Orthopaedic Infections

Question 1

soft tissue infection of the proximal or lateral nail folds; the most common hand infection

Answer 1

paronychia

Question 2

what organism causes acute paronychia?

Answer 2

staph aureus

Question 3

what pathogen causes paronychia in diabetic patients?

Answer 3

candida albicans

Question 4

a patient presents with pain over the nail fold with erythema and swelling. Dx?

Answer 4

paronychia

Question 5

what will be seen on physical exam of an acute paronychia? (3)

Answer 5

fluctuance
nail plate discoloration
nail fold tenderness + erythema

Question 6

what pathogen should we think of when a patient’s physical exam shows green nail plates?

Answer 6

pseudomonas

Question 7

what is the no-op treatment for an acute paronychia? (2)

Answer 7

warm soaks
oral antibiotics: augmentin or clindamycin

Question 8

what is the operative treatment for an acute paronychia? (3)

Answer 8

I&D
partial/total nail bed removal
oral antibiotics: augmentin or clindamycin

Question 9

what is the non-op treatment for a chronic paronychia? (2)

Answer 9

warm soaks
topical antifungal: miconazole

Question 10

what is the op treatment for a chronic paronychia?

Answer 10

nail plate removal

Question 11

subcutaneous abscesses of the fingertip pulp

Answer 11

felon

Question 12

what is the common cause of a felon? organism?

Answer 12

trauma
staph aureus

Question 13

a patient presents with severe throbbing over tip of finger with erythema and pain +/- fluctuance. PE has tenderness over finger tip and localized swelling over distal phalanx. Dx?

Answer 13

felon

Question 14

when is an xray indicated for a felon? (2)

Answer 14

hx of trauma
r/o fracture or foreign body

Question 15

what is the treatment for a felon without an abscess? (2)

Answer 15

oral antibiotics
f/u within 2 days

Question 16

what is the treatment for a felon with an abscess? (3)

Answer 16

I&D
antibiotics
+/- hospital admission

Question 17

infection along the flexor tendon sheath, caused either by penetrating trauma over the volar side of the finger or spread from a felon, septic joint, or deep infection

Answer 17

pyogenic flexor tenosynovitis

Question 18

what are the 2 most common organisms that cause pyogenic flexor tenosynovitis?

Answer 18

staph aureus (#1)
MRSA (#2)

Question 19

a patient presents with pain and swelling over flexor side of finger. Dx?

Answer 19

pyogenic flexor tenosynovitis

Question 20

what are the 4 Kanavel’s signs for pyogenic flexor tenosynovitis?

Answer 20

pain with passive extension of finger
finger held in flexion for comfort
swelling of entire finger
TTP along flexor tendon sheath

Question 21

what is the treatment for a pyogenic flexor tenosynovitis?

Answer 21

I&D by ortho

Question 22

what is a diabetic wound infection that is a complication of peripheral neuropathy?

Answer 22

charcot neuro osteoarthropathy

Question 23

what is the most common cause of charcot neuro osteoarthropathy?

Answer 23

diabetes mellitus

Question 24

diabetic foot infections begin as soft tissue infections but can lead to what?

Answer 24

bone infections

Question 25

what is the most common cause of nontraumatic LE amputation?

Answer 25

diabetic wound infections

Question 26

what are the most common pathogens of diabetic wound infections? (3)

Answer 26

staph aureus MSSA/MRSA

Question 27

a patient presents with plantar wound ulcers, redness, warmth, induration, swelling, painless malodor, and purulence. Dx?

Answer 27

diabetic wound infection

Question 28

what is the gold standard to evaluate for wound healing potential of diabetic wound infections?

Answer 28

transcutaneous oxygen pressures

Question 29

a serum albumin level of > 3 in diabetic wound infections indicates what?

Answer 29

increased healing potential

Question 30

what imaging helps identify abscess formation or osteomyelitis from diabetic wound infections?

Answer 30

MRI

Question 31

what is the management for mild diabetic wound infections? (4)

Answer 31

outpatient oral antibiotics wound care pressure off-loading

Question 32

what is the management for moderate-severe diabetic wound infections? (3)

Answer 32

IV antibiotics wound care +/- surgical intervention

Question 33

what is the most common complication following orthopaedic trauma surgery?

Answer 33

post-op wound infection

Question 34

infection of the surgical site within 30 days, or 90 days if implant was used

Answer 34

post-op wound infection

Question 35

what is the most common post-op wound infection organism?

Answer 35

staph aureus (half of those are MRSA)

Question 36

a patient presents with cellulitis appearance on their leg, pain over surgical site, and erythema +/- drainage, +/- fever, chills, and night sweats. Dx?

Answer 36

post-op wound infection

Question 37

what on physical exam of a patient with a post-op wound infection requires an urgent surgery consult?

Answer 37

hardware exposure

Question 38

what is the most accurate diagnostic used for post-op wound infections?

Answer 38

deep cultures intra-operatively

Question 39

what is the most predictive lab for post-op wound infections?

Answer 39

CRP

Question 40

what should we do for all post-op wound infections?

Answer 40

refer to orthopaedic surgeon

Question 41

what is the non-op treatment for post-op wound infections? (2)

Answer 41

oral antibiotics wound care

Question 42

what is the operative treatment for post-op wound infections? (3)

Answer 42

surgical debridement oral antibiotics +/- wound care

Question 43

flesh-eating disease that is a life-threatening bacterial deep soft tissue infection that spreads along fascial planes rapidly

Answer 43

necrotizing fasciitis

Question 44

post-surgery patients with which 2 co-morbidities have an increased risk for necrotizing fasciitis?

Answer 44

peripheral vascular disease diabetes mellitus

Question 45

what are the 3 common bacterial causes of necrotizing fasciitis? (3)

Answer 45

strep pyogenes clostridium perfringens vibrio

Question 46

a patient presents with rapidly progressing erythema with tense edema, fever, tissue tenderness, and pain out of proportion to appearance of skin. Dx?

Answer 46

necrotizing fasciitis

Question 47

what are 3 clinical features of necrotizing fasciitis that occur in the later stages?

Answer 47

tachycardia hypotension AMS

Question 48

what is the scoring system used for necrotizing fasciitis?

Answer 48

Lrinec scoring system

Question 49

what is the treatment for necrotizing fasciitis? (3)

Answer 49

emergency radial debridement IV broad spectrum antibiotics +/- extremity amputation

Question 50

infection of the bone caused via bloodstream, cellulitis, or penetrating trauma

Answer 50

osteomyelitis

Question 51

what is the most common organism that causes osteomyelitis?

Answer 51

staph aureus

Question 52

what organism do sickle cell patients suffer from if they have osteomyelitis?

Answer 52

salmonella

Question 53

what organism do infants suffer from if they have osteomyelitis? (2)

Answer 53

group A and B strep

Question 54

what organism do DM patients suffer from if they have osteomyelitis?

Answer 54

pseudomonas

Question 55

what is the most sensitive lab for osteomyelitis?

Answer 55

CRP

Question 56

what imaging is best for diagnosing early osteomyelitis?

Answer 56

MRI - shows bone and soft tissue edema

Question 57

what should we do for any patient with osteomyelitis?

Answer 57

refer to ortho for treatment

Question 58

inflammation of the joint due to infection

Answer 58

septic joint infection

Question 59

where in the body does septic joint infection most commonly occur? (3)

Answer 59

shoulder hip knee

Question 60

what organism should we suspect to be the cause of septic joint infection in a healthy sexually active young adult?

Answer 60

neisseria gonorrhea

Question 61

what is the most common organism that causes septic joint infection in all patients?

Answer 61

staph aureus

Question 62

what is the most classic sign of septic joint infection?

Answer 62

inability to bear weight + pain with axial load

Question 63

what is the gold standard for diagnosis and treatment of a septic joint infection?

Answer 63

joint aspiration

Question 64

what lab level is diagnostic for septic arthritis?

Answer 64

WBC > 50,000

Question 65

what is septic joint infection considered?

Answer 65

orthopaedic emergency

Question 66

what is the treatment for septic joint infection? (2)

Answer 66

irrigation + debridement + intraoperative cultures empiric broad spectrum IV antibiotics

Question 67

what can delayed diagnosis of septic joint infection lead to?

Answer 67

cartilage damage within 8 hours