MS 3

Question 1

infectious tenosynovitis

Answer 1

infection of a tendon and surrounding sheath, causing inflammation and pain

Question 2

infection of a tendon and surrounding sheath, causing inflammation and pain

Answer 2

infectious tenosynovitis

Question 3

infectious tenosynovitis - usually involves what part of your body, symptoms, infection, typically the result of
3

Answer 3

1. usually involves upper extremities - hands, fingers
2. +/- systemic symptoms
3. infection typically a result of direct inoculation from trauma or IV drug use

Question 4

infectious tenosynovitis - ____ signs are suggestive of infectious tenosynovitis

Answer 4

Kanavel signs

Question 5

infectious tenosynovitis - Kanavel signs include
4

Answer 5

1. pain w/ passive extension - earliest sx
2. fusiform swelling of the digit
3. digit held in slight flexion at rest
4. tenderness along tendon sheath - late finding

Question 6

infectious tenosynovitis - img/testing

Answer 6

consider x ray to evaluate for bony involvement or subcutaneous emphysema

Question 7

infectious tenosynovitis - infectious flexor tx

Answer 7

emergency - needs ortho, go to ER

Question 8

non infectious tenosynovitis - tx

Answer 8

may be referred to Ortho or hand specialist

Question 9

tenosynovitis - when to refer to ER

Answer 9

all suspected cases of infectious tenosynovitis

Question 10

septic arthritis

Answer 10

infection in a joint, usually d/t bacteria

Question 11

infection in a joint, usually d/t bacteria

Answer 11

septic arthritis

Question 12

septic arthritis - clinical pres
2

Answer 12

1. erythematous, warm, painful, edematous joint
2. may have systemic sx - fever in <50%

Question 13

septic arthritis - infection spreads how

Answer 13

through direct inoculation or hematogenous route (trauma to area, drug IV use, surgery, UTI, skin infection)

Question 14

septic arthritis - risk factors
4

Answer 14

1. skin infection
2. recent procedure
3. immunosuppression meds
4. DM

Question 15

septic arthritis - physical exam findings
2

Answer 15

1. limited ROM - pain w/ passive and active ROM
2. erythema, edema, effusion, warmth

Question 16

septic arthritis - img/testing
2

Answer 16

1. consider plain films to assess bony involvement, foreign body, subcutaneous emphysema
2. US can help evaluate for fluid collection or abscess and assist w/ aspiration

Question 17

septic arthritis - gold std for dx
1

Answer 17

1. joint aspiration (prior to starting abx) for fluid analysis including gram stain, cell count, culture, and crystal analysis - if available in ER, otherwise send to ER

Question 18

septic arthritis - tx

Answer 18

refer all suspected cases to ED for joint aspiration before abx start

Question 19

bursitis

Answer 19

inflammation of the bursa

Question 20

inflammation of the bursa

Answer 20

bursitis

Question 21

acute traumatic/hemorrhagic bursitis occurs from

Answer 21

direct trauma causing bleeding into the bursa

Question 22

chronic bursitis occurs from

Answer 22

microtrauma from repetitive friction (kneeling) or inflammatory conditions (gout, RA)

Question 23

septic bursitis occurs from

Answer 23

local infection or direct inoculation

Question 24

chronic inflammatory bursitis - presents as
4

Answer 24

1. pain
2. erythema
3. limited ROM
4. often r/t occupation (flooring, plumbing, janitorial industries)

Question 25

traumatic/hemorrhagic bursitis - presents as 3

Answer 25

1. acute pain 2. edema 3. limited ROM

Question 26

septic bursitis - presents as 6

Answer 26

1. acute pain 2. edema 3. erythema 4. limited ROM 5. hx of trauma 6. immunocompromised

Question 27

chronic inflammatory bursitis - physical exam findings 4

Answer 27

1. mild tenderness 2. +/- erythema 3. edema 4. ROM usually preserved

Question 28

traumatic/hemorrhagic bursitis - physical exam findings 4

Answer 28

1. edema 2. acute pain 3. +/- ecchymosis 4. limited ROM

Question 29

septic bursitis - PE findings 6

Answer 29

1. pain 2. erythema 3. warmth 4. edema 5. +/- fever 6. +/- lymphadenopathy

Question 30

bursitis - img/testing, consider ordering 3

Answer 30

1. plain film 2. US 3. aspiration

Question 31

bursitis - order plain film to check for 3

Answer 31

1. bony involvement 2. foreign body 3. subcutaneous emphysema

Question 32

bursitis - US can assist w/

Answer 32

determining bursal involvement in the setting of significant edema from cellulitis as well as assist w/ aspiration

Question 33

bursitis - consider dx aspiration and evaluation what

Answer 33

fluid for gram stain, cell count, culture, and crystal analysis

Question 34

bursitis - DD 5

Answer 34

1. joint effusion 2. RA/OA 3. septic arthritis 4. cellulitis 5. gout

Question 35

chronic inflammatory bursitis - tx 3

Answer 35

conservative - RICE, NSAIDs, avoid aggriv. factors

Question 36

chronic inflammatory bursitis - tx, what is rarely needed

Answer 36

aspiration and steroid injections

Question 37

traumatic bursitis - tx 2

Answer 37

1. conservative - RICE 2. consider therapeutic aspiration

Question 38

septic bursitis - tx 2

Answer 38

1. consider aspiration prior to abx 2. mild - cephalexin 500 mg PO q6H or bactrim DS 1-2 tabs PO q12h for 10 days

Question 39

septic bursitis - disposition

Answer 39

need aspiration prior to abx tx - send to ER if unable to do aspiration