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18 ORR > Orthopedic Infections > Flashcards

Orthopedic Infections Flashcards

1
Q

most common pathogens in both abscess and cellulitis

A

staph and strep

hemophilus in children

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2
Q

cellulitis vs abscess

A
  • cellulitis: infection of subcutaneous tissue, managed medically
  • abscess: localized soft tissue infection, may req surgical
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3
Q

reminders for abscess/cellulitis

A
  • early recognition is key
  • prompt iv antibiotics vs gram+ and anaerobes
  • beta-lactamase inhibitor and anaerobic coverage if necessary
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4
Q

what is an erysipela

A
  • due to gabhs
  • acute, progressively elarging, red, painful, raised plaques
  • bacteremia = fever ad toxicity
  • tx: penicillinase-resistant penicillin, 1st gen cepha
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5
Q

what is necrotizing fassciitis

A
  • infection of fascia
  • group a, c, or g strep, clostridia, polymicrobial with aerobes and anaerobes, mrsa
  • tx: aggressive surgical debridement and antibiotics
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6
Q

what is gas gangrene

A
  • due to clostridium, strep, and other gram (-)
  • contaminated wounds that were sutured
  • progressive pain, distal edema, foul smelling sero-sanguinous discharge
  • xray: gas in soft tissues
  • tx: surgical debridement, pen g/clinda, metronidazole, hyperbaric o2
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7
Q

what is toxic shock syndrome

A
  • due to staph or group a/b/c/g strep pyogenes
  • post-op patients and minor traumatic wounds
  • fever, hypotension, erythematous macular rash with serous exudate
  • tx: surgical debridement, fluid replacement, iv antibiotics vs gram+
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8
Q

what is foot puncture syndrome

A
  • antbiotic that covers pseudomonas

- tx: surgical debridement, aminoglycosides + piperacillin or ciprofloxacin

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9
Q

what is paronychia

A
  • nailfold infection, can be due to s aureus
  • contact with oral mucosa = herpes simplex
  • dishwashers = candida
  • tx: incision, drainage, medications
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10
Q

what is felon

A
  • infection of fingertip pulp space
  • due to s aureus
  • tx: incision, drainage, anti-staph infection
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11
Q

what are human bites

A
  • can be due to s viridans, s bacteriodes, s epidermidis, corynebacterium
  • eikenella corrodens (tx: penicillin and 2nd gen cephalosporin)
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12
Q

common empiric antibiotics

A

read

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13
Q

consequences of dm on skin/bones

A
  • tissue hypoperfusion and ischemia
  • delayed wound healing
  • diabetic neuropathy = deformity and ulcers
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14
Q

how to assess diabetes (foot)

A
  • assess severity of dm

- assess blood flow (palpate distal pulses like dorsalis pedis or post tibial pulse, measure abi)

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15
Q

abi ratios

A
  • <0.95: significant narrowing of one or more blood vessels
  • <0.80 pain in the foot, leg, or butt during exercise (intermittent claudication)
  • <0.4 symptoms at rest
  • <0.25 severe limb threatening peripheral arterial disease
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16
Q

t/f ankle reading is lower than brachial reading

A

false

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17
Q

other ways to determine blood flow

A
  • gold standard: peripheral angiogram

- duplex us

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18
Q

wager’s classification of diabetic foot diseases

A

read

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19
Q

treatment for diabetic foot diseases

A
  • cover for polymicrobial infections (gram+, gram-, anaerobic)
  • read table of antibiotics!!
  • serum glucose control
  • improve peripheral blood flow
  • wound care
20
Q

organisms in acute osteomyelitis

A
  • blood brone from remote part of entry
  • from adjacent focus (septic arthritis, soft tissues)
  • directly introduced
  • s aureus!! (g+ > g-)
21
Q

epi of acute osteomyelitis

A
  • children

- metaphysis of long bones (vascular + hairpin architecture)

22
Q

diagnostics of acute osteomyelitis

A
  • <2 weeks
  • fever, pain, swelling, erythema, inability to move or bear weight
  • labs: leukocytosis, elevated crp, elevated csr, positive blood cultures
23
Q

radiographs in acute osteomyelitis

A
  • demineralization after 10 days to 2 weeks
  • penetration at least 1 cm of cortex = seen in xray
  • usually normal xray
  • whole body bone scan: asymmetry in uptake
24
Q

significance of whole body radionuclide bone scan in acute osteomyelitis

A
  • shows affected bone
  • does not tell what’s the diagnosis (infection vs malignancy)
  • subtle/stress fractures
  • avascular necrosis
  • osteomyelitis
  • total hip/knee arthroplasty loosening
  • phase studies (3 or 4 phase)
25
Q

significance of mri in acute osteomyelitis

A
  • shows changes in 3-5 days
  • most sensitive test, but too expensive
  • edema fluid and pus is low (dark) in t1, and high (bright) in t2
  • normal: marrow is dark on t2
26
Q

treatment of acute osteomyelitis

A
  • antibiotics for 6 wks (7d iv, 5 wks oral) or until esr is normal
  • immobilize extremity
  • surgical drainage
27
Q

what is a good response in acute osteomyelitis

A
  • increased well being
  • fever lysis
  • increased appetite, feeding, activity
28
Q

recommended antibiotics for s aureus, enterobacteriaceae, gas/gbs in newborns

A

antibiotics that cover penicillin resistant s pneumoniae and 3rd gen cephalosporin

29
Q

recommended antibiotics for = 4 yo (h influenzae, strep, s aureus)

A

cefuroxime or 3rd gen cephalosporin

30
Q

recommended antibiotics for >4 yo (h influenzae, strep, s aureus)

A

prsp or first gen cephalosporin

31
Q

recommended antibiotics in adults (s aureus, enterobacteriaceae, strep)

A

prsp or first gen cephalosporin

32
Q

what is chronic osteomyeltitis

A
  • formation of sequestrum (dead bone) and involcrum (new bone)
  • inadequately treated acute type or immunocompromised patients
  • sinus tracts form and drain chronically (-> squaca)
33
Q

natural history of untreated osteomyelitis

A
  • metaphyseal abscess
  • local extension
  • penetrates cortex to form subperiosteal abscess
  • penetrates periosteum to form soft tissue abscess
  • pathologic fracture development -> invade adjacent joint or form sinus
  • chronic osteomyelitis with sequestrum
34
Q

bone’s dual blood supply

A

nutrient artery: from medullary cavity (inside)

periosteal artery: from periosteum (outside)

35
Q

when medullary cavity is filled with pus, __ happens

A
  • periosteum is push away by pus and bone is deprived of blood supply
36
Q

treatment of chronic osteomyelitis

A
  • resembles local malignant tumor
  • removal of all dead tissues and sinus tract
  • stabilize bone
  • provide soft tissue coverage
  • manage bone gap (grafts)
  • appropriate antibiotics
37
Q

mechanisms of septic arthritis

A
  • blood borne organism from remote focus
  • contiguous spread from metaphyseal osteomyelitis in children
  • secondary to invasive diagnostic or therapeutic joint procedure
38
Q

patients at risk for septic arthritis

A
  • neonates
  • iv drug users
  • elderly
  • immunocompromised w/ dm
39
Q

causative organisms of septic arthritis

A
  • s aureus!!
  • n gonorrhea (!! in healthy sexually active adolescents and adults)
  • pseudomonas (!! iv drug users)
  • gram - (e coli, proteus, kleb, enterobacter)
  • strep (gbs!! infants, elderly, dm)
  • propiiionibacterium acnes (shoulder injury)
  • salmonella or spneumoniae
  • bartonella henselae (hiv)
  • pasturella multocida
  • eikenella corrodens
  • candida
40
Q

diagnosis of septic arthritis

A
  • joint aspirate
  • extreme joint pain on passive motion !!
  • local and systemic signs of infection
  • septic hip: (FABER) Flexion, ABduction, External Rotation)
41
Q

treatment of septic arthritis

A
  • penicillinase-resistant synthetic penicillin + beta lactamase inhibitors
  • anti-gonoccocal agents
  • anti-pseudomonad aminoglycoside
42
Q

t/f eptb is usually paucibacillary and non-infectious unless with ptb or during surgical procedures

A

true

43
Q

what is potts disease

A
  • tb infection affecting 2 adjacent vertebral bodies
  • causes collapse, kyphotic deformity (gibbus) and cord/nerve compression
  • sensory, motor, autonomic deficits
  • ankylosis at healing
44
Q

diagnostics for eptb/potts disease

A
  • esr and crp

- clinical trial of anti-koch for 2 weeks

45
Q

treatment for eptb/potts disease

A
  • quadruple anti-kochs for 6 mos
  • hrze 2 mos
  • hre 4 mos (or 10 mos)

18 ORR (21 decks)

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