Non-traumatic joint pain and infection

Question 1

soft tissue neoplastic, neurogenic fibromyalgia, and infection are examples of what kind of musculoskeletal pain?

Answer 1

nonarticular

Question 2

what are examples of monoarticular musculoskeletal pain

Answer 2

OA

crystals

infections

Question 3

what are mono or polyarticular diseases of musculoskeletal pain

Answer 3

lyme disease

syphillis

Question 4

RA, lupus, scleroderma, polymyositis, polymyalgia rheumatica, and vasculitis are examples of what kind of musculoskeletal pain?

Answer 4

polyarticular

Question 5

deterioration of articular cartilage from repetitive forces or alteration in joint/body mechanics

non-inflammatory

Answer 5

OA

Question 6

in obese patients what is the ratio for the higher involvement of knees vs hips in OA

Answer 6

4:1

Question 7

sx of OA

Answer 7

• pain: deep ache, localized
• stiffness: early AM, improved with light activity
• weakness
• mechanical sx: crepitus possible

pain increases with heavy/prolonged activity improved with rest

Question 8

OA tx?

Answer 8

• rest/activity modifications
• NSAIDs
• walking aids
• bracing
• modalities
• weight loss
• glucosamine chondroitin sulfate
• corticosteroid injections
• viscosupplementation
• patches/creams
• surgery

Question 9

what are contraindications to using cortisone?

Answer 9

infection

cancer

osteonecrosis

AVN

4 weeks prior to surgery

total joint replacement

Question 10

what gene is RA associated with

Answer 10

HLA

Question 11

in what joints is there pain for RA

Answer 11

MCP (classic)
Wrists
PIP (SPARES DIP)

Question 12

what ligaments are commonly affected in RA

Answer 12

atlanto-axial

Question 13

Felty’s syndrome

Answer 13

RA

neutropenia

splenomegaly

Question 14

if someone with a prosthetic joint has glycocalyx what do you expect?

Answer 14

Septic arthritis

Question 15

what joints most commonly get septic arthritis

Answer 15

Knee and hip

followed by wrist, ankles, shoulders, spine

Question 16

Tx of septic arthritis

Answer 16

IV abx

irrigation

debridement

Question 17

physiological change of septic arthritis

Answer 17

fluid pressure increase

pH decrease

activated proteolytic enzymes

Question 18

WBC count and PMN in total joint vs native joint fluid

Answer 18

Total:

• WBC = 6,000
• PMN = 60%

Native:

• WBC = 75,000
• PMN = 80%

Question 19

when you aspirate a joint what needs to be done

Answer 19

total cell count - aerobic and anerobic

crystal analysis too

Question 20

what effects on the joint does septic arthritis have?

Answer 20

chondrolysis

destruction of tendons

synovitis and proliferation

Question 21

what gram positive organisms can be found in septic arthritis

Answer 21

1 staph aureus/epidermidis - native and total joints

Question 22

what bacteria often causes septic arthritis in kids when they experience a puncture wound

Answer 22

pseudomonas

Question 23

what gram negative bacteria is often found in septic arthritis of the elderly and IV drug users

Answer 23

E. coli

Question 24

when would you see anaerobic and polymicrobial bacteria in septic arthritis?

Answer 24

total joint

immunocompromised

DM

Question 25

what is kocher criteria used for?

Answer 25

likelihood of septic arthritis

Question 26

in kocher criteria you will get 1 point for each: | ???

Answer 26

non-weight bearing SED rate >40 fever 38.5 C (101.3) WBC >12,000

Question 27

sx of septic arthritis

Answer 27

join pain pain with active/passive ROM swelling, redness, tender to touch limb position: hip-flex/adducted/internal rotation fever, chills

Question 28

if someone has septic arthritis what do you do?

Answer 28

admit, labs, blood cultures, arthrocentesis, abx (must give a lot of fluid), surgery

Question 29

what are indications for arthrocentesis

Answer 29

unexplained effusion decompression of hemorrhagic effusion evaluation of antibiotic response in septic joint

Question 30

___ is a transundate of plasma that is actively secreted by synovial fluid

Answer 30

joint fluid

Question 31

indolent effusions with minimal discomfort and inflammation suggests what?

Answer 31

TB or fungal cause

Question 32

what type of synovial fluid would present with minimal inflammation, capillary leakage, and metabolism of Hgb to bilirubin

Answer 32

xanthocrhomic

Question 33

if synovial fluid is bloody whats going on

Answer 33

hemarthrosis

Question 34

what is normal color, viscosity, WBCs, PMN, glucose, and protein for normal synovial fluid

Answer 34

color: clear viscosity: increased WBCs: <200 PMN <25 Glucose: same as serum Protein: <2.5

Question 35

what is the color of synovial fluid if inflammatory (crystals, Rh, Reiter's, Rh fever)? ``` viscosity? WBC? PMN? Glucose? Protein? ```

Answer 35

clear yellow turbid ``` viscosity: decreased WBC: up to 100,000 PMN: 40-90 Glucose: <40 Protein: >2.5 ```

Question 36

in septic arthritis (staph, gonnoccal, TB) for the synovial fluid was is the - color - Viscosity - WBC - PMN - Glucose - Protein

Answer 36

- color: turbid - viscosity: decreased - WBC: 75,000-100,000 - PMN: 40-100 - glucose: reduced - protein: >2.5

Question 37

what labs would you order to anaylze synovial fluid

Answer 37

cell count gram stain aerobic and anaerobic crystal analysis

Question 38

in osteomyelitis why is diaphyseal involvement less common

Answer 38

epiphyseal growth plate acts as a barrier to infection

Question 39

in someone with osteomyelitis what would you expect to see on a radiograph

Answer 39

capsular distension patchy osteoporosis diffuse lysis of subchondral bone reactive sclerosis deformtiy

Question 40

what injury would you worry about post-traumatic arthritis for

Answer 40

intraarticular fracture

Question 41

crystal: hydroxyapatite indicates what

Answer 41

calcific tendinitis

Question 42

crystal: calcium oxalate indicates what

Answer 42

chronic renal disease hemodialysis

Question 43

cholesterol crystal indicates what

Answer 43

chronic RA effusions

Question 44

crystals - lipid liquid indicates what

Answer 44

acute chronic arthritis/fracture

Question 45

it is rare to find crystal w/o elevated ____

Answer 45

neutrophils - associated with inflammation

Question 46

crystal analysis indicative of gout

Answer 46

needle shapes and neg. birefringent

Question 47

Gout signs/sx

Answer 47

severe joint pain and tenderness hot, dusky red swelling 1st MTP is most common; also knees and ankles 40-50 y/o most common NIGHT ATTACKS punched out lesions on Xrays

Question 48

Tx of gout

Answer 48

colchicine NSAIDs corticosteroids allopurinol, probenecid

Question 49

Pseudogout has high _1_ correlation and age _2_ is most common it can be associated with _3_ disorders the _4_ is most commonly involved

Answer 49

1. genetic 2. 50+ 3. metabolic (hyperparathyroidism, hemochromatosis, hypothyroidism, hypophastasia, hypomagnesemia, Wilson's dx) 4. knee

Question 50

how is pseudogout diagnosed (what findings)

Answer 50

synovial fluid analysis chondrocalcinosis on xray crystal analysis: rhomboid crystals, + birefringenc

Question 51

neurogenic-neurovascular reflex on periarticular circulation (happens to diabetics)

Answer 51

Charcot's arthropathy

Question 52

what can cause avascular necrosis

Answer 52

alcohol trauma steroids

Question 53

WHAT ARE THE SECONDARY METASTATIC TUMORS FROM BONE TUMORS

Answer 53

Bone Tumors Proudly Love Killing - Breast: lytic - Thyroid: lytic - Prostate: dense often blastic - Lung: lytic - Kidney: lytic - bleed a lot, nearly 2x as common