Rheumatology
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| Giant Cell Arteritis labs | High ESR, CRP & IL-6 ; mild norm/norm anemia w/ thrombocytosis; temporal art bx is diagnostic
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| Elevated ESR, Leukopenia, Elevated ACE levels (40-80% prevalence) | sarcoidosis
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| Schirmer test: to confirm dx of: | Sjogren dz
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| needle-like morphology and strong negative birefringence, under polarized light= | gout
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| Birefringence: Urate crystals | strongly negatively birefringent, needle shaped
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| Birefringence: CPPD crystals | positively birefringent, rhomboid crystals
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| Gout: Not useful in dx: | serum uric acid, plain films
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| Gold standard in dx of gout | joint aspirate demonstrating uric acid crystals
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| 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
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| 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
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| Sarcoid: Dx | Bx; Bronchoscopy; PFT; serum ACE; CXR; Gallium Scan; MRI / CT; Vit D sensitivity; Mediastinoscopy
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| 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
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| Gono arthritis: labs | syn fluid, blood cx not too helpful; cx likely infected mucosal surfaces (cervix, anus, oropharynx); WBC usually normal
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| Essential for dx / tx of infxs arthritis: | synovial fluid (usu pos as are cx) (Blood cx pos in 50%)
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| TB arthritis: labs | Syn fluid cell counts may be lower (than other infxs arth); AFB found in syn fluid in <20%
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| Fungal arthritis: Labs | cx joint fluid may be neg; Complement fixation, antigen assays, synovial bx: all dx important
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| 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
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| RA labs: CCP vs RF | 30% RA pts are RF neg; 60% RA pts CCP pos (RF for severe dz)
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| Dx gold std for PM/DM | bx (open bx preferred; can do needle)
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| Inflam myopathies: ANA Ab | 50% prev; High titers usually indicate presence of another CTD
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| Inflam myopathies: Anti-Jo Ab | 25% prev; PM or DM & ILD, arthritis, Raynaud’s
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| Inflam myopathies: Anti-PM-Scl | low prev; Ab to nucleolar protein complex; assoc with PM/SSc
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| Inflam myopathies: Anti-Mi-2 | low prev; DM with V sign, shawl sign
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| Scleroderma: ANA | prev 95%; both lcSSc & dcSSc
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| Scleroderma: anti-topoisomerase (Scl-70) | more assoc w/diffuse dz; assoc w/ tendon rubs, pulmo fibrosis, inc mortality
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| Scleroderma: anti-centromere | more in LcSSc; assoc w/ CREST, pulmonary HTN, Raynaud
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| 2 autoAbs unique to scleroderma: | anti-topoisomerase (Scl-70); anti-centromere
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| Giant cell arteritis Labs | very high ESR/CRP, anemia, low albumin
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| Wegener: dx | bx involved tissue (gold std)
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| Wegener: Labs: | c-ANCA (anti-neutrophil cytoplasmic antibody) (AKA PR3-ANCA, reacts w/ proteinase-3); inflammation: high ESR, CRP, anemia
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| Wegener: bx | of most available tissue (esp lung or kidney)
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| Sjogren: Testing: Eyes: | Schirmer test: measures tear production on paper (+ if <5mm); Rose-Bengal staining: shows corneal damage
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| Sjogren: Testing: Mouth: | salivary gland bx; lower lip bx = lymphocyte infiltrate & gland fibrosis
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| Sjogren: Testing: Labs: | 70% +RF; 60% +ANA; 60% Ro Ab; 40% La Ab
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| Anti-phospholipid syndrome dx / testing: | Anti-cardiolipin Ab; Lupus anticoag; False pos RPR
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| Fibromyalgia: Labs | within normal limits
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| Mixed Connective Tissue Dz Testing: | pos anti-RNP Ab
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| Polymyositis labs | high CPK & aldolase
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| PMR labs | Elevated CRP & ESR (>50), not so high as in giant cell arteritis
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| polyarteritis nodosa dx studies | vessel bx or angiogram; high ESR, CRP, urine pro, ANCA; HBsAg
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| Psoriasis labs | high ESR; N/N anemia; hyperuricemia; normal RF
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| Temporal bone fx: dx | CT Temporal Bone, non-contrasted; ENT Consult
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| Shoulder x-rays | AP Grashey (30 deg), scap Y, axillary
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| Painless bony mass. Plain films = stalky or broad-based projection from bone surface | Osteochondroma
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| MRI sensitive/not sensitive for: | sensitive for meniscus; not good for chondral injury (effusion, nonlocal, nontender)
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| Rhabdomyolysis: Labs | Myoglobinuria; CK elevated 5-10x normal (37-200)
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| Plain Films: Consider: | Consider joint above & below injury
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| CT scan: defines: | Defines bony anatomy
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| MRI: defines: | Defines soft tissues
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| Nuclear medicine studies: | Help define tumors, etc
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| EMG: Evaluates: | Evaluates denervation of muscle units
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| NCS: Evaluates: | Evaluate conduction velocities
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| 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
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| Hemodynamically Unstable Fx: if fx identified or suspected: | CT (+/- MRI)
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| Septic joint/osteo: Dx tests | Bone scans localize osteomyelitis; Joint aspiration to identify organism
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| MS Imaging | Plain films (at least 2 views); consider joints above/below injury; CT (bony); MRI (ST); nuc med (tumors); EMG/NCS
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| Trauma x-ray series | Lateral C-Spine; PA Chest; AP Pelvis
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| MS injuries: plain films | At least 2 views; Check entire film; Consider joint above & below injury
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| Nuclear med studies to: | define tumors, etc
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| Posterior fat pad is always: | pathologic
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| 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
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| test that should be ordered to rule out DVT in the case of shoulder pain | doppler ultrasound
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| initial test to be ordered to evaluate post-operative pain | x-ray to evaluate for hardware failure
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| Antibodies in DM & PM | Anti-Jo, ANA
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Created by:
Abarnard
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