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MOHD Keystone Exam 3 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Infection begins in skin, passes through muscle/tendon, reaches bone

A

Contiguous spread

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2
Q

Devitalized bone acting as foreign body =

A

sequestrum –> chronic drainage, colonization, abx don’t reach bone

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3
Q

Risk factors for hematogenous spread

A

IV drug useIV lines (dialysis, cancer)

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4
Q

Presentation of osteomyelitis

A

Acute: pain, fever, pus, red/hot areaChronic: drainage, non-healing ulcer, probe to bone

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5
Q

Metal device contaminated, spreads to bone

A

Surgical/trauma spread

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6
Q

Most common cause of septic arthritis

A

Bacterial (usually S. aureus but don’t forget Gonococcal)Can also be viral, fungal, mycobacterial

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7
Q

Hematogenous likely organisms

A

Usually one organismUsually S. aureusMay also be Coag - staph, gram - rods

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8
Q

Arthrocentesis in septic arthritis will show

A

High WBC (>50,000), High % neutrophil (>90%), high protein perform crystal analysis to r/o

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9
Q

Risk factors for septic arthritis contiguous spread

A

Cellulitis, abscess, osteomyelitis next to joint, Diabetes

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10
Q

Blood infection reaches bone

A

Hematogenous spread

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11
Q

Labs for osteomyelitis

A

Inflammatory markers, High WBC

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12
Q

Risk factors for septic arthritis hematogeneous spread

A

IV drug useIV lines (dialysis, cancer)Sexual intercourse (gonococcal)

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13
Q

Contiguous likely organisms

A

Usually polymicrobial (travel via skin)Usually S. aureusAlso streptococci, Coag - staph, gram - rods, anaerobes

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14
Q

Risk factors for contiguous spread:

A

uncontrolled diabetesneuropathycallus/foot deformity

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15
Q

Polymicrobial bloodstream infections are common in

A

IV drug users

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16
Q

Diagnosing Osteomyelitis:

A

Labs (ESR, CRP, WBC) + imaging (X-ray or MRI)Bone biopsy for 100%

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17
Q

Location of hematogenous osteomyelitis in children

A

metaphysis in long bones(nutrient artery comes into bone, makes loop –> slow blood stream, few phagocytic cells)

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18
Q

Symptoms: pain, fever, pus, red/hot area

A

osteomyelitis

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19
Q

Red, hot, painful joints are characteristic of

A

SEPTIC arthritis

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20
Q

Diagnosing Gonococcal arthritis considers

A

young adults, polyarthritis, urethral/cervix/throat discharge

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21
Q

What is important in treating after wash/drainage and IV antibiotics?

A

Early ROM exercise for affected joints

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22
Q

Osteoarthritis is inflammatory/non-inflammatory

A

non-inflammatory

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23
Q

Tibiofemoral knee presentation

A

Medial pain (varus), limited flexion, deformity, instability, mechanical catching, stair difficulty

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24
Q

Imaging for OA includes

A

AP pelvis, true later, frog-leg lateral

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25
Q

Characterisitic findings of OA include

A

Subchondral bone hypertrophyCartilage (joint-space) lossOsteophytesSubchondral cysts

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26
Q

Pharm used for OA injections

A

cortisone analoghyaluronate (not recommended)(cannot regrow cartilage)

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27
Q

Patellofemoral knee presentation

A

anterior knee pain, pain ascending stairs (not as bad as tibiofemoral)

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28
Q

Nerve responsible for knee pain with hip arthritis

A

Obturator nerve referred pain

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29
Q

Late issues leading to joint replacement revision

A

OsteolysisLooseningWear

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30
Q

Heberden’s nodes are on

A

DIP joint

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31
Q

Oral pharm for OA

A

oral NSAIDs

32
Q

Evaluation of OA may include these labs

A

Inflammatory labs to r/o inflammatory arthritis, infection

33
Q

Bouchard’s nodes are on

A

PIP joint

34
Q

A medial wedge would be used for

A

Varus knee moment

35
Q

Fusion might be used in _______ and is effective by _____________

A

Foot, ankle, spine; eliminating motion

36
Q

A lateral wedge would be used for

A

Valgus knee moment

37
Q

Physical risks of hip or knee replacement include

A

Thromboembolitic disease (DVT, PE)Neurovascular injuryBleedingWound healing issuesFracture (intra or post op)Hip: dislocation, limp, HO, LLDKnee: stiffness, laxity, PF problemsCardiopulm: MI, stroke, death

38
Q

Pain and swelling in big toe

A

Podagra

39
Q

Triggering events in gout attack

A

TraumaDietary/OH excessDiuretic use/change

40
Q

Risk of gout:

A

Age, family history, obesity, diabetes, HTN, OH use, acute illness, surgery

41
Q

Calcium pyrophosphase (CPP) crystals are deposited in

A

articular cartilagemenisci, synovium, periarticular tissues

42
Q

May be used to treat CHRONIC inflammatory CPPD

A

Hydroxychloroquine, Methotrexate if NSAIDs or Colchisine inadequate

43
Q

Intercritical period in gout is

A

Asymptomatic periods

44
Q

How likely is another acute gout attack in the first year after a first attack/presentation?

A

60%

45
Q

Allopurinol side effects

A

Allopurinol hypersensitivity, NVD, marrow suppression, hepatitis, fever, vasculitis, alopecia

46
Q

CPPD is associated with

A

aging, hyperparathyroidism, hemochromatosis, trauma, hypophos/hypomag

47
Q

Asymptomatic hyperuricemia begins at

A

Puberty for menMenopause for women

48
Q

Clinical presentation of CPPD

A

Usually mostly asymptomatic

49
Q

Asymptomatic hyperuricemia is associated with

A

hypertension, hyperglycemia, obesity, hyperlipidemia, CV disease

50
Q

Tophi =

A

Aggregated MSU crystalsUsually located on ulnar surface of forearms, tendons, olecranon, ear, joints

51
Q

Options for acute gout therapy

A

colchicine NSAIDcorticosteroidsjoint injection if no infection

52
Q

Febuxostate

A

non-competitive xanthine oxidase inhibitor

53
Q

Joints affected by Acute Gout

A

MTP, instep, ankles, knees, prepaterllar/olecranon bursae

54
Q

Acute gout is usually ______articular

A

MONOarticular

55
Q

Allopurinal, Febuxostate are…

A

Xanthine oxidase inhibitors Stop purine metabolism, uric acid doesn’t form

56
Q

It is possible for people in an acute attack to have a normal uric acid level

A

True - 50% will have normal level

57
Q

Acute CPP (pseudogout) presents with

A

acute/subacute arthritis for several days, monoarthritis (knees, wrists), podagra UNcommon, may follow surg/trauma/illness/diuresis

58
Q

Characteristic Radiology finding of Tophi/Chronic gout

A

Punched out erosions surrounded by radiodensityJoint space preservation, normal mineralizationLate disease: punched out lesions with overhanging edges

59
Q

Chronic/tophaceous gout is usually _____articular

A

POLYarticular

60
Q

Side effects include cardiovascular (MI, CVA), elevated liver transaminases, gout flare

A

Febuxostat

61
Q

Chronic Kidney Disease is probably d/t

A

precipitation of uric acid crystalshypertensiondiabetesRaising SUA induces glom HTN, fibrosisLowering SUA may slow CKD progression

62
Q

Presumptive Gout Diagnosis

A

Rapid, severe painPain, erythema, swellingHyperuricemia

63
Q

Chronic Inflammatory CPPD presents as

A

polyarticular, symmetric arthritis of small joints in hands/feet

64
Q

What happens when phagocytes ingest crystals?

A

Lysis and inflammatory response

65
Q

mimics DJD

A

OA with CPP clinical presentation

66
Q

Risk for kidney stones is _______ to uric acid level (SUA)

A

proportional

67
Q

Colchicine

A

Inhibits microtubule formation (turn off cytokine cascade, inhibit NLRP3 assembly)

68
Q

What is released with macrophace lysis?

A

IL-1, IL-18, cytokinesFollowed by neutrophil infiltration

69
Q

Management of Gout

A

Baseline: Ed, diet, lifestyleLook for secondary hyperuricemia causesAcute therapy (colchicine, NSAID, corticosteroids, joint injection if no infection)

70
Q

Diagnosis of CPPD

A

Weakly birefringent, Positive birefringents (aligned blue calcium)Rhomboid crystals, intracellular

71
Q

Things that can lead to hyperuricemia

A

High purine dietAlcohol (beer highest)Fructosecell deathATP -> AMP -> Uric acid

72
Q

XOI alternative

A

Probenecid

73
Q

Diagnosis of Gout

A

Demonstrate needle shaped crystal inside cell, Negatively birefringent, Parallel-yellow (plane of polarization)(If the crystal is perpendicular to plane it will be blue)

74
Q

CPPD radiology features

A

Cartilage calcification (deposition into fibrous/hyaline calcium)Uniform joint space lossNo erosionsKnees > Hands > Symphasis

75
Q

Uricosuric added to XOI if

A

XOI not tolerated, under 60, normal renal function, no history of stones, more than 2 attacks/year,

MOHD Keystone Exam 3 (5 decks)

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