ortho, rhabdo and SA lecture

Question 1

inflammation of a joint secondary to an infection is what

Answer 1

Septic arthritis

Question 2

Causes of Septic Arthritis (Broad) and types

Answer 2

Bacterial
Fungal
Viral

Monoarticular or Polyarticular

Question 3

Signs and symptoms
specific and non-specific
of septic arthritis

Answer 3

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

Question 4

transient synovitis is most common in what joint

Answer 4

hip

Question 5

transient synovitis is most common in what ages

Answer 5

3-10 yrs old

Question 6

relationship between osteomyelitis and Septic arthritis

Answer 6

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

Question 7

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

Answer 7

obese adolescent males

Question 8

avascular necrosis of femoral head

Answer 8

Legg-Calve-Perthes Disease (LCPD)

Question 9

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

Answer 9

sudden limp

Question 10

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

Answer 10

Males
generally Caucasians and Asians

Question 11

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

Answer 11

X ray

Question 12

risk factors for Septic arthritis

Answer 12

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

Question 13

what is this

Answer 13

Legg-Calve-Perthes Disease (LCPD)

Question 14

What is this

Answer 14

SCFE

Question 15

Ice cream sign on x ray

Answer 15

SCFE

Question 16

what is this

Answer 16

septic arthritis

Question 17

lab findings for Septic arthritis

Answer 17

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

Question 18

imaging and cultures for Septic arthritis

Answer 18

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

Question 19

treatment for septic arthritis

Answer 19

joint aspiration

Emergent surgery for washout

IV antibiotics

physical therapy and mobilization

Question 20

Biggest culprit for Septic Arthritis

Answer 20

Staph aureus

Question 21

septic arthritis bugs neonates higher risk for

Answer 21

gonorrhea
GBS

Question 22

septic arthritis bugs
toddlers higher risk for

Answer 22

kingella kingae
gram neg

Question 23

septic arthritis bugs
adolescents

Answer 23

sexually active
gonorrhea

Question 24

septic arthritis bugs
sickle cell disease

Answer 24

Salmonella

Question 25

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

Answer 25

cover for fungal

Question 26

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

Answer 26

Rhabdomyolysis "think about release of muscle content into circulation"

Question 27

causes of Rhabdomyolysis

Answer 27

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

Question 28

infection causes of Rhabdomyolysis

Answer 28

Herpes HIV Legionella Strep

Question 29

Myocytes comprised of

Answer 29

Potassium Phosphorous Creatinine kinase myoglobin

Question 30

myoglobin job is

Answer 30

to deliver oxygen to the cell

Question 31

myoglobin is comprised of

Answer 31

globin and heme

Question 32

when myoglobin is released what happens

Answer 32

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

Question 33

classic sign of rhabdomyolysis

Answer 33

Muscle pain Muscle weakness Red/brown/Tea colored or coca cola colored urine

Question 34

Ways Rhabdomyolysis causes AKI

Answer 34

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

Question 35

electrolyte abnormalities in Rhabdomyolysis

Answer 35

Hyperkalemia Hyperphosphatemia Hypocalcemia

Question 36

Hyperkalemia causes what

Answer 36

affects heart -arrythmias -ascending muscle weakness

Question 37

Hyperphosphatemia leads to hypocalcemia why

Answer 37

bc phos binds to calcium so it decreases available calcium

Question 38

Hypocalcemia

Answer 38

anxiety muscle contractions