CMN 574.1 FB Questions And Verified Detailed Answers
574.1 Fact: Gonococcal Arthritis Treatment:
1. In most cases, patients suspected of the disease should be admitted to the hospital
to exclude endocarditis
2. The rapid rise in resistant strains to penicillin makes inpatient treatment advisable -
Answer 3. Step-down treatment from parenteral to oral antibiotics is no longer
recommended
4. Once improvement has been achieved for 24-48 hours, patients receive ceftriaxone
250mg IM every 24 hours to complete a 7-14 day course
574.1 Fact: Urethral, throat, cervical, and rectal cultures should be done in all patients
with suspected gonococcal arthritis since they are often positive in the absence of local
symptoms - Answer xxx
574.1 Rhabdomylolysis is associated with:
A. Crush injuries
B. Prolonged immobility
C. Drug toxicities
D. All of the above - Answer D. all of the above
574.1 T/F Sjogren syndrome can occur in isolation or in association with another
rheumatic disease. - Answer True
574.1 Fact: Gonococcal arthritis Clinical Findings:
1. 1-4 days of migratory polyarthralgias involving the wrist, knee, ankle, or elbow
2. Thereafter, 2 patterns emerge: a) tenosynovitis that affects the wrists, fingers,
ankles, or toes [60% of patients]; b) purulent monarthritis that involves the knee, wrist,
ankle, or elbow [40% of patients]
, 3. Most patients will have asymptomatic but highly characteristic skin lesions
consisting of 2-10 small necrotic pustules distributed over the extremities, especially
the palms and soles - Answer xxx
574.1 T/F There is no evidence that patients with prosthetic joints undergoing
procedures should receive antibiotic prophylaxis to prevent joint infection. - Answer T.
Although the American Academy of Orthopedic Surgeons advocates prescribing
antibiotic prophylaxis for any patient with a prosthetic joint replacement undergoing a
procedure that can cause bacteremia (McPhee p. 827)
574.1 The synovial fluid analysis in nongonococcal acute bacterial arthritis usually
reveals a Leukocyte count that exceeds:
A. 20,000
B. 30,000
C. 40,000
D. 50,000
Bonus: Often, the WBC count is even greater than ________ - Answer D.
Bonus: > 100,000.
574.1 Which of the following is critical for diagnosis of nongonococcal acute bacterial
arthritis:
A. Blood cultures
B. MRI
C. Synovial fluid analysis
D. CT - Answer C. synovial fluid analysis
574.1 Which joint is most frequently involved in nongonococcal acute bacterial arthritis:
A. Hip
B. Knee
C. Shoulder
, D. Ankle - Answer B.
574.1 What is the key risk factor for nongonococcal acute bacterial arthritis:
A. Bacterermia
B. Prosthetic joints
C. Compromised Immunity
D. Loss of skin integrity
E. All of the above - Answer E. all of the above.
574.1 Which organism is the most common cause of nongonoccocal septic arthritis:
A. Methicillin-resistant S aureus
B. Escherichia coli
C. Psedomonas aeruginosa
D. Staphylococcus aureus - Answer d. Staphylococcus aureus
574.1 Fact: Reactive Arthritis:
1. Precipitated by gastrointestinal or sexually transmitted infection (though can occur
without an apparent preceding infection)
2. Predominance in males after an STI (ratio males to females 9:1)
3. Extra-articular manifestations include urethritis, conjunctivitis, uveitis, and
mucocuteaneous lesions
4. Arthritis is commonly asymmetric and involves the large weight-bearing joints (knee
and ankle) - Answer 5. While most signs of the disease disappear within days/weeks, the
arthritis may persist for several months or become chronic
6. Recurrences of any of the clinical manifestations are common; permanent sequelae
may result especially in the joints
7. NSAIDs are the mainstay of therapy
8. Antibiotics given at the time of a nongonococcal STI reduces the chance of this
disorder
, 574.1 Fact: The effective treatment of nongonococcal acute bacterial septic arthritis
requires appropriate antibiotic therapy together with drainage of the infected joint.
Hospitalization is always necessary. The duration of antibiotic therapy is usually 4-6
weeks. Early orthopedic consultation is essential. - Answer The outcome depends on
the health of the patient, the causative organism, and the promptness of treatment.
574.1 Which is one of the most devastating complications of Behcet disease:
A. Anterior and posterior uveitis
B. Erythema nodosum-like lesions
C. Apthous ulcerations of the mouth
D. Pathergy phenomenon
Bonus: The involvement of the ____ system is another cause of major potential morbidity
with Behcet disease with lesions mimicking multiple sclerosis. - Answer A. Anterior &
posterior uveitis
Bonus: CNS
574.1 Ankylosing spondylitis is a chronic inflammatory disease manifested clinically by
pain and progressive stiffening of the:
A. Knees
B. Ankles
C. Spine
D. Wrists - Answer C. spine
574.1 T/F All patients with ankylosing spondylitis should be referred to a physical
therapist. - Answer True
574.1 What is the first-line treatment for ankylosing spondylitis and may slow
radiographic progression of spinal disease:
574.1 Fact: Gonococcal Arthritis Treatment:
1. In most cases, patients suspected of the disease should be admitted to the hospital
to exclude endocarditis
2. The rapid rise in resistant strains to penicillin makes inpatient treatment advisable -
Answer 3. Step-down treatment from parenteral to oral antibiotics is no longer
recommended
4. Once improvement has been achieved for 24-48 hours, patients receive ceftriaxone
250mg IM every 24 hours to complete a 7-14 day course
574.1 Fact: Urethral, throat, cervical, and rectal cultures should be done in all patients
with suspected gonococcal arthritis since they are often positive in the absence of local
symptoms - Answer xxx
574.1 Rhabdomylolysis is associated with:
A. Crush injuries
B. Prolonged immobility
C. Drug toxicities
D. All of the above - Answer D. all of the above
574.1 T/F Sjogren syndrome can occur in isolation or in association with another
rheumatic disease. - Answer True
574.1 Fact: Gonococcal arthritis Clinical Findings:
1. 1-4 days of migratory polyarthralgias involving the wrist, knee, ankle, or elbow
2. Thereafter, 2 patterns emerge: a) tenosynovitis that affects the wrists, fingers,
ankles, or toes [60% of patients]; b) purulent monarthritis that involves the knee, wrist,
ankle, or elbow [40% of patients]
, 3. Most patients will have asymptomatic but highly characteristic skin lesions
consisting of 2-10 small necrotic pustules distributed over the extremities, especially
the palms and soles - Answer xxx
574.1 T/F There is no evidence that patients with prosthetic joints undergoing
procedures should receive antibiotic prophylaxis to prevent joint infection. - Answer T.
Although the American Academy of Orthopedic Surgeons advocates prescribing
antibiotic prophylaxis for any patient with a prosthetic joint replacement undergoing a
procedure that can cause bacteremia (McPhee p. 827)
574.1 The synovial fluid analysis in nongonococcal acute bacterial arthritis usually
reveals a Leukocyte count that exceeds:
A. 20,000
B. 30,000
C. 40,000
D. 50,000
Bonus: Often, the WBC count is even greater than ________ - Answer D.
Bonus: > 100,000.
574.1 Which of the following is critical for diagnosis of nongonococcal acute bacterial
arthritis:
A. Blood cultures
B. MRI
C. Synovial fluid analysis
D. CT - Answer C. synovial fluid analysis
574.1 Which joint is most frequently involved in nongonococcal acute bacterial arthritis:
A. Hip
B. Knee
C. Shoulder
, D. Ankle - Answer B.
574.1 What is the key risk factor for nongonococcal acute bacterial arthritis:
A. Bacterermia
B. Prosthetic joints
C. Compromised Immunity
D. Loss of skin integrity
E. All of the above - Answer E. all of the above.
574.1 Which organism is the most common cause of nongonoccocal septic arthritis:
A. Methicillin-resistant S aureus
B. Escherichia coli
C. Psedomonas aeruginosa
D. Staphylococcus aureus - Answer d. Staphylococcus aureus
574.1 Fact: Reactive Arthritis:
1. Precipitated by gastrointestinal or sexually transmitted infection (though can occur
without an apparent preceding infection)
2. Predominance in males after an STI (ratio males to females 9:1)
3. Extra-articular manifestations include urethritis, conjunctivitis, uveitis, and
mucocuteaneous lesions
4. Arthritis is commonly asymmetric and involves the large weight-bearing joints (knee
and ankle) - Answer 5. While most signs of the disease disappear within days/weeks, the
arthritis may persist for several months or become chronic
6. Recurrences of any of the clinical manifestations are common; permanent sequelae
may result especially in the joints
7. NSAIDs are the mainstay of therapy
8. Antibiotics given at the time of a nongonococcal STI reduces the chance of this
disorder
, 574.1 Fact: The effective treatment of nongonococcal acute bacterial septic arthritis
requires appropriate antibiotic therapy together with drainage of the infected joint.
Hospitalization is always necessary. The duration of antibiotic therapy is usually 4-6
weeks. Early orthopedic consultation is essential. - Answer The outcome depends on
the health of the patient, the causative organism, and the promptness of treatment.
574.1 Which is one of the most devastating complications of Behcet disease:
A. Anterior and posterior uveitis
B. Erythema nodosum-like lesions
C. Apthous ulcerations of the mouth
D. Pathergy phenomenon
Bonus: The involvement of the ____ system is another cause of major potential morbidity
with Behcet disease with lesions mimicking multiple sclerosis. - Answer A. Anterior &
posterior uveitis
Bonus: CNS
574.1 Ankylosing spondylitis is a chronic inflammatory disease manifested clinically by
pain and progressive stiffening of the:
A. Knees
B. Ankles
C. Spine
D. Wrists - Answer C. spine
574.1 T/F All patients with ankylosing spondylitis should be referred to a physical
therapist. - Answer True
574.1 What is the first-line treatment for ankylosing spondylitis and may slow
radiographic progression of spinal disease:
