Mehlman/UW septic arthritis 11-29 (2) Flashcards
M. what is biggest risk factor? 1st important point
ABNORMAL JOING ARCHTECTURE
M. what about fever? 2nd important point
You DO NOT nedd to have fever
M. whats always answer for tx? 3rd important point
aspiration of the knee OR arthrocentesis
BEFERE Abs.
nu cia kaip visada, is pradziu paimam megini ir paskui duodam antibus
M. arthrocenthesis.
what is HY point about fluid?
we are looking for high leukocytes + will do a culture of aspirate
HY: bacteria can be NEGATIVE, but it does not exclude septic arthritis
M. 1st Risk group - artificial joints
Protetic joints - cannot be more abnormal architecture than this:D
mo - s aureus
M. 2nd Risk group - 3 diseases?
RA, OA, juvenile RA
mo - s aureus
M. 3rd group - young/sport/trauma
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
M. CP?
hot, red, painful joint +/- fever in previously mentioned groups
M. Gonococcus = sexually active.
they give 2 cases on usmle.
.
M. gonococcus.
1) monoarthritis of the knee in sexually active young patient, with no other information provided.
.
M. gonococcus.
2) as a triad: monoarthritis or polyarthritis; cutaneous
papules; tenosynovitis (inflammation of tendon sheaths).
.
M. Septic arthritis Tx in general? 2
Treatment is surgical drainage of the joint + antibiotics.
USMLE doesn’t care about
the exact antibiotics.
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.
.
M. exceedingly HY are intense exercise and recent joint trauma. Case?
16 F + red hot knee joint + had kickboxing yesterday = do aspiration
M. obesity = biggest risk factor for OA.
Case with septic arthritis?
55M + BMI 40 (OBESITY) + red hot knee –> probably has OS due to obesity –> OA incr. risk for septic arthritis –> so arthrocenthesis
M. also OA + septic.
Obesity -> risk for OA
BUT
also pay attention to hight height in YOUNG PATIENTS.
weird case.
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)
UW table septic.
risk factors? 5
Abnormal joints: OA, RA, prostetic joint, gout
Age > 80
DM
IV drug abuse, alcoholism
Intra-articular GK injections
UW table septic.
CP?
acute monoarthritis: hot, red, swollen, decr. ROM
+/- fever
elevated ESR and CRP
UW table septic.
diagnosis?
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.
UW table septic.
Tx gram positive cocci?
M say, kad arthrocenthesis –> just then abs ir kad usmle dont give a fuck about type of abs.
UW abs: vancomycin
UW table septic.
Tx gram negative rod abs?
third generation cephalosporin
UW table septic.
Tx if negative microscopy? abs
vancomycin (+ third generation cephalosporin if immunocompromised)
M. gonoccocus.
what is triad?
……
cutaneous papules;
tenosynovitis (inflammation of tendon sheaths).
monoarthritis or polyarthritis
M. gonoccocus.
what is triad?
monoarthritis or polyarthritis;
……
tenosynovitis (inflammation of tendon sheaths).
cutaneous papules
M. gonoccocus.
what is triad?
monoarthritis or polyarthritis;
cutaneous papules;
…..
tenosynovitis (inflammation of tendon sheaths).
UW septic. Q. risk factors?
Risk factors – abnormal joint structure, which in this case is RA.
UW septic. Q. Chronic immunosuppression –> incr. risk for infection. (eg is there is RA)
.
UW septic. Q. what important systemic symptoms, esp in elderly?
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
