Bone and Joint Infections - Hall

Question 1

Which is more likely to cause a bone infx, strep or S aureus

Answer 1

staph aureus

Question 2

Do you need to do a needle biopsy if you have a positive blood culture?

Answer 2

nope

Question 3

What is the sensitivity of a needle biopsy?

Answer 3

80%

Question 4

Can you rely on cultures taken from fistulas or sinus tract?

Answer 4

only if they culture a single organism or staph aureus

Question 5

what is the gold standard for bone infection diagnosis?

Answer 5

open bone biopsy

Question 6

If cultures are sterile after three days but you know there is an infection, what should you do?

Answer 6

grow cultures for 15 days

Question 7

What are the situations in which a prosthetic may be retained after debridement?

Answer 7

symptoms <3 weeks
stable implant
easy to treat organism

Question 8

What are the conditions for a single-stage prosthesis replacement?

Answer 8

symptoms >3 weeks
soft tissue in good shape
no co-morbidities
easy to treat organism

Question 9

what is the first sign of an epidural abcess?

Answer 9

spinal ache

Question 10

What are the indications for debridement of vertebral osteomyelitis?

Answer 10

Instability
Abcess
Cord compression
Cervical infection
Medical failure
Neurological signs or symptoms

Question 11

t/F: imaging within four weeks of osteomyelities Tx usually look worse

Answer 11

true

Question 12

How do you diagnose osteomyelitis?

Answer 12

histopathologic evidence with supporting microbiological data

Question 13

describe how the following findings will predict bone involvement:
size of lesion
probe depth
ESR

Answer 13

> 2cm large and >3mm deep
if probe goes to bone
ESR >70

Question 14

What are the best imaging studies for a diabetic foot?

Answer 14

plain film
Ct
MRI
nuke med

Question 15

T/F: plain films are insensitive to actue osteomyelitis in a diabetic foot

Answer 15

true

Question 16

What would you see on a plain film in a chronic infection of a diabetic foot?

Answer 16

sclerosis, periosteal elevation, and sequestra

Question 17

What is the best method for detecting small areas of necrossi, gas, and foreign bodies?

Answer 17

CT

Question 18

WHat is the best single test for a diabetic foot infection>?

Answer 18

MRI

Question 19

In the TC-99 bone scan, when will soft tissue infections be positive and when will osteomyelitis be present?

Answer 19

soft tissue: immediate and at 15 mins

osteomyelitis: delay greater than 4 hours

Question 20

What organisms can cause an infected ulcer?

Answer 20

S. aureus, B-streptococci

Question 21

What organisms cause a chronically infected ulcer?

Answer 21

S. aureus, ß streptococci, enterococci, Enterobacteriaceae, Pseudomonas species

Question 22

What species cause a necrotic, malordorous, fetid foot?

Answer 22

S. aureus, ß streptococci, enterococci, Enterobacteriaceae, Pseudomonas species and anaerobes

Question 23

What is the treatment for a diabetic foot?

Answer 23

Surgical debridement (with bone cultures)
Re-vascularization if needed
Long-term antibiotics

Question 24

T/F: abx alone may be sufficient to treat a diabetic foot

Answer 24

true

Question 25

T/F: you should always include gram pos coverage for staph aureus when giving Abx for a diabetic foot infection

Answer 25

true

Question 26

When should you add gram neg coverage for a DM foot?

Answer 26

for chronic wounds or pts previously treated with abx

Question 27

When do you inlcude anaerobic coverage for a DM foot?

Answer 27

necrotic foot with odor

Question 28

When do you narrow your abx coverage for a dM foot?

Answer 28

upon pos cultures

Question 29

WHere should you take your culture from in a DM foot?

Answer 29

bone

Question 30

T/F: coverage of enterococci is not necessary but MRSA is in DM feet

Answer 30

true

Question 31

What is the indication for pseudomonas coverage when treating a dM foot?

Answer 31

after the wound has been treated with hydrotherapy

Question 32

When do avirulent bugs like coag negative staph or corynebacterium become a problem?

Answer 32

when the host is immunocompromised with sig. soft tissue necrosis

Question 33

Mild DM foot infx should be treated for how long?

Answer 33

1-2 weeks

Question 34

Moderate to severe DM foot infx should be treated for how long?

Answer 34

2-4 weeks

Question 35

osteomyelitis in a DM foot should be treated for how long?

Answer 35

4-6 weeks or longer

Question 36

Acute angle deformities of the thoracic spine with granulomas on biopsy, with possibly septic joints makes you think of what bug?

Answer 36

TB

Question 37

What are indications for surgery in Pott’s disease?

Answer 37

Neurological deficits Instability Cervical disease Medical failure including non-adherence

Question 38

In DEVELOPED countries, what does skeletal TB represent?

Answer 38

reactivation of old focus of infection; Dz of adults

Question 39

In the DEVELOPING world, skeletal TB presents in pts who....

Answer 39

recently acquired TB; Dz of children

Question 40

What is the average length of symptoms of skeletal TB prior to Dx?

Answer 40

16-19 months

Question 41

T/F: Local swelling, pain, fluctuance; systemic symptoms (fever, sweats, etc) are often absent in skeletal TB

Answer 41

true

Question 42

Pulmonary disease is present in what portion of skeletal TB?

Answer 42

30%

Question 43

Pott's disease, aka (blank)

Answer 43

tuberculosis spondylitis

Question 44

Describe the progression of Pott's disease

Answer 44

Infection begins in the anterior aspect of the vertebral body leading to anterior collapse and spread of the infection along the anterior ligament

Question 45

Most cases of Pott's disease have what regions of vertebrae affected?

Answer 45

thoracic and lumbar

Question 46

1/2 pts with Pott's disease also have (blank), which if calcified are diagnostic for TB

Answer 46

abcesses

Question 47

What is the common presentation of Pott's disease?

Answer 47

50% have weakness or paralysis at the time of presentation or during Rx 50% associated with disc involvement 50% without disc involvement are younger and more likely to have other skeletal lesions 77% have epidural involvement by MRI (Pertuiset, 1999)

Question 48

T/F: gonorrheal infections will show up most of the time in the CSF

Answer 48

true

Question 49

What is the abx for reactive arthritis?

Answer 49

ceftriaxone

Question 50

SAUSAGE DIGITS makes you think:

Answer 50

about sausages, aka penises, aka GC infection

Question 51

What are the risk factors for reactive arthritis?

Answer 51

enteric infection, IBD

Question 52

What causes pyogenic arthritis in the newborn?

Answer 52

Staphylococcus aureus Enterobacteriaceae Group B streptococcus

Question 53

How do you treat pyogenic arthritis in the newborn?

Answer 53

PRSP + third generation cephalosporin

Question 54

What bugs cause pyogenic arthritis in a child 3-6 months old?

Answer 54

Staphylococcus aureus H. influenzae Streptococci Enterobacteriaceae

Question 55

How do you treat pyogenic arthritis in a kid 3-6 months old?

Answer 55

(PRSP or first generation cephalosporin) + third generation cephalosporin

Question 56

What bugs cause septic arthritis in an adult?

Answer 56

Staphylococcus aureus Group A streptococci Enterobacteriaceae

Question 57

What do you use to treat septic arthritis in an adult?

Answer 57

[(PRSP or first gen cephalosporin) + (APAG or Ciprofloxacin)] or Timentin or Piperacillin Tazobactam or Unasyn

Question 58

what caues infection of a joint replacement?

Answer 58

Staphylococcus epidermidis Staphylococcus aureus Enterobacteriaceae Pseudomonas

Question 59

How do you treat infections of joint replacements?

Answer 59

Vancomycin + ciprofloxacin or aztreonam or APAG