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33 Cards in this Set
- Front
- Back
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What is arthrocentesis?
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Arthrocentesis is a needle aspiraate of synovial fluid for microscopic analysis. The cell count is the most accurate way of telling immediately if there is an infection versus inflammation. Counts from 0 to 2,000 are normal; from 2,000 to 20,000 are from inflammatory disorders such as gout. Counts above 50,000 are from infections. Counts between 20,000 and 50,000 are indeterminate.
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When do I answer arthrocentesis?
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Look for a patient wiht a new onset of a joint that is warm to touch, painful, and swollen from an effusion with decreased mobility. Iin gout, the serum uric acid may be elevated.
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What are possible findings evident in the two synovial fluid samples using arthrocentesis?
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The slides depicted here are indicative of the following:
Gout: Negatively birefringent needle-shaped crystals. These are monosodium urate crystals. Pseudogout: Positively birefringent rhomboid-shaped crystals. |
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What is aldolase associated with?
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Aldolase is released from damaged skeletal muscle and is elevated in inflammatory myopathies such as polymyositis and dermatomyositis. Creatinine and CPK are also elevated.
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When do you answer aldolase?
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Look for a case of an older woman with difficulty rising form a chair. There may be a heliotrope rash and Gottron's papules. Aldolase, or CPK, is the answer to the question "What is the best initial diagnostic test?"
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What is the most accurate test for polymyositis and dermatomyositis?
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The most accurate tests are the electromyogram and the muscle biopsy. These confirm the diagnosis of polymyositis and dermatomyositis when the aldolase is elevated.
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For which clinical scenario is allergy testing used?
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Allergy testing is the subdermal exposure to trace amounts of suspected allergens with subsequent visual inspection for signs of hypersensitivity. This is used when a patient has allergic symptoms (runny nose, watery eyes, sneezing) and the direct cause is unknown. Specifically used to investigate food, pet, aeroallergen (pollens, dust), venom (wasps, bees)
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When is allergy testing contraindicated?
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Allergy testing is contraindicated when there is a hight risk of anaphylaxis based on past exposures or uncontrolled severe asthma.
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What medication must be stopped before allergy testing?
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Beta blockers such as propranool should be stopped prior to testing for allergens for which tere might be severe reactions during desensitization. If anaphylaxis occurs, we want to use epinephrine to reverse it, and beta blockers will make the epinephrine less effective.
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What diseases are ANA, Double-Stranded DNA and ANti-Sm Antibodies associated with?
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ANA is more than 98% sensitive for SLE but ANA is not specific for SLE. A negative ANA excludes SLE with a 998% negative predictive value. Anti-ds-DNA antibodies are 99% specific for SLE. Anti-Smith antibodies are extremely specific for lupus.
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When do you answerANA, Double-Stranded DNA and ANti-Sm Antibodies?
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Answer ANA, anti-Sm and ds-DNA when you see a young female with multiple spontaneous abortions (lupus anticoagulant), rash, and joint pains.
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What condition is Anticentromere Antibodies associated with?
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Anticentromere antibodies ar specific for CREST syndrome. CREST is calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactylyl, and telangiectasia. Antitopoisomerase (SCL-70) is specific for the systemic disease (systemic sclerosis).
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When do you answer anticentromere antibodies?
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Answer anticentromere antibodies as the "best initial test" when you see a female 30 to 50 years of age with positive rheumatoid factor adn a positive ANA.
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What are antihistone antibodies specific for?
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Antihistone antibodies are most often associated with drug-induced lupus. The most common drug that cause lupus are procainamide, hydralazine, phenytoin, sulfonamides, isoniazid, and penicillamine.
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What is the treatment for drug induced lupus?
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There is no specific therapy. Stop the medication.
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What diseases are Anti-Ro / Anti-La Antibodies?
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Anti-Ro and -La antibodies are associated with Sjogren's syndrome. Sjogren's syndrome presents with a positive ANA, anti-Ro / anti-La antibodies, and a positive rheumatoid factor.
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When are Anti-Ro / Anti-La Antibodies the answer?
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Answer anti-Ro and -La when you see the triad of keratoconjunctivitis (sicca syndrome), xerostomia, and arthritis, or dry eyes, dry mouth, and arthritis.
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What is Anti-Scl 70 Antibodies?
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Anti-scl 70 antibodies ar directed against topisomerase-1 and are ordered when systemic sclerosis, particularly the diffuse type, is suspected.
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When do you answer anti-scl 70 antibodies?
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Look for polyarthralgia; Raynaud's phenomenon; thick, hidebound skin; dysphagia; and GI tract hypomotility as well as pulmonary and renal abnormalities.
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How would a negative test affect management?
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Anti-scl 70 antibodies have low sensitivity (30%). Hence, a negative test would not rule out the disease if clinical suspicion is high.
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What is the patient at risk for if the anti-scl 70 is positive?
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Anti-scl 70 is most strongly correlated with severe lung involvement such as pulmonary fibrosis.
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What is C-ANCA (Antineutrophil Cytoplasmic Antibody)?
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C-ANCA is the best initial test to make a specific diagnosis of Wegener's granulomatosis.
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How is C-ANCA test done?
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C-ANCA is a blood test. A pattern is seen on indirect immunofluorescence microscopy that indicates antibodies directed against proteinase 3 of neutrophils.
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When do you answer C-ANCA?
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Answer C-ANCA when you see upper and lower respiratory problems combined wiht signs of renal disease such as hematuria and red cell casts in teh urine. There will be hemoptysis, cough, and sputum with an abnormal chest X-ray not responsive to antibiotics. Otitis and sinusitis will also be present.
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What is the most accurate diagnostic test?
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The most accurate test for Wegener's granulomatosis is a biopsy of the lung or the kidney.
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What does DEXA scanning show?
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DEXA scan is used to diagnose osteoporosis. Dexa scanning is used to detect decreased bone density when compared to the general population.
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When do you answer DEXA scan?
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Answer DEXA scanning for postmenopausal women or patients with high cortisol states like Cushing's syndrome, exogenous steroid use, hyperthyroidism, or with hyperparathyroidism.
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What is the treatment?
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Treatment is with estrogens, bisphosphonates, and SERM such as raloxifen and tamoxifen.
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For which clinical condition(s) would you use muscle biopsy?
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Muscle biopsy is used to diagnose a suspected myopathy such as:
Glycogen storage diseases Mitochondrial gene malformations Dystrophinopathies (Duchenne's/Becker's) Dermatomyositis/polymyositis |
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Wen do you answer muscle biopsy?
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Answer muscle biopsy when you see proximal muscle weakness described as "weak shoulder abduction" or "weakness rising from a chair." This is usually associated wiht myalgia (muscle soreness) and other signs of myopathy such as recurrent rhabdomyolysis. There may also be a family history of a similar problem because many muscle disorders are inherited.
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For which muscle diseases would you not answer muscle biopsy?
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Although somewhat similar in presentation because of the weakness you should not answer muscle biopsy with:
Endocrine-related myopathies (thyroid/diabetes) Neuropathies (myasthenia gravis) |
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What disease is Rheumatoid factor associated with?
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Rheumatoid factor (RF) is present in more than 70% of patients with rheumatoid arthritis (RA), however RF is not specific for RA.
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When do we answer rheumatoid factor?
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Answer RF when you are presented with a woman with symmetric inflammatory arthritis that is worse in the morning, affecting wrists, MCP, and PIP joints. Look for an elevated ESR or synovial fluid with an elevated white count between 2,000 and 20,000 cells.
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