3009322
Descripción
Fichas por esther.westwood, actualizado hace más de 1 año
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Creado por esther.westwood
hace más de 9 años
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| Pregunta | Respuesta |
| What are the indications for synovial fluid analysis? | Acute bacterial sepsis Crystal associated disease Often combined with steroid injection |
| What 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) |
| What does inflammation in a joint do to synovial fluid? | Increased volume Increasing cell count and more neutrophils = high turbidity Reduction in viscosity |
| What 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 |
| What does synovial fluid analysis involve? | Naked eye assessment Gram stain and culture Polarised light microscopy |
| What is pyarthrosis and what can it occur in? | Pus in the synovial fluid Sepsis and crystals |
| What 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. |
| What is this? | CPPD crystals on compensated polarised microscopy. They are rhomboid, small and usually sparse with weak birefringence and a positive sign of birefringence. |
| What 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) |
| What is a rouleaux? | The stack of erythrocytes formed by doing an ESR. |
| A) 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 |
| What 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. |
| Which conditions cause A) Neutrophilia B) Eosinophilia C) Lymphocytopaenia D) Thrombocytopaenia? | A) SLE, gout B) Wegener's (granulomatosis with polyangiitis) C) SLE D) SLE |
| What is rheumatoid factor? | An IgM autoantibody against IgG |
| What 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 |
| What percentage of RA patients are RF positive a) at diagnosis b) after 1 year? | A) 60% B) 70% |
| What is the sensitivity and specificity of RF for RA? | Good sensitivity, poor specificity |
| What is anti-CCP and what is it positive in? | Anti - cyclic citrullinated peptides: antibodies against modified arginine (citrullinated) residues Rheumatoid arthritis |
| What 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 |
| What 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 |
| DISTRIBUTION of ANA What conditions will show these distributions? A) Diffuse and homogeneous B) Speckled C) Nucleolar D) Anticentromere | A) SLE B) Mixed connective tissue disease C) Primary Sjogren's syndrome D) CREST syndrome - calcinosis of the fingertips sometimes present |
| What 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-1 | A) 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 |
| What 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 |
| What is synovial biopsy reserved for? | Chronic monoarthritis |
| What might cause a chronic monoarthritis? | Chronic infection (e.g. TB) Foreign body Sarcoidosis PVNS (pigmented villonodular synovitis) Amyloid |
| What is serum uric acid measurement used for? | Monitoring of gout treatment (gout diagnosis is by crystal identification). |
| What is the target serum uric acid in gout treatment? | <360umol/L |
| What 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 |
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