Septic arthritis + Limb ischemia

Question 1

RF for septic arthritis

Answer 1

DM, immune deficient, structural abnormalities

IVDU, TB

Question 2

Investigations for ?septic arthritis

Answer 2

Bloods
Aspirate joint + joint fluid analysis = diagnostic
X ray joint = findings: capsule + soft tissue swelling, joint space widening
Sepsis screen

Question 3

Management of septic arthritis

Answer 3

Surgical = arthrocentesis, lavage, debridement
NSAIDs
Abx - IV for 2 weeks
Flucloxacillin + benpen

Question 4

Organisms causing septic arthritis + management

Answer 4

Gonococcal - young fit adults. 
Cefotaxime
TB - caseating granulomas, weight loss
Meningococcus - penicillin
Lyme - fever, headache, rash - treat with amoxicllin, doxycycline

Question 5

Causes of acute leg ischaemia

Answer 5

Thrombosis
Embolisation
Trauma (compartment syndrome)

Question 6

Investigations for acute leg ischaemia

Answer 6

Doppler USS of limbs + CT angiography

Question 7

Management of acute leg ischaemia

Answer 7

IV heparin infusion
Surgery: embolectomy or intraarterial thrombolysis
If irreversible: urgent amputation

Question 8

What are the S+S of irreversible acute leg ischaemia?

Answer 8

Mottled, non-blanching appearance, hard woody muscles

Question 9

Long term management of leg ischaemia

Answer 9

Anti-platelet (aspirin/ clopidogrel)Warfarin

Question 10

What is reperfusion injury?

Answer 10

Sudden increase in capillary permeability can cause compartment syndrome
Release K+ causes hyperkalaemia leading to acidosis leading to AKI

Question 11

What is Virchow’s triad?

Answer 11

Stasis of blood flow
Endothelial injury
Hypercoagulability
Causes of DVT