Infectious Disease

Question 1

what are the 5 cardinal signs of cellulitis?

Answer 1

rubor (redness)
tumor (edema)
dolor (pain) 
calor (heat)
functio lasea (loss of function)

Question 2

what is red streaking caused by inflammation of lymphatic channels draining the site of infection called?

Answer 2

lymphangitis

Question 3

how would you describe an open lesion?

Answer 3

record depth, size, shape, tissue or debris within lesion

Question 4

what is fluctuance?

Answer 4

fluid beneath surface of skin which may be an abscess or hematoma

Question 5

what is crepitus?

Answer 5

feeling of creptus is created by subcutaneous air or gas

*creptus w/ S/S is considered a surgical emergency

Question 6

what is transient bacteremia?

Answer 6

bacteremia that happens on daily basis

Question 7

what is intermittent bacteremia?

Answer 7

septic foci seeding the blood

Question 8

what is continuous bacteremia?

Answer 8

bacterial endocarditis

Question 9

what are the limits of blood culture protocol?

Answer 9

• need large volume of blood >20cc
• expensive
• can take up to 5 days to grow
• usually 3 sets (aerobic and anaerobic) are drawn 30 min. apart

Question 10

what are the guidelines for admitting a patient with infection to hospital?

Answer 10

• high fever >101 F
• high WBC > 13,000
• systemic infection or sepsis
• failure to respond to outpatient therapy
• need IV to administed parenteral agent
• debridement requiring general anesthesia
• systemic disease

Question 11

when is surgical intervention indicated for cellulitis?

Answer 11

not indicated unless there is an abscess

Question 12

what kind of infections cause cellulitis?

Answer 12

usually Gram + infection

Question 13

what are the 2 mechanisms by which an infectious agent enter bone?

Answer 13

1. hematogenous- seeding thru blood stream from distant source
2. external or contiguous force- from adjoining soft tissue or direct implementation

Question 14

what are the pathophysiology steps of osteomyelitis?

Answer 14

sequestrum
involucrum
cloaca

Question 15

what is sequestrum?

Answer 15

as infection progresses within bone, segments of necrotic bone are isolated from viable bone

Question 16

what is involucrum?

Answer 16

outer cortex of bone violated with elevation of periosteum and stimulation of new bone to wall off infection

Question 17

what is cloaca?

Answer 17

new bone formation violated releasing infection into soft tissue

Question 18

hematogenous osteomyelitis occurs where in children? what about in elderly?

Answer 18

children- affects metaphyseal region of rapidly growing long bones

elderly- vertebrae

Question 19

what is the most common single organism infection that causes hematogenous osteomyelitis?

Answer 19

Staph aureus

Question 20

which organism is the cause of hematogenous osteomyelitis in neonates?

Answer 20

group B strep

Question 21

which organism is the cause of hematogenous osteomyelitis in children under 2?

Answer 21

H. influenza

Question 22

describe the anatomic type of classification (Cherny and Mader classification) for osteomyelitis.

Answer 22

type 1: medullary osteo
type 2: superficial osteo
type 3: localized osteo
type 4: diffuse osteo

Question 23

describe the physiologic class of classification for osteomyelitis.

Answer 23

A-host: good immune system and delivery
B-host: compromised locally (BL) or systemically (BS)
C0host: no treatment, or tx is worse than disease itself

Question 24

what is the gold standard for diagnosing osteomyelitis?

Answer 24

bone biopsy and bone culture ***

Question 25

describe radiographic findings of osteomyelitis.

Answer 25

30-50% bone destruction

-radiographic findings lag 2 weeks

Question 26

chronic osteomyelitis with sinus tracts is associated with what cancer?

Answer 26

squamous cell CA

Question 27

what is the gold standard for treating puncture wounds?

Answer 27

debridement and irrigation

*antibiotics cannot compensate for improper wound care

Question 28

which region is most likel to get osteomyelitis?

Answer 28

forefoot (zone 1)- metatarsal neck distally

Question 29

describe the Waldvoegel classification.

Answer 29

acute (initial episode) - based on how people acquire osteomyelitis: hematogenous, secondary to contiguous focus, or associated with vascular insufficiency
chronic (recurrent)

Question 30

What is the most common isolated organism from puncture wounds?

Answer 30

staph aureus

Question 31

if there is OM after a puncture wound, then what is the most common organism isolated?

Answer 31

pseudomonas