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MSK 1 > Bone Infection > Flashcards

Bone Infection Flashcards

1
Q

localized infection of bone marrow

A

osteomyelitis

occurs when bone integrity is interrupted

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2
Q

osteomyelitis occurs due to (3)

A 
hematogenous spread
contagious spread (adjacent structures/joints)
direct inoculation (sx, trauma)
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3
Q

hematogenous osteomyelitis

A

after bacteremia

typically mono microbial

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4
Q

hematogenous osteomyelitis mc affects?

A

vertebrae in adults (IVDA)

long bones in children and infants

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5
Q

mc organisms of hematogenous osteomyelitis

A

staph aureus

pseudomonas and enterobacter

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6
Q

hematogenous osteomyelitis patho

A

beings inside bone and grows towards cortex (perosteal elevation)

inflammation of overlying soft tissue and sinus track development to drain thru skin

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7
Q

contagious or direct inoculation osteomyelitis

A

MC from trauma and vascular dz

polymicrobial

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8
Q

post trama osteomyelitis

A

MC adults, in tibia, due to S. aureus

begins OUTSIDE cortex and works its way towards medullary canal

abscess increases pressure and compromises O2 delivery = expand and growth of more bacteria

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9
Q

osteomyelitis due to vascular disease

A

MC due to inadequate inflammatory respond to minor trauma and invasion of multiple organisms to feet

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10
Q

osteomyelitis due to vascular disease pathogens

A 
strep species 
entroecoccus 
coagulase postive and negative staphylococci 
gram neg bacilli
anerobic organisms
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11
Q

acute osteomyelitis

A

less than 2 weeks, MC in kids

several days of dull pain, LOCALIZED tenderness, warmth and swelling, systemic symptoms

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12
Q

children with acute osteomyelitis

A

decreased ROM of extremity and pain

malaise

fevers

irritability

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13
Q

chronic osteomyelitis

A

2-3 months, MC in adults

pain, redness, swelling, DRAINING sinus tract

DM

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14
Q

DM osteomyelitis

A

exposed bone or large ulcer (>2x2 cm) OR if bone is palpable on exam = LIKELY osteomyelitis

ESR > 60 also indicated

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15
Q

overall, ____ is mc etiologic agent in direct inoculation and hematogenous spread osteomyelitis

A

staphylococcus

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16
Q

bones affected by osteomyelitis DM

A

tarsal
metatarsal
phalanges

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17
Q

bones affected by osteomyelitis neonates, children

A

long bones (hematogenous spread_

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18
Q

bones affected by osteomyelitis CABG

A

sternum

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19
Q

bones affected by osteomyelitis endocarditis

A

vertebral bodies (diskitis)

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20
Q

osteomyelitis predisposing factors

A 
DM
IVDA 
ulcers 
trauma 
surgery 
hx of prosthesis
21
Q

osteomyelitis PE

A

evaluate ulcers to “probe to bone” - assume osteomyelitis

22
Q

pathognomonic osteomyelitis

A

sinus tract drainage

23
Q

osteomyelitis WU

A

CBC
blod culture
wound culture

BONE BX and CuLTURE = golds standard

24
Q

osteomyelitis imaging

A

plain films first

MRI test of choice (After plain films) to determine if soft tissue or bone infxn

25
Q

osteomyelitis tx

A

abx (parenteral) and possible sx AFTER culture

26
Q

surgery is indicated for osteomyelitis :

A
  1. failure of abx
  2. infected surgical hardware
  3. chronic osteomyelitis w/necrotic bone and soft tissue
  4. clear necrotic tissue at an ulcer site
27
Q

osteomyelitis ABX

A

quinalones have a high degree of bone penetration

typically do Vanco + fluroquinaolone

28
Q

osteomyelitis adjunctive tx

A

HBO
NPWT (wound vac)

+/- re-vascualrization (vascular insufficiency)

29
Q

long term chronic osteomyelitis

A

squamous cell carcinoma or fibrosarcoma

30
Q

septic arthritis

A

infection fo joint space

acute mono-articular arthritis (single, swollen joint)

31
Q

RF of septic arthritis

A 
DM 
immunosuppresive tx
prosthetic hardware
recent joint sx
IVDA, alcoholism 
sexually active young
32
Q

sources of infection septic arthritis

A

trauma
hematogenous spread
surgical infection

33
Q

pathogenesis septic arthritis

A

bacteria enter joint via various mechanisms and produce inflammatory response = swelling, erythema, and warmth of joint space

34
Q

MC pathogens in septic arthritis

A

Staph aureus overall

N. gonorrhea in young, sexually active adults

35
Q

septic arthritis where

A

MC in knee

next hip

36
Q

polyarticular septic arthritis

A

20% of case present with this

MC see overwhelming sepsis

37
Q

pediatrics and septic arthritis

A

lower extremity joints

38
Q

acute septic arthritis differential

A

monoarticular = septic arthritis or gout

poly articular = reactive arthritis or viral arthritis

39
Q

chronic septic arthritis (>12 weeks)

A

mono= osteoarthritis

poly - osteoarthritis or RA

40
Q

septic arthritis exam

A

fever, chills, rigors, systemic symtoms

joint pain, swelling, warmth, restricted ROM

hot, red painful joint

41
Q

septic arthritis diagnosis

A

acute, hot painful joint

CBC, blood culture, ESR, CRP

XR normal

42
Q

diagnostic study of choice for septic arthritis

A

arhtrocentesis to evaluate fluid

visualization, stain and culture, leukocyte could and glucose level

43
Q

septic arthritis arthrocentesis results

A 
opaque
>3.5 volume 
leukocytes 15-100k 
often POSITIVE 
<25
44
Q

septic arthritis tx

A

vanc + ceftriazone IV x 4-6 weeks

ortho consult and consideration for debridement

45
Q

stage I septic arthritis

A

remove prothesis and place a spacer

six weeks of ABX (often all IV)

46
Q

stage II septic arthritis

A

placement of new prosthesis with antibiotic impregnated cement (95% success)

47
Q

septic arthritis prognosis

A

not much change

difficult to predict final outcome
polyarthrtiic joint higher mortality rate

48
Q

predictors for poor outcome septic arthritis

A

old age
preexisting dz
synthetic material

MSK 1 (9 decks)

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