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Block A > WCS82 + Rheumatology Teaching clinic > Flashcards

WCS82 + Rheumatology Teaching clinic Flashcards

1
Q

Ddx for monoarthritis

A 
Septic arthritis
Crystal arthritis
Hemarthrosis
OA
JIA
Coagulopathy
Avascular necrosis of the bone
Monoarticular presentation of polyarticular diseases (RA, JIA, viral, SpA, PsA)
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2
Q

Polyarticular disease presenting with monoarticular onset sometimes

A

RA
JIA
Viral arthritis
Spondyloarthritis (reactive, psoriatic, IBD associated)

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3
Q

What does a history of using steroids suggest the etiology of arthritis to be

A

infection

osteonecrosis

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4
Q

What does a history of using anticoagulants or bleeding disorders suggest the etiology of arthritis to be

A

hemarthrosis

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5
Q

What does a history of previous acute attacks of self limiting arthritis suggest the etiology of arthritis to be

A

crystal arthritis

inflammatory arthritis syndrome

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6
Q

Indications for synovial fluid analysis

A
  • suspect septic arthritis
  • suspect crystal arthritis
  • suspect hemarthrosis
  • differentiate inflammatory from mechanical arthritis
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7
Q

what do you send synovial fluid for

A
  • gross examination (appearance, color, viscosity)
  • microscopy (cell count, differential count, polarized light)
  • microbiology (gram smear, culture, tb)
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8
Q

negative and positive birefringence and shape of gout and pseudogout

A

gout needle shaped, negative birefringence (yellow)

pseudogout rhomboid shaped, positive birefringence (blue)

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9
Q

arthroscopy use

A

diagnostic

  • direct vision to articular surface for assessment of degree of cartilage damage
  • synovial biopsy for equivocal cases

therapeutic

  • debridement of damaged cartilage
  • removal of loose bodies
  • temporary pain relief
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10
Q

most likely microoarganism for septic arthritis

A

gram positive

staphylococcus aureus

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11
Q

route of infection for septic arthritis

A
  1. hematogenous
  2. osteomyelitis
  3. adjacent soft tissue infection
  4. iatrogenic
  5. penetrating trauma
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12
Q

risk factors for septic arthritis

A
  • extremes of age
  • chronic arthritic syndromes
  • prosthetic joint
  • intraarticular injection or arthrocentesis
  • parenteral drug use
  • sexual activity
  • chronic systemic illness
  • chronic skin infection
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13
Q

Ix for septic arthritis

A
  • synovial fluid aspiration
  • blood for blood culture, CBC, ESR, CRP, electrolytes, LRFT
  • septic workup (throat swab, nasal swab, urine, (stool))
  • plain xray/ MRI
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14
Q

3 stages of gout

A
  • asymptomatic hyperuricemia
  • acute gouty attack with intercritical gout
  • chronic tophaceous gout
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15
Q

where can tophi be found? what is implied if there is tophus

A

periarticular tissues, helix of ears, tendon sheaths, (larynx, tongue, heart)
imply gout is chronic

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16
Q

radiological description of gout

A

punched out erosion (mouse bite erosion)

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17
Q

Causes of hyperuricemia

A
  • dietary excess
  • overproduction of urate by cells
    • primary (idiopathic, HGPRT deficiency, hyperactive PRPP synthase)
    • secondary (myeloproliferative/lymphoproliferative disorders, hemolysis, psoriasis, glycogen storage diseases)
  • underexcretion of urate by RENAL and gut
    • primary idiopathic
    • secondary (decreased renal function, metabolic acidosis, dehydration, diuretics, hypertension, hyperparathyroidism, drugs - salicylates, lead nephropathy)
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18
Q

Acute gouty attack treatment

A
  • oral indomethacin/ etoricoxib
  • colchicine
  • intraarticular steroid injection
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19
Q

urate lowering therapy drugs

A 
xanthine oxidase inhibitor
- allopurinol
- febuxostat
uricosuric agents
- probenecid
- sulphinpyrazone
20
Q

adverse drug reaction associated with allopurinol

A

SCAR severe cutaneous adverse reaction

  • TEN toxic epidermal necrolysis
  • vasculitis
21
Q

adverse drug reaction associated with probenecid

A

nephrotic syndrome

22
Q

adverse drug reaction associated with urate lowering therapy

A
  • bm suppression
  • hepatitis
  • allopurinol - SCAR, vasculitis
  • probenecid - nephrotic syndrome
23
Q

When should urate lowering therapy be considered

A

• Recurrent and troublesome acute attacks
• Evidence of tophi or chronic joint damage
• In the presence of renal disease
• The patient is young, the uric acid level is high, and
there is a family history of renal or heart disease
• Evidence of primary purine overproduction and
hyperexcretion

24
Q

common sites for chondrocalcinosis

A

knees, acetabulum, TFCC

25
Q

CPPD disease causes

A

primary

  • hereditary
  • sporadic

secondary to metabolic disease

  • hyperparathyroidism
  • hypothyroidism
  • gout
  • hemachromatosis
  • ageing
  • hypomagnesemia
  • hypophosphatemia
26
Q

Causes of hemarthrosis

A
  • trauma
  • anticoagulants
  • hemophilia
27
Q

3 steps p/e for bones and joints

A

look feel move

28
Q

Radiological findings of OA and RA

A

OA Loss - loss of joint space, osteophytes, subchondral cyst, subchondral sclerosis
RA (in carpal bones, ulnar head, mcp, pip) Less - loss of joint space, erosion, soft tissue swelling, soft bones osteopenia

29
Q

OA treatment

A

Non pharma

  • lifestyle modification
  • physio
  • fluid aspiration

pharma

  • NSAID/coxib (paracetamol if dm or renal impairment)
  • local injection of steroids and hyaluronic acid
30
Q

before injecting steroids to joint what must you exclude first

A

septic arthritis

31
Q

What infection gives reactive arthritis

A
  • post-streptococcal

- Reiter’s syndrome

32
Q

When should systemic treatment be considered over intraarticular injections
Points to note in i/a injection (duration, technique)

A

Magic number 3
systemic treatment if >= 3 joints symptomatic
at most 3 injections per joint per year, avoid reinjection within 3 months
aseptic technique

33
Q

complications of i/a injection

A
  • septic arthritis
  • microcrystal induced arthritis (steroids)
  • fat atrophy over site of injection
  • diabetic decompensation
34
Q

Polyarthritis in elderly with constitutional symptoms, RF and CCP negative first exclude:

A

paraneoplastic arthritis

35
Q

atlanto-axial subluxation suggests which arthritis

A

RA

36
Q

Blood test for RA

A

ESR, CRP, RF, antiCCP

37
Q

Views for Xray hands RA

A

AP view, Ball catching view

38
Q

Approach for interpreting hand xray ABCDs

A

Alignment
Bone (Mineralization, periarticular osteopenia, osteophytes, erosions, fractures)
Cartilage (joint spaces, calcifications)
Distribution (pattern of involvement, symmetry)
Soft tissues (swelling, calcifications)

39
Q

Views for xray knees

A

AP standing
lateral
skyview

40
Q

Clinical hand deformities in RA

A
  • ulnar deviation of fingers with subluxation of mcp
  • boutonniere deformity
  • swanneck deformity
  • z deformity of the thumb
41
Q

Newly dx RA further investigations

A
  • screening for DM, lipid
  • hep status
  • g6pd status
  • cxr, Lung function test
  • MSK USG, MRI
42
Q

USG hands views

A

transverse, longitudinal

43
Q

DMARDs for RA
anchoring drug:
other first line DMARDs:
bridging agent

A

anchoring: MTX
others: sulphasalazine, leflunomide, hydroxychloroquine
bridging agent: prednisolone

44
Q

which DMARDs for RA are not compatible with pregnancy and which is compatible

A

mtx and leflunomide not compatible, hydroxychloroquine compatible

45
Q

Biologics for RA

A
  • TNF antagonist - infliximab, etanercept, adalimumab, golimumab
  • B-cell inhibitors - rituximab
  • antiIL6 - tocilizumab
  • Tcell costimulation inhibitor - abatacept
46
Q

RA associated morbidities

A
  • osteoporosis (RA and steroid induced)
  • CV risk (RA and NSAID)
  • lymphoma (RA and antiTNF)
  • infection (steroid)
  • GI and renal complications (NSAID)

Block A (11 decks)

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