03a: OA, Infectious, etc. Flashcards
(26 cards)
Synovial fluid analysis: Group I fluid is (inflamm/non-inflamm), (clear/turbid/opaque), with (high/low) viscosity. It contains WBC count of about:
Non-inflammatory, clear, high viscosity;
0-2,000 WBCs
Synovial fluid analysis: Group II fluid is (inflamm/non-inflamm), (clear/turbid/opaque), with (high/low) viscosity. It contains WBC count of about:
Inflammatory, turbid, low viscosity;
2000-50,000 WBCs
Synovial fluid analysis: Group III fluid is classified as (X), (clear/turbid/opaque), with (high/low) viscosity. It contains WBC count of about:
X = septic
Opaque, low viscosity;
Over 50,000 WBCs
Synovial fluid analysis: osteoarthritis likely produces fluid that falls into which Group?
Group I (non-inflammatory)
Synovial fluid analysis: Lyme infection likely produces fluid that falls into which Group?
Group II (inflammatory, NOT septic)
Synovial fluid analysis: vasculitis likely produces fluid that falls into which Group?
Group I (non-inflamm)
Synovial fluid analysis: gout/pseudogout likely produce fluid that falls into which Group?
Either II or III (WBC count 2,000-100,000)
Patient presents with bursitis that’s inflamed, erythematous, and warm. Synovial fluid analysis reveals WBC of 2,000. The fluid falls into group (I/II/III) and the patient should likely be treated with (X).
III;
X = antibiotics
Septic bursal fluids are deceptively low in WBC- may have bacterial infection
with cell count 2,000-12,000, so always treat bursal fluids as septic until proven
otherwise
List exceptions that should be considered during synovial fluid analysis.
- Immunocompromised patients may not be able to mount WBC count (septic until proven otherwise)
- Bursal fluids deceptively less inflammatory (septic until proven otherwise)
Joint pain in (X) locations is likely not from osteoarthritis, since the disease rarely involves these joints.
X = ankle (tibiotalar), wrist, elbow
Your patient has been suffering with OA in the knees for years. You notice on follow-up that her quad muscle strength has declined. What concerns you about this?
Risk of knee bucking/giving away, leading to fall
Your patient has been suffering with OA in the knees for years. She tells you on follow-up that she’s getting less sleep as a result of the pain. What’s your next step in management?
Discuss options for surgery (night pain signals end-stage disease)
Initial med to use for OA.
Acetaminophen
Second med to try for OA if (X) isn’t controlling pain.
X = acetaminophen
NSAIDs (Ibuprofen, Naproxen)
T/F: corticosteroid injections have been proven helpful for OA.
True - temporary relief
(X) is effective in OA for its placebo effect.
X = glucosamine
List the infectious arthritis that mimic RA, affecting (one/many) (small/large) joints.
Many, small joints;
Viral
List the infectious arthritis that have a speed of onset of a few days.
Septic and gonococcal
List the infectious arthritis for which synovial fluid culture is high-yield diagnostic tool.
Septic
List the infectious arthritis that are osteoarthritis look-alikes.
TB and Lyme
Patient presents with swelling/pain involving DIP joints. It must be one of which causes on your differential?
OA, psoriatic, gout!!!
RA affects the same joints as (has similar joint distribution to):
SLE
T/F: RA doesn’t affect the spine.
True
Greatest risk factor for ILD in dermatomyositis/polymyositis.
Anti-synthetase Ab (anti-Jo-1)
