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Lecture Notes- Orthopaedics and Fractures > Infections > Flashcards

Infections Flashcards

1
Q

What organism causes cellulitis

A

B-haemolytic streptococci usually group A strep (progenies)

Others include staph aureus

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2
Q

Describe the clinical presentation of cellulitis

A

infected area is painful, hot and oedematous usually with lymphangitis

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3
Q

What si the treatment for cellulitis

A

antibiotics - amoxicillin

necrotising fasciitis may require surgery

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4
Q

What is the curative treatment for an abscess

A

drainage

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5
Q

What organism is responsible for the tetanus infection

A

C. tetani bacillus (anaerobic)

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6
Q

Where is tetanus more often seen

A

tropics

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7
Q

How long is the incubation period of tetanus

A

2 days to 3 weeks

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8
Q

What can cause tonic and clonic muscle contracture in a tetanus infection
What muscles are often affected

A

a powerful neurotoxin which is produced at site of infection and then the facial and jaw muscles producing lockjaw.
Gradual muscle involvement spreads and leads to respiratory arrest

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9
Q

What causes gas gangrene

A

Anaerobic bacillus C perfringens

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10
Q

Where does gas gangrene occur

A

in wounds contaminated by soil and manure especially if necrotic tissue is present

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11
Q

What is often associated with wound botulism

A

IV drug usage where spew contaminated batches of heroin have been injected directly into tissues (skin popping)

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12
Q

What is the classical presentation of wound botulism

A

Bilateral cranial neuropathies associated with symmetrical descending weakness
absence of fever
normal heart rate
blurred vision

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13
Q

What is the treatment for wound botulism

A

Soft tissue debridement
appropriate antibiotics (metronidazole)
anti-toxin administration
Supportive care - ITU and intubation

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14
Q

What is acute osteomyelitis

A

a common condition that is usually caused by Staph progenies

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15
Q

Who is most commonly affected by acute osteomyelitis

A

children

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16
Q

What may predispose to acute osteomyelitis

A

poor living conditions

17
Q

What bones are most commonly affected by acute osteomyelitis

A

Lower end of the femur
upper end of the tibia
either end of humerus, radius and ulna
vertebral bodies

18
Q

What actually happens in acute osteomyelitis

A

Usually a preceding injury
confined space and tension results in tissue necrosis
abscess may form within the bone
plus breaks out under the periosteum penetrating a point on the surface of the skin

19
Q

What are some of the clinical features of acute osteomyelitis

A 
fever 
pain
swelling 
tenderness
oedema and pus 
Swelling of nearby joint due to a sympathetic effusion
failure to thrive
cries when limb is moved
20
Q

What is the management fro acute osteomyelitis

A 
Blood culture 
Broad spectrum antibiotics 
Surgical drainage is pus is suspected 
Change of antibiotics depending on the microbiology result 
6 weeks of antibiotic therapy
21
Q

What is a guide to the rate of recovery of acute osteomyelitis

A

ESR levels

22
Q

How is a diagnosis of osteomyelitis of the spine sometimes made

A

blood culture and aspiration or drainage of pus from a paravertebral abscess

23
Q

How does osteomyelitis of the spine occur

A

usually secondary to bacteraemic spread; common sources include skin and soft tissue infections, cannula/ line associated infections
UTI
endocarditis
RTI

24
Q

How can acute suppurative arthritis occur

A

from progression of osteomyelitis
from haematogenous spread
in rheumatoid joints
following penetrating injuries

25
Q

What joints affected by osteomyelitis are more likely to cause acute suppurative arthritis

A

Hip and upper end of the radius (elbow)

26
Q

Describe the radiological changes in acute suppurative arthritis

A

may be none in the early stages

later, sub-periosteal new bone may become visible with generalised periarticular porous

27
Q

How can a diagnosis of acute suppurative arthritis be made

A

aspiration and identification of organisms by blood culture

28
Q

What is the management for acute suppurative arthritis

A

infected joint must be surgically washed out

29
Q

What is chronic paronychia

A

a persistent nail-fold infection usually caused by a fungus or by repeated irritation e.g. detergents

30
Q

What is the usual causative organism of chronic paronychia

A

Herpes simplex

31
Q

How might chronic pyogenic osteomyelitis arise

A

After trauma to bone (open fracture, penetrating injury, bullet wounds)
Haematogenous spread
Inadequately treated acute osteomyelitis
Complication of surgery particularly when foreign material is implanted

32
Q

Describe the clinical course of chronic pyogenic osteomyelitis

A

Flares of infection with pain and swelling and often pus alternating with periods of quiescence sometimes lasting several years

33
Q

What investigations should be performed for chronic pyogenic osteomyelitis

A

X Rays - demonstrate the abnormal bone texture with thickening and diffuse cavity formation
Culture of the pus from a persistent sinus usually yields mixed organisms from secondary infection

34
Q

What is involved in treating chronic pyogenic osteomyelitis

A

Acute episodes - appropriate antibiotic and surgical drainage if necessary
Eradication- long term antibiotics combined with excision of sequestra and opening up or poorly draining cavities
Open a wound widely, scrape out cavities and close the defect with muscle on a vascular pedicle or a split-skin graft
Amputation may occasionally be required

35
Q

What are the prominent features of TB of bones and joints

A

Destruction of bone and articular cartilage by TB granulation tissues
Thickening of synovial membrane - destroys the articular cartilage
Abscess formation - in spinal tuberculosis - pus tracks along tissue planes
Fibrosis - occurs in the healing phase

36
Q

What are the Xray features of TB of bones and joints

A

Osteoporotic changes around the joint
Erosion of the joint surfaces and loss of joint space
Destruction of bone
Soft tissue shadows representing abscesses (BIRD’S NEST SHADOW)

37
Q

What are the investigations for TB of bones and joints

A 
ESR 
Moderate lymphocytosis 
Tuberculin test may be positive 
Biopsy of lymph glands may show TB - biopsy of bone or synovium usually more reliable 
Bacilli may be cultures from sputum
38
Q

What is the treatment of TB of bone and joints

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

39
Q

What are the 4 reasons for formation of a sinus

A

congenital - persistance of an embryological structure
Foreign body - often a problem with infected prostheses
Chronic infection - TB or fungal infection may produce a chronic sinus after the abscess has discharged or been drained
Neoplasia - a sinus may communicate with a neoplastic mass

Lecture Notes- Orthopaedics and Fractures (23 decks)

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