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Rheumatology > Dx testing > Flashcards

Dx testing Flashcards

1
Q

What is rheumatoid factor

A

Antibodies directed against the Fc portion of IgG

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2
Q

who is the RF found in most commonly

A

RA pts

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3
Q

a + RF factor correlates w/…

A

more severe/ more articular dz

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4
Q

seronegative RF w/ symtoms…prognosis

A

better than RF +

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5
Q

do titers change with the RF

A

no

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6
Q

can a normal person have + RF

A

yes, 3%

over 70 = 10-15%

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7
Q

when to test RF

A

Useful in patients who present with an inflammatory polyarthritis
Recognize other possible etiologies of a positive RF
A negative study does not exclude the diagnosis of Seronegative RA
No need to repeat a positive test serially

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8
Q

what is Anti-citrullinated peptide antibodyCCP Antibody

A

Arginine residues are replaced with citrulline

ACPA (Anti-Citrullinated Peptide Antibodies) are directed against a protein that may be critical to the immune response in Rheumatoid Arthritis

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9
Q

which is more specific: RF or CCP

A

CCP

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10
Q

CCP antibody interesting facts

A

may appear before RA symptoms do

related to cig smoking

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11
Q

what two tests are used for RA

A

RF

CCP

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12
Q

which is more sensitive/specific for hep c pts: RF or CCP

A

CCP

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13
Q

ANA is + in what % of SLE

A

99%

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14
Q

what is ANA very sensitive but not specific for

A

SLE

many false +s

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15
Q

drug induced + ANA

A 
Procainamide
Hydralazine-htn
Minocycline
Diltiazem
Penicillamine
Isoniazid
Quinidine
Chlorpromazine
Methyldopa
TNF alpha blockers
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16
Q

ANA recommendations

A

99% sensitivity for SLE: Therefore a negative test helps to
exclude SLE
Useful to order in setting of inflammatory arthritis or extra-
articular manifestations of SLE or other connective
tissue diseases
Many false positive tests in the general population
Not useful to monitor disease activity

17
Q

anti DNA anitbody s/s

A

for SLE very specific but not sensitive, can monitor dz activity

18
Q

anti-sm body

A

for SLE very specific but not sensitive, cannot monitor dz activity

19
Q

location of Anti-SSA(Ro)/SSB(La) Antibody found

A

cytoplasm and nucleus

20
Q

+ Anti-SSA(Ro)/SSB(La) Antibody associated with

A

Associated with Sjögren’s Syndrome (70%)

21
Q

what do you use if the ANA doesnt find an SLE pt

A

Anti-SSA(Ro)/SSB(La) Antibody

finds the 1%

22
Q

Neonatal lupus syndrome and congenital heart block

  • what can you use to test for it
  • what is it
A

Anti-SSA(Ro)/SSB(La) Antibody

If mom has SSA + antibody, babies will be born with a lupus rash (goes away after 6 months) and have very low heart rate (congenital heart block in utero) , may need pacemaker for baby (permanent)

23
Q

what can you use to check for Antiphospholipid Antibodies syndrome

A

Anti-cardiolipin Ab

24
Q

clinical features of Antiphospholipid Antibodies syndrome

A 
Recurrent venous or arterial thrombosis
Recurrent fetal loss
Thrombocytopenia
Livedo Reticularis
Valvular Heart Disease
25
Q

Anti-neutrophil Cytoplasmic Antibody (ANCA) often found in pts w/

A

vasculitis

26
Q

c-ANCA

A

Anti-proteinase 3 antibody (PR3)
Associated with Wegener’s (highly specific but not always sensitive) and RPGN
Does not always correlate with disease activity

27
Q

p-ANCA

A

Anti-myeloperoxidase antibody (MPO)
Associated with vasculitis, especially microscopic polyangiitis and allergic angiitis and granulomatosis (Churg-Strauss Syndrome)

28
Q

what is sed rate and what is it useful in

A

Nonspecific test for inflammation
Very useful in diagnosis and monitoring of Polymyalgia Rheumatica and Giant Cell Arteritis (almost always high)
Sometimes helpful in diagnosis and monitoring of RA, Vasculitis, SLE, Bone and Joint Infections
Elevated with Anemia, older age, diabetes, obesity

29
Q

HLA-B27 MC dz associated with it

A 
Ank. Spondy. 95%
Reiter’s 70%
Psoriatic Axial 50%
IBD Axial 50%
Uveitis 35%
Normal Caucasian 8%
Normal African American 3%
30
Q

Synovial Fluid: Group I

A

Non-inflammatory conditions such as Osteoarthritis, trauma, endocrinopathies, neuropathic joint, Paget’s disease, ischemic necrosis, amyloidosis
Pale yellow, transparent, high viscosity
WBC is less than 2,000 cells/mm3 usually (low)
Negative culture, no crystals

31
Q

Synovial Fluid: Group II

A

Inflammatory conditions such as Rheumatoid Arthritis, Psoriatic, Spondyloarthropathies, Connective Tissue Diseases, Microcrystalline disease
Deeper yellow color, translucent
WBC 2,000 - 75,000+ cells/mm3
Cultures negative, crystals found in some

32
Q

Synovial Fluid: Group III

A

Septic (Bacterial)
Purulent, opaque fluid
WBC often over 50,000 cells/mm3 (but can be as low as 2,000) with predominance of PMNs (> 90%)
Gram stains and cultures are positive

33
Q

Synovial Fluid: Group IV

A

Hemorrhagic
Bloody appearance
Due to trauma, neuropathic joints, bleeding disorders, tumors, sickle cell disease

34
Q

Radiology RA

A 
Periarticular soft tissue swelling
Juxta-articular osteoporosis
Uniform loss of joint space
Lack of bone formation
Marginal erosions
Synovial cyst formation
Subluxations
Symmetrical distribution in certain joints
35
Q

Radiology OA

A 
Nonuniform loss of joint space
Absence of erosions
Subchondral new bone formation
Osteophyte formation
Cysts
Subluxation
Characteristic distribution
36
Q

Psoriatic Arthritis: Radiology

A 
Fusiform soft tissue swelling
Dramatic joint space loss
**“Pencil-in-cup” erosions
Often asymmetrical
Characteristic joints involved
37
Q

Ankylosing Spondylitis: Radiology

A

Irregularity of Sacroiliac joint
Sclerosis of the sacrum and iliac bones
Ankylosis with loss of joint space
Squaring of vertebral bodies with ivory corners
Thin, delicate syndesmophytes leading to bamboo spine

38
Q

Gout: Radiology

A 
Tophi
Joint space preservation
Punched out erosions with sclerotic borders
Overhanging edge of cortex
Asymmetrical distribution
Characteristic joint involvement

Rheumatology (9 decks)

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