OnlineMedEd - Rheumatology: Monoarticuloarthropathy Flashcards

1
Q

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

A

aspirate the joint fluid

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2
Q

Single inflamed joints are either ________________.

A

septic or crystal

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3
Q

Analysis of joint fluid from a crystalopathy will show ________________.

A

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

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4
Q

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

A

kidney disease (in whom NSAIDs are contraindicated)

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5
Q

Gout can result from two pathologic states: ___________________.

A

decreased elimination of uric acid or increased production of uric acid

Most people with gout are over producers.

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6
Q

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

A

probenecid

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7
Q

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

A

IV fluids

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8
Q

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

A

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

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9
Q

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

A

chronic kidney disease, excess alcohol intake, or diuretic use

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10
Q

What three dietary items increase the risk of gout?

A
  • Meat
  • Alcohol
  • Fructose
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11
Q

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

A

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

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12
Q

What is the purpose of obtaining uric acid levels?

A

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.

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13
Q

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

A

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

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14
Q

Nongonococcal infections can be seeded by two mechanisms: ________________.

A

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

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15
Q

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

A
  • IV drug abusers
  • Hemodialysis patients
  • Immunocompromised patients
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16
Q

How should septic arthritis from MSSA be treated?

A

With nafcillin

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

17
Q

How are infected prosthetic joints treated?

A

The hardware must be removed.

18
Q

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

A

nothing

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

19
Q

How is gonococcal arthritis treated?

A

Ceftriaxone and either doxycycline or macrolides