Rheum - MedEd - approach to joints Flashcards

1
Q

Approach to joint pain: 2 main things to consider

A

Timing and Toxicity

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2
Q

Toxic and acute joint is:

A

Red, hot, swollen, painful, febrile, loss of function

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3
Q

Toxic and acute joint/loss of function - differential

A

Trauma, infection, crystals, reactive (gonorrhea in joint or in body)

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4
Q

Indolent and chronic joint - what is the first thing to consider

A

Inflammatory or not

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5
Q

Indolent and chronic joint - noninflammatory - differential

A

Osteoarthritis - obese, in dependent joints, not inflammatory, no fever, no ESR/CRP

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6
Q

Indolent and chronic joint - inflammatory - what to ask?

A

How many joints are involved?

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7
Q

Chronic, indolent, inflammatory joint - 1 joint - what to consider on differential

A

Usually the same as acute toxic joint

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8
Q

Chronic, indolent, inflammatory joint - multiple joints - differential

A

SLE, RA - seropositive
Seronegative spondyloathropathies
Other Connective Tissue Diseases - could cause inflammation of other organs

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9
Q

What to do for red, hot, swollen joint? Procedure

A

Arthrocentesis

Though may not always do in practice, i.e. in gout

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10
Q

Interpret arthrocentesis - what are the components looking for

A
Appearance
WBC
PMNs
Gram stain, culture
Crystals
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11
Q

Normal arthrocentesis

A

Normal: serous fluid, <200 WBC, 25% PMNs, no gram stain, no crystals

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12
Q

OA arthrocentesis

A

OA: (can be red, hot, swollen, though not supposed to be inflammatory) will see essentially a normal tap, serous, <2000 WBC, 25% polys

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13
Q

Inflammatory arthrocentesis

A

Inflammatory: cloudy fluid, >2000 but <50,000 WBCs, 50% polys, no gram stain or culture, might have crystal disease (gout or pseudogout)

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14
Q

Septic arthrocentesis

A

Septic: will pull out pus (opaque, white), >50,000 WBCs, culture positive, crystals negative, stain positive with staph, for gonorrhea will need nuclear acid amplification

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15
Q

Serology - lupus

A

ANA, ds-DNA, anti-histone Ab

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16
Q

Serology - RA

A

Anti-CCP, RF

17
Q

Serology - scleroderma, CREST

A

Anti-centromere Ab

18
Q

Serology - scleroderma, systemic

A

Topoisomerase

19
Q

Serology - autoimmune hepatitis

A

Smooth muscle

20
Q

Serology - sjogren’s

A

Ro and LA

21
Q

Serology - dermatomyositis, polymyositis

A

Jo

22
Q

Serology - mitochondrial

A

PBC