(Nisha) Rheumatology p189-204

Question 1

Chronic, slowly progressive, erosive damage to joint surfaces; loss of articular cartilage causing increasing pain with minimal or absent inflammation

Answer 1

Osteoarthritis

Question 2

Increasing ____ and ____ to the joint increases incidence of DJD

Answer 2

Age, trauma

Question 3

Does playing contact sports and obesity increase DJD?

Answer 3

Yes

Question 4

What joints is DJD present in?

Answer 4

Weight bearing joints (knee, hip, ankle)

Question 5

What joints are affected in osteoarthritis?

Answer 5

DIP> PIP and MCP

Question 6

Heberden nodes

Answer 6

DIP enlargement

Question 7

Bouchard nodes

Answer 7

PIP enlargement

Question 8

Are lab tasts normal or abnormal in Osteoarthritis?

Answer 8

Normal

Question 9

The most accurate test for osteoarthritis

Answer 9

Radiography of the affected joint

Question 10

What will X-ray of affected joint show? (osteoarthritis)

Answer 10

Joint space narrowing, osteophytes, dense subchondral bone, bone cysts

Question 11

How do you treat osteoarthritis?

Answer 11

Weight loss & moderate exercise
Acetominophen (best initial analgesic)
NSAIDS
Capsaicin cream
Intraarticular steroids (if other medical therapy does not control the pain)
Hyaluronan injection in joint
Joint replacement if disease is severe

Question 12

Absence of inflammation, normal lab tests, short duration of stiffness distinguishes _____ from _____

Answer 12

DJD, rheumatoid arthritis

Question 13

Defect in urate metabolism with 90% of cases in men. (urate overproduction or underexcretion)

Answer 13

Gout

Question 14

Causes of overproduction of urate?

Answer 14

Idiopathic
Increased turnover of cells (cancer, hemolysis, psoriasis, chemotherapy)
Enzyme deficiency (Lesch-Nyhan syndrome, glycogen storage disease)

Question 15

Causes of under excretion of urate?

Answer 15

Renal insufficiency
Ketoacidosis or lactic acidosis
thiazides and aspirin

Question 16

A 58 year old man comes in with fever and sudden excruciating pain, redness, and tenderness of the big toe at night after binge drinking. Dx?

Answer 16

Gout

Question 17

MTP joint of the great toe is the most frequently affected site in gout. True or false?

Answer 17

True. Can also occur in the ankle, feet, knees

Question 18

Presentation of chronic gout?

Answer 18

Tophi tissue (deposition of urate crystals)
Uric acid kidney stones
Long asymptomatic period between attacks

Question 19

What is the most accurate test for Gout?

Answer 19

Aspiration of the joint showing needle shaped crystals with negative birefringence on polarized light microscopy

Question 20

Treatment of Acute attack (Gout)

Answer 20

NSAIDS > colchicine - best initial therapy
Corticosteroids (steroids is the answer when no response to nsaids or contraindications to nsaids such as renal insufficiency)
Colchicine used in those who cannot use either NSAIDS or steroids

Question 21

Treatment of Chronic Gout?

Answer 21

Diet (decrease alcohol, high purine foods such as meat and seafood)
Stop thiazides, aspirin, and naicin (use losartan first for HTN)
Colchicine (effective at preventing second attack of gout and sudden fluctations in uric acid levels due to probenecid or allopurinol)
Pegloticase (dissolves uric acid)
Probenecid and sulfinpyrazone (increase excretion of uric acid) - rarely used

Question 22

Side effect of colchicine ?

Answer 22

Diarrhea, bone marrow suppression (neutropenia)

Question 23

TEN and Steven johnson syndrome is a side effect of what drug used for gout?

Answer 23

Allopurinol

Question 24

Best drug for BP in gout?

Answer 24

Losartan (ARB) lowers uric acid

Question 25

Calcium containing salt depositing on articular cartilage ?

Answer 25

Pseudogout (CPDD)

Question 26

Risk factors for pseudogout?

Answer 26

Hemachromatosis, hyperparathyroidism, diabetes, hypothyroidism, wilson disease

Question 27

What joints are affected in Pseudogout?

Answer 27

large joints. knee, wrist

Question 28

Are DIP and PIP affected in CPDD?

Answer 28

No

Question 29

Most accurate test for CPDD?

Answer 29

Arthrocentesis (positively birefringement rhomboid shaped crystals)

Question 30

CPPD treatment?

Answer 30

NSAIDS. severe disease (intraarticular steroids such as triamcinolone), colchicine prevents subsequent attacks

Question 31

a 80 year female comes in with painful joints (DIP, PIP, hip and knees). The pain worsens with use. Aspiration of synovial fluid shows <200 wbc, osteophytes and joint space narrowing. Dx?

Answer 31

Osteoarthritis

Question 32

A 40 year old man comes in with pain of the big toe after a night of binge drinking. Aspiration shows 2k-50k WBC, negatively birefringent needles. Dx?

Answer 32

Gout

Question 33

A 40 year old man with hx of hemochromatosis and hyperparathyroidism comes in with pain in his wrists and knees. Aspiration shows 2k - 50k WBC, positively birefringent rhomboids and chrondrocalcinosis on x-ray. Dx?

Answer 33

CPDD

Question 34

a 25 year old female comes to the clinic complaining of pain in the joints of her hands. She says the pain is severe in the morning and gets better with use. Aspiration shows 10k-20k wbc, antiCCP. Dx?

Answer 34

R.A

Question 35

A 18 year old male comes to clinic complaing of a hot knee joint. He has a fever of 102F. Aspiration shows >50k neutrophils. Dx?

Answer 35

Septic arthritis

Question 36

Lumbosacral strain treatment?

Answer 36

Nsaids

Question 37

Compression of the spinal cord is due to ?

Answer 37

malignancy, infection.