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Rhematology > Infections > Flashcards

Infections Flashcards

1
Q

Which is the most common joint in which septic arthritis develops?

A

The knee

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2
Q

What is the most common bacteria to cause septic arthritis?

A

Staphylococcus aureus

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3
Q

What is a common cause in young adults who are sexually active?

A

Neisseria gonorrhoeae

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4
Q

Which bacteria is likely to cause septic arthritis in prosthetic joints?

A

Staph epidermidis

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5
Q

What bacteria can cause septic arthritis?

A
  • Staphylococcus aureus
  • Neisseria gonorrhoeae
  • Staph epidermidis
  • Lyme disease
  • Haemophilus influenzae - used to be high in children but now vaccine for it
  • Gram-NEGATIVE bacteria e.g. E.coli or Pseudomonas Aeruginosa in the elderly or very young or those who are systemically unwell/ IV drug user
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6
Q

What are the risk factors for septic artheritis?

A
  • Prosthetic joints
  • Diabetes mellitus
  • Immunosuppression e.g. HIV
  • Pre existing joint disease e.g. RA (10x)
  • Low socioeconomic status
  • Age <15 and >55
  • IVDU (Intravenous Drug user)
  • Osteomyelitis
  • Intra-articular injection
  • Recent joint surgery
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7
Q

What are the signs for septic arthritis?

A
  • Red hot swollen joint, usually just one joint

- Tachy and feverish

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8
Q

What are the symptoms in the early infection with septic arthritis?

A

Wound inflammation/discharge, joint effusion, loss of function and pain

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9
Q

What are the symptoms in the late disease?

A
  • Presents with pain or mechanical dysfunction

- Fluid accumulation leading to joint destruction

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10
Q

What would you see in the FBC?

A

Raised WCC

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11
Q

What will you see in the joint aspiration?

A
  • Fluid will be purulent/opaque/thick/pussy due to the high WCC in it
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12
Q

What should normal joint aspiration fluid look like?

A

Yellow and quite thin

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13
Q

What would you see in the xray in septic arthritis?

A

Not much unless you can see loosening or bone loss around a previously well fixed implant

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14
Q

What is the main differential for crystal arthritis and what test therefore distinguishes the two?

A

Crystal arthritis and joint aspiration will show the crystals if not infection

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15
Q

What is the pharmacological treatment for septic arthritis?

A

IV antibiotics for 6-12 weeks

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16
Q

What type of bacteria are you targeting in septic arthritis?

A

Gram negative cocci

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17
Q

What antibiotic would you give in the majority of cases?

A

IV flucloxacillin (targets most gram negative)

18
Q

What antibiotic would you give if allergic to penicillin?

A

Erythromycin

19
Q

What antibiotic would you give for MRSA?

A

Vancomycin

20
Q

What surgical options could be used in septic arthritis?

A
  • needle aspiration to decompress the joint

- arthroscopic lavage

21
Q

What is osteomyelitis defined as?

A

Infection of bone

22
Q

Does osteomyelitis usually affect a single bone or multiple sites?

A

A single bone

23
Q

How can you categorise osteomyelitis?

A
  • Acute haematogenous
  • Secondary to continuous local infection
  • Direct inoculation from trauma or surgery
24
Q

What does chronic osteomyelitis mean?

A

Bone necrosis (months to years)

25
Q

What organisms are likely to cause osteomyelitis?

A
  • Staph aureus - commonest cause
  • Pseudomonas
  • E coli
  • Streptococci
26
Q

What two routes can the bacteria spread via?

A

Direct or haematogenous

27
Q

What does haematogenous spread mean?

A

Spreads to the bones via the blood

28
Q

What bones are most likely to be affected by haematogenous spread in adults and in children?

A
  • Children - long bones

- Adults - vertebrae

29
Q

What is the necrotic bone referred to as?

A

The sequestrum

30
Q

What is new bone formation called?

A

Involucrum

31
Q

What is process that leads to new bone formation in osteomyelitis?

A
  1. Inflammatory exudate in the marrow
  2. Increased intramedullary pressure
  3. Extension of exudate into the bone cortex
  4. Rupture through the periosteum
  5. Interruption of periosteal blood supply
  6. Leaves pieces of seperated dead bone
  7. New bone forms here
32
Q

What are the risk factors for osteomyelitis?

A
  • Diabetes mellitus
  • IV drug user
  • Immunosuppression
33
Q

How does osteomyelitis present?

A
  • Non specific pain at the site of infection
  • Fever, malaise, fatigue
  • Local inflammation
  • Wound drainage
  • Reduced range of movement
34
Q

What would you see on the blood test in osteomyeltistis?

A

Raised ESR/CRP and WCC

35
Q

What is the gold standard investigation for osteomyelitis?

A

Bone biopsy with culture. Only 50% of cases will show on a blood culture

36
Q

What would you see on the xray in osteomyelitis?

A 
- cbone density 
changes aren't apparent for 10-14 days 
- Shows haziness and loss of 
- Subperiosteal reaction 
- Sequestrum and involucrum can be seen in later infection
37
Q

Why is an MRI better then an xray?

A
  • Shows inflammation better

- Shows changes 3-5 days as well as soft tissue involvement

38
Q

What is the non-pharmacological treatment for osteomyelitis?

A

Bed rest if its spinal

39
Q

What is the pharmacological treatment for osteomyelitis?

A
  • Flucoxicillin or vancomycin for 6 weeks
40
Q

What would you use if the infection was caused by TB?

A

Triple therapy

41
Q

What surgical therapy can be done?

A
  • Debridement

- Hardware replacement or removal

Rhematology (8 decks)

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