Disorders Of Trunk And Spine/msk Infections

Front 1

L4 responsibilities
(motor, reflex, dermatomal sensation)

Back 1

Motor: tibialis anterior
Reflex: knee jerk
Sensation: Medial aspect of calf/foot

Front 2

L5 responsibilities
(motor, reflex, dermatomal sensation)

Back 2

Motor: extensor hallicus longus
Reflex: none
Sensation: central forefoot

Front 3

S1 responsibilities
(motor, reflex, dermatomal sensation)

Back 3

Motor: peroneus longus and brevis
Reflex: ankle jerk
Sensation: lateral aspect of foot

Front 4

Signs/symptoms of cauda equina syndrome

Back 4

Urinary incontinence
Saddle anesthesia
Decreased anal sphincter tone
Bilateral lower extremity weakness
Progressive neurologic defects

Front 5

Define cauda equina syndrome

Back 5

A neurologic condition in which damage to the cauda equina causes acute loss of function of the lumbar plexus

Front 6

Anulus fibrosis and nucleus pulposus typically occur in which direction?

Back 6

Posterolaterally

Front 7

When ordering imaging studies of the back (s-rays) in which position should the patient be?

Back 7

Standing
AP and Lateral

Front 8

Define Osteoporosis

Back 8

Defined when there is abnormal bone remodeling and fragility

Front 9

Two types of osteoporosis

Back 9

Primary: postmenopausal or elderly people
Secondary: hormonal imbalance, malignancies, or GI problems

Front 10

Best diagnostic tool for osteoporosis

Back 10

Dexa scan

Front 11

Treatment for osteoporosis

Back 11

Prevention is key! (lifestyle and diet choices)
Meds: estrogen, calitonin, PT, bone building drugs such as "forted"

Front 12

Two types of Osteomyelitis

Back 12

Acute Hematogenous Osteomyelitis (kids MC)
Chronic Osteomyelitis (adults MC)

Front 13

Define Acute Hematogenous Osteomyelitis AHO

Back 13

Infection of the bone stemming from bacterimia. It is most often due to Staph aureus and is most commonly found in long bones of peds patients.

Patient may have recent Hx of puncture wound

Front 14

Which two bones does AHO effect most commonly

Back 14

Distal femur
Proximal tibia

Front 15

Which part of the long bone is most affected by AHO?
Epiphysis or metaphysis

Back 15

Metaphysis

Bacteria tend to lodge in an end artery in this area and multiply.

Front 16

Signs and symptoms of AHO

Back 16

Acute tenderness
Fever
Rapid pulse
Localized pain that may radiate to adj. joint
Decreased activity/ROM

Front 17

Lab/Diagnostic Findings in AHO

Back 17

Elevated WBC w/ Left shift, elevated ESR and CRP

Plain radiographs are often false negatives early on

Front 18

Treatment of AHO

Back 18

Emperical antibiotics (ciprofloxacin until culture returns with sensitivity of the bacterium)
Typically treated for 6 weeks

Drainage and debridment in serious cases

Front 19

Define Chronic Osteomyelitis

Back 19

Necrotic bone becomes walled off by a sheath or sac
Arises from acute but untreated AHO
The cavity contains pieces of dead bone, granulation tissue and bacteria

Front 20

What is a sequestrum

Back 20

Dead piece of walled off bone

Front 21

Treatment for Chronic Osteomyelitis

Back 21

Surgery
debridement and reconstruction #1
open drainage, sequestrectomy, amputation

Hyperbaric Oxygen following surgery for some canditates

Front 22

Define Septic Arthritis

Back 22

Inflammation of the joint due to bacteria
Hematogenous spread is the most common type

Front 23

Most common joint affected by septic arthritis

Back 23

Knee joint

Front 24

Most common bacterium causing septic arthritis

Back 24

Staph aureus

Front 25

Signs and symptoms of septic arthritis

Back 25

Swelling
Pain
Limited ROM in that joint
*typically only one joint*

Front 26

Best diagnostic tool for septic arthritis?
What does it look like?

Back 26

Arthrocentesis of joint fluid

Creamy-grayish color with turbidity
Less viscous, no stringing of the joint fluid
*(stringing is normal)*

Front 27

Is there more or less glucose in joint fluid when the joint goes septic?

Back 27

Much less!
<50% of what's in the blood

Front 28

Treatment of septic arthritis

Back 28

Rocephin shot in the buttock until culture comes back
ABX are usually given for 6 weeks (first by IV followed with PO)

Surgery: arthroscopic drainage and debridement

Front 29

Four main purposes for performing surgery in septic arthritis

Back 29

Decreases intraarticular pressure
Decreases bacterial count
Removes purulent discharge
Improves cartilage nutrition

Front 30

Define septic bursitis

Back 30

Inflammation or degeneration of a bursa due to infection

Front 31

Common causes for septic bursitis

Back 31

Direct puncture wound (superficial bursa)
Cellulitis spread (superficial bursa)
Hematogenous spread (deep bursa)

Front 32

Most common organism for septic bursitis

Back 32

Staph aureus

Front 33

Signs and symptoms of septic bursitis

Back 33

Pain
Swelling
WARMTH
TTP
Redness
Fever

Front 34

Treatment for septic bursitis

Back 34

Appropriate ABX with...
Adequate draining of infected bursal fluid

Dicloxacillin 500 mg QID
MRSA = clindamycin
**Bursal excision is a last resort**

Front 35

How does gangrene develop?

Back 35

Blood supply is cut off to the affected body part as a result of various processes such as infection, vascular disease, or trauma.

Front 36

Define dry gangrene

Back 36

Reduction of blood flow through the arteries (vasculitis)

Gradual and slow

Front 37

Define wet gangrene

Back 37

Develops as a complication of an untreated wound. Swelling due to infection stops blood flow and WBCs cannot reach the affected part of the body.

Front 38

Define gas gangrene

Back 38

Type of wet gangrene caused by Clostridia.
Produces a poisonous toxin and gas.

Front 39

Signs and symptoms of gangrene

Back 39

Area turns blue or black
Pain in a localizes area that is severe
Pus or blood draining from wound
Foul smelling odor discharges from wound

Front 40

Clinical presentation of of dry gangrene

Back 40

Dry and numb
Red to brown to black discoloration

Front 41

Clinical presentation of wet gangrene

Back 41

Swollen, decays, foul smelling, oozing, black
Extremely painful
Fever is present

Front 42

Clinical presentation of gas gangrene

Back 42

Swollen with red/brown bloody discharge
Crackling sensatin when the area is pressed
Extremely painful
Pt has fever, increased HR, rapid breathing
**can be life threatening**

Front 43

Treatment of gangrene

Back 43

IV antibiotic and surgery are primary treatments

Dry: anticoagulants, pain relief, amputation
Wet: ABX, Surgical debridement, amputation, IV fluids
Gas: hyperbaric oxygen chamber may be helpful