MSK 1 Flashcards
risk factors for prostethic joint infection
RA, DM, malnutrition, obesity
0-3 months early post op PJI caused by what and symptoms
SA, strep, enterococci
fever, warmth, effusion, drainage
3-12 months causes and symptoms
coag neg staph
persistent pain, device loosening, fistula
> 24 months spread how and what
blood spread
SA, E Coli
investigations for PJI
3 sets of culture, ECHO, ESR, CRP, FBC, U&Es, inflam markers
DAIR
how long course of antibiotics
debridement, antibiotics, implant retention
4-6weeks
2 stage how long
6 weeks of antibiotics then break for surgery
ABs given proph
PA
1.2g Co-amox peri op within 60 mins of op and then 2 doses post op within 72 hours of op
PA - cotrimoxazole
ABs in theatre
Cipro 400mg IV
Vancomycin IV
ABs on ward
Cipro 500mg BD
continue vanc
PO rifampicin if rifampicin sensitive staph
when should ciprof be stopped
if no GN bacteria on culture results
osteomyelitis is what
inflammation of bone and medullary cavity
Acute osteo
where
few days to 2w
shoulder, ankle, hip, elbow
chronic osteo
2w over
SIRS usually absent
delay in treatment of acute
No ABs till culture results
ix important to do and why
joint washout/aspirate for microscopy and culture in case septic joint
treatment of osteomyelitis
PA
Fluclox IV 2g QDS 2 w then ORAL total 4-6w
IV Clindamycin 600mg QDS
treatment of chronic osteo
PO fluclox 1g QDS
MRSA osteo
IV vanc
investigations for septic arhtiris
cultures, CRP, FBC, U&Es, ERP, lactate, fluid washout/aspirate, USS, MRI, XR, CT
symptoms of septic arhtritis
single joint
decreased ROM, pain, swelling, red, hot
systemic upset
treatment septic
IV fluclox 2g QDS for 2w then oral
PA IV clindamycin 600mg QDS
if under 5 for septic
add ceftriaxone for HI and king ella cover
SIRS is 2 or more of what
temp >38 or <36
HR >90
RR>20 or PaCO2 <4.3
WBC>12000 or <4000
cellulitis treatment mild
oral fluclox 1g WDS for 7days
if not resolving cellulitis
doxy 100mg BD for 7d
septic cellulitis
fluclox 1g QDS IV 2g if BMI>30
symptoms of abscess
defined and fluctuating, red, pain
history of trauma
treatment of abscess
surgical incision and drainage
analgesia
splint
ABs
gas ganagrene caused by what which is what
clostridium perfringes
GN strictly anaerobic rods
how does gas gangrene happen and what are the predisposing factors
spores into tissue
PDF - dead tissue, anaerobic conditions
spores germinal creating gab bubbles which leads to crepitus
treatment of gas gangrene
urgen debridement
penicillin or metro or both
+/- hyperbaric oxygen if severe
tetanus causes by what which is what
clostridium tetanus
gram positive anaerobic rods
where are tetanus spores found
incubation periods
soil, gardens, animal bites
4d-several weeks
what does tetanus do
neuroxin - spastic paralysis - locked jaw - muscles spasm
treatment of tetanus
surgical debridement
antitoxins
penicillin/metro
booster vaccination
how long is tip toeing common
any action
<3s
wil resolve
cavus feet causes
any action
can be inherited
if assymetrical investigate
flat feet normal?
any action
causes
normal
resolves at ages 4-8
flexible ligamentous laxity
rigid - tarsal coalition
intoeing causes
femoral neck anteverions
internal tibial torsion
metatarsal adductus
femoral neck anteversion
check what
any action
hip rotational angle
resolves
internal tibial torsion check what
any action
check foot shape. thigh-foot angle
resolves
metatarsal adducts is what
any action
banana feet
resolves spontaneously if persists - cast
out toeing normal
action
resolves by age 2
interfere if does not resolve as risk of patellofemoral pain
bow legs are what
resolves?
when to investigate
genu varum
resolves by age 4-5
decreased height - skeletal dysplasia
assym - pathology
knock knees another name for what
peak at when
what should the intermaleolar distance be at age 11
genu valgus
- 5 yo
8cm. if >8 -> refer
club foot is what
deformation of cavus
adducts varus equinos
causes of clubfoot
associations
idiopathic
associated with CP, spina bifida, edwards, oligohydraminos, arthrogryoposis
treatment of clubfoot
Ponseti method - cast and maniupalation from birth till 10-12 weeks
night brace till child is 4yo
relapse rate of clubfoot
15%
opposite of clubfoot
rocker bottom feet