Monoarticular Inflammatory Arthritis Flashcards
Recurrent attacks of acute arthritis
Caused by:
Gout
MSU crystals in synovium
Elevated serum uric acid
Tophi are associated with ___
gout
T/F: Acute gout has a monoarticular onset that is most commonly seen in the knee.
False. Most common in 1st MTP
Which of the following is TRUE about acute gout? A. Abrupt onset B. Involves constitutional symptoms C. Often requires medication to resolve D. Lasts for months E. Erythema & desquamation
A,E
B. No constitutional systems
C,D . Self limited in 1 week
T/F: Elevated uric acid is diagnostic of acute gout.
False. 50% w/ normal uric acid during acute attack
T/F: Acute gout episodes start immediately with the onset of hyperuricemia.
T/F: Hyperuricemia starts during puberty in females, middle aged in males.
False. Start 10-20 years after onset of hyperuricemia
False. Puberty in males, menopause in females
Diagnosis of gout
Demonstrate crystals
Needle shaped
Intracellular
Negatively birefringement (parallel-yellow)
Which of the following is an indication for urate lowering therapy in gout?
A. 1 gout attack and chronic liver disease
B. Tophi
C. >3 attacks/year
D. History of kidney cancer
B
A. 1 gout attack and chronic KIDNEY disease
C. >2 attacks/year
D. History of kidney stones
Acute therapy for gout include all EXCEPT: A. Colchicine B. NSAID C. Joint injection D. Ice/rest E. Corticosteroids
D. Ice/rest for acute CPPD
CPPD has same acute therapy with addition of ice/rest
CPPD =
Calcium pyrophosphate deposition disease
All of the following are sites where CPP crystals deposit EXCEPT: A. Articular cartilage B. Menisci C. Bone D. Synovium E. Periarticular tissues
C
T/F: CPPD is most commonly associated with diabetes.
False. associated w/ aging
And disease: Hyperparathyroidism Hemochromatosis Trauma Hypophosphatasia Hypomagnesemia (Don't even bother remembering these 2 days before the test...)
All of the following are clinical presentations of CPPD except:
A. Acute CPP
B. Chronic CPP crystal infectious arthritis
C. OA w/ CPPD
D. Asymptomatic CPPD
B. Chronic CPP crystal inflammatory arthritis = speudo-rheumatoid
A. Acute CPP = psuedogout
C. OA w/ CPPD = pseudo-OA
D. Asymptomatic CPPD = only seen on xray w/ no symptoms
Diagnosis of CPPD
Positive birefringence
Aligned, Blue, Calcium (ABC)
Rhomboid crystals
T/F: CPPD and infection can coexist.
True!
Most common locations of CPPD
Knees > hands > symphysis
*contradiction of slides: wrists > knees > symphysis
T/F: Radiologic features of CPPD include poor mineralization, asymmetric joint space loss and erosion with osteophyte formation.
False. Normal mineralization, uniform joint space loss, NO erosion
True part: osteophyte formation
Most common pathogens of septic arthritis (2)
S. aureus
N. gonorrhea (young, horny people)
T/F: Septic arthritis spreads hematogenously.
True
Most important initial step in evaluation of monoarticular arthritis
Arthrocentesis
Most common locations of septic arthritis
Knee > > > hip > others
T/F: Migratory joint pain is seen in septic arthritis caused by S. aureus.
False. Gonococcal
Diagnosis of septic arthritis
Synovial fluid:
Low viscosity
Opaque/purulent
WBC > 50,000
Cultures: synovial fluid (100% +), blood (50% +) any potential sites (urethra, cervix)
T/F: Treatment for septic arthritis include abx injection at site.
False. Parenteral abx
Empiric therapy
All of the following are characteristics of malignancy EXCEPT: A. Night time pain B. Weight loss C. Severe fatigue D. polyartricular
D. Metastatic disease is usually monoarticular
T/F: Staph aureus septic arthritis is most commonly seen in the wrist.
False. Knee
