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Infectious diseases > 21- Osteomyelitis > Flashcards

21- Osteomyelitis Flashcards

1
Q

osteomyelitis is classified based on

A
  • mechanism of infection (non/hematogenous)

- duration of illness (acute/chronic)

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2
Q

acute osteomyelitis

A

has symptoms duration of a few days or weeks and has no sequestra

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3
Q

sequestra

A

pieces of necrotic bone that separate from viable bone due to elevated medullary pressure due to bone marrow inflammation. These are seen on Xray

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4
Q

chronic osteomyelitis

A

a long standing infection over months or years, with sequestra
THE PRESENCE OF A SINUS TRACT IS PATHOGNOMONIC

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5
Q

non hematogenous osteomyelitis

A

occurs as a result of contiguous spread of infection to bone from adjacent soft tissues or joints
- or via direct inoculation of infection to the bone due to trauma or surgery

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6
Q

hematogenous osteomyelitis is
Occurs more in which age?
Is it mono or polymicrobial

A

is caused by microorganisms that seed the bone in the setting of bacteremia

  • occurs mostly in children
  • most common form in adults is vertebral osteomyelitis (males>50, drug users)
  • is usually monomicrobial (S aureus)
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7
Q

etiology of non hematogenous osteomyelitis

A

polymicrobial or mono.
S aureaus (and MRSA), coagulase - staphylococci, aerobic gram - bacilli
- less common: corynebacteria, fungi, mycobacteria

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8
Q

symptoms of acute osteomyelitis

A

gradual onset of symptoms over several days, dull pain at site with/out movement
- tenderness, warmth, erythema, swelling, fever, rigors

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9
Q

SX of chronic osteomyelitis

A

FEVER IS USUALLY ABSENT
- pain, erythema, swelling, draining sinus tract
intermittent flares of pain and swelling

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10
Q

dx of chronic osteomyelitis

A

deep extensive ulcers that fail to heal after several weeks (esp when lesions lie over bony prominences)
- non healing fractures

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11
Q

T/F osteomyelitis can be due to P aeruginosa

A

T, when it develops in the foot post nail puncture

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12
Q

initial assessment of suspected osteomyelitis should include

A
  • probing the bone with a sterile blunt metal tool
  • this test is pos if you have a hard gritty surface
  • this test isnt very reliable
  • the test is done in the setting of diabetes foot ulcers
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13
Q

T/F symptoms of hematogenous vs non hematogenous osteomylitis are indistnguishable

A

T

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14
Q

complications of osteomyelitis are

A 
sinus tract formation
contiguous soft tissue infection
abscess
septic arthritis
systemic infection
bony deformity
fracture
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15
Q

sx of non hematogenous osteomyelitis

A
  • new or worsening musculoskeletal pain
  • cellulitis
  • diabetic ulcers probe to bone
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16
Q

dx of osteomyelitis

A

culture from involved bone biopsy
clincial and radiological findings (for pts with >2 weeks symptoms use x ray, for <2 weeks symptoms use advanced imaging)

17
Q

T/F open biopsy is preferred to needle biopsy

A

T

18
Q

when do you need surgical debridment for osteomyelitis

A

decubitus ulcers, wounds with compromised vasculature

19
Q

ddx for osteomyelitis

A 
soft tissue infection
charcot arthropathy
osteonecrosis
gout
fracture
bursitis
bone tumor
sickle cell vaso occlusive pain crisis
synovitis
Complex regional pain syndrome
20
Q

screening for osteomyelitis is done by which test

A

probe bone test

Is positive if a hard gritty surface is felt

21
Q

RF for non hematogenous osteomyelitis

A

poorly healing tissue wounds, previous joint replacing surgery, peripheral vascular disease, peripheral neuropathy, diabetes

22
Q

RF for hematogenous osteomyelitis

A

endocarditis, indwelling devices, orthopedic devices, injection drug use, hemodialysis, sickle cell dx

23
Q

the pathogens found in hematogenous osteomyelitis in drug users are

A

P aeruginosa

Serratia marcescens

24
Q

What is a brodie abscess

A

is a region of suppuration and necrosis encapsulated by granulation tissue within a rim of sclerotic bone
Occur with subacte/chronic osteomyelitis in metaphysis of long bones in pts <25 y
Usually of hematogenous origin
Often with S aureus (pain lasting wks to mons with/out fever)
Most common site is distal tibia (then femus, fibula, radius ulna)
Shows as a single lesion near metaphysis radiographically

25
Q

If metal hardware is present, you cant put the pt in an MRI, how do you image for osteomyelitis

A

nuclear test imaging

26
Q

How to ID pathogen in osteomyelitis

A

bone biopsy, cultures from swabs or material from needle puncture should NOT BE USED

27
Q

T/F percutaneous bone biopsy should be done through intact bone

A

T

28
Q

T/F pts with osteomyelitis involving the hip, vertebrae, or pelvis tend to manifest few signs or symptoms other than pain

A

T

29
Q

T/F in the setting of chronic osteomyelitis, leukocytosis is uncommon, the ESR/CRP can be elevated or normal

A

T

30
Q

T/F long bone osteomyelitis can present as septic arthritis of the knee hip or shoulder

A

T
This occurs if infection within the metaphysis (most common site of infection in long bone osteomyelitis) breaks through the bone cortex leading to discharge of pus into the joint

31
Q

Emphysematous osteomyelitis def, etiology

A

rare, intraosseous gas in the extra axial skeleton (pelvis, sacrum, lower extremity bones vertebrae)
Usually with hematogenous spread with comorbidities
Can be mono or poly microbial
Etiology: Enterobacteriaceae, fusobacterium necrophorum

32
Q

is surgical debridement always needed for osteomyelitis

A

no, only if you have decubitus ulcers/wounds with compromised vasculature
In this case you can take bone sample at the same time as debridement

33
Q

Are sinus tract cultures a good idea

A

no, results often dont correlate with pathogen in bone

34
Q

histopathology of osteomyelitis shows

A

necrotic bone with resorption adjacent to an inflammatory exudate

Infectious diseases (36 decks)

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