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1
Q

predisposing factors for sepsis in unusual joints

A

(eg: sternoclavicular joint)
- IV drug use
- large vein catheterization

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2
Q

most common type of nontraumatic acute monoarthritis in young, sexually active people in the US

A
  • gonococcal arthritis (3-4 x more common in women than men)
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3
Q

nongonocococal septic arthritis

A
  • most destructive type of septic arthritis
  • generally monoarticular (most often knees)
  • S. aureus most common, also non group A beta hemolytic strep, gram negative, and S. pneuomoniae
    (anaerobic and gram neg more common in IC people)
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4
Q

common cause of inflammation of a single large joint?

A

Lyme disease (mycobaterial, fungal and viral infections are rare)

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5
Q

what kinds of crystals can elicit acute monoarthritis?

A
  • monosodium urate (gout)
  • calcium pyrophosphate dihydrate (CPPD, pseudogout)
    also:
  • calcium oxalate (renal dialysis)
  • apatite
  • lipid crystals
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6
Q

risk factors for spontaneous osteonecrosis

A

alcoholism

chronic corticosteroid use

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7
Q

clue: sudden onset of pain in seconds or minutes

A

potential dx: fracture, internal derangement, trauma, loose body

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8
Q

clue: onset of pain over several hours or one to two days

A

potential dx: infection, crystal deposition disease, other inflammatory arthritic condition

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9
Q

clue: insidious onset of pain over days to weeks

A

potential dx: indolent infection, osteoarthritis, infiltrative disease, tumor

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10
Q

clue: IV drug use, immunosuppression

A

potential dx: septi arthritis

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11
Q

clue: previous acute attacks in any joint, with spontaneous resolution

A

potential dx: crystal deposition disease, other inflammatory arthritic condition

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12
Q

recent prolonged course of corticosteroids

A

potential dx: infection, avascular necrosis

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13
Q

clue: coagulopathy, use of anticoagulants

A

potential dx: hemarthrosis

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14
Q

clue: urethritis, conjunctivitis, diarrhea, and rash

A

potential dx: reactive arthritis

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15
Q

clue: psoriatic patches or nail changes such as potting

A

potential dx: psoriatic arthritis

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16
Q

clue: use of diuretics, presence of tophi, history of renal stones or alcoholic binges

A

potential dx: gout

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17
Q

clue: eye inflammation, low back pain

A

potential dx: ankylosing spondylitis

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18
Q

clue: young adulthood, migratory polarthralgias, inflammation of the tendon sheaths of hands and feet, dermatitis

A

potential dx: gonococcal arthritis

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19
Q

clue: hilar adenopathy, erythema nodosum

A

potential dx: sarcoidosis

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20
Q

bulge sign

A
  • the medial or lateral compartment is stroked and the fluid moves through the suprapatellar area into the opposite compartment, resulting in a visible bulge (indicates small effusion)
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21
Q

types of noninflammatory arthritis

A

( less than 2000 WBC)

- osteoarthritis, trauma, avascular necrosis, Charcot’s arthropathy, hemochromatosis, pigmented villonodular synovitis

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22
Q

types of inflammatory arthritis

A

( >2000 WBC)
- septic arthritis (>90% PMNs), crystal-induced monoarthritis (gout, pseudogout), RA, spondyloarthropathy, SLE, juvenile RA, lyme,

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23
Q

can crystals be present in a septic joint?

A

yes

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24
Q

is fever helpful in distinguishing infectious arthritis from others?

A

fever may be absent in patients with infectious monoarthritis but can be a presenting feature in acute attacks of gout or pseudogout
- fever may occur for other reasons in certain patients (eg: the IC)

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25
Q

does a normal serum uric acid level make gout less likely?

A

no, serum uric acid levels often are lowered in patents with acute gout
- conversely, there may be unrelated hyperuricemia in patients with other conditions

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26
Q

are gram staining and culture of synovial fluid sufficient to exclude infection?

A

no, cultures of blood, urine or another primary site of infection (eg: abscess) must be obtained and repeated as necessary if infection is strongly suspected clinically.
- culture results may be negative in early infection

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27
Q

definition of polyarticular joint pain

A

pain in more than 4 joints

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28
Q

differential diagnosis of polyarticular joint pain (general)

A

viral infection, indirect bacterial infection (reactive arthritis), direct bacterial infection, other infections, crystal-induced synovitis, systemic rheumatic disease, systemic vasculitis disease, spondyloarthropathies, endocrine disorders, malinancy

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29
Q

types of polyarticular joint pain that can cause viral infection

A

parovirus b19, enterovirus, adenovirus, epstein-barr, coxsackievirus, cytomegalovirus, rubella, mumps, hep B, VZV, HIV

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30
Q

types of indirect bacterial infections that can cause polyarticular joint pain

A

eg: reactive arthritis

gonorrhea, bacterial endocarditis, campylobacter, chlamydia, salmonella, shigella, yersinia, whipple’s, group A strep

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31
Q

types of direct bacterial infections that can cause polyarticular joint pain

A

gonorrhea, s. aureus, gram negative bacilli, bacterial endocarditis

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32
Q

other types of infections that can cause polyarticular joint pain

A

lyme (borrelia burgdorferi), tuberculosis, fungi

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33
Q

crystal-induced synovitis that can cause polyarticular joint pain

A

gout, pseudogout, hydroxyapatite

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34
Q

types of systemic rheumatic disease that can cause polyarticular joint pain

A

rheumatoid arthritis, SLE, polymyositis/dermatomyositis, juvenile RA, scleroderma, Sjogren’s, Behcet’s, polymyalgia rheumatica

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35
Q

types of systemic vasculitis disease that can cause polyarticular joint pain

A

schlonlein-henoch purpura, hypersensitivity vasculitis, polyarteritis nodosa, Wegener’s granulomatosis, giant cell arteritis

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36
Q

types of spondyloarthropathies that can cause polyarticular joint pain

A

ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, reactive arthritis

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37
Q

types of endocrine disorders that can cause polyarticular joint pain

A

hyperparathyroidism, hyperthyroidism, hypothyroidism

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38
Q

types of malignancies that can cause polyarticular joint pain

A

metastatic cancer, multiple myeloma

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39
Q

other types of diseases that can cause polyarticular joint pain

A

osteoarthritis, hyperrmobility syndromes, sarcoidosis, fibromyalgia, osteomalacia, sweet’s syndrome, serum sickness

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40
Q

parvovirus b19 polyarticular infection

chronology, inflammation, distribution, other signs, gender ratio

A 
acute
yes
small joints, symmetrical, no axial involvement
lacy rash, malar rash 
3:1 (F:M)
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41
Q

rheumatoid arthritis

chronology, inflammation, distribution, other signs, ratio

A

chronic
yes
small and large joints, symmetrical, cervical axial involvement
subcutaneous nodules, carpal tunnel syndrome
3:1

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42
Q

SLE

chronology, inflammation, distribution, other signs, ratio

A

chronic
yes
small joints, symmetrical, no axial involvement
malar rash, oral ulcers, serositis (pleuritis or pericarditis)
9:1

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43
Q

osteoarthritis

chronology, inflammation, distribution, other signs, ratio

A 
chronic
no
lower extremity joints, proximal and distal IP joints, first carpometacarpal joint, sometimes symmetrical, cervical and lumbar involvement
none
1:1
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44
Q

fibromyalgia

chronology, inflammation, distribution, other signs, ratio

A

chronic
no
diffuse pattern, symmetrical, axial involvement
myalgias, tender points, irritable bowel syndrome
9:1

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45
Q

ankylosing spondylitis

chronology, inflammation, distribution, other signs, ratio

A 
chronic
yes
large joints, symmetrical, axial involvement
iritis, tendonitis, aortic insuficiency
1:1 to 1:5
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46
Q

psoriatic arthritis

chronology, inflammation, distribution, other signs, ratio

A

chronic
inflammation
large and small joints, sometimes symmetrical + axial involvement
psoriasis, dactylitis (sausage digits), tendonitis, onychodystrophy
1:1

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47
Q

arthritis vs arthralgia

A 
arthritis = joint pain w/ inflammation
arthralgia = joint pain w/o inflammation
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48
Q

signs of inflammation

A

erythema, warmth, pain and swelling
fatigue, weight loss, fever
morning stiffness lasting longer than 1 hr

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49
Q

reticulated (lacy) rash, facial exanthem (slapped cheek)

A

parvovirus B19

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50
Q

malar rash

A

SLE, parvo b19, lyme, rosacea, seborrhea, dermatomyositis

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51
Q

plaques (scalp, navel, gluteal cleft)

A

psoriasis

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52
Q

heliotrope

A

dermatomyositis

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53
Q

erythema chronicum migrans

A

lyme

54
Q

erythema marginatum rheumaticum

A

rheumatic fever

55
Q

erythema nodosum

A

sarcoidosis, Crohns

56
Q

pyoderma gangrenosum

A

IBD, RA, SLE, ankylosing spondylitis, sarcoidosis, Wegener’s granulomatosis

57
Q

palpable purpura

A

hypersensitivity vasculitis, Schonlein-Henoch purpura, PAN

58
Q

livedo reticularis

A

antiphospholipidd antibody syndrome, vasculitis, cholesterol emboli

59
Q

keratoderma blennorrhagicum

A

reactive arthritis, psoriatic arthritis

60
Q

discoid skin lesions

A

discoid lupus, SLE, sarcoidosis

61
Q

Gottron’s papules or plaques

A

dermatomyositis

62
Q

vesicopustule on erythematous base

A

gonococcal arthritis

63
Q

iritis or uveitis

A

spondyloarthropathies, sarcoidosis, Wegener’s

64
Q

conjunctivitis

A

spondyloarthropathies, SLE, Wegener’s

65
Q

cytoid bodies (retinal exudates)

A

SLE

66
Q

scleritis

A

RA, relapsing polychondritis

67
Q

ischemic optic neuritis

A

GCA, Wegener’s

68
Q

oral ulcers

A

SLE, Behcet’s, reactive arthritis, Wegener’s

69
Q

parotid enlargement

A

Sjogrens, sarcoidosis

70
Q

macroglossia

A

amyloidosis

71
Q

scalp tenderness

A

GCA

72
Q

bloody or severe sinusitis

A

Wegener’s

73
Q

inflammation of ear lobe

A

relapsing polychondirits

74
Q

onycholysis

A

psoriatic arthritis, hyperthyroidism

75
Q

pitting nails

A

psoriatic arthritis

76
Q

nail clubbing

A

IBD, whipple’s, hyperthyroidism

77
Q

nodules

A

RA, gout, whipple’s, rheumatic fever, amyloidosis, sarcoidosis

78
Q

tophi

A

gout

79
Q

jaundice

A

hepatitis, hemochromatosis

80
Q

hyperpigmentation

A

whipple’s, hemochromatosis

81
Q

telangiectasia

A

scleroderma

82
Q

thickened skin

A

scleroderma, amyloidosis, eosinophilic fasciitis

83
Q

hair thinning

A

hypothyroidism, SLE

84
Q

tender points

A

fibromyalgia

85
Q

tender points

A

fibromyalgia

86
Q

heberden’s nodes

A

DIP joints

OA

87
Q

Bouchard’s nodes

A

PIP joints

OA

88
Q

Boutonniere and swan-neck deformities

A

RA SLE, Ehlers-Danlos

89
Q

dactylitis

A

spondyloarthropathies

90
Q

bursitis and enthesitis

A

spondyloarthropathies

91
Q

mitral regurg and stenosis

A

rheumatic fever

92
Q

aortic regurg

A

anklosing spondylitis, rheumatic fever, relapsing polychondritis, reactive arthritis, Marfan syndrome, Takayasu’s arteritis

93
Q

cardiomyopathies

A

viral infection, amyloidosis, sarcoidosis, SLE, polymyositis

94
Q

new murmur, fever

A

bacterial endocarditis, rheumatic fever

95
Q

diminished peripheral pulses

A

GCA, Takayasu’s arteritis

96
Q

hepatomegaly

A

whipple’s, hemochromatosis, amyloidosis, Wilson’s

97
Q

positive fecal occult blood test

A

IBD

98
Q

prostatitis

A

reactive arthritis, ankylosing spondylitis

99
Q

urethritis or cervicitis

A

reactive arthritis, gonococcal arthritis

100
Q

scrotal or vulvar ulcers

A

Behcet’s

101
Q

hypogonadism

A

hemochromatosis

102
Q

balanitis circinata

A

reactive arthritis

103
Q

entrapment neuropathies

A

RA, hypothyroidism, hyperparathyroidism

104
Q

facial palsy

A

lyme

105
Q

peripheral neuropathy

A

SLE, amyloidosis

106
Q

chorea

A

antiphospholipid antibody syndrome, SL, rheumatic fever

107
Q

mononeuritis multiplex

A

RA, SLE, lyme, vasculitis

108
Q

seizures

A

SLE

109
Q

most important risk factors for septic arthritis

A
  • prosthetic hip or knee joint
  • skin infection
  • joint surgery
  • rheumatoid arthritis
  • age >80 yrs
  • diabetes mellitus
110
Q

examples of large vessel vasculitis

A

takayasu arteritis

giant cell arteritis

111
Q

examples of medium vessel vasculitis

A

polyarteritis nodosa

kawasaki disease

112
Q

examples of ANCA-associated small vessel vasculitis

A

microscopic polyangiitis
granulomatosis with polyangitis (wegener’s)
eosinophilic granulomatosis (churg-strauss)

113
Q

examples of immune complex small vessel vasculitis

A

cryoglobulinemia vasculitis
IgA vasculitis (Henoch-Schonlein)
hypocomplemenemic urticarial vasculitis (anti-C1q vasculitis)
anti-GBM disease

114
Q

examples of variable vessel vasculitis

A

Behcet’s disease

Cogan’s syndrome

115
Q

examples of vasculitis associated w/ systemic disease

A

lupus vasculitis
rheumatoid vasculitis
sarcoid vasculitis

116
Q

Takayasu arteritis

A

often granulomatous
affects aorta and/or major branches
onset usually

117
Q

GCA

A 
often granulomatous
affects aorta/or major branches, usually carotid and vertebral arteries 
often involves temporal artery 
onset usually >50 yrs 
often ass. w/ polymyalgia rheumatica
118
Q

polyarteritis nodosa

A

necrotizing arterities of medium or small arteries w/o glomerulonephritis. not ass/ with ANCA

119
Q

Kawasaki disease

A

arteritis ass. w/ mucocutaneous LN syndrome and predominately affecting medium and small arteries.
coronary arteries often involved.
usually affects children

120
Q

ANCA-associated vasculitis

A

necrotizing vasculitis affecting small vessels.

ass. w/ MPO, ANCA or proteinase 3

121
Q

microscopic polyangiitis

A

necrotizing vasculitis affecting small vessels.
necrotizing glomerulonephritis very common
pulmonary capillaritis often occurs

122
Q

granulomatosis w/ polyangiitis (wegener’s, GPA)

A

necrotizing granulomatous inflammation usually involving upper + lower resp tract (small vessels)
necrotizing glomerulonephritis is common

123
Q

eosinophilic granulomatosis w/ polyangiitis (Churg Strauss)

A

eosinophil-rich and necrotizing granulomatous inflammation often involving resp tract
ass. w/ asthma and eosinophilia
ANCA more frequent when glomerulonephritis is present

124
Q

immune complex vasculitis

A

small vessels

glomerulonephritis is frequent

125
Q

anti-glomerular basement membrane disease

A

affects glomerular capillaries (glomerulonephritis) and pulmonary capillaries (pulmonary hemorrhage)

126
Q

cryoglobulinemic vasculitis

A

ass. w/ serum cryoglobulins

skin, glomeruli and peripheral nerves often involved

127
Q

IgA vasculitis (henoch-schonlein)

A

small vessels
often involves skin and GI tract
often causes arthritis

128
Q

hypocomplementemic urticarial vasculitis (anti-C1Q vasculitis)

A

urticaria, hypocomplementemia

glomerulonephritis, arthritis, obstructive pulmonary disease and ocular inflammation are common

129
Q

Behcet’s disease

A

recurrent oral and/or genital aphthous ulcers, w/ cutaneous, ocular, articular, GI and/or CNS inflammatory lesions

130
Q

Cogan’s syndrome

A

ocular inflammatory lesions (interstitial keratitis, uveitis, episcleritis), and inner ear disease (sensorineural hearing loss, vestibular dysfunction)
vasculitic signs: arteritis, aortitis, aortic aneurysms, and aortic and mitral valvulitis

Rheumatology (10 decks)

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