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Oxford Clinical Cases > Acute Joint Pain > Flashcards

Acute Joint Pain Flashcards

1
Q

Categories for joint pain

A

Articular
Periarticular
Non-articular

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2
Q

Articular causes of joint pain

A 
Trauma (fracture, meniscal tear)
Gout
Pseudo gout 
Septic arthritis 
Seronegative spondyloarthropathy 
Transient synovitis
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3
Q

Periarticular causes of joint pain

A

Ligament damage
Tendinitis
Bursitis

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4
Q

Non articular causes of joint pain

A

Nerve entrapment
Radiculopathy
Bone issues (malignancy, osteomyelitis)

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5
Q

Risk factors for septic arthritis

A

Immunosupression (diabetes, steroids, HIV)
Prosthetic joints
Trauma

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6
Q

Risk factors for haemoarthrosis

A

Coagulopathy (e,g. Haemophilia)
Anticoagulant (warfarin)
Trauma (e.g. ACL injury)

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7
Q

Recent infection followed by joint pain implies…

A

Transient synovitis (reactive arthritis)
Can’t see, can’t pee, can’t climb a tree
Often triggered by GI infection or STI

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8
Q

Which drugs predispose to gout?

A

Thiazides, aspirin, cyclosporin

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9
Q

If knee is painful, which other joints should you assess?

A

1 above and 1 below

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10
Q

Bowel disease that can cause joint pains and mouth ulcers

A

Crohn’s disease

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11
Q

How might you assess neurovascular competency in acute joint pain?

A

Distal pulses

Sensation and movement of joint

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12
Q

How can you discriminate between septic arthritis and other causes of monoarticular pain

A

ARTHROCENTESIS

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13
Q

Crystals in gout

A

Needle shaped and negatively bifringent

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14
Q

Crystals in pseudogout

A

Positively bifringent and rhomboid shaped

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15
Q

Signs of septic arthritis in the aspirated fluid

A

Elevated WCC
Cloudy
Bacteria visible on microscopy

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16
Q

Haemarthrosis with fat globules present implies…

A

Fracture

The fat comes from the bone marrow

17
Q

If haemarthrosis despite no trauma or infection what do you need to check?

A

Clotting factors

Look at FVIII and FIX (A and B haemophilia)

18
Q

Antibody testing for rheumatoid arthritis

A

Anti-CCP

19
Q

A radiograph may be useful in an acutely painful joint because…

A

Can pick up fractures
Can pick up Perthe’s disease
Erosion of joint surfaces

20
Q

Which type of scan is good if you suspect soft tissue injury (e.g. meniscal tear)?

A

MRI

21
Q

Arthrocentesis sample contains PMNs and negatively birefringent crystals, how do you rule out septic arthritis?

A

Gram staining for the presence of microbes

22
Q

Management of acute gout

A
  1. ACUTE = colchicine, NSAIDs

If they cant take these (hepatic failure or gastric ulcer/asthma), can consider steroid injections

23
Q

Management of gout chronically

A

Allopurinol (decrease urate production), inhibitor of xanthine oxidase. Must give it with colchicine for 6 weeks because initial therapy can induce a gout attack!

Also drugs in chemo and if allopurinol isn’t tolerated. But rarer and expensive.

24
Q

Initial management of suspected septic arthritis

A

Arthrocentesis
Analgesia
Blood cultures
Broad spectrum antibiotics

25
Q

Definitive management of septic arthritis

A

Joint aspiration and lavage by the surgeons

Referred to orthopaedic surgeons

26
Q

What can a repetitive job like stacking shelves put you at risk of?

A

Bicipital tendonitis

27
Q

Management of bicipital tendonitis

A

Analgesia
REST
Corticosteroid injection into the space but NEVER into the tendon

28
Q

Management of suspected gonoccocal transient synovitis

A

Analgesia (regular)
Rest of the affected joint
IV antibiotics until septic arthritis is excluded
Opthalmology review (for the conjunctivitis)

29
Q

Secondary causes of increased urate

A

Starvation
Cytotoxic drugs
Chronic renal disease

30
Q

Most likely infective organism in prosthetic joint septic arthritis

A

Staph epidermis

Oxford Clinical Cases (11 decks)

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