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Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

This is a chronic, slowly progressive, erosive damage to joint surfaces; this loss of articular cartilage causes increasing pain with minimal or absent inflammation

A

Osteoarthritis

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2
Q

This is the more commonly affected joint in the hand in Osteoarthritis

A

Distal interphalangeal (DIP) joints

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3
Q

DIP enlargement

A

Heberden nodes

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4
Q

PIP enlargement

A

Bouchard nodes

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5
Q

What is the most accurate test for Osteoarthritis?

A

X-Ray of the affected joint

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6
Q

What would you see in an X-Ray of the affected joint in Osteoarthritis?

A

Joint space narrowing
Osteophytes
Dense subchondral bone
Bone cysts

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7
Q

What are your treatment options for Osteoarthritis?

A
  • Weight loss and moderate exercise
  • Acetaminophen - best initial analgesic
  • NSAIDS - if symptoms are not controlled with acetaminophen
  • Capsaican cream
  • Intraarticular sterods - if other medical therapy does not control pain
  • Hyaluronan injection in joint
  • Joint replacement if function is compromised
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8
Q

What is the etiology of Gouty arthritis?

A

defect in urate metabolism with 90% of cases in men. This can be from overproduction or underexcretion

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9
Q

Patient comes in with sudden, excruciating pain, redness, and tenderness of the big toe at night after binge drinking with beer. Temperature is 38C. What is the most likely diagnosis?

A

Gouty Arthritis

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10
Q

What is the frequently affected site in Gouty Arthritis?

A

Metatarsal phalangeal (MTP) joint of the great toe

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11
Q

This are tissue deposits of urate crystals with foreign body reaction. MOst oftehn it occurs in cartilage, subcutaneous tissues, bone, and kidney. They often take years to develop.

A

Tophi

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12
Q

This is the most accurate test for Gouty Arthritis?

A

Aspiration of the joint showing needle-shaped crystals with negative birefringence on polarized light microscopy

White cells count would be 2000 to 50,000/ul and are predominantly neutrophils

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13
Q

What would you expect in the lab result of an acute attack of Gouty Arthritis?

A

Elevated ESR and Leukocytosis

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14
Q

What would you give for an acute attack of Gout?

A
  1. NSAIDS (Ibuprofen)
  2. Corticosteroids if no response to NSAIDS and if there is renal insufficiency
  3. Colchicine is used in those who cannot use either NSAIDS or steroids
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15
Q

Give adverse effects of Colchicine

A

Diarrhea and bone marrow (neutropenia)

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16
Q

What us your drug of choice for hypertension in patients with Gouty Arthritis?

A

Losartan

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17
Q

What drugs should you stop if patient has gouty arthritis?

A

Thiazides, Aspirin, Niacin

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18
Q

This drug decreases production of uric acid

A

Allopurinol

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19
Q

This is a xanthine oxidase inhibitor that is used of allopurinol is contraindicated.

A

Febuxostat

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20
Q

This drug dissolves uric acid by accelerating uric acid metabolism.

A

Pegloticase

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21
Q

These drugs increase the excretion of uric acid in the kidney (uricosuric). They are contraindicated in renal insufficiency.

A

Probenecid and Sulfinpyrazone

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22
Q

What is the adverse effect of Allopurinol?

A

Toxic epidermal necrolysis or Stevens-Johnson syndrome

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23
Q

This disease arise from calcium-containing salts deposit6ing in the articular cartilage. It is associated with diabetes, hypothyroidism, and Wilson disease.

A

Calcium Pyrophosphate Deposition Disease or ‘Pseudogout’

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24
Q

Give 2 risk factors for CPPD

A

Hemochromatosis

Hyperparathyroidism

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25
Q

How does CPPD diiffer from gout and osteoarthritis in terms of presentation?

A

Knee and Wrist are affected but not particulary first MCP of foot; the DIP and PIP are not affected

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26
Q

What is the most accurate test for CPPD?

A

Arthrocentesis

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27
Q

What will you see in the synovial fluid analysis in CPPD?

A

2,000-50,000 WBCs, positively birefringent rhomboids

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28
Q

What is the best initial therapy for CPPD?

A

NSAIDS

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29
Q

Where does disk herniations usually occur?

A

L4/5 and L5/S1 level account for 95% of all disk herniations.

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30
Q

Give the motor deficit, reflex affected, and sensory area affected if the herniation involves the L4 nerve root?

A

Dorsiflexion of foot
Knee jerk
Inner calf

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31
Q

Give the motor deficit, reflex affected, and sensory area affected if the herniation involves the L5 nerve root?

A

Dorsiflexion of toe
None
Inner forefoot

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32
Q

Give the motor deficit, reflex affected, and sensory area affected if the herniation involves the S1 nerve root?

A

Eversion of foot
Ankle jerk
Outer foot

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33
Q

What is the most accurate test for Disk Herniation?

A

MRI

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34
Q

What is the treatment for cord compression?

A

Systemic Glucocorticoids
Chemotherapy for Lymphoma
Radiation for many solid tumors
Surgical decompression if steroids and radiation are not effective

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35
Q

What are your treatment options for Epidural abscess?

A

Steroids - to control acute neurological deficit

Vancomycin or Linezolid until the sensitivity of the organism is known

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36
Q

What is the treatment for Cauda equina syndrome?

A

Surgical decompression

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37
Q

What is the treatment for disk herniation?

A

NSAIDs with CONTINUATION of ordinary activities (bed rest is wrong answer)

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38
Q

A man with a history of prostate cancer comes to the emergency department with severe back pain and leg weakness. He has tenderness of the spine, hyperreflexia, and decreased sensation below his umbilicus.

What is the most appropriate next step in the management of this patient?

a. Dexamethasone
b. MRI
c. X-ray
d. Radiation
e. Flutamide
f. Ketoconazole
g. Finasteride
h. Leuprolide
i. Biopsy
j. Orchiectomy

A

A. When there is obvious cord compression, the most important step is to begin steroids urgently in order to decrease the pressure on the cord.

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39
Q

Patient is over 60 years old with back pain while walking, radiating into the buttocks and thighs bilaterally. The pain is described as worse when walking downhill, and better when sitting, but the pedal pulses and ankle/brachial index are normal. Unsteady gait while walking also occur. What is the most likely diagnosis?

A

Lumbar Spinal Stenosis

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40
Q

What is the diagnostic test for Lumbar Spinal Stenosis?

A

MRI

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41
Q

What are the initial treatment for Lumbar Spinal Stenosis?

A 
Weight Loss
Pain meds (NSAIDs, Opiates, Aspirin)
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42
Q

Patient is typically a young woman with chronic musculoskeletal pain and tenderness with trigger points of focal tenderness at the trapezius, medial fat pad of the knee, and lateral epicondyle. What is the most likely diagnosis?

A

Fibromyalgia

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43
Q

What is the best initial therapy for Fibromyalgia?

A

Dual Reuptake Inhibitors such as Duloxetine or Venlafaxine

Steroids are WRONG answer for Fibromyalgia

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44
Q

This is defined as a peripheral neuropathy from the compression of the median nerve as it passes under the flexor retinaculum.

A

Carpal Tunnel Syndrome

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45
Q

This is done to reproduce pain and tingling with tapping or percussion of the median nerve.

A

Tinel sign

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46
Q

This is done to reproduce symptoms of carpal tunnel with flexion of the wrists to 90 degrees

A

Phanel sign

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47
Q

What is/are the most accurate diagnostic test for Carpal Tunnel Syndrome?

A

Electromyography

Nerve Conduction Testing

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48
Q

What is the best initial therapy for Carpal Tunnel Syndrome?

A

Wrist Splints

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49
Q

What are other treatment options for Carpal Tunnel Syndrome aside from wrist splints?

A

Steroid injection is used if splints and NSAIDs do not control symptoms

Surgery can be curative

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50
Q

This is the hyperplasia of the palmar fascia leading to nodule formation and contracture of the fourth and fifth fingers. There is a genetic predisposition and an association with alchoholism and cirrhosis.

A

Dupuytren Contracture

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51
Q

This treatment helps early Dupuytren contracture.

A

Collagenase injection

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52
Q

What is the most accurate test for rotator cuff injury?

A

MRI

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53
Q

This is an autoimmune disorder predominantly of the joints but with many systemic manifestations of chronic inflammation. This is more common in women.

A

Rheumatoid Arthritis

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54
Q

The is the key to the diagnosis of Rheumatoid Arthritis

A

morning stiffness of multiple small, inflamed joints.

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55
Q

What joint is spared in Rheumatoid Arthritis?

A

DIP

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56
Q

This syndrome is defined as dry eyes, mouth, and other mucous membranes

A

Sicca syndrome

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57
Q

What is the most common cause of death in Rheumatoid Arthritis?

A

Coronary Artery Disease

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58
Q

This is a syndrome with the triad of right atrium, splenomegaly, neutropenia

A

Felty syndrome

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59
Q

This is a syndrome with the triad of right atrium, pneumoconiosis, lung nodules

A

Caplan syndrome

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60
Q

How would you establish a diagnosis of Rheumatoid Arthritis?

A

A total of 6 or more points

Joint involvement (up to 5 points)
ESR or CRP (1 point)
Duration for longer than 6 weeks (1 point)
RF or anti-CCp (1 point)
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61
Q

What should you give to an erosive Rheumatoid Arthritis?

A

Methotrexate

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62
Q

What does erosive disease means in RA?

A

Joint space narrowing
Physical deformity of joints
X-ray abnormalities

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63
Q

A patient with long-standing RA is to have coronary bypass surgery. Which of the following is most important prior to surgery?

a. Cervical spine x-ray
b. Rheumatoid factor
c. Extra dose of methotrexate
d. ESR
e. Pneumococcal vaccination

A

A. RA is associated with C1/C2 subluxation. Cervical spine imaging to detect possible instability of the vertebra is essential prior to the hyperextension of the neck that typically occurs with endotracheal intubation.

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64
Q

What are the adverse effects of Methotrexate?

A

Liver toxicity
Bone marrow suppression
Pumonary toxicity

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65
Q

If patient with Rheumatoid arthritis is not responding to Methotrexate, what can you give him instead?

A

Tumor Necrosis Factor Inhibitors (Infliximab, Adalimumab, Etanercept, Golimumab, Certolizumab)

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66
Q

What is the toxicity of anti-TNF drugs?

A

Reactivation of TB: screen with a PPD prior to their use

Infection

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67
Q

This is an agent that is originally developed for non-Hodgkin lymphoma, is effective in RA as a DMARD by removing CD20 positive lymphocytes from circulation. It is used in combination with methotrexate in those not responding to anti-TNF medications.

A

Rituximab

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68
Q

This agent can be used as a monotherapy as a DMARD in cases of mild disease in which to avoid toxicity of methotrexate.

A

Hydroxychloroquine

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69
Q

Hydroxychloroquine is toxic to the _________.

A

retina

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70
Q

These agents are alternative DMARDs to add to methotrexate if anti-TNF agents do not control disease.

A

Sulfasalazine
Leflunomide
Abatacept
Anakinra

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71
Q

GIve adverse effects of Sulfasalazine

A

Bone marrow toxicity
Hemolysis with G6PD
Rash

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72
Q

What are the best initial therapy for the pain of RA?

A

NSAIDs

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73
Q

What is/are adverse effect of Gold Salts in RA?

A

Nephrotic Syndrome

74
Q

This patient is young, comes in with high, spiking fever that has no clearly identified etiology and is associated with salmon colored rash on chest and abdomen. What is the MOST LIKELY diagnsosis?

A

Juvenile Rheumatoid Arthritis or Adult Still Disease

75
Q

What is markedly elevated in a patient with Juvenile Rheumatoid Arthritis?

A

Ferritin

76
Q

What is your treatment strategy for Juvenile Rheumatoid Arthritis?

A

Aspirin/NSAIDs —> Steroids (if no response) –> TNF drugs (if resistant to steroids)

77
Q

Give 4 manifestations of SLE in the skin.

A

Malar rash
Discoid rash
Photosensitivity
Oral ulcers

78
Q

This is a joint manifestation of SLE.

A

Arthritis (often the first symptom that brings patient to seek medical attention) SLE gives joint pain without deformation or erosion, that is why the x-ray is normal

79
Q

This is the inflammation of the pleura and pericardium that gives chest pain potentially with both pericardial and pleural effusion associated with SLE?

A

Serositis

80
Q

What is the most common glomerulonephritis in SLE?

A

Membranous Glomerulonephritis

81
Q

These are ocular findings you may appreciate in a patient with SLE.

A

Photophobia
Retinal lesions (cotton wool spots)
Blindness

(Not part of formal diagnostic criteria)

82
Q

This is a hematologic finding that is part of the diagnostic criteria of SLE.

A

Hemolytic anemia

however, Anemia of Chronic Disease is more commonly found

83
Q

These are markers you will find in SLE.

A

ANA
Anti-double-stranded (DS) DNA and anti-Sm
Decreased complement levels
Anti-SSA and anti-SSB

84
Q

A 34-year-old woman with a history of SLE is admitted with pneumonia and confusion. As you are wrestling with the decision over a bolus of high-dose steroids in a person with an infection, you need to determine if this is a flare of lupus, or simply an infection with sepsis causing confusion.

Which of the following will help you the most?

a. Rise in anti-Sm
b. Rise in ANA
c. Decrease in complement
d. Decrease in complement and rise in anti-DS DNA
e. MRI of the brain
f. Response to steroids

A

D. Although anti-SM is specific for SLE, the level does not change in an acute flare. ANA levels do not tell severity of disease. MRI of the brain is most often normal in lupus celebrities unless there has been a stroke. In an acute lupus flare, complement levels drop and anti-DS DNA levels rise. The SSA, SSB, and anti-SM tests are most useful when the ANA is positive and DS-DNA test is negative

85
Q

How would you treat an acute lupus flare?

A

High-dose boluses of steroids

86
Q

How would you determine the severity of lupus nephritis?

A

Kidney Biopsy

87
Q

What is the most common cause of death for young patients with SLE?

A

Infection

88
Q

What is the most common cause of death for older patients with SLE?

A

Accelerated atherosclerosis –> Myocardial Infarction

89
Q

This is an idiopathic disorder with IgG or IgM antibodies made against negatively charged phospholipids.

A

Antiphospholipid syndrome

90
Q

What are the two main types of Antiphospholipid Syndrome?

A

Lupus anticoagulant

Anticardiolipin antibodies

91
Q

How does Antiphospholipid Syndrome presents?

A

thromboses of both arteries and veins and recurrent spontaneous abortions

92
Q

What is the best initial test for Antiphospholipid Syndrome??

A

Mixing study (patient’s plasma is mixed with an equal amount of normal plasma)

93
Q

What will you expect from the mixing study of Antiphospholipid Syndrome?

A

elevated aPTT

normal PT
normal INR

94
Q

This is the most specific test for lupus anticoagulant.

A

Russell viper venom test (RVVT)

95
Q

How would you treat clots in APL?

A

NOAC or heparin and warfarin

96
Q

What should be investigated for anticardiolipin antibody as a cause of spontaneous abortion?

A

Two or more first-trimester events or a single second-trimester event

97
Q

What is the treatment to prevent recurrence of spontaneous abortion in APL?

A

Heparin and Aspirin

98
Q

What is another term for Limited Scleroderma?

A

CREST Syndrome

Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia
99
Q

Patient is a young woman (20-40s) with fibrosis of the skin and internal organs such as the lung, kidney, and GI tract. What is the MOST LIKELY diagnosis?

A

Scleroderma (Systemic Sclerosis)

100
Q

What is the most specific test for Scleroderma?

A

SCL-70 (Anti-topoisomerase)

101
Q

This antibodies are extremely specific for CREST syndrome.

A

Anticentromere antibodies

102
Q

This drug can slow underlying process of limited scleroderma.

A

Methotrexate

103
Q

What will you use for renal crisis in Limited Scleroderma?

A

ACE inhibitors

104
Q

Limited scleroderma presents with GERD. What can you give the patient?

A

PPIs

105
Q

What can you give for Raynaud phenomenon in Limited Scleroderma?

A

Calcium Channel blockers

106
Q

What can you give for Pulmonary Fibrosis in Scleroderma?

A

Cyclophosphamide

107
Q

Crest Syndrome + involvement of lungs, kidney, heart = __________

A

Scleroderma

108
Q

This is an inflammatory myopathies that present with malar involvement, shawl sign, heliotrope rash, and gottron papules.

A

Dermatomyositis

109
Q

This is an inflammatory myopathy that present as progressive proximal muscle weakness without the presence of rash.

A

Polymyositis

110
Q

What is the best initial test for Polymyositis/Dermatomyositis?

A

CPK and Aldolase

111
Q

What is the most accurate test for Polymyositis/Dermatomyositis?

A

Muscle Biopsy

112
Q

What immunologic markers will you expect for Polymyositis/Dermatomyositis?

A

Positive ANA

Anti-Jo antibodies (assoc. with lung fibrosis)

113
Q

What are your treatment options for Polymyositis/Dermatomyositis?

A

Steroids

If unresponsive:

  • Methotrexate
  • Azathiprine
  • Intravenous Immunoglobulin
  • Mycophenolate

Hydroxychloroquine helps skin lesion

114
Q

This is an idiopathic autoimmune disorder secondary to antibodies predominantly against lacrimal and salivary glands; 90% of those affected are women. It is also associated with RA, SLE, Primary biliary cirrhosis, Polymyositis, and Hashimoto thyroiditis.

A

Sjogren Syndrome

115
Q

How does Sjogren syndrome presents?

A

dryness of mouth and eyes

116
Q

This is an ocular abnormality that gives the feeling of “sand in the eyes” as well as burning and itching.

A

keratoconjunctivitis sicca

117
Q

What is the most dangerous complication of Sjogren syndrome?

A

Lymphoma

118
Q

What is the best initial test for Sjogren syndrome?

A

Schirmer test

-a piece of filter paper is placed against the eye and observed for the amount of tears produced by the amount of wetness on the filter paper

119
Q

What is the most accurate test for Sjogren syndrome?

A

Lip or Parotid gland biopsy

120
Q

What is the best initial test on blood for Sjogren Syndrome?

A

SS-A and SS-B / Ro and La

121
Q

What is the best initial therapy for Sjogren Syndrome?

A

Water the Mouth

122
Q

This 2 drugs increases acetylcholine; increases rates of saliva production

A

Pilocarpine and Cevimeline

123
Q

It is a disease of small and medium-sized arteries leading to a diffuse vasculitis that inexplicably spares the lungs.

A

Polyarteritis nodosa (PAN)

124
Q

What organ is spared in PAN?

A

Lungs

125
Q

What is the most accurate test for PAN?

A

Biopsy of a symptomatic site

126
Q

What is the most common neurological abnormality in PAN?

A

Peroneal neuropathy leading to Foot drop

Look for a stroke in a young person

127
Q

How would you treat PAN?

A

Prednisone and Cyclophosphamide

128
Q

This disease occurs in those over age 50 with pain and stiffness in shoulder and pelvic girdle muscles, difficulty combing hair and rising from a chair, elevated ESR, normochromic, normocytic anemia

A

Polymyalgia Rheumatica

129
Q

Treatment for Polymyalgia Rheumatica

A

Steroids

130
Q

This disease seems to be on a spectrum with PMR but there are visual symptoms, jaw claudication, scalp tenderness, headache, and other symptoms such as decreased arm pulses, bruits near the clavicles or aortic regurgitation.

A

Giant Cell (Temporal) Arteritis

131
Q

What will you see in the diagnosis of Giant Cell Arteritis?

A

Elevate ESR and C-reactive protein

132
Q

What is the most accurate test for Giant Cell Arteritis?

A

Biopsy of Temporal Artery

133
Q

How would you treat Giant Cell Arteritis?

A

High-dose Prednisone

134
Q

You see a patient with upper and lower respiratory tract findings such as sinusitus, otitis media, mastoiditis, oral and gingival involvement, in association with renal insufficiency. What is the MOST LIKELY diagnosis?

A

Wegener Granulomatosis (Granulomatosis with Polyangitis)

135
Q

What is the best initial test for Wegener Granulomatosis?

A

C-ANCA

136
Q

What is the best test for Wegener Granulomatosis?

A

Lung Biopsy

137
Q

How would you treat Wegener Granulomatosis?

A

Prednisone and Cyclophosphamide

138
Q

This is a pulmonary-renal syndrome presenting with asthma and eosinophilia/ There can be fever, weight loss, joint pain, and skin findings.

A

Churg-Strauss Syndrome (Allergic Angitis)

139
Q

What is an initial test for Churg-Strauss Syndrome?

A

P-ANCA

140
Q

What is the most accurate test for Churg-Strauss Syndrome?

A

Biopsy

141
Q

This is a vasculitis that is more frequently seen in children. It is characterized by pain and bleeding in the GIT, purpura, arthralgia, and hematuria.

A

Henoch-Schonlein Purpura

142
Q

What is the most accurate test for HSP?

A

Biopsy

143
Q

What will you see in the biopsy of HSP?

A

Leukocystoclastic Vasculitis

144
Q

How would you treat HSP?

A

Most cases resolve spontaneously.

Steroids are the answer for severe abdominal or progressive renal insufficiency.

145
Q

This is mostly associated with chronic hepatitis C. It is also found with endocarditis and other connective tissue disorders such as Sjogren Syndrome. It manifests as joint pain, glomerulonephritis, purpuric skin lesions, and neuropathy.

A

Cryoglobulinemia

146
Q

How would you treat Cryoglobulinemia?

A

Hepatitis C medications

147
Q

This is an Asian or Middle Eastern person with painful oral and genital ulcers in association with erythema nodosum-like lesions of the skin. Ocular lesions leading to uveitis and blindness can also occur, as well as arthritis and CNS lesions mimicking multiple sclerosis. What is the most likely diagnosis?

A

Behcet Syndrome

148
Q

What is the pathergy of Behcet Syndrome?

A

sterile skin pustules from minor trauma like a needle stick

149
Q

The patient is a young man with low backache and stiffness of his back and pain that radiates to the buttocks with flattening of the normal lumbar curvature and decreased chest expansion. Enthesopathy occurs at the Achilles tendon. What is the most likely diagnosis?

A

Ankylosing Spondylitis

150
Q

What is the best initial test for Ankylosing Spondylitis?

A

X-Ray of the Sacroiliac joint

151
Q

What is the most accurate test for Ankylosing Spondylitis?

A

MRI

152
Q

What is the best initial treatment for Ankylosing Spondylitis?

A

Exercise program and NSAIDs

153
Q

This patient presents with joint pain, more often starting in men under the age of 40, involvement of the spine and large joints, negative rheumatoid factor, + HLA-B27, uveitis, has a history of Psoriasis and nail pitting. What is the most likely diagnosis?

A

Psoriatic Arthritis

154
Q

What is the best initial test for Psoriatic Arthritis?

A

X-Ray of the joint showing a “pencil in a cup” deformity

155
Q

What is the best initial therapy for Psoriatic Arthritis?

A

NSAIDs

Methotrexate if no response to NSAIDs. Anti-TNF agents if methotrexate does not control disease. DO NOT give Steroids.

156
Q

This type of seronegative spondyloarthropathy occurs secondary to inflammatory bowel disease, STI, or GI infection. What is the most likely diagnosis?

A

Reactive Arthritis (Reiter Syndrome)

157
Q

What is the triad of Reiter Syndrome?

A 
Joint pain
Ocular findings (uveitis, conjunctivitis)
Genital abnormalities (urethritis, balanitis)
158
Q

What is/are your treatment options for Reactive Arthritis?

A

NSAIDs and correct underlying cause

Sulfasalazine if NSAIDs cannot control symptoms. Steroid injections into joints also help.

159
Q

This patient is most often an older woman, with vertebral fractures leading to loss of height or wrist fracture. Many are asymptomatic. What is the most likely diagnosis?

A

Osteoporosis

160
Q

What is the most accurate test for Osteoporosis?

A

Bone densitometry (DEXA) scanning

161
Q

How can you differentiate osteopenia vs osteoporosis?

A

Osteopenia - bone density (T-score) is between 1 and 2.5 standard deviations below normal

Osteoporosis - T-score more than 2.5 deviations below normal. All blood tests are normal in osteoporosis

162
Q

What are the best initial therapy for Osteoporosis?

A

Vitamin D and Calcium

163
Q

What are adverse effects of Bisphosphonates?

A

Prolonged contact with esophagus

164
Q

When multiple options are presented for Osteoporosis treatment, what would be the best answer?

A

Vitamin D, Calcium, Bisphosphonates

165
Q

What are the most common etiology for Septic Arthritis?

A

Staphylococcus (40%)
Streptococcus (30%)
Gram-negative rods (20%)

166
Q

What is the best initial and most accurate test for Septic Arthritis?

A

Arthrocentesis - aspiration of the joint with a needle

167
Q

What are the best initial empiric therapy for Septic Arthritis?

A

Ceftriaxone and Vancomycin

If culture shows that staph sensitive, switch vancomycin to oxacillin or cefazolin

168
Q

What will you see in the synovial analysis of Septic Arthritis in terms of Leukocytosis?

A

> 50,000-100,000 cells/ul

169
Q

What will you see in the synovial analysis of Gonococcal Arthritis in terms of Leukocytosis?

A

30,000-50,000 cells/ul

170
Q

This triad differentiate Gonococcal Arthritis from Septic Arthritis.

A

Polyarticular involvement
Tenosynovitis (inflammation of the tendon sheats, making finger movement painful)
Petechial rash

171
Q

What is the diagnostic test for Gonococcal Arthritis?

A

Synovial Fluid Analysis

Culture MULTIPLE sites:
Pharynx
Rectum
Urethra
Cervix
172
Q

What is the best empiric therapy for Gonoccocal Arthritis?

A

Ceftriaxone, Cefotaxime, or Ceftizoxime

173
Q

What will you test for recurrent gonorrhea infection?

A

Terminal complement deficiency

174
Q

What is the most common cause for Osteomyelitis?

A

Staphylococcus aureus

175
Q

What is the most commonly identified organism in patients with sickle cell disease?

A

Salmonella

176
Q

Patient is a diabetic patient with an ulcer from peripheral neuropathy or vascular disease with warmth, redness, and swelling in the area. There may also be a draining “purulent sinus tract” in the lesion. Most patients are afebrile. What is the most likely diagnosis?

A

Osteomyelitis

177
Q

What is the best initial test for Osteomyelitis?

A

X-Ray

178
Q

What is the most accurate test for Osteomyelitis?

A

Biopsy

179
Q

How would you treat Osteomyelitis?

A

Confirm sensitivity of organism.

Sensitive staphyloccoci - best treated with oxacillin, cefazolin, nafciliin, or ceftriaxone

Resistant staphyloccoci - vancomycin or linezolid

E. Coli - Ciprofloxacin

180
Q

What is the adverse effect of Fluroquinolones?

A

It can cause Achilles tendon rupture

Contraindicated in pregnancy and in children because they interfere with bone growth.

Medicine (15 decks)

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