Swollen Joint

Question 1

What are the typical investigations done for a swollen joint?

Answer 1

FBC
CRP
U+Es
Serum Urate
X-ray
Joint aspiration

Question 2

What are the management steps if a patient has red flag sepsis secondary to septic arthritis?

Answer 2

Blood cultures
Lactate
Urine output
02
IV fluids
IV abx

Question 3

What is the typical causative organism of septic arthritis?

Answer 3

Staphylococcus aureus

Question 4

How does staphylococcus aureus appear on gram staining?

Answer 4

Gram +
Cocci
Clusters

Question 5

What are some causative organisms of septic arthritis?

Answer 5

Staphylococcus aureus
Streptococcus pneumoniae
Neisseria Gonorrhoea

Question 6

Why does you sometimes aspirate joints if they are swollen in ED and other times in theatre?

Answer 6

Aspirate in theatre if patient has Intra articular metal work.

Question 7

What are some causes of knee infections?

Answer 7

Osteomyelitis
Bursitis
Cellulitis
Joint space
Myositis

Question 8

How are infected bursitis different to bursitis?

Answer 8

With bursitis patients aren’t typically systemically unwell and bursa isn’t very red or hot

Question 9

What investigations do you do on a joint aspirate?

Answer 9

WCC
Crystal analysis
Cultures
Gram staining

Question 10

What are the methods of spread to causes septic arthritis?

Answer 10

Haematogenous spread
Spread from adjacent infection
Direct innoculation

Question 11

How does a patient with septic arthritis of the knee typically present?

Answer 11

Antalgic gait
Painful joint
Red swollen joint
Reduced ROM
Pyrexia
Rigours

Question 12

How is septic arthritis managed?

Answer 12

Sepsis 6
Joint aspirate
Joint wash out (remove any infected metal work/joint prosthesis)

Question 13

What are some complications of septic arthritis?

Answer 13

Sepsis
Osteomyelitis
Death
Osteoarthritis

Question 14

What are some differentials of a painful swollen joint?

Answer 14

Septic arthritis
Gout
Pseudogout
Bursitis
Rheumatoid arthritis
Psoriatic arthritis
Fracture

Question 15

What are the risk factors of gout?

Answer 15

Diet
Alcohol
Obesity
Family history
CKD
Men

Question 16

What is the drug used to manage chronic gout?

Answer 16

Allopurinol

(Reduces bodies uric acid levels)

Question 17

What are the 2 medications that can be given for acute gout?

Answer 17

Naproxen (NSAID)

Colchicine (when NSAID contraindicated)

Question 18

What are the contraindications to NSAIDs?

Answer 18

Peptic ulcers
GI bleeds
Renal impairment
Severe heart failure
Hepatic impariment
Pregnancy (early closing of ductus Arteriosus)

Question 19

What is visible on examination when a patient has gout?

Answer 19

Gouty typhi (yellowing)
Erythemmma
Swelling

Question 20

What type of crystals are gout crystals?

Answer 20

Negatively birefringent needle shaped crystals

Question 21

What type of crystals are Pseudogout crystals?

Answer 21

Postitively birefrigent rhomboid shaped crystals

P for positive and Pseudogout

Question 22

What joint does gout typically affect?

Answer 22

1st metatarsalphalangeal joint

Question 23

What joint does psuedogout typically affect?

Answer 23

Knee joint

Question 24

What investigations are done for gout/psuedogout?

Answer 24

Serum Urate
Joint aspirate if uncertain (potential septic arthritis)

Question 25

What is the pathophysiology of pseudogout?

Answer 25

Calcium pyrorphosphate deposits on JOINT CARTILAGE (CHONDROCALCINOSIS)