Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
37 Cards in this Set
- Front
- Back
|
____ % OF DIAbetics will have a foot ulcer in theri lifetime.
|
15%
|
|
|
Cause of ulcers?
|
cumulative loading
Trauma Loss of protective sensation PVD venous insufficiency infection |
|
|
colonization
|
presence of multiplying bacteria with no overt or host immunologic reaction
|
|
|
What kind of things impair hot response
|
hyperglycemia
ischemia neuropathy edema |
|
|
Why does OM destroy bone matrix
|
proeolytic enzymes
hypermia osteoclast |
|
|
What radionucleotide does the bone scan use
|
technetium
|
|
|
What is the most likely organism from a puncture wound
|
pseudomonas
|
|
|
If a patient is diabetic what is the most common organism in wound?
|
staph aureus
|
|
|
If a patient has sicke cell what is the most common organism in ulcer
|
salmonella
|
|
|
What should the ESR value be for ostoemyelitis
|
greater than 70 is OM
|
|
|
Aht is a normal CRP
|
below one
|
|
|
Is blood culture usually positive in chronic OM
|
no
|
|
|
If you resect all the osteomyeltic bone ow long should you keep antibiotics on
|
2-5 days
|
|
|
If there is some infection left after resection of infected bone how long should you keep patient on antibiotics
|
4-6 weeks
|
|
|
If you do no resection of osteomyelitc bone how long should you keep patient on antibiotics?
|
at LEAST 3 months
|
|
|
Clinical findings indicative of OM?
|
exposed bone
probe to bone ulcer that does not respond to treatment, greater than 2 cm sed rate > 70 mm/h CRP > 1 |
|
|
Possible signs and symptoms of OM
|
None, Pain, Tenderness, Fever, Nausea/vomiting
Erythema, swelling, sinus tract, drainage, limp, fluctuance |
|
|
What could happen if make innapropriate use of antimicrobials on a pt. with OM?
|
you could obscure signs and symptoms of OM?
|
|
|
Why is it important to obotain an OM diagnosis quickly
|
decrease incidence of chrinic osteomyelits
decrease bone destruction |
|
|
Between sequestrum and involucruma which is live bone which is dead bone
|
sequestrum is dead bone involucrum is live bone that forms around it
|
|
|
What do you see on a radiograph of OM?
|
soft tissue: swelling, obscured soft tissue planes, haziness,
osseous: hyperemia, demineralization, lyses, perosteal reaction, sclerosis (late stage), sequestrum/involucrum |
|
|
In celluslitis what phase do you see bone scan light up?
|
phase 1 and 2, but not 3 (or 4)
|
|
|
In OM what phase do you see the bone scan light up
|
phase 1, 2, and 3 (and 4)
|
|
|
What radionucleotide imaging is most specific for OM?
|
ceretec
|
|
|
What scan is best for diagnosing OM?
|
MRI
|
|
|
What do you see in T1 and T2 MRI's if pt. has OM?
|
T1 - decreased signal intensity of bone marrow
T2 - increased signal intensity |
|
|
How can you enhance MRI for looking at OM, when could you not use it?
|
Post gadolinium enhancement helps with identifying OM, don't use on pt. with renal disease.
|
|
|
What will you see on the path report for OM
|
histological: bone fragments/necrosis with associated infiltration by leukocytes and inflammatory cells
|
|
|
Antibiotic coverage of OM should always include____?
|
staph aureus coverage
|
|
|
Can you cure chronic OM with antibiotics
|
No, need resection of bone
|
|
|
Osteomyelitis surgical principles?
|
debride/reswect necrotic infected tissue and bone
obliterate dead space stabilization antimicrobial therapy (including antibiotic beads) soft tissue coverage restore effective blood supply |
|
|
What is the difference between PMMA be and calcium sulfate beads
|
PMMA produces heat so antibiotic can be unstable, you have to take them out eventually,
|
|
|
What antibiotics do you most often use on antibiotic beads?
|
gentamycin, tobramycin, vancomycin
|
|
|
Goals of surgical mangagement of OM?
|
1) healing soft tissue
2) reconstruct a foot that is funcitona nd plantigrade 3) preserve as muc hf the functional foot as possible |
|
|
Any one with an ABI of _____ or below is not a surgical candidate unless ____
|
Any one with an ABI of .6 or below is not a surgical candidate unless it's an emergency
|
|
|
Factors that predict failur of OM surgery
|
presence of edema
presence of atherosclerotic disease superimposed charcot OM/charcot of rearfoot hyperglycemia noncompliance |
|
|
What other disease can look similar to Charcot disease's pencil in a cup bone
|
psoriatic arthritis
|
