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MSK Week 1 2017/18 > 5: Microbiology > Flashcards

5: Microbiology Flashcards

1
Q

What is osteomyelitis?

A

Inflammation of bone and medulla, usually found in the long bones

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2
Q

Can osteomyelitis recur after treatment?

A

Yes, so long treatment duration required (e.g 6 weeks)

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3
Q

By which means can osteomyelitis spread?

A

Contiguously - i.e direct contact

Haematologically - via blood vessels

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4
Q

Osteomyelitis can be diagnosed ___ or ___.

A

directly (you found the bug)

indirectly (X-RAY/MRI evidence + clinical suspicion)

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5
Q

How is osteomyelitis treated?

A

Debridement (removal of damaged tissue and foreign material, draining of pus)

Antimicrobial drugs for at least 6 weeks

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6
Q

What are the principles of diagnosis of MSK infections?

A

Suspect disease - take a history, examine patient

Sample - bone biopsy is gold standard, cross-sectional imaging

Treat - wait for microbiology or treat immediately if septic

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7
Q

Take - blood, lactate, urine analysis

Give - oxygen, fluids, antibiotics

A
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8
Q

osteomyelitis highly likely in diabetic feet if:

  • you can probe all the way to bone
  • ulcer >2cm in diameter has been present for >2 months
A
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9
Q

Why are bone biopsies preferred versus swabs for diagnosing bone infections?

A

Swabs don’t reach inner medulla

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10
Q

revise characteristic symptoms of inflammation

A
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11
Q

Bone is highly ___ to infection.

A

resistant

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12
Q

If in doubt, which organism is responsible for osteomyelitis?

A

Staph. aureus

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13
Q

When can antibiotics be given to a patient with osteomyelitis?

A

Once you’ve proved they have an infection i.e a positive biopsy/swab

Or they clearly have sepsis

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14
Q

Coagulase negative Staph. (such as ___ ___) are commensal bacteria but like to colonise foreign material like plastic and metal to cause disease.

A

Staph. epidermidis

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15
Q

Staphylococci are (aerobic / anaerobic).

A

aerobic

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16
Q

Which antibiotic is used to treat Staph. aureus?

A

IV Flucloxacillin

IV Clindamycin (penicillin allergic)

IV Vancomycin (MRSA)

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17
Q

What are three toxins produced by Staph. aureus?

A

Enterotoxin - food poisoning

SSSST - staph. scalded skin syndrome toxin

PVT - panton valentine leukocidin

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18
Q

Staph. aureus is coagulase ___ and shows up ___ on agar plates.

A

positive

golden

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19
Q

Which type of fracture tends to get infected?

A

Open fractures

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20
Q

How are open fractures treated?

A

Debridement

Reduced & fixation - bone ends brought together

Soft tissue cover

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21
Q

How may you tell that an open fracture is infected?

A

Wound is healing poorly, doesn’t close up

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22
Q

What is an infectious complication of diabetes, occuring due to venous insufficiency?

A

Diabetic foot infection

23
Q

Which sign should raise suspicion of osteomyelitis secondary to diabetic vascular insufficiency?

A

You can PROBE TO BONE

24
Q

Is osteomyelitis secondary to diabetic foot ulcers caused by one organism?

A

Rarely

but treat with fluclox and see what the response is, then add gentamicin (for ?gram negatives) and metronidazole (for anaerobes)

25
Q

look at antibiotic spectrum of action

A
26
Q

If it’s so powerful, why isn’t vancomycin given for MSSA?

A

Evidence shows that more people with MSSA die on vancomycin compared to flucloxicillin

27
Q

Flucloxicillin is given intravenously to treat osteomyelitis. When it’s time to switch to an oral drug, what do you use?

A

Doxycycline

28
Q

What drugs are used to treat suspected gram negative and anaerobic osteomyelitis (i.e if it’s smelly and rotten?

A

Gentamicin IV (Gram negatives)

Metronidazole (anaerobes)

29
Q

What is haematogenous osteomyelitis?

A

Blood spread of infection to bone

30
Q

Who tends to get haematogenous osteomyelitis?

A

Prepubescent children

PWID

Patients with central lines / dialysis / elderly

31
Q

Outside of the UK, what organism can cause haematogenous osteomyelitis which is very very pus-y?

A

Mycobacterium tuberculosis

32
Q

Which organism is the most likely cause of haematogenous osteomyelitis?

A

Staph. aureus

33
Q

Which antibiotic covers beta-haemolytic Strep. which may rarely be responsible for osteomyelitis?

A

Flucloxicillin

so we bueno

34
Q

What are some unusual sites for osteomyelitis in PWID?

A

Sternoclavicular joint

Pubic symphysis

i.e if it’s a strange site ask about this

35
Q

Which test is used to classify Strep. species?

A

Haemolysis

36
Q

Which group of Strep. is most commonly seen in osteomyelitis?

What do they look like on haemolysis?

A

Group A Strep.

Beta (complete) haemolysis - appears white on plate

37
Q

Patients on which kidney treatment may develop haematogenous osteomyelitis?

A

Dialysis

38
Q

osteitis pubis

and clavic osteomyelitis

A
39
Q

What are three groups of patients who have an unusual predisposition to osteomyelitis?

A

Sickle cell anaemics

Gaucher’s disease

SAPHO/CRMO

40
Q

What is the abnormal casual organism for osteomyelitis in people with sickle cell anaemia?

A

Salmonella

(or Staph. aureus)

41
Q

What is a rare genetic disorder associated with an increased risk of bone infections?

A

Gaucher’s disease

42
Q

sapho/crmo

A
43
Q

What name is given to osteomyelitis affecting the spine?

A

Vertebral osteomyelitis

44
Q

Vertebral osteomyelitis tends to cause symptoms associated with the ___ level it’s at.

A

spinal

45
Q

How does vertebral osteomyelitis tend to spread?

A

Haematogenous

46
Q

What organisms can cause vertebral osteomyelitis?

A

Staph. aureus

Gram negatives

Anaerobes

Mycoplasma tuberculosis

47
Q

What are some symptoms of vertebral osteomyelitis?

A

Fever

Insidious pain

Raised CRPs

Occasionally raised white cell count

48
Q

How is suspected vertebral osteomyelitis investigated?

A

BIOPSY (direct)

MRI/CT scan (indirect)

49
Q

How is vertebral osteomyelitis treated?

A

Drainage of epidural / psoas abscesses

Antibiotics for 6 weeks

50
Q

When should an MRI be repeated in patients with vertebral osteomyelitis?

A

Unexplained increases in inflammatory markers

Increasing pain

New signs/symptoms

51
Q

What is the drug of choice for vertebral osteomyelitis in Scotland?

A

Flucloxacillin

52
Q

Internationally, what organism may cause vertebral osteomyelitis?

What is the disease called in this cause?

A

TB

Pott’s disease

53
Q

What must be offered to patients presenting with skeletal TB?

A

HIV test

54
Q

Is skeletal TB limited to one vertebral disc?

A

No, crosses discs causing a shitload of damage

MSK Week 1 2017/18 (10 decks)

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