Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ID Review > Bone and Joint Infections > Flashcards

Bone and Joint Infections Flashcards

1
Q

Who should get pseudomonal coverage in a diabetic foot infection? [2]

A
  1. Exposure to water
  2. Clinical failure while receiving nonpseudomonal therapy

–> Pseudomonas is implicated only in a small percentage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Labs to order in diabetic foot infection? [5]

A
  1. CBC
  2. CMP
  3. A1c
  4. ESR/CRP
  5. Blood cultures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mgmt of foot ulcer in a patient with DM without redness, warm, swelling, drainage or order

A

Local wound care

No abx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Length of abx therapy for diabetic foot infection?

A

4-6 weeks if no surgical debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Definition of a mild diabetic foot infection?

A

Do not extend deeper than skin and subcutaneous tissues, erythema is <2 cm from ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Definition of a moderate diabetic foot infection?

A

Infection extends deeper than skin and subcutaneous tissues, erythema is >2 cm from ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Definition of a sever diabetic foot infection?

A

There is associated systemic signs and symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment of a mild diabetic foot infection? [3]

A
  1. Bactrim
  2. Clinda
  3. Doxy

–> MRSA/MSSA likely etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of a moderate diabetic foot infection? [2]

A
  1. Bactrim + Augmentin

2. Clinda + Fluoquinolone [Cipro, levo, moxi]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Three mechanisms of septic arthritis development? [3]

A
  1. Hematogenous spread from distant foci of infection [endovascuar, odontogenic]
  2. Contiguous spread [steroid injection, trauma]
  3. Extension from osteomyelitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most commonly involved joints in septic arthritis? [5]

A
  1. Knee [50%]
  2. Hip
  3. Shoulder
  4. Elbow
  5. Ankle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What joint involvement should prompt evaluation for IVUD? [2]

A
  1. SI joint

2. Sternoclavicular joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Labs to obtain in evaluation of septic arthritis [4]

A
  1. CBC
  2. CMP
  3. ESR/CRP
  4. Blood cultures [positive in up to 50% of cases]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What joint fluid studies be sent

A
  1. Cell count and diff
  2. Gram stain and cultures [Aerobic, anaerobic, fungal AFB]
  3. Crystal analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Imaging studies to get?

A
  1. X-ray
  2. MRI [or CT if you cant get an MRI]
  3. Echo if endocarditis is suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does disseminated gonococcal infection present?

A

Arthralgias [migratory], tenosynovitis [extensor] and rash [arthritis-dermatitis syndrome].

Purulent distal mono or oloigoarthritis can be seen in 1/3 of uncreated cases effecting the knees, wrists, and ankles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the cutaneous findings in a DGI

A

Maculopapular rash to pustular dermatosis of the palms and soles with 10-15 lesions on average.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Organisms to cause septic arthritis postpartum or in a recent history of GU tract manipularion

A

Mycoplasma hominis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who gets GBS septic arthritis

A

Poorly controlled DM, cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Who gets strep pneumo septic arthritis

A

Those with splenic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the WBC count, PMN%, and appearance of the synovial fluid in non-inflammatory OA.

A

WBC: <200
PMN%: <25
Fluid: Transparent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the WBC count, PMN%, and appearance of the synovial fluid in a normal patient

A

WBC: <200
PMN%: <25
Fluid: Transparent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the WBC count, PMN%, and appearance of the synovial fluid in inflammatory arthritis [gout, pseudogout, RA]

A

WBC: >2,000
PMN: 50% or more
Fluid: Mildly opaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the WBC count, PMN%, and appearance of the synovial fluid in septic arthritis

A

WBC: >50,000
PMN: 75% or more
Fluid: Cloudy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Describe the WBC count, PMN%, and appearance of the synovial fluid in hemarthrosis
WBC: Variable, may be falsely elevated due to RBCs PMN: 50-75% Fluid: Bloody
26
Diagnosis of DGI?
NAAT of throat, rectum, urethra | NAAT of synovial fluid
27
Treatment of DGI?
1. Ceftriaxone 1g IV q24 + Azithro 1g PO 1x. | 2. May step down to doxycycline or cefixime if susceptible.
28
How does lyme arthritis present?
Monoarthritis in the knee most commonly | May not have systemic symptoms
29
Diagnosis of lyme arthritis
PCR for lyme in the synovial fluid
30
Treatment of lyme arthritis?
1. Doxy 2. Amoxicillin [alt] 3. Cefuroxime [alt] 30 days of treatment
31
Most common nontuberculous mycobacteria that cause septic joints? [2]
1. Chelonae | 2. Fortuitum
32
Most common cause of fungal septic arthritis
Candida | --> Uncommon
33
Lab work up of septic arthritis? [5]
1. CBC 2. CMP 3. CPK 4. ESR/CRP 5. Viral serologies?
34
Viruses that may cause inflammatory arthritis?
1. HIV 2. HBV 3. HCV 4. Parvo B19 5. Alphaviruses [Chikungunya]
35
Presentation of HBV arthritis
1. RA like in the prodromal stage of hep B which resolves with development of jaundice 2. Less RA like in setting of chronic infection
36
Presentation of HCV arthritis
1. RA-like pattern | 2. Oligoarthritis with involvement of larger joints which can be associated with mixed essential cryolobulinemia
37
Joint manifestations of chikungunya
Affects both small and large joints Typically >10 joints affected Associated rash and high fever 1/3 develop chronic symptoms with relapsing-remitting or unremitting patterns
38
Diagnosis of chikungunya
PCR if symptoms <1 week | IgM/IgG if >1 week
39
What HLA is reactive arthritis a/w?
HLA-B27
40
Presentation of reactive arthritis?
``` Asymmetric oligoarthritis of large joints Urethritis Uveitis or Conjunctivitis Enthesitis Dactylitis Keratoderma blennorhagica ```
41
Organisms a/w reactive arthritis? [5]
1. Chlamydia 2. Shigella 3. Salmonella 4. Campy 5. Yersinia
42
Diagnosis of reactive arthritis?
Exclusion
43
Mgmt of bacterial non-gonoccal septic arthritis
4 weeks of directed therapy
44
Mgmt of fungal and tuberculous septic arthritis
At least 6 months abx + surgery
45
Uncommon way vertebral osteo can be caused?
Esophageal perforation | GI tract in inflammatory bowel disease
46
Most common area in the back vertebral osteo occurs? [3]
1. Lumbar 2. Thoracic 3. Cervical
47
Labs to obtain in vertebral osteo? [4]
1. CBC 2. CMP 3. ESR/CRP 4. Blood cultures [+ >75% of cases]
48
When should you give abx prior to biopsy in vertebral osteo? [2]
1. Unstable 2. Neurologic compromise --> Otherwise should be held until a microbiologic diagnosis is made.
49
Etiology of vertebral osteo
1. Staph aureus >50% | 2. Enteric GNR ~30% [predominately lumbar spine]
50
Who gets GBS vertebral osteo
Poorly controlled DM
51
Who gets coag-negative stapg vertebral osteo?
Those with hardware
52
Who gets pseudomonas vertebral osteo?
Immunocompromise, IVDU
53
Who gets salmonella vertebral osteo
Sickle cell disease patients
54
Who gets candida vertebral osteo?
IVDU, those with indwelling caths
55
What part of the spine does TB present in?
Thoraco-Lumbar
56
How does TB vertebral osteo look on imaging?
Spreads along the anterior ligaments of the vertebra, spares disc space until late in disease.
57
What infection presents as sacroiliitis or spondylodiscitis a/w consumption of unpasteurized milk and cheeses in the Middle East and Mediterranean?
Brucellosis
58
Tx of vertebral osteo? [3]
6-8 weeks of targeted abx for bacterial 12 weeks for brucella 24 weeks for fungal or AFB [standard RIPE therapy]
59
Define an early PJI. Etiology?
Onset <3 months from surgery. Acquired during joint implantation. Staph aureus
60
Define a delayed PJI. Etiology?
Onset3-24 months from surgery. Acquired during joint implantation. Coag negative staph, Cutibacterium
61
Define a late PJI. Etiology?
Onset >24 months from surgery due to hematogenous spread | Staph and Strep
62
PJI mimics?
1. Metallosis [metal on metal wear of endoprosthesis leading to a local hypersensitivity reaction]. 2. Aseptic loosening 3. Crystalline arthropathy
63
Organisms that can lead to PJI of the shoulder but rarely in the hips or knees?
Cutibacterium acnes
64
Cause of culture negative PJI?
1. Pre-treatment with abx 2. Brucella 3. Coxiella
65
Labs to order in PJI?
1. CBC 2. CMP 3. ESR/CRP 4. Blood cultures
66
Dx of PJI?
Arthrocentesis [hold abx until after if pt is stable]
67
What studies should be ordered from arthrocentesis?
1. Gram stain and culture [aerobic, anaerobic, fungal, TB] 2. Cell count and diff 3. Crystal analysis 4. ?Alpha-defensin
68
Treatment of an early PJI?
DAIR [Debridement, Antibiotics, Implant Retention] - Only if it is well fixed prosthesis - Must NOT have sinus tract - 2-6 weeks IV abx followed by 3-6 months of PO abx with rifampin if Staph is involved
69
Treatment of late PJI
Two stage exchange Stage 1 is prothesis excision with placement of antibiotic laden cement as a temporary spacer for 6 weeks Check for treatment response with ESR/CRP Stage 2 is reimplantation 6 weeks of IV abx for this.
70
NOTE
For PJI add rifampin if there is Staph causing the infection.
71
What is Brodie's Abscess
Subacute hematogenous osteomyelitis
72
Who gets Brodie's Abscess
Children and young adults
73
MRI finding with Brodie's Abscess?
Penumbra sign on MRI
74
Pathophysiology of Brodie's Abscess
Bacterial deposit in the medullary canal of a metaphyseal bone [this area is super vascular]
75
Most common cause of Brodie's Abscess
Staph aureus
76
For vertebral osteo when is a tissue sample NOT needed?
When blood cultures grow staph aureus or lugdunensis
77
If in vertebral osteo the tissue sample is negative what is the next step?
1. Repeat biopsy | 2. Open surgical biopsy
78
Presentation of Potts disease
Indolent | Often constitutional symptoms but may not have.
79
What is a gibbus deformity?
This is anterior collapse of the vertebral body in Potts disease
80
Causes of culture negative Septic Arthritis?
1. HACEK 2. Gonococcal 3. Mycoplasma 4. Lyme
81
What might make the diagnosis of delayed PJI challenging?
WBC count >3000 considered PJI until proven otherwise ESR/CRP may not be elevated Cultures only 50-60% positive Symptoms are indolent
82
Treatment of staph aureus infection of PJI in which hardware is maintained?
1. 4-6 weeks of IV abx targeted with rifampin | 2. Oral abx + rifampin for additional 2 months. [often quinolones in combination with rifampin]
83
Who gets 1 stage exchanges? How long are they treated?
Acute infections, subacute infections with healthy tissues of the HIP ONLY. 2-6 weeks of IV abx with 3-6 months of PO abx with rifampin if staph.
84
Who gets 1 stage exchanges? How long are they treated?
Acute infections, subacute infections with healthy tissues of the HIP ONLY. 2-6 weeks of IV abx with 3-6 months of PO abx with rifampin if staph.
85
What type of morphology does mycoplasma have on culture plate?
"Fried Egg"
86
What is Madura Foot?
Chronic SSTI due to mold in those that walk barefoot. May cause osteomyelitis

ID Review (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions