Infection and inflammation

Question 1

Clinical presentation of septic arthritis

Answer 1

Limping, refuse to bear weight
Resistance to passive motion
Severe pain on attempted motion
Warmth, erythema, soft tissue swelling and effusion
If hip: Flexion, abduction and external rotation

Question 2

Xray and USG of septic arthritis

Answer 2

Ultrasound: Effusion / periosteal elevation
Xrays: Subluxation or dislocation of joint, soft tissue swelling, joint space widening

Question 3

Cause of septic arthritis

Answer 3

Primary seeding of synovial membrane
Infection in adjacent metaphyseal bone
Directly from infection in the adjoining epiphysis

Question 4

Investigation for TB septic arthritis

Answer 4

Early morning sputum sample
Stains: Ziehl Neelsen stain
Cultures: Lowenstein Jensen medium for 6 weeks
Biopsy: Classic granuloma with caseating central necrosis
Skin test: Heaf test and mantoux test
Blood test: Selective immunological interferon gamma test (IGT)

Question 5

Management for MRSA septic arthritis

Answer 5

IV Glycopeptide
For MRSA resistance to glycopeptide, oxazolidinone and linezolid