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Orthobullets Trauma > Septic Arthritis in Adults > Flashcards

Septic Arthritis in Adults Flashcards

1
Q

most commonly affected joints

A

knee
hip
shoulder
elbow
ankle
SC joint

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2
Q

SC joint infection found commonly in what patient population

A

IV drug users

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3
Q

IV drug users common site of septic arthritis

A

SC joint

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4
Q

the most common pathogen in all patients, including IV drug users

A

staph aureus

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5
Q

SC joint arthritis-advanced imaging (CT/MRI) should be obtained preoperatively to rule out ____or chest wall phlegmon

A

retrosternal abscess

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6
Q

SC joint arthritis- advanced imaging (CT/MRI) should be obtained preoperatively to rule out retrosternal abscess or ____

A

chest wall phlegmon

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7
Q

____ arthritis- advanced imaging (CT/MRI) should be obtained preoperatively to rule out retrosternal abscess or chest wall phlegmon

A

SC joint

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8
Q

risk factors for septic arthritis

A

age > 80 years
diabetes
rheumatoid arthritis
cirrhosis
HIV
history of crystal arthropathy
endocarditis or recent bacteremia
IV drug user
recent joint surgery

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9
Q

medical problems that increase risk of septic arthritis

A

diabetes
rheumatoid arthritis
cirrhosis
HIV

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10
Q

3 etiologies of bacterial seeding of joint

A

bacteremia
direct inoculation
contiguous spread

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11
Q

direct inoculation from _____

A

from trauma or surgery

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12
Q

contiguous spread from ____

A

adjacent osteomyelitis

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13
Q

septic arthritis causes irreversible ____ in an involved joint

A

cartilage destruction

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14
Q

cartilage injury can occur by ______ hours

A

8

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15
Q

cartilage injury caused by release of _____ from inflammatory cells (PMNs)

A

proteolytic enzymes

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16
Q

associated conditions

A

prosthetic implant infection

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17
Q

most common organism and accounts for >50% of cases

A

staph aureus

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18
Q

this organism accounts for ~20% of cases

A

neisseria gonorrhea

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19
Q

most common organism in otherwise healthy sexually active adolescents and young adults

A

neisseria gonorrhea

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20
Q

manifests as a bacteremic infection
arthritis-dermatitis syndrome in ~60% of cases
localized septic arthritis in ~40% cases

A

neisseria gonorrhea

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21
Q

neisseria gonorrhea manifestations

A

arthritis-dermatitis syndrome (60%)
localized septic arthritis (40%)

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22
Q

this bacteria accounts for 10-20% of cases

A

gram negative bacilli-proteus, ecoli, klebsiella, enterobacter

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23
Q

risk factors for gram negative bacilli septic arthritis

A

neonates
IV drug users
elderly
immunocompromised patients with diabetes

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24
Q

neonates
IV drug users
elderly
immunocompromised patients with diabetes

A

gram negative bacilli septic arthritis risk factors

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25
GBS septic arthritis associated with what patient population?
predilection for infants, elderly and diabetic patients
26
propionibacterium acnes associated with ____
shoulder surgery
27
associated with shoulder surgery
propionibacterium acnes
28
salmonella or streptococcus pneumoniae seen in patients with ____
sickle cell disease
29
bacteria seen in sickle cell disease
salmonella or streptococcus pneumoniae
30
bartonella henselae seen in patients with ____
HIV
31
this bacteria seen in patients with HIV
bartonella henselae
32
seen in patients with history of IV drug abuse
pseudomonas
33
pseudomonas seen in patients with
history of IV drug abuse
34
pasteurella multocida seen in patients _____
with dog or cat bites
35
bacteria seen in patients with dog or cat bites
pasteurella multocida
36
eikenella corrodens seen in patients with ____
human bites
37
bacteria seen in patients with human bites
eikenella corrodens
38
fungal/candida found in _____ patients
immunocompromised
39
_____ organisms found in immunocompromised host
fungal/candida
40
symptoms of septic arthritis
pain in affected joint fevers (only present in 60% of cases) may appear toxic
41
physical exam:
erythema effusion extremity tends to be in position of maximum joint volume hip would be in FABER position (flexed, abducted, externally rotated) warmth tender motion inability to bear weight inability to tolerate PROM
42
on physical exam, the extremity tends to be in the position of _____
maximum joint volume
43
recommended radiographs
AP and lateral
44
radiographic findings
may show joint space widening or effusion periarticular osteopenia
45
ultrasound indications
may help in confirming joint effusion in large joint such as hip can be used in guiding aspirations
46
MRI indications
detects joint effusion, and may detect adjacent bone involvement such as osteomyelitis
47
detects joint effusion, and may detect adjacent bone involvement such as osteomyelitis
MRI
48
labs demonstrate:
WBC >10K cells/mL with left shift ESR >30 mm/hr CRP >1
49
rises within 2 days of infection and can rise 3-5 days after initiation of appropriate antibiotics, and returns to normal 3-4 weeks
ESR
50
best way to judge efficacy of treatment, as it rises within few hours of infection, and may normalize within 1 week of treatment
CRP
51
gold standard for treatment and allows directed antibiotic treatment
joint fluid aspirate
52
joint fluid aspirate should be analyzed for
cell count with differential gram stain culture glucose level crystal analysis
53
on aspirate, joint fluid appears ____
cloudy or purulent
54
cell count with WBC > _____ is considered diagnostic for septic arthritis, however lower counts may still indicate infection
50,000
55
antibiotics administered within ____ hours of arthrocentesis can lower synovial WBC count and lead to false negative results
24
56
septic synovial fluid has low viscosity compared to normal synovial fluid (high viscosity)
string sign
57
what is the string sign
septic synovial fluid has low viscosity compared to normal synovial fluid (high viscosity)
58
is the string sign positive or negative in septic arthritis?
negative
59
utilized to determine if wound near a joint communicates with the joint
saline load test
60
what is the saline load test
utilized to determine if wound near a joint communicates with the joint
61
______ mL of saline is needed to reach 95% sensitivity
155
62
______ mL of saline is needed to reach 99% sensitivity
175
63
septic arthritis differential
crystal arthropathy cellulitis bursitis
64
operative treatment includes:
IV abx, operative irrigation and drainage of the joint
65
initiate empiric antibiotic therapy _____ to definitive cultures based on patient age and or risk factors
prior
66
transition to organism-specific antibiotic therapy based once obtain ______
culture sensitivities
67
treatment can be monitored by following serum _____ levels during treatment
WBC, ESR, and CRP
68
Operative irrigation and drainage of the joint technique
irrigation debridement cultures
69
complications:
Arthritis Fibrous ankylosis Osteomyelitis

Orthobullets Trauma (63 decks)

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