Exam 3 - Endocarditis and bone/joint infections Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 3 - Endocarditis and bone/joint infections > Flashcards

Flashcards in Exam 3 - Endocarditis and bone/joint infections Deck (42):
1

what is the most common bug that causes osteomyelitis

staph aureus

2

what type of bone/joint infection is life threatening

septic arthritis

3

standard duration of abx treatment for bone/joint infections?

4 - 6 weeks

4

For bone/joint infections: when can oral antibiotic therapy be given?

oral only used for osteomyelitis and to COMPLETE parenteral regimen

5

Able to give oral abx to kids when?

they have had a good clinical response to IV abx

6

Able to give oral abx to adults when?

if pt does NOT have diabetes or does NO have peripheral vascular disease

7

3 main therapeutic approaches to managing septic arthritis

appropriate abx
joint drainage
joint rest

8

what does PJI stand for

prosthetic joint infetion

9

PJIs: almost always necessitate the need for _________ and __________ of IV and/or oral abx therapy

need surgical intervention and prolonged courses

10

T or F: bone has poor perfusion

false!! great perfusion (lots of venous capillaries)

11

what are the 3 differ sections of the bone

epiphysis
metaphysis
diaphysis

12

what part of the bone is the epiphysis

it is the part at the END of the bone

13

what is the periosteum

fibrous/cellular envelope surrounding the bone

14

blood vessels supplying bone tissue are predominantly located in what parts of the bone

epiphysis and metaphysis

15

Epiphysis and diaphysis are separated by the _______ which is rapidly growing area of the bone with lots of blood vessels (aka infection can get here super easily)

epiphyseal growth plate

16

When blood flow is ________ an infection is possible with bacterial colonization

blood flow is SLOWED considerably

17

Definition of Osteomyelitis

purulent inflammation of the bone marrow and surrounding bone associated with an infection

18

Osteomyelitis is classified by what?

the route that the infecting organism reaches the bone

19

what are the 3 different routes that osteomyelitis can occur

hematogenous spread
contiguous spread
vascular insufficiency

20

Osteomyelitis: Hematogenous Spread
Risk factors?

sickle cell
or
transient/persistent bacteremia!!

21

Osteomyelitis: Hematogenous Spread
Typically involves metaphysis of RAPIDLY growing _____ bones in kids
examples of these bones?

rapidly growing LONG bones

ex: femur, tibia, humerus, fibula

22

Osteomyelitis: Hematogenous Spread
Typically involves _____ bones in adults

vertebrae (lumbar or thoracic)

23

Osteomyelitis: Hematogenous Spread Pathogenesis
the acute infectious process will increase _______ -> compromises ______ -> leads to _____

increase bone pressure; compromises blood flow; leads to necrosis

24

Osteomyelitis: Hematogenous Spread Pathogenesis
Cytokine release by the infection will cause promotion of ______ activity which will decrease bone integrity

promote osteoCLASTs

25

Osteomyelitis: Hematogenous Spread Pathogenesis with elevated bone pressure and necrosis will cause _______ of diseased bone from healthy bone (called ________)

cause FRAGMENTATION
called SEQUESTRUM

26

Osteomyelitis: Hematogenous Spread Pathogenesis
continued spread of infection leads to outer layers of bone and soft tissue which leads to abscess and draining _______

sinus tracts

27

Osteomyelitis: Contiguous Spread Pathogenesis
how does the pathogen get to the bone?

gets to the bone from an ADJACENT soft tissue infection or direct inoculation during trauma/puncture wounds or surgery

28

Osteomyelitis: Vascular insufficiency Pathogenesis
is a subset of ________

contiguous spread

29

Osteomyelitis: Vascular insufficiency Pathogenesis
Risk factors are who?

pts with diabetes or peripheral vascular disease

30

What bug are worried about for Osteomyelitis in sickle cell pts

salmonella

31

what is the best radiologic thing to diagnose osetomyelitis

MRI (more sensitive)

32

Is it best to get a culture for osteomyelitis - yes or no? and why?

yes - get a freaking culture
do not want to do empiric therapy for 4 - 6 weeks...

33

Empiric therapy for Osteomyelitis:
Adults

nafcillin or cefazolin (MSSA)

34

Empiric therapy for Osteomyelitis:
Post-Op/Post trauma pts

pip/tazo, or cefepime, or meropenem(add vanc if MRSA worried)

*these drugs bc want to cover pseudomonas (the hospital bug..)

35

Empiric therapy for Osteomyelitis:
IV Drug user

cefepime or ceftazidime
(want pseudomonas coverage for IV drug users..)

36

Directed therapy for Osteomyelitis:
S.Aureus?

Nafcillin or cefazolin
if severe allergy: vanc or clinda
if MRSA: vanc, dapto, linezolid

37

3 routes that Septic arthritis can occur

hematogenous spread
direct inoculation
contiguous spread from infected soft tissue or bone

38

The most common pathogen for septic arthritis is _______
oddly tho -- for adults in age range 15 - 40 the bug _______ is oddly common

most common = s.aureus

oddly common bug is Neisseria gonorrhoeae

39

what bug is know to come from cat/dog bites

pasterurella multocida

40

Most septic arthritis cases are mono or poly articular

usually mono!!

41

Gonococcal arthritis:
4 times more common in men or women?

and why?

more common in women

more common in women because there is a higher risk of dissemination during menstruation/pregnancy or postpartum

42

the gram stain of gonococcal arthritis (synovial fluid should be checked!!) will be what?

gram negative diplococci