B6-078 Osteomyelitis

Question 1

what population is more prone to developing long bone osteomyelitis?

Answer 1

children

**blood slows down around growth plates, allowing bacteria to settle in

Question 2

why does he say that acute vs chronic is not really important?

Answer 2

generally needs to be removed regardless

Question 3

stop […] 3-4 weeks prior to bone biopsy if possible

Answer 3

antibiotics

Question 4

why is bone biopsy preferred over culturing the sinus tract?

Answer 4

may not reflect what is going on at the bone

Question 5

loss of […] of bone mineralization is required to see changes on Xray

Answer 5

30-50%

**negative film does not rule out

Question 6

what is the issue with bone scan?

Answer 6

highly sensitive but not specific

Question 7

best imaging test for osteomyelitis

Answer 7

MRI

sensitive and specific

Question 8

what will infected marrow look like on MRI?

Answer 8

low intensity T1
high intensity T2

Question 9

does a negative WBC scan rule out osteomyelitis?

Answer 9

no

Question 10

treatment of Stage 1 in children

Answer 10

4 wks antibiotics

Question 11

stage 1 means

Answer 11

hematogenesis, confined to bone marrow

Question 12

the bacteria form a […], making treatment difficult

Answer 12

biofilm

Question 13

bacteria in a biofilm were found to have upregulated resistance to [2]

Answer 13

phagocytosis
antibiotics

Question 14

highly bioavailable antibiotics in bone [4]

Answer 14

TMP/SMX
linezolid
fluoroquinolone
clindamycin

Question 15

vertebral osteomyelitis is caused by

Answer 15

hematogenous seeding due to slow blood flow at disk

**usually S.Aureus

Question 16

most common places for vertebral osteomyelitis [2]

Answer 16

lumbar
thoracic

Question 17

focuses on the anterior aspect of the vertebral body

Answer 17

tuberculosis vertebral osteomyelitis

Question 18

what causes the degradation of the bone matrix in osteomyelitis?

Answer 18

granular enzymes released by PMNs

Question 19

secreted by PMNs and known to cause osteoclastic bone degradation [2]

Answer 19

IL 1
E2

Question 20

if surgery to remove infected hardware is not an option, what is the next best course of action?

Answer 20

IV antibiotics for 4-6 weeks followed by indefinite oral antibiotics

Question 21

things that would cause increased uptake of tracer on bone scan [3]

Answer 21

infection
neoplasm
trauma

**sensitive, but not specific for OM

Question 22

in a patient with peripheral vascular disease, […] should be done prior to additional surgery

Answer 22

vascular ultrasound

Question 23

what kind of things raise suspicion for peripheral vascular disease?

Answer 23

tobacco
diabetes
wound dehiscence