(Masoomeh) Rheumatology p218-226

Question 1

what are 3 types of seronegative spondyloarthropathies

Answer 1

ankylosing spondylitis
psoriatic arthritis
reactive arthritis( reiters syndrome)

Question 2

symptoms/features of spondyloarthropathies

Answer 2

joint pain
men age 20-30yrs
involves spine and large joints
negative rheumatoid factor
enthesopathy
uveitis
HLA b27

Question 3

symptoms of ankylosing spondylitis (AS)

Answer 3

low back ache and morning stiffness of back and radiates to buttocks with flattening of normal lumbar curvature and decreased chest expansion.
arthritis
Atrioventricular block
uveitis

Question 4

Dx of AS…..initial and accurate

Rx of AS

Answer 4

initial=x-ray of sacroiliac joint
accurate=MRI
ESR elevated in 85%
Rx==exercise and NSAIDS…..if NSAIDS insufficient then use anti-TNF drugs

Question 5

what are the charachteristic findings of psoriatic arthritis

Answer 5

sausage digits from enthesopathy

nail pitting and onchylosis

Question 6

what is dx of psoriatic arthritis

Answer 6

elevated ESR
initial test is x-ray of joint showing pencil in a cup deformity
elevated uric acid level

Question 7

Rx of psoriatic arthritis

Answer 7

NSAIDS….if no response then methotrexate,

anti TNF factors if no response to methotrexate

Question 8

what is the triad of Reactive Arthritis

Answer 8

Joint pain (oligoarthritis)
Ocular findings (conjuctivitis, uveitis)
Genital abnormalities (Uretheritis, Balantitis)

Question 9

Rx of reactive arthritis

Answer 9

NSAIDS

sulfasalazine is used if nsaids dont work

Question 10

Risk factors of Osteoporosis

Answer 10

old women with vertebral fractures leading to loss of height and wrist fractures

Question 11

when is bone densitometry recommended

Answer 11

all women above age 65

Question 12

dx of osteoporosis

Answer 12

bone densitometry (DEXA) scan

Question 13

what is T-score of osteopenia and osteoporosis

Answer 13

in osteopenia T-score is between 1 and 2.5 standard deviation below normal
in osteoporosis T-score is more than 2.5 standard deviation below normal

Question 14

rx of osteoporosis

Answer 14

vitamin D and calcium
bisphosphonates
estrogen replacement / Raloxifene in postmenopausal women
Teriparatide- analogue of PTH
calcitonin nasal spray

Question 15

what is the etiology of septic arthritis

Answer 15

staphylococcus-40%
streptococcus-30%
gram negative rods-20%

Question 16

sx of septic arthritis

Answer 16

warm, red and immobile joint with a palpable effusion, chills and fever happens because of bacteremia

Question 17

initial and accurate test of septic arthritis

Answer 17

arthrocentesis (aspiration of the joint with a needle)

Question 18

what does joint fluid show in septic arthritis

Answer 18

leukocytosis more than 50,000 to 100,000 cells predominantly neutrophils
gram stain positive in 50%, gram negative bacilli 75% with staphylococcus
synovial fluid culture positive 70-90% sensitive
blood culture- 50% sensitive

Question 19

Rx of septic arthritis

Answer 19

ceftriaxone and vancomycin