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phase2a medicine > bone infection and a bit more arthritis > Flashcards

bone infection and a bit more arthritis Flashcards

Questions focussing on reactive, psoriatic, and septic arthritis (i.e. the arthritic diseases upon which the syllabus places less importance, and which are less common). Also includes information about osteomyelitis.

1
Q

who is likely to get reactive arthritis?

A

a 20 year old 1-4 weeks post chlamydia

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2
Q

signs of reactive arthritis

A

swelling and pain of the knee, ankle, and foot
iritis
mouth ulcers
Reiter’s syndrome

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3
Q

what does Reiter’s syndrome involve?

A

urethritis
conjunctivitis
arthritis

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4
Q

diagnosis of reactive arthritis

A

increased ESR and CRP
culture stool if diarrhoea
sexual health review

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5
Q

treatment of reactive arthritis

A

splint joint
NSAIDs
consider methotrexate or sulfasalazine after 6 months

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6
Q

who will develop psoriatic arthritis?

A

someone with psoriasis

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7
Q

signs of psoriatic arthritis

A

dactylitis
pitting
telescoping
nail changes

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8
Q

diagnosis of psoriatic arthritis

A

erosions visible on XR

resorption of terminal phalanges

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9
Q

treatment for psoriatic arthritis

A 
NSAIDs
methotrexate
sulfasalazine
cyclosporin
anti-TNF agents
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10
Q

risk factors for osteomyelitis

A 
damaged joint
bacteraemia
trauma
skin break ulcer
diabetes
rheumatoid arthritis
immune diseases
elderly
immunosuppression
peripheral vascular disease
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11
Q

which organism is likely to cause osteomyelitis in native joints?

A

S.aureas

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12
Q

how can someone develop osteomyelitis?

3 causes

A

haematogenous spread
direct inoculation
contigious spread (from adjacent tissues)

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13
Q

how does osteomyelitis look on a plain x-ray?

A 
cortical erosion 
periosteal reaction 
mixed lucency 
sclerosis
sequestra
soft tissue swelling
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14
Q

signs of osteomyelitis

A 
fever
pain 
fatigue
lost range of motion 
swelling
red and warm 
nausea
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15
Q

what should you do with patients with staphylococcal bacteraemia?

A

ECHO to rule out infective endocarditis

MRI spine to rule out osteomyelitis

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16
Q

differential diagnosis for osteomyelitis

A 
gout
soft tissue infection 
Charcot joint
avascular necrosis
malignancy
bursitis
fracture
17
Q

diagnostic tests for osteomyelitis

A

bloods - FBC, U&E, CRP and ESR raised
XR and MRI
PCR
marrow aspiration

18
Q

how high is CRP for an infection?

A

> 150

19
Q

pathology of acute osteomyelitis

A

inflammatory cells, oedema, vascular congestion, small vessel thrombosis, high WCC

20
Q

pathology of chronic osteomyelitis

A

necrotic bone sequestra, new bone formation, neutrophil exudates, lymphocytes, histiocytes

21
Q

treatment of osteomyelitis

A 
surgery - aspirate and wash out joint
antibiotics - initially broad spectrum (ceftriazone)
stop immunosuppression 
if on prednisolone, double the dose
analgesia
splinting and rest
22
Q

how long should you treat TB osteomyelitis for?

A

12 months

23
Q

which antibiotics should you use to treat S.aureus osteomyelitis?

A

flucoxacillin, erythromycin, or doxyltetracycline

24
Q

what percentage of cases of septic arthritis are caused by Staphylococci?

A

50%

25
Q

what is the success rate for one stage exchange for the treatment of septic arthritis?

A

85%

two stage exchange has a 90-95% success rate

26
Q

risk factors for septic arthritis

A 
prosthetic joint
diabetes mellitus
immunosuppression 
elderly
damaged joints
27
Q

what is most likely to cause septic arthritis is young and sexually active patients?

A

Gonococcal

28
Q

what is most likely to cause septic arthritis in immunocompromised patients?

A

Strep pyogenes
P.aeruginosa (IVDU)
TB

29
Q

signs of septic arthritis

A 
prosthetic loosening
expansion of cortex on XR
ectopic bone formation
painful to move joint
high temperature
signs of inflammation
30
Q

diagnosis of septic arthritis

A

joint aspirate and culture
XR
FBC, ESR, alpha-defensin

31
Q

how to prevent septic arthritis

A

totally clean operating theatre
give patients broad spectrum antibiotics and clean skin with antibiotics prior to joint surgery
gentamicin in bone cement

32
Q

treatment for septic arthritis

A 
aspirate for pain 
IV antibiotics
surgery - joint washout / amputation / exchange arthroplasty
RICE
physiotherapy
temporarily stop immunosuppression
33
Q

which organisms are likely to cause septic arthritis in children?

A

S.aureus
group A strep
gram -ve bacilli

phase2a medicine (53 decks)

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