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Clinical Laboratory Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

The following presentation is concerning for…

Symmetric polyarthritis
Pleuritic CP
Raynaud’s
Malar Rash/Discoid rash

A

SLE

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2
Q

Active SLE is indicated with what level of C3/C4?

A

low complement levels

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3
Q

What SLE specific dx labs would you order for a suspected case of SLE?

A

ANA

Anti-dsDNA Abs

Anti-Smith Abs

Anti-phospholipid Abs

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4
Q

Which ANA subtype typically remains positive even in SLE remission, and is detected in 10-50% of patients?

A

Anti-Sm

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5
Q

Which ANA subtype is specific for SLE, and levels fluctuate with activity of SLE…

A

Andi-dsDNA

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6
Q

A patient presenting with the following hx is concerning for…

aching

redness and swelling of hands, fingers, knees

2 hr morning stiffness

A

RA

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7
Q

A physical exam showing the following is concerning for…

Erythema/swelling of PIP and MCPs

Ulnar deviation at MCP

A

RA

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8
Q

With RA, ESR and CRP are…

A

elevated

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9
Q

What are two 1st line labs to get with RA?

A

RF, CBC

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10
Q

What Ab test is specific for RA?

A

Anti-CCP

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11
Q

A patient with the following presentation is concerning for…

  • dry mouth/eyes
  • diffuse joint and muscle pain
  • increased dental cavities
A

Sjogren syndrome

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12
Q

What Ab tests should be ordred for suspected sjogren’s cases?

A

Anti-ro, anti-la Abs

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13
Q

A patient with the following presentation is concerning for…

  • limited shoulder ROM bilaterally
  • morning stiffness and on car rides
  • recent onset UE/LBP/Hip/thigh pain
A

PMR

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14
Q

Elevated _______ is characteristic in PMR and is associated with what condition?

A

ESR

giant cell temporal arteritis

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15
Q

Is ESR/CRP specific for PMR?

A

no

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16
Q

What lab results would you expect for each of the following for fibromyalgia?

CBC
ANA
RF
CRP
ESR
A

all normal

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17
Q

A patient with the following is concerning for…

  • LBP and progressive stiffness
  • worse in AM
  • LBP worse with inactivity
  • Hx of plantar fascitis
A

ankylosing spondylitis

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18
Q

Bamboo spine and sacroiliitis on imaging is concerning for…

A

ankylosing spondylitis

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19
Q

What lab is strongly associated with ankylosing spondylitis?

A

HLA-b27

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20
Q

CREST syndrome is associated with…

A

Systemic sclerosis

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21
Q

CREST stands for…

A 
calcinosis
reynauds
esophageal dysfunction
sclerodactyly
telangiectasia
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22
Q

ANA is _____ in 95% of systemic sclerosis patients…

A

positive ANA

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23
Q

Which antibody is associated with diffuse, cutaneous systemic sclerosis?

A

Anti-Scl-70

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24
Q

Anti-dsDNA Ab

A

SLE

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25
Q

Anti-Sm Ab

A

SKE

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26
Q

Anti-Ro/SSA

A

Sjogren

27
Q

Anti-La/SSB

A

Sjogren

28
Q

Anti-Scl-70

A

systemic sclerosis

29
Q

Anticentromere (ACA)…

A

Crest/limited systemic sclerosis

30
Q

Ab positive in RA…

A

ANA, RF, Anti-CCP

31
Q

Chronic, symmetric polyarthritis

positive RF

positive anti-CCP

A

RA

32
Q

polyarthritis, rash, nephritis, serositis

+ ANA
+ Anti-dsDNA
+ Anti-Sm

A

SLE

33
Q

Acute onset proximal myalgia
morning stiffness
age > 55

High ESR
improvement w/ CS

A

Polymyalgia rheumatica

34
Q

Tender points, non-restorative sleep/fatigue, normal labs…

A

fibromyalgia

35
Q

Sicca Complex (dry glands)

+ Anti-Ro
+ Anti-La

A

Sjogren’s

36
Q

CREST syndrome

+ Anti-SCL-70
+ ACA

A

Systemic Sclerosis

37
Q

Back pain/stiffness
Bamboo spine

+ HLA-b27

A

ankylosing spondylitis

38
Q

The below are 5 indications for…

new onset monoarthritis

crystal-induced arthritis

infx/septic arthritis

inflamm/non-inflamm arthritis

unexplained swelling

A

arthrocentesis/synovial fluid analysis

39
Q

What is the most feared complication of arthrocentesis?

A

septic joint

40
Q

What are three concerns for GC injection…

A

tendon rupture
nerve damage
osteonecrosis

41
Q

What are 2 derm complications from joint aspiration/injection

A

skin atrophy

hypopicmentation

42
Q

On gross inspection of synovial fluid, what should you look for?

A

Clarity
Color
Viscosity

43
Q

On microscopic assessment of synovial fluid, what three things are normal?

A

high viscosity
clear
acellular

44
Q

What are the 4 categories of joint effusions?

A

non-inflammatory
inflammatory
septic
hemorrhagic

45
Q

3 causes of _______ joint effusion…

OA
Trauma
Avascular necrosis

A

noninflammatory

46
Q

5 causes of ______ joint effusion…

septic arthritis
RA/SLE
spondy
lyme disease
crystals/gout
A

inflammatory

47
Q

3 causes of septic joint effusion…

A

bacteria, fungi, mycobacteria

48
Q

4 causes of _______ joint effusion…

hemophilia
trauma
tumor
anticoagulation

A

hemorrhagic

49
Q

WBC > ________ is typically inflammatory…

A

2000

50
Q

What type of effusion…

  • yellow color
  • high viscosity
  • 0-2000 WBCs
  • < 25% PMNs
A

Noninflammatory

51
Q

What type of effusion…

  • opaque/translucent
  • yellow
  • low viscosity
  • PMNs 50+ %
A

inflammatory

52
Q

What type of effusion…

  • opaque
  • yellow/green
  • 20,000-100,000 WBCs
  • PMNs 75% +
A

septic

53
Q

WBCs > _______ should be considered septic until proven otherwise…

A

100k

54
Q

PMNs 75+ considered…

A

septic

55
Q

Can you have septic arthritis if WBC < 100k?

A

yes

56
Q

Cx of joint fluid is positive in…

A

septic

57
Q

A patient with the following hx is concerning for…

  • swollen, painful, red joint
  • hot to touch
  • mild fever
A

septic arthritis

58
Q

Joint fluid that is turbin, WBC 88k, 90% neutrophils, pos Cx.. this indicates…

A

septic arthritis

59
Q

Patient presents with joint pain at base of 1st toe after eating prime rib, cocktails, dancing.

What type of crystals confirm dx of gout

A

MSU, negatively-birefringent needle shaped

60
Q

A patient presents with…

  • joint pain, swelling, redness
  • no fever
  • X-Ray shows chondrocalcinosis.

What type of crystals would indicate pseudogout?

A

Calcium pyrophosphate dihydrate (CPPD), positively birefringent, rhomboid shape

61
Q

What is the gold standard for analyzing crystals…

A

polarized light microscopy

62
Q

This measure is a material’s ability to refract light rays

A

birefringence

63
Q

Which crystals appear yellow when parallel to the compensator of the microscope?

A

mono-sodium urate (MSU)

negative birefringent

64
Q

Which crystals appear blue when parallel to the compensator?

A

CPPD

positive birefringent

Clinical Laboratory Medicine (9 decks)

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