Term
| A 23 yo woman is diagnosed with osteomyelitis. She is an IV heroin user and has a past medical history that is significant for sickle cell anemia. While you are awaiting culture results, she needs to begin empiric antibiotic treatment. In addition to S aureus, what other organism is this patient at risk for? |
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Definition
IVDU makes her at risk for Pseudomonas
Sickle Cell increases risk for Salmonella |
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Term
| How does osteomyelitis present? |
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Definition
| pain with overlying erythema, edema, and tenderness. Pts also may have an overlying ulcer or skin interruption. Systemic symptoms include fevers, chills, and fatigue. |
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Term
| How do you diagnose osteomyelitis? |
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Definition
Blood cultures and radiograph of the area. If imaging (-), but high suspicion, order MRI or bone scan.
Consider ESR and CRP.
Bone biopsy is definitive. |
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Term
| How do you treat osteomyelitis? |
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Definition
unless patient is septic, delay antimicrobial therapy until micro specimen has been obtained through debridement.
Start with broad coverage antibiotics and treat for 4-6 weeks. |
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Term
| What are the most common organisms in osteomyelitis? |
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Definition
General: S aureus
Sickle cell: Salmonella
IVDU: Pseudomonas |
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Term
| What complications are there to osteomyelitis? |
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Definition
| amputation, sepsis, and death |
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Term
| What is septic arthritis? |
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Definition
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Term
| What are the risk factors for septic arthritis? |
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Definition
| Recent instrumentation of a joint, joint damage, gonococcal infection, and bacteremia. |
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Term
| How does septic arthritis present? |
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Definition
| Erythematous, warm, swollen, and painful joint wiht decreased range of motion. Gonococcal septic arthritis may present with multiple infected joints. Pts can have fever and chills. |
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Term
| What is the DDx for septic arthritis? |
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Definition
| Trauma, hemarthrosis, ostoarthritis, crystalline arthropathy, RA |
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Term
| How do you diagnose septic arthritis? |
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Definition
Arthrocentesis with gram stain, culture, cell count/diff, and crystal analysis.
Blood culture. |
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Term
| How do you treat septic arthritis? |
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Definition
Start broad coverage abx after specimen is obtained.
Surgical mgmt wiht washout and 4-6 weeks of directed antimicrobials is needed for mgmt. |
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Term
| What are the complications of septic arthritis? |
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Definition
| Joint destruction, sepsis, and death |
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Term
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Definition
| Inflammation and microperforations of the diverticula. |
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Term
| How does diverticulitis present? |
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Definition
| Fever, chills, nausea, vomiting, and abdominal pain, classically in the LLQ. Occasionally there may be a palpable mass in the LLQ. |
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Term
| How do you diagnose diverticulitis? |
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Definition
CT scan.
Get CBC and blood cultures.
DO NOT SCOPE patient. HIGH RISK FOR PERF! |
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Term
| What is the ddx for diverticulitis? |
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Definition
| UC, Crohn's, perforating colon cancer. |
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Term
| How do you treat diverticulitis? |
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Definition
| Bowel rest and antimicrobial coverage of G- and anaerobic organisms (cipro and metro). If diverticular abscess is present, manage surgically with a drain or resection. |
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Term
| What are the complications to diverticulitis? |
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Definition
| Abscess, obstruction, sepsis, death. |
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