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ID Boards > SSTI, Bone and Joint > Flashcards

SSTI, Bone and Joint Flashcards

1
Q

Complication of furuncle/carbuncle involving nares or medial third of face

A

cavernous sinus thrombosis

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2
Q

SSTI a/w freshwater, estuarine (brackish) water, floodwater

medicinal leeches

A

aeromonas

→ cellulitis, traumatic wound infection, myonecrosis, necrotizing SSTI

Tx: 3rd gen ceph, FQ, bactrim

*for pts receiving leech therapy - give ppx cipro

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3
Q

tx for vibrio

A

doxy + CRO/cefotax

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4
Q

SSTI + handling raw seafood

A
  • vibrio - shellfish, liver/iron disease
  • erysipelothrix - shrimp, crab, fish
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5
Q

SSTI + foot baths, nail salon

A

M fortuitum

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6
Q

Dx criteria for burn wound sepsis

A
  • presence of clinical features of infection and systemic signs
  • wound bx = bacterial count >105/gm of tissue w/ evidence of invasion into unburned tissue on histopath
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7
Q

SSTI that develop rapidly w/in 48hrs of surgery

A

think GAS and Clostridium

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8
Q

animal hide/wool

pruritic papule → vesicles/bullae → ulcerate → painless black eschar w/ surrounding induration

A

cutaneous anthrax

tx w/ cipro or doxy x60 days

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9
Q

Organisms whose growth is stimulated by excess iron

A

“VELARY” = the sails of a ship

  • Vibrio
  • E coli
  • Listeria
  • Aeromonas
  • Rhizopus spp (Mucor)
  • Yersinia enterocolitica
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10
Q

SSTI a/w oysters

rapid onset - red, painful, hemorrhagic bullae

  • diagnosis and RF
  • Tx
A

vibrio vulnificus

  • liver disease (EtOH, hemachromatosis, etc)
  • Tx: doxy + CRO (alt = FQ)
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11
Q

on a certain medication

fluctuant tender furuncle

F, generalized erythroderma (bullous lesions develop)

skin bx: intra-epithelial split in skin

A

Staph aureus SSS

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12
Q

Strep vs Staph TSS

  • predisposition
  • focal pain - y/n
  • tissue necrosis/inflammation
  • N/V, renal failure, DIC - y/n
  • erythroderma
  • bacteremia
  • mortality
A
  • staph: tampon, surgery, colonization; strep: cuts, burns, erysipelas, varicella
  • staph: no; strep: yes
  • staph: rare; strep: common
  • staph and strep: yes
  • staph: very common; strep: less common
  • staph: very rare; strep: 60%
  • staph: <3%; strep: 30-70%
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13
Q

after cut/abrasion exposure to swine or fish

severe throbbing pain

A

erysipelothrix (GPR)

  • Dx: culture (aspirate/bx)
  • Tx: PCN, cephs, clinda, FQ
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14
Q
A

Bullous impetigo

Staph

***good theme for boards:

  • honey-crusted: strep
  • bullae = staph
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15
Q
A

Strep impetigo

Strep: groups A, B, C, G

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16
Q

etiologies for folliculitis

A
  1. SA
  2. PSAR (hot tub)
  3. Candida (obese pt)
  4. Malassezia furfur = lipophilic yeast
  5. AIDS = idiopathic eosinophilic pustular folliculitis
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17
Q

anaerobic small GNR

human bite injury

dx and tx

A

eikenella

Susc: PCN, FQ, TMP/SMX, doxy

R: clinda, keflex, metronidazole

**amox/clav = TOC for human bites

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18
Q

homeless w/ animal bites

contaminated water/food

fever, extremity rash

symmetrical polyarthralgias

A

rat bite fever (Strep moniliformis)

tx: PCN, doxy

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19
Q

tx for capnocytophaga

A

amox/clav

can use zosyn, PCN, clinda (add clinda if needing to use other abx for tx of animal bite, such as bactrim or doxy)

R to: bactrim, ?vanc

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20
Q

pathogens in dog bites

A
  • pasteurella
  • capnocytophaga (splenectomy, liver disease)
  • human skin: SA, strep pyogenes
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21
Q

6 pathogens that can cause infection after cat bites

A
  • pastuerella
  • anaerobes
  • bartonella henselae
  • rabies
  • S aureus
  • Strep spp
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22
Q

imaging abn at pubic symphysis (bone marrow edema w/ some symmetric bone erosions)

negative cultures and bxs

unresponsive to abx courses

pt with waddling gait

A

consider osteitis of the pubic symphysis

noninfectious - a/w radiation, vaginal delivery

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23
Q

spinal osteo as sacroiliitis or spondylodiscitis

A

think of brucellosis (w/ risk factors)

24
Q

Bone/joint infection

+

Cat/dog bite

A

pasteurella spp

25
Q

Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral

Immune-complex arthritis a/w cryoglobulinemia

A

think HCV

26
Q

Bone/joint infection

+

human bite wounds

recent dental procedures

A

HACEK

(eikenella w/ human bite)

27
Q

Bone/joint infection

+

NE/upper MW

tick exposure

subacute monoarthritis (knee MC) w/ large effusion

A

lyme

28
Q

Bone/joint infection

+

children < 4yo

Grows poorly in cx (dx via PCR)

A

kingella kingae

29
Q

young adults with asymmetric oligoarthritis + urethritis, uveitis, or conjunctivitis

dx and what IDs are a/w?

A

Reactive arthitis (sterile inflammation 2/2 dysregulated immune response from antecedent infection)

  • C. trachomatis (can be seen via NAAT in urine)
  • Shigella
  • Salmonella
  • Campy
  • Yersinia
30
Q

lab testing for suspected disseminated gonococcal infection

A

include indirect testing (via mucosal NAAT)

With septic arthritis: NAAT may be helpful, but not FDA-approved. Blood cultures are low-yield

culturing requires chocolate agar or Thayer-Martin medium

31
Q

Bone/joint infection

+

Madura foot (barefoot walking)

environmental contamination

IC hosts (neutropenic)

A

molds

32
Q
  • Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral
  • serum-sickness like reaction, resolves with development of jaundice
  • often also polyarteritis nodosa
A

think HBV

33
Q

Late Non-union:

  • Micro:
  • Surgical Strategy:
  • Abx management:
A
  • Indolent (CoNS, cutibacterium)
  • HW removal, revision fixation
  • Path-directed tx
34
Q

septic arthritis

negative cx (or delayed cx)

A

think: gonococcus, HACEK, lyme, mycoplasma

35
Q

bone/joint infection

+

splenic dysfunction

A

Strep pneumo

36
Q

Bone/joint infection

+

humoral deficiency

postpartum women

tough to grow on cx

Fried egg on culture

A

mycoplasma spp

37
Q

2 locations of septic arthritis that should raise suspicion of IVDU

A
  • sternoclavicular joint
  • SI joint
38
Q

Bone/joint infection

+

IC host, indwelling line, IUD

A

PSAR

39
Q

Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral

women, history of exposure to young children (teacher, parent)

hands often involved

A

parvo B19

40
Q
  • Tenosynovitis (esp extensor surface)
  • Migratory arthralgias
  • purulent arthritis (often w/ lower PMN count)
A

gonococcal arthritis

Highest yield dx: mucosal site sampling (cervical, urethral). Blood (<30%) and synovial fluid (<50%) lower yield

+ compatible syndrome

41
Q

bone/joint infection

+

fight bite, oral flora, contamination of IVDU

A

think of Eikenella and peptostreptococcus

42
Q

Early/delayed infections prior to fx union

  • Micro:
  • Surgical Strategy:
  • Abx management:
A
  • SA = MC
  • Debride and retain (assuming implants fixed well)
  • Path-directed; rifampin + if staph
43
Q

vertebral osteo (thoracic>lumbar)

anterior involvement –> kyphosis deformation

sparing disc space (until later)

A

think Pott’s disease

indolent presentation

44
Q

Bone/joint infection

+

unpasteurized dairy

travel to endemic regions (Latin Am, Mediterranean, Middle East)

sacroiliitis, spondylodiscitis

A

Brucella spp

45
Q

cutibacterium acnes in seeing of PJI

A

often a/w shoulder PJI

46
Q

Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral

+ travel

A

always consider alphaviruses (esp Chik)

47
Q

Bone/joint infection

+

tenosynovitis

Dermatitis

arthritis

A

N gonorrhea

48
Q

Bone/joint infection

+

IC hosts, IDU

A

candida spp

49
Q

bone/joint infection

+

brackish water, water exposure/contamination

A

Think aeromonas (esp “brackish” water)

also consider pseudomonas

50
Q

bone/joint infection

+

malignancy

A

think of GBS

51
Q

Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral

non-immune (not born in US), cervical LAD

A

rubella

52
Q

rash, high fevers, arthritis (>10joints)

Asia, Africa, Europe, Caribbean

relapsing-remitting or unremitting

Dx and testing

A

think of Chik

RT-PCR if within 1wk of sx

serology if sx >1wk (IgM can be detected up to 3mos)

53
Q

Bone/joint infection

+

SCD

DM

IC

reptile exposure

travel to developing world

unsafe food hygiene

+/- GI illness

A

salmonella

54
Q

PJI Management Table

A
55
Q

HCV arthritis

A
  • typically RA-like pattern (symm wrists, MCP, PIPs)
  • also can be oligoarthritis w/ large joints (a/w mixed essential cryoglobulinemia)
  • d/t immune complex formation
56
Q

walled off intra-osseous abscess of metaphyseal bone (surrounded by rim of sclerotic bone)

in children/young adults

A

brodie’s abscess (subacute hematogenous osteo)

  • MC d/t SA
  • “penumbra sign” = granulation tissue lining abscess cavity – looks like double line

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