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Swollen Joints Flashcards

1
Q

What are the three ways a joint can become swollen

A

Due to soft tissue swelling
Knee effusion
Inappropriate deposition of tissue

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2
Q

What is knee effusion

A

When fluid accumulates within the intraarticular space of the knee
Can be blood- irritates
Or synovial fluid

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3
Q

What is it called when fluid accumulates within the eintraarticular space of the knee

A

Knee effusion

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4
Q

What two fluids can accumulate in the knee causing a knee effusion

A

Blood or synovial fluid

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5
Q

What symptoms occur due to knee effusion

A

Pain
Swelling
Reduced range of movement in the knee

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6
Q

A patient presents with swelling and pain in his right knee. He states than he hasn’t been able to bend or straighten his knee completely in the past couple of days. What’s the diagnosis

A

A knee effusion

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7
Q

What is haemarthrosis

A

Accumulation of blood in a joint

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8
Q

What is haemarthrosis mostly caused by

A

ACL ruptures
Patella dislocation
Meniscal tears

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9
Q

What is it called when blood accumulates in a joint

A

Haemarthrosis

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10
Q

What is liphaemarthrosis

A

Accumulation of fat and blood in a joint following a fracture

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11
Q

When does lipohaemarthrosis occur

A

After a fracture

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12
Q

A patient comes in with pain and swelling in his knee following a tibial condyle fracture. He has limited movement of his knee and his knee is very warm. What is mostly likely occurring in his knee joint

A

Lipohaemarthrosis

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13
Q

What investigations would you do if you suspect a patient is suffering from either haemarthrosis or lipohaemarthrosis

A

Blood tests
Imaging- X-rays
Synovial fluid- basic tests

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14
Q

When taking blood tests from a patient with suspected haemarthrosis, what would you test for?

A

Full blood count- white blood cells and haemoglobin
Inflammatory markers- CRP/ESR
Blood cultures

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15
Q

What is the normal appearance, WCC, crystals and culture of an aspiration sample without haemarthrosis

A

Appearance- clear viscous fluid
WCC- 0-200 cells/uL
Crystals- none
Culture- sterile

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16
Q

If a patient has haemarthrosis, what would the appearance, WCC, crystal and culture of their knee aspiration sample be

A

Appearance- red, pink or brown and highly viscous
WCC- 0-200 cells/uL- normal
Crystals- none- normal
Culture- sterile- normal

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17
Q

A patient has haemarthrosis and has an X- ray taken. What would be seen on the image

A

Some fluid accumulation in the joint

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18
Q

What is the management of both haemarthrosises

A

Manage the fracture/ dislocation/ ligament tear
Synovial fluid aspiration

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19
Q

What is rheumatoid arthritis

A

Autoimmune condition affecting synovium- thin layer of connective tissue that lines inside of joints

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20
Q

What are the auto-antibodies that cause rheumatoid arthritis

A

Anti-cyclic citrullinated peptide antibodies
Also known as anti-CCP

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21
Q

How is rheumatoid arthritis caused

A

Anti-CCP antibodies attack synovium
Leads to inflammation
Causes formation of pannus- abnormal tissue growth in joints- causes swelling, pain and can cause damage
Pannus is erosive- can destroy articular cartilage and bone

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22
Q

What sex does rheumatoid arthritis affect more

A

Females
2-4 times greater in females compared to males

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23
Q

What is the peak onset of rheumatoid arthritis

A

30-50 years

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24
Q

In rheumatoid arthritis there is a bilateral distribution of small joints. What does this mean?

A

Means that the joints affected on one side of the body are the same joints affected on the other side of the body.
Eg. Arthritis in knuckle of middle finger on left hand means arthritis in knuckle of middle finger on right hand

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25
Where does rheumatoid arthritis affect first then spread to
Affects distal joints to begin with then can spread more proximally
26
What are the key symptoms of rheumatoid arthritis
Painful joints Stiffness- typically in the morning Swollen joints Erythematous- superficial reddening of the skin Hot joints
27
A female patient aged 45 experiences pain in both her hand- specifically her phalangeal joints. They appear to be swollen and hot to touch. What is the assumed diagnosis?
Rheumatoid arthritis
28
What tests would you carry out to confirm a patient has rheumatoid arthritis after they have come in with the symptoms
Blood tests X rays
29
What would you test for in a blood test when investigating rheumatoid arthritis and why
Full blood count- may have anaemia or raised platelets CPR/ESP- may be raised- inflammation Presence of anti-CPP antibodies or rheumatoid factor
30
You take some X-rays of a suspected rheumatoid arthritis patient. What on the X-ray would confirm your suspicions
Loss of joint space Juxta-articular osteoporosis- bone loss around the joints Marginal erosions- breaks in the bone- occur edge of joint Soft tissue swelling
31
When would you perform an aspirate for rheumatoid arthritis
When the affected area is large- eg. Large joint Not when area is small- eg. Hands
32
If a patient has rheumatoid arthritis, what would the appearance, WCC, crystal and culture of their aspiration sample be
Appearance- yellowish/ green- low viscosity- abnormal WCC- 2,000-100,000 cells/uL- higher than normal Crystals- none- normal Culture- sterile- normal
33
What is the management of rheumatoid arthritis
Steroids- Glucocorticoids- short term only Immunosuppressants- methotrexate
34
A female aged 45 comes in with pain and swelling in both her hands. An aspiration sample is taken. The results show a yellow liquid with a low viscosity, with white blood cell count 6000, no crystals and a sterile culture. What’s the diagnosis?
Rheumatoid arthritis
35
What joints does osteoarthritis affect
Synovial joints
36
What is the pathophysiology of osteoarthritis
Excessive/ uneven loading of joint Swollen cartilage due to damage- increase proteoglycan content in extracellular matrix- new chondrocyte formation After initial attempts to repair- several years- proteoglycan content falls- cartilage becomes soft and loses elasticity Articular cartilage damaged, flaking and fibrillation occur in normally smooth surface Cartilage erodes- bone touches bone
37
What kind of arthritis erodes cartilage and leads to bone touching bone
Osteoarthritis
38
What sex is more likely to suffer from osteoarthritis
Female
39
What are some risk factors of osteoarthritis
Increasing age Previous trauma to joint Occupation Increased BMI- overweight/ obesity Previous infection/ bleeding into joint Genetics
40
What are some symptoms of osteoarthritis
Joint pain that worsens during exercise, but relieved by rest Morning stiffness that lasts less than 30 mins Bony swelling and deformities Reduced range of movement Crepitus- grinding/creaking sensation on moving joint Tenderness around joint ‘Flares’- swelling, inflammation and increased pain
41
A female patient aged 55 comes in with pain in knee- its swollen and cant move it properly. She says it hurts when she does exercise but the pain goes away during rest. What’s the diagnosis and why?
Osteoarthritis
42
Name 4 differences between osteoarthritis and rheumatoid arthritis
43
If you suspect a patient has osteoarthritis what investigations do you do and what do you check for
Take bloods- CRP may be raised in flare- otherwise nothing specific- diagnosis usually on clinical presentation and examination findings X- ray- Loss of joint space - Osteophyte formation - Subchondral sclerosis - Subchondral cysts (LOSS)
44
When would you take a synovial fluid sample from a patient that you suspects has osteoarthritis
If they are in flare and need to rule out other conditions
45
What would a synovial fluid sample of a patient with osteoarthritis show- appearance, WCC, crystals and culture
Appearance- normal viscosity- large volume WCC- 0-2000 cells/uL- slightly higher than normal Crystals- usually none- normal Culture- sterile- normal
46
What is the management strategy for a patient with osteoarthritis
Basic- Analgesia -Exercise -Weight loss if overweight Advanced- steroid injection Extreme- joint replacement- arthroplasty
47
When would you suspect a patient has septic arthritis instead of any other type of arthritis
When they have a fever As well as common symptoms of arthritis
48
What is the pathophysiology of septic arthritis
Most common cases staphylococcus aureus bacteria present in blood Trauma or surgery causes direct inoculation Or can be caused by contiguous spread- spread from nearby- eg. Bone infection
49
What are some symptoms of septic arthritis
Pain Reduced range of movement Inability to weight bear Swollen, hot joint Painful palpation Feeling generally unwell- fever
50
You see a patient and suspect the have septic arthritis- what investigations would you do
Bloods X-ray
51
What would an x-ray of a person with septic arthritis show
Could see joint space widening or effusion Or could just be normal
52
What would the blood results of a person with septic arthritis be- appearance, WCC, crystals and culture
Appearance- cloudy with low viscosity- abnormal WCC- 50,000- 200,000- very high Crystals- usually none- normal Culture- positive- abnormal
53
Why do you need to take bloods, not just an x-ray if you suspect a patient has septic arthritis
X-ray can sometimes look normal Septic arthritis caused by bacteria- blood will contain bacteria and WBC- triggers immune respones so WCC high and culture will be positive
54
What is the management strategy for a patient with septic arthritis
Immediate IV antibiotics Surgery to wash out joint
55
What are some symptoms of gout
Swollen, red and tender joint- Patient may not be able to tolerate palpation Acute onset pain- reaches peak over 6-12 hours Symptoms usually resolve in 2 weeks
56
What is the pathophysiology of gout
Crystals form due to high levels of urate Deposition of monosodium urate crystals within joint cause pain Crystals lead to inflammation and damage joint
57
What causes high urate levels
Kidney not removing urate Increased production of urate
58
What are some risk factors of gout
Affects males more than females 40-60 years old Increased consumption of meat/seafood/alcohol/sugar Diuretics Obesity Diseases that have high metabolic turnover- eg. Psoriasis, leukaemia or chemotherapy
59
A patient comes in with suspected gout. What investigations would you do?
Bloods X-rays
60
You take bloods from a patient with suspected gout. What would the results be if the patient has indeed got gout.
Raised urate levels and CRP/ESP
61
You take an X-ray of a patient with suspected gout. What would the images look like if the patient has indeed got gout.
If gout is early- may not be able to see anything If repeated attacks- may see punched out lesions May see crystal deposition in soft tissue- gout tophi
62
What would the results synovial fluid aspirate of a person with gout show. Appearance, WCC, crystals, culture.
Appearance- clear, low viscosity- normal WCC- 500-200,000- high Crystals- needle shaped- abnormal Culture- sterile- normal
63
How do you manage an acute attack of gout
NSAIDS- reduce inflammation and treat pain Rest Ice packs Elevate limb
64
Management after an acute attack of gout
Urate- lower therapy- allopurinol long term to prevent future attacks Manage diet Weight loss
65

MD003 (19 decks)

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