CME questions: diagnostic tests for rheumatic disease: clinical utility revisited.1. Which one of the following is true? a. The classification criteria for rheumatoid arthritis were developed to guide clinicians evaluating patients with joint pain b. By definition, patients who do not meet the classification criteria for rheumatoid arthritis do not have the disease c. The classification criteria for rheumatoid arthritis were developed to provide some measure of comparability among patients in research studies d. None of the above 2. Although the antinuclear antibody (ANA) is present in nearly all patients with systemic lupus erythematosus Systemic Lupus Erythematosus Definition Systemic lupus erythematosus (also called lupus or SLE) is a disease where a person's immune system attacks and injures the body's own organs and tissues. Almost every system of the body can be affected by SLE. (SLE SLE systemic lupus erythematosus. SLE abbr. systemic lupus erythematosus Systemic lupus erythematosus (SLE) ), the disease is relatively rare. Therefore, a. The sensitivity of the ANA may be low in a primary care practice b. The positive predictive value Positive predictive value (PPV) The probability that a person with a positive test result has, or will get, the disease. Mentioned in: Genetic Testing positive predictive value of the ANA may be low in a primary care practice c. The negative predictive value The negative predictive value is the proportion of patients with negative test results who are correctly diagnosed. Worked example
Condition (as determined by "Gold standard") True False is low regardless of the clinical setting d. The sensitivity of the ANA is low regardless of the clinical setting e. None of the above 3. Which one of the following is true regarding measurement of antinuclear antibodies (ANAs)? a. The assay is standardized so results from one lab can be readily compared with the results from another b. The ANA should be measured while the patient is fasting c. Viral infection, drug therapy and genetic predisposition may cause the ANA to be positive even in the absence of rheumatic disease d. A positive result at any titer is clinically important e. None of the above 4. Which of the following is true regarding the erythrocyte sedimentation rate Erythrocyte Sedimentation Rate Definition The erythrocyte sedimentation rate (ESR), or sedimentation rate (sed rate), is a measure of the settling of red blood cells in a tube of blood during one hour. (ESR)? a. A small number of clinical conditions can cause marked elevations of the ESR (e.g., ESR > 100) b. Polymyalgia rheumatica should not be considered when the ESR is normal c. The ESR tends to be higher in men compared with women d. The ESR tends to rise with age e. None of the above 5. When deciding between ordering an ESR or C-reactive protein (CRP), clinicians should keep in mind that: a. As a measure of inflammation, the CRP changes more slowly than the ESR b. When the CRP is markedly elevated in the setting of systemic inflammation, its utility as a measure of cardiovascular disease risk is maintained c. The CRP is clearly a better choice d. It is highly unusual for the CRP to be normal when the ESR is elevated e. None of the above 6. The anti-citrullinated cyclic protein (anti-CRP) is a relatively new test associated with rheumatoid arthritis. Based on published reports thus far, its advantage over other available tests is its: a. High negative predictive power b. High sensitivity c. High specificity d. Low cost e. None of the above 7. With regard to the antineutrophilic cytoplasmic antibody (ANCA), which of the following is true? a. Vasculitides associated with a positive ANCA include Wegener granulomatosis, Churg-Strauss vasculitis Vasculitis Definition Vasculitis refers to a varied group of disorders which all share a common underlying problem of inflammation of a blood vessel or blood vessels. The inflammation may affect any size blood vessel, anywhere in the body. and microscopic polyangiitis b. The ANCA is typically positive in large vessel vasculitis large vessel vasculitis Internal medicine Vasculitis of the aorta and its major tributaries, which supply the extremities, head, neck Examples Giant cell/temporal arteritis, Takayasu's arteritis. See Systemic vasculitis. , such as temporal (giant cell) arteritis arteritis Inflammation of the arteries. It occurs in diseases including syphilis, tuberculosis, and lupus erythematosus. Varieties not closely associated with systemic disease or disease of an organ outside the cardiovascular system have been described as temporal arteritis, c. When the ANCA is positive, there is little reason to determine whether there are antibodies directed against proteinase-3 (pr-3) or myeloperoxidase (MPO) d. The ANCA is an excellent screening test for vasculitis e. None of the above 8. A positive ANA in an anti-centromere pattern is associated with: a. CREST syndrome (limited form of scleroderma) b. Progressive systemic sclerosis progressive systemic sclerosis n. A systemic disease marked by formation of hyalinized and thickened collagenous fibrous tissue, with thickening and adhesion of skin to underlying tissues, especially of the hands and face. (diffuse form of scleroderma) c. Primary sclerosing cholangitis Primary sclerosing cholangitis A chronic disease in which it is believed that the immune system fails to recognize the cells that compose the bile ducts as part of the same body, and attempts to destroy them. d. Autoimmune hepatitis e. Celiac disease 9. The HLA-B27 test is particularly helpful in the evaluation of patients with: a. An initial episode of uveitis uveitis Inflammation of the uvea, the middle coat of the eyeball. Anterior uveitis, involving the iris or ciliary body (containing the muscle that adjusts the lens) or both, can lead to glaucoma and blindness. b. Low back pain c. "Failed back" syndrome d. Psoriatic arthritis e. None of the above 10. For a patient with joint pain that might be due to gouty arthritis, marked hyperuricemia hyperuricemia /hy·per·uri·ce·mia/ (-u?ri-se´me-ah) uricemia; an excess of uric acid in the blood.hyperurice´mic hy·per·u·ri·ce·mi·a n. An unusually high concentration of uric acid in the blood. suggests that: a. The diagnosis of gout is likely, as marked hyperuricemia is otherwise rare b. The diagnosis of gout is unlikely because uric acid falls during acute attacks of gouty arthritis c. The patient could have renal insufficiency or dehydration d. Joint aspiration is unlikely to add additional useful information e. None of the above Answers to CME Questions 1. D, 2. B, 3. C, 4. D, 5. E, 6. C, 7. A, 8. A, 9. E, 10. C |
|
||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion