Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pharmacotherapy 4270 > Bone & Joint Infections (Final Exam) > Flashcards

Bone & Joint Infections (Final Exam) Flashcards

1
Q

this is inflammation of the bone marrow and adjacent bone due to bacterial infection; generally an uncommon disease

A

osteomyelitis (OM)

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

this is acute inflammation of the synovial membranes, with purulent effusion into a joint due to bacterial infection

A

septic arthritis (SA)

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

true or false: septic arthritis is more common than osteomyelitis

A

true

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

this infection is hematogenous (infection that occurs via the blood stream and the most common cause is S. aureus

A

osteomyelitis

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

true or false: osteomyelitis is more common in adults than children

A

false

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

true or false: osteomyelitis is a contiguous infection (can spread to a bone close by)

A

true

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

osteomyelitis can develop in patients with _________ which is very difficult to manage, and peripheral vascular disease comprises 34% of cases

A

vascular insufficiency

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

osteomyelitis infections in patients with vascular insufficiency are often __________ (monomicrobial or polymicrobial)

A

polymicrobial

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

what bacteria are most commonly seen in osteomyelitis in patients with vascular insufficiency

A

Staph and Strep or the combination of Staph, Strep and enterococcus

(enterococcus and anaerobic organisms can also be involved)

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

which feature of osteomyelitis does this describe:
a) hematogenous
b) adjacent/contiguous site of infection
c) vascular insufficiency

  • usually seen in adults
  • foot is common site of infection
  • risk factors: diabetes, peripheral vascular disease
  • often polymicrobial (Staph, Strep, gram-negative bacilli, anaerobic organisms)
  • pain, swelling, drainage, ulcer formation
A

c) vascular insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

which feature of osteomyelitis does this describe:
a) hematogenous
b) adjacent/contiguous site of infection
c) vascular insufficiency

  • predominant in paediatrics
  • tibia, femur (children), vertebrae (adults) are common sites of infection
  • risk factors: bacteremia
  • only caused by one organism: Staph or gram-negative bacilli
  • fever, chills, local tenderness, swelling, limitation of motion
A

a) hematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

which feature of osteomyelitis does this describe:
a) hematogenous
b) adjacent/contiguous site of infection
c) vascular insufficiency

  • usually seen in adults
  • femur, fibula, tibia, skill, mandible site of infections
  • risk factors: surgery, trauma, cellulitis, joint prothesis
  • often polymicrobial (staph, strep, gram-negative bacilli, anaerobic organisms)
  • fever, warmth, swelling, unstable joint
A

b) adjacent/contiguous site of infection

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

what are the main differences in symptoms of osteomyelitis between adults and children

A

systemic symptoms are less common in adults (usually only local symptoms)

in children, infection is characterized by an onset of high fever and chills, localized pain, tenderness and swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

acute osteomyelitis may present slowly with onset over a few days but usually appears within _______

A

2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

true or false: acute osteomyelitis may present with local symptoms such as erythema, swelling, and warmth at the site of infection may be present and common to ALL AGE GROUPS

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

in this type of onset of osteomyelitis, symptoms may include generalized malaise, mild pain over severe; weeks with minimal fever or other constitutional symptom

A

subacute presentation

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

in this type of onset of osteomyelitis, symptoms occur over a longer duration of time, usually more than 2 weeks and may present with swelling, pain, and erythema at the site of infection but systemic symptoms are less common

A

chronic

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

this type of radiographic investigation has poor sensitivity as bone changes not often seen until later (10-14 days after infection). can be used to rule out other diagnosis such as fractures

A

x-ray

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

this is the most useful tool for diagnose and assessing the extent of infection for osteomyelitis

A

MRI

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

this will show bony erosion better than an x-ray and is useful if there is no access to an MRI

A

CT scan

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

_________ and _________ bone scanning can detect infection after one day of symptoms (90% sensitivity)

A

Technetium & Gallium

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

this laboratory investigation is necessary to make accurate bacteriologic diagnosis. can be an abscess or sore (caution when interpreting results!! what you get on swab may not be what’s infecting the bone

A

bone aspiration

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

what are some other laboratory investigations that may be present with osteomyeltits

A

increased ESR, CRP and WBCs (WBCs may be normal in chronic cases)

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

what are the goals of therapy for osteomyelitis & septic arthritis

A
  • eradicate the infection thus decreasing mortality
  • prevent long term sequelae through effective treatment of the infection
  • provide cost-effective, convenient therapy
25
Q

what is the empiric treatment for osteomyelitis in newborns

A

cefazolin iV

26
Q

what is the empiric treatment for osteomyelitis in children 3 y/o or younger

A
  • if vaccinated for H. influenzae type b: cefazolin IV
  • if not vaccinated: cefuroxime IV
27
Q

what is the empiric treatment for osteomyelitis in children over the age of 4

A

vancomycin IV, Clindmaycin IV or cefazolin IV

28
Q

what is the empiric treatment for osteomyelitis in IV drug abusers

A

Vancomycin q12h plus cipro po BID or ceftazidime or cefepime IV q8h

29
Q

what is the empiric treatment for osteomyelitis in adults

A

Vancoymic q12h or Cefazolin IV q8h

30
Q

what is the empiric treatment for postoperative or post-trauma patients with osteomyelitis

A

Vancomycin IV q12h plus ceftazidime or cefepime IV q8h

31
Q

what is the empiric treatment for patients with vascular insufficiency in osteomyelitis

A

Vancomycin IV q12h plus ceftriazone od

32
Q

what empiric antibiotic should be added on if there is anerobes suspected (necrosis) with osteomyelitis

A

metronidazole q8h or clindamycin

33
Q

what is the usual duration of therapy for osteomyelitis

A

usually 4-6 weeks (IV alone or IV + PO)

34
Q

what is the criteria for the use of oral outpatient antibiotics to complete therapy for osteomyelitis

A

children with good clinical response to IV therapy and adults without DM or peripheral vascular disease and ALL of the following
- confirmed osteomyelitis
- initial clinical response to parenteral antibiotics (resolution of erythema, swelling and tenderness and until the patient is afebrile)
- suitable oral agent available
- compliance ensured

35
Q

this is usually acquired by hematogenous spread and more often in those greater than 16 years old

A

septic arthritis

36
Q

general presentation of this is a 1-2 week history of fever, pain, DECREASED MOBILITY, swelling, increased ESR or CRP, peripheral WBC rarely over 14, 000 with elevated intra-synovial WBC

A

septic arthritis

37
Q

this type of septic arthritis most often only involves a single joint, usually the knee

A

non-gonococcal

38
Q

this type of septic arthritis is more common in women. a common symptom is migratory polyarthralgia, where one joint is swollen and red and then another joint gets infected, probably before the first joint fully heals.
fever, dermatitis, tenosynovitis (inflammation of the tendon sheath) and pustular or petechial skin lesions may also be present

A

gonococcal

39
Q

what are some radiographic & laboratory investigations useful for diagnosing septic arthritis

A
  • xray: often reveals distention of joint capsule and swelling of adjacent tissue
  • CT and MRI are useful
  • joint aspiration (arhtrocentesis): presence of purulent fluid, many WBC (normally almost none) and low synovial glucose levels are indicate of septic arthritis
  • culture synovial fluid and blood
  • if sexually active, culture urethra, cervix, anal cavity and throat because gonorrhoea could be the cause of this
40
Q

what are the most often associated bacteria with acute monoarticular septic arthritis

A

S. aureus, streptococci
gram -ve bacilli in the elderly and immunocompromised

41
Q

what are the most often associated bacteria with acute polyarticular septic arthritis

A

n. gonorrhoea

42
Q

what are the most often associated bacteria with post-op, post injection or post-prothesis septic arthritis

A

S. epi, S. aureus, enterobacteriae, pseudomonas (hospital acquired bacteria)

43
Q

what is used for empiric treatment of monoarticular septic arthritis

A

ceftriazone IV q12-24h

44
Q

what is used for empiric treatment of polyarticular septic arthritis

A

ceftriaxone IV q24h

45
Q

what is used for empiric treatment of prosthetic joint septic arthritis

A

vancomycin IV q12h + rifampin PO q12h

*may not be healed by antibiotics, joint may need to be replaced

46
Q

what is the duration of therapy for gonococcal septic arthritis

A

7 days

47
Q

what is the duration of therapy for non-gonococcal septic arthritis

A

14-28 days

48
Q

what is the duration of therapy for prosthetic joint septic arthritis

A

42 days

49
Q

monitoring protocol for OM and SA: when should culture and susceptibility be done?

A

at initiation of tx (no need to repeat unless clinical failure or origin was not from a deep culture site e.g. surgical sample)

50
Q

monitoring protocol for OM and SA: when should WBC count be taken

A

one time per week until within normal range

51
Q

monitoring protocol for OM and SA: when should CSR and ESR be taken

A

weekly

52
Q

monitoring protocol for OM and SA: how often should clinical signs of inflammation (redness, pain, swelling, tenderness and fever) be monitored

A

daily during initiation of therapy

53
Q

monitoring protocol for OM and SA: how often should adherence of outpatient therapy be monitored

A

reinforce before starting therapy and with each healthcare visit

54
Q

monitoring protocol for OM and SA: how often should CBC be taken

A

weekly

55
Q

this increases the likelihood of surgical intervention and longer durations of antibiotic therapy. impairs healing of relying wound and acts as a focus for recurring infection. any ulcer with a positive “probe to bone” test or in which bone is visible is likely to be complicated by OM

A

diabetic foot - osteomyelitis

56
Q

are ESR and CRP useful for monitoring in diabetic foot ulcer

A

low sensitivity but if elevated, may be useful to monitor response

57
Q

true or false: for diabetic foot ulcer, soft tissue specimens provide more accurate microbiologic data than bone specimens

A

false - other way around; bone better than soft tissue

58
Q

in terms of radiographic investigations, how is diabetic foot ulcer diagnosed?

A

obtain plain radiograph (x-ray)
if OM is suspected but not confirmed by X-ray get an MRI

59
Q

how long is duration of therapy for diabetic foot ulcer

A

usually more than 6 weeks

pharmacotherapy 4270 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions