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MSK > Monoarthritis > Flashcards

Monoarthritis Flashcards

1
Q

Give some differentials for mono articular arthritis

A 
Gout
Pseudogout
Septic arthritis
Reactive arthritis
Osteoarthritis
Internal derangement
(osteomyelitis, Ca bone)
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2
Q

How could you differentiate between gout and pseudogout?

A

Joint aspirate:
Gout - monosodium urate crystals, negatively birefringent under plane polarised light
Pseudogout - calcium pyrophosphate crystals, positively birefringent

History - ask about risk factors for gout

Site

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3
Q

What are the signs of septic arthritis?

A 
Fever
Swelling
Severer tenderness
Erythema
Warmth
Markedly restricted ROM
Guarding
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4
Q

Who is at risk of septic arthritis?

A

Immunocompromised - steroids,diabetes etc
IVDU
Joint prosthesis
Penetrating trauma

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5
Q

What organisms usually cause septic arthritis in IVDUs?

A

S aureus

Pseudomonas

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6
Q

What is the good standard diagnostic test for septic arthritis?

A

Joint aspiration and culture of synovial fluid

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7
Q

What organisms may cause septic arthritis?

A 
S aureus
Strep
Pseudomonas
Gonococci
TB
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8
Q

How would you manage septic arthritis?

A

Analgesia
NSAIDs
Antibiotics
Urgent orthopaedic referral for washout

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9
Q

What is the gold standard diagnostic test and result for gout?

A

Joint aspiration

Presence of negatively birefringent needle shaped crystals (monosodium urate)

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10
Q

Hw does gout usually present?

A

Acutely inflamed, painful red joint.
Usually first metatarsophalangeal joint
Gouty tophi on ears and tendon sheaths

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11
Q

How would you manage an acute attack of gout?

A

NSAIDs
Colchicine
Analgesia

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12
Q

What lifestyle advice would you give to someone with gout?

A

Dietary changes - avoid high purine foods
Less alcohol
Weight loss

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13
Q

Why is allopurinol contraindicated in acute gout?

A

Can make the acute attack worse

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14
Q

What medication is used to prevent further attacks of gout?

A

Allopurinol

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15
Q

What might you see on X-ray in a patient with Pseudogout?

A

Chondrocalcinosis

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16
Q

What might you see on X-ray in a patient with gout?

A

Punched out lesions
Sclerosis
Tophi

17
Q

How would you manage Pseudogout?

A

Symptomatic treatment only

Ice packs
Analgesia
Joint aspiration to help pain
NSAIDs
Colchicine
Intra articulate steroid injections
Systemic steroids if severe
18
Q

What are the ADRs of steroids?

A 
Osteoporosis
Myopathy
Peptic ulcers disease
Immunosuppression
Glaucoma, cataracts
Skin atrophy, easy bruising, delayed wound healing
Diabetes
Dyslipidaemia
Weight gain and fat redistribution
19
Q

how long after an acute attack of gout should you wait before giving allopurinol?

A

4-6 weeks

to prevent it precipitating another attack

MSK (6 decks)

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