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MSK Week 1 2017/18 > 5: Microbiology > Flashcards

5: Microbiology Flashcards

(54 cards)

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1
Q

What is osteomyelitis?

A

Inflammation of bone and medulla, usually found in the long bones

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2
Q

Can osteomyelitis recur after treatment?

A

Yes, so long treatment duration required (e.g 6 weeks)

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3
Q

By which means can osteomyelitis spread?

A

Contiguously - i.e direct contact

Haematologically - via blood vessels

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4
Q

Osteomyelitis can be diagnosed ___ or ___.

A

directly (you found the bug)

indirectly (X-RAY/MRI evidence + clinical suspicion)

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5
Q

How is osteomyelitis treated?

A

Debridement (removal of damaged tissue and foreign material, draining of pus)

Antimicrobial drugs for at least 6 weeks

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6
Q

What are the principles of diagnosis of MSK infections?

A

Suspect disease - take a history, examine patient

Sample - bone biopsy is gold standard, cross-sectional imaging

Treat - wait for microbiology or treat immediately if septic

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7
Q

Take - blood, lactate, urine analysis

Give - oxygen, fluids, antibiotics

A
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8
Q

osteomyelitis highly likely in diabetic feet if:

  • you can probe all the way to bone
  • ulcer >2cm in diameter has been present for >2 months
A
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9
Q

Why are bone biopsies preferred versus swabs for diagnosing bone infections?

A

Swabs don’t reach inner medulla

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10
Q

revise characteristic symptoms of inflammation

A
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11
Q

Bone is highly ___ to infection.

A

resistant

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12
Q

If in doubt, which organism is responsible for osteomyelitis?

A

Staph. aureus

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13
Q

When can antibiotics be given to a patient with osteomyelitis?

A

Once you’ve proved they have an infection i.e a positive biopsy/swab

Or they clearly have sepsis

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14
Q

Coagulase negative Staph. (such as ___ ___) are commensal bacteria but like to colonise foreign material like plastic and metal to cause disease.

A

Staph. epidermidis

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15
Q

Staphylococci are (aerobic / anaerobic).

A

aerobic

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16
Q

Which antibiotic is used to treat Staph. aureus?

A

IV Flucloxacillin

IV Clindamycin (penicillin allergic)

IV Vancomycin (MRSA)

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17
Q

What are three toxins produced by Staph. aureus?

A

Enterotoxin - food poisoning

SSSST - staph. scalded skin syndrome toxin

PVT - panton valentine leukocidin

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18
Q

Staph. aureus is coagulase ___ and shows up ___ on agar plates.

A

positive

golden

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19
Q

Which type of fracture tends to get infected?

A

Open fractures

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20
Q

How are open fractures treated?

A

Debridement

Reduced & fixation - bone ends brought together

Soft tissue cover

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21
Q

How may you tell that an open fracture is infected?

A

Wound is healing poorly, doesn’t close up

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22
Q

What is an infectious complication of diabetes, occuring due to venous insufficiency?

Study These Flashcards
A

Diabetic foot infection

23
Q

Which sign should raise suspicion of osteomyelitis secondary to diabetic vascular insufficiency?

Study These Flashcards
A

You can PROBE TO BONE

24
Q

Is osteomyelitis secondary to diabetic foot ulcers caused by one organism?

Study These Flashcards
A

Rarely

but treat with fluclox and see what the response is, then add gentamicin (for ?gram negatives) and metronidazole (for anaerobes)

25
look at antibiotic spectrum of action
26
If it's so powerful, why isn't vancomycin given for MSSA?
Evidence shows that more people with MSSA die on vancomycin compared to flucloxicillin
27
Flucloxicillin is given intravenously to treat osteomyelitis. When it's time to switch to an oral drug, what do you use?
**Doxycycline**
28
What drugs are used to treat suspected **gram negative** and **anaerobic** osteomyelitis (i.e if it's smelly and rotten?
**Gentamicin** **IV** (Gram negatives) **Metronidazole** (anaerobes)
29
What is **haematogenous osteomyelitis**?
**Blood spread of infection to bone**
30
Who tends to get **haematogenous osteomyelitis**?
**Prepubescent children** **PWID** **Patients with central lines / dialysis / elderly**
31
Outside of the UK, what organism can cause haematogenous osteomyelitis which is very very pus-y?
*Mycobacterium tuberculosis*
32
Which organism is the most likely cause of haematogenous osteomyelitis?
***Staph. aureus***
33
Which antibiotic covers beta-haemolytic *Strep.* which may rarely be responsible for osteomyelitis?
**Flucloxicillin** so we bueno
34
What are some unusual sites for osteomyelitis in PWID?
**Sternoclavicular joint** **Pubic symphysis** i.e if it's a strange site ask about this
35
Which test is used to classify *Strep.* species?
**Haemolysis**
36
Which group of *Strep.* is most commonly seen in osteomyelitis? What do they look like on haemolysis?
**Group A *Strep.*** Beta (complete) haemolysis - appears white on plate
37
Patients on which kidney treatment may develop haematogenous osteomyelitis?
**Dialysis**
38
osteitis pubis and clavic osteomyelitis
39
What are three groups of patients who have an unusual predisposition to osteomyelitis?
**Sickle cell anaemics** **Gaucher's disease** **SAPHO/CRMO**
40
What is the abnormal casual organism for osteomyelitis in people with sickle cell anaemia?
***Salmonella*** | (or *Staph. aureus*)
41
What is a rare genetic disorder associated with an increased risk of bone infections?
**Gaucher's disease**
42
sapho/crmo
43
What name is given to osteomyelitis affecting the spine?
**Vertebral osteomyelitis**
44
Vertebral osteomyelitis tends to cause symptoms associated with the ___ level it's at.
**spinal**
45
How does vertebral osteomyelitis tend to spread?
**Haematogenous**
46
What organisms can cause vertebral osteomyelitis?
***Staph. aureus*** Gram negatives Anaerobes ***Mycoplasma tuberculosis***
47
What are some symptoms of vertebral osteomyelitis?
**Fever** **Insidious pain** **Raised CRPs** Occasionally raised white cell count
48
How is suspected vertebral osteomyelitis investigated?
**BIOPSY** (direct) **MRI/CT scan** (indirect)
49
How is vertebral osteomyelitis treated?
**Drainage of epidural / psoas abscesses** Antibiotics for 6 weeks
50
When should an MRI be repeated in patients with vertebral osteomyelitis?
**Unexplained increases in inflammatory markers** **Increasing pain** **New signs/symptoms**
51
What is the drug of choice for vertebral osteomyelitis in Scotland?
**Flucloxacillin**
52
Internationally, what organism may cause vertebral osteomyelitis? What is the disease called in this cause?
**TB** **Pott's disease**
53
What must be offered to patients presenting with skeletal TB?
**HIV test**
54
Is skeletal TB limited to one vertebral disc?
**No, crosses discs causing a shitload of damage**

MSK Week 1 2017/18 (10 decks)

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