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49 Cards in this Set
- Front
- Back
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Osteomyeltis is a consequence of...
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hematogeneous dissemination of bacteria
invasion from a contiguous source of infection skin breakdown in the setting of vascular insufficiency |
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What is osteomyelitis (hematogenous dissemination) associated with?
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Sickle Cell Anemia
Injection Drug Users Elderly |
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With IV drugs users, what is the most common pathogen for osteomyelitis?
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staph. aureas
- but also Pseudomonas and Serratia |
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With sickle cell anemia, what is the most common pathogen of osteomyelitis?
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Salmonellae
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Where is the most common location for IV drug users to get osteomyelitis?
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the spine
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Where do the elderly get osteomyelitis?
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thoracic and lumbar vertebral bodies
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What are the risk factors for the elderly for getting osteomyelitis?
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DM, IV catheters, indwelling urinary catheters
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Osteomyelitis in IV drugs users can progress to what?
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epidural abscess - fever, pain, sensory and motor loss
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Patients with hematogenetic dissemination of bacteria osteomyelitis will present with what?
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sudden onset of high fever, chills
pain and tenderness of involved bone |
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When osteomyelitis comes from an invasion from a contiguous source of infection, what are the most common sites?
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prosthetic joint replacement
decubitus ulcer neurosurgery trauma |
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What are the most common contiguous source pathogens of osteomyelitis?
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staph. aureus
strep. epidermidis |
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True or False: With osteomyelitis, plain films may be falsely negative early in the infection.
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True
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What are early findings of osteomyelitis on radiograph?
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soft tissue swelling
loss of tissue plains periarticular demineralization of bone |
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Two weeks after the onset of symptoms with osteomyelitis, what will you see on x-ray?
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erosion of bone and alteration of cancellous bone appear --> periostitis
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What is the most sensitive test for detecting osteomyelitis?
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MRI
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What is the advantage of using radionuclide bone scanning in osteomyelitis?
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it can detect multifocal sites of infection
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True or False: Ultrasound in osteomyelitis can detect effusions within joints and extra-articular soft tissue fluid collects and can also detect bone infections.
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False: It cannot detect bone infections.
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If blood cultures are positive (in osteomyelitis), do you do a bone biopsy?
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No
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True or False: Cultures from overlying ulcers, wounds, or fistulas are reliable in the diagnosis of osteomyelitis.
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False: they are unreliable
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What is the most common pathogen of hematogenous osteomyelitis?
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staph. aureus
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True or False: Most hematogenic osteomyelitis is a single organism.
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True
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A newborn with osteomyelitis probably is infected with what organism?
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group B streptococci or E. coli
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What is the most common pathogen for early childhood hematogenic osteomyelitis?
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group A streptococci
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True or False: Contiguous focus of infection (in osteomyelitis) is often from a single organism.
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False: aften polymicrobial with gram negative and anaerobic bacteria
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What are possible complications from osteomyelitis?
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Chronic infection
Anemia Markedly elevated ESR Weight loss Weakness Amyloidosis, nephrotic syndome May arise in persistently infected tissue - pseudoepitheliomatous hyperplasia - squamous cell carcinoma - fibrosarcoma |
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How do you treat osteomyelitis?
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debridement of necrotic tissue
prolonged administration of antibiotics |
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How long do you treat osteomyelitis with antibiotics?
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4-6 weeks
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If one has vertebral body osteomyelitis and epidural abscess, how do you treat it?
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urgent neurosurgical decompression
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What antibiotics do you use to treat osteomyelitis?
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oral quinolone for 6-8 weeks for chronic osteomyelitis with susceptible organisms
combined with rifampin when treating staph. aureus |
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When is a person's peak bone mass?
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age 30
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What is considered osteopenia?
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T-scores between -1 and -2.5
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What is considered osteoporosis?
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T scores at or below -2.5
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What is primary osteoporosis?
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occurs with age and sex steroid deficiency
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What is secondary osteoporosis?
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caused by diseases and/or medications
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What are risk factors for osteoporosis?
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Age
Exercise-related amenorrhea Early menopause Corticosteroid use Thin body habitus Sedentary lifestyle Inadequate calcium or Vit. D intake Family History White or Asian race High alcohol consumption Smoking Hyperthyroidism Chronic kidney or liver disease |
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What are secondary causes of osteoporosis?
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hyperparathyroidism
chronic renal failure multiple myeloma leukemia hyperthyroidism excessive thyroid replacement hypercortisolism metastatic cancer |
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What are predisposing drugs for osteoporosis?
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Corticosteroids
Thyroid hormone Anticonvulsants Heparin Excessive use of aluminum-containg antacids Furosemide |
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What are the guidelines for BMD testing?
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Women >65
Postmenopausal women with risk Men >70 Adults with fragility fracture Comorbidities asssociated with bone loss Considering treatment Monitor treatment |
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Who should be treated for osteoporosis?
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T-score -2.0, no risk factors
T-score -1.5, one or more risk factors Prior vertebral or hip fracture |
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What are some non-pharmacological management options for osteoporosis?
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Regular weight-bearing exercise
Fall prevention Avoid excessive caffeine, alcohol, carbonated drinks Avoid smoking Monitor/minimize thyroid hormone and corticosteroid use |
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How do you prevent osteoporosis?
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Vitamin D 200-600 IU/day
Exercise, weight bearing Calcium Raloxifene (Evista) Bisphosphonates |
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What is Raloxifene (Evista)?
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a selective estrogen receptor modulator
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When can't you use raloxifene (Evista)?
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with a history of bloodclots
with menopausal symptoms |
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How do you treat osteoporosis?
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Calcium
Vitamin D Raloxifene Bisphosphonates Calcitonin Porteo |
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True or False: Calcitonin is more potent than bisphosphonates.
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False
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When do you use Forteo?
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only for severe osteoporosis
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What is the blackbox warning on Forteo?
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blackbox warning for osteosarcoma
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True or False: Premenopausal use of OC's reduces postmenopausal vertebral and hip fracture risk by 25%.
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True
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What is the Black Box warning for Depo Provera?
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women may lose significant BMD
loss is greater with increasing duration and may not be completely reversible |
