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Derm Rheum > Bone, Joint, and Muscle Infection - Cross > Flashcards

Bone, Joint, and Muscle Infection - Cross Flashcards

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Dermatology Board Prep flashcards
1
Q

Septic arthritis definition?

A

Typically refers to bacterial infection in a joint.

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2
Q

Septic Arthritis main route of infection? Others?

A

Usually hematogenously acquired

Other routes: Direct inoculation of bacteria into joint through surgery, trauma; contiguous spread from adjacent infected soft tissue or bone

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3
Q

Most common bug in “Step on a Nail” septic arthritis

A

Pseudomonas Aeruginosa

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4
Q

Most common bug in “Bit by my dog/cat” septic arthritis

A

Pasteurella Multocida

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5
Q

Most common bug in sickle cell septic arthritis

A

Salmonella

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6
Q

Pseudomonas Aeruginosa seen in these patients with septic arthritis?

A

IVDU (IV Drug Use), iatrogenic septic joint post surgical procedure/injection

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7
Q

Most common bug causing septic arthritis?

A

Staph aureus

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8
Q

Most important risk factor in septic arthritis?

A

preexisting abnormal joint architecture (i.e. RA, osteoarthritis, gout)

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9
Q

Risk factors for septic arthritis?

A

Abnormal joint architecture (most important), RA, osteoarthritis, gout, advanced age, diabetes, IVDU, immunosuppression, endocarditis

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10
Q

2nd most frequent cause of septic arthritis?

A

Strep; GAS, GCS, GGS

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11
Q

Neonate has septic arthritis. What bug? This bug causes septic arthritis in what other patients?

A

Group B strep, also in diabetics, those with malignances

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12
Q

Sacroiliac joint arthritis. Bug? Source?

A

Brucella from unpasteurized milk. Super rare. Dr. Cross hasn’t seen it.

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13
Q

Sternoclavicular septic arthritis or clavicular osteomyelitis. Most likely in what patients?

A

IV drug users

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14
Q

RA patients most likely to get septic arthritis from what bug?

A

Staph aureus

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15
Q

Most common joint affected in septic arthritis?

A

The knee ( around 50%), mono-articular in 80-90% of cases

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16
Q

Most common joint affected in septic arthritis in children?

A

The hip

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17
Q

What bug causes gas gangrene?

A

Clostridium perfringens

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18
Q

Typical clinical presentation of a patient with septic arthritis

A

Intense pain and loss of function of that joint over 1-2 weeks; swelling, erythema, and increased joint warmth

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19
Q

What is characteristic of children with a septic hip?

A

they hold the hip in a flexed and externally rotated position, resist all ROM

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20
Q

Dx of septic arthritis requires what?

A

arthrocentesis of affected joint

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21
Q

Arthrocentesis facts

> how many cells usually required to make dx?

What type of cells are most abundant?

> how many cells pretty much is a dead giveaway for septic arthritis

Blood culture usually +?

A

> 50,000 usually septic

mostly neutrophils

> 100,000 = “you can pretty much bet this is a septic joint”

Blood cultures not often +

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22
Q

Most important thing to look for when aspirating a joint that is suspected to be septic?

A

The presence of crystals, if crystals are present then it’s gout, not septic arthritis

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23
Q

Nonspecific lab findings seen in septic arthritis

A

Leukocytosis, elevated ESR and/or CRP

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24
Q

Early X-ray findings in septic arthritis

A

periarticular soft tissue swelling, nml osseous structures

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25
Q

Late X-ray findings in septic arthritis

A

Joint space loss, bony erosion/destruction

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26
Q

Ultrasound of septic joint is useful for what?

A

assess for presence of effusion and to guide needle aspiration if needed

27
Q

Who are you going to immediately call if pt has septic arthritis?

A

Future drew aka ortho to come for drainage +/- irrigation and debridement

28
Q

What bug causes a migrating arthritis

A

Gonococcus

29
Q

Presentation of gonococcal arthrits

A

Triad of dermatitis (this is key), tenosynovitis, and migratory polyarthralgia

30
Q

Epidemiology of Gonococcal arthritis. List a few

A

4x more common in women; <40 years old, lower socioeconomic status, multiple sex partners, illicit drug use

31
Q

Pathogenesis of Gonococcal arthritis

A

Results due to occult bacteremia; infection could have been contracted days to months prior to dissemination

32
Q

Risk factors for gonococcal arthritis?

A

Women during menstruation, pregnancy, or postpartum; complement deficiencies (C5-C8)

33
Q

General outcome of blood cultures

A

around 25% are positive; don’t be fooled by negative blood cultures

34
Q

Joints that gonococcal arthritis normally affects

A

Knees, wrists, ankles

35
Q

What is this? What disease is this associated with? Early or late in progression of disease?

A

Erythema migrans aka Bullseye rash = Early Infection Stage 1 Lyme disease

36
Q

Common bug that causes lyme disease?

A

Borrelia burgdorferi

37
Q

Lyme disease common where (geography)?

A

Common in northern states; NOT common in TN or Missouri.

  • Hey lets go picket in front of the Infectious disease convention. Theyll start listening to us then.
38
Q

Stages of Lyme disease?

A

Stage 1 (early infection): erythema migrans; classic “bullet” rash

Stage 2 (early infection): Secondary skin lesions similar to initial lesions, but smaller; malar rash and conjunctivitis

Stage 3 (Persistent infection): intermittent attacks of joint swelling, especially large joints like the knee; even in untreated patients persistent arthritis normally resolves completely over several years

39
Q

Test used to diagnose Lyme disease

A

Lyme western blot test

40
Q

Alpha toxin associated with what bug? Main effect?

A

clostridium perfringens, causes hemolysis leading to anemia

41
Q

Gas gangrene in a patient causes what?

A

myonecrosis, necrotizing fasciitis

42
Q

Leukocyte threshold for diagnosis of prosthetic joint infection

A

Threshold is much lower for leukocytosis in the synovial fluid when compared to a nml joint; prosthetic joints don’t have the amount of vascular access for inflammatory cells

43
Q

Treatment for prosthetic joint infection

A

REMOVE THE PROSTHESIS; prolonged abx therapy

44
Q

Conjunctivitis, palsies, and meningitis are associated with what disease?

A

Early Infection Stage II of Lyme Disease

Features: include secondary skin lesions similar to initial lesions, but smaller; malar rash and conjunctivitis

  • heart and nervous system including palsies and meningitis
45
Q

Pt has abscess on spine, whats your likely dx?

A

Pott’s disease (MTB osteomyelitis of spine)

46
Q

Likely source and route leading to Pott’s Disease

A

TB of lung spread hematogenously to spine

47
Q

What bug causes double zone of hemolysis on blood agar?

A

clostridium perfringens

48
Q

Osteomyelitis due to candida infection seen in what patients? Other bugs common to this subset of patients?

A

IV drug users. Staph aureus, pseudomonas, candida, and serratia

49
Q

Causes of viral arthritis?

A

Rubella, Parvo B19, HCV, HBV

50
Q

Characteristic course of viral arthritis?

A

short duration, most resolve spontaneously; small joints of the hands most commonly affected

51
Q

How is the inflammation caused in viral arthritis

A

Immune complex formation; deposition in the joints causes inflammation

52
Q

Most common causes of osteomyelitis

A

Common (>50% of cases) = Staph aureus, coag - staph (S. epidermidis, etc)

Less common (>25% of cases) = streptococci, enterococci, gram - (pseudo in someone stepped on a nail), anaerobes, MTB

53
Q

Pathogenesis of staph aureus causing osteomyelitis?

A

Expresses high affinity adhesions to components of bone matrix that express fibronectin, laminin, collagen, etc

  • it was bolded in her notes.
54
Q

Presentation of osteomyelitis

A

Nonspecific pain around the involved site with absence of systemic signs/symptoms

55
Q

In osteomyelitis, what usually alerts you to the source?

A

Location, location, location

56
Q

Osteomyelitis as a result of hematogenous seeding in adults is usually what type?

A

vertebral osteomyelitis

57
Q

Hematogenous long bone osteomyelitis: mono or polymicrobial?

A

monobacterial

58
Q

Contiguous infection osteomyelitis: mono or polymicrobial?

A

polymicrobial

59
Q

Foot osteomyelitis in diabetics is usually due to what route of infection?

A

result of contiguous spread

60
Q

Foot osteomyelitis after nail puncture usually due to what route of infection?

A

Result of direct inoculation

61
Q

Long bones of the lower extremity are the most common location of infection in what subset of patients with osteomyelitis?

A

Acute hematogenous osteomyelitis in children, obviously a result of hematogenous seeding

62
Q

Patient comes in with neck/back pain symptoms. What is an important question to ask?

A

Have you had recent injections in your back/neck. Rare but could be vertebral osteomyelitis due to iatrogenic cause (like injecting a long ass needle in someones neck)

63
Q

Complement deficiency risk factor for what? What complements specifically?

A

gonococcal arthritis, C5-C8

Derm Rheum (39 decks)

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