Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK/Rheum path > Infectious arthritis > Flashcards

Infectious arthritis Flashcards

1
Q

What is significant about acute bacterial arthritis?

A

medical emergency warranting rapid, accurate Dx and immediate Tx and is usually result of bacteremic seeding from S. aureus (esp in adults)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are poor prognostic factors in bacterial joint infections?

A

old age, RA, infection in prosthetic joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the proper Tx for patients with early prosthetic joint infections?

A

debride; ATBx, implant retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the proper Tx for late prosthetic joint infections?

A

ATBx Tx directed at isolated organism w/ removal of prosthesis before reimplantation of new one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who is at highest risk for polyarticular septic arthritis?

A

neonates; sickle cell anemia; RA patients; Neiserria organisms along with salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

T/F bacterial arthritis is most commonly monoarticular

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Classic presentation on nongonococcal arthritis

A

acute onset of pain, swelling and decreased ROM of single joint with large joints more commonly affected that is typically seen in immunocompromised/sensitive patients

hips in infants and small children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should be done on all patients who present with an inflamed joint?

A

arthrocentesis and synovial fluid analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who is at highest risk for gonococcal arthritis?

A

sexually active young adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does gonococcal arthritis present?

A

1) fever, vesiculopustular skin lesiom, tenosynovitis, polyarthralgia
2) prevalent arthritis of knee, wrist or ankle while more than 1 joint may be affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long should the duration of antibiotic Rx be for bacterial arthritis?

A

2-6 wks for non-gonococcal septic arthriitis

1 week for gonococcal arthritis with ceftriaxone use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define lyme disease manifestations

A

expanding macular skin lesion=> erythema migrans;

50% have musculoskeletal signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is key for the host in defense against lyme disease?

A

IgG containing immune complexes and cryoglobulins are key;

secondary are Th1 and Th17 cells mediating Lyme arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does a mycobacterial infection affect the bones and joints?

A

chronic localized infection involving the spine, less often the hip or knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are musculoskeletal mycobacterial infections difficult to diagnose?

A

rarity of disease that many lack the pain, fever, chills and other Sx associated with bacterial infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical presentation of spinal TB

A

localized pain that may or may not be associated with low grade fever, weight loss and nonspecific constitutional Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does TB osteomyelitis begin?

A

hematogenous implantation of organizing in medullary area and metaphyseal involvement(common) spreading through the growth plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common presentation in TB osteomyelitis?

A

bone pain most common

draining sinus, abscess formation, local swelling, tenderness are common but may be delayed many years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should be considered in patients from endemic areas who present with multiple destructive skeletal lesions?

A

multifocal osteoarticular TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does septic arthritis from TB typically present?

A

monoarticular arthritis typically of large joints such as hip/knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F in TB associated with septic arthritis, acid fast bacilli are typically present

A

false, only 10-20%

synovial fluid is typically positive for culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the tuberculous spondylitis sites of involvement?

A

1) vertebral body
2) posterior osseous or ligamentous structures
3) prevertebral tissues
4) extension to intervertebral disk
5) subligamentous spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Who is at risk for latent TB reactivation?

A

patients with systemic rheumatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What molecule plays a key role in granuloma formation and stabilization?

A

TNF-a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Define Poncet's disease
aseptic inflammatory polyarthritis occuring in presence of active TB commonly in knee, ankles and elbows
26
In contrast to TB, nontuberculosis mycobacteria is likely to cause what?
tenosynovitis, synovitis or osteomyelitis and LESS LIKELY to cause spinal infection
27
How can nontuberculosis mycobacteria be distinguished from TB with regards to musculoskeletal infections?
they cannot be distinguished so correct diagnosis requires tissue biopsy and culture
28
What is critical in proper diagnosis of fungal infections?
exam and culture of infected tissue
29
What types of fungal infections are likely to cause osteomyelitis?
coccidioidomycosis, blastomycosis, cryptococcosis, candidiasis
30
What types of fungal infections are likely to cause fungal arthritis?
sporotrichosis, cryptococosis, cocidioidomycosis, blastomycosis, candidiasis
31
Why is diagnostic confusion of coccidioidomycosis present?
delayed dissemination after primary infection along w/ atypical presentation
32
What are the most common manifestations of osteoarticular disease associated with blastomycosis?
bone pain, swelling and soft tissue abscesses
33
How will arthritis present associated with blastomycosis?
monoarticular in knee, ankle and elbow
34
What will synovial histology show if positive for blastomycosis?
epithelioid granulomas with budding yeast forms
35
How does cryptococcal arthritis present?
overall a rare involvement but indolent monoarticular arthritis in 60% and polyarthritis in remainder
36
What types of bone lesions are associated with cryptococcal infections? what will probably be in the DDx?
osteolytic lesions for bone infection; DDx may be confused with metastatic neoplasm
37
What is a serious complication of candidiasis? why?
osteomyelitis => due to hematogenous dissemination in adults/children commonly located in 2 adjacent vertebrae or in single long bone can infect older prosthesis
38
What is the clinical presentation of candidiasis?
typically arthritis in the knee causing localized pain and bone changes demonstrated in radiographs of symptomatic site
39
What is important for sporotrichosis articular infection?
propensity to spread to adjacent soft tissue forming draining sinuses and constitutional Sx are unusual
40
Sporotrichosis synovitis is characterized by what?
destructive pannus and nonspecific granulomatous or non-granulomatous inflammation
41
What disease likes bone and cartilage leading to what 2 diseases?
Scedosporium prolificans leading to both septic arthritis and osteomyelitis
42
What is a key feature in the relationship of HIV infection and rheumatic diseases?
CD4 mediated diseases like RA and SLE go into remission w/ disease activity and flare w/ anti-retroviral Tx
43
What can be attributed to HIV-associated arthralgias?
circulating viral and host immune complexes owing to HIV infection or others such as Hep C
44
Define painful articular syndrome with HIV associated bone and joint disease
self limited syndrome occurring in late stage HIV lasting 24 hr w/ few clinical findings with no known cause but commonly affecting knees
45
Define HIV associated arthritis
majority of HIV patients get this w/ OLIGOARTHRITIS usually in lower extremities that is self limited
46
Define REactive arthritis occurring in HIV infection
associated w/ HLA-B27 presenting in LE peripheral arthritis w/ mucocutaneous features but less axial involvement
47
Psoriasis and psoriatic arthritis in HIV patients
polyarticular and lower limb progressive disease that is responsive to HIV Tx
48
How is undifferentiated spondyloarhtiris characterized?
Sx of reactive arthritis or psoriatic arthritis in patients w/o full disease clinically
49
Avascular necrosis of bone is associated with HIV how?
HAART regimen causing pain on weight bearing activities
50
HIV and hypertrophic pulmonary osteoarthropathy
affects bones, joint and soft tissues and develops in HIV infected patients WITH PNEUMOCYSTIS JIROVECI PNEUMONIA
51
Osteopenia and osteoporosis associated with HIV
3x more common regardless of therapy
52
What are the 4 HIV associated muscle diseases?
1) Myalgia, fibromyalgia 2) noninflammatory necrotizing myopathy and HIV related wasting syndrome (cachexia) 3) Nemaline myopathy (Z band disruption in type I) 4) HIV associated polymyositis (lower CPK levels in HIV)
53
What musculoskeletal features are associated with diffuse infiltrative lymphocytosis syndrome (salivary gland enlargement and peripheral CD8 lymphoctosis)?
peripheral arthritis | polymyositis
54
What are is associated with HIV associated musculoskeletal infections?
``` pyomyositis; bacterial arthritis/osteomyelitis; musculoskeletal TB; atypical mycobacterial infection; fungal infections parasitic infections ```
55
***What are the rheum complications of HIV treatment?***
Myopathy; osteonecrosis and parotid lipomatosis; adhesive capsulitis, Dupuytren's, tenosynovitis, TMJ dysfxn
56
How does viral arthritis present?
acute, symmetric polyarthritis that is typically assoicated with a rash
57
What is the most common viral arthritis agent in US?
parvo B19 => subtle/absent rash in adults
58
What Sx may occur after a rubella vaccination?
arthralgia, arthritis, neuropathic pain
59
What types of viruses are associated with mosquitos? what do they cause?
Alphaviruses that cause arthritis and rash
60
What does Hep B virus infection present as?
arthritis-urticaria syndrome
61
How will Hep C virus infection present?
Cryoglobulinemic vasculitis presenting as palpable purpura of lower legs
62
T/F viral modifications may contribute to autoimmunity
true => regulate cellular gene expression
63
How do viruses affect the synovium?
immune response targets antigens on cell surface targeting that cell for destruction and alter cell cell interactions leading to Ab response to generate immune complexes at site of infection or systemically
64
What is a characteristic and most useful Dx test of joint symptoms and rash with parvo B19?
***serum anti-B19 IgM Ab***; | failure to develop IgG Abs causing chronic B19 arthropathy
65
Rubivirus or alphavirus patients will have joint Sx when? How to diagnose?
in women, 1 week before or after a rash with symmetric or migratory arthralgias common in synovitis Diagnose: anti-IgG Ab seroconversion requires paired acute and convalescent sera
66
Describe joint involvement with HBV
sudden in onset and severe with symmetric and simultaneous involvement of several joints; may be migratory/additive
67
At onset of arthritis from HBV, what is present in blood tests?
peak levels of serum Hep B surface antigen; anti-hep B core antigen IgM antibodies; soluble immune complexes that lead to immune complex-mediated arthritis with deposition in synovium
68
Acute HCV infections presents how?
acute onset polyarthritis in rheumatoid distribution and associated with type II and III cryoglobulinemia
69
***What is the triad associated with essential mixed cryoglobulinemia?***
***arthritis, palpable purpura and cryoglobulinemia***
70
Define acute rheumatic fever
delayed, nonsuppurative sequel of a pharyngeal infection with group A strept causing polyarthritis that progressively goes through joints presenting 2-3 weeks after initial pharyngitis
71
What 3 Ab titers are elevated in acute rheumatic fever?
streptolysin O; hyaluronidase; streptokinase
72
What is the most important virulence factor of group A strept in musculoskeletal manifestations?
M protein due to similar homology of tropomyosin and myosin
73
What are the major manifestations of acute rheumatic fever?
``` polyarthritis; chorea; subQ nodules; erythema marginatum; carditis ```

MSK/Rheum path (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions