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Rheum Labs
Rheumatology
| Question | Answer |
|---|---|
| Giant Cell Arteritis labs | High ESR, CRP & IL-6 ; mild norm/norm anemia w/ thrombocytosis; temporal art bx is diagnostic |
| Elevated ESR, Leukopenia, Elevated ACE levels (40-80% prevalence) | sarcoidosis |
| Schirmer test: to confirm dx of: | Sjogren dz |
| needle-like morphology and strong negative birefringence, under polarized light= | gout |
| Birefringence: Urate crystals | strongly negatively birefringent, needle shaped |
| Birefringence: CPPD crystals | positively birefringent, rhomboid crystals |
| Gout: Not useful in dx: | serum uric acid, plain films |
| Gold standard in dx of gout | joint aspirate demonstrating uric acid crystals |
| CPPD dx | demo crystals in jt fluid; chondrocalcinosis on plain film; CT, MRI and U/S all detect CPPD; do serum Ca, Mg, PO4, alk phos, ferritin, Fe, TIBC |
| Spondylo labs | inc acute phase reactants (ESR, CRP); hi plts; N/N anemia; hi serum IgA; (rare: hi AlkPhos); hi CPK; mild hi CSF protein & complement |
| Sarcoid: Dx | Bx; Bronchoscopy; PFT; serum ACE; CXR; Gallium Scan; MRI / CT; Vit D sensitivity; Mediastinoscopy |
| Most common Ab’s assoc with SLE | ANA (best screening test); dsDNA (hi titer diagnostic); anti-Smith to confirm; anti-RNP (not spec for SLE); Ro, La |
| Gono arthritis: labs | syn fluid, blood cx not too helpful; cx likely infected mucosal surfaces (cervix, anus, oropharynx); WBC usually normal |
| Essential for dx / tx of infxs arthritis: | synovial fluid (usu pos as are cx) (Blood cx pos in 50%) |
| TB arthritis: labs | Syn fluid cell counts may be lower (than other infxs arth); AFB found in syn fluid in <20% |
| Fungal arthritis: Labs | cx joint fluid may be neg; Complement fixation, antigen assays, synovial bx: all dx important |
| RA: Labs | no single dx test confirms RA; acute phase reactants (ESR, CRP, thrombocytosis); autoAbs (CCP more specific than RF; ANA); anemia of chronic dz; synovial fluid analysis; inc WBCs, mostly PMNs |
| RA labs: CCP vs RF | 30% RA pts are RF neg; 60% RA pts CCP pos (RF for severe dz) |
| Dx gold std for PM/DM | bx (open bx preferred; can do needle) |
| Inflam myopathies: ANA Ab | 50% prev; High titers usually indicate presence of another CTD |
| Inflam myopathies: Anti-Jo Ab | 25% prev; PM or DM & ILD, arthritis, Raynaud’s |
| Inflam myopathies: Anti-PM-Scl | low prev; Ab to nucleolar protein complex; assoc with PM/SSc |
| Inflam myopathies: Anti-Mi-2 | low prev; DM with V sign, shawl sign |
| Scleroderma: ANA | prev 95%; both lcSSc & dcSSc |
| Scleroderma: anti-topoisomerase (Scl-70) | more assoc w/diffuse dz; assoc w/ tendon rubs, pulmo fibrosis, inc mortality |
| Scleroderma: anti-centromere | more in LcSSc; assoc w/ CREST, pulmonary HTN, Raynaud |
| 2 autoAbs unique to scleroderma: | anti-topoisomerase (Scl-70); anti-centromere |
| Giant cell arteritis Labs | very high ESR/CRP, anemia, low albumin |
| Wegener: dx | bx involved tissue (gold std) |
| Wegener: Labs: | c-ANCA (anti-neutrophil cytoplasmic antibody) (AKA PR3-ANCA, reacts w/ proteinase-3); inflammation: high ESR, CRP, anemia |
| Wegener: bx | of most available tissue (esp lung or kidney) |
| Sjogren: Testing: Eyes: | Schirmer test: measures tear production on paper (+ if <5mm); Rose-Bengal staining: shows corneal damage |
| Sjogren: Testing: Mouth: | salivary gland bx; lower lip bx = lymphocyte infiltrate & gland fibrosis |
| Sjogren: Testing: Labs: | 70% +RF; 60% +ANA; 60% Ro Ab; 40% La Ab |
| Anti-phospholipid syndrome dx / testing: | Anti-cardiolipin Ab; Lupus anticoag; False pos RPR |
| Fibromyalgia: Labs | within normal limits |
| Mixed Connective Tissue Dz Testing: | pos anti-RNP Ab |
| Polymyositis labs | high CPK & aldolase |
| PMR labs | Elevated CRP & ESR (>50), not so high as in giant cell arteritis |
| polyarteritis nodosa dx studies | vessel bx or angiogram; high ESR, CRP, urine pro, ANCA; HBsAg |
| Psoriasis labs | high ESR; N/N anemia; hyperuricemia; normal RF |
| Temporal bone fx: dx | CT Temporal Bone, non-contrasted; ENT Consult |
| Shoulder x-rays | AP Grashey (30 deg), scap Y, axillary |
| Painless bony mass. Plain films = stalky or broad-based projection from bone surface | Osteochondroma |
| MRI sensitive/not sensitive for: | sensitive for meniscus; not good for chondral injury (effusion, nonlocal, nontender) |
| Rhabdomyolysis: Labs | Myoglobinuria; CK elevated 5-10x normal (37-200) |
| Plain Films: Consider: | Consider joint above & below injury |
| CT scan: defines: | Defines bony anatomy |
| MRI: defines: | Defines soft tissues |
| Nuclear medicine studies: | Help define tumors, etc |
| EMG: Evaluates: | Evaluates denervation of muscle units |
| NCS: Evaluates: | Evaluate conduction velocities |
| Hemodynamically Unstable Fx imaging/look for: | AP lateral xray: Inspect inner/ outer main ring cortices; 2 small rings; SI joint spaces (equal); symphysis pubis should align, < 5mm joint space; acetabulum |
| Hemodynamically Unstable Fx: if fx identified or suspected: | CT (+/- MRI) |
| Septic joint/osteo: Dx tests | Bone scans localize osteomyelitis; Joint aspiration to identify organism |
| MS Imaging | Plain films (at least 2 views); consider joints above/below injury; CT (bony); MRI (ST); nuc med (tumors); EMG/NCS |
| Trauma x-ray series | Lateral C-Spine; PA Chest; AP Pelvis |
| MS injuries: plain films | At least 2 views; Check entire film; Consider joint above & below injury |
| Nuclear med studies to: | define tumors, etc |
| Posterior fat pad is always: | pathologic |
| Bucket-handle or corner fracture on x-ray = | Metaphyseal Corner fx; less common, more specific for abuse than diaphyseal fx; represent planar fx through primary spongiosa |
| test that should be ordered to rule out DVT in the case of shoulder pain | doppler ultrasound |
| initial test to be ordered to evaluate post-operative pain | x-ray to evaluate for hardware failure |
| Antibodies in DM & PM | Anti-Jo, ANA |
Created by:
Abarnard
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