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Undeleted > Arthritis 1 > Flashcards

Arthritis 1 Flashcards

1
Q

2 cats of rheumatic disease

A
  1. iflamm

2. non inflamm

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2
Q

2 cats of inflamm

A
  1. autoimmune

2. non-autoimmune

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3
Q

4 examples of auto immune

A
  1. RA
  2. lupus and other collagen
  3. vasculitis
  4. spondyloarthritis
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4
Q

3 examples of non-autoimmune

A
  1. crystal induced
  2. infection induced
  3. hemoarthritis
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5
Q

3 possible localizations

A
  1. mono arth
  2. oligo 1-4 joints
  3. poly arth - >4 joints
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6
Q

2 reasons for early intervention

A
  1. improve function

2. prevent damage

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7
Q

4 parts of makinga diagnosis

A
  1. Hx
  2. Px
  3. imaging
  4. labs
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8
Q

5 features of inflammatory

A
  1. painful joint
  2. warmth
  3. swelling
  4. marked stiffness esp, in morning
  5. typical patterns
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9
Q

5 features of non-inflammatory

A
  1. painful joint
  2. little warmth
  3. swelling sometimes
  4. minimal stiffness - after gelling
  5. typical patterns
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10
Q

4 things to consider to decide type

A
  1. Number of joints involved
  2. Pattern of joints involved
  3. time course and evolution
  4. age of indiv
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11
Q

4 parts of pattern to look at

A
  1. symetry
  2. upper vs. lower
  3. axial?
  4. characteristic joints
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12
Q

** 3 possible causes of acute, inflamatory monoarthritis

A
  1. infection
  2. crystals
  3. blood
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13
Q

features of hemarthrosis

A
  • bleed in a joint
  • most often with clotting abnormality
  • if trauma, consider a fracture
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14
Q

features of septic arthritris

A
  • life threatening

- mort 10-50%

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15
Q

where does septic come from

A
  • mostly hematogenous
  • major abct are Gr+ cocci (staph A most common)
  • some Gr- bacc
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16
Q

risk factors for septic artgh

A
  • recent infection
  • portal of entry
  • prosthetic joint
  • damaged joint
  • immunocompromised
  • elderly
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17
Q

2 types of gonorrhea arth

A
  1. typical mono in young healthy indiv

2. disseminated infection - migratory, tenosynovitis

18
Q

def. crystal arth

A

inflammation created by crystals depostied in joint tissues

19
Q

3 types of crystals

A
  1. urate - gout
  2. calcium pyrophosphate - pseudo gout
  3. cal. hydroxyapatate
20
Q

3 features of crystal arth

A
  1. dep. in the synovial fluid
  2. attacks are an acute and dramatic monoarth
  3. usually self limited
21
Q

age of onset of gout

A

men - 40-60

women older

22
Q

pathway of uric acid

A

purine>hypoxanthine>xanthine> (via xantine oxydase)>uric acid

23
Q

3 mech. of uric acid buidup

A
  1. dietary intake (red meat, fish, beer)
  2. synteheis (error of metabolism, ethanol, illness)
  3. underexcretion (renal fail, metabolic syn, diuretics)
24
Q

4 major gout risk factors

A
  1. illness
  2. surgery
  3. meds
  4. alc
25
Q

inital gout episode (typical)

A

1st MTP

  • acute and intermittent
  • may become chronic
26
Q

what are tophi

A

tissue deposits of of urate outside the joint (lumps)

27
Q

def. CPPD

A

from Ca pyrophosphate

- pseudo gout - gout-like attacks

28
Q

typical presentaion of CPPD

A

> 60yo

- typically wrist and knee

29
Q

typical presentation of hydroxyapatate

A
  • younger indivs
  • acute arth.
  • shoulder, hip, first toe
30
Q

3 universal features of acute monoarth

A
  1. swelling, pain, redness
  2. fever
  3. malaise
31
Q

4 features to look for on physical

A
  1. portal of entry
  2. tophi
  3. bruising suggestive of coag. defect
  4. skin lesions typical of GC arth
32
Q

2 tests to do for monoarthririts

A
  1. synovial fluid anal

2. imaging

33
Q

3 Cs of synovial fluid anal

A

Culture
Cell count
Crystals

34
Q

**what is cutoff for inflammatory

A

WBC>2000

35
Q

what is typical but not always infections

A

WBC>50000

36
Q

2 features of gout crystals

A
  1. long and needle

2. neg, birefringence

37
Q

2 feature of CPPD crystals

A
  1. rhomboid

2. pos. birefringence

38
Q

use of x-rays

A
  • as a baseline

- lask spec. in acute setting

39
Q

mgmt of acute crystal arth.

A 
treat inflammation
- NSAIDS
- prednisone
- injections
rest, ice, elevation
40
Q

mgmt of spetic arth

A
  • start empiric ABs as soon as fluid drawn
  • change AB when get cultures back
  • daily drain of joint space
41
Q

mgmt of hemoarth

A
  • drain the blood

- inject glucocorticoids

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