SSTI (2) OM and AI

Question	Answer
------------- consists of flattened, cornified cells that are continuously renewed, resulting in shedding of the outermost layer of skin cells and associated skin bacteria.	The stratum corneum [aka Epidermis]
------------ consists of connective tissue and contains blood vessels, lymphatics, sensory nerve endings, sweat and sebaceous glands, and hair follicles. Subcutaneous fat consists of a loose connective tissue of fat cells.	dermis
Risk Factors for Skin and Soft Tissue Infection include	1. Damage to corneal layer (puncture, scrape, abrasion) 2. Excessive skin moisture (allows for organism growth, including Gram negatives) 3. Poor hygiene 4. Inadequate blood supply (peripheral vascular disease) 5. Underlying diseases (diabetes mellitus, obesity, malnutrition, immunosuppression, IV drug use
Non pharmacotherapy for SSTI	1. keep draining wounds covered with clean, dry bandages 2. to maintain good personal hygiene with regular bathing and hand cleansing with soap and water or an alcohol-based hand gel 3. avoid reusing or sharing personal items (razors, towels) that have contacted infected skin 4. thoroughly clean household surfaces, especially those that come into frequent contact with bare skin.
------------ is infection of the bone that results from spread through the bloodstream; this type is described classically as a disease of children because most cases occur in patients < 20 years of age; in adults, it presents as vertebral osteomyelitis.	Hematogenous OM
---------- is infection of the bone from an adjacent soft tissue infection or from direct inoculation (surgery, trauma, puncture wound); most cases occur in patients > 50 years of age	Contiguous OM
----------- occurs in patients with diabetes mellitus or peripheral vascular disease; these patients are usually > 50 years of age.	OM secondary to vascular insufficiency
Infectious arthritis is acquired by----------?	1. hematogenous spread (usually) 2. contiguous spread a. via adjacent soft tissue infection b. via direct contamination of joint space
State the 2 types of infectious arthritis and their etiologies.	1. gonococcal arthritis (caused by Neisseria gonorrhoeae) 2. nongonococcal arthritis (caused by S. aureus).
List RFs of OM	1. poor circulation 2. recent injury (such as a broken bone that breaks the skin or a deep puncture wound) 3. orthopedic surgery, or 4. IV drug use.
Describe the acute stage of osteomyelitis.	1. occurs < 6 wks 2. w/n 48 hrs bone necrosis occur 3. at the end of the first week numerous chronic inflammatory cells release IL 1, 6, 11 and TNF. 4. Also, increase ostoclastic bone resorption, ingrowth of fibrous tissue and the deposition of reactive bone in the periphery
Describe the chronic stage of osteomyelitis.	1. Occur > 6 wks 2. occurs in avascular and necrotic bone
common sites of infection of osteomyelitis in infants (<~18 months)	1. Metaphysis (phagocytes are less active here) 2. Epiphysis 3. Articular surface 4. capsular and tendoligamentous insertions 5. Cartilages
common sites of infection of osteomyelitis in infants (>~18 months)	1. the infection cannot spread to the joint because the hematogenous route is blocked by the epiphyseal/growth plate; hence, localization of microorganisms in the metaphysis is typical.
common sites of infection of osteomyelitis in adults	1. epiphyses 2. subchondral regions 3. infection of the articular surface or capsular and tendoligamentous joint insertions is uncommon in adults 4. medullary cavity
hematogenous (OM) etiology	1. S. aureus (most common) 2. S. epidermidis = patients w/ prostheses 3. P. aeruginosa = IV drug users or patients who step on a nail in wet grass (remember that Pseudomonas likes to grow in water).
contiguous (OM) and secondary to vascular insufficiency etiology	1. polymicrobia 2. S. aureus 3. S. epidermidis 4. P. aeruginosa 5. E. coli 6. anaerobes (B. fragilis)
Infectious Arthritis (IA) etiology	1. S. aureus 2. N. gonorrhoeae
Infectious Arthritis (IA) RFs	1. systemic corticosteroid use 2. pre-existing inflammatory arthritis 3. diabetes mellitus (DM) 4. prosthetic joint surgery 5. trauma 6. unprotected sexual intercourse 7. hormonal factors
OM signs and symptoms	1. tenderness of the affected area 2. pain 3. swelling 4 fever and chills 5. decreased range of motion 6. elevated erythrocyte sedimentation rate (ESR) 7. elevated C-reactive protein (CRP) 8. elevated WBC count.
the laboratory reference range of ESR is ---------?	1-15 mm/hr in males 1-20 mm/hr in females
4 diagnosis of lower extremity OM in patients with diabetes mellitus (DM) include -------	1. an ulcer area > 2 cm2 2. a positive probe-to-bone test 3. an ESR > 70 mm/hr 4. an abnormal x-ray
IA signs and symptoms	1. fever 2. a painful, swollen joint in the absence of trauma 3. Elevated ESR and WBC count 4. purulent fluid 5. a synovial fluid WBC count of > 50,000 cells/mm3 (especially with > 90% polymorphonuclear cells or PMNs), or 6. positive Gram’s stain confirms the presence of infection.
Gonococcal arthritis facts to know includes -----------?	1. usually affects women between the ages of 18 and 30 who are sexually active. 2. typically polyarticular (affecting multiple joints) 3. may be associated with a rash of small papules on the trunk or extremities 4. most commonly affected joints are the knee, hip, ankle, elbow, wrist, and shoulder [SHE-KAW]
Non-Gonococcal arthritis facts to know includes -----------?	1. involves a single joint 2. is not associated with a rash

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	Created by Sam Adeyiga about 4 years ago