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RB Y2 MSK 02 - Rheumatology > MSK Infections > Flashcards

MSK Infections Flashcards

(71 cards)

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1
Q

gram positive penicillin allergic

A

vancomycin

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2
Q

staph epididermis treatment

A

vancomycin

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3
Q

h influenzae treatment

A

ceftriaxone

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4
Q

anaerobes treatment

A

metronidazole

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5
Q

anaerobes example

A

clostridium and bacteriocides

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6
Q

gram negative treatment

A

gentamicin

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7
Q

gram negative examples

A

bordatella, h influenza, coliforms, h pylori, campylobacter

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8
Q

adult osteomyelitis

A

inflammation of the bone and medullary cavity, usually located in one of the long bones

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9
Q

how can adult osteomyelitis be classified

A

acute/chronic conitguous/haematogenous host status eg presence of vascular insufficiency

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10
Q

what forms of adult osteomyelitis can progress to chronic

A

ALL

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11
Q

how long must the antibiotic course for adult osteomyelitis be

A

minimum 6 weeks as can recur after treatment

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12
Q

clinical approach to infection

A

clinical suspicion - history is key examination confirmation treatment

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13
Q

how can infection be confirmed

A

indirect - CT scan and MRI (best) direct - bone biopsy gold standard, also surgical sample, histology wound swabs and blood cultures are not very useful except in septic patients

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14
Q

what is the gold standard direct investigation for infection

A

bone biopsy

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15
Q

what is the best indirect investigation for infection

A

MRI

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16
Q

predispoing conditions

A
  • Sickle cell anaemia
  • IV drug user
  • DM
  • Immunosuppression
  • alcohol excess
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17
Q

open fractures

A

early management is key - debridement, fixation and soft tissue cover the clinical clue is non union and poor wound healing

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18
Q

infection of open fractures

A

3-25% get infected - tends to be S aureus and aerobic gram negative bacteria

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19
Q

name 2 aerobic gram negative bacterias

A

pseudomonas and legionella

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20
Q

diabetes/vascular insufficiency

A

are often polymicrobial and the diagnosis can be challenging are difficult to clear once infection is established

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21
Q

CF of diabetes/vascular insufficiency

A

Microneurovascular dysfunction with loss of nociceptive reflex and inflammatory response - diminished sensation in feet - ischaemic toes - pressure ulcers - diabetic foot ulcer

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22
Q

treatment of diabetic foot ulcers

A

debridement and antimicrobials

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23
Q

what is the likely bacteria in mild to moderate diabetic foot ulcer

A

s aureus - flucloxacillin

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24
Q

who is haematogenous osteomyelitis seen in

A

prepubertal children, PWID,, central lines/dialysis/elderly

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25
haematogenous osteomyelitis - PWID
can be contiguous, haematolgoical or direct inoculation. often seen at unusual sites
26
haematogenous osteomyelitis - PWID organisms
staph and strep and often unusual pathogens
27
dialysis patients with haematogenous osteomyelitis
high staphlocccal colonisation rates there are often co morbidities present
28
osteitis pubis
inflammation of the pubic symphysis. well known complication of invasive procedure about pelvis, may also occur as an inflammatory procedure in athletes
29
clavicle osteomyelitis
v unusual, risk factors are neck surgery or subclavian vein catheterisation
30
typical causative organism of sickle cell osteomyelitis
12% of people with sickle cell disease get it salmonella
31
gaucher's disease
lysosomal storage disease that may mimic bone crisis and often affects the tibia
32
bone crisis
severe bone pain as a result of infarction
33
pathogens in gaucher's disease
if it is bone crisis - sterile if infected - s aureus
34
SAPHO and CRMO
SAPHO in adults, CRMO in kids causes general constitutional symptoms and multifocal osteitis. there is a genetic role
35
how does vertebral osteomyelitis occur
mostly haematogenous, but can be associated with local spread from epidural or psoas abscess
36
how does one confirm vertebral osteomyelitis
MRI
37
CF of vertebral osteomyelitis
fever and inc WCC and inflammatory markers insidious pain and tenderness neurological symptoms and signs
38
clinical approach to infection: treatment
debridement antimicrobials - AFTER microbial diagnosis unless there s acute presentation or sepsis
39
treatment of vertebral osteomyelitis
large abscesses need to be drained 6 week minimum antimicrobials
40
when to repeat MRI in vertebral osteomyelitis
increasing pain, inc in inflammatory markers or new signs/symptoms
41
skeletal TB
pott's disease - often no systemic symptoms - some have skin and soft tissue infection - less than half have pulmonary TB
42
treatment of pott's disease
check reduced receptors in kids for IFN gamma etc offer HIV test in adults
43
what are the risk factors for infection in prosthetic joints
rheumatoid arthritis (IS drugs?), diabetes, malnutrition and obesity
44
why are prosthetic joints difficult to treat
a biofilm (layer of bugs lying on top of joint) forms and antibiotics struggle to penetrate it
45
how do bugs get into joints
during surgery (can take a month to present) or through blood stream
46
when is s epididmeris colonisation considered serious
only when multiple showings of it - normal commensal of skin
47
planktonic bacteria
free in the blood - causes bacteraemia
48
sessile bacteria
sits on joint/metal/plastic and forms a biofilm a phenotypic transformation of planktonic bacteria
49
diagnosis of prosthetic joint infection
is difficult as it is caused by organisms that are common contaminants culture of tissue is taken
50
treatment of prosthetic joints
epididmeris- vancomycin ideally the prosthetic joint is removed, in some elderly people it is just derided but this has a poor prognosis
51
septic arthritis
inflammation of the joint space caused by infection
52
when should septic arthritis be considered
in any acutely inflamed joint as it can destroy a joint in under 24 hours
53
where does septic arthritis commonly affect
knee - 50% cases
54
how does the joint become infected in septic arthritis
blood borne, direct inoculation, or extension of local infection
55
what severe thing is occasionally seen in septic arthritis
PVL producing S aureus - increases virulence
56
cause of septic arthritis in prosthetic joints
coagulase negative staphylococci eg staph epidermidis
57
cause of septic arthritis in sexually active ppl
Neissera gonorrhoea (aerobic gram negative diplococci)
58
cause of septic arthritis in pre school children
H influenzae - less common now due to vaccination
59
key investigation for septic arthritis
joint aspiration for synovial fluid microscopy and culture
60
what must be excluded in septic arthritis
gout - can present in same way
61
\<5 with septic arthritis treatment
Ceftriaxone (h infuenzae)
62
pyomyositis
bacterial infection of the skeletal muscles that result in a pus filled abscess
63
cause of pyomyositis
90% staphylococcal
64
what is often the cause of pyomyositis in contaminated wounds
clostridial infection
65
myositis
canbe viral, protozoic or fungal
66
what is tetanus caused by
clostridium tetani - gram postiive anaerobic rods forms spores
67
clinical features of tetanus
exotoxin causes muscle spasms and rigidity spasms can be induced by bright lights and loud noises
68
classical description of tetanus
locked jaw
69
incubation period for tetanus
4 days to several weeks
70
tetanus treatment
surgical debridement antitoxin supportive measure antibiotics not that useful as due to toxin
71
what do tetanus survivors need
booster vaccine - not immune

RB Y2 MSK 02 - Rheumatology (33 decks)

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