Cross In Class Flashcards
C.
Ultrasound with show effusion, X-ray would show arthritis/soft tissue swelling (and the effusion)
CBC will show luekocytosis
ALWAYS get blood cultures
What other non-specific lab tests could you obtain that would be helpful in correct Dx?
- ESR, CRP
- Look for crystals in synovial fluid (would = gout) instead of infectious arthritis
B. This is reactive arthritis (Steptococci next most common)
Remmeber the specific groups!
IVDU-Pseudomonas and staph
SCD-Salmonella
Young sexually active- N. gonorrheae
C.
What does Cefepime cover for?
sensitive gram + (strep and MSSA, but not MRSA)- same with ceftriaxone and all gram neg
How to treat a negative gram stain with reactive arthritis?
broad coverage with Vanco AND Cefepime
Call surgery for drainage +- irrigation and debridement to prevent irreversible loss of joint function
A. History will tell you if direct inoculation
Note that if you stick a needle into a joint with cellulitis, you can introduce bacteria
Important risk factors for inefctive arthritis?
- abnormal joint architecture
- IVDU
- endocarditis
- advanced age
- DM
- immunosuppression
C. ESR would be specific and will increase the risk of a septic joint
Staph aureus
What question should ask next?
Is she sexually active and has she had any dysuria or abnormal vaginal discharge
Most likely diagnoses?
GDI caused by Neiserria (risk: multiple sex factors, menstruation DURING sex, pregnancy or being postpartum, C5-C8 deficiency)
doesnt really present like a true septic arthritis- more of a migratory arthritis
What is the most important toxin being prodcued by the organism causing this?
Alpha toxin (Clostridium perfringens)
B. This is Lyme Disease (the blood test is a western blot)
Where is Lyme disease most common?
Mostly in the North and East coast
More common tick based infections in TN?
Eurlickia and Anaplasmosis
What is a controversial sequelae to tick bites?
there can be chronic fatigue that presents after a tick bite and sometimes these patients get doxycycline or macrolides and they feel better so they want more but there are some anti-inflammatory properties to these drugs so its probably just that
Can see nodular infiltrates in the upper lobes
B.
Remember that with a TB osteo disease it Is active but you might not get the constitutional symptoms and all that typical of lung TB
