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RRPA Clinical Med II > Osteomyelitis/Septic Arthritis Schoenwald (Exam 1) > Flashcards

Osteomyelitis/Septic Arthritis Schoenwald (Exam 1) Flashcards

1
Q

What is osteomyelitis?

A

Infection of bone

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2
Q

What is the most common bacterial cause of osteomyelitis?

A

Staph aureus

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3
Q

Patients with sickle cell anemia are prone to osteomyelitis caused by what bacteria?

A

Salmonella

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4
Q

T/F? Nearly all patients with osteomyelitis present with fever.

A

False - fever is not a good indicator of osteomyelitis

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5
Q

Why is diabetes a risk factor for osteomyelitis?

A

Diabetic foot ulcers are typically painless, and wounds can reach the bone before a patient notices the wound.

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6
Q

T/F? Deep wounds are the only way bacteria can be introduced to the bone, causing osteomyelitis?

A

False - osteomyelitis can be due to hematogenous spread of bacteria.

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7
Q

What labs would you expect to be elevated in a patient with osteomyelitis?

A

Acute phase reactants, such as ESR and CRP.

CBC may show elevated white count.

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8
Q

Do bone fractures increase risk of osteomyelitis?

A

Yes

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9
Q

Name some risk factors for osteomyelitis.

A

Any condition that weakness the immune system such as: diabetes, organ transplant, chemotherapy, AIDS, kidney failure, sickle cell anemia
IV drug use, joint replacement, peripheral neuropathy, Peripheral vascular disease

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10
Q

You are seeing a patient with a diabetic foot ulcer that you can probe down to the bone. The patient states the ulcer has been present for 3 weeks. You order an XR of the foot. What do you expect to see on the XR?

A

Cortical bone erosion, periosteal reaction, and lucency or osteolysis.

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11
Q

You highly suspect osteomyelitis in a patient whos symptoms began 5 days ago. The XR shows now acute abnormalities. What do you do next?

A

Order an MRI.

Remember that abnormalities may not be seen in plain films until 7-15 days after onset.

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12
Q

What is the surgical treatment for osteomyelitis?

A

Surgical debridement of bone

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13
Q

What is the preferred empiric antibiotic therapy for osteomyelitis?

A

Vancomycin 1g IV q12 hours +/- rifampin 300-450mg po bid
AND
Ceftriaxone 2g IV qd

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14
Q

For what duration should osteomyelitis be treated with IV antibiotics?

A

6 weeks

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15
Q

What is the preferred treatment for osteomyelitis caused by MSSA?

A

Nafcillin 2g IV q4 hours or Cefazolin 2g IV q8 hours

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16
Q

Just for fun flashcard

Who is Brodie and why did he want an abscess named after him?

A

A Brodie’s abscess is named after Sir Benjamin Collins Brodie, who first described the condition in the 1830’s.
He is good friends with Dr. Witwer.

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17
Q

What is a Brodie’s abscess

A

A bone abscess that is walled off by the bodies immune system.

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18
Q

What is the most common bone to be affected by a Brodie’s abscess?

A

The tibia

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19
Q

What is the most common organism to cause a Brodie’s abscess?

A

Staph aureus

20
Q

You started empiric tx of an osteomyelitis and cultures now come back showing an MRSA infection. What changes do you make to the patients antibiotic therapy?

A

You can stop the ceftriaxone and continue with the vancomycin +/- rifampin

21
Q

You are seeing a patient who stepped on a nail, which penetrated through the bottom of his shoe and punctured the bottom of his foot, what organism should you worry about and what should you treat it with?

A

Pseudomonas, because it can live in the bed of shoes.

Treat with a fluoroquinolone (Cipro)

22
Q

What is the most common organism isolated in septic arthritis?

A

Staph aureus

23
Q

What organism might you suspect in a 28 year old, sexually active patient with septic arthritis?

A

Neisseria gonorrhoeae

24
Q

T/F? Previously damaged joints are more susceptible to septic arthritis.

A

True

25
Q

What bacteria do you expect to be isolated from a joint aspiration in a patient with reactive arthritis?

A

No bacteria - Reactive arthritis is triggered by an infection, but the joint itself does not become infected.

26
Q

Reactive arthritis is more common in patients who are _________ positive.

A

HLAB27

27
Q

What are some common infections to trigger reactive arthritis?

A

Chlamydia and various GI bugs (salmonella, Yersinia, Campylobacter, C Diff.)

28
Q

Is fever a more common symptom in patients with septic arthritis or osteomyeltits?

A

Septic arthritis

29
Q

What are the 3 most common joints involved in septic arthritis?

A

Knee
Hip
Shoulder

30
Q

What differences might you see in a patient with Gonococcal arthritis vs a patient with non-gonococcal arthritis?

A

Gonococcal lesions

Arthralgias of multiple joints

31
Q

Treatment for septic arthritis that is non-gonococcal?

A

MRSA risk - vancomycin

No MRSA risk - cefazolin (Ancef) or keflex (cephalexin)

32
Q

Treatment for gonococcal arthritis?

A

IV ceftriaxone x 2 weeks +/- doxycycline

33
Q

Hematogenous spread:

Sickle cell pts susceptible to what?

A

Sickle salmonella (get it?)

34
Q

Osteomyelitis
Hematogenous spread
Elderly and IV drug users susceptible to what organism?

A

Staph aureus

35
Q

Osteomyelitis

Sx?

A 
Fever
Bone/joint pain
Elevated CRP/ESR
Bone can be swabbed
Wound present greater than 6 weeks
36
Q

Osteomyelitis

Risk factors?

A 
Bone fx
Any condition that weakens immune system:
Diabetes
Organ transplant
Chemo
AIDS
Kidney failure
IV drug use
Joint replacement
Sickle cell anemia
PAD/PVD
37
Q

Osteomyelitis

Minimum weeks you must give Abx?

A

6 weeks

Targeted to organism

38
Q

Osteomyelitis

Tx with what Abx?

A

Vanco for staph/MRSA
Nafcillin for MSSA
Ceftriaxone for gram Pos

39
Q

Osteomyelitis
What is the name for the bone abscess that can be encapsulated by the body’s immune defenses for years, most commonly assoc. with S aureus, most commonly affects tibia?

A

Brodie’s abscess

40
Q

Nail through tennis shoe into foot
What organism?
Drug of choice for tx?

A 
Pseudomonas
Ciprofloxacin (covers pseudomonas)
41
Q

Osteomyelitis
Infectious arthritis v Reactive arthritis
Which one has bacteria at/in the joint?

A

Infectious

Reactive is postexposure after infection clears

42
Q

Osteomyelitis
Infectious arthritis
Most caused by what organism? Hint: same as osteomyelitis

A

S aureus

N gonorrhoeae in sexaully active younger folk

43
Q

Osteomyelitis
Reactive arthritis
More common in those pts who have which gene that also causes ankylosing spondylosis?

A

HLAB27

44
Q

Osteomyelitis
Reactive arthritis
Is commonly caused by what organism?

A

Chlamydia

Also GI bugs

45
Q

Osteomyelitis
Gonococcal arthritis
Arthralgias of?

A

Multiple joints

46
Q

Osteomyelitis
Gonococcal arthritis
Sx: Asymetric?

A

Tenosynovitis

RRPA Clinical Med II (45 decks)

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