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Internal Medicine > Joint Disease > Flashcards

Joint Disease Flashcards

Osteoarthritis RA Septic Arthritis Reactive Arthritis

1
Q

Modifiable Risk Factors for Osteoarthritis? (3)

A
  • Obesity
  • Trauma
  • Labor-intensive Occupations
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2
Q

Most common presentations of Osteoarthritis?

A
  • Stiffness

- Joint Pain

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3
Q

Symptoms that differentiate Osteoarthritis from Rheumatoid Arthritis?

A 
Osteoarthritis:
- Worsens w/ activity or weight bearing
- DIP & PIP w/ MCP sparing
Rheumatoid:
- Improves with Activity
- Spares DIP
- Morning Stiffness
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4
Q

Presentations of Osteoarthritis on X-ray?

A
  • Joint space narrowing
  • Osteophtyes
  • Subchondral sclerosing
  • Subchondral cysts
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5
Q

Preferred Pharmacological Treatment of Osteoarthritis?

A
  • Topical NSAIDS –> Oral NSAIDS
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6
Q

Autoimmune disease that causes muscles and joint pain. Associated w/ Temporal Arteritis

A

Polymyalgia rheumatica

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7
Q

Presentation of Polymyalgia Rheumatica?

A
  • Pain in neck, Shoulders, hip

- Symmetrical morning Muscle Pain/Stiffness

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8
Q

Physical Exam observations of Polymyalgia Rheumatica?

A
  • Edema in extremities
  • Fatigue
  • Tenderness to Palpitation
  • Normal Muscle Strength
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9
Q

Lab Abnormalities?

A
  • Increased ESR w/ decreased hematocrit
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10
Q

Treatment for Polymyalgia Rheumatica?

A

Low dose corticosteriods

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11
Q

Most common pathogen in Septic Arthritis?
In young adults?
In sickle cell patients?
In IV drug users and diabetics?

A
  • Staph. Aureus (most common overall)
  • N. gonorrhoeae
  • Salmonella
  • P. aeruginosa
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12
Q

Presentation of Septic Arthritis?

A
  • Fever
  • Pain in affected joint
  • Pain in range of motion
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13
Q

Serum findings of Septic Arthritis?

A
  • WBC > 10,000
  • ESR > 30
  • CRP > 5
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14
Q

Diagnosis of Septic Arthritis?

A

Joint Aspirate w/ 50,000+ WBC

also low glucose and high neutrophils

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15
Q

Treatment of Septic Arthritis?

A

Joint drainage + Appropriate Antibiotic

  • S. Aureus: Pencillinase- Resistant (nafcillin, oxacillin)
  • N. gonorrhoeae: Ceftriaxone,
  • Gram neg: Cephalosporin, Fluoroquinolone
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16
Q

Rheumatoid Arthritis presents with what deformities?

A
  • Ulnar Deviation
  • Boutonniere Deformities
  • MCP hypertrophy
  • Z thumb
  • Swan neck Deformities
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17
Q

Cause of Pannus and joint damage in Rheumatoid Arthritis?

A

Pannus is caused by cell-mediated immune response. IL-1 and TNF-a in the pannus lead to joint damage

18
Q

Systemic manifestations of necrotic, non-healing leg ulcers, neutropenia, splenomegaly, indicate what syndrome that is associated with long-term RA?

A

Felty Syndrome

19
Q

Joint aspiration of RA would show?

A
  • Decreased Complement

- Increased leukocyte count

20
Q

Other Lab Findings in RA?

A
  • Anti-Cyclic Citrullinated Peptide
  • Increased ESR, CRP
  • Rheumatoid Factor (only 75%)
  • Positive ANA (only 40%)
21
Q

Choice imaging of RA and finding?

A

X-Ray

  • Findings:
    • Joint Erosion
    • Joint Subluxation
    • Joint Space Narrowing
22
Q

First Choice Treatment for RA?

A

Methotrexate (DMARD)
Other DMARDs: Disease modifying anti-rheumatic drugs
- Sulfasalazine
- Hydroxycholoroquine

23
Q

Treatment for resistant RA?

A
  • Add Biologic DMARD (etanercept, infliximab, adalimumab

- Add another DMARD

24
Q

What should the patient be screened for before strting DMARDs?

A
  • Hep B & C

- Latent TB

25
Q

Causes of underproduction of uric acid in Gout?

A
  • Renal Disease

- Diurectics

26
Q

Causes of overproduction of uric acid in Gout?

A
  • Cancer
  • Hemoglobinopathies
  • Obesity
27
Q

Diagnosic criteria of Gout?

A

Joint aspiration shows needle shaped, negatively birefringent crystals

28
Q

Complications of chronic gout?

A

Tophi-> Deformation

29
Q

First line treatment for Gout?

A

NSAIDS (naproxen, indomethacin)

30
Q

Which NSAID is avoided in Gout and why?

A

Aspirin due to reduction in uric acid excretion at low doses

31
Q

Alternative Treatments for Gout?

A
  • Colchicine (microtuble inhibitor)

- Glucocorticoids

32
Q

Classes of agents used to treat chronic gout?

A
  • Uricosuric agents (e.g. probenecid, sulfinpyrazone)
  • Xanthine oxidase inhibitors (e.g. allopurinol, febuxostat)
  • Recombinant uricases(e.g.pegloticase, rasburicase
33
Q

Contraindication for Probenicid?

A

Nephrolithiasis

34
Q

Possible side effect of Allopurinol?

A

Stevens-Johnson Syndorme

35
Q

Diagnostic criteria for Pseudogout?

A

Rhomboid shaped, positively bifringent crystals in aspirate.

Podagra rules out Pseudogout

36
Q

Findings on X-Ray in Pseudogout?

A

Chondrocalcinosis (calcification in joints)

37
Q

Complication of Pseudogout?

A

Risk of Osteoarthritis in Affected joints

38
Q

Treatment of Pseudogout?

A
  • NSAIDS

- Colchicine

39
Q

Which joints do Psoriatic Arthritis affects?

A
  • Smaller joints of the upper extremities.

* Distal Interphalangeal joints*

40
Q

Lab Findings in Psoriatic Arthritis?

A
  • Increased Uric acid
  • Negative ANA and Rheumatoid factor
  • Increased ESR
41
Q

Treatment of Psoriatic Arthritis?

A

NSAIDS

42
Q

Complications of Psoriatic Arthritis?

A
  • Hypertension

- Conjunctivitis

Internal Medicine (15 decks)

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