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30 Cards in this Set
- Front
- Back
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What type of arthritis is marked by organisms actually growing inside the joint
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Septic Arthritis
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What is monoarthritis until proven otherwise
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septic arthritis
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As the number of joints involved increases what happens to the probable dx of septic arthritis
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it goes down more joints involved the less likely it is to be septic arthritis
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If pt has polyarthritis but one joint is reacting differently then the others what should you suspect
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even though many joints have arthritis only one is acting differently this is like a monoarthritis and should be treated as if it was septic arthritis in that joint
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If pt presents with fever and arthritis what should you suspect
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septic arthritis
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What dx procedure is mandatory if septic arthritis is suspected
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arthrocentesis
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When should you perform arthrocentesis
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suspected arthritis it is mandatory, strongly advised if crystal or hemarthrosis is suspected. Useful in differentiating inflammatory from non-inflammatory arthritis. Must be done for synovial biopsy
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When can arthrocentesis be used therapeutically
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for tense effusion to relieve pain and improve function, remove blood or pus from the joint, injection of steroid and other intra-articular therapies, for tidal lavage of joints
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When is arthrocentesis contraindicated
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never absolutely contraindicated but not advised in bleeding diathesis or anti coagulation, cellulitis or allergy to topical or indictable anesthetics
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What is the most important test to run on the synovium you collected from arthrocentesis
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gram stain and culture and sensitivity
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What studies should be run on synovial fluid obtained from arthrocentesis
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gross exam to classify the fluid, gram stain, C & S, cell count and differential, glucose determination
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What happens to the clarity of joint fluid as class increases from normal to 3
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it becomes more opaque
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What does missing string sign indicate
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inflammatory synovium it behaves like water and doesn't make the string sign when dripped out of a needle
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What is the most common type of organism that causes septic arthritis
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Gram + organisms 70%, 50% staph aureus
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What is the best type of antibiotic to start a pt with while you wait for the gram stain and culture and sensitivity to come back
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start them on a Ab that covers gram + organisms as they account for 70% of septic arthritis cases and pray it isn't MRSA
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What are the Gram - organisms that rarely cause septic arthritis
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salmonella (SLE, HIV, SS), Pseud. Aeruginosa (IVDA), DGI (septic or sterile immune complex mediated)
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What organisms is associated with polyarticular dx
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strep organisms
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what is the most common cause of septic arthritis in younger sexually active populations
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Gonococcal Arthritis
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How does gonococcal arthritis typically present
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as a oligoarthritis, fever, rash and tenosynovitis
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What risk factors increase the likelihood of developing disseminated gonococcal infection with joint involvement
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menstruation, pregnancy and C5-9 deficiencies
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What signs will often be present if pt has septic arthritis in the spine
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chronic unrelenting back pain, fever and local tenderness. Infection usually crosses disc space,
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What is an indication that TB is causing the spinal septic arthritis
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T10-L2 region involved with paraspinal cold abscess
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What is the management approach for spinal septic arthritis
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start Ab and repeat arthrocentesis. Surgical Drainage after 72hrs. Monitor improvement with serial joint fluid aspiration
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If pt has septic arthritis at unusual sites what may have been the way the organism was introduced into their body
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IV drug abuse
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You get a C&S back and find out it is a spirochetal infection what is the likely cause
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Lyme arthritis,
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What test can confirm Lyme arthritis
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western blot
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What tx will you give for a pt with chronic Lyme arthritis
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IV antibiotic possible synovectomy
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What are the Jones criteria for
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dx of rheumatic fever
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what are the major criteria of the Jones criteria
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Arthritis, Carditis, Chorea, erythema marginatum, nodules.
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What are the minor criteria of the Jones criteria for rheumatic fever
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recent strep, Elevated ASOT, antistrep abs, Group A strep on C & S, recent scarlet fever
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