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MSKJaz > Infections > Flashcards

Infections Flashcards

1
Q

inflammation of bone medulla - usually in one of the long bones =

A

osteomyelitis

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2
Q

osteomyelitis caused by open #s are due to ___
clinical clues = __+__
causative org.s =
Rx =

A

contiguous infection
non-union + poor wound healing
S. aureus + aerobic gram +ve bacilli
aggressive debridement, fixation and soft tissue cover

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3
Q

if step on nail and get a contiguous osteomyelitis the causative org is likely to be

A

pseudomonas

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4
Q

diabetes and vascular insufficiency usually cause a ____ osteomyelitis

A

contiguous

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5
Q

diabetic foot problems = (8)

A 
ulcers
loss of nociception
loss of apocrine/eccrine sweat glands
ischaemia
claw toes
cavus (increases P on MT heads)
altered capillary exchange (BM thickening and glycation of matrix protein)
neuropathy
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6
Q

suspect osteomyelitis if ulcer: //__ > ___ test/increased ___ > ___ > bone biopsy for ___

A

deep/indolent/chronic
bone probe
plain radiographs
histology and culture

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7
Q

Rx of ulcer with osteomyelitis

A

debride and antimicrobials (usually polymicrobial as chronic and tissue necrosis)

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8
Q

avoid ____ therapy in osteomyelitis - wait until results from ___. Unless __/___

A

empirical Abx
biopsy
septic/soft tissue infection

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9
Q

if can see bone/tendon at ulcer surface =

A

osteomyelitis

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10
Q

for acute and chronic osteomyelitis Abx usually =

unless allergic/MRSA =

A

Flucloxacillin 2g qds IV

vancomycin

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11
Q

5 groups where haematogenous osteomyelitis is seen

A 
prepubertal (lots of developing metaphyses)
PWIDs
central line
dialysis
elderly
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12
Q

unusual sites of osteomyelitis seen in PWIDs

A

SCJ, SChoJ, SIJ, pubic symphysis

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13
Q

organisms that can be the cause of osteomyelitis in PWIDs =

A

Staph, Strep

unusuals - pseudomonas, candida, eikenella corrodens (if lick needle) aerobic gram -ves

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14
Q

organisms seen in dialysis osteomyelitis

A

Staph aureus and aerobic gram -ves

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15
Q

sickle cell osteomyelitis is a ____ OM, can be multifocal leading to ____
organisms =

A

acute long bone OM
septic arthritis due to impaired blood flow
Salmonella + S. aureus

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16
Q

osteitis pubis is a rare OM site due to ___/__/__

A

urogynae procedures
surgery <=18mnths after infection (aseptic)
athletes

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17
Q

clavicle OM can be due to __/__

A

neck Sx + subclavian catheterisation

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18
Q

lysosomal storage disorder that can mimic bone crisis (sterile) often causes tibial OM =
organism =

A

Gaucher’s disease

S. aureus

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19
Q

SAPHO stands for ___

Paed form = CRMO aka

A 
Synovitis
Acne
Pustulosis
Hyperostosis
Osteitis syndrome

Chronic Recurrent Multifocal Osteomyelitis

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20
Q

s+s of SAPHO

A 
lytic lesions, increased inflam markers
fever
wt loss
malaise
multifocal OM
exacerbations and remissions
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21
Q

odd sites of OM in SAPHO

A

chest wall, pelvis, spine, lower limb

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22
Q

if simple S. aureus bacteraemia treatment duration =

if seeded =

A 
2wk = simple
6wk = seeded
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23
Q

if central line is present is best to __ if +ve blood culture
if can’t then ___ to rule out endocarditis

A

remove it

TOE

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24
Q

vertebral OM is mostly ___

may be ass with __/___ abscess

A

haematogenous

epidural/psoas abscess

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25
Q

causes of vertebral OM =

A 
PWID
IV site infection
GU infection
STI
post op
(all mostly haematogenous)
26
Q

s+s of vertebral OM

A

fever, insidious pain and tenderness of vertebra affected, neurological, increased inflam markers, increased WCC

27
Q

Rx of vertebral OM

A

drain abscess
6wk Abx (not empirical - get biopsy)
expect ESR to decrease by more than 50% in a month

28
Q

Ix for vertebral OM

A

poke test - poke vertebrae until find tender one
MRI
biopsy

29
Q

skeletal tb =

A

Pott’s disease

30
Q

in kids with Potts disease check if have reduced receptors for __ +__

A

IFNgammaR1

IL12beta1

31
Q

organism that causes a necrotising pneumonia, skin infection and is invasive - infects prosthetic joints
must request a specific PCR test as isnt routine

A

PVL producing S. aureus

32
Q

Rx of prosthetic joint infection=

A

remove joint
flucloxacillin, clindamycin and linezolid (limited to 4wks)
depends on sensitivities for 6 wks
Reimplant joint after 6wks

33
Q

why is linezolid treatment limited to 4wks

A

if more it increases chances of bone marrow failure and is expensive

34
Q

planktonic =

A

bacteria in bacteraemia - in free existence

35
Q

sessile bacteria =

A

phenotypic transformation of planktonic bacteria - form biofilm and ECM on surface

36
Q

Rx of sessile bacteria ie. biofilm =

A

oral rifampicin (and bone active Abx)

37
Q

organisms that infect prosthetic joints =

A 
S aureus and epidermidis
propionic bacteria (shoulders)
E. coli
pseudomonas aeruginosa
fungi
mycobac
38
Q

organisms that cause septic arthritis

A 
S. aureus
Strep
coag -ve staph (prosthetics)
neisseria gonorrheae (STI)
H influ (in <5yos)
Lyme's
virus
39
Q

Ix for septic arthritis

A

Aspirate joint - turbid, do microscopy and C+S - exclude crystals
blood cultures if pyrexial

40
Q

Septic Arthritis Rx =

A

high dose flucloxacillin presumptively
ceftriaxone if <5yo and H. influ cause
adjust when know the org

41
Q

common sites of knee bursitis

A

pre and supra patellar

42
Q

knee bursitis org and Rx =

A

S. aureus

flucloxacillin

43
Q

pyomysitis is a surgical ___

A

emergency

44
Q

causes of pyomysitis

A

bacterial - 90% staph
MSSA in healthy in tropics
IS in temperate climates - pseudomonas, beta haem strep, enterococcus
clostridium tetani in infected wounds

45
Q

gram +ve strict anaerobe, spores in soil and gardens =

A

clostridium tetani

46
Q

clostridium tetani releases a ___ which causes ___ as it binds to inhibitor neurons

A

neurotoxin

spastic paralysis

47
Q

drumstick shape on culture =

A

clostridium tetani

48
Q

Rx of clostridium tetani => pyomysitis

A

debride
antitoxin
penicillin
metronidazole

49
Q

myositis is mostly caused by __

A

bacteria

50
Q

pus lesions of bone appearance on xray

A

blacker bit in bone

51
Q

bone scan shows ___ reaction to infection

A

osteoblast

52
Q

on MRI pus appears

A

white

53
Q

most common 2 causes of acute osteomyelitis

in kids/IS can be

A

trauma / open #

haematogenous/other cause

54
Q

Ix for chronic osteomyelitis

A

plain xray and MRI

bloods usually unhelpful

55
Q

chronic osteomyelitis:

___=>__ in joint cavity and between cortex and periosteum => ___

A

bone abscess
pus
cortical destruction

56
Q

chronic osteomyositis may => involucrum which is a __

A

bone growth around outside of sequestrum (dead bone)

57
Q

in cellulitis skin fills with __

A

gas

58
Q

in cellulitis give Abx to cover __+__ eg __+__

A

strep and staph

flucloxacillin and benzylpenicillin

59
Q

skin feels like bubble wrap =

A

necrotising fasciitis

60
Q

Rx of nec fasc

A

Sx to remove dead tissue and pus + foreign bodies
target Abx
biopsy and debride

61
Q

2 groups at risk of nec fasc

A

IS

cancer patients

62
Q

tests for infected arthroplasty =

A

Joint aspiration (best)
Xray (important)
bone scan
CRP

MSKJaz (28 decks)

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