Presby Manual - Infectious Disease

Front 1

what two questions should you ask yourself when establishing a tx plan for infection

Back 1

-is hospitalization required (oral vs IV antibiotics) and is surgical intervention required (OR I&D)

Front 2

when getting the NLDOCAT of an infected pt, what questions should you ask

Back 2

-any previous ulcer or infection, any recent antibiotic usage, trauma, last meal, check shoegear for foreign body, F/C/NS/N/V

Front 3

if a pt with an infection has a history of post -op surgery, what bacteria is responsible

Back 3

staph aureus

Front 4

if a pt with an infection has a history of IV line, what bacteria is responsible

Back 4

staph epidermidis

Front 5

if a pt with an infection has a history of implant, what bacteria is responsible

Back 5

staph epidermidis

Front 6

if a pt with an infection has a history of scratching, what bacteria is responsible

Back 6

tinea infection with secondary bacterial infection (gram neg)

Front 7

if a pt with an infection has a history of puncture wound, what bacteria is responsible

Back 7

-cellulitis can be caused by staph and strep, or osteo can be caused by pseudomonas

Front 8

if a pt with an infection has a history of IV drug use, what bacteria is responsible

Back 8

MRSA, MRSE, Pseudomonas

Front 9

if a pt with an infection has a history of water realted infection, what bacteria is responsible

Back 9

pseudomonas, aeromonas hydrophilia, vbrio vulnificans,mycobacterium marinum

Front 10

if a pt with an infection has a history of dog/cat bites, what bacteria is responsible

Back 10

pasteurella multicida

Front 11

if a pt with an infection has a history of human bites, what bacteria is responsible

Back 11

eikenella corrodens

Front 12

what part of your body regulates body temperature

Back 12

hypothalamic regulatory center

Front 13

what stimuli affect the hypothalamus to regulate temperature to cause a fever

Back 13

endogenous pyrogens secreted by leukocytes and Kupffer cells (also bacterial endotoxins, phagocytosis and certain immune rxns)

Front 14

what are kupffer cells

Back 14

-specialized macrophages in the liver

Front 15

During infection and fever endogenous pyrogen increases the set point of the body and temp is raised; what are 2 signs of increased set point

Back 15

chills and fever

Front 16

what should one suspect if a pts post-op temperature is 107

Back 16

anesthetic hyperthermia

Front 17

what should one suspect if a pts post-op temperature is 105

Back 17

blood transfusion rxns

Front 18

what should one suspect if a pts post-op temperature is 104

Back 18

closed abscesses

Front 19

what should one suspect if a pts post-op temperature is 103

Back 19

atelectasis/pneumonitis.drug rxns/liver disease

Front 20

what should one suspect if a pts post-op temperature is 102

Back 20

wound infection

Front 21

what should one suspect if a pts post-op temperature is 101

Back 21

draining abscess

Front 22

what should one suspect if a pts post-op temperature is 100

Back 22

benign post-op fever, post anesthesia overshoot

Front 23

what should one suspect if a pts post-op temperature is 98

Back 23

usual range of normal

Front 24

what should one suspect if a pts post-op temperature is 96

Back 24

post op hypothermia

Front 25

in times of infection, what vital signs will increase in value

Back 25

-temp, BP, pulse, respiratory rate, BG is diabetic

Front 26

what are 4 signs of septic patient

Back 26

elevated temp, hypotensive, tachycardic, tachypnic (rapid breathing)

Front 27

what is the difference between septicemia and bacteremia

Back 27

bactermia means there is bacteria in the blood and it can spread to distant foci; septicemia in addition to bacteremia has F/C and represents the failure of the body to localize infection

Front 28

if pulses are non-audible, check with a doppler; if they are still non-audible or weak...

Back 28

get n on-invasive arterial studies (PVR's)

Front 29

what ABI is inadequate for healing in DM

Back 29

ABI less then 0.45

Front 30

how many mmHg is needed to heal a digital wound (blood flow)

Back 30

at least 30 mmHg

Front 31

when assessing someone with an infection, what questions should you ask yourself during their Derm exam? (think of the 5 cardinal signs of inflammation)

Back 31

Dolor (most imp, even neuropathic pts will have pain), Rubor, Calor, Tumor, Functio Lasea {pain, red, heat, swelling, loos of fxn}

Front 32

why do you get rubor and calor at the sight of infection

Back 32

at the site of inflammation blood vessels dilate and there is increase blood flow to the area

Front 33

why do you get tumor (swelling) at an infection site

Back 33

there is extravasation of phagocytes and fluid into the perivascular space resulting in tumor (swelling)

Front 34

what is extravasation

Back 34

refers to the leakage of fluid (movt of WBC from the capillaries to the tissues surrounding them)

Front 35

why does a pt with an infection have dolor and loss of function

Back 35

the edema from extravasation causes stretching of the cutaneous nerve fibers causing pain, which then causes loss of fxn

Front 36

fact: always note the intensity of the signs of inflammation (dolr, calor, etc) and compare to the contralateral limb

Back 36

.

Front 37

what are the 5 characteristics you should use when evaluating and describing a wound

Back 37

location, size, base, depth, drainage, odor, margins of wound, surrounding tissue.(MS BOD LSD)

Front 38

when should size of a wound be measured (before or after debridement)

Back 38

after debridement

Front 39

what are the diff kinds of bases you can have in a wound

Back 39

granular, fibrotic, fatty, necrotic, mascerated

Front 40

what questions should you ask about depth

Back 40

does wound probe to bone or track up tendon sheaths or fascial planes, is bone or tendon exposed?

Front 41

wagner classification doesnt take presence of neuropathy or size of lesion into account; but what are its Grades based on

Back 41

depth

Front 42

Wagner Grade 0

Back 42

no open lesions may have keratosis or cellulitis

Front 43

Wagner Grade 1

Back 43

superficial ulcer, doest go beyond skin

Front 44

Wagner Grade 2

Back 44

beyond full thickness of skin, Ulcer extends to ligament, tendon, joint capsule or deep fascia without abscess/osteomyelitis

Front 45

Wagner Grade 3

Back 45

ulceration to bone, Deep ulcer with abscess, osteomyelitis or joint sepsis

Front 46

Wagner Grade 4

Back 46

wet or dry Gangrene localized to forefoot or heel (may or may not have cellultis)

Front 47

Wagner Grade 5

Back 47

extensive gangrene to portion of the foot or whole foot, foot salvage is not possible

Front 48

what types of drainage can you have in a wound

Back 48

-serous, serosanguinous, hemorrhagic, liquefactive, purulence

Front 49

what does a fruity wound odor suggest

Back 49

pseudomonas

Front 50

what does a foul odor indicate

Back 50

anerobes

Front 51

abnormal redness of the skin due to capillary congestion such as inflammation

Back 51

erythema

Front 52

acute spreading infection of the skin and CT

Back 52

cellulitis

Front 53

how do cellulitis and erythema differ

Back 53

cellulitis is more wide spread and its boundaries are NOT clearly demarcated

Front 54

what are the most common bacteria assoc with cellulitis

Back 54

staph aureus and Group A strept

Front 55

when checking the surrounding tissue of a wound, what words can you use

Back 55

erythema, cellulitis,edema, lymphadenopathy, lymphangitis

Front 56

as edema decreases, what happens to the skin lines

Back 56

you see an increase in skin lines

Front 57

what is lymphadenopathy

Back 57

As infection-fighting cells and fluid accumulate, the lymph nodes enlarge to many times their normal size. the lymph nodes may also be red and warm.

Front 58

if you suspect lymphadenopathy in a pt, where should you check for swollen lymph nodes

Back 58

in the groin and behind the knee

Front 59

lymphangitis

Back 59

blood poisoning, red streaks up the legs along the lymphatic channels from infection into the blood

Front 60

what is the #1 cause of lymphangitis

Back 60

Group A Strept

Front 61

what is the etiology and process of lymphangitis

Back 61

-infection is drained from teh body via lymphatics; lymph nodes can bc swollen during this process (lymphadenopathy) due to excess bacteria and inc pressure from edema; when nodes are overwhlemed, lymph drainage can be blocked and red streaks occur

Front 62

how can bacteremia lead to septicemia

Back 62

bacteria can seed the blood via the lymphatics which can lead to septicemia

Front 63

always get an x-ray with an infected pt so you have a baseline, what should you be looking for onthe x-ray

Back 63

soft tissue swelling, gas in soft tissues, foreign body, trauma, osteomyelitis

Front 64

when looking for osteo on an infected pts xray; what are you looking for

Back 64

periosteal reaction, lytic changes with sclerotic border, cortical breaking, osseous destruction, sequestrum, involucrum, cloaca, Brodie's abscess

Front 65

Periosteal reaction

Back 65

callus formation or formation of new bone in response to injury; white fuzziness out of line of the normal coritcal bone line

Front 66

lytic lesion with sclerotic border

Back 66

dark hole in the bone with a white sclerotic border (seen in osteo)

Front 67

sequestrum

Back 67

piece of dead bone that becomes seperated from healthy bone during necrosis (detached necrotic cortical bone)

Front 68

involucrum

Back 68

new layer of bone growth outside existing bone, results from the stripping of the periosteum by build up of pus in the bone and new bone growing from the periosteum

Front 69

cloaca

Back 69

space in which the dead bone resides

Front 70

brodie's abscess

Back 70

subacute osteomyelitis (common in tibia)

Front 71

what is the lag time for osteo to show on x-ray

Back 71

10-14 days

Front 72

Fact: Diagnosis is made by clinical exam, Radiographic studies are ONLY an adjunct!!

Back 72

.

Front 73

involucrum is a cloak of laminated /spiculated periosteal reaction; does this occur before or after sequestrum

Back 73

before

Front 74

what first line tests would you order for a pt with infection upon inital presentation

Back 74

CBC with diff, Chem Panel

Front 75

what is included in a Chem panel

Back 75

BUN, Creatine, Glucose, electrolytes (Na,K, Cl, CO2)

Front 76

what is included in a CBC with diff

Back 76

Hgb, Hct, platelet count, WBC count, differential looks at white blood cells into each type: neutrophils (also known as segs, PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophils, and basophils

Front 77

what second line tests should be performed after intial presentation of infection to monitor progress or rule out other sources of infection

Back 77

ESR/CRP, blood cultures, urinalysis, urine culture

Front 78

if a pt has an infection and they need to go to surgery what tests should be ordered

Back 78

PT, PTT, LFT's, CXR, EKG

Front 79

PTT

Back 79

partial thromboplastin time:how long it takes for the blood to clot

Front 80

PT

Back 80

Prothrombin time: time it takes for the liquid portion of your blood (plasma) to clot

Front 81

LFT

Back 81

liver fxn tests

Front 82

CXR

Back 82

chest xray

Front 83

what WBC count signifies infection

Back 83

higher then 10,000 (Leukocytosis)

Front 84

list the types of WBC

Back 84

Never Let Mom Eat Beans (neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils)

Front 85

what are 2 other names for neutrophils

Back 85

PMN (polymorphonuclear cells) or Band cells

Front 86

what is the diff between a PMN and a band cell

Back 86

-PMN is a mature neutrophil, band cell is an immature neutrophil

Front 87

inital killer cell

Back 87

neutrophil; contains lysozome and lactoferrin

Front 88

how long does a neutrophils fxn last

Back 88

-its half life is 6 hours but it lasts 1-2 days

Front 89

how long does it take for a PMN to mature

Back 89

14 days

Front 90

what do basophils contain

Back 90

heparin, histamine and other substances to contract smooth muscle and inc permeability of BV's

Front 91

when are eosinophils increased

Back 91

NAACP- neoplasms, allergies, addisons, collagen and vascular dz, parasites

Front 92

neutrophils is the 1st line of phagocytic response, what is the second

Back 92

monocyte (replaces the neutrophil with in 24 hours)

Front 93

what is a macrophage activated from during an inflammatory state

Back 93

macrophage

Front 94

what does a macrophage do

Back 94

-it is a agressive phagocytic, bacteriocidal, long lived cell that processes antigens and delivers them to lymphocytes for specific antibody prodcution

Front 95

WBC that posess cellular mediators for immunity (B cells/T cells)

Back 95

Lymphocytes

Front 96

cells produced from bonemarrow and produce specific antibody

Back 96

B cell

Front 97

cells produced from thymus and produce specific sensitized lymphocytes

Back 97

T cell

Front 98

when a pt has infection, why do you get Leukocytosis (inc WBC) w/ a shift to the left (inc band cells)

Back 98

the body tries to fight infection by inc WBC, specifically neutrophils. But the neutros dont have time to mature to PMN's before they are needed to "kill" the infection and band cells are produced

Front 99

what does BUN measure

Back 99

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down.

Front 100

when is BUN often performed

Back 100

to test kidney fxn (not as specific as Cr); measures hydration state

Front 101

best index of renal fxn

Back 101

creatine clearance; helps to determine proper antibitoic dosages

Front 102

what does a chem panel include

Back 102

BUN, creatine, Glucose, Electrolytes (Na, K, Cl, CO2)

Front 103

normal BUN

Back 103

7-20 mg/dL

Front 104

normal creatine

Back 104

038-1.4 mg/dL

Front 105

ESR

Back 105

-erythrocyte sed rate; measures the distance in mm a column of erythrocytes falls in 1 hour

Front 106

ESR is a non-specific test for..

Back 106

inflammation, infection, malignancy, renal disease, connective tissue disease and age

Front 107

used as a baseline to monitor effectiveness of tx, how often should it be taken

Back 107

5-7 days

Front 108

C reactive protein is similar to ESR but more difficult to perform and more expensive;

Back 108

CRP is produced by the liver and increases during inflammation

Front 109

if a pt has leukocytes and nitrates in the urine

Back 109

probably UTI

Front 110

what are good antibiotic choices to start before culture and sensitivity results

Back 110

Ancef/Flagyl or Bactrim/Flagyl or Unasyn

Front 111

I&D of infected wound

Back 111

dont use a touniquet (need to differentiate btwn healthy bleeding tissue and necrotic tissue), incise down to bone and do not seperate tissue planes) ..see pg 29

Front 112

what soft tissue cultures should you take of a infected wound you are I&D ing

Back 112

soft tissue swabs for gram stain, aerobic, anaerobic, fungal and acid fast

Front 113

what bone cultures should you take of an infected wound

Back 113

take bone pieces for bipsy and culture, also request sensitivites for all tissue and bone cultures

Front 114

when irrigating an infected wound:

Back 114

pulse lavage or 60 cc syringe wiht an 18 gauge blunt tip needle; use normal saline

Front 115

I&D wounds s hould be packed open, when can they be closed

Back 115

when all signs of infection are gone, usually 3-4 days after I&D

Front 116

why should you use a wet to dry dressing for daily wound care of an open wound

Back 116

it absorbs fluid exudates, faciliates debridement upon removal

Front 117

what solutions can be used for a wet to dry dressing

Back 117

saline, betadine, dilute betadine, Dakins, Acetic acid

Front 118

why use saline in dressing

Back 118

isotonic and drying

Front 119

why use betadine in a dressing

Back 119

drying, antimicrobial, but can be caustic to tissues (dilute betadine is less drying and caustic)

Front 120

what is Dakins and why use it in a dressing

Back 120

(.25% hypochlorate); it is antimicrobial and promoets granulation tissue

Front 121

when should you use acetic acid in a wound dressing

Back 121

antimicrobial and good for pseudomonas

Front 122

with respect to wound healing, should the limbs be elevated

Back 122

yes, this encourages venous and lymphatic drainage to reduce edema and improve local blood flow (DO Not elevate in pts with compromised circulation)

Front 123

when an I&D was performed on an infected wound with necrotic tissue, what type of wound closure should be employed

Back 123

Delayed Primary Closure; usually 3-4 days after intial I&D

Front 124

intentions of wound healing

Back 124

primary intention, in which all tissues, including the skin, are closed with suture material after completion of the operation; secondary intention, in which the wound is left open and closes naturally; and third intention, in which the wound is left open for a number of days and then closed if it is found to be clean.

Front 125

what are 3 classifications of osteomyelitis (Waldvogel)

Back 125

hematogenous, contiguous, vascualr impairment, chronic osteomyelitis

Front 126

hematogenous osteomyelitis

Back 126

usually staph aureus or strep in neonates

Front 127

contiguous osteomyelitis

Back 127

direct infection bone from exogenous source or spread of infection from a near by infected focus (prosthesis, implants, open fx)

Front 128

why do pts with vascular compromise get osteo

Back 128

-these pts have difficulty mounting an inflammatory response and have poor delivery of antibiotic to the site (vacularity needs to be addressed to insure healing)

Front 129

piece of necrotic tissue, usually bone that has become seperated from surrounding healthy tissue

Back 129

sequestrum

Front 130

the sheath of new bone that forms around a sequestrum

Back 130

involucrum

Front 131

a chronic abscess of boe surrounded by dense fibrous tissue and sclerotic bone

Back 131

brodie's absces

Front 132

acute osteomylelitis

Back 132

supperative infection with edema, vascular congestion and small vesssel thrombosis

Front 133

what causes the symptoms of acute osteomyelitis

Back 133

the acute inflammation causes an increase in osseous pressure and intravascualr thrombosis; the suppuration produces sub-periosteal abscess that may discharge into surrounding tissues

Front 134

chronic osteomyelitis

Back 134

infected dead bone or scar tissue, ischemic soft tissue envelope and a refractory clinical course (reoccurs despite surgical and antibotic intervention)

Front 135

Clerny-Mader classifies osteomyelitis based on anatomic and physiologic stage; what are the anatomic stages

Back 135

medullary, superficial, localized and diffuse

Front 136

Clerny-Mader classifies osteomyelitis based on anatomic and physiologic stage; what are the physiologic stages; these are the factors that may compromise their healing

Back 136

A: Normal Host
BS: Systemically compromised Host
BL: locally compromised host
C: tx is worse then the disease

Front 137

how much resorption is needed to detect osseous changes of osteomyelitis on x-ray; how long does this take

Back 137

30-50% resorption occurs in 10-14 days

Front 138

as far as radiographic signs of osteomyelitis go; list the 3 signs and the order in which they appear

Back 138

soft tissue swelling, periosteal rection (thickening or elevation), focal osteopenia

Front 139

how can osteomyelitis be diagnosed

Back 139

bone biopsy; hematogenous osteo can be dx by a positive blood culture and a positive bone scan

Front 140

what are the primary goals of I&D of infected wounds

Back 140

1. adequate drainage
2. thorough drainage
3. obliteration of dead space
4. antimicrobial coverage

Front 141

what are the 4 steps of surgical tx of infected wounds

Back 141

1. debridement of nonviable and marginally viable tissue
2. antibiotic PMMA impregnated beads
3. Ingress-Egress Systems
4. bypass surgery (vasc consult)

Front 142

what is PMMA

Back 142

PMMA is a clear plastic (Polymethylmethacrylate )impregnated beads

Front 143

what is ingress-egress system used in surgical wound tx

Back 143

Closed suction irrigation: closed system w/ continula flushing of the wound via inflow tubing (ingress) and outflow tubing (egress)

Front 144

what antibiotic is generally used with PMMA beads and why

Back 144

gentamycin; because it is NOT heat labile and the curing process of the PMMA is an exothermic process

Front 145

Gentamycin is a heat stabile antibiotic used with PMMA beads, what are some other antibiotics used

Back 145

Cephalasporins (Cefazolin,Moxalactam,Cefotaxime)
Tobramycin, Vancomycin, Ticarcillin

Front 146

how long should antibiotic impregnated beads be left in a wound

Back 146

2-4 weeks

Front 147

primary surgical tx of an infected wound includes debridement and irrigation, what does secondary surgical tx include

Back 147

reconstruction of bone and tissue with bone grafts/tissue grafts and deplayed primary closure

Front 148

after surgical tx of an infected wound, how long should the pt remain on antibiotics

Back 148

6-8 weeks

Front 149

how often should a post surgical infected wound pt be scheduled for follow up care

Back 149

For first 6 mths, every month.
6 mths-1 year, every 3 months.
1 yr-2 yr, every 5 months.

Front 150

what criteria should the antibiotic used for localized dose at specific target tissue sites

Back 150

water soluble, non-toxic to tissue, bactericidal, available in powder form, heat stable if used with PMMA

Front 151

Systemic antibiotic therapy alone does not usually eradicate bacteria because of poor penetration into bone; Local application of antibiotics can provide high drug concentrations at the site of infection and can avoid systemic effects; other then PMMA beads what else can be antibiotic carriers

Back 151

cancellous bone graft, demineralized bone matrix, Ca hydroxyapatite, plaster of paris

Front 152

how are PMMA antibiotic beads made

Back 152

-monomer(liquid) and polymer(powder) are mixed together with a powdered antibiotic. then small beads are formed and placed on a 26 or 28 gauge wire like a beaded necklace.

Front 153

where are PMMA antibiotic beads used normally

Back 153

they are implanted into a dead space, typically in an area of debrided osteomyelitic bone

Front 154

if you have a 40-60 gram pack of PMMA; how much cefazolin powder do you add

Back 154

4-8 grams

Front 155

if you have a 40-60 gram pack of PMMA; how much cefotaxime powder do you add

Back 155

4-8 grams

Front 156

if you have a 40-60 gram pack of PMMA; how much nafcillin powder do you add

Back 156

4-8 grams

Front 157

if you have a 40-60 gram pack of PMMA; how much Tobramycin powder do you add

Back 157

5-10 grams

Front 158

if you have a 40-60 gram pack of PMMA; how much vancomycin powder do you add

Back 158

4-8 grams

Front 159

if you have a 40-60 gram pack of PMMA; how much Ticarcillinpowder do you add

Back 159

6-13 grams

Front 160

if you have a 40-60 gram pack of PMMA; how much clindamycin powder do you add

Back 160

4-8 grams

Front 161

what is the general ratio of antibitoic powder to bead ratio suggested by Cierny

Back 161

1:5

Front 162

what is one major disadvantage of PMMA beads

Back 162

have to remove them after 10-14 days

Front 163

a multitude of bacteria, viruses, mycobacteria and fungi have been associated with this type of CURABLE arthritis

Back 163

Septic arthritis

Front 164

list the mechanisms of septic arthritis (how the pt gets it)

Back 164

1. direct joint invasion by the microbe
2. joints can be indirectly affected by immune response of the host (ex. Hep B and gonococal arthritis)
3. other unknown causes from enteric gram negatives like shigella and yersinia

Front 165

what are some predsposing factors for acute bacterial arthritis

Back 165

1.RA
2.crystal induced arthritis
3.osteoarthritis,charcot jts,hemarthroses(bleeding into jt spaces)
4.chronic systemic dz (SLE,sickle cell,cancer)

Front 166

Why are RA pts susceptible to acute bacterial arthritis

Back 166

damaged joint is a good nidus for infection

Front 167

most acute bacterial arthritis occurs from hematogenous dissemination from a primary source of infection, by also from...

Back 167

extension of an adjacent soft tissue infection or adjoining osteomyelitis

Front 168

there are three stages of cartilage destruction, what is the inital phase

Back 168

liberation of lysozomal enzymes from PMN's and synovial lining cells result in loss of proteoglycan from cartilage

Front 169

what is the 2nd stage of cartilage destruction of a joint

Back 169

increased mechanical stress and inadequate nutrition result in chondrocyte damage

Front 170

what is the final stage of cartialge destruction of a joint

Back 170

enzymes released from PMN's and synovial lining cells with the altered joint mechanics destroy the collagen network

Front 171

what are the clinical features of a septic arthritic joint

Back 171

1.red, hot, swollen and acutely painful; usually affects one joint
2. low grade fever
3. infectious focus involving any site (skin,nasopharynx,sinuses,lungs,cervix,rectum)

Front 172

what are the main three joints where acute bacterial arthritis is seen

Back 172

knee, hip, ankle (with knee the most common)

Front 173

what are the lab tests of a pt with acute bacterial arthritis

Back 173

leukocytosis, elevated ESR, synovial fluid white count >50,000 cells/cm and more then 90% PMN's

Front 174

what tests are obligatory when septic arthritis is suspected

Back 174

gram stain and synovial fluid culture

Front 175

gram negative cocci with high incidence in acute bacterial arthritis

Back 175

gram neg cocci (n. gonorrhea)

Front 176

Tx of acute bacterial arthritis

Back 176

1. antibiotics based on synovial gram stain
2. aspiration of joint daily
3. open surgical drainage if lack of response to ab therapy
4. immobilize and rest joint

Front 177

what is the most common form or cause of acute bacterial arthritis

Back 177

disseminated gonococcal arthritis to the joints from a prmary source

Front 178

most pts with disseminated gonococcal infections are <40 with promiscuity; where are the primary sites of infection

Back 178

the urethra in men, the cervix in women and the rectum and pharynx of both sexes

Front 179

what are the clinical symptoms of gonococcal arthritis pts

Back 179

fevers, chills, malaise, migratory arthritis, periarticular pain and swelling, tenosynovitis, skin lesions

Front 180

what is the appearance of the skin lesions in gonococcal arthritis

Back 180

small red macules that can dvlp into pustule lesions; characterized by a gray, necrotic center with a hemhorrhagic base

Front 181

how is gonococcal arthritis diagnosed

Back 181

by clinical symptoms and by primary source cultures, joint cultures and synovial fluid cultures

Front 182

how is gonococcal arthritis treated

Back 182

1. IV antibiotics (Ceftriaxone,Ceftizoxime,Cefotaxme) then PO antibiotics(Ceftin, Augmentin,Cipro)
2. joint aspiration
3. joint immobilization

Front 183

what is augmentin made of

Back 183

amoxicillin and clavulanate

Front 184

viral arthritis has non-specific symptoms and is relatively short lived and rarely causes joint damage; list 4 common causes of viral arthritis

Back 184

Hep B, Rubella, Parvovirus B19, HIV related arthropathy

Front 185

type of arthritis that is usually monoarticular and in the large weight bearing joints

Back 185

fingal arthritis

Front 186

Superficial fungi that can cause fungal arthritis

Back 186

Sporothrix schenckii, Candida albicans, Actinomyces israelii, maduromycoses

Front 187

deep fungi that can cause fungal arthritis

Back 187

aspergillus fumigatus, histoplasma capsulatum, cryptococcus neoformans, Coccidiodes, blastomyces

Front 188

what can cause mycobacterial bone and joint infections

Back 188

Extrapulmonary TB caused by dissemination of bacilli by hematagenous spread or lymphatic drainage from another area of TB

Front 189

what does synovial pathology of a pt with TB mycobacterial joint infections show

Back 189

chronic granulomatous reaction with giant Langerhan-type cell infiltration; acid fast stain of the synovium or surrounding tissue may reveal organisms

Front 190

what is the most imp reason to perform a synovial fluid analysis

Back 190

to rule out bacterial infection in a severely inflamed joint; to help differ btwn septic arthritis and crystal induced arthritis

Front 191

Arthrocentesis

Back 191

-removal of joint fluid that is therapeutic by relieving pressure and also diagnostic

Front 192

complications of arthrocentesis

Back 192

iatrogenic infectioon of a previously sterile joint, bleeding at puncture site and within the joint, possible injury to cartilage by needle, vasovagal episode during/after procedure

Front 193

what is the technique for an arthrocentesis

Back 193

1. move the joint through ROM to resuspend its contents
2. outline anatomic joint outlines
3.mark the area to be aspirated with the retracted end of a pen
4. cleanse skin and use local anesthetic
5. betadine scrub, then alcohol
6. use a gauge > 20
7. stretch the skin and aspirate slowly

Front 194

what happens to the viscosity of synovial fluid during inflammation

Back 194

its viscosity decreases and it can flow from the aspiration syringe like water

Front 195

what is the normal viscosity of synovial fluid like

Back 195

it stretches one inche before seperating

Front 196

what happens to the color and clarity of synovial fluid during inflammation

Back 196

clarity decreases (cant read newspaper through it),

Front 197

what does normal synovial fluid look like

Back 197

transparent straw or yellow color depending on the amt of albumin or bilirubin present

Front 198

microscopic analysis of synovial fluid can include wet mounts, crystal analysis and stains: what stains can be used

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gram stain, prussian blue stain, Ziel-Nielson stain, Congo red stain, Alizarin stain

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Polarizing light microscope is used to look at joint crystals in synovial fluid; what do monosodium urate crystals look like (Gout)

Back 199

needle shaped or long with blunt ends and display a negative befringence

Front 200

what is negative birefringence

Back 200

Negative birefringence – yellow when is parallel to the light, and blue when is perpendicular( 2 "l''s" in yellow and paralell)

Front 201

which joint crystals have a postive birefringence

Back 201

CPPD-Calcium Pyrophosphate Dihydrate Deposition Disease

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what is birefringence

Back 202

having two indices of refraciton

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pseudogout

Back 203

CPPD-Calcium Pyrophosphate Dihydrate Deposition Disease

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what are calcium oxalate crystals associated with

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renal failure

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what are crystals of protein associated with

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dysprotenemic states

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what are cholesterol crystals associated with

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chronic inflammatory disease

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Prussian blue stain is a stain for iron, when will iron show up in synovium

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pigmented villonodular synovitis or hemochromatosis

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hemochromatosis

Back 208

iron buildup

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what is Ziel Nielson stain useful for evaluating

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tuberculosis

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what is congo red stain useful for evaluating

Back 210

amyloid deposits show an apple-green birefringence on polarized light examination

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what is Alizarin Red S stain used for

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calcium stain for apatite crystals

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what is a mucin clot test

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several drops of synovial fluid are added to 20 mL of 5% acetic acid, allowing 1 minute for a clot to form

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when do you get a "good clot" from a mucin clot test

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firm mass that does not fragment on shaking (comes from a normal or osteoarthritis fluid)

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when do you get a "poor clot" from a mucin clot test

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easily forms flakes, shreds, cloudiness (comes from inflammatory fluids)

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a good mucin clot reflects the normal integrity of what compound

Back 215

hyaluronate

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synovial fluid glucose concentration is normally slightly less then that of blood glucose, what glucose level suggests joint infection

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a very low level of gluose in the synovial fluid

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what factors contribute to the increasing incidence and risk of TB

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supression of the immune system, dvlpment of drug resistant strains of mycobacterium, aging population, inc # of healthcare workers who are exposed

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what pre-exisitng disease has the leading risk for reactivation of laten TB infection

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HIV

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which organism is responsible for TB infections in the US

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Mycobacterium tuberculosis

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what is Pott's disease

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TB of the vertebra

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what are the steps of tx for TB

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1. pt is isolated
2. contact CDC and infection specialist
3. minimum of 3 antibiotics, one of which should be bactericidal
4. tx for 6-9 mths if only pulmonary involvement, tx for 12-18 mths if extrapulmonary TB

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what are some possible antibiotic choices for TB and their doses

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Isoniazid (3-5 mg/kg/day)
Pyridoxine (10 mg QD)
Rifampin (10mg/kg/day)
Pyrazinamide (20-25 mg/kg/day)
Ethambutol (15-25 mg/kg/day)
Streptomycin (15-20 mg/kg/day)

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a human retrovirus that infects lymphocyets and other cells bearing the CD4 surface marker

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HIV