bone and joint infections

Question 1

septic arthritis risk factors (4)

Answer 1

• IV drug use
• diabetes
• immunosuppression
• pre-existing joint disease

Question 2

septic arthritis most common causes

Answer 2

• s. aureus
• streptococci

Question 3

septic arthritis most common cause in kids < 5

Answer 3

H. influenzae

Question 4

septic arthritis most common cause in young adults

Answer 4

gonorrhoea

Question 5

septic arthritis most common cause in IV drug users and the elderly

Answer 5

E. coli

Question 6

septic arthritis presentation

Answer 6

extremely painful red, hot, swollen and tender monoarthritis

Question 7

septic arthritis diagnosis

Answer 7

• bloods (CRP and blood culture)
• x-ray of joint
• joint aspiration (synoviral microscopy and culture)

Question 8

septic arhtritis management

Answer 8

• antibiotics (flucloxacillin/clindamycin IV for 2 weeks, then oral for 2-4 weeks)
• possible surgical wash out

Question 9

prosthetic joint infection early post op cause

Answer 9

s. aureus

Question 10

prosthetic joint infection delayed post op causes

Answer 10

• s. epidermis
• propionibacterium acnes

Question 11

prosthetic joint infection late post op causes

Answer 11

• s. aureus
• e. coli

Question 12

prosthetic joint infection early post op time period

Answer 12

0-3 months

Question 13

prosthetic joint infection delayed post op time period

Answer 13

2-24 months

Question 14

prosthetic joint infection late post op time period

Answer 14

> 24 months

Question 15

prosthetic joint infection early post op presentation

Answer 15

• sepsis
• warm joints with signs of effusion

Question 16

prosthetic joint infection delayed post op presentation

Answer 16

• persistent pain at joint
• loosening of prosthesis

Question 17

prosthetic joint infection diagnosis

Answer 17

peri-operative tissue, blood and pus culture

Question 18

prosthetic joint infection management

Answer 18

• prophylaxis (co-amoxiclav/co-trimoxazole)
• debridement and antibiotics (flucloxacillin/vancomycin, ciprofloxacin if gram negative, rifampicin if staph sensitive)
• either implant retention or replacement

Question 19

osteomyelitis most common site in kids

Answer 19

metaphysis

Question 20

osteomyelitis acute causes (3)

Answer 20

• s. aureus (most common)
• streptococci
• h. influenzae

Question 21

osteomyelitis chronic causes (4)

Answer 21

• TB
• pseudomonas aeruginosa
• salmonella (complication of sickle cell anaemia)
• e. coli

Question 22

osteomyelitis presentation

Answer 22

• pain, swelling and erythema at site of infection
• low grade fever
• fatigue and malaise

Question 23

osteomyelitis diagnosis

Answer 23

• MRI
• bloods (FBC, CRP, culture)
• joint or abscess culture
• bone biopsy

Question 24

osteomyelitis acute management

Answer 24

flucloxacillin/clindamycin IV (vancomycin if MRSA)

Question 25

osteomyelitis chronic management

Answer 25

* flucloxacillin/doxycycline (co-trimoxazole if MRSA) * debridement

Question 26

what is necrotising fasciitis

Answer 26

severe infection of subcutaneous soft tissues that most commonly occurs in limbs, abdominal walls and groin

Question 27

necrotising fasciitis type 1 cause

Answer 27

mixed aerobes and anaerobes

Question 28

necrotising fasciitis type 2 causes

Answer 28

group A strep (strep. pyogenes)

Question 29

necrotising fasciitis presentation

Answer 29

- fever and mild inflammation with out of proportion pain and rapid spread of inflammation - severe pain felt at sight of infection with only mild inflammation

Question 30

necrotising fasciitis diagnosis

Answer 30

start treatment immediately if suspected

Question 31

necrotising fasciitis management

Answer 31

debridement and antibiotics (penicillin /clindamycin)

Question 32

gas gangrene cause

Answer 32

clostridium perfinegens

Question 33

gas gangrene presentation

Answer 33

- usually follows on form penetrative wound - skin discolouration and bubbling

Question 34

gas gangrene management

Answer 34

* debridement * antibiotics (penicillin and metronidazole)

Question 35

tetanus cause

Answer 35

clostridium tetani

Question 36

tetanus presentation

Answer 36

- follows on from penetrative trauma - spastic paralysis

Question 37

tetanus management

Answer 37

- surgical debridement - antibiotics (penicillin and metronidazole) - anti-toxin - prophylaxis with vaccination