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MSK > Infection > Flashcards

Infection Flashcards

1
Q

Hematogenous Osteomyelitis in (adults/children) occurs in the Metaphysis because

A

Children; hairpin turns of metaphyseal blood vessels slow blood flow, allowing bacteria to grow

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2
Q

Hematogenous Osteomyelitis in (adults/children) occurs in vertebral bodies and joints

A

Adults (no physeal barrier)

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3
Q

In children, the growth plate (physis) will serve as a barrier to infection, but even before skeletal maturity, Acute Osteomyelitis CAN spread to which select joints

A

Ankle (distal Fibula)
Elbow (Radial neck)
Shoulder (proximal Humerus)
Hip (proximal Femur)

*note that ALL are sites of RAPIDLY growing physes

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4
Q

Clinical presentation of hematogenous osteomyelitis

A

Pain/tenderness
Fever
Elevated ESR and CRP

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5
Q

Radiographic findings of osteomyelitis

A
  1. periosteal elevation/luncency
  2. Usually at major joints
  • Takes 1-2 weeks to show changes on x-ray
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6
Q

What are the common causative organisms of osteomyelitis?

A
  1. Native joints: Staph aureus (gram +, catalase +, coagulase +)
  2. Implant joints: Staph epi (gram+, catalase +, coagulase -)
  3. Sickle cells: Salmonella (gram -)
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7
Q

Bacterial inoculation of rapidly growing joints (Hips and Knees) due to high blood supply, and thus increased possibility for bacterial seeding; Sternoclavicular joint can also be affected in IV drug users

A

Infectious (Septic) Arthritis

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8
Q

How is septic arthritis diagnosed?

A
  1. Exam findings: red, swollen, painful joint
  2. Joint aspiration
    - WBC >50,000
    - High PMN %
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9
Q

Tx for septic arthritis

A

surgical (irrigation & debridement; hip replacement)

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10
Q

What are the common causative organisms of septic arthritis?

A
  1. Staph aureus

2. Neisseria gonorrhoaea

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11
Q

What are the common causative organisms of prosthetic joint infection?

A
  1. staph. epidermidis (coag -)

2. P. acnes (only in shoulder replacement)

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12
Q

What algorithm can you use to evaluate aspirated synovial fluid in the setting of Joint Pain?

A

1) Blood? Yes (trauma, coagulopathy, tumor.) or No (next step)
2) If no, WBC >2K? Yes (inflammatory arthritis or septic arthritis (WBC >20K)) or No (trauma, osteoarthritis, AVN)
3) If yes to #2, test for crystals (rule out gout)

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13
Q

Pertinent Gram-negative ZOONOTIC rods for MSK infections

A

Brucella
Francisella
Pasteurella
Bartonella

“-ellas”

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14
Q

Pertinent Gram-positive ZOONOTIC rod for MSK infections

A

Bacillus anthracis

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15
Q

gram - zoonotic (cow, sheep, goat) rod transmitted through ingestion of contaminated milk (unpasteurized) or skin (butchering products)

A

Brucella

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16
Q

Brucella is facultative intracellular bacteria that survives within_____ and forms ______

A

macrophages; granulomas

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17
Q

What are the clinical and lab findings of brucella infection?

A
  1. Fever
  2. General Lymphadenopathy
  3. Splenomegaly
  4. Sacroiliac joint tenderness (lower back pain)
  5. Elevated WBCs, PMNs
  6. Elevated liver enzymes
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18
Q

gram - zoonotic (rabbit, deer) rod transmitted by ticks/flies or cutaneous exposure to animal tissue

A

Francisella tularensis

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19
Q

F. tularensis has a very low infectious dose and therefore can be a potential

A

bioterrorism agent

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20
Q

What are the clinical and lab findings of tularemia?

A
  1. Fever
  2. Non-healing ulcerated lesion
  3. Painful axillary lymphadenopathy
  4. Elevated WBCs, PMNs
  5. NORMAL liver enzymes
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21
Q

F. Tularensis grows within_____ and forms ______

A

macrophages; granulomas

22
Q

Zoonotic bacteria associated with Granuloma formation

A

Brucella

Francisella tularensis

23
Q

Treatment for Brucella and F. tularensis

A

Doxycycline, Streptomycin

24
Q

gram - zoonotic (dogs, cats) rod transmitted by dog or cat bites; associated with complications such as osteomyelitis, endocarditis, meningitis); commonly seen in immunocompromised/diabetic patients

A

Pasteurella multocida

25
Q

Zoonotic bacteria associated with bipolar staining (its core stains lighter than the edges) of capsule and no growth on MacConkey Agar

A

Pasteurella multocida

26
Q

gram - zoonotic (cats) rod transmitted by cat scratches/bites; low virulence so usually self-limited

A

Bartonella henslea

27
Q

Clinical findings of Bartonella infection

A
  • fever

- Lymphadenopathy along scratch

28
Q

Clinical finding for Bartonella in Immunocompromised hosts (AIDS)

A

Bacillary angiomatosis

29
Q

Gram-positive zoonotic rod; SPORE-FORMING; human infection acquired via cutaneous exposure, inhalation/ingestion

A

Bacillus anthracis

30
Q

What cutaneous disease is caused by Bacillus anthracis?

A

Pigmented eschar (scab) or necrotic lesion

31
Q

What inhalation disease is caused by Bacillus anthracis?

A

Wool-sorters’ disease (hemorrhagic mediastinitis, pleural effusions, septic shock)

32
Q

A SPIROCHETE bacteria that is transmitted by black-legged TICKS in spring/summer; causes lyme disease (borreliosis)

A

Borrelia burgdorferi

33
Q

Symptoms/clinical presentation of lyme borreliosis

A
  1. Fever, chills
  2. ERYTHEMA MIGRANS (Bulls-eye rash)
  3. Facial palsy
  4. arthritis/joint pain
  5. swollen knee
34
Q

How to diagnose Lyme Disease

A

ELISA

Western Blot

35
Q

Treatment for Lyme Disease

A

Doxycycline

Amoxicillin

36
Q

Which zoonotic bacteria are associated with ticks

A

Francisella tularensis

Borrelia burgdorferi

37
Q

+ssRNA enveloped viruses that cause Dengue infection; insect-borne (mosquitoes)

A

Flavivirus

38
Q

Severe fever illness with rash and “breakbone fever” (severe muscle/joint pain that feels like a broken bone); acute but self-limiting

A

Dengue Fever

39
Q

Progression of Dengue fever; causes hemorrhagic shock

A

Dengue Hemorrhagic Fever

40
Q

How does an infection of a DIFFERENT Dengue serotype result in a worsening of symptoms

A

Antibodies to the previous serotype DON’T neutralize the different serotype–> Activation of complement –> cytokine storm–> Shock and Hemorrhage

41
Q

Zika and yellow fever viruses are what type of viruses?

A

flaviviruses

42
Q

Coagulase-negative Staphylocci

A

S. epidermidis

S. saprophyticus

43
Q

Coagulase-positive Staphylocci

A

S. aureus

44
Q

S. aureus shows as ___________ on Mannitol Salt Agar

A

Gold/yellow

45
Q

Findings of normal synovial fluid

A
  1. Clear
  2. <200 PMNs
  3. glucose levels equal to that in blood
46
Q

Findings of synovial fluid during infection

A
  1. Cloudy
  2. > 20,000 PMNs
  3. 1/4 glucose level of blood
47
Q

Findings of normal synovial fluid in rheumatoid arthritis

A
  1. Opalescent (less cloudy)
  2. 200-20,000 PMNs
  3. 1/2 glucose level of blood
48
Q

Form of TB that occurs outside the lungs whereby disease is seen in the vertebrae, a kind of tuberculous arthritis of the intervertebral joints

A

Pott’s disease (aka. Spinal TB)

49
Q

Gram-negative rod in GI tract; Lactose negative and H2S producer; Typhoid and Non-Typhoid species; can seed in bone marrow of SICKLE CELL patients early in childhood

A

Salmonella

50
Q

IV drug use, catheters, open fractures, and sickle cell disease are risk factors of

A

Osteomyelitis

MSK (8 decks)

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