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MSK > 2 - Acute osteomyelitis > Flashcards

2 - Acute osteomyelitis Flashcards

1
Q

bone infection?

A

osteomyelitis

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2
Q

joint infection?

A

septic arthritis

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3
Q

what type of osteomyelitis is more common?

A

non-specific

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4
Q

give 4 RFs for acute osteomyelitis?

A

children, M, history of minor trauma, other disease (e.g. diabetes)

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5
Q

3 general sources of infection in acute osteomyelitis?

A

haematogenous spread (children and elderly), local spread from trauma, 2y to vascular insufficiency

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6
Q

main route of infection for acute osteomyelitis in infants?

A

infected umbilical cord

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7
Q

3 main routes of infection for acute osteomyelitis in children?

A

boils, tonsilitis, skin abrasions

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8
Q

2 main routes of infection for acute osteomyelitis in adults?

A

UTI, arterial line

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9
Q

3 organisms causing acute osteomyelitis in infants <1 yr?

A

staph aureus, group B streptococci, E. coli

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10
Q

3 organisms causing acute osteomyelitis in older children?

A

staph aureus, strep pyogenes, haemophilus influenzae

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11
Q

main causative organism of acute osteomyelitis in adults?

A

staph aureus

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12
Q

main causative organism of acute osteomyelitis in adults with diabetic foot/ pressure sores?

A

mixed infection including anaerobes

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13
Q

main causative organism of acute osteomyelitis in adults with sickle cell disease?

A

salmonella spp

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14
Q

main causative organism of acute osteomyelitis in fishermen?

A

mycobacterium marinum

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15
Q

main causative organism of acute osteomyelitis in adults with HIV AIDS/ debilitating illness?

A

candida

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16
Q

pathology of acute osteomyelitis - 3 locations of metaphysis in long bones?

A

distal femur, proximal tibia, proximal humerus

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17
Q

pathology of acute osteomyelitis - 2 locations of metaphysis in joints?

A

hip, elbow

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18
Q

first 3 stages of pathology of acute osteomyelitis?

A

metaphysis trauma, vascular stasis, acute inflammation

19
Q

4 later stages of pathology of acute osteomyelitis which leads to recovery?

A

release of pressure, necrosis of bone, new bone formation, resolution

20
Q

what happens if acute osteomyelitis is not resolved?

A

chronic osteomyelitis

21
Q

4 clinical features in infant?

A

minimal signs - failure to thrive, drowsy/irritable, swelling (usually at knee), positional change

22
Q

4 clinical features in child?

A

severe pain, reluctant to move, tender fever, tachycardia

23
Q

4 clinical features of 1y acute OM in adult?

A

thoracolumbar spine, backache, UTI history, diabetic (immunocompromised)

24
Q

when is 2y acute OM seen?

A

after open fracture, surgery (ORIF)

25
Q

diagnosis of acute OM?

A

3 blood cultures - @ peak temperature 60% +ve

26
Q

other tests to diagnose acute OM?

A

FBC & WBC (neutrophil leucocytosis), ESR, CRP, U&Es

27
Q

4 common differentials for acute OM?

A

acute septic arthritis, acute inflammatory arthritis,

trauma, transient synovitis

28
Q

4 rare differentials for acute OM?

A

sickle cell crisis, Gaucher’s disease, rheumatic fever, haemophilia

29
Q

4 soft tissue infection differentials for acute OM?

A

cellulitis, erysipelas, necrotising fasciitis, gas gangrene

30
Q

3 imaging tests for acute OM?

A

X-ray - normal in the first 10-14 days, US, isotope Bone scan

31
Q

what is used in the isotope bone scan?

A

Tc-99, Gallium-67

32
Q

when do periosteal changes occur on radiographs?

A

10-20 days

33
Q

what changes occur at the lytic areas?

A

medullary changes

34
Q

late osteonecrosis?

A

sequestrum

35
Q

late periosteal new bone?

A

involucrum

36
Q

3 microbiological diagnosis?

A

blood cultures, bone biopsy, tissue from up to 5 sites around implant

37
Q

treatment for acute OM?

A

supportive treatment, rest & splintage, antibiotics, surgery

38
Q

supportive treatment?

A

analgesia, IV fluids, etc.

39
Q

route of antibiotics?

A

IV/ oral

40
Q

duration of antibiotics?

A

4-6 weeks

41
Q

type of antibiotics?

A

empirical - fluclox and benzylpen

42
Q

3 reasons antibiotics fail to work?

A

drug resistance, poor tissue penetration, poor drug absorption

43
Q

name 4 complications of acute OM?

A

septicemia, metastatic infection, septic arthritis, altered bone growth

MSK (26 decks)

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