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MOD 2 Quiz 1 > DS: Joint ant Bone Infections > Flashcards

DS: Joint ant Bone Infections Flashcards

1
Q

Septic arthritis?

A 
Pyogenic arthritis (synonym)
an invasion of a joint by a pathogenic bacterium causing purulence (pus formation) resulting in an extremely painful and swollen joint
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2
Q

Importance of septic arthritis?

A

bacterial arthritis is more dangerous and destructive
significant damage can occur within 24 hours
mortality around 7-15% despite antibiotic use

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3
Q

Diagnosis of septic arthritis?

A

arthroscopy or open drainage in the operating room

aka, immediate treat, surgery

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4
Q

making differential for septic arthritis?

A

it is a painful, warm arthritis
have to think about other ones of that nature
gout, reactive arthritis, RA, lupus, akylosing spondylolitis, etc

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5
Q

why is preexisting arthritis a risk factor for septic arthritis?

A

more likely to develop an infection in the joint that is already damaged

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6
Q

other risk factors for septic?

A 
steroid use
intraarticular injection
diabetes
trauma
history of STDs
other infection
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7
Q

Epidemiology of Septic?

A

usually in patients with preexisting joint problems
most are male
older than 65 yo

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8
Q

Source of infection?

A

Sepsis, spread to the joint from infection is common
trauma to the joint
direct inoculation during joint surgery

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9
Q

Etiology of septic arthritis? most common

A

Staph aureus is most common

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10
Q

septic in neonates?

A

Strep agalactiae

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11
Q

septic in sick cell?

A

step pnuemoniae

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12
Q

strep in young children?

A

Kingella Kingae

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13
Q

septic in STDs/ unsafe sex?

A

Neisseria gonnorhoeae

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14
Q

septic in unvaccinated?

A

hemophilus influenzae

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15
Q

septic in endemic areas?

A

mycobacterium tuberculosis

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16
Q

Staph aureus?

A

gram pos, facultative, catalase pos, coagulase pos

cause abscess formation in skin and subcut tissue

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17
Q

Strep pyogenes? (grp A strp)

A

gram pos cocci in chains
catalase neg, beta hemolytic, sens to bacitracin
cause infections, cellulitis, strep throat, sepsis, rheumatic fever

aka, patient with strep throat, develops joint pain after– has this

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18
Q

Strep agalactiae? (grp B strep)

A

gram pos cocci in chains
beta hemolytic, carried in maternal gential tract
cause meningitis, pneumonia, and sepsis in neonates

19
Q

Strep pneumoniae?

A 
gram pos, lancet shaped, diplocci
alpha hemolytic
sens to optochin
polysaccharide capsule
cause pneumonia, otitis media, meningitis, sepsis

(sickle cell)

20
Q

Neisseria?

A

gram neg, diplo, coffee bean shape
produce cytochrome oxidase
STD causes urethritis and cervictitis

21
Q

Kingella Kingae?

A

fastidious aerobic gram-neg coccobacilli
most commonly isolated from blood and synovial fluid
colonize oral mucosa
cause endocarditis and joint infections in young child (2 mo- 2 yrs)

22
Q

Clinical features of septic arthritis?

A

infection is generally monoarticular
knee is the most common, followed by hip
swollen, hot, painful joint in a patient with fever

23
Q

How do organisms invade in septic?

A

invade via bloodstream, direct inoculation or by continuous spread from infected periarticular tissue

previous damaged joints are most susceptible, synovial membranes of these joints exhibit neovascularization and increased adhesion factors

24
Q

How does s. aureus bind to joint?

A

via specific tissue adhesion factors

25
Q

how does s. aureus cause damage and multiply?

A

organisms pathological properties, chondrocyte proteases, as well as host’s polymorphonuclear leukocytes response

26
Q

Pannus formation?

A

layer of fibrovascular or granulation tissue

beings and cartilage erosion occurs at the lateral margins of the joint

large effusions impair the blood supply, aseptic necrosis of bone

27
Q

atherocentesis?

A

to obtain joint fluid

28
Q

lab diagnosis?

A

atherocentesis, then gram stain joint fluid, cell count and differential, culture joint fluid

Staph aureus, step, and neisseria most common

29
Q

Treatment of septic?

A

arthroscopy or open drainage of joint

antibiotic therapy depends on organism isolated

30
Q

Treat s. aureus?

A

Naficillin, Vancomycin

31
Q

Treat with penicillin?

A

S. pyogenes

S. pneumoniae

32
Q

Treat with ceftriaxone?

A

S. pneumoniae

N. gonnorhoeae

33
Q

Osteomyelitis?

A

difficult to diagnose until about 50% of the bone matrix must be removed before the lytic process can be visualized
no changes occur on a standard x-ray until 10 days after onset of illness

34
Q

Pathophysiology of osteomyelitis?

A

occurs more frequent in children when long bones grow
a trauma disrupts blood vessels and cause hematoma
Metaphysis is predisoposed to infection

35
Q

Why is the metaphysis predisposed to infection?

A

because capillaries make sharp loops close to the growth plate then expand to large sinusoidal vessels that connect to venous network, an increase in diameter slows blood flow, cause sludging, and microclots

36
Q

Diagnosis of Osteomyelitis?

A

patient will have a fever and severe localized skeletal pain
radiologic findings of localized inflammatory process (xray, bone scan, CT/MRI)
blood culture, bone aspirate for culture

37
Q

What will a bone scan show?

A

increased blood flow, pooling, and reactive new bone formation

38
Q

Etiology of Osteomyelitis? Children?

A 
S. aureus most common
Strep agalactiae (grp B) neonates
step pneumo (2 mo- 2yrs)
Haemophilus influenza (2 mo-2yrs unvaccinated)
Kingella Kingae (2mo to 2 yrs)
Strep pyogenes (grp A) school age children
39
Q

Etiology of Osteomyelitis in adults?

A 
S. aureus most common
gram neg rods/ E coli, Klebsiella/Enterobacter 
Salmonella (sickle cell)
Pseudomonas and Serratia (IV drug users)
Other (fungir, mycobacteria)
40
Q

Treatment of Osteomyelitis?

A

surgical debridement of necrotic bone material

antibiotics depends on organism isolated (high dose, parenterally, long course)

41
Q

Infections with prostheses?

A

only .5-1% become infected
infection develops at the bone-cement interface, cemeneted with polymethylacrylate
source may be introduced through surgery or be from a hematogenous origin

42
Q

Etiology of infections with prostheses?

A 
Staphylococcus most common
(Staphylococcus epidemidis)- due to slime layer which binds to surface of prosthetic device
(Staph aureus)
Strep species
Gram neg
Enterococcus
mixed flora
other (fungi, mycobacteria)
43
Q

Treatment of infections with prostheses?

A

surgery, often removal of prosthetic is required with debridement of necrotic tissue
antiobiotics depend on organism isolated

MOD 2 Quiz 1 (9 decks)

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