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Bone Path II > 5. MSK infection > Flashcards

5. MSK infection Flashcards

1
Q

What causes 90% of suppurative (pyogenic) osteomyelitis?

A

Staphylococcus aureus

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2
Q

What groups of people are at high risk of getting suppurative osteomyelitis?

A 
Immunosuppressive
Alcoholic
New horns
IV drug addicts
Diabetic
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3
Q

What is the MC pathway of infection for suppurative osteomyelitis?

A

Hematogenous

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4
Q

How does suppurative osteomyelitis present in younger patients vs adult patients?

A

Younger: fever, chills, pain, swelling, loss of limb fxn, ⬆️ ESR and WBC (shift left)

Adult: insidious, chronic, fever, malaise, edema, erythema, pain

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5
Q

Suppurative osteomyelitis is MC in which age group?

A

2-12 yo

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6
Q

What is mainliner syndrome?

A

IV drug user

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7
Q

What is the MC cause of mainliner’s syndrome?

A

Pseudomonas infection (NOT Staph. Aureus)

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8
Q

What location of the body does mainliner syndrome attack?

A

Axial skeleton “S” joints

  • Spine
  • SI joint
  • Symphysis pubis
  • Sternoclavicular
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9
Q

What are the 3 key radiographic features of osteomyelitis?

A

Seqeustrum
Involucrum
Cloaca

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10
Q

What is the Seqeustrum?

A

Island of dead bone

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11
Q

What is the involucrum?

A

Thick layer of periosteal new bone that forms around sequestering

From the Latin “involvere” meaning roll in, envelop.

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12
Q

What is the cloaca?

A

Opening in an involucrum that drains pus and debris out of infected bone.

There may be a sinus tract that opens to the skin surface.

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13
Q

What is Brodie abscess?

A

Intraosseous abscess AKA focal osteomyelitis

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14
Q

What Sx of Brodie abscess?

A

Local pain
Worse at night
Relieved by aspirin

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15
Q

What 2 conditions are relieved by aspirin?

A

Osteoid Osteoma and

Brodie Abscess

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16
Q

Common location for Brodie abscess?

A

Metaphyseal

  • Distal OR proximal tibia
  • Distal femur
  • Fibula
  • Distal radius
17
Q

What is septic arthritis?

A

A destructive, intra-articular infection with pain and decreased ROM that typically is monoarticular

18
Q

What are MC location sites of septic arthritis?

A

Knee

Hip

19
Q

What studies give you the earliest DX for septic arthritis

A

US
MRI
Aspirate (to identify specific pathogen)

(Radiographs not recommended d/t latent period)

20
Q

What is Waldenstrom sign?

A

Increased distance b/w Kohler teardrop to medial femoral head

21
Q

What is the typical Waldenstrom measurement?

A

Typical: unilateral <11m or <2mm diff L vs R

Waldenstrom measurement: distance b/w Kohler teardrop to medial femoral head

22
Q

What are 2 osseous and articular findings for septic arthritis?

A

1 - Marked and rapid* joint space loss

2 - Loss of subarticular cortical bone AKA bone is becoming extinct

*bc its rapid, you can r/o arthritis. If it was NOT rapid, then DDX arthritis

23
Q

What is spondylodiscitis?

A

An infection involving the disc and adjacent vertebral body that typically occurs in younger and older patients

24
Q

What is the MC location for spondylodiscitis? (Single level? Multiple levels?)

A

Lumbar spine

Single level 65% of the time
Multiple contiguous levels 20% of the time

25
Q

What is the MC presenting symptom for spondylodiscitis?

A

Back pain (fever is less common)

26
Q

What is the radiographic latent period for spondylodiscitis? (AKA how long will radiographs be normal for?)

A

2-4 weeks

27
Q

What is the best imaging for spondylodiscitis?

A

MRI

Bone scan

28
Q

What is the Tx for spondylodiscitis?

A

Surgical drainage and debridement (remove damaged tissue and foreign objects)

29
Q

What is the cause of non-suppurative infection / tuberculosis?

A

2˚ to hemotogenous spread from respiratory infection

30
Q

What is the MC location for TB?

A

Thoracic and lumbar

31
Q

What are the symptoms of skeletal tuberculosis?

A

Insidious onset
Pain is mild
Few remarkable systemic signs

Appendicular Sx: tenderness, swelling, joint effusion, increased skin temp

32
Q

What is the xray description of 20-60% skeletal TB?

A

“Pott’s Disease”

Begins at endplate, disc space loss is earliest sign, lytic destruction 2-5 months, paravertebral soft tissue mass

33
Q

Where does tubercular arthritis MC happen?

A

Hip and knee 75%

34
Q

Is tubercular arthritis mono or polyarticular?

A

Monoarticular

35
Q

What is phemister triad?

A

1- Progressive, slow joint space narrowing
2- Juxtaarticular osteoporosis
3- Peripheral erosive defects

36
Q

What does phemister triad suggest?

A

Tubercular arthritis

37
Q

At end stage of tubercular arthritis, what happens?

A

Fibrous ankylosis

Bone Path II (9 decks)

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