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Clin Med II - Exam 2 > Schoenwald > Flashcards

Schoenwald Flashcards

1
Q

what do you think when you see bone/joint pan and elevated APR

A

osteomyelitis

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2
Q

what are the 2 types of osteomyelitis

A

acute

chronic

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3
Q

suspect osteomyelitis if (2)

A
  1. bone can be probed w. swab from wound site
  2. wound > 6 weeks duration
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4
Q

what are 2 imaging choices for osteomyelitis

A
  1. plain film xray
  2. MRI if xray negative and high suspicion for osteomyelitis
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5
Q

osteomyelitis is __ or

__ infxn of the bone

A

bacterial

fungal

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6
Q

what are the 3 sources of osteomyelitis

A
  1. hematogenous
  2. invasion from contiguous focus of infxn
  3. skin breakdown
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7
Q

what are 5 hematogenous sources of ostomyelitis

A
  1. bacteremia
  2. sickle cell anemia
  3. elderly
  4. IVD users
  5. DM
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8
Q

a diabetic foot infxn is an example of which source of osteomyelitis

A

invasion from contiguous focus of infxn

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9
Q

vascular insufficiency or trauma is an example of which type of osteomyelitis

A

skin breakdown

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10
Q

what bacteria is associated w. SSA and osteomyelitis

A

salmonella

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11
Q

what test do you order for definitive confirmation of osteomyelitis

A

bone culture

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12
Q

what is the main organism associated w. osteomyelitis in non SSA patients

A

s. aureus

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13
Q

osteomyelitis in DM pt’s is often

A

polymicrobial

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14
Q

what bacteria would you suspect if a pt had osteomyelitis from a nail through the foot

A

pseudomonas

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15
Q

MRI will usually show infxn how long after clinical symptoms

A

7-15 days

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16
Q

what do you think when you see an MRI w. cortical erosion, periosteal rxn, lucency, or osteolysis

A

osteomyelitis

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17
Q

what are the treatment steps for osteomyelitis

A
  1. debridement of bone
  2. minimum 6 weeks abx targeted to organism
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18
Q

what is the minimum amt of time for abx in osteomyelitis

A

6 weeks

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19
Q

what is the empiric abx of choice for osteomyelitis

A

vanco 1 gm IV q 12 hr +/- Rifampin

PLUS

Cefriaxone 2 gm IV q 24 hr

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20
Q

after cultures, what abx should you use for MSSA

A

Nafcillin 2 gm iv q 4 hr

OR

Cefazolin 2 gm IV q 8 hr

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21
Q

what is the abx of choice if culture shows MRSA

A

vanco 1 gm IV q 12 hr +/- rifampin 300-400 mg po tid

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22
Q

what is the abx of choice if osteomyelitis culture shows pseudomonas

A

Cipro

must also check for foreign body and do tetanus prophylaxis if nail

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23
Q

what is the abx of choice for mild osteomyelitis

A

doxycycline → good bone penetration

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24
Q

how should you treat osteomyelitis in DM pt

A
  1. debride and get cultures
  2. no empiric therapy → wait for culture to preserve kidneys
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25
Q

what labs should you order for continued monitoring for osteomyelitis

A
  1. CBC
  2. CMP
  3. APR
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26
Q

what is the mc affected bone in brodie’s abscess

A

tibia

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27
Q

what is brodie’s abscess

A

abscess walled off by body’s immune system for years

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28
Q

what are 3 symptoms of brodie’s abscess

A
  1. pain
  2. +/- outward drainage externally
  3. red and swollen around bone
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29
Q

what is the pathogen associated w. brodie’s abscess

A

s. aureus

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30
Q

what is this showing

A

brodie’s abscess

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31
Q

what might brodie’s abscess look like on xray

A

small luscent area

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32
Q

what are the 3 causes of infectious arthritis (septic arthritis)

A
  1. direct inoculation of joint space by bacteria
  2. contiguous spread
  3. bacteremia
  4. previously damaged joint
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33
Q

what is the most common cause of infectious (septic) arthritis

A

bacteremia

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34
Q

what 2 pt populations are vulnerable to infectious (septic) arthritis from a previously damaged joint

A
  1. RA
  2. prosthetic joint
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35
Q

what joints are mc in infectious (septic) arthritis

A

knee

hip

shoulder

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36
Q

spread of infectious arthritis is usually

A

monoarticular

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37
Q

what are 4 symptoms of infectious (septic) arthritis

A
  1. fever
  2. pain at joint
  3. erythema of joint
  4. impaired ROM
  5. monoarticular
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38
Q

what is the most common cause of infectious (septic) arthritis in young, healthy, sexually active pt’s

A

gonorrhea

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39
Q

what is the op tx for infectious (septic) arthritis

A

doxycycline

OR

Bactrim

→ to cover MSSA and MRSA

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40
Q

what is the tx for infectious (septic) arthritis if only MSSA isolated

A

Nafcillin

OR

Keflex

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41
Q

besides abx, how else should you treat infectious (septic) arthritis

A

fluid drainage

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42
Q

what is reactive arthritis

A

rxn to infectious arthritis outside of the active infxn

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43
Q

what kind of process is reactive arthritis

A

delayed inflammatory

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44
Q

reactive arthritis is more common in what pt population

A

HLAB27 (ankylosing spondylitis)

45
Q

what are the 3 most common bacteria in reactive arthritis

A
  1. chlamydia
  2. trachomatis
  3. various GI bugs
46
Q

what GI bugs are commonly seen in reactive arthritis

A

salmonella

yersinia

campylobacter

c.diff

47
Q

what are the 2 tx options for reactive arthritis

A
  1. NSAIDs
  2. smoldering infxn: continue abx
48
Q

what are 4 cardinal symptoms of gonococcal septic arthritis

A
  1. fever
  2. arthralgias of multiple joints
  3. asymmetric tenosynovitis
  4. skin pustules
49
Q

where doe infectious gonococcal arthritis usually begin

A

hands

50
Q

what are 3 diagnostic tests for gonococcal septic arthritis

A
  1. fluid aspirate and culture
  2. blood cultures
  3. xray
51
Q

how is gonococcal septic arthritis spread

A

disseminated from bacteria from cervix, urethra, or pharynx

52
Q

what is the tx for gonococcal septic arthritis

A
  1. ceftriaxone
  2. fluid drainage
53
Q

what are the 6 considerations in wound assessment

A
  1. tissue type
  2. wound exudate
  3. periwound condition
  4. pain level
  5. size
54
Q

what are 4 wound tissue types

A
  1. necrotic
  2. infective
  3. granulation
  4. maceration
55
Q

periwound area is any area that extends __ cm from the edge of the wound

A

4 cm

56
Q

many people with wounds have __ wound sensation

A

poor

57
Q

when documenting a wound, note the __

and __

A

size

depth

58
Q

what does optimal wound tissue look like

A

beefy red granulation

59
Q

escar around the edges of a wound may indicate

A

necrosis

60
Q

what is wound maceration

A

lightening of skin

bumpy/wrinkled

61
Q

epithelization means

A

tissue healing

62
Q

slough is __

and must be __ for healing

A

remnants of WBC

debrided

63
Q

where do pressure ulcers occur

A

areas of bony prominences → ankles, elbows, tailbone

64
Q

what are the stages of pressure ulcers

A

1-4-unstageable

65
Q

stage 1 pressure ulcer

A

nonblanchable erythema of intact skin

66
Q

stage 2 pressure ulcer

A

partial thickness skin loss w. exposed dermis

67
Q

stage 3 pressure ulcer

A

full thickness w. skin loss

68
Q

stage IV pressure ulcer

A

full thickness and tissue loss

69
Q

unstageable pressure ulcer

A

obscure full thickness skin and tissue loss

70
Q

deep tissue pressure injury

A

persistent, non blanchable

deep red, maroon, purple

71
Q

what are 4 rf for nonhealing wounds

A
  1. smoking!!
  2. endocrinology problems → DM, hypothyroidism
  3. hematologic problems → polycythemia
  4. CVD issues → CVD, COPD
72
Q

what is the mc location for venous ulcerations (venous stasis)

A

gaiter area of leg → 95%

usually medial

73
Q

venous ulceration usually have __ edges

A

sloping

74
Q

what are 5 characteristics of venous ulcerations (venous stasis)

A
  1. edema
  2. hemosiderin staining
  3. hair loss of extremity
  4. weeping → exudate
  5. itching
75
Q

what are 5 rf for venous ulcerations (venous stasis)

A
  1. varicose veins
  2. DVT
  3. chronic venous insufficiency
  4. poor calf muscle fxn
  5. obesity
76
Q

when should compression stockings be used for venous ulceration/stasis

A

if caused by edema

77
Q

when should compression stockings be avoided for venous ulcerations/stasis

A

if arterial flow is compromised → poor pulse

78
Q

what is the mc location for arterial ulcers

A

toes, foot, ankle

79
Q

what do the edges of an arterial ulcer look like

A

punched out

80
Q

what are 3 characteristics of arterial ulcers

A
  1. painful even w.o inflammation
  2. exudate rare
  3. edema uncommon
81
Q

what are 3 rf for arterial ulcers

A
  1. PVD
  2. DM
  3. SSA
82
Q

ulcer appears punched out w. well demarcated edges; pale, necrotic base; surrounding skin dusky or shiny; hairless

A

arterial ulcer

83
Q

what is hyperemia

A

pinkish-red skin

84
Q

what type of ulcer is caused by decreased arterial blood supply to LE, tissue hypoxemia, and damage

A

arterial ulcer

85
Q

what are 5 tx for arterial ulcers

A
  1. restore arterial fxn if possible
  2. usually surgery
  3. medications not helpful
  4. wound tx
  5. smoking cessation
86
Q

what test is useful to determine the extent of PVD

A

ankle brachial index (ABI)

87
Q

how do you measure ABI

A

measure systolic bp in both brachial and then both dorsal pedis/posterior tibial arteries → then divide

88
Q

what should the pt do for 10 min before ABI

A

rest

supine

89
Q

what is nl for ABI

A

1.0 - 1.4

90
Q

what does an ABI >4 indicate

A

noncompressible calcified vessel

91
Q

what does an ABI <0.9 indicate

A

dx of PAD

92
Q

what does an ABI 0.5-0.8 indicate

A

moderate arterial dz → refer to specialist

93
Q

what does an ABI < 0.5 indicate

A

severe arterial dz → refer to specialist

94
Q

you should refer pt to specialist if ABI is

A

0.8 or lower

95
Q

name 3 ways that negative pressure wound therapy (wound vac) enhances healing

A
  1. reduces edema
  2. increases rate of granulation tissue
  3. stimulates circulation
96
Q

wound vac is a __ system

that removes __ and

promotes __

A

sealed

fluid

circulation

97
Q

you should not use wound vac on

A

infected areas

98
Q

what are 4 contraindications for wound vac

A
  1. malignancy of wound → ex melanoma
  2. untreated osteomyelitis
  3. placement of dressings in contact w. exposed bv, organ, or nerve
  4. nonenteric or unexplained fistulas
99
Q

what are 7 indications for wound vac

A
  1. chronic wounds
  2. acute wounds
  3. traumatic wounds
  4. partial thickness
  5. dehisced (open) wounds → reopened
  6. diabetic ulcers
  7. pressure ulcers
100
Q

what are indications for growth factors/skin graft substitutions

A

small area

not much skin to use

101
Q

what are 2 examples of growth factors

A
  1. apligaf
  2. dermagraft
102
Q

what are 3 types of debridement

A
  1. enzymatic
  2. mechanical
  3. sharp
103
Q

what is enzymatic debridement

A

chemical agents that eat away dead tissue

104
Q

most enzymatic debridement agents have been

A

taken off market

ex Santol

105
Q

why are enzymatic debridement agents harmful

A

can’t discern good tissue from bad tissue

106
Q

what is mechanical debridement

A

wet to dry dressings (gauze) → applied to wound → takes away tissue when pulled off

107
Q

peroxide and iodine are considered __ debridement

but can be __ to tissue

A

mechanical

destructive

108
Q

what is sharp debridement

A

surgical/scalpel to remove tissue

109
Q

what are 3 considerations for wound follow up

A
  1. close monitoring
  2. weekly visits
  3. careful documentation!!

Clin Med II - Exam 2 (14 decks)

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