OnlineMedEd - Rheumatology: Monoarticuloarthropathy

Question 1

Remember: red, hot, swollen joint…. ______________.

Answer 1

aspirate the joint fluid

Question 2

Single inflamed joints are either ________________.

Answer 2

septic or crystal

Question 3

Analysis of joint fluid from a crystalopathy will show ________________.

Answer 3

crystals, fewer than 50,000 cells, and slightly cloudy but not acutely pus-filled joint fluid

Question 4

Colchicine is often the first treatment for crystal flares in patients with _____________.

Answer 4

kidney disease (in whom NSAIDs are contraindicated)

Question 5

Gout can result from two pathologic states: ___________________.

Answer 5

decreased elimination of uric acid or increased production of uric acid

Most people with gout are over producers.

Question 6

If a person has gout due to decreased excretion of uric acid, then they should be treated with _______________.

Answer 6

probenecid

Question 7

In patients at risk of tumor lysis syndrome, prophylaxis is done with allopurinol and ______________.

Answer 7

IV fluids

Question 8

If someone develops tumor lysis syndrome, treat them with _______________.

Answer 8

rasburicase (or other agents that increase the solubility of uric acid)

Question 9

Patients with gout most commonly have one of three risk factors: _________________.

Answer 9

chronic kidney disease, excess alcohol intake, or diuretic use

Question 10

What three dietary items increase the risk of gout?

Answer 10

• Meat
• Alcohol
• Fructose

Question 11

Typically, you should only obtain a patient’s uric acid level when ________________.

Answer 11

they have repeated attacks despite lifestyle modifications and you intend to place them on chronic therapy

Question 12

What is the purpose of obtaining uric acid levels?

Answer 12

If you are putting someone on chronic therapy (e.g., allopurinol), then you need to monitor uric acid levels to assess risk. Risk of gout decreases when uric acid levels are less than 6.8.

Question 13

Allopurinol can trigger acute gouty attacks. What should you do if this occurs?

Answer 13

Continue administration of allopurinol and treat the symptoms with the usual triplet of NSAIDs, colchicine, or steroids.

Question 14

Nongonococcal infections can be seeded by two mechanisms: ________________.

Answer 14

direct from the nearby skin (which will be evidenced by an abscess near the swollen joint) or hematogenous spread

Question 15

List three populations that are at increased risk of nongonococcal joint infections.

Answer 15

• IV drug abusers
• Hemodialysis patients
• Immunocompromised patients

Question 16

How should septic arthritis from MSSA be treated?

Answer 16

With nafcillin

In reality, though, vancomycin or linezolid are often used because MRSA can take time to identify and infected joints can be lost.

Question 17

How are infected prosthetic joints treated?

Answer 17

The hardware must be removed.

Question 18

Most of the time, joint infections from N. gonorrheae will show _____________ Gram stains.

Answer 18

nothing

As such, nucleic acid amplification tests (NAATs) are the preferred diagnostic.

Question 19

How is gonococcal arthritis treated?

Answer 19

Ceftriaxone and either doxycycline or macrolides