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  #1  
Old 04-30-2012
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Rheumatology/Orthopedics Synovial fluid analysis indication of immediate surgery?

Which of the following synovial fluid characteristics would warrant immediate surgical intervention?

A. High viscosity
B. 15.000 neutrophils per mel
C. Negatively birefringent crystals
D. 1500 WBC per mel
E. Positive rheumatoid factor
F. Positively birefringent crystals
G. Glucose of45 mg/dl
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Old 04-30-2012
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i am between b. and d....i think d is the answer
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Old 04-30-2012
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B,.gout & pseudogout, RA alone not are indication for immediate surgery, so = C, E, F are out; protein & glucose has little value in synovial analysis, so A&G OUT. D. WBC SHOULD BE MORE THAN 50,OOO,
I THINK ANS IS = B.
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Old 04-30-2012
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i will go out on a limb and say G
because in pleural effusion the two indications for surgery are pH < 7.2 and low glucose.
i am ashamed to choose this answer but the others dont seem correct
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Old 04-30-2012
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I am between choosing A or B
High viscosity could mean hg'ic trauma of Referring to blood.
And high neutrophils could mean septic which must be aspirated until dry....
My final guess would be B
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my ans was wrong
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Old 05-01-2012
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The only thing that can damage the joint within hours is infection, so i think if pt dont respond on abx & tap within hour then surgery is necessary
Thus i think the ans is neutro>15000
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Old 05-01-2012
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guys ans is B. and guess what, its from usmleworld....damn! never expected this from them.

reason.
glucose less than 25 units
cell count more than 50 k
neutrophils more than 75 %
means septic joint->can be indication for surgery.

however, cell count anywhere above 2k in can be seen in septic joint.

does septic joint means surgery always ?
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Old 05-01-2012
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A.) high vicosity? will septic arthritis cause increased viscosity??




Quote:
Originally Posted by tyagee View Post
Which of the following synovial fluid characteristics would warrant immediate surgical intervention?

A. High viscosity
B. 15.000 neutrophils per mel
C. Negatively birefringent crystals
D. 1500 WBC per mel
E. Positive rheumatoid factor
F. Positively birefringent crystals
G. Glucose of45 mg/dl
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Old 05-01-2012
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Quote:
Originally Posted by tyagee View Post
guys ans is B. and guess what, its from usmleworld....damn! never expected this from them.

reason.
glucose less than 25 units
cell count more than 50 k
neutrophils more than 75 %
means septic joint->can be indication for surgery.

however, cell count anywhere above 2k in can be seen in septic joint.

does septic joint means surgery always ?
I haven't seen the explanation to this yet, but my understanding is you have to aspirated the pus out until the joint is dry (basically like a washout out) and meanwhile cover the patient with IV antibiotics.
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Quote:
Originally Posted by tyagee View Post
guys ans is B. and guess what, its from usmleworld....damn! never expected this from them.

reason.
glucose less than 25 units
cell count more than 50 k
neutrophils more than 75 %
means septic joint->can be indication for surgery.

however, cell count anywhere above 2k in can be seen in septic joint.

does septic joint means surgery always ?

-u know what i get it B by exclusion.but the pmn that gevin is very high,might =purulent thick that can't aspirat=indication for surgery in septic artheritis?!!!!!!!
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Old 05-01-2012
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Quote:
Originally Posted by um aala View Post
-u know what i get it B by exclusion.but the pmn that gevin is very high,might =purulent thick that can't aspirat=indication for surgery in septic artheritis?!!!!!!!
From wiki....


Diagnosis is by aspiration (giving a turbid, non-viscous fluid), Gram stain and culture of fluid from the joint, as well as tell-tale signs in laboratory testing (such as a highly elevated neutrophils (approx. 90%), ESR or CRP). The ESR and CRP are almost always raised on admission, CRP being faster in diagnostics.[12]
The Gram stain can rule in the diagnosis of septic arthritis however cannot exclude it.[13]
X-rays - may not be helpful early, but may show subtle increase in joint space tissue swelling.
Ultrasound - may reveals joint effusion.

Therapy is usually with intravenous antibiotics, analgesia and washout/aspiration of the joint to dryness. Among pediatric patients with an acute hematogenous septic arthritis a short total course of 10 days of antimicrobials is sufficient in uncomplicated cases.[14]
In infection of a prosthetic joint, a biofilm is often created on the surface of the prosthesis which is resistant to antibiotics. Surgical debridement or arthrotomy is usually indicated in these cases. A replacement prosthesis is usually not inserted at the time of removal to allow antibiotics to clear infection of the region.
Patients in whom surgery is contraindicated may trial long-term antibiotic therapy.[15]
Close follow up with physical exam & labs must be done to make sure patient remain afebrile, pain resolved, improved range of motion and normalized lab values.
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Orthopedics-, Rheumatology-, Step-2-Questions, Surgery-

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