1. Bone and Joint Infections Tutoring
Alaina Darby

2. JT is a 46 yo WM who presents with pain and swelling in his leg after injuring it last week. Which test would be most beneficial to determine if he has osteomyelitis?
Three Phase Bone Scan
Gallium-67
MRI
X-ray
A… potentially C

3. JT is a 46 yo WM who presents with pain and swelling in his leg after injuring it last week. What lab values would you most expect to find if it is osteomyelitis?
WBC 15,000 with right shift
ESR 15 mm/hr
CRP 40 mg/L
Temp 99 F B

4. JT is a 46 yo WM who presents with pain and swelling in his leg after injuring it last week. He can still walk on it. How would you classify him using Cierny Mader Staging? Bs Bl
Bls C D

5. JT is a 46 yo WM who presents with pain and swelling in his leg after injuring it last week. He can still walk on it. You find out that he was recently diagnosed with DM after noticing excessive urination and tingling in his fingers. How would you classify him now using Cierny Mader Staging? Bs Bl
Bls C C

6. Cierny Mader Factors Systemic Generally LARGE! Local Generally small
Nutrients
Organs
Decreased O2
Immune system (and comorbidities)
Age
Generally LARGE!
(Big Picture things)
Local
Lymph/vessels
Scarring/fibrosis
Nerves
Tobacco
Generally small

7. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. The doctor diagnoses him with osteomyelitis. The infection started in the skin and worked its way into the bone. Which of the following is the most likely cause for this patient?
Hematogenous osteomyelitis
Contiguous osteomyelitis with generalized vascular disease
Chronic osteomyelitis
Contiguous osteomyelitis without generalized vascular disease B

8. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. The doctor diagnoses him with osteomyelitis. The infection started in the skin and worked its way into the bone. The infection has not reached the medulla. What Stage of Cierny Mader would this be?
Stage 1
Stage 2
Stage 3
Stage 4 B

9. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. Which of the following would be the least likely pathogen in this patient?
S. aureus
Pseudomonas
S. epidermidis
S. pyrogenes D

10. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. Which of the following would be the best empiric treatment?
Cefazolin + Nafcillin
Cefepime + Nafcillin
Ceftriaxone + Nafcillin
Ceftazidime + Zosyn B

11. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. You give him Cefepime + Nafcillin. Considering his DM, what might you want to add?
Zosyn
Clindamycin
Ciprofloxacin
Tobramycin B

12. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. Cultures from his bone biopsy come back with S. pneumonia. What antibiotic should he receive?
PCN-G
Vancomycin
Ampicillin
Ceftriaxone A

13. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. Cultures from his bone biopsy come back with PCN-intermediate S. pneumonia. What antibiotic should he receive?
PCN-G
Vancomycin
Ampicillin
Ceftriaxone D

14. JT is a 46 yo WM with DM and DMPN who presents with pain and swelling in his leg after injuring it last week. Cultures from his bone biopsy come back with PCN-resistant S. pneumonia. What antibiotic should he receive?
PCN-G
Vancomycin
Ampicillin
Ceftriaxone B

15. Cultures from a bone biopsy come back with Enterococcus
Cultures from a bone biopsy come back with Enterococcus. What antibiotic would be least likely to work?
PCN-G
Vancomycin
Ampicillin
Ceftriaxone D

16. Cultures from a bone biopsy come back with S. aureus
Cultures from a bone biopsy come back with S. aureus. What antibiotic would be least likely to work?
PCN-G
Vancomycin
Nafcillin
Ceftriaxone A

17. Cultures from a bone biopsy come back with S. aureus
Cultures from a bone biopsy come back with S. aureus. It is determined to be MRSA. How should you treat?
PCN-G
Vancomycin
Nafcillin
Ceftriaxone B

18. Cultures from a bone biopsy come back with S. aureus
Cultures from a bone biopsy come back with S. aureus. It is determined to be MRSA. How should you treat if you wanted to keep them on the same medication when released as an outpatient?
Bactrim
Linezolid
Daptomycin
Vancomycin B

19. Cultures from a bone biopsy come back with S. aureus
Cultures from a bone biopsy come back with S. aureus. It is determined to be MRSA. How should you dose the Vanc for a 70 kg patient?
2.1g LD, 210mg Q12h MD
2.1g LD, 160mg Q12h MD
no LD, 100mg Q12h MD
no LD, 160mg Q12h MD C

20. Cultures from a bone biopsy come back with S. aureus
Cultures from a bone biopsy come back with S. aureus. It is determined to be MRSA. How should you dose the Vanc for a 70 kg patient?
2.1g LD, 2.1g Q12h MD
2.1g LD, 1.6g Q12h MD
no LD, 1g Q12h MD
no LD, 1.6g Q12h MD C

21. Cultures from a bone biopsy come back with Pseudomonas
Cultures from a bone biopsy come back with Pseudomonas. How should you treat?
Cefazolin + AMG
Ceftazidime + AMG
Ceftriaxone + AMG
Cefotetan + AMG B

22. LK is a 24 yo WF who presents with pain in multiple joints
LK is a 24 yo WF who presents with pain in multiple joints. What is the most likely pathogen?
Gonorrhea
S. aureus
E. coli
Fungal A

23. LK is a 24 yo WF who presents with pain in multiple joints
LK is a 24 yo WF who presents with pain in multiple joints. How should she be treated?
Ceftriaxone for 2-3 weeks
Ceftriaxone for 1 week
Cefazolin for 2-3 weeks
Cefazolin for 1 week B

24. Which of the following is most indicative of septic arthritis vs inflammatory arthritis in synovial fluid?
Drastically elevated WBCs
Low viscosity
Yellow color
Opaque fluid A

25. JF has RA and presents with joint pain
JF has RA and presents with joint pain. Labs reveal WBC of 55K and PMNs 80%. What is the most likely pathogen?
Gonorrhea
S. aureus
E. coli
Fungal B