Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal > Septic, Crystal and Reactive Arthritis > Flashcards

Septic, Crystal and Reactive Arthritis Flashcards

1
Q

What are the clinical features of acute mono arthritis?

A

Inflammation (redness, swelling, heat, pain, loss of function)
+/- fever
+/- leukocytosis and raised CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute mono-arthritis is septic until proven otherwise. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors of septic arthritis?

A 
Previous arthritis
Trauma
Diabetes Mellitus
Immunosuppression
Bacteraemia
Sickle cell anaemia
Prosthetic joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the pathogenesis of septic arthritis?

A

Bacteria enter the joint and deposit in the synovial lining. This can be via haematogenous spread or local invasion and inoculation. There is rapid entry of bacteria into the synovial fluid as there is no basement membrane and the synovial fluid has a close relationship to blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which joints are most commonly affected by septic arthritis?

A

Knee is most common

Hip, ankle, shoulder, wrist and elbow are other common sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In what age group does polyarticular septic arthritis usually occur?

A

> 60 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Polyarticular septic arthritis can commonly occur in patients with what underlying disease?

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the most common causative organisms of polyarticular septic arthritis?

A

Streptococcal and staphylococcal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Polyarticular septic arthritis has a worse prognosis than monoarticular septic arthritis. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why should a wide bore needle be used to sample the synovial fluid when infection is suspected?

A

Pus may be very viscous and difficult to aspirate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the expected results from a synovial fluid sample in septic arthritis?

A 
Cell count >50,000 WBCs/mm^3
Differential >75% PMNs
Glucose low
Gram stain relatively insensitive
Culture positive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causative organisms should be suspected in infectious arthritis in immune compromised individuals?

A

Aerobic gram negative bacteria
Anaerobic gram negative bacteria
Mycobacterial species
Fungal species (sporotrichosis, cryptococcosis, blastomycosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is septic arthritis managed?

A

Joint aspiration
Antibiotic therapy
Surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How often should a joint be aspirated in septic arthritis?

A

Daily or more frequently if required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should surgical intervention. be used in septic arthritis?

A

If the patient is not responding after 48 hours of appropriate therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should septic. arthritis be monitored to ensure. clearance of infection?

A

Serial synovial fluid analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What diseases can cause crystal arthritis?

A

Gout

Calcium pyrophosphate deposition disease

18
Q

What are the risk factors for gout?

A 
Age
Male
Race
Genetic factors
Impaired renal function
Obesity
Alcohol consumption
High purine diet
HFCS
Certain medications
19
Q

Which medications increase the risk of gout?

A 
Aspirin. (75mg has effect)
Diuretics
Cyclosporins
Pyrazinimide
Ethambutol
Nicotinic acid
20
Q

When can a presumptive diagnosis of gout be made. in the absence of synovial. fluid aspiration?

A

Typical presentation of podagra and a history of gout flare. or hyperuricaemia

21
Q

What are the differential diagnoses of gout?

A

Septic arthritis

Psuedogout (CPPD)

22
Q

What are the goals of treatment for gout?

A

Relieve pain and reduce inflammation via non-pharmacological methods (e.g. cold packs) and NSAIDs. Long-term goals of treatment are to prevent further. acute attacks, prevent joint damage and eliminate tophi

23
Q

What lifestyle modifications should be used in gout?

A

Reduce alcohol
Weight loss
Moderate exercise
Diet modification - reduce purine intake, reduce fructose containing drinks, include skimmed milk, low fat yoghurt, vegetable. protein and cherries every day in diet

24
Q

Which patients should be treated. for gout?

A 
Recurrent attacks >2 in a year
Tophi
Chronic gouty arthritis
Renal impairment
History of urolithiasis
Diuretic therapy use
Primary gout starting at a young age (<40 years)
Very high serum. urate >500 micro mol/L
25
Q

What two agents can be used as urate lowering therapies in gout?

A

Allopurinol

Febuxostat

26
Q

At what dose should allopurinol be started at. and to what dose can it be increased to in the treatment of gout?

A

Start at 100mg, then increase every 4 weeks by 100mg until 900mg. or reached target urate level

27
Q

At what dose should febuxostat be started at and to what dose can it be increased to in the treatment of gout?

A

80mg

Can be increased to 120mg after 4. weeks if not at target urate

28
Q

What gene is reactive arthritis associated with?

A

HLA-B27

29
Q

Why is reactive arthritis not a true septic arthritis?

A

Because a viable organism cannot be recovered from the joint

30
Q

Give examples of enteric infections which can cause reactive arthritis?

A 
Salmonella
Shigella
Yersinia
Campylobacter
Clostridium
31
Q

Give examples of GU infections which can cause reactive arthritis?

A

Chlamydia trachomas
Neisseria gonorrhoea
Mycoplasma genitalium
Ureaplasma urealyticum

32
Q

In what groups is reactive arthritis common in?

A

20-40 years ofage

Men

33
Q

How many weeks post-infection does reactive arthritis occur?

A

2-6 weeks

34
Q

Describe the extra-articular presentations of reactive arthritis?

A

Conjunctivitis, iritis, keratitis, episcleritis
Keratoderma blennorhagica and nail dystrophy
Circinate balanitis
Stomatitis, diarrhoea
Rarely cardiac involvement with. aortitis.

35
Q

Describe the pathogenesis of reactive arthritis?

A

Cross reactivity between bacterial antigen and joint tissues leading to a perpetuating Th2 cell mediated response. Persistence of the antigenic material due to failed clearance possible due to polymorphisms of toll-like receptors.

36
Q

What investigations should be conducted in reactive arthritis?

A 
Joint aspiration
Swabs (urethral/cervical)
Screen for other related infections
Inflammatory markers ESR and CRP
Chalmydia serology
HLA-B27
37
Q

How is mild reactive arthritis managed?

A

NSAIDs and simple analgesia

38
Q

How is moderate reactive arthritis managed?

A

NSAIDs
Joint aspiration
Corticosteroid injection

39
Q

How is severe or prolonged reactive arthritis managed?

A

DMARDs

40
Q

What drug can be used in chronic chlamydia related acquired reactive arthritis?

A

Lymecycline

41
Q

Most cases of reactive arthritis are self limiting. T/F?

A

True

Musculoskeletal (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions