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T&O > Hot Swollen Joint > Flashcards

Hot Swollen Joint Flashcards

1
Q

What is the differential diagnosis for red swollen knee?

A 
Septic arthritis 
Gout 
Flare up of OA
Pseudogout 
RA
Reactive arthritis 
MSK injury 
Haemarthosis 
Psoriatic arthritis 
Lyme disease
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2
Q

What investigations would you do for someone with red swollen knee?

A

Baseline blood + CRP/ESR
Joint space Aspiration
X-Ray - fracture?

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3
Q

What are some signs to look for on examination painful swollen joint?

A 
Erythema 
Swelling 
Temp
Joint line tenderness 
Scars 
Range of movement
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4
Q

What test would you request from the aspiration?

A

Gram stain
Leukocytes count
Polarising microscopies (crystals)
MC&S (microscopy, culture and sensitivity)

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5
Q

Describe the fluid that may be seen in aspiration of septic arthritis?

A

Turbid

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6
Q

What is the most common microorganisms that cause septic arthritis?

A

Staphylococcus aureus

Neisseria gonorrhoea (in younger pts)

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7
Q

What are the three ways bacteria will ‘seed’ into joint?

A

Bacteraemia (e.g. UTI , cellulitis, chest infection)
Direct inoculation
Spreading from adjunct osteomyelitis

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8
Q

What are the risk factors for septic arthritis?

A 
Age >80 
Pre-existing joint disease 
DM/immunosuppressive 
CKD 
Prosthesis 
IV drug use
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9
Q

Why is surgical history important in painful swollen joint?

A

Due to prosthetic joint infections which need to be aspirated in theatre

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10
Q

What other imaging will be useful for suspected septic arthritis?

A

CT or MRI if in sternoclavicular/sacroiliac

Radionuclide scans - isolated joints in sacroiliac joint

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11
Q

What is the management for septic arthritis?

A

Joint washout/irrigation (open/arthroscopic)+ debridement
Samples taken
Empirical Antibiotics started
Monitoring post-op

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12
Q

How long are antibiotics given in septic arthritis?

A

Two weeks IV

The oral after that up to 6 weeks

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13
Q

What is the main complications of septic arthritis?

A

OA

Osteomyelitis

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14
Q

Does a negative gram stain rule out septic arthritis?

A

No, only 30% have positive gram stain

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15
Q

What are the management options for prosthetic joint infections (PJI)?

A
  • Non-operative - long -term antibiotics - elderly, un-fit for surgery
  • DAIR procedure - joint washout + replace plastic part of implant
  • one/two-stage revision procedure
  • excision arthroplasty + may have arthrodesis
  • Amputation
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16
Q

What is the GOLD standard treatment for prosthetic joint infections?

A

Two-stage revision procedure

17
Q

What are the associated feature of reactive arthritis?

A

Anterior uveitis
Conjunctivitis
Urethritis

18
Q

Which gene is associated with reactive arthritis?

A

HLA-B27

19
Q

What is the risk factors for atraumatic haemarthosis?

A

Clotting disorder

Anticoagulants

20
Q

What is the treatment for atraumatic haemarthosis?

A

RICE , Splinting, analgesia
Manage clotting disorder
Aspiration may provide relief but may recur

21
Q

What is the most common joint affected by pseudogout?

A

Knee

Followed by wrist

22
Q

What can be seen on an X-ray of pseudogout?

A

Chondrocalinosis

23
Q

What is seen on polarising microscopy for pseudogout?

A

Positivity bifingement rhomboid-shaped crystals

24
Q

What is the treatment for pseudogout?

A

RICE, Splinting, analgesia

NSAIDS if tolerated
Intra-articular steroids
Colchicine can be used prophylactially

25
Q

Which joint does gout usually affect?

A

1st MTP joint

26
Q

What is seen on polarising microscopy in gout?

A

Needle shaped mondo sodium urate crystals, negatively bifringement

27
Q

What may be seen on a x-ray of gout?

A

Subcondral sclerosis, swelling, erosions

Punched out lesions

28
Q

What are the two types of gout?

A

Primary - idiopathic - purine metabolism

Secondary - associated with disease with high metabolic turnover e.g. psoriasis, chemo

29
Q

Is serum urate diagnostic of gout?

A

No it is not useful in acute phase but may be used to monitor treatment e.g from allopurinol

30
Q

What is the treatment of gout?

A

NSAIDs or colchicine in acute phase (consider glucosteroids)

Long term in recurrent attacks - Allopurinol or colchicine - 6 weeks after acute attack

31
Q

What are the risk factors for pseudogout?

A

Hyperparathyroidism
Hypophosphatemia
Advanced age

32
Q

What is the classification used for RA?

A

EULAR classification

33
Q

What conditions are in the group of spondyloarthopathies?

A

Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis
Enteropathic arthropathy

Seronegative conditions - associated with HLA B27

T&O (13 decks)

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