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Senior - ID 3 > 20 - Osteopres > Flashcards

20 - Osteopres Flashcards

1
Q

MC joint infection?

A

Knee

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2
Q

Warning sings for joint infection?

A 
Sudden onset pain
Decreased motion
Fever >102.2
Selling 
Effusion
Warmth
Monoarticular infection
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3
Q

Common labs with joint infections?

A 
ESR
Synovial cell count 
WBCs >50,000-100,000ml (septic)
PML 90%
Glucose - low
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4
Q 
#1 joint infection
?
A

Staph aureus

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5
Q

Other common joint bacteria?

A

Prostetic joint - MRSA/S. Pyogenes

Neisseria gonorrhea

Mycobacterial/fungal

Viral: rubella, parvo, hepatitis

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6
Q

Warning sign for joint infection being n. Gonorrhea?

A

The associated rash

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7
Q

X ray for joint infection?

A

Initial = negative

Later:

  • soft tissue swelling
  • distention
  • narrow joint space
  • capsule
  • bony erosions
  • fat pad
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8
Q

Tx for joint infection?

A

Abx
- empiric/specific
Drain/aspirate
Synovectomy

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9
Q

Common abx for joint infection?

A

Nafcillin or oxacillin
- MSSA IV

Vancomycin + rifmpin IV
- MRSA

Ceftazidime (fortaz) IV
- P. Aeroginosa

Ceftriaxone (rocephin)
- N. Gonorrhoeae

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10
Q

Septic bursitis locations and types?

A

Superficial bursa
- infectious bursitis

Patellar/olecranon

  • older adults
  • trauma
  • repetitive activity
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11
Q

S/s of septic bursitis?

A 
Fever
Cellulitis
Swelling
TTP
Erythema
Decreased motion
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12
Q

Fever and cellulitis require?

A

Immediate aspiration

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13
Q

MC septic bursitis?

A

Staph aureus

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14
Q

Septic bursitis may be the 1st sign of?

A

Septic arthritis in pts with RA

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15
Q

MC bursas to get septic bursitis?

A

Olecranon

Prepatellar

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16
Q

Types of osteomyelitis?

A

Acute and chronic

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17
Q

Acute osteomyelitis?

A

Presents W/in 2 weeks

- bacteria penetrates the bone causing abscess formation

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18
Q

Why does bacteria cause osteomyelitis?

A

Penetrates the bone causing abscess formation

  • derives bone of blood supply
  • leads to necrosis of bone
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19
Q

Chronic osteomyelitis?

A

Occurs after 1+ months of bone infection

  • recurrent infections
  • non-healing wounds
  • draining wounds/sinuses

Often have a hx of acute osteomyelitis

20
Q

Why are abx ineffective for osteomyelitis?

A

Cycle of infection and bone destruction w/o an efficient blood supply prevents penetration of abx

21
Q

Types of infection of osteomyelitis?

A

Trauma to periosteum
Contiguous spread
Hematogenous seeding

22
Q

What is contiguous spread (in reference to osteomyelitis)

A

Often polymicrobial

  • abscess
  • diabetic foot ulcer
  • decubitus ulcer
  • post-op wound infection
23
Q

WTF is hematogenous seeding of bone?

A

Spread through blood

Often monomicrobial

  • endocarditis
  • sepsis
  • UTI
  • IVDU
  • Pulmonary TB
  • Sickle cell
24
Q

Osteomyelitis and ulcers?

A

15% of osteomyelitis pts get ulcers

85% (of the 15%) end in amputation
- 60% 5 yr mortality on amputations

60% have DM

25
Pressure injury staging (national pressure ulcer advisory panel NPUAP) Pics on 19-24
``` Stage 1: - intact skin - non blanchable Stage 2: - partial thickness - loss of dermis - shallow ulcer - w/o sloughing Stage 3: - full thickness - subC fat - slough - necrotic tissue Stage 4: - full thickness - loss of bone/tendon/muscle - slough/eschar - exposed muscle - bone/tendon visible/palpable ```
26
What is unstageable osteomyelitis?
Full thickness tissue loss that is obscured by slough in the wound bed - Must be explored/derided to determine stage
27
STDI in osteomyelitis?
Suspected deep tissue injury - purplish area due to damage of underlying tissue-evolution - may include thin blister over dark wound bed
28
Areas that medical device pressure injuries can occur
Nasal cannula - ears Foley cath IV tube Mucosal membrane pressure injury - ET tube or tape Around mouth,nasal cannula in nares
29
Wagner grading system?
System for diabetic (neuropathic) foot ulcers
30
Wagner grading system stages
Grade 0: fully epithelialized - redness, callous, bony deformity Grade 1: superficial - partial thickness foot ulcer limited to dermis - not extending to subcutaneous tissue Grade 2: deep ulcer -> sub C tissue to tendon, joint, bone - w/o osteomyelitis,abscess, or joint sepsis Grade 3: deep ulcer - w osteomyelitis, abscess joint sepsis Grade 4: gangrene - toes/forefoot Grade 5: gangrene - extensive/foot
31
Presentation of osteomyelitis?
``` Pain Muscle spasm Draining sinus Fever/chills Erythemia ```
32
Labs for osteomyelitis?
ESR CRP Culture (diagnostic)
33
Standard technique for culturing osteomyelitis?
Bone and needle aspirate - not from superficial site (i.e. draining sinuses) Bx must be done 48hrs post abx or before starting them
34
Usual part of bone affected by osteomyelitis?
Metaphases of long bones is most freq
35
Common bugs for osteomyelitis?
``` Staph aureus - MC Coag neg staph Enterococci Gram neg rods - pseudomonas - serratia - e-coli - salmonella Anaerobes (diabetic foot infections) MRSA in joint associated infections ```
36
Less common pathogens for osteomyelitis?
``` TB Brucellosis Coccidiomycosis Blastomycosis Histoplasmosis ```
37
Radiology studies for osteomyelitis
X ray - (may not be pos for 2-6 weeks) Bone scan - pos in 2 days MRI/CT - pos in 2 days
38
X ray findings for osteomyelitis?
lytic lesions periostitis endosteal scalloping - focal or diffuse
39
Why is debridement important?
Necrotic tissue acts as a physical barrier | - debride devitalized tissue
40
What must be done with osteomyelitis
Must resect infected bone | - it will recur
41
Poor outcomes with osteo are associated w?
DM SCD Vascular disease
42
Meds for osteomyelitis?
Pathogen specific 4-6 wks PO therapy Can do abx impregnated beads Hyperbaric oxygenation
43
Prosthetic joint infections come from?
Contamination during surgery - 1-9% risk - elbows are highest risk
44
Diagnosis of prosthetic joint infections?
Onset w/in 6 mo of surgery Looks like septic arthritis Labs: look like osteo
45
Radiologic findings for prosthetic joint infection?
Endosteal scalloping - focal or diffuse Osteomyelitis
46
Tx for prosthetic joint infection
Two fold - eradicate infectious agent - maintenance of function of joint Can do: re-implant, arthrodesis, amputate or implant salvage
47
What did the stoner ask his doctor for?
A joint replacement

Senior - ID 3 (11 decks)

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