03a: OA, Infectious, etc.

Question 1

Synovial fluid analysis: Group I fluid is (inflamm/non-inflamm), (clear/turbid/opaque), with (high/low) viscosity. It contains WBC count of about:

Answer 1

Non-inflammatory, clear, high viscosity;

0-2,000 WBCs

Question 2

Synovial fluid analysis: Group II fluid is (inflamm/non-inflamm), (clear/turbid/opaque), with (high/low) viscosity. It contains WBC count of about:

Answer 2

Inflammatory, turbid, low viscosity;

2000-50,000 WBCs

Question 3

Synovial fluid analysis: Group III fluid is classified as (X), (clear/turbid/opaque), with (high/low) viscosity. It contains WBC count of about:

Answer 3

X = septic
Opaque, low viscosity;

Over 50,000 WBCs

Question 4

Synovial fluid analysis: osteoarthritis likely produces fluid that falls into which Group?

Answer 4

Group I (non-inflammatory)

Question 5

Synovial fluid analysis: Lyme infection likely produces fluid that falls into which Group?

Answer 5

Group II (inflammatory, NOT septic)

Question 6

Synovial fluid analysis: vasculitis likely produces fluid that falls into which Group?

Answer 6

Group I (non-inflamm)

Question 7

Synovial fluid analysis: gout/pseudogout likely produce fluid that falls into which Group?

Answer 7

Either II or III (WBC count 2,000-100,000)

Question 8

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).

Answer 8

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

Question 9

List exceptions that should be considered during synovial fluid analysis.

Answer 9

1. Immunocompromised patients may not be able to mount WBC count (septic until proven otherwise)
2. Bursal fluids deceptively less inflammatory (septic until proven otherwise)

Question 10

Joint pain in (X) locations is likely not from osteoarthritis, since the disease rarely involves these joints.

Answer 10

X = ankle (tibiotalar), wrist, elbow

Question 11

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?

Answer 11

Risk of knee bucking/giving away, leading to fall

Question 12

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?

Answer 12

Discuss options for surgery (night pain signals end-stage disease)

Question 13

Initial med to use for OA.

Answer 13

Acetaminophen

Question 14

Second med to try for OA if (X) isn’t controlling pain.

Answer 14

X = acetaminophen

NSAIDs (Ibuprofen, Naproxen)

Question 15

T/F: corticosteroid injections have been proven helpful for OA.

Answer 15

True - temporary relief

Question 16

(X) is effective in OA for its placebo effect.

Answer 16

X = glucosamine

Question 17

List the infectious arthritis that mimic RA, affecting (one/many) (small/large) joints.

Answer 17

Many, small joints;

Viral

Question 18

List the infectious arthritis that have a speed of onset of a few days.

Answer 18

Septic and gonococcal

Question 19

List the infectious arthritis for which synovial fluid culture is high-yield diagnostic tool.

Answer 19

Septic

Question 20

List the infectious arthritis that are osteoarthritis look-alikes.

Answer 20

TB and Lyme

Question 21

Patient presents with swelling/pain involving DIP joints. It must be one of which causes on your differential?

Answer 21

OA, psoriatic, gout!!!

Question 22

RA affects the same joints as (has similar joint distribution to):

Answer 22

SLE

Question 23

T/F: RA doesn’t affect the spine.

Answer 23

True

Question 24

Greatest risk factor for ILD in dermatomyositis/polymyositis.

Answer 24

Anti-synthetase Ab (anti-Jo-1)

Question 25

In dermatomyositis/polymyositis, anti-synthetase syndrome would be characterized by which clinical features?

Answer 25

1. Mechanic’s hands
2. Fever
3. ILD
4. Raynaud’s

Question 26

Which tools/info would you use to distinguish DM/PM flare from steroid-induced myopathy?

Answer 26

1. Muscle enzyme level (not elevated in steroid-induced)

2. EMG inflammatory myositis findings (absent in steroid-induced)