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CC3 - Investigations
Investigations relevant to rheum and ortho.
101
Medical
Undergraduate 1
05/14/2015

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Term
What can both chronic inflammatory disease and NSAID therapy cause in an FBC?
Definition
Anaemia
Term
What kind of anaemia can occur in autoimmune disease?
Definition
Haemolytic
Term
What is polymorphonuclear leukocytosis?
Definition
An increased number of neutrophils.
Term
What does polymorphonuclear leukocytosis suggest?
Definition
infection or inflammation.
Term
What effect does prolonged corticosteroid use have on the white cell count?
Definition
It reduces it.
Term
In SLE, what can happen to the white cell count?
Definition
It can be reduced.
Term
In bone marrow suppression from DMARDs, what can happen to the white cell count?
Definition
It can be reduced.
Term
What does SLE stand for?
Definition
Systemic Lupus Erythematosis
Term
What is thrombocytosis?
Definition
A high platelet count.
Term
What is often found in the FBC in active inflammatory disease?
Definition
Thrombocytosis.
Term
Give two conditions where thrombocytopenia is found.
Definition
SLE and antiphospholipid syndrome.
Term
What is the proper name for a low platelet count?
Definition
Thrombocytopenia.
Term
Does a low or normal white cell count always exclude sepsis?
Definition
No, not if the clinical situation indicates otherwise.
Term
What does ESR stand for?
Definition
Erthrocyte Sedimentation Rate
Term
Is ESR specific?
Definition
no.
Term
What does ESR measure?
Definition
The rate of aggregation of erthrocytes, which increases with the concentration of plasma proteins such as fibrinogen and immunoglobulins.
Term
What happens to the upper limit of ESR with age?
Definition
It increases.
Term
What is CRP?
Definition
C-Reactive Protein, a non-specific marker of inflammation that rises in infectious and inflammatory disorders.
Term
Which rises more rapidly, esr or crp?
Definition
CRP
Term
How quickly does CRP typically rise following an inflammatory event?
Definition
6-10 hours.
Term
When might renal impairment occur?
Definition
In gout or connective tissue disorders.
Term
What would happen to the levels of urea in the blood in renal impairment?
Definition
They would decrease.
Term
What aspect of the liver function test is raised in Paget's disease?
Definition
Alkaline Phosphotase.
Term
What do methotrexate, sulphasalazine and NSAIDs all have in common?
Definition
They are used in some musculoskeletal problems and they can all be hepatotoxic.
Term
Which acid is usually raised in those with gout?
Definition
Uric acid
Term
Can uric acid be normal during an acute flair or gout?
Definition
Yes
Term
When does hypocalcaemia classically occur?
Definition
Osteomalacia.
Term
When can hyperclacaemia occur?
Definition
Malignancy.
Term
When is creatine kinase raised?
Definition
Following trauma or inflammation.
Term
Why are autoantibodies not hugely useful?
Definition
They can occur in healthy people, giving false positives, and hence have little diagnostic value.
Term
When could autoantibodies justifiably be asked for?
Definition
When there is a real clinical suspicion of an autoimmune condition.
Term
What is rheumatoid factor?
Definition
An antibody directed against fragment Fc of IgG.
Term
What proportion of those with RA have rheumatoid factor?
Definition
75%
Term
What does ACPA stand for?
Definition
Anticitrullinated Peptide Antibodies
Term
What is ACPA highly specific to?
Definition
RA
Term
How soon before RA can ACPA be detected?
Definition
Years.
Term
What aspects of RA is ACPA associated with?
Definition
joint errosion and more aggresive disease.
Term
Can ACPA be found in those who are Rheumatoid Factor negative?
Definition
Yes.
Term
What does ANCA stand for?
Definition
Antineutrophil Cytoplasmic Antibodies.
Term
What are ANCA?
Definition
Antibodies directed against enzymes present in neutrophil granules, associated with vasculitic and inflammatory conditions.
Term
What are the two main patterns of immunofluorescence when it comes to ANCA?
Definition
Cytoplasmic and Perinuclear.
Term
What does c-ANCA stand for?
Definition
Cytoplasmic - Antineutrophil Cytoplasmic Antibodies.
Term
What does p-ANCA stand for?
Definition
Perinuclear - Antineutrophil Cytoplasmic Antibodies.
Term
Which protein does c-ANCA most commonly bind to?
Definition
proteinase 3 (PR3)
Term
Which protein does p-ANCA most commonly bind to?
Definition
Myeloperoxidase (MPO)
Term
What is the old name for Granulomatosis with polyangiitis?
Definition
Granulomatosis.
Term
Which antibodies are found in 80% of patients with Granulomatosis with polyangiitis?
Definition
Antibodies to PR3 (proteinase 3)
Term
Which antibodies are commonly found in polyarteritis nodosa?
Definition
Antibodies to MPO (myeloperoxidase)
Term
What two antibodies are found in antiphospholipid syndrome?
Definition
Lupus anticoagulant and anticardiolipin.
Term
What happens to serum levels of complement proteins when the complement system is activated?
Definition
They are reduced.
Term
What kind of chains can be found in myeloma?
Definition
Free light chains
Term
What happens to levels of C3 and C4 in active lupus?
Definition
They are reduced.
Term
What happens to levels of C3 and C4 in some types of vasculitis?
Definition
They are reduced.
Term
What is the most important investigation in suspected septic or crystal athritis
Definition
Synovial fluid analysis/Aspiration.
Term
What colour is synovial fluid normally?
Definition
Pale yellow and clear.
Term
What are two possible causes of blood in synovial fluid following aspiration?
Definition
Haemarthrosis or puncture of a blood vessel on aspiration.
Term
What causes synovial fluid to turn cloudy?
Definition
Increased cell count due to inflammation or septic arthritis.
Term
What are the two causes of puss in synovial fluid, and which is the more likely?
Definition
Septic and crystal arthritis, of which septic is more likely.
Term
What causes synovial fluid to turn chalky?
Definition
Gout crystals.
Term
When should a gram stain and culture of synovial fluid always be carried out?
Definition
If there is any suspicion of septic arthritis.
Term
What kind of bifringence do urate crystals exhibit?
Definition
Strong, negative.
Term
What does negative bifringence mean?
Definition
Those crystals parallel to the plane of light appear yellow, those perpendicular appear blue.
Term
Does the absence of organisms on microscopy of synovial fluid exclude infection?
Definition
No.
Term
What is an NCS?
Definition
A nerve conduction study.
Term
What is an EMG?
Definition
Electromyography.
Term
What are NCS and EMG? (In broad terms)
Definition
Electrophysiological tests used to diagnose and assess neuromuscular problems.
Term
What doe electrophysiological tests help to differentiate between?
Definition
Primary muscle disease and neuropathic disorders.
Term
What do NCS measure?
Definition
The conduction velocity of motor and sensory nerves, localising and assessing the severity of peripheral nerve lesions.
Term
What do EMG measure?
Definition
Spontaneous and voluntary electrical activities of muscles.
Term
What are plain radiographs good at imaging?
Definition
Bone
Term
Put the following in order from lightest to darkest on an x-ray:
Muscle
Fat
Bone
Air
Definition
Bone
Muscle
Fat
Air
Term
When do women need to avoid x-rays?
Definition
During pregnancy.
Term
What 2 views are normally required when x-raying a fracture?
Definition
anteroposterior and lateral.
Term
Name 2 special x-ray views that are sometimes required.
Definition
Skyline, scaphoid
Term
Give three advantages of ultrasound.
Definition
It's cheap, safe and portable.
Term
What would be your first choice to image the shoulder to check for rotator cuff injuries?
Definition
Ultrasound.
Term
What would be your first choice to image the hip to check for joint effusion?
Definition
Ultrasound.
Term
What would be your first choice to image the shoulder to check for a fracture?
Definition
Plain film radiograph.
Term
What is MRI great for imaging?
Definition
Bone marrow or soft tissue.
Term
What would be your first choice for imaging a nerve root compression?
Definition
MRI
Term
What would be your first choice for imaging a meniscal injury?
Definition
MRI
Term
What would be your first choice for imaging inflammatory back disease?
Definition
MRI
Term
What can MRI be used to image in rheumatology?
Definition
Synovitis and erosive damage.
Term
Give 5 examples where you will see increased uptake in a bone scan.
Definition
Increased uptake typically takes place in growth plates, arthritis, metastases, Paget disease and infection.
Term
What is the most commonly used isotope for bone scans?
Definition
technetium-99
Term
Give 2 examples where you will see decreased uptake in a bone scan.
Definition
Some tumours (haemopoietic), and in avascular bone.
Term
Are bone scan sensitive?
Definition
Yes
Term
Are bone scans specific?
Definition
No
Term
What would be your first choice for imaging a nerve root compression?
Definition
MRI
Term
What would be your first choice for imaging a meniscal injury?
Definition
MRI
Term
What would be your first choice for imaging inflammatory back disease?
Definition
MRI
Term
What can MRI be used to image in rheumatology?
Definition
Synovitis and erosive damage.
Term
Give 5 examples where you will see increased uptake in a bone scan.
Definition
Increased uptake typically takes place in growth plates, arthritis, metastases, Paget disease and infection.
Term
What is the most commonly used isotope for bone scans?
Definition
technetium-99
Term
Give 2 examples where you will see decreased uptake in a bone scan.
Definition
Some tumours (haemopoietic), and in avascular bone.
Term
Are bone scan sensitive?
Definition
Yes
Term
Are bone scans specific?
Definition
No
Term
What does DEXA stand for?
Definition
Dual Energy X-ray Absorptiometry.
Term
What is arthrography?
Definition
Where a patient has air or contrast injected into their joint prior to imaging.
Term
What kind of pathology are MRI arthrograms good for diagnosing?
Definition
Intra-articular pathology.
Term
When are plain x-ray arthrograms still used?
Definition
Imaging hip conditions in children.
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