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Critical Care 2 > ortho, rhabdo and SA lecture > Flashcards

ortho, rhabdo and SA lecture Flashcards

1
Q

inflammation of a joint secondary to an infection is what

A

Septic arthritis

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2
Q

Causes of Septic Arthritis (Broad) and types

A

Bacterial
Fungal
Viral

Monoarticular or Polyarticular

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3
Q

Signs and symptoms
specific and non-specific
of septic arthritis

A

specific
-Joint pain
-Joint warmth or redness
-unilateral swelling
-Limp/refusal to ambulate
-Pain with movement of joint

non-specific
-fever
-lethargy
-irritability
-Decreased PO intake
-Favoring or a specific positioning

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4
Q

transient synovitis is most common in what joint

A

hip

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5
Q

transient synovitis is most common in what ages

A

3-10 yrs old

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6
Q

relationship between osteomyelitis and Septic arthritis

A

The infection from the joint can move into the long bone causing osteo or the osteomyelitis can move into the joint causing septic arthirits

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7
Q

Slipped capital femoral epiphysis (SCFE) is most common in who

A

obese adolescent males

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8
Q

avascular necrosis of femoral head

A

Legg-Calve-Perthes Disease (LCPD)

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9
Q

How does Legg-Calve-Perthes Disease (LCPD) usually present

A

sudden limp

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10
Q

Legg-Calve-Perthes Disease (LCPD) is most common in who

A

Males
generally Caucasians and Asians

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11
Q

How do you distinguish Legg-Calve-Perthes Disease (LCPD) from Septic Arthritis

A

X ray

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12
Q

risk factors for Septic arthritis

A

Neonate with co-infections
Joint trauma
skin lesions
Recent or concurrent illness
immunocompromised (esp HIV and sickle cell disease)
sexual activity - Neisseria Gonorrhea
Gender - males more frequently then females
Joint prosthesis

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13
Q

what is this

A

Legg-Calve-Perthes Disease (LCPD)

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14
Q

What is this

A

SCFE

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15
Q

Ice cream sign on x ray

A

SCFE

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16
Q

what is this

A

septic arthritis

17
Q

lab findings for Septic arthritis

A

Elevated CBC, CRP, ESR
WBC > 50,000
CRP and ESR >20

18
Q

imaging and cultures for Septic arthritis

A

non specific findings on X ray
Joint aspirate gram stain/cell count/culture

19
Q

treatment for septic arthritis

A

joint aspiration

Emergent surgery for washout

IV antibiotics

physical therapy and mobilization

20
Q

Biggest culprit for Septic Arthritis

A

Staph aureus

21
Q

septic arthritis bugs neonates higher risk for

A

gonorrhea
GBS

22
Q

septic arthritis bugs
toddlers higher risk for

A

kingella kingae
gram neg

23
Q

septic arthritis bugs
adolescents

A

sexually active
gonorrhea

24
Q

septic arthritis bugs
sickle cell disease

A

Salmonella

25
Q

septic arthritis bugs
immune compromised or prolonged abx therapy what do you need to cover for

A

cover for fungal

26
Q

injury to skeletal muscle that leads to cellular damage, apoptosis and necrosis

A

Rhabdomyolysis

“think about release of muscle content into circulation”

27
Q

causes of Rhabdomyolysis

A

trauma

hypoperfusion (tourniquet)

exertion (seizures)

body temperature (malignant hyperthermia, electric shock, cardioversion, electrical defib)

drugs and toxins - Statins, heroin, cocaine, carbon monoxide

genetic

metabolic

conditions/electrolyte

abnormalities

infection -Herpes, HIV, legionella, strep

28
Q

infection causes of Rhabdomyolysis

A

Herpes
HIV
Legionella
Strep

29
Q

Myocytes comprised of

A

Potassium
Phosphorous
Creatinine kinase
myoglobin

30
Q

myoglobin job is

A

to deliver oxygen to the cell

31
Q

myoglobin is comprised of

A

globin and heme

32
Q

when myoglobin is released what happens

A

when released from the muscle, it goes through glomerulus of kidney where it is filtered and then gets reabsorbed in the convoluted tubules where it gets broken down to heme and globin. A small portion of myoglobin is always excreted in urine but generally concentration is <10 micrograms/L. In rhabdo - initially your glomerulus and tubules can keep up but eventually they cant keep up and your myoglobin will shoot up. This will appear as coca cola or tea colored urine

33
Q

classic sign of rhabdomyolysis

A

Muscle pain

Muscle weakness

Red/brown/Tea colored or coca cola colored urine

34
Q

Ways Rhabdomyolysis causes AKI

A

1) Heme component of myoglobin builds up in that tubular epithelial cell and causes obstruction of tubular outflow.

2) myoglobin in large concentrations is cytotoxic to renal cells (direct injury)

3) Myoglobin causes vasoconstriction in the kidneys leading to hypoperfusion

35
Q

electrolyte abnormalities in Rhabdomyolysis

A

Hyperkalemia
Hyperphosphatemia
Hypocalcemia

36
Q

Hyperkalemia causes what

A

affects heart
-arrythmias
-ascending muscle weakness

37
Q

Hyperphosphatemia leads to hypocalcemia why

A

bc phos binds to calcium so it decreases available calcium

38
Q

Hypocalcemia

A

anxiety
muscle contractions

Critical Care 2 (14 decks)

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