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MSK2 F > Lab Testing In Rheumatic Dx > Flashcards

Lab Testing In Rheumatic Dx Flashcards

1
Q

What are the non-specific acute phase reactants?

A

ESR (erythrocyte sedimentation rate): rise w/ age, monitor dx activity (PMR, GCA)

CRP (c-reactive protein): synthesized in liver, monitor dx activity, pro-inflammatory cytokines inc CRP, CRP activates complement > phagocytosis

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2
Q

What CRP value represents an inflammatory process? Does this value fluctuate faster or less than ESR?

A

> 8 mg/L

More

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3
Q

Are serologies an appropriate single definitive diagnostic tool?

A

No

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4
Q

What is Rheumatoid Factor? What produces it?

A

Auto-antibody (IgM) that targets Fc portion of IgG

B-cells in synovial joints of RA pts

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5
Q

Is RF found in healthy people? Is it always found in sick people?

A

Yes

No

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6
Q

What’s the significance of the RF level?

A

High levels associated w/ more aggressive dx and worse prognosis

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7
Q

What lab result gives a 99.5% specificity for RA?

A

Pos anti-CCP + Pos RF

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8
Q

Whats does anti-CCP target? What does it signal?

A

Citrullinated proteins

Aggressive and erosive dx

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9
Q

Which test alone is most specific for RA?

A

Anti-CCP (more-so than RF)

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10
Q

What marker is 99% indicative of SLE?

A

Anti-SM antibodies in an ANA

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11
Q

What is a rim pattern ANA associated w/?

A

Anti-DS DNA in Lupus

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12
Q

What hematologic results would you expect in a pt being worked up for SLE?

A

Hemolytic anemia w/ reticulocytosis (lots of young/immature RBCs)

Leukopenia

Lymphopenia

Throbocytopenia

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13
Q

Is ANA (anti-nuclear antibody) found in normal healthy pts?

A

Yes, 30% of the time

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14
Q

What test comes up as a false positive in SLE?

A

RPR (test for syphilis)

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15
Q

What lab is used to support a streptococcal infection?

A 
ASO titer (antistreptolysin O antibody)
- group A strep infection
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16
Q

What is rheumatic fever?

A

Rheumatic fever is a reaction to the group A strep infection

17
Q

What are the Jones criteria?

A

Sxs of rheumatic fever

Carditis
Joint inflammation (arthritis)
Chorea (involuntary purposeless movements)
Sub-Q nodules
Erythema marginatum (rash)
18
Q

Does a strep infection cause arthritis? If so, where?

A

It can, part of rheumatic fever response

Asymmetrically in large joints (knees, hips, elbows, ankles)

19
Q

Difference between RA vs strep infection?

A

RA = symmetrical joint involvement

Strep infection = asymmetrical joint involvement

20
Q

What uric acid level is a factor in gout attacks?

A

Uric acid (urate) > 6.8 mg/dl

21
Q

Gout is due to in part..?

A

Under excretion (kidney dx) or over-production (alcohol, food) of uric acid

22
Q

Where and when do gout attacks often occur?

A

1st MTP joint of the foot at night

23
Q

What’s the state of a gouty joint?

A

Hot, swollen, tender, dusky/red

24
Q

What are tophi?

A

Associated w/ gout, nodular deposits of monosodium urate crystals in the skin

25
Q

Number of joints involved terminology includes:

A 
Mono arthritis (one joint)
Oligo arthritis (2-3)
Pauci arthritis (4-5)
Poly arthritis (6 or more)
26
Q

In regards to inflammation, what are the cardinal signs?

A

Pain, swelling, redness, heat, tenderness, stiffness

27
Q

What’s the involvement of distal interphalangial joints in RA vs OA?

A 
RA = not involved
OA = involved
28
Q

What is the swan neck deformity and what’s it associated w/? Boutonniere?

A

Both involved w/ RA

Swan: flexion of DIPJ (swans head), extension of PIPJ

Boutonniere is the opposite

29
Q

What Bowel dxs are associated w/ arthritis?

A

IBD:

  • ulcerative colitis
  • chrohn’s dx
  • Behcet’s

Bowel infection > reactive arthritis

30
Q

What’s a Charcot’s joint associated w/? What is it?

A

DM

Painless joint d/t excessive n dmg by DM

31
Q

What’s Cheiroarthropathy and what is it associated w/?

A

Hands are stiff and skin on hands are thick

DM

32
Q

What’s Carpal/Tarsal tunnel syndrome associated w/ regarding arthritic pairings?

A

Thyroid dx

33
Q

Xerophthalmia is associated w/ what dxs regarding arthritis?

A

Sjogren’s

Sarcoid

34
Q

What are cytoid bodies and when are they seen?

A

White lesions of the retina

SLE

35
Q

Rim patterned DNA =

A

ANA result of Anti-DS DNA

36
Q

What are the possible results of a joint analysis?

A

Normal fluid (clear, <200 cells)
Non-inflammatory (200-2000 cells)
Inflammatory (2000-50000, cloudy)
Septic (>50000, cloudy)

MSK2 F (12 decks)

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