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Bloc H - Movement > June 6 M2-Monoarthritis > Flashcards

June 6 M2-Monoarthritis Flashcards

1
Q

important thing to check in monoarthritis

A

inflammatory vs mechanical problem

  • morning stiffness
  • mobility = better or worse?
  • systemic symptoms?
  • pain with or without swelling?
  • wake up at night?
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2
Q

common causes of monoarthritis

A
  • crystals (gout = uric acid, pseudogout = CPPD, basic calcium oxalate)
  • infection (bacterial, fungal, mycobacterial)
  • trauma
  • internal derangement
  • OA exacerbation
  • less common = chronic inflammatory
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3
Q

most important step in diagnosis of monoarthritis

A

aspirate the joint and analyze the synovial fluid.

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4
Q

what can indicate monoarthritis is caused by crystal?

A
  • older men and women + no infection
  • recurrent episodes
  • acute onset
  • gout (uric acid) = MTP, ankle, knee (knee or wrist for CPPD)
  • currently on cyclosporine or diuretic or low dose aspirin
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5
Q

what can indicate monoarthritis is caused by infection (septic arthritis)?

A
  • young men and women (think gonorrhea)
  • acute onset
  • medium to large weight bearing joint
  • travel, sexual intercourse, IVDU
  • constitutional symptoms
  • fever
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6
Q

what can indicate monoarthritis is caused by trauma

A

-hemarthrosis

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7
Q

what can indicate monoarthritis is caused by an inflammatory process?

A

-gradual onset

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8
Q

what can indicate monoarthritis is caused by an inflammatory process?

A
  • gradual onset
  • SpA = asymmetrical + lower extremities, larger joints
  • symptoms outside the joint
  • other medical issues exist (uveitis, IDB, etc.)
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9
Q

what can indicate monoarthritis is caused by an inflammatory process?

A
  • gradual onset
  • SpA = asymmetrical + lower extremities, larger joints
  • symptoms outside the joint
  • other medical issues exist (uveitis, IDB, etc.)
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10
Q

(imp) effusion vs synovitis (imp to check on exam)

A

effusion = within the joint

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11
Q

investigations in monoarthritis

A

arthrocentesis (tap the joint)
XR
cultures

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12
Q

synovial fluid depending on disease

A
  • clear = non inflammatory
  • yellow = inflammatory
  • septic = blurry, heterogenous dark yellow, orange
  • red = hemorrhagic
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13
Q

most important thing not to miss in monoarthritis presentation + why

A

septic arthritis

  • high mortality
  • joint starts to have irreversible destruction after 2-3 days
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14
Q

2 types of acute monoarticular arthritis

A

gonococcal vs non-gonococcal

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15
Q

charact of non-gonococcal acute monoarthritis presentation

A
  • fever
  • abrupt swelling
  • knee, hip, ankle
  • prior CS injection
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16
Q

most common pathogen of non-gonococcal acute monoarthritis

A

staph aureus

17
Q

tx of non-gonococcal acute monoarthritis

A

Abx

18
Q

charact of acute gonococcal monoarthritis

A

either of

  1. dermatitis-septic arthritis syndrome with joint inflammation and skin near joint red + skin PUSTULES
  2. purulent arthritis without skin lesions (looks like non gonoccocal)
19
Q

dermatitis-arthritis syndrome (acute gonococcal monoarthritis) typical signs

A
  • fevers, chills malaise
  • tenosynovitis
  • migratory polyarthralgia
20
Q

dx of gonococcal vs non gonoccocal acute monoarthritis

A 
non-gonoccocal = synovial tap + culture
gonococcal = synovial tap + PCR (or culture)
21
Q

tx of acute gonococcal monoarthritis

A

3rd gen cephalosporin

22
Q

uric acid crystals vs calcium pyrophosphate dihydrate crystals

A
  • gout = needle shaped, NEGATIVE birefrigence (yellow when parallel to polarizing microscope, blue perpendicular)
  • CPPD: smaller, rhomboid shaped, don’t shine a lot, POSITIVELY bifrefigent (blue when parallel to polarizing microscope)
23
Q

CPPD disease is what

A

umbrella term for many things

  • asymptomatic
  • pseudogout
  • pseudoRA
  • pseudo OA
  • pseudo neuropathic joint
24
Q

pseudogout typical presentation

A

acute monoarthritis of knee in elderlee with chondrocalcinosis on XR + no reason to suspect infection

25
Q

tx of CPPD

A

like gout, give NSAIDs or CS for acute episodes

-BUT NO TX PROPHYLAXIS TO REDUCE CALCIUM DEPOSITION (as in uric acid reducing therapy)

Bloc H - Movement (48 decks)

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