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Session 4 CM Rheum-4

CM- Rheum -4- Septic Arthritis

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