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RUSVM LASx PRACTICE QUESTIONS > Exam 2: Septic Arthritis/ Physitis > Flashcards

Exam 2: Septic Arthritis/ Physitis Flashcards

1
Q

What 3 types of septic arthritis are seen in foals?

A

S, E, P

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2
Q

Which type of septic arthritis seen in foals usually only effects 1 site?

A

P-type

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3
Q

Which type(s) of septic arthritis seen in foals usually effects multiple sites?

A

S and E

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4
Q

What is the most common etiology of septic arthritis?

A

Bacterial

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5
Q

What is the greatest risk factor for septic arthritis/physitis in foals?

A

Failure of passive transfer

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6
Q

Why do you NEVER debride in cases of P-Type septic arthritis in foals?

A

Debridement damages the physis and causes premature closure!

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7
Q

What do you expect the cell count to be of synovial fluid analysis

in a foal with S or E-Type septic arthritis?

A

greater than 50,000

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8
Q

What do you expect the neutrophil percentage to be of synovial fluid analysis

in a foal with S or E-Type septic arthritis?

A

greater than 90% neutrophils

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9
Q

What abnormalties do you see on bloodwork in

cases of S or E-Type septic arthritis?

A

Increased fibrinogen ± leukocytosis

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10
Q

In cases of S or E-Type septic arthritis,

Fibrinogen is usually ______mg/dL with bone involvement

A

>900 mg/dL

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11
Q

What is the prognosis for septic arthritis in foals?

A

77% survival in foals

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12
Q

What are the iatrogenic risk factors for septic arthritis in adults?

A

Iatrogenic: synovial sx, fracture repair, arthrocentesis

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13
Q

This pathogen is seen as the causative agent in a third of the iatrogenic cases

of septic arthritis in adults, especially in arthrocentesis

A

Staphylococcus spp.

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14
Q

What is the gold standard for diagnosis of septic arthritis?

A

Microbiology

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15
Q

At what age is S-type septic arthritis seen in foals?

A

Less than 1 week old

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16
Q

What solutions should (and shouldn’t) be used for lavage in a case of septic arthritis?

A

USE: Balanced electrolyte solution (LRS, Normosol) +/- DMSO

Do NOT add chlorhexidine, povidone iodine- cytotoxic and unhelpful

Do NOT give 5% dextrose solution- will be feeding the bacteria!

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17
Q

What organism is most commonly isolated in a case of septic arthritis?

A

Staphylococcus spp.

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18
Q

T/F: In a case of septic arthritis in adults and foals,

it is important to check the umbilicus as a source of infection

A

FALSE

Only check umbilicus in foals

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19
Q

When is it acceptable to stop antibiotic treatment for septic arthritis?

A

Minimum 30 days and 2 weeks beyond resolution of clinical signs (whichever is longer)

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20
Q

T/F: Arthrotomy is contraindicated in the treatment of septic arthritis in cattle.

A

False

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21
Q

What is the mainstay of treatment for septic arthritis?

A

LAVAGE- Early and often; large volumes (5-10 liters)

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22
Q

What type of septic arthritis in foals typically presents with swelling, but usually without effusion?

A

P-Type

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23
Q

What are the three types of septic arthritis in foals?

A

S, E, P (Synovial, Epiphysis, Physis)

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24
Q

With what type of septic arthritis in foals might you be able to see subchondral lysis on radiographs?

A

E-Type

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25
Q

This is the most distal nerve block performed in the horse:

A

Palmar digital nerve block

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26
Q

Horses undergoing arthrodesis of this joint have an 80% prognosis for return to work:

A

Hindlimb pastern arthrodesis

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27
Q

This is the primary collagen found in tendons:

A

Type 1

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28
Q

Which type of septic arthritis seen in foals usually only effects 1 site while the others effect multiple sites?

A

P-type

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29
Q

Which type(s) of septic arthritis seen in foals usually effects multiple sites?

A

S and E-Types

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30
Q

What is the most common etiology of septic arthritis?

A

Bacterial

31
Q

What is the greatest risk factor for septic arthritis/physitis in foals?

A

Failure of passive transfer

32
Q

Why do you NEVER debride in cases of P-Type septic arthritis in foals?

A

Debridement damages the physis and causes premature closure!

33
Q

What do you expect the cell count to be of synovial fluid analysis in a foal with S or E-Type septic arthritis?

A

Greater than 50,000

34
Q

What do you expect the neutrophil percentage to be of synovial fluid analysis in a foal with S or E-Type septic arthritis?

A

Greater than 90% neutrophils

35
Q

What abnormalities do you see on bloodwork in cases of S or E-Type septic arthritis?

A

Increased fibrinogen ± leukocytosis

36
Q

In cases of S or E-Type septic arthritis, Fibrinogen is usually ______mg/dL with bone involvement

A

>900 mg/dL

37
Q

What is the prognosis for septic arthritis in foals?

A

77% survival in foals

38
Q

What are the iatrogenic risk factors for septic arthritis in adults?

A

Iatrogenic: synovial sx, fracture repair, arthrocentesis

39
Q

This pathogen is seen as the causative agent in a third of the iatrogenic cases of septic arthritis in adults, especially in arthrocentesis

A

Staphylococcus spp.

40
Q

In order to determine failure of passive transfer in a foal, you look at IgG levels. What is the normal level in a foal?

A

IgG greater than 800

41
Q

What sites are most common for S-Type septic arthritis in foals?

A

Stifle, Tibiotarsal

42
Q

What sites are most common for E-Type septic arthritis in foals?

A

Distal femur, talus, tibia, radius

43
Q

What sites are most common for P-Type septic arthritis in foals?

A

Distal physis of MC3/MT3, radius, tibia

44
Q

Acute, severe, very painful lameness in a foal less than 1 week old with effusion present is most characteristic of this type of septic arthritis.

A

S-Type

45
Q

Mild, intermittent lameness in a foal a couple weeks old is seen. Suddenly, the lameness is exacerbated and effusion is seen. The foal had a history of diarrhea and its IgG levels at birth were low. What is your most likely diagnosis?

A

E-Type Septic Arthritis

46
Q

A 2 month old foal is normal and healthy. All of a sudden, he becomes lame. You have localized the problem to the distal MT3. There are no signs of joint effusion, but on radiographs, soft tissue swelling is seen along with lysis around the physeal plate. What is your most likely diagnosis?

A

P-Type Septic Arthritis

47
Q

How do you confirm your diagnosis of P-Type Septic Arthritis?

A

Aspirate the physis and submit for culture

48
Q

If you cannot get a physis aspirate, what can you do to confirm your diagnosis of P-Type?

A

Bone biopsy

49
Q

When running diagnostics for suspected septic arthritis, culture _______ treating with antibiotics

A

Culture before treating with antibiotics

50
Q

Can you still culture if antibiotics have been given?

A

YES, but make sure to put the sample in the appropriate culture broth

51
Q

Why do you tap AWAY from the wound in cases of septic arthritis?

A

To avoid bringing bacteria into the joint in case the joint isn’t actually involved.

Distend joint to determine joint involvement!

52
Q

What are the 4 main goals of treatment of septic arthritis?

A

Eradicate infection

Eliminate inflammation

Minimize matrix loss

Minimize cartilage damage

53
Q

After sample has been acquired, what type of antibiotics are given to treat septic arthritis?

A

Broad-spectrum (PEN/GEN) AND local antibiotics

54
Q

Needle, or through-and-through lavage, uses ________ gauge needles, which are placed in all compartments

A

14 – 16G

55
Q

Needle, or through-and-through lavage requires sedation and local anesthesia. What drugs are used in the joint to accomplish this?

A

2% Mepivicaine or Carbocaine

56
Q

Why is Amikacin (Aminoglycoside) used as a first line defense locally in the treatment of septic arthritis even though bacteria are only intermittently susceptible to it?

A

Putting Amikacin directly into the joint allows for a HIGH MIC

57
Q

_______mg of Amikacin provides _______ hours concentration,

which is greater than the MIC for most common pathogens

A

500 mg of Amikacin provides 72 hours concentration,

which is greater than the MIC for most common pathogens

58
Q

This type of tourniquet is used to accomplish regional limb perfusion and is left on for 30 minutes

A

Esmarch tourniquet

59
Q

This agent is used topically to help keep inflammation down during regional limb perfusion

A

SURPASS®

60
Q

In cattle, this agent is used via regional limb perfusion in the treatment of septic arthritis

A

Florfenicol

61
Q

In cattle, Florfenicol is used via regional limb perfusion because it is effective against these 2 bacterias responsible for causing septic arthritis

A

F. necrophorum, A. pyogenes

62
Q

What is the general rule of thumb for dosage of antibiotics via regional limb perfusion?

A

1/3 of the systemic dose

63
Q

A 25-27G ______ catheter is used to deliver antibiotics via regional limb perfusion

A

Butterfly catheter

64
Q

This joint replacement fluid is the best adjunct therapy for treatment of septic arthritis because it is chondroprotective and not immunosuppressive while it replaces synovial fluid.

A

HA- Hyaluronic Acid

65
Q

What medication is contraindicated in the treatment of septic arthritis?

A

STEROIDS (immunosuppressive!)

66
Q

What agent is instilled into the joint after arthrocentesis in order to prevent

septic arthritis?

A

Ceftiofur

67
Q

Describe the pathogenesis of septic arthritis

A

Synovitis–>Fibrin deposition–> Cellular infiltrates (inflammatory mediators)–>

decreased HA synthesis + loss of PG–> Joint effusion

Creates a cycle of cartilagenous matrix destruction

68
Q

What do you see on radiographs of E-Type Septic Arthritis?

A

Subchondral lysis

69
Q

In a suspected case of septic arthritis, C&S was inconclusive. What do you do next

if you still think it is, in fact, SA?

A

submit for FUNGAL culture

and repeat culture if the initial sample is negative

70
Q

This is an important complication of septic arthritis and can

be the rate-limiting step

A

Contralateral limb laminitis

71
Q

Which antibiotic can be given CRI to treat septic arthritis?

A

Beta-lactam abx

72
Q

For regional limb perfusion:

qs to _______ mL for DISTAL limb

and

qs to _______ mL if ABOVE carpus/tarsus

A

qs to 30 mL for DISTAL limb

and

qs to 60 mL if ABOVE carpus/tarsus

73
Q

What analgesic agents are used to treat patients with septic arthritis due to it

being excruciatingly painful

A

NSAIDS (Monitor for toxicity)

OPIATES

LIDOCAINE/KETAMINE (CRI)

OPIATES and DETOMIDINE (Via Epidural Catheter for hindlimb SA)

OMEPRAZOLE AND SUCRALFATE (GI Protectants to prevent ulcers)

RUSVM LASx PRACTICE QUESTIONS (24 decks)

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