Rheumatology- Arthritis & Joint Disease

Question 1

Septic bursitis

Answer 1

infection of the bursa, can occur due to penetrating trauma, superficial abrasions (eg from working while kneeling) or extension of local cellulitis. Gram-positive skin flora. Drater risk in immunocompromised pts.

Question 2

S&S septic bursitis

Answer 2

Boggy swelling of the brush
Erythema 
Warmth
Pain 
Fever 
Normal ROM (as oppose to septic arthritis)

Question 3

Management of septic bursitis

Answer 3

Aspiration to confirm diagnosis
Systemic Abx

Drainage if no improvement in 48hrs or compressive symptoms

Question 4

Clinical distinction b/w noninflamatorry bursitis and septic bursitis.

Answer 4

Erythema and warmth are atypical for noninflammatory but can be hard to differentiate. Aspiration should be done to rule out infection

Question 5

S&S septic arthritis

Answer 5

Severe pain with passive ROM
Swelling
Erythema 
Fluctuant 
Fever

Question 6

Pathogens of clenched-fist bite

Answer 6

septic arthritis caused by puncture during punch to human mouth

Oral flora: (eikenella corrodes, B-lactamase anaerobes)
Skin flora: (streptococci, staph. aureus)

Question 7

Management of clenched-fit bite

Answer 7

1. Urgent Open surgical irrigation & debridement (MCP small joint, cant drain like large joints)
2. Intraop IV abx (ampicillin/sulbactam)

Oral abx: Amoxicillin/ clavulanate

Question 8

Hemophilic arthropathy mechanism

Answer 8

Joint damage caused by intra-articular bleeding. Hemosiderin deposition –> synovial inflammation –> fibrosis and destruction of cartilage and bone

Question 9

S&S hemophilic arthropathy

Answer 9

Hx of bleeding disorder
Chronic worsening joint pain
Swelling
Limited ROM passive and active

Question 10

Chondrocalcinosis

Answer 10

calcified articular cartilage on radiograph.

Diagnostic of calcium pyrophosphate dehydrate deposition disease (CCPD) (aka pseudogout)

Question 11

Joints involved in RA

Answer 11

PIP, MCP, MTP
(spares DIP)
Wrist

Late:
Knee/ elbows/ shoulders
Cervical Spine

Question 12

RA complication of cervical spine involvement

Answer 12

Atlantoaxial subluxation: potentially life-threatening complication that can cause spinal cord compression and difficulties with intubation

Question 13

S&S cervical myelopathy in RA

Answer 13

Neck pain
progressive spastica quadriparxsis
Sensory defeats in hands &feet