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Block 5 - Pulm and Skeletal > Skeletal Micro > Flashcards

Skeletal Micro Flashcards

0
Q

What are the three mechanisms of spread to a joint?

A 
Hematogenously 
Direct inoculation (trauma, surgery, injection, bite)
Contiguous spread (ulcers)
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1
Q

What are the three different syndromes resulting from infection of joints?

A

Acute bacterial - usually mono or oligo articular, rapid onset and progression, can cause permanent damage
Viral - poly articular, symmetric, no therapy required, resolves spontaneously with no permanent damage
Chronic mono or oligo arthritis - mycobacteria, fungi, or fastidious bacteria)

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2
Q

What are risk factors for dev of septic arthritis?

A

Underlying abnormal joint
Systemic conditions
Sequela of osteomyelitis in joints where capsule inserts distal to epiphyses of associated bone (hip, proximal radius)

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3
Q

What are the most commonly affected joints in septic arthritis?

A

Weight bearing joints
Especially knee
Hip also a lot in kids

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4
Q

How is the pain different in septic arthritis than bursitis?

A

SA - pain more intense with extension than flexion

Bursitis - pain more intense with flexion than extension

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5
Q

What is needed for diagnosis of septic arthritis?

A

Joint fluid WBC > 50,000-100,000

Gram stain and culture can help

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6
Q

What are the treatment objectives with septic arthritis?

A

Drainage of infected joint fluid
Antibiotic therapy - empiric then narrow - 2-4 weeks (usually 4, 2 in gonorrhoeae)
Early rehab to preserve joint function

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7
Q

What should you treat for if a patient is immunocompromised?

A

GNRs

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8
Q

What are the different methods of drainage of an infected joint?

A

Repetitive aspirations
Arthroscopic drainage
Open drainage - hip and shoulder

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9
Q

What are predictors of poor outcome in septic arthritis?

A 
Underlying joint disease
Delay in appropriate treatment
Multiple joint involvement
Elderly
Involvement of hip or shoulder
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10
Q

What is the most common virus responsible for viral arthritis and what is its presentation?

A

Parvovirus B19
Slap cheek rash on face of children, fine reticular rash on trunk and legs - unusual in children
Arrest at pronormoblast stage can mimic anemia
Usually large joints in hand, can mimic RA
Usually resolves within 2 weeks

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11
Q

How is diagnosis of viral arthritis from parvovirus B19 done?

A

Serum IgM antibody to parvovirus
PCR analysis
Bone marrow biopsy

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12
Q

What is the main mechanism and most common cause of infection of prosthetic joints?

A

Direct inoculation

Coagulase negative staph as common or more than s aureus

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13
Q

How does the presentation of an infected prosthetic joint compare to an infected native joint?

A

Usually less severe and more chronic
Present sub-acutely over months
Main symptom is progressive joint pain

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14
Q

What do radiographs show in infected prosthetic valves?

A

Lucencies around prosthesis
Movement of device
Reaction of periosteum of adjacent bone

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15
Q

When are outcomes of a one step protocol favorable?

A

When relatively avirulent organisms involved

16
Q

When are chronic suppressive antibiotics okay as opposed to removal of an infected prosthetic joint?

A

Low virulence organism
Removal of prosthetic is risky
Prosthesis functions reasonably well

17
Q

What are the two syndromes caused by gonococcal septic arthritis?

A

Arthritis

Tenosynovitis-dermatitis (dermatitis-arthritis)

18
Q

Which joints are more commonly affected in gonococcal septic arthritis?

A

Knees
Wrists
Ankles

19
Q

How is disseminated gonococcal infection diagnosed?

A

Gram stain and culture yield is low
Must culture mucosal surfaces - cervix, urethra, rectum, pharynx
NAATs of mucosal surfaces adjunct for culture

20
Q

What is the treatment of disseminated gonococcal infection?

A

No need for surgery

IV ceftriaxone for 2 weeks

21
Q

What are the symptoms of chronic infectious arthritis?

A

Mono articular involvement, slow onset, indolent course, lack of systemic symptoms, progressive destruction of joint
Physical exam mostly normal - just pain and possible effusion

22
Q

What pathogens are associated with chronic arthritis?

A 
Syphillis 
Lyme disease
Whipples disease 
Fungal pathogens - blastomyces, coccidioides, paracoccidioides, not histo 
Tb
23
Q

How is chronic arthritis due to fungal pathogens diagnosed and treated?

A

Organisms seen in synovial fluid
Operative drainage usually unnecessary
Medical therapy with anti fungal drugs (itraconazole)

24
Q

Which two bursa are predominately affected by septic bursitis?

A

Olecranon

Prepatellar

25
Q

What is the pathogenesis of septic bursitis?

A

Usually trauma to overlying skin
Often simultaneous cellulitis
Spread from contiguous focus - skin
Mostly s aureus, some skin strep

26
Q

What is the treatment for septic bursitis?

A

Antibiotics, oral or IV

Operative resection of bursa if failure to respond to antibiotics or it recurs

27
Q

What are the most common locations for osteomyelitis?

A

Long bones of extremities (legs more than arms)
Bones of feet
Vertebral column

28
Q

When does osteomyelitis begin to show changes on radiographs?

A

Two weeks after infection starts

29
Q

What’s the gold standard for diagnosing osteomyelitis?

A

Bone biopsy and culture

30
Q

How long is therapy needed for osteomyelitis?

A

Minimum of 6 weeks for adults

31
Q

What is acute hematogenous osteomyelitis?

A

Most common form in prepubertal children and IVDA and patients with catheters
Metaphysis of long bones - distal end of femur and proximal end of tibia
Antibiotics for three weeks

32
Q

What is the cause of vertebral osteomyelitis?

A

Generally hematogenous but direct implantation can occur - s aureus, brucella, tb, fungal = blasto, cocc.
Can cause abscesses in surrounding tissues
Can be complicated by collapse of vertebra or cord compression

33
Q

What are the symptoms of vertebral osteomyelitis?

A

Slowly progressive back pain
Maybe night sweats and fever
No fever until later in course
Tenderness

34
Q

How is vertebral osteomyelitis diagnosed?

A

Bone biopsy and culture

MRI for imaging

35
Q

What is the treatment for vertebral osteomyelitis?

A

Minimum 4-6 weeks antibiotics, usually 6

Surgery generally unnecessary unless unstable spine or large abscess

36
Q

What is the course of osteomyelitis in diabetics?

A

Often indolent - months before presentation, no systemic symptoms
Recurrence frequent after antibiotic therapy - progressively proximal amputations common

37
Q

What vascular insufficiency is associated with osteomyelitis?

A

Microvascular in diabetics

Macrovascular in peripheral vascular disease

38
Q

What is acute vs. chronic cellulitis in patients with vascular disease generally due to?

A

Acute - s aureus or beta hemolytic strep

Chronic - anaerobes or enterobacteriaceae

Block 5 - Pulm and Skeletal (19 decks)

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