Wounds / Soft tissue Injury/Joints/STD

Question 1

Most frequent pathogen isolated from plantar puncture wound osteomyelitis

Answer 1

Pseudomonas aeruginosa

particularly when puncture goes through an athletic shoe

Question 2

Recommendation for use of prophylactic antiobiotics in puncture wounds

Answer 2

1. high risk patients (diabetics, immunocompromised)
2. Forefoot injuries (deeper)
3. Puncture through athletic shoes

Question 3

Antibiotic choices for puncture wounds, when indicated

Answer 3

1. Cipro for athletic shoe punctures
2. Cefazolin, Cephalexin, Cefadroxil
3. Antistaph penicillins (oxacillin, dicloxacillin)
4. Azithromycin
5. MRSA - Bactrim or Clindamycin

Question 4

Indications for primary suture closure of animal bite wounds

Answer 4

1. Face or scalp
2. Simple, no devitalized tissue, single layer
3. No underlying fracture
4. Host not immunocompromised

Question 5

Pathogen most often causing sepsis etc in immunocompromised patients w animal bites

Answer 5

Capnocytophaga canimorsus

covered by Augmentin

Question 6

“High risk” animal bite wounds

Answer 6

1. Cat or human bites
2. Livestock bites
3. Monkey bites
4. Puncture wounds
5. HAND or foot wounds
6. Heavily contaminated, older, or devitalized wounds
7. Signs of infection at first evaluation
8. Diabetic or immunocompromised patients

Question 7

Catbite infection is often due to

Answer 7

Pasteurella multicida

covered by Augmentin

Question 8

Treatment / prophylaxis for high risk bite wounds

Answer 8

3-5 day course of:

1. Augmentin for most
2. Cipro for fish bites
3. Azithromycin for bartonella (cat scratch)

• *Penicillin allergic patients**
  1. Doxycycline or Cefuroxime (Ceftin) for CAT bites
  2. Clindamycin + Cipro for DOG bites

Question 9

“cat scratch fever” caused by and treated by

Answer 9

Bartonella henselae

Azithromycin

Question 10

Regional lymphadenopathy + mild constitutional sx developing 7-12 days after a cat bite or scratch

Answer 10

Cat scratch fever - bartonella henselae

Azithromycin

Question 11

Pathogens associated with human bites

Answer 11

Staph and strep
Eikenella corrodens

Prophylaxis with Augmentin

Question 12

Calcium pyrophosphate crystals,
yellow, rhomboid
positive birefringence

Answer 12

Pseudogout

Question 13

1st line tx acute gout

Answer 13

NSAIDs 5-7days
Indomethacin 50mg TID
or naproxen

or Colchicine 0.6mg/h

Question 14

1st line tx acute gout in renal impaired patienst

Answer 14

Prednisone

Narcotics

Question 15

most common causes of viral arthritis in US

Answer 15

Parvovirus B19
Rubella
Hepatitis B

Question 16

Traumatic hemarthrosis has a high association with

Answer 16

Ligamentous injury or an intra-articular fracture

Question 17

arthritis, urethritis, and conjunctivitis

Answer 17

Reactive arthritis

Question 18

most common STD

Answer 18

Chlamydia

Question 19

Chlamydia + Gonorrhea tx

Answer 19

Azithromycin, 1 G PO single dose (Chlamyd) +
Ceftriaxone 250mg IM single dose (Gonorr)
** OK for pregnant women **

OR
Doxy 100mg PO BID x 7 days

Question 20

Syphilis tx

Answer 20

Benzathine Penicillin G 2.4 million u IM single dose
OK for pregnant women

Doxycycline twice daily for 2 weeks may be used in penicillin-allergic patients

Question 21

Syphilis diagnosis

Answer 21

The VDRL and rapid plasma reagin tests are used as screening tests and also, once diagnosis is made, to assess disease activity and response to treatment.

Positive results must be confirmed with an immunoassay specific for T. pallidum antibodies.