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DPT 516 > Quiz #5 > Flashcards

Quiz #5 Flashcards

1
Q

what is osteomyelitis?

A

bone inflammation caused by infection

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2
Q

what bones are typically affected by osteomyelitis?

A

pelvis (from UTIs), or arm (from IV)

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3
Q

what can osteomyelitis lead to?

A

septicemia or septic infection of a joint

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4
Q

where does osteomyelitis tend to occur in children?

A

near growth plates of long bones

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5
Q

where does osteomyelitis tend to occur in adults?

A

lumbar spine (bc of proximity to bladder)

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6
Q

what is the etiology of osteomyelitis?

A

usually caused by staph aureus infection in acute osteomyelitis

binds to cartilage and releases toxins

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7
Q

what is exogenous osteomyelitis?

A

invasion of bone from outside (open fx, puncture wound)

absess can infect bone

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8
Q

what is the prognosis for exogenous osteomyelitis in pts with DM, vascular insufficiency, or who are immunocompromised?

A

poor

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9
Q

what is hematogenous osteomyelitis?

A

spread of organisms from pre-existing infections through blood

often UTI

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10
Q

who does acute osteomyelitis occur the most in?

A

children and boys

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11
Q

who does chronic osteomyelitis occur the most in?

A

adults and the immunocompromised

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12
Q

what in a radiograph will indicate osteomyelitis?

A

opacity of bone

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13
Q

what are the risk factors for osteomyelitis?

A

chronic illness, alcohol abuse, diabetes, malignant, malnutrition, renal/hepatic failure, MRSA, large doses of steroids or immunosuppressants

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14
Q

what are some additional risk factors for development of osteomyelitis?

A

calcaneal or sacral decubiti deeper than 3 mm or >2 cm ^2

SCI w/complete motor or sensory loss

slow healing post-op wound

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15
Q

what does a radiograph show with periprosthetic infection?

A

periosteal new bone formation, scattered foci of osteomyelitis, subchondral bone resporption (late finding)

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16
Q

what is the gold stand for periprosthetic infection testing?

A

intra operative cultures

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17
Q

how is periprosthetic infection managed from least to most severe?

A

irrigation and debridement w/component retention, one or two-stage exchange, antibiotic suppression, resection, arthrodesis (jt fusion), or amputation

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18
Q

what is usually the first cause of prosthetic failure?

A

mechanical loosening

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19
Q

what is usually the second cause of prosthetic failure?

A

infection

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20
Q

what is the initial stage of pathogenesis of osteomyelitis?

A

inflammatory response

vascular loop in growing bone

arterioles form loop and drain in medullary cavity w/o establishing a capillary bed

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21
Q

what is the long bone metaphysis pathogenesis of osteomyelitis?

A

bone is porous and allows exudate from the infection to speard easily

organism grows and forms pus

increased bone tension in rigid medullary cavity

puss forced in Haversian canals

bacteria proliferates unimpeded

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22
Q

what is the subperiosteal absess formation pathogenesis of osteomyelitis?

A

bone is denied blood supply and may cause necrosis

necrotic cells are a fertile bed for infectious agents to multiply

no sensory nerve endings in cancellous bone so the process progresses without pain

necrosis stimulates the periosteum to form new bone

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23
Q

what is the last phase of pathogenesis of osteomyelitis?

A

sheath of new bone (involucrum) forms around sequestrum of necrotic tissue

chronic stage

more common in children, more fx in adults

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24
Q

is the involucrum and sequestrum more common in children or adults?

A

children

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25
Q

what is vertebral osteomyelitis?

A

affect the metaphysis or cartilagenous end plates

spreads to IV discs and adjacent tissues

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26
Q

what adjacent tissues does vertebral osteomyelitis spread to?

A

posteriorly into epidural

anterior into hip flexors like illiospoas

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27
Q

what is often the chief complaint (CC) in adults with osteomyelitis?

A

back pain, low grade fever once it becomes systemic

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28
Q

t/f: adults with osteomyelitis often have delayed s/s bc the cortex of the bone has no nerve endings

A

true

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29
Q

what are the clinical manifestions of osteomyelitis in children?

A

acute, severe symptoms (high fever, intense pain)

locally-edema, erythema, tenderness

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30
Q

t/f: there can be antalgic gait if osteomyelitis is in LEs

A

true

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31
Q

is it easier to detect osteomyelitis in the extremities or trunk? why?

A

in the extremities bc there is often unexplained cellulitis

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32
Q

what is a RED FLAG of osteomyelitis?

A

dactylitis (sausage toes)

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33
Q

what are some additional clinical manifestations of osteomyelitis?

A

back pain aggravated by motion (may be non mechanical)

radiculopathy

pain with hip extension

meningitis

infected/non-healing ulcers after several weeks of appropriate care

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34
Q

these are all ways to prevent what?

open fx management

screening risk factors

identification of early warning signs

pin site care

s/p jt replacement

proper nutritional health

A

osteomyelitis

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35
Q

how is osteomyelitis managed?

A

IV and high dose antibiotics based on culture results

intra-articular surgery for debridement and jt reconstruction once infection is eliminated

radical debridement over serial debridement due to reoccurrence

oral or bead chain antibiotics used prophylactically

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36
Q

when would you normally starting seeing abnormalities in osteomyelitis radiographs?

A

after 2 weeks

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37
Q

what is the prognosis for osteomyelitis?

A

small risk of death in immunocompromised

70-90% infection arrest rate

delayed treatment-permanent loss of bone structure

may impact long bone growth in children

excellent w/early antibiotic therapy

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38
Q

what is involved in the PT screening of osteomyelitis?

A

thorough history and review of systems

fever

unexplained weight loss

h/o cancer

failure to respond to intervention

disturbed sleep

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39
Q

what are the 4 groups of infectious arthritis?

A
  1. bacterial (focus for this class)
  2. fungal
  3. viral
  4. reactive
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40
Q

what is bacterial infectious arthritis?

A

caused by gonococcal, endocarditis, or Lyme

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41
Q

what is fungal infectious arthritis?

A

caused by candida

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42
Q

what is viral infectious arthritis?

A

caused by Epstein-Barr, HIV, mumps, or rubella

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43
Q

what is reactive infectious arthritis?

A

acute rheumatic fever, chlamydial infection

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44
Q

what is the most common etiology of infectious arthritis?

A

staph aureus, strep, kingella kingae, neisseria, gonorrhea

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45
Q

what is the most common way infectious arthritis spreads?

A

hematogenous (through the blood)

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46
Q

what are the primary risk factors for infectious arthritis?

A

OA, RA, ETOH, IV drug use, HIV

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47
Q

who is at the greatest risk for infectious arthritis?

A

older adults and children

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48
Q

what are the 6 mechanisms of infectious arthritis?

A
  1. direct inoculation
  2. direct extension
  3. hematogenous
  4. bacterial products
  5. phagocytosis of bacteria
  6. bacterial toxins
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49
Q

what mechanism of infectious arthritis is being described?

bacteria rapidly multiplies in liquid culture of jts

killed by phagocytes of synovial cells from micro-abcesses in synovial membrane

A

direct inoculation

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50
Q

what mechanism of infectious arthritis is being described?

periarticular osteomyelitis

contagious ST injuries

A

direct extension

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51
Q

what mechanism of infectious arthritis is being described?

multiply in enlarging abcsesses of synovial lining until they break into jt cavity

A

hematogenous

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52
Q

what mechanism of infectious arthritis is being described?

endotoxins and cell wall fragments

release of tumor necrosis factor and interleukin 1

leads to inflammation

A

bacterial products

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53
Q

what mechanism of infectious arthritis is being described?

autolysis of neutrophils

release of lysosomal enzymes into jt

leads to synovial, ligament, and cartilage damage

A

phagocytosis of bacteria

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54
Q

what mechanism of infectious arthritis is being described?

activation of the coagulation system

causes intervascular thrombosis in sub-synovial vessels and fibrin deposition on the surface of synovium and articular cartilage

provides gelatinous nidus for bacterial replacement

microvascular disruption leads to ischemia and necrosis, permitting further abscess formation which destroys cartilage matrix

synovial membrane proliferation–> pannus (inflammatory exudate)

A

bacterial toxins

55
Q

what are the classic signs of infection?

A

acute onset of pain, swelling, tenderness, loss of motion, and sometimes drainage

56
Q

what are the manifestations of infectious arthritis?

A

classic signs of infection

jt destruction, pathological fxs, growth deficits, deformity, dislocation, septic shock, multi-organ disease, pericarditis, pyelonephritis (kidney infection)

WBCs release enzymes that destroy cartilage

monoarticular sepsis

57
Q

what is the most common spot for monoarticular sepsis from infectious arthritis in adults?

A

hips or knees

58
Q

what is the most common spot for monoarticular sepsis from infectious arthritis in children?

A

ankles or elbows

59
Q

what most often causes monoarticular sepsis in children and adults?

A

staph aureus

60
Q

what are some ways that infectious arthritis is managed?

A

needle aspiration (assisted by fluoroscopy and live x-ray)

antibiotic therapy

IV antibiotics w/follow-up oral meds with corticosteroids

tidal irrigation, arthroscopy, arthrotomy, open drainage

jt rest

61
Q

what is antibiotic therapy for infectious arthritis based on?

A

cultures, stains, WBC count, ESR or sedimentation rate, c-reactive protein (CRP)

62
Q

how is jt rest provided for infectious arthritis?

A

splinting/casting w/intermittent ROM exercises to prevent jt contractures

63
Q

what is ESR or sedimentation rate?

A

measure of inflammatory activity in the body

64
Q

t/f: the ESR is a stand alone test

A

false

65
Q

how does the ESR monitor progress of inflammatory diseases in the body?

A

it measures the distance RBCs fall in a hour

the further down they fall the more inflammation bc inflammation causes cell clumping, making the RBCs more dense so that they fall quicker

66
Q

what is the prognosis for infectious arthritis if treatment is initiated w/in 5-7 days of its onset?

A

excellent

67
Q

t/f: there are long term functional deficits in infectious arthritis based on jt damage

A

true

68
Q

what is the mortality rate of infectious arthritis?

A

10-25%

69
Q

what % of survivors of infectious arthritis have permanent jt disability?

A

25-50%

70
Q

is the knee, hip, or shoulder associated with better outcomes in infectious arthritis?

A

the knee

71
Q

what are the PT implications for infectious arthritis?

A

early recognition is key!!!

be aware of pt history, risk factors, and s/s of infection

can result in residual impairments like ankylosis (self-fusion of a jt)

72
Q

what is myositis?

A

muscles inflammation from an autoimmune or viral bacterial, parasitic infection

73
Q

what are the 3 ways myositis is most commonly manifested as?

A
  1. dermatomyositis (DM)
  2. polymyositis (PM)
  3. inclusion body myositis (IBM)
74
Q

who is DM more common in?

A

children and older adults

75
Q

what are the common parasitic causes of myositis?

A

staph aureus, triconella, tapeworm larvae

76
Q

what is the most acquired muscles disease in populations over 50 y/o?

A

IBM

77
Q

what is the etiology of myositis?

A

intramuscular fiber degeneration–>fiber destruction and severe weakness

78
Q

what is the primary cause of muscle damage in myositis?

A

inflammation

79
Q

t/f: myositis can result from drug therapy

A

true

80
Q

what is usually the first sign of malignancy?

A

myositis

81
Q

why may myositis be a good sign in ca?

A

it shows that there is an immune rxn against the tumor

82
Q

what are clinical manifestations of myositis?

A

nonspecific symptoms of inflammation

tissue necrosis and extensive muscles damage, atrophy, and weakness

dysphagia, Raynauds, cardiomyopathy, pulmonary fibrosis, purple rash, and eyelid edema (may want to ask about visual disturbances)

frequent falls, trouble w/transfers and stairs, drop foot, weak grip

83
Q

what is the gold standard for dx of myositis?

A

muscle biopsy

84
Q

how can myositis be diagnosed?

A

biopsy, EMG, and lab values

85
Q

what differentiates between DM, PM, and IBM myositis?

A

a muscle biopsy

86
Q

what lab value would indicate the presence of myositis?

A

increased creatinine kinase in the blood (5-10x higher w/PM)

87
Q

how are PM and DM myositis managed?

A

immunosuppressive therapy and corticosteroids

88
Q

is there a successful intervention for IBM?

A

no:(

89
Q

what are the PT implications for myositis?

A

recognition of symptoms

thorough hx including meds

submax exercise is effective

eccentric and intense exercise should be avoided

watch exercises in persons w/symptomatic myotoxicity

90
Q

what tendons or bursae are more susceptible to infection?

A

tendons and bursae closer to the surface bc they can have direct contact with microorganisms

91
Q

what population is more susceptible to tendon and bursa infections by direct contact with microorganisms?

A

wrestlers

92
Q

how else can tendons and bursae become infected?

A

big bites and diabetes

direct inoculations via abrasion and corticosteroid injections into inflamed bursa/tendon

staph aureus

93
Q

what is the most common way tendons and bursae become infected?

A

staph aureus

94
Q

who is at greater risk for tendon and bursa infection other than wrestlers?

A

diabetics and immunocompromised

95
Q

what is the pathogenesis of tendon and bursa infections?

A

hands: spread along synovial sheaths, fascial planes, and lymphatic channels

bursa: membrane similar to synovium in infectious arthritis

96
Q

what are the clinical manifestations of tendon and bursa infection?

A

olecranon or prepatellar bursitis

tendon sheaths

infectious tenosynovitis

97
Q

what are the s/s of olecranon or prepatellar bursitis?

A

pain, swelling, and decreased ROM and function

possible cellulitis

98
Q

what are the most commonly infected bursae?

A

olecranon and prepatellar bursae

99
Q

what are commonly affected tendon sheaths?

A

hands

100
Q

what are the s/s of infectious tenosynovitis?

A

finger maintains slight flexion

fusiform swelling

pain w/passive or active extension

tenderness along the sheath into the palm

101
Q

how are tendon/bursa infections diagnosed?

A

examination w/identified local swelling

aspiration for cultures

102
Q

what is the treatment of tendon and bursa infection?

A

antibiotics are typically adequate

surgical incision and drainage necessary sometimes

bursectomy occationally

prompt Rx is crucial

103
Q

what is the purpose of a bursectomy in bursa infections?

A

removal of the bursa and then regrowth of a normal bursa

104
Q

what are the PT implications for tendon and bursa infections?

A

immobilization an delevation

early and aggressive rehab typically necessary

careful monitoring

frequent Rx adjustments based on status

splinting for protection but w/eventual recovery and function in mind

early ROM as soon as infection begins to subside

105
Q

how is the hand often immobilized and why?

A

in flexion bc it lengthens the collateral ligaments

106
Q

how is the wrist often immobilized?

A

30-50 deg ext

107
Q

how are the MCPs often immbolized?

A

75-90 deg flex

108
Q

how are the IPs often immobilized?

A

in full ext

109
Q

what is juvenile idiopathic arthritis (JIA) ?

A

several chronic inflammatory disorder affecting jts

110
Q

what is the most common arthritis affecting children?

A

JIA

111
Q

most forms of JIA are more common in…

A

girls

112
Q

entheses JIA is more common in…

A

boys

113
Q

t/f: JIA is an autoimmune disease

A

true

114
Q

what is the pathogenesis of JIA?

A

imbalance of regulatory T cells stimulates release of inflammatory cytokines that lead to jt damage

abnormal bone growth possible due to interleukin-16 released from T cells

persistent activation of immune cells (monocytes, macrophages)

115
Q

t/f: JIA can be remitting or unremitting

A

true

116
Q

what are the 5 types of JIA?

A
  1. oligoarthritis
  2. polyarthritis
  3. psoriatic arthritis
  4. enthesis-related “spondyloarthritis”
  5. undifferentiated
117
Q

what is the oligoarthritis type JIA?

A

affects 4 or fewer joints

usually knee, ankle, shoulder, or elbow

118
Q

what is the most common subtype of JIA?

A

oligoarthritis

119
Q

what is the polyarthritis type of JIA?

A

affects 5 or fewer jts often bilaterally

25% in children with JIA

120
Q

what is the psoriatic arthritis type of JIA?

A

jt symptoms paired with scaly rash that presents b4 or after onset of jt symptoms

121
Q

what is the enthesis-related “spondyloarthritis” type of JIA?

A

inflammation targeting the entheses

only subtype more common in boys

122
Q

what is undifferentiated JIA?

A

symptoms that don’t match any subtype

123
Q

what are the s/s of JIA?

A

joint pain/stiffness

fatigue

blurry vision/dry eyes

appetite loss

limited ROM

rash

red, tender, swollen joints

high fever

124
Q

what are the risk factors for JIA?

A

children ages 2-3 are at highest risk

girls are twice as likely to develop JIA

exposure to infections

genetic/family factors may be involved (not enough research)

125
Q

t/f: JIA is a diagnosis of exclusion

A

true

126
Q

what a some common differential diagnosed with JIA?

A

Lyme arthritis

sickle cell arthritis

osteomyelitis

post strep reactive arthritis

acute rheumatic fever

127
Q

how is JIA diagnosed?

A

ESR

CRP

antinuclear antibodies

rheumatoid factor and anti-cyclic citrullinated peptide antibodies

HLA-B27

CBC

arthrocentesis

x-ray

US

MRI

128
Q

what is the medical management of JIA?

A

NSAIDS

DMARDs

biological response modifiers (methotrexate)

corticosteroids

for advanced arthritis: osteotomy, synovectomy, arthrodesis, total jt replacement (last resort)

129
Q

what is the prognosis for JIA?

A

1/2 of children fully recover

some have continued symptoms or develop advanced arthritis

130
Q

what should be looked for in an exam of JIA?

A

joint pain, swelling, stiffness

eye inflammation

reduced ROM

muscle weakness

anemia

fatigue

131
Q

what are red flags that require a referral in JIA?

A

unremitting pain that disturbs sleep

fever, malaise, weight loss, excessive sweating

bone/joint pain accompanied by fever

132
Q

what are the tests and measures for JIA?

A

JADAS and JAMAR outcome measures15

MMT

functional testing

measure ROM and joint mobilization

measure aerobic capacity

vitals

133
Q

what are the PT interventions for JIA?

A

regular exercise

ROM

modalities

pt education

DPT 516 (14 decks)

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