Mehlman/UW septic arthritis 11-29 (2)

Question 1

M. what is biggest risk factor? 1st important point

Answer 1

ABNORMAL JOING ARCHTECTURE

Question 2

M. what about fever? 2nd important point

Answer 2

You DO NOT nedd to have fever

Question 3

M. whats always answer for tx? 3rd important point

Answer 3

aspiration of the knee OR arthrocentesis
BEFERE Abs.

nu cia kaip visada, is pradziu paimam megini ir paskui duodam antibus

Question 4

M. arthrocenthesis.
what is HY point about fluid?

Answer 4

we are looking for high leukocytes + will do a culture of aspirate

HY: bacteria can be NEGATIVE, but it does not exclude septic arthritis

Question 5

M. 1st Risk group - artificial joints

Answer 5

Protetic joints - cannot be more abnormal architecture than this:D

mo - s aureus

Question 6

M. 2nd Risk group - 3 diseases?

Answer 6

RA, OA, juvenile RA

mo - s aureus

Question 7

M. 3rd group - young/sport/trauma

Answer 7

3) young healthy
patients with recent trauma (e.g., car accident) or high-intensity exercise causing microtrauma (e.g., kickboxing/soccer tournament, long hike);

mo - s aureus

Question 8

M. CP?

Answer 8

hot, red, painful joint +/- fever in previously mentioned groups

Question 9

M. Gonococcus = sexually active.
they give 2 cases on usmle.

Answer 9

.

Question 10

M. gonococcus.
1) monoarthritis of the knee in sexually active young patient, with no other information provided.

Answer 10

.

Question 11

M. gonococcus.
2) as a triad: monoarthritis or polyarthritis; cutaneous
papules; tenosynovitis (inflammation of tendon sheaths).

Answer 11

.

Question 12

M. Septic arthritis Tx in general? 2

Answer 12

Treatment is surgical drainage of the joint + antibiotics.

USMLE doesn’t care about
the exact antibiotics.

Question 13

M. USMLE like to give vignette of RA + septic arthritis. since there are few affected joints, it may look like ,,RA flare”, but no, need to do aspiration to rule out septic arthritis.

Answer 13

.

Question 14

M. exceedingly HY are intense exercise and recent joint trauma. Case?

Answer 14

16 F + red hot knee joint + had kickboxing yesterday = do aspiration

Question 15

M. obesity = biggest risk factor for OA.
Case with septic arthritis?

Answer 15

55M + BMI 40 (OBESITY) + red hot knee –> probably has OS due to obesity –> OA incr. risk for septic arthritis –> so arthrocenthesis

Question 16

M. also OA + septic.
Obesity -> risk for OA
BUT
also pay attention to hight height in YOUNG PATIENTS.
weird case.

Answer 16

Young patient + height 6’2 + BMI 30 + red hot knee.
same –> do arthrocenthesis.

Big and tall - are increased risk for OA in younger age (<50)

Question 17

UW table septic.
risk factors? 5

Answer 17

Abnormal joints: OA, RA, prostetic joint, gout
Age > 80
DM
IV drug abuse, alcoholism
Intra-articular GK injections

Question 18

UW table septic.
CP?

Answer 18

acute monoarthritis: hot, red, swollen, decr. ROM
+/- fever
elevated ESR and CRP

Question 19

UW table septic.
diagnosis?

Answer 19

arthrocenthesis!!! leukocytosis (>50 k), gram stain, culture

negative bacteria does not exclude diagnosis

dar buvo pamineta blood cultures - nu cia turbut jeigu dahuja karsciuoja, bet mehlman neminejo sito labai.

Question 20

UW table septic.
Tx gram positive cocci?

Answer 20

M say, kad arthrocenthesis –> just then abs ir kad usmle dont give a fuck about type of abs.

UW abs: vancomycin

Question 21

UW table septic.
Tx gram negative rod abs?

Answer 21

third generation cephalosporin

Question 22

UW table septic.
Tx if negative microscopy? abs

Answer 22

vancomycin (+ third generation cephalosporin if immunocompromised)

Question 23

M. gonoccocus.
what is triad?
……
cutaneous papules;
tenosynovitis (inflammation of tendon sheaths).

Answer 23

monoarthritis or polyarthritis

Question 24

M. gonoccocus.
what is triad?
monoarthritis or polyarthritis;
……
tenosynovitis (inflammation of tendon sheaths).

Answer 24

cutaneous papules

Question 25

M. gonoccocus.
what is triad?
monoarthritis or polyarthritis;
cutaneous papules;
…..

Answer 25

tenosynovitis (inflammation of tendon sheaths).

Question 26

UW septic. Q. risk factors?

Answer 26

Risk factors – abnormal joint structure, which in this case is RA.

Question 27

UW septic. Q. Chronic immunosuppression –> incr. risk for infection. (eg is there is RA)

Answer 27

.

Question 28

UW septic. Q. what important systemic symptoms, esp in elderly?

Answer 28

Sometimes septic arthritis in the background of RA will not have overt signs (fevel, chill, periph. Leukocytosis) – esp. common in elderly and may lead to delayed diagnosis