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MSK clin Med > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What type of salter Harris fracture is above the growth plate

A

2

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2
Q

What type of salter Harris fracture is below the growth plate

A

3

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3
Q

What type pf salter Harris fracture is through the growth plate

A

4

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4
Q

What type of salter Harris fracture causes the erasure of the growth plate (compression of it)

A

5

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5
Q

What type of salter Harris fracture is the separation of the growth plate

A

1

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6
Q

What is the most sensitive test for osteomyelitis

A

MRI

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7
Q

Which gender is more likely to get pediatric osteomyelitis

A

Boys (2x more)

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8
Q

What is the reason otherwise healthy kids will get osteomyelitis

A

Function of rich blood supply and an immature immune system

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9
Q

What is pediatric osteomyelitis often mistaken for

A

malignancy

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10
Q

What is the most common area in the body that children will get osteomyelitis

A

Femur and tibia

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11
Q

What pathogen is generally the cause of pediatric osteomyelitis

A

S. Aureus

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12
Q

What is the cause of osteomyelitis in sickle cell patients?

A

Salmonella

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13
Q

What is the most common reason neonates typically get osteomyelitis

A

Group B strep

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14
Q

What is the typical presentation in pediatric osteomyelitis

A

Febrile
Chills
Malaise
Localized pain/swelling
Unable to bear weight

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15
Q

What are acute phase reactants

A

ESR and CRP

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16
Q

What will be seen in a CBC with diff if a child has osteomyelitis

A

> 70% PMNs

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17
Q

How long does a child have to have osteomyelitis before changes are seen on X-ray

A

1-3 weeks

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18
Q

What is seen with chronic cases of pediatric osteomyelitis

A

Sequestrum and involcrum

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19
Q

What test should always be done for infections

A

biopsy

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20
Q

What test should always be done with tumors

A

Culture

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21
Q

When should a biopsy and culture be done in regards to antibiotics

A

Before starting treatment

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22
Q

What empiric treatment is used for non-surgical cases of pediatric osteomyelitis

A

Nafcillin or Oxacillin (Targeted antibiotics)

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23
Q

What is given for pediatric osteomyelitis with suspected MRSA

A

Clindamycin or vancomycin

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24
Q

How long is osteomyelitis generally treated for

A

4-6 weeks

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25
Q

How is pediatric osteomyelitis generally treated when surgery is required

A

Irrigation and debridement
Antibiotic impregnated cement beads
IV antibiotics x6 weeks

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26
Q

What do you watch the ESR and CRP for while treating pediatric osteomyelitis

A

A downward trend (CRP in 48-72 hrs) to know that the treatment is working

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27
Q

How do you confirm the resolution of an osteomyelitis infection

A

Culture after treatment has been given

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28
Q

What is the most common bacteria for adult osteomyelitis and where is the most common site of infection

A

S. Aureus
Vertebrae

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29
Q

How is adult osteomyelitis classified

A

by duration of symptoms

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30
Q

How long does acute osteomyelitis last in adults

A

Days to weeks after inoculation

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31
Q

How long does subacute osteomyelitis last in adults

A

weeks to months

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32
Q

How long does chronic osteomyelitis last in adults

A

months+ with reoccuance

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33
Q

What are the difference mechanisms of infection for adult osteomyelitis

A

Direct inoculation/contiguous spread
Sequela from vascular disease
neuropathy
hematogenous spread

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34
Q

If someone get osteomyelitis via surgery or trauma, what type of spread in this

A

direct inoculation / contiguous spread

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35
Q

If someone gets osteomyelitis from ulcers or is seen in LE, what is the mechanism of infection

A

Sequela via vascular disease
neuropathy

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36
Q

If someone get osteomyelitis via a UTI, endocarditis, dialysis.. what type of spread is this

A

Hematogenous spread

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37
Q

Where is osteomyelitis generally seen in adults

A

lower extremity

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38
Q

What is a chronic presentation of osteomyelitis in adults

A

fever, variable pain, purulence/abcess, open wound

Ability to probe to the bone on any wound or sinus tract

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39
Q

What is the gold standard for diagnosing adult osteomyelitis

A

Culture and biopsy

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40
Q

If someone is unable to mount an immune response to osteomyelitis, what tests will NOT be helpful

A

No increase in WBC
ESR/CRP unhelpful
Abscess in absent

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41
Q

What is the most common treatment for osteomyelitis in adults

A

Surgery

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42
Q

When is osteomyelitis non-surgical

A

Pt. unable to tolerate surgery
When in the spine

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43
Q

What are nonsurgical treatment options for adult osteomyelitis

A

IV antibiotics
Chronic suppressive antibiotics

44
Q

When is a hyperbaric tank used in adult osteomyelitis

A

When it is refractory

45
Q

How is adult osteomyelitis treated surgically

A

I&D (Generally multiple)
Closed wound vac
Target IV antibiotics
Amputation if unable;e to salvage

46
Q

What type of joint is septic arthritis seen in

A

native joints

47
Q

Who is septic arthritis more common in

A

Children

48
Q

Where is septic arthritis seen in kids

A

hip or knee (More often the hip)

49
Q

Where is septic arthritis seen in adults most commonly

A

Knee

50
Q

If septic arthritis is seen in the SC joint- what is it indicative of

A

IVDU

51
Q

Which kids are at higher risk for septic arthritis

A

Premie (Immature immune system)
C-Section
NICU babies
h/o Invasive procedures (Usually NICU babies)

52
Q

If septic arthritis is from contiguous spread, what is it caused from

A

Osteomyelitis

53
Q

How do adults most commonly get septic arthritis

A

Hematogenous spread (immune compromised)

Direct inoculation (Trauma that penetrates the joint capsule)

54
Q

How to kids generally get septic arthritis

A

Hematogenous spread

55
Q

What organism causes septic arthritis in children

A

Most common: Staph aureus or strep

Kingella Kingae

56
Q

What causes septic arthritis is sexually active adults

A

Gonoccocal (Neisseria gonorrhoeae)

57
Q

What is the cause of septic arthritis in IVDU patients

A

Gram negative bacilli (E.coli, Klebsiella, enterobacter)

58
Q

What is usually the cause of septic arthritis in sickle cell patients

A

Strep pneumo or salmonella (Encapsulated organism-gut bacteria)

59
Q

What organism causes septic arthritis after shoulder surgery

A

P. acnes

60
Q

What is generally the cause of septic arthritis in animal bites

A

Pasturella multocidia

61
Q

What is the cause of septic arthritis after the human bites

A

Eikenella corrodens

62
Q

What is a typical presentation of septic arthritis

A

Acute joint pain
Joint effusion
Erythema
Warm to touch
Inability to bear weight

63
Q

What is the typical presentation of septic arthritis in children

A

Hip resting in FABER position
Refusal to move extremity

64
Q

What is the FABER position

A

Flexion
ABduction
External Rotation

65
Q

What is the gold standard to diagnose septic arthritis

A

Arthrocentesis

66
Q

What are the differential diagnosis’s that need to be ruled out for septic arthritis

A

Lyme (PCR)
Gout (Crystal analysis)

67
Q

What needs to be tested with an arthrocentesis

A

Cell count with diff
Culture (Aerobic, anaerobic, AFB, Fungal)
Synovial fluid glucose

68
Q

What is an AFB and what does it test for

A

Acid fast

Tests for mycobacterium which is an infectant for TB

69
Q

What can you see on an X-ray OF a pediatric patient with septic arthritis

A

Joint space widening

70
Q

What will ultrasound show in someone with septic arthritis

A

Can demonstrate effusion but will not show if there’s infection or not

71
Q

What does MRI show with septic arthritis

A

Will show joint effusion and possible adjacent osteomyelitis in both adults and peds

72
Q

What is typical treatment for septic arthritis

A

Washout (Arthroscopic vs open)
Empiric antibiotics

73
Q

What antibiotics are used to treat septic arthritis

A

Vancomycin to cover staph +/- ceftriaxone
Ceftriaxone alone to cover neisseria gonorrhea

74
Q

What is the only reason a washout would not be done for septic arthritis

A

If its gonococcal because that can be handled non-operatively

75
Q

What are the complications associated with septic arthritis

A

Progression to osteomyelitis

End stage arthritis

76
Q

When is the prognosis of septic arthritis bad in children

A

Age< 6months
Osteomyelitis already present
Delay > 4days till presentation

77
Q

What is transient synovitis

A

Self limited inflammation of the synovium

78
Q

Where is transient synovitis typically seen

A

the hip

79
Q

What is transient synovitis preceded by

A

URI

80
Q

What is the treatment for transient synovitis

A

Analgesics
activity modification will resolved

81
Q

What is the most common tick borne illness in the US

A

Lyme arthritis

82
Q

Where is Lyme an endemic

A

Midwest and northeast

83
Q

What is the causative agent of Lyme arthritis

A

Borriela Burgdorferi

84
Q

When is early Lyme disease present

A

1-30 days post infection (Erythema migrans)

85
Q

When is acute disseminated Lyme infection present

A

weeks to months post infection

86
Q

When is late Lyme disease present

A

Months to years after infection

87
Q

If a patient presents with Mono or oligoarthritis, intermittent, self limiting joint effusion, warmth to the touch, and joint pain… what is the likely diagnosis

A

Lyme arthritis

88
Q

What is the presentation for Lyme arthritis

A

+/_ hx of EM/ tick bites
No systemic symptoms
Mono or oligoarthritis
Intermittent,self limiting joint effusion
Warmth to the touch
+/- joint pain

89
Q

How would you work up someone with Lyme arthritis

A

Elevated ESR/CRP
Positive Lyme serology
Arthrocentesis
Confirmatory synovial Lyme PCR

90
Q

What might you see in a positive Lyme serology

A

IgM antibiodies if early
IgG antibodies if late

91
Q

How would you treat septic arthritis

A

28days oral antibiotics

If symptoms persist, switch to IV antibiotics or a second round

92
Q

What are the antibiotics you could use to treat Lyme arthritis

A

Doxycycline (Most common)
Amoxicillin
Cefuroxime
ceftriaxone

93
Q

What is a serious complication for a total joint arthroplasty

A

Periprosthetic joint infection

94
Q

Does a primary or a secondary total joint arthroplasty have a higher infection risk

A

Secondary

95
Q

what is the most common pathogen that causes periprosthetic joint infections

A

S. Aureus

96
Q

If you get a negative culture with a suspected joint infection, do you rule out the possibility of an infection?

A

No.. some bacteria has long incubation periods

97
Q

If a patient presents with drainage from a joint more than 2 weeks post op, what do you suspect

A

Periprosthetic joint infection

98
Q

If a patient presents with drainage from their joint, red/swollen/tender joint post surgery, chronic pain, decreasing ROM what are you suspicious of

A

Periprosthetic joint infection

99
Q

What would you see in a CBC with diff in a preiprosthetic joint infection

A

Lower WBC levels

100
Q

What is the treatment for an acute infection of a TJA

A

Washout and poly exchange
Targeted IV antibiotics (6weeks)

101
Q

If a patient has a chronic TJA infection what is the treatment

A

Removal of implants
Diret antibiotic inoculation
Target IV antibiotics

102
Q

If there was a failure to clear a PJI what is the treatment

A

Chronic suppressive oral antibiotics
Local wound care
Resection W/O re-implanation
Amputation

103
Q

What is a girdlestone

A

Resection without preimplantation

104
Q

What is the pre-procedure prophylaxis for a TJA

A

Amoxicillin
Clindamycin

105
Q

Why do you retain hardware regardless of infection if a fracture is less than 6 weeks old

A

Because it is more important to keep joint stability

106
Q

Which types of TJA have the highest failure rates

A

Intermedullary nails and open fracture

MSK clin Med (12 decks)

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