PANCE Blueprint Musculoskeletal (8%)

Infectious Diseases (PEARLS)

The NCCPA™ Musculoskeletal Content Blueprint infectious diseases (PEARLS) 

Acute and chronic osteomyelitis (ReelDx) Osteomyelitis is INFECTION OF BONE by pyogenic organisms

Acute osteomyelitis is most commonly seen in children with S. aureus as the most common organism

  • Sickle cell disease - Salmonella is pathognomonic

Chronic osteomyelitis is most common in adults secondary to open injury of bone and surrounding soft tissue

  • S. aureus is the most common organism (80%)
  • Staph epidermidis in prosthetic joints
  • Gram-negative pseudomonas in IVDU


  • acute hematogenous spread most common in general - especially children
  • direct inoculation from infection close to bone - trauma, surgery, prosthetic joint
  • contiguous spread with vascular insufficiency

Diagnose with BONE ASPIRATION Gold Standard

Treatment: IV antibiotics for 4-6 weeks and at least 2 weeks of IV antibiotics

  • Newborn (<4 months) - Group B Strep - nafcillin or oxacillin + 3rd gen cephalosporin
  • > 4 months S. aureus - MSSA - Nafcillin + Ancef MRSA - Vancomycin or Linezolid
  • Sickle cell - Salmonella - 3rd gen cephalosporin or FQ (Cipr)
  • Puncture wound - Pseudomonas - Cipro or levofloxacin
Septic arthritis (ReelDx) Infection of JOINT CAVITY - most dangerous form of acute arthritis MEDICAL EMERGENCY

S. aureus is most common (40-50%) N. gonorrhea in sexually active young adults, streptococci

Diagnose with ARTHROCENTESIS WBC > 50,000

Treatment is based on gram stain- 2-4 week course of antibiotics - Arthrotomy with joint drainage

  • Gram (+) cocci - Nafcillin (Vanco if MRSA) - Vanco or Clindamycin if PCN allergic
  • Gram (-) cocci - Ceftriaxone
  • Gram (-) rods - Ceftriaxone
Osteoarthritis (Lecture) (Prev Lesson)
(Next Lesson) Osteomyelitis (ReelDx)
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