Mehlman/UW septic arthritis

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).