Cross In Class

Question 1

Answer 1

C.

Ultrasound with show effusion, X-ray would show arthritis/soft tissue swelling (and the effusion)

CBC will show luekocytosis

ALWAYS get blood cultures

Question 2

What other non-specific lab tests could you obtain that would be helpful in correct Dx?

Answer 2

• ESR, CRP
• Look for crystals in synovial fluid (would = gout) instead of infectious arthritis

Question 3

Answer 3

B. This is reactive arthritis (Steptococci next most common)

Remmeber the specific groups!

IVDU-Pseudomonas and staph

SCD-Salmonella

Young sexually active- N. gonorrheae

Question 4

Answer 4

C.

Question 5

What does Cefepime cover for?

Answer 5

sensitive gram + (strep and MSSA, but not MRSA)- same with ceftriaxone and all gram neg

Question 6

How to treat a negative gram stain with reactive arthritis?

Answer 6

broad coverage with Vanco AND Cefepime

Question 7

Answer 7

Call surgery for drainage +- irrigation and debridement to prevent irreversible loss of joint function

Question 8

Answer 8

A. History will tell you if direct inoculation

Note that if you stick a needle into a joint with cellulitis, you can introduce bacteria

Question 9

Important risk factors for inefctive arthritis?

Answer 9

• abnormal joint architecture
• IVDU
• endocarditis
• advanced age
• DM
• immunosuppression

Question 10

Answer 10

C. ESR would be specific and will increase the risk of a septic joint

Question 11

Answer 11

Staph aureus

Question 12

What question should ask next?

Answer 12

Is she sexually active and has she had any dysuria or abnormal vaginal discharge

Question 13

Most likely diagnoses?

Answer 13

GDI caused by Neiserria (risk: multiple sex factors, menstruation DURING sex, pregnancy or being postpartum, C5-C8 deficiency)

doesnt really present like a true septic arthritis- more of a migratory arthritis

Question 14

Answer 14

Question 15

What is the most important toxin being prodcued by the organism causing this?

Answer 15

Alpha toxin (Clostridium perfringens)

Question 16

Answer 16

Question 17

Answer 17

B. This is Lyme Disease (the blood test is a western blot)

Question 18

Question 19

Where is Lyme disease most common?

Answer 19

Mostly in the North and East coast

Question 20

More common tick based infections in TN?

Answer 20

Eurlickia and Anaplasmosis

Question 21

What is a controversial sequelae to tick bites?

Answer 21

there can be chronic fatigue that presents after a tick bite and sometimes these patients get doxycycline or macrolides and they feel better so they want more but there are some anti-inflammatory properties to these drugs so its probably just that

Question 22

Answer 22

Can see nodular infiltrates in the upper lobes

Question 23

Answer 23

B.

Question 24

Answer 24

Remember that with a TB osteo disease it Is active but you might not get the constitutional symptoms and all that typical of lung TB

Question 25

Answer 25

C.

Question 26

Answer 26

G.

Fungi that can cause osteomyelitis in an IVDU- Candida (gets on needles)

Question 27

Question 28

Question 29

Answer 29

C.

Question 30

Answer 30

Fluctuant means movable which suggests abscess

C.

Question 31

Answer 31

A. Could be GAS (this is pyomyositis)

this woman had transient bacteremia affect giving birth that went to the muscle and caused an abscess

Question 32

Question 33

Answer 33

Cats can have staph aureus as well!

Question 34