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CM2 Exam1 > Osteomyelitis- Schoenwald > Flashcards

Osteomyelitis- Schoenwald Flashcards

1
Q

Infection and inflammation of the bone is called what?

A

Osteomyelitis

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2
Q

Name three sources of osteomyelitis?

A
  • Hematogenous spread through blood
  • Invasion from a contiguous focus of infection- diabetic foot
  • Skin breakdown- vascular insufficiency or trauma
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3
Q

What is bacteremia?

A

Presence of bacteria in the bloodstream

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4
Q

Sickle cell is from what organism

A

Salmonella

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5
Q

Who are at risk for hematogenous spread of osteomyelitis?

A

Sickle cell, elderly, IV drug users

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6
Q

__________ is a risk factor to hematogenous spread of osteomyelitis

A

Diabetes

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7
Q

What symptom is not a good indicator of osteomyelitis?

A

Fever because most don’t have it

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8
Q

Name two symptoms related to osteomyelitis and what labs would be elevated

A

bone or joint tenderness/pain and elevated acute phase reactants (Sed rate and CRP)

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9
Q

You can suspect osteomyelitis if…

A
  • bone can be probed with swab from wound site

- Wound > 6 weeks in duration

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10
Q

What is the most common sickle cell organism?

A

Salmonella

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11
Q

Name some diseases that cause a weakening of the immune system and lead to osteomyelitis?

A
  • Diabetes
  • Organ transplant
  • Chemo
  • AIDS
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12
Q

What imaging test is used to diagnose osteomyelitis?

A

Plain film xray of suspected area

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13
Q

What findings do you expect to see on an xray of a patient with osteomyelitis?

A
  • cortical bone abnormalities
  • cortical erosion, periosteal reaction, and lucency or osteolysis.

However, these abnormalities may not be apparent until 7-15 days after the onset of acute clinical osteomyelitis

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14
Q

Bone abnormalities on an xray of a patient with osteomyelitis may not be apparent until _______ days after onset of acute clinical osteomyelitis

A

7-15 days

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15
Q

If osteomyelitis is suspected and xray is negative, what is the next test that should be done?

A

MRI

B/c abnormalities may not be apparent until 7-15 days after the onset of acute clinical osteomyelitis

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16
Q

What bloodwork would help us diagnose osteomyelitis?

A

Sed rate, CRP, CMP, WBC, CBC

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17
Q

What is the first step of treatment of osteomyelitis?

A

Debridement of bone & culture

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18
Q

In patients with osteomyelitis, they must be on IV abx for at least how many weeks?

A

Six

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19
Q

It is important to consider what when choosing an antibiotic for ostemyelitis?

A

Keep in mind bone penetration ability of chosen antibiotic

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20
Q

Name the empiric abx choices for osteomyelitis? (empiric means when antimicrobials are given to a person before the specific bacterium or fungus causing an infection is known)

A

Vanco +/- rifampin (which helps entry into the bone) AND Ceftriaxone (if no MRSA risk)

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21
Q

Which medicine should not be given as a single agent in osteomyelitis because of resistance to __________?

A

Rifampin, staph

22
Q

____________ is the preferred med for MSSA

A

Nafcillin

23
Q

_________ are bone abscess that can be walled off by body’s immune defenses for years

A

Brodie’s abscess

24
Q

Most commonly isolated organism of brodie’s abscesses is?

A

Staph aureus

25
Q

Most commonly affected bone in Brodie’s abscesses?

A

Tibia (BroTie) T for Tibia

26
Q

What is the most commonly associated

organism in non diabetics?

A

Staph

27
Q

Best treatment for MRSA?

A

Vanco

28
Q

To treat diabetics for osteomyelitis, what do you do?

A

Debride and get cultures (usually no empiric tx). Start doxy until you get them back

29
Q

This medication is used in diabetics when waiting for cultures to come back and can penetrate bone well

A

Doxycycline

30
Q

Usual treatment duration is _____ weeks of IV antibiotic therapy

A

6

31
Q

A patient complains that he was walking yesterday and a nail went through his tennis shoe into foot. WHat is the most likely organism?

A

Pseudomonas

32
Q

A patient complains that he was walking yesterday and a nail went through his tennis shoe into foot. What is the best treatment?

A

Fluroquinolone (Cipro)

33
Q

A patient complains that he was walking yesterday and a nail went through his tennis shoe into foot. What is an important thing to ask the patient?

A

If he got a tetanus shot and is UTD

34
Q

Septic arthritis is also known as ___________

A

infectious arthritis

35
Q

Infectious arthritis causes direct invasion of the _________ space by _______

A

joint, bacteria

36
Q

What population is more at risk for infectious arthritis?

A

Elderly >65 and mostly male

37
Q

Mc organism that causes infectious arthritis?

A

Staph

38
Q

In younger, more sexually active patients, what is the mc organism of infectious arthritis?

A

Neisseria gonorrhoeae

39
Q

Mechanism of infectious arthritis?

A
  • Direct inoculation (trauma)
  • Contiguous spread (from another site of focus)
  • Bacteremia-most common
  • Previously damaged joints,especially in RA, most susceptible
40
Q

What is the mc mechanism of infectious arthritis?

A

Bacteremia

41
Q

When there has been an infection and the infection clears and a patient gets arthritis, this is called _________

A

Reactive arthritis

42
Q

Reactive arthritis is mc in those patients who have this gene __________

A

are HLAB27 +

43
Q

Mc organisms involved in reactive arthritis?

A

Chlamydia trachomatis & various GI bugs (Salmonella, Yersinia, Campylobacter, C diff)

44
Q

Name three mc joints involved in reactive arthritis?

A
  1. knee
  2. hip
  3. shoulder
45
Q

Disseminated bacteria from cervix, urethra or pharynx makes you think of what type of arthritis?

A

Gonococcal arthritis

46
Q

Arthralgias of multiple joints & Asymetric tenosynovitis make you think of what type of arthritis?

A

Gonococcal arthritis

47
Q

With this type of arthritis, you need to be really careful when looking at the skin because… “Typically hands with progression to other joints- skin pustules any location”

A

Gonococcal arthritis

48
Q

An enlarged, warm and red knee would be a sign of what type of arthritis?

A

Septic arthritis

49
Q

How to diagnose gonococcal arthritis?

A

Fluid aspirate and culture, blood cultures, XRAY

50
Q

A patient who is > 35 probably has arthritis from _______ and a patient who is <35 probably has arthritis from _________

Name the organisms

A

staph, gonococcal

51
Q

What antibiotics for non gonococcal arthritis (septic)?

A

Staph directed so vancomycin if MRSA risk & cephalexin for no MRSA risk

52
Q

What antibiotics for gonococcal arthritis?

A

Ceftriaxone + doxy

CM2 Exam1 (6 decks)

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