A-V Blocks
play_arrow A-V Blocks Dr Swapnil Pawar Atrioventricular Blocks Written by Dr Andrew Lam First Degree Heart Block Prolongation of the PR interval (>200ms) Benign as an isolated entity that doesn’t […]
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Septic Arthritis
Dr Swapnil Pawar
Differentials for Mono-arthritis | |
Infective (i.e. septic arthritis) | History:
· Hot, swollen singular joint · Constitutional symptoms (high-grade fever, malaise, weight loss) Exam: · Inability to weight bear Diagnostic investigation: Joint aspirate · Macroscopic: Turbid purulent fluid · Microscopic: Elevated WCC with >70% PMN · Culture: Positive |
Crystallopathy (i.e. gout, pseudogout) | History:
· Severe pain, redness, warmth and swelling usually worst within 12-24h from onset · Involvement of first MTP or knee · History of self-limiting attacks of arthritis Exam: · Presence of tophi Diagnostic investigation: Joint fluid aspirate (crystallopathy), MRI · Gout: negatively birefringence + yellow needle shape · Pseudogout: positively birefringence + rod-shaped |
Haemarthrosis (i.e. clotting disorders) | History:
· Minimal trauma swelling · History of coagulopathy Exam: · Hot, swollen joint · ± limited range of motion Diagnostic investigation: Joint fluid aspirate · Macroscopic: tinged red · Microscopic: xanthochromia · Culture: negative |
Trauma (i.e. fracture, meniscal tear, soft tissue injury) | History: Trauma preceding joint pain
Exam: Pain on active and/or passive movement + limited range of motion Diagnostic investigation: X-Ray (fracture), MRI (soft-tissue injury) |
Systemic rheumatic disease (i.e. Rheumatoid arthritis, spondyloarthritis, SLE, sarcoidosis) | History:
· “Morning stiffness” that worsens with immobility · Multi-system involvement (fatigue, rash, adenopathy, alopecia, oral ulcers, pleuritic chest pain, Raynaud phenomenon, dry eyes and mouth) · Family history of rheumatic diseases Exam: · Eye & skin involvement · Joint swelling and deformity (swelling of MCP, swan neck deformity) Diagnostic investigation: Diagnostic criteria that usually involves clinical, laboratory and imaging results |
Tumour | History:
· Localised pain or swelling for a few weeks-months · Possible noticed following minor trauma Exam: · Distinct soft tissue mass · Firmly attached to bone and tender to palpation Diagnostic investigation: Needle biopsy or operative biopsy |
Osteoarthritis | History:
· Joint pain and stiffness that worsens with mobility but improves with rest · History of progressive pain Exam: · Usually involving knees, hips · Joint deformity (subluxation of thumb) Diagnostic investigation: Clinical + X-Ray |
Helfgott SM. (2021) Monoarthritis in adults: Etiology and evaluation. In: UpToDate, M. R. Curtis (Ed), UpToDate. Retrieved January 15 2022, from https://www.uptodate.com.acs.hcn.com.au/contents/monoarthritis-in-adults-etiology-and-evaluation
The suggested duration for antibiotic therapy (adults) is recommended to be for a total of 4 weeks (2 weeks IV). However, these treatment durations do not apply to gonococcal arthritis, which should be treated for 7 days.
Organism | Antibiotic Regimen |
Staphylococcal species (gram-positive)
|
Flucloxacillin 2g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly
If non-severe hypersensitivity to penicillin, cefazolin 2g IV q8hrly |
MRSA (suspected or increased risk of MRSA) | Vancomycin IV
OR depending on local guidelines Clindamycin 600mg IV q8hly or Lincomycin 600mg IV 8hly |
Streptococcal OR
Gram-negative septic arthritis |
Ceftriaxone 2g (child: 50 mg/kg up to 2 g) intravenously daily
OR Cefotaxime 2g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly |
Septic Arthritis [published 2019 April]. In: Therapeutic Guidelines [digital]. Melbourne: Therapeutic Guidelines Limited; 2022 Jan. <https://www.tg.org.au>
Dr Swapnil Pawar December 23, 2021
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