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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 (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 of the ANA may be low in a primary care practice

c. The negative predictive value 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 (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 and microscopic polyangiitis

b. The ANCA is typically positive in large vessel vasculitis, such as temporal (giant cell) 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 (diffuse form of scleroderma)

c. Primary sclerosing cholangitis

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

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 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
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Title Annotation:continuing medical education
Publication:Southern Medical Journal
Date:Jul 1, 2005
Words:684
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