Flashcards
Tests
Cards in this deck (28)
- 1What are the indications for synovial fluid analysis?Acute bacterial sepsis
Crystal associated disease
Often combined with steroid injection - 2What is normal synovial fluid like?Low volume
Low cell count (of mononuclear cells)
Translucent and straw-coloured
High viscosity (stringy due to high hyaluronic acid content) - 3What does inflammation in a joint do to synovial fluid?Increased volume
Increasing cell count and more neutrophils = high turbidity
Reduction in viscosity - 4What might blood stained synovial fluid indicate if it is a) uniform (haemarthrosis) or b) non-uniform?A) Trauma, severe inflammation in RA/sepsis/crystals, bleeding diathesis, rare tumours, ?subchondral fracture if lipid layer on surface
B) Traumatic aspiration - 5What does synovial fluid analysis involve?Naked eye assessment
Gram stain and culture
Polarised light microscopy - 6What is pyarthrosis and what can it occur in?Pus in the synovial fluid
Sepsis and crystals - 7What is this?Urate crystals on compensated polarised microscopy.
They are brightly birefringent, needle shaped, large and often numerous. They have a negative sign of birefringence. - 8What is this?CPPD crystals on compensated polarised microscopy. They are rhomboid, small and usually sparse with weak birefringence and a positive sign of birefringence.
- 9What happens to the FBC/ESR and CRP/ferritin/LFTs in the acute phase response? What induces these changes?Low Hb (anaemia), high platelets (thrombocytopaenia), neutrophilia
Raised ESR/CRP
Raised ferritin
Low albumin
Macrophage activity releasing cytokines, with effects on bone marrow, the brain (fever) and the liver
(nduction of IL-1 and TNF, causing induction of IL-6 and LIF, causing liver induction) - 10What is a rouleaux?The stack of erythrocytes formed by doing an ESR.
- 11A) What determines an ESR? B) What will cause an increased ESR?A) The type and amount of proteins in the blood
B) Increased fibrinogen, and increased immunoglobulins - 12What might cause ESR and CRP to be asymmetrical?The CRP is more sensitive than the ESR and rises and comes down faster. It is also produced by the liver, so in liver damage, the ESR may rise while the CRP stays low.
- 13Which conditions cause A) Neutrophilia B) Eosinophilia C) Lymphocytopaenia D) Thrombocytopaenia?A) SLE, gout
B) Wegener's (granulomatosis with polyangiitis)
C) SLE
D) SLE - 14What is rheumatoid factor?An IgM autoantibody against IgG
- 15What condition is rheumatoid factor positive in?RA
Connective tissue disease (SLE, sclorederma, Sjogren's syndrome, DM)
Chronic infection (bacteria - SBE, viral - rubella, CMV, IM; parasites)
MEC, hyper-gamma-globulinaemic purpura
Normal - 16What percentage of RA patients are RF positive a) at diagnosis b) after 1 year?A) 60%
B) 70% - 17What is the sensitivity and specificity of RF for RA?Good sensitivity, poor specificity
- 18What is anti-CCP and what is it positive in?Anti - cyclic citrullinated peptides: antibodies against modified arginine (citrullinated) residues
Rheumatoid arthritis - 19What is a) the sensitivity b) the specificity of anti-CCP for RA? C) What is it like as a prognostic indicator?A) 70-80%
B) >90%
C) If it is positive at presentation, the prognosis is worse. It may precede the onset of RA - 20What is antinuclear factor? What conditions is it positive in? What is its sensitivity and specificity like?The SLE marker (around 100% of SLE patients are ANA+)
RA, Felty's, Sjogren's, scleroderma, polymyositis, autoimmune thyroid, liver disease, drugs, normal
High sensitivity but poor specificity for SLE - 21DISTRIBUTION of ANA What conditions will show these distributions? A) Diffuse and homogeneous B) Speckled C) Nucleolar D) AnticentromereA) SLE
B) Mixed connective tissue disease
C) Primary Sjogren's syndrome
D) CREST syndrome - calcinosis of the fingertips sometimes present - 22What are these antibodies against cellular compartments likely to be positive in? A) dsDNA B) histones C) Ro (SS-A) D) La (SS-B) E) SM F) RNP G) Jo-1A) Lupus (nephritis)
B) lupus (H2A, H2B-drug induced)
C) Sjogren's and neonatal lupus
D) Sjogren's
E) lupus (nephritis and CNS)
F) lupus, Reynaud's
G) polymyositis, alveolitis - 23What causes neonatal lupus and how does it present?Crossing of anti-Ro antibodies across the placenta. A rash that resolves spontaneously, and can cause complete heart block
- 24What is synovial biopsy reserved for?Chronic monoarthritis
- 25What might cause a chronic monoarthritis?Chronic infection (e.g. TB)
Foreign body
Sarcoidosis
PVNS (pigmented villonodular synovitis)
Amyloid - 26What is serum uric acid measurement used for?Monitoring of gout treatment (gout diagnosis is by crystal identification).
- 27What is the target serum uric acid in gout treatment?<360umol/L
- 28What are some possible causes of an elevated CPK (creatinine phosphokinase)?Inflammatory myopathy +/- vasculitis
Muscular dystrophy
MND
Alcohol/drugs
Trauma or strenuous exercise
MI
Hypothyroidism, metabolic myopathy