Swollen Joint

Question 1

Investigations

Answer 1

Bloods - FBC, CRP, ESR, U+Es, Urate
Xray
Joint aspiration
Blood culture - septic arthritis

Question 2

Man causative organism for septic arthritis

Answer 2

Staph aureus

Question 3

Gout diagnosis

Answer 3

Joint aspiration - PCR, culture and microbiology

Question 4

Pseudogout

Answer 4

Inflammatory arthritis caused by calcium pyrophosphate crystal deposition in joint
Mimics gout
Commonly in proximal joints such as knee and wrist
Rhomboid crystals on light microscopy

Question 5

Classification of RA

Answer 5

EULAR classification

• joint distribution
• serology
• symptom duration
• acute phase reactants

6+ - definite RA

Question 6

HLA - B27

Answer 6

Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis

Question 7

Haemarthrosis

Answer 7

Bleeding in joint space can be due to trauma or anticoagulants

Ix

• Routine Bloods + clotting
• X-ray
• joint aspiration

Mx - RICE:
Rest, ice, compression and elevation
Analgesia

Check ligamentous or meniscal injuries - ACL contains genicular artery

Question 8

Mx of septic arthritis

Answer 8

Sepsis 6
IV abx - 2 weeks
Long tem abx - 4 - 6 weeks
Surgical irrigation and debridement - washout

Question 9

Complications septic arthritis

Answer 9

OA and osteomyelitis

Question 10

History

Answer 10

SQITAR 
\+ Precipitating factors 
\+ ability to weight bear
\+ hand dominance 
\+ activity before trauma 
\+ systemic symptoms 
\+ other joints 
\+ GI (enteropathic arthritis) or GU (reactive arthritis) 
\+ skin changes - psoriasis

Question 11

Joint aspiration

Answer 11

opacity
colour
pus
MCS
light microscopy

Question 12

RF for pseudogout

Answer 12

Advanced age
Hyperparathyroidism
Hypophosphatemia

Question 13

Risk factors for septic arthritis

Answer 13

Age > 80 yo 
Pre - existing joint disease e.g. RA 
DM 
Immunocompromised 
CKD
Hip or knee prosthesis 
IVDU