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Ortho > Non-traumatic joint pain and infection > Flashcards

Non-traumatic joint pain and infection Flashcards

1
Q

soft tissue neoplastic, neurogenic fibromyalgia, and infection are examples of what kind of musculoskeletal pain?

A

nonarticular

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2
Q

what are examples of monoarticular musculoskeletal pain

A

OA

crystals

infections

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3
Q

what are mono or polyarticular diseases of musculoskeletal pain

A

lyme disease

syphillis

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4
Q

RA, lupus, scleroderma, polymyositis, polymyalgia rheumatica, and vasculitis are examples of what kind of musculoskeletal pain?

A

polyarticular

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5
Q

deterioration of articular cartilage from repetitive forces or alteration in joint/body mechanics

non-inflammatory

A

OA

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6
Q

in obese patients what is the ratio for the higher involvement of knees vs hips in OA

A

4:1

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7
Q

sx of OA

A
  • pain: deep ache, localized
  • stiffness: early AM, improved with light activity
  • weakness
  • mechanical sx: crepitus possible

pain increases with heavy/prolonged activity improved with rest

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8
Q

OA tx?

A
  • rest/activity modifications
  • NSAIDs
  • walking aids
  • bracing
  • modalities
  • weight loss
  • glucosamine chondroitin sulfate
  • corticosteroid injections
  • viscosupplementation
  • patches/creams
  • surgery
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9
Q

what are contraindications to using cortisone?

A

infection

cancer

osteonecrosis

AVN

4 weeks prior to surgery

total joint replacement

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10
Q

what gene is RA associated with

A

HLA

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11
Q

in what joints is there pain for RA

A

MCP (classic)
Wrists
PIP (SPARES DIP)

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12
Q

what ligaments are commonly affected in RA

A

atlanto-axial

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13
Q

Felty’s syndrome

A

RA

neutropenia

splenomegaly

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14
Q

if someone with a prosthetic joint has glycocalyx what do you expect?

A

Septic arthritis

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15
Q

what joints most commonly get septic arthritis

A

Knee and hip

followed by wrist, ankles, shoulders, spine

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16
Q

Tx of septic arthritis

A

IV abx

irrigation

debridement

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17
Q

physiological change of septic arthritis

A

fluid pressure increase

pH decrease

activated proteolytic enzymes

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18
Q

WBC count and PMN in total joint vs native joint fluid

A

Total:

  • WBC = 6,000
  • PMN = 60%

Native:

  • WBC = 75,000
  • PMN = 80%
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19
Q

when you aspirate a joint what needs to be done

A

total cell count - aerobic and anerobic

crystal analysis too

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20
Q

what effects on the joint does septic arthritis have?

A

chondrolysis

destruction of tendons

synovitis and proliferation

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21
Q

what gram positive organisms can be found in septic arthritis

A

1 staph aureus/epidermidis - native and total joints

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22
Q

what bacteria often causes septic arthritis in kids when they experience a puncture wound

A

pseudomonas

23
Q

what gram negative bacteria is often found in septic arthritis of the elderly and IV drug users

A

E. coli

24
Q

when would you see anaerobic and polymicrobial bacteria in septic arthritis?

A

total joint

immunocompromised

DM

25
Q

what is kocher criteria used for?

A

likelihood of septic arthritis

26
Q

in kocher criteria you will get 1 point for each:

???

A

non-weight bearing

SED rate >40

fever 38.5 C (101.3)

WBC >12,000

27
Q

sx of septic arthritis

A

join pain

pain with active/passive ROM

swelling, redness, tender to touch

limb position: hip-flex/adducted/internal rotation

fever, chills

28
Q

if someone has septic arthritis what do you do?

A

admit, labs, blood cultures, arthrocentesis, abx (must give a lot of fluid), surgery

29
Q

what are indications for arthrocentesis

A

unexplained effusion

decompression of hemorrhagic effusion

evaluation of antibiotic response in septic joint

30
Q

___ is a transundate of plasma that is actively secreted by synovial fluid

A

joint fluid

31
Q

indolent effusions with minimal discomfort and inflammation suggests what?

A

TB or fungal cause

32
Q

what type of synovial fluid would present with minimal inflammation, capillary leakage, and metabolism of Hgb to bilirubin

A

xanthocrhomic

33
Q

if synovial fluid is bloody whats going on

A

hemarthrosis

34
Q

what is normal color, viscosity, WBCs, PMN, glucose, and protein for normal synovial fluid

A

color: clear
viscosity: increased

WBCs: <200

PMN <25

Glucose: same as serum

Protein: <2.5

35
Q

what is the color of synovial fluid if inflammatory (crystals, Rh, Reiter’s, Rh fever)?

viscosity? 
WBC?
PMN?
Glucose?
Protein?
A

clear
yellow
turbid

viscosity: decreased
WBC:  up to 100,000
PMN: 40-90
Glucose: <40
Protein: >2.5
36
Q

in septic arthritis (staph, gonnoccal, TB) for the synovial fluid was is the

  • color
  • Viscosity
  • WBC
  • PMN
  • Glucose
  • Protein
A
  • color: turbid
  • viscosity: decreased
  • WBC: 75,000-100,000
  • PMN: 40-100
  • glucose: reduced
  • protein: >2.5
37
Q

what labs would you order to anaylze synovial fluid

A

cell count

gram stain

aerobic and anaerobic

crystal analysis

38
Q

in osteomyelitis why is diaphyseal involvement less common

A

epiphyseal growth plate acts as a barrier to infection

39
Q

in someone with osteomyelitis what would you expect to see on a radiograph

A

capsular distension

patchy osteoporosis

diffuse lysis of subchondral bone

reactive sclerosis

deformtiy

40
Q

what injury would you worry about post-traumatic arthritis for

A

intraarticular fracture

41
Q

crystal: hydroxyapatite indicates what

A

calcific tendinitis

42
Q

crystal: calcium oxalate indicates what

A

chronic renal disease

hemodialysis

43
Q

cholesterol crystal indicates what

A

chronic RA effusions

44
Q

crystals - lipid liquid indicates what

A

acute chronic arthritis/fracture

45
Q

it is rare to find crystal w/o elevated ____

A

neutrophils - associated with inflammation

46
Q

crystal analysis indicative of gout

A

needle shapes and neg. birefringent

47
Q

Gout signs/sx

A

severe joint pain and tenderness

hot, dusky red swelling

1st MTP is most common; also knees and ankles

40-50 y/o most common

NIGHT ATTACKS

punched out lesions on Xrays

48
Q

Tx of gout

A

colchicine

NSAIDs

corticosteroids

allopurinol, probenecid

49
Q

Pseudogout has high 1 correlation and age 2 is most common

it can be associated with 3 disorders

the 4 is most commonly involved

A
  1. genetic
  2. 50+
  3. metabolic (hyperparathyroidism, hemochromatosis, hypothyroidism, hypophastasia, hypomagnesemia, Wilson’s dx)
  4. knee
50
Q

how is pseudogout diagnosed (what findings)

A

synovial fluid analysis

chondrocalcinosis on xray

crystal analysis: rhomboid crystals, + birefringenc

51
Q

neurogenic-neurovascular reflex on periarticular circulation (happens to diabetics)

A

Charcot’s arthropathy

52
Q

what can cause avascular necrosis

A

alcohol

trauma

steroids

53
Q

WHAT ARE THE SECONDARY METASTATIC TUMORS FROM BONE TUMORS

A

Bone Tumors Proudly Love Killing

  • Breast: lytic
  • Thyroid: lytic
  • Prostate: dense often blastic
  • Lung: lytic
  • Kidney: lytic - bleed a lot, nearly 2x as common

Ortho (9 decks)

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