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Infection Related Rheumatic Disorders > 44 Infectious Arthritis and Osteomyelitis > Flashcards

44 Infectious Arthritis and Osteomyelitis Flashcards

1
Q

Frequently affected joint in septic arth

A

Knee and hip

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2
Q

Acute septic arth, duration

A

<2 weeks

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3
Q

Subacute septic arth,septic arth,, duration

A

2w-3m

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4
Q

Chronic osteomy, duration

A

> 3m

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5
Q

Usual sites of infection in reactive arth

A

Upper airway
GI
GU

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6
Q

Septic arth, MC pathogenic mechanism

A

Hematogenous

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7
Q

Joints with intraarticular metaphyses, giving increased risk for extension of infection from bone to joint space

A

Hips and shoulders

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8
Q

Conditions MC associated with hip septic arth

A

URTI with oral ulceration
Atopic derm with erosive skin infection
Varicella

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9
Q

Joints affected with septic arth, in IV drug users

A

SI joint
SC joints

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10
Q

Septic arth is MC caused by this organism

A

S. aureus

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10
Q

Organism implicated in septic arth in sickle cells dse

A

Salmonella

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11
Q

Organism that should be considered in young children with culture-neg skeletal infections

A

Kingella kingae

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12
Q

MC sites of septic arth

A

Joints of lower ext: knees > hips

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13
Q

Predisposes to multiple joint septic arth

A

Chronic granulomatous dse
AIDS

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14
Q

Recomm labs for septic arth

A

CBC, CRP, ESR, PCT

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15
Q

Very important test for synovial fluid since culture can be negative

A

GS

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16
Q

Protein and gluc content in septic arth

A

Protein >2.5g/dL, glucose low relative to plasma

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17
Q

Blood cultures are (+) in ___% of patients with septic arth

A

40

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18
Q

T/F No causative agent is ever identified in significant number of children with septic arth

A

T

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19
Q

Synovial fluid PCR remains diagnostic in up to ___ days after antibiotic initiation

A

6

20
Q

T/F S. aureus is common even in culture neg MSK infections

A

T

21
Q

Imaging modality of choice in children with septic arth

A

UTZ

22
Q

T/F UTZ should be performed in all patients suspected to have septic arth

A

T

23
Q

Common organisms in septic arth per age

A

Pg 588 box

24
Q

MC organism in hematogenous nonneonatal septc arth

A

S. aureus

25
Q

1st-line for S. aureus in previously healthy children in communities with low (<10%) rate of CA-MRSA

A

1st- or 2nd-gen cephalosporin (Cefaz, Cefu)

26
Q

Drug of choice for S. aureus in previously healthy children in communities with>10% rate of MRSA and resistance to Clinda is low (<10%)

A

Clinda

27
Q

REgionally common causative agent of septic arth in children <4y

A

Kingella kingae

28
Q

Drug of choice for Kingella kingae septic arth

A

Cephalosporins

29
Q

Drug of choice for Salmonella septic arth

A

Ceftriaxone

30
Q

Duration of septic arth treatment

A

IV: 2-4 days with clinical recovery and CRP decreasing
Oral: 10d-2w in previously healthy nonneonatal children if with clinical recovery and CRP decreasing

31
Q

Target vanco trough level

A

15-20 ug/mL

32
Q

Duration of septic arth treatment for CA-MRSA

A

IV: 1-2 weeks
Total IV + oral: 4-6 weeks

33
Q

T/F Salmonella requires longer duration treatment than salmonella septic arth

A

T

34
Q

Flowchart for workup and treatment of septic arth in children

A

Pg 591

35
Q

Recommended empiric abx for septic arth: Child <3m

A

Cefotax + nafcillin/oxacillin (if >1week in NICU, consider Vanco)

36
Q

Recommended empiric abx for septic arth: Child >3m

A

CA-MRSA <10%: Nafcillin/oxacillin or cefazolin
CA-MRSA >10%: Clinda or vanco

37
Q

Surgery for septic arth is reserved for

A

Cases unresponsive to abx or have delayed presentation

38
Q

T/F Intraarticular administration of abx may be necessary in some cases of septic arth

A

F, abx penetrate joints fluid readily

39
Q

Excellent lab measure for recovery in septic arth

A

Serial CRP

40
Q

T/F Decreasing CRP indicates clinical recovery even if fever persists

A

T

41
Q

Duration of monitoring of septic arth patients

A

At least 1 year

42
Q

Cause neonatal septic arth through seeding from birth canal

A

S. aureus, GBS, G- (e. coli, neisseria)

43
Q

REcommended treatment for neonatal septic arth

A

Anti staph penicillin + aminoglycoside

44
Q

Predisposing factors for septic arth in neonates

A

Umbi cath
Prematurity
Septicemia

45
Q

Pathognomonic findings for neonatal septic arth

A

Motionless hip joint that is flexed, abducted, and externally rotated

46
Q

Hip septic arth MC affects what age group

A

Infants and young children

47
Q

Organism that may cause purulent arthritis in several joints

A

N. gonorrhea

48
Q

MC mechanism of spread of mycobacterial arthritis

A

Hematogenous

Infection Related Rheumatic Disorders (3 decks)

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