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 (A)</p> Signup and view all the answers

What is a common presentation for polyarthritis?

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

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

<p>Psoriatic arthritis (C)</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. (B)</p> Signup and view all the answers

What is essential to rule out in cases of pseudogout?

<p>Primary hyperparathyroidism (B)</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. (B)</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. (B)</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 (A)</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. (B)</p> Signup and view all the answers

Which condition is strongly associated with enthesitis?

<p>Psoriatic arthritis (A)</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. (A), Systemic lupus erythematosus (SLE). (C)</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. (B)</p> Signup and view all the answers

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

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

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

<p>Arthrodesis (B)</p> Signup and view all the answers

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

<p>Acute viral infection. (D)</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. (C)</p> Signup and view all the answers

Which feature is commonly associated with systemic sclerosis?

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

Which biochemical abnormality is normal in renal osteodystrophy?

<p>Phosphate. (A), Calcium. (C), 25(OH)D. (D)</p> Signup and view all the answers

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

<p>Lower limb predominance (B)</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 (D)</p> Signup and view all the answers

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

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

What is a common precipitating factor for a fragility fracture?

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

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

<p>Femoral neck fracture (C)</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 (A)</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 (D)</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 (B)</p> Signup and view all the answers

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

<p>Rehabilitation with physiotherapy (D)</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 (D)</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. (A)</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. (B)</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. (D)</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. (B)</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. (A)</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. (D)</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. (C)</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. (A)</p> Signup and view all the answers

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

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

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

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

What is the role of orthoses in patient care?

<p>Reduce instability and control abnormal movement (C)</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 (A)</p> Signup and view all the answers

What is a temporary measure to support painful joints?

<p>Splints (C)</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 (A)</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 (B)</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 (C)</p> Signup and view all the answers

Flashcards

Gout Serum Uric Acid

Elevated serum uric acid levels are often seen in gout, but a normal level doesn't rule out gout, especially during acute attacks where levels temporarily drop. High uric acid levels don't definitively confirm gout, as many with high uric acid never develop it.

C-Reactive Protein (CRP)

C-reactive protein (CRP) is a good marker for infection and inflammation, more specific than ESR (erythrocyte sedimentation rate).

ESR vs. CRP (autoimmune diseases)

In autoimmune conditions like lupus and systemic sclerosis, CRP might be normal, while ESR is elevated during active disease. Elevated CRP in these situations suggests a secondary infection, not the underlying disease.

Serum Creatine Phosphokinase (CPK)

Serum CPK levels help diagnose muscle disorders (myopathy/myositis), but isn't highly reliable due to low specificity and sensitivity. Elevated levels can occur in other conditions.

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CPK Elevated Causes

Elevated CPK can occur due to inflammatory myositis, muscular dystrophy, motor neuron disease, alcohol/drugs (especially statins), myocardial infarction, trauma/exercise/immobilisation, hypothyroidism, and viral myositis.

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Rheumatoid Factor (RF)

Rheumatoid factor (RF) is an antibody found in some rheumatic diseases, targeting the Fc fragment of human immunoglobulin.

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Biochemical tests interpretation

When interpreting biochemical test results, always consider the patient's clinical picture, and different hospital's test accuracy variations.

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Biochemical Abnormalities (Skeletal Diseases)

Biochemical markers like calcium, phosphate, alkaline phosphatase (ALP), parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and vitamin D can indicate various skeletal disorders like osteoporosis, Paget's disease, renal osteodystrophy, and vitamin D deficiency.

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Septic Arthritis

Inflammation of a joint caused by infection.

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Arthroscopic Washout

Surgical procedure to remove infected fluid from a joint.

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Blood Cultures

Testing blood samples for presence of infection.

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CRP and ESR

Blood markers elevated in inflammatory conditions (including sepsis and arthritis).

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Gout

Type of arthritis caused by uric acid crystal buildup in joints.

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Pseudogout

Type of arthritis caused by calcium pyrophosphate crystals in joints.

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Polyarthritis

Pain and swelling in five or more joints.

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Rheumatoid Arthritis

Chronic inflammatory condition affecting joints, often symmetrical.

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Viral Arthritis

Joint inflammation caused by a viral infection, temporary.

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Osteoarthritis

Degenerative joint disease, common in older adults, affecting specific joints.

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Intra-articular glucocorticoid injection

Injection of steroid into the joint to reduce inflammation.

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Inflammatory Arthritis

Arthritis with characteristic symptoms like early-morning stiffness and worsening with inactivity.

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Psoriatic Arthritis (PsA)

A type of inflammatory arthritis strongly associated with enthesitis, affecting small joints.

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Rheumatoid Arthritis (RA)

Symmetrical inflammatory arthritis affecting small joints (hands, feet, wrists).

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Enthesitis

Inflammation at the point where tendons or ligaments attach to bone.

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Spondyloarthritis (SpA)

A type of inflammatory arthritis with asymmetry, lower limb predominance, and enthesitis.

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Inflammatory Small Joint OA

Inflammation in small joints similar to PsA in pattern.

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Proximal and Distal Interphalangeal (PIP and DIP) Joints

Joints in the fingers between the knuckles and the fingertip.

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Metacarpophalangeal (MCP) Joints

Joints between the hand (metacarpal) bones and the fingers (phalanges).

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Nail Pitting

Small pits on the surface of the nail associated with PsA.

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Onycholysis

Separation of the nail from the nail bed; associated with PsA.

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Symmetrical Joint Involvement

Similar involvement on both sides of the body, as seen in RA.

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Fragility fracture

A fracture caused by a fall from a standing height or less, often due to osteoporosis or osteopenia.

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Vertebral fracture

A break in one of the vertebrae, often from bending, lifting, or falling.

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Stress fracture

A fracture caused by repetitive stress, like running or excessive training.

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High-energy fracture

A fracture caused by significant trauma.

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Pathological fracture

A fracture caused by a pre-existing disease or condition like malignancy or bone disease, needing only minimal trauma.

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X-ray investigation

Imaging method for visualizing bones to detect fractures and underlying disorders.

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MRI (Magnetic Resonance Imaging)

Advanced imaging technique, used when X-rays don't show a fracture but suspicion remains high.

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DXA scan

A bone density scan used to diagnose osteoporosis in patients over 50 with fragility fractures.

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Fracture management (acute stage)

Includes pain relief (possibly opiates), fracture reduction, and limb immobilization.

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Femoral neck fracture

Fracture of the femoral neck, often needing joint replacement surgery due to risk of non-union or avascular necrosis.

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Rehabilitation

Physiotherapy and supervised exercises for regaining mobility and strength.

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Suspected Vertebral Fracture

A broken vertebrae, clinically suspected. Needs examination for end plate depression on X-ray.

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Rheumatic Disease Interventions

Treatment options for rheumatic diseases encompassing education, exercise, pain management, and disease-modifying therapies.

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Patient Education

Providing information about the condition, treatment, and prognosis to improve outcomes and reduce healthcare costs.

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Aerobic Conditioning

Exercise program focused on cardiovascular fitness, reducing pain and disability in rheumatic conditions.

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Muscle Strengthening

Exercises to build muscle strength around affected joints, reducing pain and improving function in rheumatic conditions.

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Simple Analgesics

Over-the-counter pain relievers used to manage discomfort in rheumatic conditions.

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Disease-Modifying Therapy

Treatments aimed at altering the disease process in rheumatic conditions, slowing progression.

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Pacing of Activities

Scheduling activities to avoid overexertion and preserve energy in managing rheumatic conditions.

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Education for Children and Adolescents

Multidisciplinary approach to education, support for the whole family, and assistance for school and psychological well-being.

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Exercise for Chronic Arthritis

Aerobic and local strengthening exercises can reduce pain, improve function, and address associated issues.

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Exercise Frequency

Short, frequent sessions of strengthening exercise are more beneficial than infrequent, prolonged ones.

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Weight-bearing exercise in osteoporosis

Exercise that puts pressure on bones, resulting in modest bone density increases and slower bone loss.

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Joint protection

Strategies to avoid worsening arthritis symptoms caused by impact or repeated joint use.

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Impact loading

Forces on a joint during activities that cause strong impact.

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Repetitive use

Repeated use of a joint or nearby tissue that can worsen arthritis symptoms.

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Local heat/ice

Applying heat or ice to a specific area to soothe muscle pain and inflammation in rheumatic diseases.

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Hydrotherapy

Using water to relieve pain and improve movement in rheumatic diseases.

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Splints

Temporary supports for painful joints preventing harmful postures.

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Orthoses

More permanent devices decreasing joint instability and abnormal movement.

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Aids & appliances

Tools like raised toilet seats, or adapted tools to improve daily living.

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Self-help/coping strategies

Methods to manage chronic pain and disability.

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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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