Arthritis and Sepsis Assessment Quiz
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Questions and Answers

What should be done if sepsis is suspected in a large joint?

  • Administer oral antibiotics immediately
  • Check serum uric acid levels
  • Conduct a physical examination only
  • Perform arthroscopic washout and send fluid for culture (correct)

    • Which test can help assess the response to treatment in suspected sepsis or arthritis?

  • C-reactive protein (CRP) levels and ESR (correct)
  • Thyroid function tests
  • Complete blood count (CBC)
  • Liver function tests

    • Which condition typically shows symmetrical involvement of small joints and may include a rash?

  • Viral arthritis (correct)
  • Rheumatoid arthritis
  • Osteoarthritis
  • Psoriatic arthritis

    • Which option describes the characteristics of osteoarthritis?

    <p>Symmetrical, targeting specific joints with bony nodes</p> Signup and view all the answers

    What is a common presentation for polyarthritis?

    <p>Pain and swelling affecting five or more joints</p> Signup and view all the answers

    In the context of arthritis, which condition is associated with dactylitis?

    <p>Psoriatic arthritis</p> Signup and view all the answers

    What is the implications of having normal serum uric acid levels in the diagnosis of gout?

    <p>It does not exclude the diagnosis of gout.</p> Signup and view all the answers

    What is essential to rule out in cases of pseudogout?

    <p>Primary hyperparathyroidism</p> Signup and view all the answers

    What does a normal serum uric acid level indicate regarding gout during an acute attack?

    <p>Gout may still be present despite normal levels.</p> Signup and view all the answers

    In which scenario might an elevated serum C-reactive protein (CRP) be misleading?

    <p>In a patient with systemic sclerosis with an intercurrent illness.</p> Signup and view all the answers

    Which arthritis is characterized by symmetrical involvement of the small joints of the hands and feet?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What is a limitation of serum creatine phosphokinase (CPK) levels in diagnosing myopathy?

    <p>Raised levels can occur in various conditions.</p> Signup and view all the answers

    Which condition is strongly associated with enthesitis?

    <p>Psoriatic arthritis</p> Signup and view all the answers

    Which autoimmune connective tissue disease may present with a normal CRP but an elevated ESR in active disease?

    <p>Scleroderma.</p> Signup and view all the answers

    What does an elevated rheumatoid factor (RF) indicate?

    <p>It is a non-specific marker for various rheumatic diseases.</p> Signup and view all the answers

    Nail pitting and dystrophy are clinical features specifically associated with which type of arthritis?

    <p>Psoriatic arthritis</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with extra-articular features of SLE?

    <p>Arthrodesis</p> Signup and view all the answers

    Which condition is NOT typically associated with elevated serum creatine phosphokinase (CPK) levels?

    <p>Acute viral infection.</p> Signup and view all the answers

    What does the presence of alkaline phosphatase (ALP) indicate in the context of osteoporosis post-fracture?

    <p>It can be normal or raised depending on the phase of healing.</p> Signup and view all the answers

    Which feature is commonly associated with systemic sclerosis?

    <p>Xerostomia and dry skin</p> Signup and view all the answers

    Which biochemical abnormality is normal in renal osteodystrophy?

    <p>Phosphate.</p> Signup and view all the answers

    Which of the following is a common feature of spondyloarthritis (SpA)?

    <p>Lower limb predominance</p> Signup and view all the answers

    In which type of arthritis may you find involvement of proximal and distal interphalangeal joints?

    <p>Psoriatic arthritis</p> Signup and view all the answers

    Which condition can present with photosensitivity as an extra-articular feature?

    <p>Systemic lupus erythematosus</p> Signup and view all the answers

    What is a common precipitating factor for a fragility fracture?

    <p>Fall from standing height or less</p> Signup and view all the answers

    Which imaging method should be used first to investigate a suspected vertebral fracture when X-rays show no evidence of a fracture?

    <p>MRI</p> Signup and view all the answers

    What type of fracture is particularly associated with non-union and avascular necrosis?

    <p>Femoral neck fracture</p> Signup and view all the answers

    What should be included in X-ray evaluations for suspected fractures?

    <p>The whole bone and joints at either end</p> Signup and view all the answers

    For patients over the age of 50 with fragility fractures, what screening should be performed?

    <p>DXA scan for osteoporosis</p> Signup and view all the answers

    What is a key component of the management approach for managing an acute fracture?

    <p>Adequate pain relief and immobilisation</p> Signup and view all the answers

    What kind of treatment is typically required after healing from a fracture?

    <p>Rehabilitation with physiotherapy</p> Signup and view all the answers

    Which of the following conditions may be detected on X-rays that reveal a vertebral fracture?

    <p>Paget's disease</p> Signup and view all the answers

    What is a key benefit of education for patients with rheumatic diseases?

    <p>It can improve adherence to treatment protocols.</p> Signup and view all the answers

    Which type of exercise is most beneficial for patients with chronic arthritis?

    <p>Small amounts of strengthening exercises performed frequently.</p> Signup and view all the answers

    Which intervention can help in managing pain and improving flexibility in patients with rheumatic diseases?

    <p>Pacing of activities combined with rehabilitation.</p> Signup and view all the answers

    Which of the following is NOT a core intervention for patients with rheumatic diseases?

    <p>Self-medication with herbal remedies.</p> Signup and view all the answers

    What role does the inclusion of a patient's partner or carer play in managing chronic conditions?

    <p>It is essential, particularly in childhood conditions and beneficial for many chronic adult conditions.</p> Signup and view all the answers

    Which of the following is a physical treatment option for patients with rheumatic diseases?

    <p>Local glucocorticoid injections.</p> Signup and view all the answers

    Which of the following has been shown to produce long-term pain reduction in patients with rheumatic diseases?

    <p>Aerobic fitness training.</p> Signup and view all the answers

    What is one of the advantages of non-pharmacological treatments in managing rheumatic diseases?

    <p>They can be safe, cost-effective, and offer long-lasting effects.</p> Signup and view all the answers

    What effect do weight-bearing exercises have on patients with osteoporosis?

    <p>Slow down bone loss</p> Signup and view all the answers

    Which strategy is recommended to minimize joint strain in patients with arthritis?

    <p>Cessation of contact sports</p> Signup and view all the answers

    What is the role of orthoses in patient care?

    <p>Reduce instability and control abnormal movement</p> Signup and view all the answers

    How do local heat and ice packs benefit patients with rheumatic diseases?

    <p>Induce muscle relaxation and relieve symptoms</p> Signup and view all the answers

    What is a temporary measure to support painful joints?

    <p>Splints</p> Signup and view all the answers

    Which of the following assists patients with daily living activities to maintain independence?

    <p>Occupational aids and appliances</p> Signup and view all the answers

    What recommendation is made regarding prolonged rest for patients with chronic pain?

    <p>Prolonged rest must be avoided</p> Signup and view all the answers

    What effect does hydrotherapy have on patients with chronic pain conditions?

    <p>Enhances movement in a low-load environment</p> Signup and view all the answers

    Study Notes

    Musculoskeletal System Disorders

    • Affect all ages and ethnic groups
    • Account for 25% of new consultations in general practice in the UK
    • Manifestations include pain and impairment of locomotor function
    • More common in women and increase with age
    • Common cause of physical disability in older people

    Bone Structure

    • Two main types:
      • Flat bones (skull) formed by intramembranous ossification
      • Long bones (femur, radius) formed by endochondral ossification
    • Components:
      • Cortical bone: dense, forms outer layer
      • Trabecular bone: inner meshwork, contains bone marrow
    • Cell types:
      • Osteoclasts: resorb bone
      • Osteoblasts: form bone
      • Osteocytes: sense and respond to mechanical stimuli
      • Bone marrow stromal cells: produce RANKL and M-CSF

    Bone Remodelling

    • Cyclical process: quiescence, resorption, reversal, formation
      • Osteoclasts remove old bone
      • Osteoblasts replace with new bone
    • Mediators:
      • RANKL: stimulates osteoclast formation
      • RANK: receptor for RANKL (activates osteoclast formation)
      • OPG: decoy receptor for RANKL (inhibits osteoclast formation)
      • Sclerostin (SOST): inhibits bone formation
      • Wnt family members: stimulate bone formation

    Joint Structure

    • Types: fibrous, fibrocartilaginous, synovial
    • Synovial joints contain:
      • Synovial fluid: lubricates the joint
      • Articular cartilage: covers bone ends
      • Synovial membrane: lines the joint capsule
      • Ligaments: strengthen the joint capsule
      • Bursae: cushion tendons and muscles
    • Synovial cells:
      • Type A: phagocytic, remove debris
      • Type B: fibroblast-like, secrete synovial fluid

    Musculoskeletal Disease Investigations

    • Clinical history and examination often sufficient for diagnosis
    • Joint aspiration: used for septic arthritis, crystal arthritis or bleeding
    • X-rays: diagnosis and monitoring of many bone and joint diseases
    • Bone scintigraphy: useful for metastatic bone disease, Paget's, etc
    • MRI: detailed images of bone and soft tissues in musculoskeletal diseases
    • Ultrasound: detect early synovitis, evaluating tendon lesions
    • Blood tests: assess metabolic bone disease, muscle diseases, gout
    • Immunological tests: used in rheumatic diseases (e.g., rheumatoid factor, anti-CCP antibodies, ANAs)
    • Tissue biopsy: can confirm diagnosis, assess tissue samples for infection or other issues

    Gout

    • One of the most common inflammatory arthritides
    • Sudden onset of pain in a joint (typically first metatarsophalangeal joint)
    • Characterized by inflammation, redness, and swelling.
    • Caused by increased serum uric acid (hyperuricemia):
    • either overproduction or underexcretion
    • Characterized by formation of monosodium urate (MSU) crystals in joints
    • Can be treated with colchicine, NSAIDs, corticosteroids, and/or urate-lowering medications (e.g., allopurinol).

    Septic Arthritis

    • Infection within a joint
    • Red Flag: do not miss
    • Sepsis
    • Infection in one area causes a whole body response.
    • Can be diagnosed via blood tests (ESR, CRP), blood cultures, X-rays and joint fluid analysis.
    • Treatment includes antibiotics administered intravenously, joint drainage, monitoring
    • Prevention:
    • Avoid procedures that could introduce microorganisms into the joint

    Rheumatoid Arthritis

    • Chronic autoimmune inflammatory disorder
    • Characterized by:
    • Early morning stiffness (lasts > 30 minutes)
    • Fatigue and tired easily
    • Painful and swollen joints
    • Inflammation of the lining of the joints (synovium)
    • Common sites are hands (small joints of the wrist and fingers)
    • Treatment includes NSAIDs, corticosteroids, DMARDs (methotrexate) and biologics

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    Description

    Test your knowledge on the assessment and management of arthritis and sepsis. This quiz covers various conditions related to joint health, symptoms, diagnostic tests, and treatment implications. Perfect for healthcare professionals dealing with joint diseases.

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