question 5

How do you diagnose osteomyelitis?

Answer 5

Gold standard is MRI, but x-ray can be used initially. Added contrast will light up the collection of the localised inflammatory response (periosteal reaction).

Question 6

What antibodies are used to test for rheumatoid arthritis?

Answer 6

Anti-CCP = RA, high specificity and sensitivity

Rheumatoid factor = present in a proportion of RA but can be positive in numerous other rheumatological conditions

Question 7

What antibodies are used for test for suspected connective tissue disease?

Answer 7

ANA = high sensitivity but low specificity for SLE. If positive ANA helps clarify the condition to varying degrees of sensitivity and specificity
Anti-dsDNA = high sensitivity and specificity for SLE, can monitor disease flare

Question 8

What antibody is used for suspected small/medium vessel vasculitis?

Answer 8

ANCA = used for small vessel vasculitis diagnosis and monitoring disease activity. c-ANCA (PR3) is more common in GPA and p-ANCA (MPO) is associated mainly with EGPA.