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Session 4 CM Rheum-4
CM- Rheum -4- Septic Arthritis
| Question | Answer |
|---|---|
| What type of arthritis is marked by organisms actually growing inside the joint | Septic Arthritis |
| What is monoarthritis until proven otherwise | septic arthritis |
| As the number of joints involved increases what happens to the probable dx of septic arthritis | it goes down more joints involved the less likely it is to be septic arthritis |
| If pt has polyarthritis but one joint is reacting differently then the others what should you suspect | even though many joints have arthritis only one is acting differently this is like a monoarthritis and should be treated as if it was septic arthritis in that joint |
| If pt presents with fever and arthritis what should you suspect | septic arthritis |
| What dx procedure is mandatory if septic arthritis is suspected | arthrocentesis |
| When should you perform arthrocentesis | suspected arthritis it is mandatory, strongly advised if crystal or hemarthrosis is suspected. Useful in differentiating inflammatory from non-inflammatory arthritis. Must be done for synovial biopsy |
| When can arthrocentesis be used therapeutically | for tense effusion to relieve pain and improve function, remove blood or pus from the joint, injection of steroid and other intra-articular therapies, for tidal lavage of joints |
| When is arthrocentesis contraindicated | never absolutely contraindicated but not advised in bleeding diathesis or anti coagulation, cellulitis or allergy to topical or indictable anesthetics |
| What is the most important test to run on the synovium you collected from arthrocentesis | gram stain and culture and sensitivity |
| What studies should be run on synovial fluid obtained from arthrocentesis | gross exam to classify the fluid, gram stain, C & S, cell count and differential, glucose determination |
| What happens to the clarity of joint fluid as class increases from normal to 3 | it becomes more opaque |
| What does missing string sign indicate | inflammatory synovium it behaves like water and doesn't make the string sign when dripped out of a needle |
| What is the most common type of organism that causes septic arthritis | Gram + organisms 70%, 50% staph aureus |
| What is the best type of antibiotic to start a pt with while you wait for the gram stain and culture and sensitivity to come back | start them on a Ab that covers gram + organisms as they account for 70% of septic arthritis cases and pray it isn't MRSA |
| What are the Gram - organisms that rarely cause septic arthritis | salmonella (SLE, HIV, SS), Pseud. Aeruginosa (IVDA), DGI (septic or sterile immune complex mediated) |
| What organisms is associated with polyarticular dx | strep organisms |
| what is the most common cause of septic arthritis in younger sexually active populations | Gonococcal Arthritis |
| How does gonococcal arthritis typically present | as a oligoarthritis, fever, rash and tenosynovitis |
| What risk factors increase the likelihood of developing disseminated gonococcal infection with joint involvement | menstruation, pregnancy and C5-9 deficiencies |
| What signs will often be present if pt has septic arthritis in the spine | chronic unrelenting back pain, fever and local tenderness. Infection usually crosses disc space, |
| What is an indication that TB is causing the spinal septic arthritis | T10-L2 region involved with paraspinal cold abscess |
| What is the management approach for spinal septic arthritis | start Ab and repeat arthrocentesis. Surgical Drainage after 72hrs. Monitor improvement with serial joint fluid aspiration |
| If pt has septic arthritis at unusual sites what may have been the way the organism was introduced into their body | IV drug abuse |
| You get a C&S back and find out it is a spirochetal infection what is the likely cause | Lyme arthritis, |
| What test can confirm Lyme arthritis | western blot |
| What tx will you give for a pt with chronic Lyme arthritis | IV antibiotic possible synovectomy |
| What are the Jones criteria for | dx of rheumatic fever |
| what are the major criteria of the Jones criteria | Arthritis, Carditis, Chorea, erythema marginatum, nodules. |
| What are the minor criteria of the Jones criteria for rheumatic fever | recent strep, Elevated ASOT, antistrep abs, Group A strep on C & S, recent scarlet fever |
Created by:
smaxsmith
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