Investigating the inflamed joint

Question 1

What is the difference in history for mechanical and inflammatory joints?

Answer 1

Worse with rest
Better with use= Inflammatory

Other way round- mechanical

Question 2

What are inflammatory markers for joint pain?

Answer 2

PV- plasma viscosity
CRP- C reactive protein
ESR- Erythrocyte sedimentation rate

Question 3

What happens to the body when there is an inflammation?

Answer 3

In inflammation there is increased production of antibodies by B cells, increased cytokine production by other white cells (locally or systemically) and increased protein
production by the liver

Question 4

What is plasma viscosity

Answer 4

measure of how much protein there is in the serum

Question 5

What is C reactive protein

Answer 5

an acute phase response produced by the liver

Question 6

How is ESR measured?

Answer 6

• it takes longer for cells to settle in inflammation

Question 7

What does high neutophils with inflammation usually mean?

Answer 7

Bacterial infection

Question 8

What does high eosinophils with inflammation usually mean?

Answer 8

Parasites

Question 9

Low lymphocytes common in what ?

Answer 9

SLE- lupus

Viral infections

Question 10

What is main cause of normocytic anaemia in inflammation?

Answer 10

anaemia of chronic disease

Question 11

What is the main cause of microcytic anaemia?

Answer 11

Iron deficiency anaemia

Question 12

Why is rheumatoid arthritis associated iron deficiency

Answer 12

Non-steroidal anti-inflammatories used for pain relief of RA

They cause iron deficiency anaemia

Question 13

What drugs cause iron deficiency anaemia?

Answer 13

NSAID’s

Non-steroidal anti-inflammatories

Question 14

What is the main cause of macrocytic anaemia?

Answer 14

B12 and folate deficiency
Alcohol
Thyroid problems

Question 15

What is the main cause of folate deficiency

Answer 15

Methotrexate- dihydrofolate reductase inhibitor

Question 16

What are common causes of hyperuricaemia?

Answer 16

Diuretic medications
Increasing age
Diet

Question 17

What are kidney function tests?

Answer 17

GFR

Question 18

What are liver function tests?

Answer 18

ALP ALT Bilirubin Albumin

Question 19

What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Osteoarthritis?

Answer 19

Normal
Normal
Normal
Normal

Question 20

What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Rheumatoid arthritis or psoriatic?

Answer 20

Somewhat Raised 30-70
Somewhat Raised 12-13
Low
Raised

Question 21

What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of SLE?

Answer 21

Somewhat Raised 30-70
Low
Low
Raised

Question 22

What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Gout?

Answer 22

Raised- 200
Raised-15-16
Low
Raised

Question 23

What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Infection?

Answer 23

Raised- 400
Raised-20-25
Low
Raised

Question 24

What does transparent yellow synovial fluid mean

Answer 24

Non-inflammatory

Question 25

What does pale yellow translucent synovial fluid mean?

Answer 25

inflammatory

Question 26

What does yellow with red bits or green synovial fluid mean?

Answer 26

Septic

Question 27

What does red synovial fluid mean?

Answer 27

Haemorrhage

Question 28

What is the viscosity of synovial fluid?

Answer 28

Consistency of egg-white

Question 29

What is the viscosity of inflammatory synovial fluid?

Answer 29

Consistency of water

Question 30

What is the protein content and glucose uric acid levels of inflammation of synovial fluid?

Answer 30

Higher protein Lower glucose Uric acid higher in gout

Question 31

What is the most common gram positive cocci?

Answer 31

Staphylococcus aureus

Question 32

What is the most common gram negative cocci?

Answer 32

Neisseria gonorrhoeae

Question 33

What shape are crystals in synovial fluid if someone with gout?

Answer 33

Needle shaped

Question 34

What shape are crystals in synovial fluid if someone with pseudogout?

Answer 34

Brick shaped

Question 35

What is the diagnosis of finding crystals in synovial fluid shaped as needle?

Answer 35

gout

Question 36

What is the diagnosis of finding crystals in synovial fluid shaped as brick?

Answer 36

pseudogout

Question 37

Is it + or - birefringence of gout crystals in synovial fluid?

Answer 37

Negative

Question 38

Is it + or - birefringence of pseudogout crystals in synovial fluid?

Answer 38

Positive

Question 39

What has + birefringence of the crystals in synovial fluid?

Answer 39

Pseudogout

Question 40

What has - birefringence of the crystals in synovial fluid?

Answer 40

Gout

Question 41

What is haemarthrosis?

Answer 41

Bleeding into a joint

Question 42

Causes of haemarthrosis

Answer 42

Trauma - injury - sports, RTC - postoperative - 'traumatic' arthrocentesis procedure (not blood, to start, but becomes bloody during the procedure) - Bleeding disorders e.g haemophilia, excess warfarin use and minor trauma - Vascular disorders - Tumours