Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > Gout, pseudogout + septic arthritis > Flashcards

Gout, pseudogout + septic arthritis Flashcards

1
Q

Differential diagnosis of a single red hot swollen joint

A

Septic arthritis
Gout
Psuedogout
Reactive arthritis
Haemarthrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Investigations of a single swollen joint

A

Joint aspiration
sent for gram staining, crystal microscopy, culture + antibiotic sensitivities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is gout?

A

Inflammatory arthritis related to hyperuricemia
Crystal arthropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pathophysiology of gout?

A
  • high blood urine acid levels
  • deposition of monosodium urate crystals in joint > inflammation
  • results in acute + chronic arthritis, gouty tophi, urate nephropathy + uric acid nephrolithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors for gout

A
  • male
  • > 40 years old
  • family history
  • obesity
  • high purine intake (meat + seafood)
  • alcohol (especially beer)
  • diuretics
  • CVD
  • smoking
  • diabetes mellitus
  • organ transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What joints are typically affected by gout?

A

Base of big toe - MTP joint
Base of thumb - CMC joint
Wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of gout

A

Acute single hot, red, swollen painful joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations + diagnosis of gout

A
  • diagnosis made clinically but supported by raised serum urate levels on blood test
  • joint aspiration + culture to rule out septic arthritis: raised monosodium urate crystals in gout + no bacterial growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the aspirated joint fluid in gout

A
  • shows monosodium urate crystals
  • needle shaped + negatively birefringement of polarised light
  • no bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

X-ray features of gout

A
  • maintained joint space
  • lytic lesions in bone
  • punched out erosions with sclerotic borders + over hanging edges
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

General prevention of gout

A
  • maintain optimal weight
  • regular exercise
  • diet modifications
  • reduced alcohol intake
  • smoking cessation
  • maintain fluid intake + avoid dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of gout

A
  • first line treatment in acute gout: NSAIDs with PPI cover
  • second line: colchicine
  • third line: oral steroids e.g. prednisone
    .
  • prophylaxis with xanthine oxidase inhibitors > lower uric acid levels: allopurinol, febuxostat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is first line treatment of gout?

A

NSAIDs
With PPI cover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is colchicine used in gout treatment + why is it only prescribed for a short course?

A
  • for patients who are inappropriate for NSAIDs e..g renal impairment or heart disease
  • it can cause abdominal pain + diarrhoea
  • dangerous in overdose + can cause multiple organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is used in prophylaxis of gout?

A

allopurinol or feboxostat
xanthine oxidase inhibitors > lower uric acid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Difference between the crystals deposited in gout + psuedogout

A

Gout - monosodium urate crystals
Psuedogout - calcium pyrophosphate crystals

17
Q

Typical presentation of pseudogout

A

Patient over 65 with rapid onset hot, swollen, stiff + painful knee

18
Q

What joints does psuedogout affect?

A
  • knee
  • shoulders
  • hips
  • wrists
19
Q

Describe the joint aspiration fluid in pseudogout

A
  • calcium pyrophosphate crystals
  • rhomboid shaped
  • positively birefringement of polarised light
  • no bacterial joint
20
Q

X ray features in pseudogout

A

Chondrocalcinosis: calcium deposits in joint cartilage > thin white line in joint space
LOSS

21
Q

Management of pseudogout

A

Symptomatic treatment - often resolves within a few weeks
- NSAIDs + PPI
- colchicine
- steroid injections
- oral steroids

22
Q

Presentation of septic arthritis

A
  • hot, red, swollen + painful joint
  • stiffness
  • reduced ROM
  • systemic symptoms e.g. fever, lethargy, sepsis
23
Q

Common bacterial causes of septic arthritis

A
  • staph aureus (most common)
  • neisseria gonorrhoea (in sexually active people)
  • strep pyogenes
  • haemophilus influenzae
  • E.coli
24
Q

When should you suspect gonococcal septic arthritis?

A

in young sexually active patient with single acutely swollen joint

25
Q

Treatment of septic arthritis

A
  • abx for 4-6 weeks (IV then oral)
  • flucolaxcillin
  • clindamyclin if penicillin allergy
  • vancomycin if MRSA suspected
26
Q

Difference in joint aspiration in gout, pseudogout + septic arthritis

A
  • gout: no bacteria, needle shaped crystals, negatively birefringent of polarised light
  • pseudogout: no bacteria, rhomboid shaped crystals, positively birefringent of polarised light
  • septic arthritis: bacteria present

Rheumatology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions