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Rheum > Rheum - MedEd - monoarticularthropathy > Flashcards

Rheum - MedEd - monoarticularthropathy Flashcards

1
Q

Red, hot, swollen joints - get arthrocentesis, two types of outcomes?

A

Septic

Crystals

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2
Q

Crystals - what on arthrocentesis

A

Negative gram stain

Usually inflammatory < 50,000 WBCs

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3
Q

Crystals - differential

A

Gout and pseudogout

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4
Q

Pseudogout - describe the crystals

A

Positively birefringent
Rhomboid shaped
Made of calcium pyrophosphate
(Pink and purple state)

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5
Q

How to treat flare of pseudogout

A

Colchine - causes diarrhea
NSAIDs
Steroids - last choice

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6
Q

Gout - describe crystals

A

Negatively birefringent
Needle shaped
Made of monosodium urate
Histology - yellow lasers

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7
Q

Gout - causes

A

Decreased elimination uric acid - (treatment is prebenecid)
Or
Increased production

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8
Q

Increased production of uric acid can be seen in…

A

Tumour lysis syndrome

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9
Q

What is tumour lysis syndrome and how to treat?

A

Dump uric acid –> lead to renal failure
Can occur in chemotherapy
Prophylaxis: with IVF, keep the kidneys peeing; also add allopurinol to prevent production of uric acid
Treatment: rasburicase

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10
Q

Gout normally presents in patients with…

A

CKD
Ethanol
HCTZ

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11
Q

Gout normally looks like…

A

Podagra

Usually bump a joint and next day becomes red, hot, swollen, tender

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12
Q

Treatment of gout

A

Treat acute flare

Colchine, NSAIDs, steroids

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13
Q

How to prevent gout long-term

A

Eliminate alcohol, red meat, seafood, fructose

Add CCB/ACE/ARB and get rid of HCTZ

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14
Q

Repeated flares of gout… what to order and do?

A

Get uric acid, goal is for uric acid < 6.8
Lifestyle modifications
Allopurinol (xanthine oxidase inhibitor) - don’t start in acute flare - this reduces uric acid levels
Prophylaxis: colchine (best), NSAIDs, steroids (lower dose)

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15
Q

Arthrocentesis - septic - what does it show?

A

> 50,000 WBCs
Positive stain and culture
Negative crystals

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16
Q

Groups of septic joints

A

Non-gonorrhea - Staph

Gonorrhea

17
Q

Septic joint - non-gonorrhea/staph - mechanisms

A

Direct inoculation - open

Hematogenous - push Staph into bloodstream - dialysis and IVDU

18
Q

Diagnosis of septic staph joint

A

Gram stain

Gram positive cocci in clusters

19
Q

Treatment septic staph joint

A

Nafcillin (MSSA) - on exam
In real life… vancomycin, linezolid (MRSA)
If really toxic –> need MRSA coverage
If there is hardware - hardware needs to come out

20
Q

Gonorrhea joint - mechanism

A

Hematogenous

History of STD/syphilis, cervicitis, etc.

21
Q

Diagnosis of gonorrhea

A

Gram stain is negative

Need NAAT, or chocolate agar

22
Q

Treatment of gonorrhea

A

Ceftriaxone for 7-14 days IV

If find gonorrhea, also treat chlamydia (and vice versa) –> either doxycycline or azithrocycline

Rheum (7 decks)

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