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Clin Med MSK: > MSK infectious disease > Flashcards

MSK infectious disease Flashcards

1
Q

What is the most sensitive test for osteomyelitis

A

MRI

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2
Q

When is pediatric osteomyelitis usually diagnosed

A

between 6-7 year olds and 2x more common in boys

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3
Q

Why is pediatric osteomyelitis common

A

rich blood supply and immature immune system
immune compromise will increase the risk (diabetes, kidney disease, sickle cell, beta thalassemia and RA)

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4
Q

how would you categorize pediatric osteomyelitis

A

spontaneous with hematogenous spread

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5
Q

what pathogens cause pediatric osteomyelitis

A

S. aureus, strep species, pseudomonas, Kingella kingae
H. influenza is more rare due to vaccination

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6
Q

what pathogen affects sickle cell patients causing pediatric osteomyelitis

A

Salmonella

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7
Q

what pathogen affects neonate causing pediatric osteomyelitis

A

Group B strep
ensure mom and baby are vaccinated

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8
Q

what is the acute presentation of pediatric osteomyelitis

A

febrile, chills, malaise, localized pain/swelling, unable to bear weight

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9
Q

what are the lab values seen in pediatric osteomyelitis

A

+/- elevated WBC count
>70% PMNs
Elevated ESR and CRP
+/- blood cultures (positive in only 35-50%)

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10
Q

What are the x-ray presentation for pediatric osteomyelitis

A

can be normal
1-3 weeks to see changes on x-ray

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11
Q

what is the preferred diagnostic test for pediatric osteomyelitis

A

MRI
usually see changes 2-3 weeks earlier than x-ray

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12
Q

what can be seen on MRI for osteomyelitis

A

presence of air in soft tissues help to differentiate from malignancy

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13
Q

what is necessary prior to antibiotic prescription for osteomyelitis

A

culture all tumors, biopsy all infections
ID causative organism and rule our malignancy

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14
Q

what does sequestrum mean

A

dead, necrotic bone tissue

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15
Q

what does involcrum mean

A

calcification surrounding sequestrum that can then lead to abscess

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16
Q

What is brighter on a T2 MRI image

A

inflammation (water, edema, fat)

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17
Q

What is the non-surgical treatment for pediatric osteomyelitis

A

targeted antibiotic treatment (IV or IM) with nafcillin or oxacillin
clindamycin on vancomycin if suspected MRSA

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18
Q

how long is antibiotic treatment for pediatric osteomyelitis

A

4-6 weeks

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19
Q

what is the surgical treatment of pediatric osteomyelitis

A

I&D
placement of antibiotic beads for local delivery
IV antibiotics for 6weeks
removal of antibiotic beads once antibiotic treatment complete

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20
Q

what needs to be done prior to antibiotic administration for pediatric osteomyelitis for surgery

A

obtain intra-operative cultures BEFORE admission of antibiotics (even pre-op antibiotic prophylaxis)

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21
Q

what are high risk groups for osteomyelitis in adults

A

immunocompromised
IVDU
vasculopaths -narrowing in vasculature
DM
Sickle cell
peripheral neuropathy
dialysis patients

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22
Q

what is the most common pathogen for osteomyelitis in adults

A

staph aureus
occasionally enterobacter or strep

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23
Q

what is the most common site for osteomyelitis in adults

A

vertebrae

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24
Q

how is osteomyelitis in adults classified

A

by the duration of symptoms (acute vs subacute vs chronic)
Mechanism of infection

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25
Q

how does osteomyelitis in adults spread

A

hematogenous spread

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26
Q

what are the common sites of origination of hematogenous spread of osteomyelitis in adults

A

Urinary tract, skin and soft tissues, endocardium (endocarditis) and IV access sites/dialysis

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27
Q

what shape does Staph aureus have

A

grape clusters

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28
Q

what are the two mechanisms of infection for osteomyelitis in adults

A

direct inoculation/contiguous spread and sequela from vascular disease/neuropathy

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29
Q

what are examples of inoculation/contiguous spread of osteomyelitis

A

surgery, trauma, wounds, infection site based on mechanism

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30
Q

what are examples of sequela from vascular disease/neuropathy for osteomyelitis

A

ulcerations usually seen distal LE

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31
Q

What is the common presentation for osteomyelitis in adults

A

chronic presentation
+/- fever, variable pain, +/- purulence/abscess, +/- open wound

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32
Q

what is important to do with any open wound with concern for osteomyelitis

A

probe to bone on any wound/sinus tract - chronic osteomyelitis

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33
Q

what lab values will likely be seen with osteomyelitis

A

elevated ESR and CRP
+/- elevated WBC count
+/- blood cultures (if sick)

34
Q

what is the typical treatment for osteomyelitis in adults

A

almost always surgical and if not option for patient IV antibiotics and chronic suppressive anx

35
Q

what is the surgical treatment for osteomyelitis in adults

A

I&D (usually multiple)
+/- antibiotic beads
often closed with a wound vac - negative pressure wound therapy
Targeted IV antibiotics for 6 weeks

36
Q

what is the treatment for extensive osteomyelitis

A

amputation

37
Q

what age group is septic arthritis more common in

A

more common in children (<2yo) than adults - but overall relatively rare

38
Q

what is the most common site for septic arthritis in kids

A

70% of cases involve hip or knee

39
Q

what are the most common site for septic arthritis in adults

A

knee is primary
others hip, shoulder, elbow, ankle and sternoclavicular joint in IVDU

40
Q

what is a big concern with sternoclavicular septic arthritis

A

endocarditis

41
Q

what are the high risk pediatric populations for septic arthritis

A

premature (immature immune system)
C-section birth
NICU babies with history of invasive procedures

42
Q

what are the high risk adult populations for septic arthritis

A

> 80 yo
DM
RA
cirrhosis
HIV+
hx gout/pseudogout
hx endocarditis or recent bacteremia
IVDU
recent surgery

43
Q

what are the classifications of spread for septic arthritis

A

hematogenous spread
direct inoculation
contiguous spread (osteomyelitis)

44
Q

what age group is at risk for getting gonococcal septic arthritis

A

young, sexually active adults

45
Q

what is the most common septic arthritis organism

A

Staph aureus or strep
(ages 2+)

46
Q

what is the presentation of septic arthritis

A

acute joint pain
joint effusion
erythema
warm to touch
decreased ROM
inability to bear weight
+/- systemic symptoms

47
Q

what is the common organism associated with dog/cat bite

A

Pasturella multocidia

48
Q

what is the common organism associated with human bite

A

Eikenella corrodens

49
Q

what is the common presentation for pediatric septic arthritis

A

hip resting in FABER position and refusal to move extremity

50
Q

what is FABER position

A

Flexion
ABduction
External Rotation

51
Q

Whats the common workup of septic arthritis

A

ESR, CRP almost always elevated
+/- Increase CBC
blood culutres
+/- Lyme western blot
Arthrocentesis

52
Q

what is the gold standard workup for septic arthritis

A

Arthrocentesis

53
Q

what is important with the CBC with dif

A

the >75% PMNs

54
Q

what are the culture orders needed with arthrocentesis

A

CBC with Diff
aerobic, anaerobic, AFB, fungal
crystal

55
Q

what is seen on MRI for septic arthritis

A

joint effusion and possible adjacent osteomyelitis

56
Q

what is the treatment for septic arthritis

A

I&D aka washout
targeted antibiotics

57
Q

what antibiotics are used for Staph in septic arthtitis

A

Vancomycin +/- ceftriaxone

58
Q

when is Ceftriaxone used alone for the treatment of septic arthritis

A

to cover Neisseria gonorrheae - gram neg

59
Q

what are the common complications of septic arthritis

A

progression to osteomyelitis and end stage arthritis

60
Q

What is Transient synovitis

A

self-limited inflammation of the synovium that occurs in peds patients
benign, self-limited condition (3-7 days)

61
Q

where does transient synovitis typically present

A

Hip

62
Q

what is transient synovitis typically preceded by

A

URI

63
Q

what is the treatment for transient synovitis

A

analgesics and activity modification until resolved

64
Q

what is does the clinical presentation of transient synovitis mimic

A

septic arthritis

65
Q

what is the causitive agent for lyme arthritis

A

Borrelia burgodorferi

66
Q

what type of bacterium is Borrelia burgodorferi

A

spirochetal bacterium

67
Q

what are the early signs of Lyme

A

erythema migrans (bulls eye rash)

68
Q

when is arthritis seen with Lyme Disease

A

late Lyme (months to years after infection)

69
Q

what is the presentation of Lyme Arthritis

A

+/- hx of EM/tick bites
mono or oligoarthritis (one or more joints)
intermittent, self-limiting joint effusions
warmth to touch
+/- joint pain

70
Q

What is the workup for Lyme Arthritis

A

ESR and CRP elevated
positive Lyme serology (ELISA, Western Blot)
positive Arthrocentesis >75% PMNs
positive Synovial fluid Lyme PCR

71
Q

What is the treatment for Lyme Arthritis

A

28 days of oral antibiotics (Doxycycline)

72
Q

What is PJI

A

periprosthetic joint infection

73
Q

What is a serious complication following TJA

A

periprosthetic joint infection - usually causes significant morbidity - occasionally mortality

74
Q

when can PJI occur

A

at ANY POINT post-operatively, even several years out

75
Q

High risk patient for PJI

A

> 40BMI
smokers
DM
CKD
Liver failure
malnutrition
+HIV
ETOH abuse
IVDU
poor dentition
patient on immunosuppressants

76
Q

what is the most common pathogen for PJI

A

S. Aureus

77
Q

what other pathogens can cause PJI

A

coagulase negative Staph, P. acnes(shoulder arthroplasty), Strep and gram-negative bacilli

78
Q

Workup for PJI

A

ESR/CRP
CBC
+/- Lyme western blot
+joint aspiration

79
Q

Why are some cultures negative with an infection

A

some bacteria have a long incubation time such as P.acnes (2 week hold)

80
Q

what is the treament of acute PJI

A

washout and poly change and targeted IV abx for 6 weeks with PICC line

81
Q

what is the treatment for chronic PJI

A

removal of implant, antibiotic spacter, targeted IV abx for atleast 6weeks, repeat aspiration and inflammatory markers, reimplantation vs repeat spacer

82
Q

what procedure is completed when there is a failure to clear the infection with a PJI

A

Girdlestone vs amputation

Clin Med MSK: (14 decks)

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