Joint pathologies

Question 1

Olecranon bursitis

Answer 1

red and hot olecranon, swelling
low-grade fever
feeling generally unwell

empirical abx
culture results- gram stain, microscopy and culture

Question 2

HSP

Answer 2

clinical presentation- purpuric rash on back, buttock and extensor surfaces.

haematuria (vasculitis processs)

Question 3

causes of gout:

Answer 3

primary hyperuricaemia
secondary hyperuricaemia:
- over production (alcohol, high purine diet, leukaemia from high cell turnover, obesity, metabolic disease)

• decreased renal excretion (thiazie- bendroflumethiazide, renal insuffuciency, volume loss- dehydration)

Question 4

ankylosing spondylitis

Answer 4

HLA-B27
normally presents in 20-30 y/o
autoimmune manifestation

• anterior uveitis (unilateral eye pain with photophobia and blurry vision)
• reactive arthritis
• pain improves with activity and not relieved by rest.

Question 5

HLA’s

Answer 5

HLA-DR3 (type 1 diabetes)
HLA-DR5 (pernicious anaemia, Hashimoto’s)
HLA-B8 (Grave’s)

Question 6

septic arthritis

Answer 6

acutely swollen tender, red, hot joint. rheumatological emergency. patella tap +ve

ix: joint aspiration
aalysis of organism, culture and sensitivity

IV abx: staph aureus. 6 weeks

Question 7

bursitis

Answer 7

aseptic condition associated with local soft tissue trauma/strain injury. spend a lot of time on knees- carpet fitters, gardeners.

Question 8

ruptured bakers cyst

Answer 8

swelling behind the knee
occurs as a result of osteoarhtriis
rupture causes pain and swelling of the calf as fluid leaks down
patella tap would not be +ve

Question 9

temporal arteritis

Answer 9

temporal headache
scalp tenderness
jaw claudation
malasie
visual loss

unilateral scalp tenderness
hardened nodular temporal artery
reduced/absent temporal pulse

• ESR
• urgent rheumatology review
• temporal artery biopsy