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Year2 MSK exam2 > SNSA and septic arthritis, part I > Flashcards

SNSA and septic arthritis, part I Flashcards

1
Q

What are the spondlyoarthropathies

A 
AS
psoriatic arthritis
reactive
arthritis with IBD
undifferentiated spondlyarthropathy
acute anterior uveitis
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2
Q

seroneg spondyloarthropathies demographic

A 
male
before age 40
inflammatory of spin and SI
HLA B27 +
RF CCP ANA -
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3
Q

what are the nonvertebral Sx of spondyloartropathies

A 
entehsopathy
asymmetric peripheral arthritis
sausage digits
uveitis
mucocutaneous lesions
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4
Q

HLA MHC and CD cell in spondlyarthropathies

A

B27
MHC1
CD8 CTLs

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5
Q

What bacteria is in stools of AS patients

A

klebsiella

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6
Q

What is targeted in Tx for HLA B 27 diseases

A

Th17 because has main role in inflammation and enthesis

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7
Q

if HLA B27 what else do you need to Dx spondylarthropathy

A

2 features

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8
Q

how do Dx inflammatory back pain

A

morning sitffness > 30 min
pain at night or early morning
improves with exercise

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9
Q

Sacroiliitis on imaging and what Dx spondyloarthropathy

A

plus 1 feature

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10
Q

what are the features of spondylarthropathies!!!

A 
arthritis
enthesitis
uveitis
dactylitis
psoriasis
CD/UC
response to NSAID
FH
HLA B27
elevated CRP
aortic insufficiency
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11
Q

signs of ankylosing spondylitis!!!!

A 
bamboo spine
SI inflammation b/l!!!
increased kyphosis
fatigue
ocular inflammation, uveitis
reduced rib expansion- reduced inhalation
weight loss (systemic sym)
possible atlantoaxial subluxation
pulmonary fibrosis-- upper lobe!!
aortic insufficiency
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12
Q

Essentials for Dx AS

A 
chronic LBP in young adults, insidious onset and worse in mroning
progressive limitation back motion or chest expansion
SI abnormalities
peripheral arthritis
inflammatory eye disease
aortic insufficiency
elevated ESR neg RF CCP
HLA B27 when Dx unclear
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13
Q

what causes limitation of chest expansion in AS

A

upper lobe pulm fibrosis

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14
Q

What is schobers test

A

when measure on back and then bend over and space above iliac crest line does not stretch out, but stays same lenght (loss of curvature)

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15
Q

lab findings for AS

A 
increased ESR
- RF
-anti CCP
mild anemia
HLA B27+
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16
Q

what are imaging for AS

A

MRI gadolinium whole body!!!
may show edema at enthesitis sites before sclerosis megins

CT scans
XR

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17
Q

What is Andersson lesion

A

degeneration of spine from AS

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18
Q

what is shiny corner sign

A

reactive sclerosis!!!

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19
Q

synchondrosis of spine anterior and thick

not in SI joint

A

DISH

diffuse interosseous skeletal hyperostosis

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20
Q

complications AS

A 
uveitis
upper lobe PF
cauda equina fibrosis
aortic regurg
heart block
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21
Q

migratory asymmetric polyarthritis for 3-4 mo
RD CCP negative
unilateral sacroiliitis
dx?

A

psoriatic arthritis

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22
Q

patterns of psoriatic arthritis

A 
unilateral sacroiliitis
oligoarthritis
asymmetrical polyarthritis
DIP
pencil in cup- arthritis mutilans- opera glass
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23
Q

labs in psoriatic arthritis

A 
HLA B27 +
RF CCP neg
UA inc
FE2+ dec!!
Th17 inc IL 17
HIV assoc!!!
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24
Q

essential for Dx psoriatic arthritis

A

psoriasis precedes arthritis
sausage appearnance of fingers and toes
unilateral sacroiliitis
pencil in cup

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25
Q

What bacteria can cause reactive arthritis

A

chlamydia, ureaplasma, mycoplasma genitalium
shigella, salmonella, yersinia enterocolitica and yersinia pseudoTB, campylobacter, clostriduium difficile
strep

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26
Q

if reactive arthritis from venereal bacterium not responding to Tx

A

then search for ureaplasma or mycoplasma genitalium

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27
Q

What types chalmydia cause GUI

A

D-K

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28
Q

reactive arthritis assoc with

A 
enthesopathy- lovers heels
inflammatory eye disease
circinate balanitis
keratoderma blenorrhagicum
oral ulcers
sacroillitis
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29
Q

lovers heals

A

enthesopathy where achilles joins in

30
Q

what is needed for Dx reactive arthritis

A

large joint oligoarthritis
sacroiliitis
uveitis, conjunctivitis
urethritis

31
Q

IBD arthritis

A

b/l symmetrical sacroiliitis
acts independently of IBD!!!!!
peripheral arthritis corresponds to IBD status!!!!

32
Q

hemophiliac cause of effusions usually

A

blood, hemarthrosis

33
Q

best way to Dx hemarthrosis

A

MRI

XR can show hemosiderin

34
Q

gram + cocci

group B lancefield Ag

A

strep agalactiae

35
Q

septic arthritis

A

monoarthritis

multi joint- RA, group B strep or endocarditis

36
Q

what patients more prone to septic arthritis

A

anti TNF therapy are twice as susceptible

37
Q

essentials Dx septic arthritis

A

sudden acute monoarticular large joint
prebious joint damage or IV drug use
WBC >50,000

38
Q

check for what in suspected septic arthritis in anti TNF therapy or HIV

A

AFB

39
Q

appearance, viscosity, total WBC and PMN %

of noninflammatory I synovial fluid

A

clear yellow
high viscosity
<25% PMN

40
Q

appearance, viscosity, total WBC and PMN %

of inflammatory II synovial fluid

A 
opaque
low viscosity
2-75,000
>50% PMN
positive crystals
41
Q

appearance, viscosity, total WBC and PMN %

of purulent type III synovial fluid

A

opaque green
low viscosity
>100,000 WBC
>75% PMN

42
Q

noninflammatory synovival fluid found in what patients

A

OA

43
Q

inflammatory synovial fluid in what patients

A

RA and crystal

44
Q

majority septic arthritis microbes

A

staph aureus
MRSA
group B strep
pneumococcos

gram -:
E coli
pseudomonas
gonorrhea
salmonella-- SLE, HIV and SS
45
Q

Prosthetic joints have what

A

biofilm to protect from staph and pseudomonas

46
Q

prosethetic infections when have had prosthetic for >24 mo are caused how

A

seeding from blood

47
Q

prosthetic infection within 3 mo of gettin prosthetic

A

staph from surgery

48
Q 
fever
 migratory polyarthralgias
meningitis
pancarditis
most likely
A

disseminated gonorrhea

49
Q

common sign of disseminated gonorrhea sequelae

A

fitz hugh curtis

perihepatitis because of adhesions below liver

50
Q

most common septic arthritis in young adults

A

gonococcal arthritis

51
Q

Signs disseminated gonococcal infection

A 
oligoarthritis
tenosynovitis
rash on palms and soles
fever
osteomyelitis possible
52
Q

risk factors for gonococcal arthritis disseminated

A

menstruation, pregnancy C5-9 deficiencies

53
Q

What is needed to Dx disseminated gonococcal infection

A

urethral, throat, cervical and rectal cultures

54
Q

What is Discitis

A

spinal septic arthritis

55
Q

what are Sx of spinal septic arthritis

A

chronic unrelenting back pain, fever, local tenderness
thoracolumbar region
crosses disc space!!!!!
can lead to TB/ Potts

56
Q

Gibbus deformity, paraspinal cold abscess

A

TB Potts disease

57
Q

vague arthritis

A

viral

58
Q

common agents for viral arthritis

A 
parvo B19
HIV
Hep B and C
EBV
adeno and coxsackie
rubella
mumps
59
Q

how can viral arthritis present

A 
migratory
wrists hands kneed
symmetric
rash
hep C can look like RA
Hep B has urticaria and dec C'
60
Q 
dry eyes and mouth and cough
SEVERE joint pain
myalgias with weakness
palmopustular psoriasis
tender mm
inc LFT enzymes
CPK elevated 
all auto immune Ab negative
b/l pulm infiltrates
A

HIV

61
Q

What immune cell is implicated in Diffuse infiltrative lymphocytosis syndrome DILS

A

CD8

62
Q

after Tx with HAART for HIV what can happen with inc CD4 count

A

CD4 can take over and attack

Immune Reconstitution inflammatory syndrome IRIS

63
Q

Sarcoidosis presents how

A

erythema nodosum
hilar adenopathy
produces ACE

64
Q

The immune reconsitituion inflammatory syndrome usually relates to what diseases

A

TB and cryptococcal meningitis

65
Q

What cause erythema nodosum with arthritis

A 
Boecks sarcoid
bechets
UC and crohns
Mycoses
Pills like BCP
Strep
66
Q

most common cause erythema nodosum

A

strep

67
Q

Lofgrens syndrome

A

sarcoidosis

perihilar lymphadenopathy and erythema nodosum

68
Q

stage II lymes

A

heart block, bells palsy, migratory arthralgias

69
Q

stage III lymes

A

oligoarthritis, encephalitis, paresthesias

70
Q

confirmation lyme

A

western blot

Year2 MSK exam2 (17 decks)

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