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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
Q

GBS septic arthritis associated with what patient population?

A

predilection for infants, elderly and diabetic patients

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26
Q

propionibacterium acnes
associated with ____

A

shoulder surgery

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27
Q

associated with shoulder surgery

A

propionibacterium acnes

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28
Q

salmonella or streptococcus pneumoniae
seen in patients with ____

A

sickle cell disease

29
Q

bacteria seen in sickle cell disease

A

salmonella or streptococcus pneumoniae

30
Q

bartonella henselae
seen in patients with ____

A

HIV

31
Q

this bacteria seen in patients with HIV

A

bartonella henselae

32
Q

seen in patients with history of IV drug abuse

A

pseudomonas

33
Q

pseudomonas seen in patients with

A

history of IV drug abuse

34
Q

pasteurella multocida
seen in patients _____

A

with dog or cat bites

35
Q

bacteria seen in patients with dog or cat bites

A

pasteurella multocida

36
Q

eikenella corrodens
seen in patients with ____

A

human bites

37
Q

bacteria seen in patients with human bites

A

eikenella corrodens

38
Q

fungal/candida
found in _____ patients

A

immunocompromised

39
Q

_____ organisms found in immunocompromised host

A

fungal/candida

40
Q

symptoms of septic arthritis

A

pain in affected joint
fevers (only present in 60% of cases)
may appear toxic

41
Q

physical exam:

A

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
Q

on physical exam, the extremity tends to be in the position of _____

A

maximum joint volume

43
Q

recommended radiographs

A

AP and lateral

44
Q

radiographic findings

A

may show joint space widening or effusion
periarticular osteopenia

45
Q

ultrasound indications

A

may help in confirming joint effusion in large joint such as hip
can be used in guiding aspirations

46
Q

MRI indications

A

detects joint effusion, and may detect adjacent bone involvement such as osteomyelitis

47
Q

detects joint effusion, and may detect adjacent bone involvement such as osteomyelitis

A

MRI

48
Q

labs demonstrate:

A

WBC >10K cells/mL with left shift
ESR >30 mm/hr
CRP >1

49
Q

rises within 2 days of infection and can rise 3-5 days after initiation of appropriate antibiotics, and returns to normal 3-4 weeks

A

ESR

50
Q

best way to judge efficacy of treatment, as it rises within few hours of infection, and may normalize within 1 week of treatment

A

CRP

51
Q

gold standard for treatment and allows directed antibiotic treatment

A

joint fluid aspirate

52
Q

joint fluid aspirate should be analyzed for

A

cell count with differential
gram stain
culture
glucose level
crystal analysis

53
Q

on aspirate, joint fluid appears ____

A

cloudy or purulent

54
Q

cell count with WBC > _____ is considered diagnostic for septic arthritis, however lower counts may still indicate infection

A

50,000

55
Q

antibiotics administered within ____ hours of arthrocentesis can lower synovial WBC count and lead to false negative results

A

24

56
Q

septic synovial fluid has low viscosity compared to normal synovial fluid (high viscosity)

A

string sign

57
Q

what is the string sign

A

septic synovial fluid has low viscosity compared to normal synovial fluid (high viscosity)

58
Q

is the string sign positive or negative in septic arthritis?

A

negative

59
Q

utilized to determine if wound near a joint communicates with the joint

A

saline load test

60
Q

what is the saline load test

A

utilized to determine if wound near a joint communicates with the joint

61
Q

______ mL of saline is needed to reach 95% sensitivity

A

155

62
Q

______ mL of saline is needed to reach 99% sensitivity

A

175

63
Q

septic arthritis differential

A

crystal arthropathy
cellulitis
bursitis

64
Q

operative treatment includes:

A

IV abx, operative irrigation and drainage of the joint

65
Q

initiate empiric antibiotic therapy _____ to definitive cultures based on patient age and or risk factors

A

prior

66
Q

transition to organism-specific antibiotic therapy based once obtain ______

A

culture sensitivities

67
Q

treatment can be monitored by following serum _____ levels during treatment

A

WBC, ESR, and CRP

68
Q

Operative irrigation and drainage of the joint technique

A

irrigation
debridement
cultures

69
Q

complications:

A

Arthritis
Fibrous ankylosis
Osteomyelitis

Orthobullets Trauma (63 decks)

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