Arthrocentesis & Joint injections

Question 1

What is the primary activated cell type in autologous conditioned serum

Answer 1

Monocytes

Question 2

What cytokine is abundant in ACS

Answer 2

IL-1ra

Question 3

What is the primary mechanism by which autologous conditioned serum exerts a therapeutic effect in a joint space

Answer 3

inhibition of inflammatory cascade

Question 4

What condition is most studied for autologous conditioned serum

Answer 4

OA

Question 5

Relationship between protein content in synovial fluid and serum

Answer 5

1/3 of protein content to serum

Question 6

What does increased synovial protein content indicate

Answer 6

Inflammatory process

Question 7

What is normal synovial glucose level

Answer 7

No lower than 10 mg/dL less than serum

Question 8

What condition is associated with increased uric acid

Answer 8

Gout

Question 9

What form of lactic acid is produced by bacteria

Answer 9

D-lactate

Question 10

What is the role of rapid lactic acid testing in urgent care

Answer 10

Rapid distinction between septic and non-septic arthritis

Question 11

What is RF

Answer 11

Ab to Ig

Question 12

What is the role of testing RF in synovial samples

Answer 12

Small amount of pts have negative serum RF with positive synovial RF

Question 13

What is a non-pathologic color of synovial fluid

Answer 13

Clear

Question 14

What is expected volume to aspirate from a non-pathological knee

Answer 14

4 mL

Question 15

What color and appearance indicates joint inflammation

Answer 15

yellow and cloudy

Question 16

What are ochronotic shards?

Answer 16

Debris from joint prosthesis

Question 17

What is the string test for

Answer 17

Qualitative measure of viscosity of synovial fluid, indirectly measures hyaluronic acid

Question 18

What causes synovial fluid to clot

Answer 18

Damaged synovial membrane (traumatic tap), fibrinogen in fluid

Question 19

What type of microbe is most commonly associated with joint infections (bacteria, virus, fungus, mycobacteria, parasite)

Answer 19

Bacteria

Question 20

What are risk factors for septic arthritis d/t mycobacterium tuberculosis

Answer 20

Low SES, alcohol/IV drug abuse, immunosuppression, HIV injection

Question 21

What would you expect to find in high amounts in synovial fluid with arthritis d/t mycobacteria?

Answer 21

Leukocytes

Question 22

What test has the highest sensitivity for infection d/t mycobacterial arthritis

Answer 22

Synovial Cx

Question 23

What organism is associated with the majority of septic arthritis (gram stain, shape)

Answer 23

Gram positive cocci

Question 24

Nongonococcal arthritis associated with drug abuse, cellulitis, abscesses, endocarditis and chronic osteomyelitis is frequently d/t what 2 organisms

Answer 24

Gram positive staph and strep

Question 25

Acute, non-traumatic, mono- or oligo- arthritis in a young, healthy, sexually active host raises the suspicion for this condition.

Answer 25

Gonococcal arthritis

Question 26

What presentation is observed in patients presenting with gonococcal arthritis

Answer 26

Tenosynovitis, rash, polyarthralgia, purulent arthritis of knee/wrist/ankle

Question 27

What do you do after a pt tests positive for septic arthritis d/t gonococcal infection

Answer 27

Test for CT, HIV, syphilis, and recommend screening partners

Question 28

Within how long should cell analysis be performed on a synovial sample

Answer 28

1 hour

Question 29

What is a general WBC differential for synovial fluid?

Answer 29

48 monocytes
24 lymphocytes
10 macrophages
7 neutrophils
4 synovial cells

Question 30

What condition is associated with a massive increase in neutrophils

Answer 30

Septic arthritis

Question 31

What are ragocytes

Answer 31

Cytoplasmic inclusions of RF within neutrophils in synovial fluid, associated with RA

Question 32

What are tart cells

Answer 32

Monocytes with phagocytosed nonlysed nuclei of lymphocytes, seen in SLE

Question 33

What factors are needed for gout dx

Answer 33

Acute joint inflammation, MSU crystals

Question 34

What do pseudogout crystals look like

Answer 34

Rhombic squares

Question 35

What is an ultra-filtrate?

Answer 35

Substance filtered by 2 barriers, ex: synovial fluid

Question 36

Is joint aspiration indicated in chronic RA?

Answer 36

No

Question 37

Joint injections are most commonly used for what condition

Answer 37

OA

Question 38

What does platelet injection cause

Answer 38

Cell proliferation, growth factor and cytokine secretion

Question 39

What are CI to PRP

Answer 39

Pregnancy, cancer, bleeding/clotting d/o

Question 40

Downsides to injectable corticosteroids?

Answer 40

Tissue toxicity, decreased response each time, suppress body’s healing mechanisms

Question 41

Which injection therapy had better effect long term in a 2006 cochrane review - corticosteroids or viscosupplementation?

Answer 41

Viscosupplementation

Question 42

What are potential side effects of corticosteroid injections?

Answer 42

Infection, skin depigmentation, tendon rupture

Question 43

What is viscosupplementation

Answer 43

Administration of synthetic hyaluronic acid

Question 44

What is the proposed benefit of viscosupplementation

Answer 44

Stimulates production of higher quality synovial fluid

Question 45

What is viscosupplementation indicated for?

Answer 45

Mild to moderate OA

Question 46

T or F: septic arthritis is a common complication of mucosal gonococcal infection

Answer 46

False