Exam 3 - Endocarditis and bone/joint infections

Question 1

what is the most common bug that causes osteomyelitis

Answer 1

staph aureus

Question 2

what type of bone/joint infection is life threatening

Answer 2

septic arthritis

Question 3

standard duration of abx treatment for bone/joint infections?

Answer 3

4 - 6 weeks

Question 4

For bone/joint infections: when can oral antibiotic therapy be given?

Answer 4

oral only used for osteomyelitis and to COMPLETE parenteral regimen

Question 5

Able to give oral abx to kids when?

Answer 5

they have had a good clinical response to IV abx

Question 6

Able to give oral abx to adults when?

Answer 6

if pt does NOT have diabetes or does NO have peripheral vascular disease

Question 7

3 main therapeutic approaches to managing septic arthritis

Answer 7

appropriate abx
joint drainage
joint rest

Question 8

what does PJI stand for

Answer 8

prosthetic joint infetion

Question 9

PJIs: almost always necessitate the need for _________ and __________ of IV and/or oral abx therapy

Answer 9

need surgical intervention and prolonged courses

Question 10

T or F: bone has poor perfusion

Answer 10

false!! great perfusion (lots of venous capillaries)

Question 11

what are the 3 differ sections of the bone

Answer 11

epiphysis
metaphysis
diaphysis

Question 12

what part of the bone is the epiphysis

Answer 12

it is the part at the END of the bone

Question 13

what is the periosteum

Answer 13

fibrous/cellular envelope surrounding the bone

Question 14

blood vessels supplying bone tissue are predominantly located in what parts of the bone

Answer 14

epiphysis and metaphysis

Question 15

Epiphysis and diaphysis are separated by the _______ which is rapidly growing area of the bone with lots of blood vessels (aka infection can get here super easily)

Answer 15

epiphyseal growth plate

Question 16

When blood flow is ________ an infection is possible with bacterial colonization

Answer 16

blood flow is SLOWED considerably

Question 17

Definition of Osteomyelitis

Answer 17

purulent inflammation of the bone marrow and surrounding bone associated with an infection

Question 18

Osteomyelitis is classified by what?

Answer 18

the route that the infecting organism reaches the bone

Question 19

what are the 3 different routes that osteomyelitis can occur

Answer 19

hematogenous spread
contiguous spread
vascular insufficiency

Question 20

Osteomyelitis: Hematogenous Spread

Risk factors?

Answer 20

sickle cell
or
transient/persistent bacteremia!!

Question 21

Osteomyelitis: Hematogenous Spread
Typically involves metaphysis of RAPIDLY growing _____ bones in kids
examples of these bones?

Answer 21

rapidly growing LONG bones

ex: femur, tibia, humerus, fibula

Question 22

Osteomyelitis: Hematogenous Spread

Typically involves _____ bones in adults

Answer 22

vertebrae (lumbar or thoracic)

Question 23

Osteomyelitis: Hematogenous Spread Pathogenesis

the acute infectious process will increase _______ -> compromises ______ -> leads to _____

Answer 23

increase bone pressure; compromises blood flow; leads to necrosis

Question 24

Osteomyelitis: Hematogenous Spread Pathogenesis

Cytokine release by the infection will cause promotion of ______ activity which will decrease bone integrity

Answer 24

promote osteoCLASTs

Question 25

Osteomyelitis: Hematogenous Spread Pathogenesis with elevated bone pressure and necrosis will cause _______ of diseased bone from healthy bone (called ________)

Answer 25

cause FRAGMENTATION | called SEQUESTRUM

Question 26

Osteomyelitis: Hematogenous Spread Pathogenesis | continued spread of infection leads to outer layers of bone and soft tissue which leads to abscess and draining _______

Answer 26

sinus tracts

Question 27

Osteomyelitis: Contiguous Spread Pathogenesis | how does the pathogen get to the bone?

Answer 27

gets to the bone from an ADJACENT soft tissue infection or direct inoculation during trauma/puncture wounds or surgery

Question 28

Osteomyelitis: Vascular insufficiency Pathogenesis | is a subset of ________

Answer 28

contiguous spread

Question 29

Osteomyelitis: Vascular insufficiency Pathogenesis | Risk factors are who?

Answer 29

pts with diabetes or peripheral vascular disease

Question 30

What bug are worried about for Osteomyelitis in sickle cell pts

Answer 30

salmonella

Question 31

what is the best radiologic thing to diagnose osetomyelitis

Answer 31

MRI (more sensitive)

Question 32

Is it best to get a culture for osteomyelitis - yes or no? and why?

Answer 32

yes - get a freaking culture | do not want to do empiric therapy for 4 - 6 weeks...

Question 33

Empiric therapy for Osteomyelitis: | Adults

Answer 33

nafcillin or cefazolin (MSSA)

Question 34

Empiric therapy for Osteomyelitis: | Post-Op/Post trauma pts

Answer 34

pip/tazo, or cefepime, or meropenem(add vanc if MRSA worried) *these drugs bc want to cover pseudomonas (the hospital bug..)

Question 35

Empiric therapy for Osteomyelitis: | IV Drug user

Answer 35

pip/tazo, cefepime, or meropenem (vanc if suspected MRSA) | want pseudomonas coverage for IV drug users..

Question 36

Directed therapy for Osteomyelitis: | S.Aureus?

Answer 36

Nafcillin or cefazolin if severe allergy: vanc or clinda if MRSA: vanc, dapto, linezolid

Question 37

3 routes that Septic arthritis can occur

Answer 37

hematogenous spread direct inoculation contiguous spread from infected soft tissue or bone

Question 38

The most common pathogen for septic arthritis is _______ | oddly tho -- for adults in age range 15 - 40 the bug _______ is oddly common

Answer 38

most common = s.aureus oddly common bug is Neisseria gonorrhoeae

Question 39

what bug is know to come from cat/dog bites

Answer 39

pasterurella multocida

Question 40

Most septic arthritis cases are mono or poly articular

Answer 40

usually mono!!

Question 41

Gonococcal arthritis: 4 times more common in men or women? and why?

Answer 41

more common in women more common in women because there is a higher risk of dissemination during menstruation/pregnancy or postpartum

Question 42

the gram stain of gonococcal arthritis (synovial fluid should be checked!!) will be what?

Answer 42

gram negative diplococci