Monoarticular Inflammatory Arthritis

Question 1

Recurrent attacks of acute arthritis

Caused by:

Answer 1

Gout

MSU crystals in synovium
Elevated serum uric acid

Question 2

Tophi are associated with ___

Answer 2

gout

Question 3

T/F: Acute gout has a monoarticular onset that is most commonly seen in the knee.

Answer 3

False. Most common in 1st MTP

Question 4

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

Answer 4

A,E

B. No constitutional systems
C,D . Self limited in 1 week

Question 5

T/F: Elevated uric acid is diagnostic of acute gout.

Answer 5

False. 50% w/ normal uric acid during acute attack

Question 6

T/F: Acute gout episodes start immediately with the onset of hyperuricemia.

T/F: Hyperuricemia starts during puberty in females, middle aged in males.

Answer 6

False. Start 10-20 years after onset of hyperuricemia

False. Puberty in males, menopause in females

Question 7

Diagnosis of gout

Answer 7

Demonstrate crystals

Needle shaped
Intracellular
Negatively birefringement (parallel-yellow)

Question 8

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

Answer 8

B

A. 1 gout attack and chronic KIDNEY disease
C. >2 attacks/year
D. History of kidney stones

Question 9

Acute therapy for gout include all EXCEPT:
A. Colchicine
B. NSAID
C. Joint injection
D. Ice/rest
E. Corticosteroids

Answer 9

D. Ice/rest for acute CPPD

CPPD has same acute therapy with addition of ice/rest

Question 10

CPPD =

Answer 10

Calcium pyrophosphate deposition disease

Question 11

All of the following are sites where CPP crystals deposit EXCEPT:
A. Articular cartilage
B. Menisci
C. Bone
D. Synovium
E. Periarticular tissues

Answer 11

C

Question 12

T/F: CPPD is most commonly associated with diabetes.

Answer 12

False. associated w/ aging

And disease:
Hyperparathyroidism
Hemochromatosis
Trauma
Hypophosphatasia
Hypomagnesemia
(Don't even bother remembering these 2 days before the test...)

Question 13

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

Answer 13

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

Question 14

Diagnosis of CPPD

Answer 14

Positive birefringence
Aligned, Blue, Calcium (ABC)
Rhomboid crystals

Question 15

T/F: CPPD and infection can coexist.

Answer 15

True!

Question 16

Most common locations of CPPD

Answer 16

Knees > hands > symphysis

*contradiction of slides: wrists > knees > symphysis

Question 17

T/F: Radiologic features of CPPD include poor mineralization, asymmetric joint space loss and erosion with osteophyte formation.

Answer 17

False. Normal mineralization, uniform joint space loss, NO erosion

True part: osteophyte formation

Question 18

Most common pathogens of septic arthritis (2)

Answer 18

S. aureus

N. gonorrhea (young, horny people)

Question 19

T/F: Septic arthritis spreads hematogenously.

Answer 19

True

Question 20

Most important initial step in evaluation of monoarticular arthritis

Answer 20

Arthrocentesis

Question 21

Most common locations of septic arthritis

Answer 21

Knee > > > hip > others

Question 22

T/F: Migratory joint pain is seen in septic arthritis caused by S. aureus.

Answer 22

False. Gonococcal

Question 23

Diagnosis of septic arthritis

Answer 23

Synovial fluid:
Low viscosity
Opaque/purulent
WBC > 50,000

Cultures: synovial fluid (100% +), blood (50% +) any potential sites (urethra, cervix)

Question 24

T/F: Treatment for septic arthritis include abx injection at site.

Answer 24

False. Parenteral abx

Empiric therapy

Question 25

All of the following are characteristics of malignancy EXCEPT:
A. Night time pain
B. Weight loss
C. Severe fatigue
D. polyartricular

Answer 25

D. Metastatic disease is usually monoarticular

Question 26

T/F: Staph aureus septic arthritis is most commonly seen in the wrist.

Answer 26

False. Knee