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MS > septic arthritis > Flashcards

septic arthritis Flashcards

0
Q

SeA is

A

monoarticualr

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1
Q

septic arthritis is always associated with

A

true arthritis, inflammation

redness, warmth, swelling, joint effusion always merit consideration of SeA even if proceeded by something else

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2
Q

acute SeA

A

bacterial and viral

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3
Q

chronic SeA

A

lyme disease, mycobacteria, gundal, honoccoal, meningiococal

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4
Q

Main cause in children

A

trauma

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5
Q

why do neonates get both SeA and osteomyelitis

A

the epi plate isnt closed so arterioles connect whole bone

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6
Q

eldelry MC is

A

prostethic joing

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7
Q

Mc microbes

A

s aureous>strep A> g- bacilli

gon in <30 years

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8
Q

gram negatives

A

only in 10% of cases, but worse prognosis than gram _

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9
Q

what do you think when you see s aureus and pseudomonas in unsuspected locations

A

SC and SI joint

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10
Q

what makes septic arthritis different from others

A

discomfort when in resting position

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11
Q

fever

A

about 50/50, but may be low grade/insignif (gono

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12
Q

migrating polyarticular

A

gono

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13
Q

look for (on PE)

A

enlarged proximal LN + original source of infection

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14
Q

6 special cases of septic arthritis

A 
gonoccal A
prosthetic joint infection
SeA in children
IVDU
septic sacroilitis
lyme disease
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15
Q

tx of gon

A

ceftriaxone

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16
Q

two presentations of gon

A

group 1- migratory

group 2- monoarticualr

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17
Q

migratory gon presents with

A

tenosynovitis
dermatitis
migratory polyarthritis + gon sx

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18
Q

synovial fluid in group 1

A

cell counts low and culture is often negative

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19
Q

blood culture in group 1

A

positive

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20
Q

how do you test in group 1

A

DNA amplification tests in urethral cervical, rectal, pharyngeal swabs

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21
Q

group 2 presents

A

after the tenosynovitis, dermatitis, and migratory polyarthritis

22
Q

group 2 has settled..

A

into 1-2 joints

23
Q

synovial fluid in group 2

A

more purulent and culture is positive

24
Q

blood culture in group 2

A

negative

25
Q

how do you test for group 2

A

DNA ampligication to detect it in synovial fluid

26
Q

50% of infected prosthetic joints infected wtih

A

coagulase negative staph

indolent course

27
Q

dx signs of prostehtic septic arth

A

joint pain, fever, swelling
occurs at rest (diff from other aspetic joint inflam)
a pos technectium scan after 8 months with prostehtic
aspirate culture *best evidence

28
Q

outcome in SeA in children

A

usually favorable unless it damages the epiphyseal plate (abscess, necrosis) or vascular supply (avascular necrosis)

29
Q

ultra sound used to

A

detect joint effusion, aspiration, culture

30
Q

ddx of sea in children

A

toxic synovitis of hte hip (more common)

31
Q

raises suspicions of drug use

A

sea in unusual locations (sc joint, si joint, pubic sympgysis, hips, shoulders)

infxn with bug other than staph (candida, pseudomonas, serratia)

32
Q

dx septic sacrolitis

A

hard to dx because cant differentiate between msucle pain, disc, dx, nerve entrapment, etc (presents with fever and back pain worsened with motion, bilateral)

33
Q

best dx of septic sacrolitsi

A

MRI- shows fluid in SI joint and neraby inflam

34
Q

non-specific diagnostics of septic arth

A

CBC (mild leuko, only 50% of cases), ESR, blood culture (unless gon)

35
Q

most important exam in diagnostics

A

synovial fluid

  • positive culture
  • wbc count >100K (>85% PMN but PMN + intracellular crystals = gout)
36
Q

floating crystals sometimes seen in

A

sea

37
Q

synovial fluid protein

A

increase in SeA but also in other forms of inflammatory arthritis

38
Q

management of sea

A

antibiotics
arthrocentesis daily
remove prothesis
admit most to hosp

39
Q

cxns of sea

A

relapse and recurrent aspectic j effusion (post-infectious synovitis)
abscess or bursa- need drainage
secondary OA can occur- tx with arthroplasty

40
Q

lyme disease is

A

borrela burgdoferi (transmitted by deerk tick)

41
Q

adult ticks get it from

A

white tailed deer

42
Q

little ticks get it frm

A

white footed mouth (90% of human cases are nymphs)

43
Q

chronic cases of lyme have

A

HLA DRB1 0401 allele or IgG anti outer surface protein

44
Q

early stage lyme

A

1st month- stage 1-localized
bulls eye
+/ fever, flu-like sx, neck stifness

45
Q

1/2 of patients wtihs tage 1

A

do not progress beyond this stage

46
Q

early stage 2

A

weeks-months; disseminated
further spread to skin and lymph nodes
migratory evolves to monoarticular (knee is MC)
cranial neuropathy (bilateral bells), meningeal irritation, peripheral neuro cv: heart block (less common pericarditis and endocarditis)

47
Q

chronic lyme

A 
stage III months-years, persistent
disabiling
subclinical encephalopathy, encephalomyelitis, peripheral neuropathy
myocarditis, pericarditis
keratitsi, itis, optic neuritis
48
Q

dx in early stage vs late stage

A

early stage- ecm is enough
olate stage- more must be done- culture is slow and usually useless, ELISA as first screen (highly sensitive), but lots of FP, esp with other spitochetes like syph, rocky mt spotted fever, etc, western blot, pcr

49
Q

tx lyme disease

A

early tx is best, but its when serological tests are least sensitive so you have dx clinically

50
Q

tx adults

A

doxy

51
Q

tx kids

A

amoxi

52
Q

tx chronic

A

ceftriaxone

MS (19 decks)

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