orthopaedic infections

Question 1

what are the risk factors for osteomyelitis?

Answer 1

diabetes
immunosuppression
surgical contamination
penetrating injury

Question 2

what can cause the infection of the bone to develop?

Answer 2

haematogenous spread
peripheral vascular disease
prosthesis

Question 3

what organisms can cause acute osteomyelitis?

Answer 3

staph aureus
streptococci
h.influenze

Question 4

what organisms can cause chronic osteomyelitis?

Answer 4

TB
pseudomonas aeroigenosa
salmonella
ecoli

Question 5

what is Potts disease?

Answer 5

TB infective spine disease that causes crush fracture of thoracic spine

Question 6

what is salmonella osteomyelitis a complication of?

Answer 6

sick cell anaemia

Question 7

what investigation is crucial for osteomyelitis ?

Answer 7

MRI

Question 8

what is the treatment for acute osteomyelitis?

Answer 8

flucloxacillin (6 weeks) IV
clindamycin if allergic
vancomycin IV is MRSA

Question 9

what is the treatment for chronic osteomyelitis?

Answer 9

antibiotics and debridement
flucloxicillin
MRSA or penicillin allergy:
co-trimoxazole or doxycycline

Question 10

in prosthetic join infections, what causative organisms form early post operative?

Answer 10

staph aureus

Question 11

in prosthetic join infections, what causative organisms form delayed post operative?

Answer 11

staph epidermis

propionbacterium acnes

Question 12

in prosthetic join infections, what causative organisms form late?

Answer 12

staph aureus or E.coli

Question 13

in early post operative infection, what is the time/route/presentation?

Answer 13

time: 0-3 months
route: perioperative
presentation: sepsis, warm joint with signs of effusion

Question 14

in delayed post operative infection, what is the time/route/presentation?

Answer 14

time: 2-24 months
route: preoperative
presentation: persistent joint pain, loosening of prosthetic

Question 15

in late operative infection, what is the time/route/presentation?

Answer 15

time: >24 months
route: haematogenous
presentation: acute or sub acute

Question 16

what is prophylaxis for prosthetic joint infection?

Answer 16

co-amoxiclav (co-trimoxazole if allergic)

Question 17

what is the therapy for prosthetic joint infection?

Answer 17

dependent on culture results/if implant retained or replaced
given for approx 12 weeks
gram postive: flucloxacillin/vancomycin 
gram negative: ciprofloxaxin
if staph sensitive: rifampicin

Question 18

what are the most common causes of septic arthritis?

Answer 18

1st: staph aureus
2nd: streptococci

Question 19

what is the most common cause of septic arthritis in children?

Answer 19

h.influenza

Question 20

what is the most common cause of septic arthritis in adolescents?

Answer 20

gonorrhoea

Question 21

what it the most common cause of septic arthritis in the old/IVDU?

Answer 21

e.coli

Question 22

what should you think if multiple septic arthritis?

Answer 22

endocarditis

Question 23

what is the management of septic arthritis?

Answer 23

antibiotics +/- surgical wash out

fluxcloxacillin (clindamycin if penicillin allergic)

Question 24

what antibiotic should be added if children to cover h.influenza?

Answer 24

ceftriaxone

Question 25

what is and where does necrotising fasciitis happen?

Answer 25

severe subcutaneous tissue infection

most commonly abdominal wall, limbs and groin

Question 26

what are the two types of causative organisms of NF?

Answer 26

type 1: mixed anaerobes and aerobes

type 2: group A strep

Question 27

what is the management for NF?

Answer 27

start treatment before result obtained
debridement + antibiotics
IV penicillin + clindamycin

Question 28

what causes gas gangrene?

Answer 28

cholstridium perfingens (sporm forming, gram positive bacillus that is a strict aerobe)

Question 29

how does gas gangrene present?

Answer 29

usually following penetrative wound
skin discolouration
bubbling of the skin

Question 30

what is the management of gas gangrene?

Answer 30

urgent debridement and antibiotics:

penecillin and metronidazole

Question 31

what is the causative organisms of tetanus?

Answer 31

cholstridium tetani:
spore forming, gram positive bacillus that is a stoic anaerobe
drumstick shaped in culture
from rusty nails

Question 32

how does tetanus present?

Answer 32

following penetrative trauma 
spastic paralysis
lock jaw 
can affect breathing 
can be triggered by loud noises and bright lights

Question 33

what is the management of tetanus?

Answer 33

surgical debridement
antibiotics - penicillin and metronidazole
anti-toxin
vaccine