MMB (022) Practical of Red Hot Joint

Question 1

The 5 possible routes of infection in septic arthritis?

Answer 1

Question 2

• Mention the possible risk factors of septic arthritis in this case

Answer 2

1.Existing joint problem (osteoarthritis)

2.Weak immune system (diabetes)

Question 3

• Mention other risk factors for septic arthritis

Answer 3

1.Existing joint problems

2. Joint trauma

3.Weak immune system , kidney and liver diseases, drugs suppressing immunity

4.Increased skin fragility

Question 4

1. Which of the following blood levels is increased in gout?

A. cholesterol

B. urea

C. uric acid

D. Bilirubin

Answer 4

C.uric acid

Question 5

Gout commonly affects big toe (T/F)

Answer 5

True

Question 6

Only men get gout (T/F)

Answer 6

False

Question 7

• Gout can be diagnosed with only a simple blood test T/F

Answer 7

False

• Note : high uric acid level is not enough for a clear diagnosis of gout. Even people without gout can have high uric acid. Finding uric acid crystals in aspirated fluid is necessary

Question 8

• Which food might protect against gout?

1. Liver
2. Shrimp
3. Skimmed milk

Answer 8

3. Skimmed milk

Question 9

•Describe the microscopy and the stain used

Answer 9

-Wright-Giemsa stain and polarised light ;

• Large numbers of neutrophils and long, needle-like, sodium urate crystals

Question 10

Answer 10

Question 11

Answer 11

Question 12

Answer 12

Question 13

Answer 13

Question 14

Answer 14

Question 15

Answer 15

A. Aspirate the olecranon bursa

Question 16

1- What are the investigations required to confirm the diagnosis?

Answer 16

-Examination of synovial fluid for ;
• White cell count, which is usually very high
• Culture for bacteria or other organisms

• X-rays: done only to look for damage or to rule out other causes

-Blood tests to monitor inflammation

Question 17

2- If aspiration of synovial fluid from the left knee is performed. Describe the findings

Answer 17

Synovial fluid smear rich in leukocytes

Question 18

3- MANAGEMENT ?

Answer 18

Antibiotics and drainage of fluid to stop injury

Question 19

1- What is your possible diagnosis?

Answer 19

GOUTY ARTHRITIS

Question 20

2- Mentions the investigations required to confirm your diagnosis.

Answer 20

-A serum urate level of approximately 6.8

• Radiographic findings:
  1. Juxta-articular erosive changes around the first MTP joint
  1. With overhanging edges
  2. Soft tissue swelling
  3. The joint space is maintained
  4. No evidence of osteopenia

Question 21

3- If synovial fluid aspiration is performed, please describe it.

Answer 21

Needle- shaped sodium urate crystals and mononuclear cells

Question 22

4- What are the risk factors in this case?

Answer 22

-Gender

-Obesity

-Diuretics

-Alcoholic

-Excessive red meat

Question 23

Three general steps of gout management ?

Answer 23

• Treating the acute attack (NSAIDs , steroids)

• Providing prophylaxis to prevent acute flares

• Lowering excessive storage of urate to prevent flares of gouty arthritis and to prevent tissue deposition of urate crystals

• Treatment of chronic gout: therapy to reduce serum uric acid level to AT LEAST 6mg/dl

Question 24

Treatment of chronic gout: therapy to reduce serum uric acid level to AT LEAST ……mg/dl

Answer 24

6mg/dl

Question 25

1- Describe the microscopic picture from the knee joint synovium.

Answer 25

-Increased vascularity

-Numerous inflammatory cells

-Synovial cell hyperplasia

Question 26

2- What is the laboratory investigation required to confirm the diagnosis?

Answer 26

Positive Rheumatoid factor and anti-CCP