4 - Tuberculosis and bone

Question 1

3 classifications of tuberculosis of the bone and joint?

Answer 1

extra-articular (epiphyseal), intra-articular (large joints), vertebral body

Question 2

name 8 clinical features of TB?

Answer 2

insidious onset, swelling, loss of weight, contact with TB, malaise, pain (especially at night), pyrexia, ankylosis

Question 3

describe 3 stages of pathology of TB in bone?

Answer 3

1y complex - in lung/gut, 2y spread, tuberculous granuloma

Question 4

is spinal TB painful?

Answer 4

not very

Question 5

what is present with spinal TB?

Answer 5

abscess/ kyphosis

Question 6

name 5 aspects of diagnosing TB?

Answer 6

long history, involvement of single joint, marked thickening of synovium, marked muscle wasting, periarticular osteoporosis

Question 7

6 investigations?

Answer 7

FBC, ESR, mantoux test, sputum/urine culture, X-ray, joint aspiration & biopsy

Question 8

name 3 things you might see on an X-ray?

Answer 8

soft tissue swelling, periarticular osteopaenia, articular space narrowing

Question 9

5 differentials?

Answer 9

transient synovitis, monoarticular RA, haemorrhagic arthritis, pyogenic arthritis, tumour

Question 10

medical treatment?

Answer 10

rest and splintage -

rifampicin, isoniazid and ethambutol for 8 weeks… THEN rifampicin and isoniazid for 6-12 months