MMB (022) Practical of Red Hot Joint Flashcards
The 5 possible routes of infection in septic arthritis?
• Mention the possible risk factors of septic arthritis in this case
1.Existing joint problem (osteoarthritis)
2.Weak immune system (diabetes)
• Mention other risk factors for septic arthritis
1.Existing joint problems
- Joint trauma
3.Weak immune system , kidney and liver diseases, drugs suppressing immunity
4.Increased skin fragility
- Which of the following blood levels is increased in gout?
A. cholesterol
B. urea
C. uric acid
D. Bilirubin
C.uric acid
Gout commonly affects big toe (T/F)
True
Only men get gout (T/F)
False
• Gout can be diagnosed with only a simple blood test T/F
False
• Note : high uric acid level is not enough for a clear diagnosis of gout. Even people without gout can have high uric acid. Finding uric acid crystals in aspirated fluid is necessary
• Which food might protect against gout?
- Liver
- Shrimp
- Skimmed milk
- Skimmed milk
•Describe the microscopy and the stain used
-Wright-Giemsa stain and polarised light ;
- Large numbers of neutrophils and long, needle-like, sodium urate crystals
A. Aspirate the olecranon bursa
1- What are the investigations required to confirm the diagnosis?
-Examination of synovial fluid for ;
• White cell count, which is usually very high
• Culture for bacteria or other organisms
- X-rays: done only to look for damage or to rule out other causes
-Blood tests to monitor inflammation
2- If aspiration of synovial fluid from the left knee is performed. Describe the findings
Synovial fluid smear rich in leukocytes
3- MANAGEMENT ?
Antibiotics and drainage of fluid to stop injury
1- What is your possible diagnosis?
GOUTY ARTHRITIS
2- Mentions the investigations required to confirm your diagnosis.
-A serum urate level of approximately 6.8
- Radiographic findings:
1. Juxta-articular erosive changes around the first MTP joint
1. With overhanging edges
2. Soft tissue swelling
3. The joint space is maintained
4. No evidence of osteopenia
3- If synovial fluid aspiration is performed, please describe it.
Needle- shaped sodium urate crystals and mononuclear cells
4- What are the risk factors in this case?
-Gender
-Obesity
-Diuretics
-Alcoholic
-Excessive red meat
Three general steps of gout management ?
• Treating the acute attack (NSAIDs , steroids)
• Providing prophylaxis to prevent acute flares
• Lowering excessive storage of urate to prevent flares of gouty arthritis and to prevent tissue deposition of urate crystals
• Treatment of chronic gout: therapy to reduce serum uric acid level to AT LEAST 6mg/dl
Treatment of chronic gout: therapy to reduce serum uric acid level to AT LEAST ……mg/dl
6mg/dl
1- Describe the microscopic picture from the knee joint synovium.
-Increased vascularity
-Numerous inflammatory cells
-Synovial cell hyperplasia
2- What is the laboratory investigation required to confirm the diagnosis?
Positive Rheumatoid factor and anti-CCP
