Mehlman reactive; UW post trauma arthritis/synovial fluid normal 03-07 (3) Flashcards

1
Q

M. Reactive. CP?

A

Classically presents as triad of
1) urethritis or abdominal infection
2) polyarthritis
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

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2
Q

M. Reactive. CP.
Classically presents as triad of
….
2) polyarthritis
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

A

1) urethritis or abdominal infection

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3
Q

M. Reactive. CP.
Classically presents as triad of
1) urethritis or abdominal infection
…..
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

A

2) polyarthritis

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4
Q

M. Reactive. CP.
Classically presents as triad of
1) urethritis or abdominal infection
2) polyarthritis
….

A

3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

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5
Q

M. cause of reactive?

A

CHLAMYDIA

gonoccus DOES NOT cause reactive on usmle

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6
Q

M. what viral can cause reactive?

A

Rubella
Hep B and C

also Yersinia

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7
Q

M. reactive part of what genetic alteration?

A

Part of HLA-B27 constellation (PAIR).

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8
Q

M. post-traumatic arthritis. CP?

sito nera lapuose, tik cia.

A

Pain in joint that can present soon, or many years after, injury, where other DDx are ruled out.

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9
Q

M. post-traumatic arthritis. case on 2CK.

case where it sounds like patellar tendonitis (i.e. 2 years of knee pain, first worsened with basketball, but then progresses to more constant pain), but then they go on to say that patient had fracture to proximal tibia 30 year ago and has varus deformity of the knee.

ANSWER - traumatic arthritis, not patella tendonitis.

A

the implication is that the etiology for patient’s arthritis is ultimately linked to the varus deformity from the prior injury

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10
Q

UW. Synovial fluid analysis.
Appearance in normal?

A

Clear

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11
Q

UW. Synovial fluid analysis.
WBC in normal?

A

<200

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12
Q

UW. Synovial fluid analysis.
PMNs in normal?

A

<25 proc.

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13
Q

UW. Synovial fluid analysis.
Appearance in non-inflammatory (eg OA)?

A

clear

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14
Q

UW. Synovial fluid analysis.
WBC in non-inflammatory (eg OA)?

A

200 - 2000

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15
Q

UW. Synovial fluid analysis.
PMNs in non-inflammatory (eg OA)?

A

25 proc.

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16
Q

UW. Synovial fluid analysis.
Appearance in inflammatory (crystals, RA)?

A

translucent or opaque

17
Q

UW. Synovial fluid analysis.
WBCs in inflammatory (crystals, RA)?

A

2000 - 100 000

18
Q

UW. Synovial fluid analysis.
PMNs in inflammatory (crystals, RA)?

A

Often >50 proc.

19
Q

UW. Synovial fluid analysis.
Appearance septic joint?

20
Q

UW. Synovial fluid analysis.
WBCs septic joint?

A

50 k - 150k

21
Q

UW. Synovial fluid analysis.
PMNs septic joint?

A

> 80 - 90 proc.

22
Q

UW reactive arthritis table. Preceding infection?

A

Genitourinary: Chlamydia trachomatis

GI: salmonella, Shigella, Yersinia, Campylobacter, Clostridioides difficile.

23
Q

UW reactive arthritis table. Genitourinary m/o?

A

Genitourinary: Chlamydia trachomatis

24
Q

UW reactive arthritis table. GI m/os?

A

GI: salmonella, Shigella, Yersinia, Campylobacter, Clostridioides difficile.

25
UW reactive arthritis table. MSK CP?3
Asymetric oligoarthritis Enthesitis Dactylitis
26
UW reactive arthritis table. extraarticular symptoms. ocular?
conjuctivitis, anterior uveitis
27
UW reactive arthritis table. extraarticular symptoms. genital?
urethritis, cervicitis, prostatitis
28
UW reactive arthritis table. extraarticular symptoms. dermal?
keratoderma blennorrhagicum, circinate balanitis
29
UW reactive arthritis table. extraarticular symptoms. GI?
oral ulcers
30
UW reactive arthritis table. Dx? 3
CLinical Elevated inflammatory markers: ESR, CRP Synovial fluid: incr. WBC (2-4k), negative gram stain and culture
31
UW reactive arthritis Q. arthritis tx?
Usually self-limited (eg, resolving within 6 months), and treatment is largely supportive. Arthralgia usually improves NSAIDs.
32
UW reactive arthritis Q. balanitis tx?
If treatment for circinate balanitis is desired, low-potency topical corticosteroids (eg, 1% hydrocortisone) are often adequate.
33
UW reactive arthritis Q. what underlying condition?
the risk of reactive arthritis is increased in patients with HLA-B27
34
UW reactive arthritis Q. when manifests?
1-4 weeks following certain GU/GI infection
35
UW reactive arthritis table. Management. 2 drugs
First line: NSAIDs sometimes antibiotics (chlamydia, non-self limiting GI infection)
36
UW reactive arthritis table. Management. If nsaids fail or contraindicated?
Intraarticular GK Systemic GK Disease-modifying antirheumatic drugs
37
UW reactive arthritis Q. first line Tx?
NSAIDS
38
UW reactive arthritis Q. why abs are not first line?
Activated lymphoid cells (from infection) migrates to joints and extraarticular sites = cause inflammation. So this infl. is not because of bacteria --> no need of abs. abs may be indicated depending on the underlying infection
39
UW reactive arthritis Q. Clinical + arthrocenthesis --> suspected ReA. what additional studies needed to establish Dx?
no additional studies primarily = clinical also arthrocentesis allows to rule out other causes buvo option HLA-B27 - in these patients is inc. risk for ReA, but is not necessary