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Musculoskeletal > Bone and Soft Tissue Infection > Flashcards

Bone and Soft Tissue Infection Flashcards

1
Q

What are the risk factors for acute osteomyelitis?

A 
Diabetes 
Rheumatoid arthritis 
Immune compromise 
Long term steroid treatment 
Sickle cell
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2
Q

What are the source of infection of acute osteomyelitis?

A 
Haematogenous spread 
Local spread from contigous site of infection
Secondary to vascular insufficiency 
Infected umbilical cord (infants) 
Boils
Tonsilitis 
Skin abrasions 
UTI 
Arterial line
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3
Q

What are the common organisms that cause acute osteomyelitis?

A 
Staph aureus
Strep pyogenes 
Haemophilus influenzae
Mycobacteroum tuberculosis 
Brucella
Group B streptococci 
E coli
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4
Q

What is the pathology of acute osteomyelitis?

A 
Starts at metaphysis 
Vascular stasis 
Acute inflammation, increased pressure 
Suppuration
Release of pressure 
Necrosis of bone 
New bone formation
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5
Q

What are the clinical features of acute osteomyelitis in infants?

A 
Failure to thrive 
Drowsy or irritable
Metaphyseal tenderness and swelling 
Decreased range of movement 
Positional change 
Commonest around knee
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6
Q

What are the clinical feature of acute osteomyelitis in children?

A 
Severe pain
Reluctant to move, not weight bearing 
May be tender fever and tachycardia 
Malaise 
Toxaemia
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7
Q

What are the clinical features of acute osteomyelitis in adults?

A

Primary OM commonly seen in thoracolumbar spine
Back ache
History of UTI or urological procedure
Elderly, diabetic, immunocompromised

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8
Q

What investigations should be used to make a diagnosis for acute osteomyelitis?

A 
History and examination 
FBC and diff WBC 
ESR, CRP 
Blood cultures x3
U&Es 
X ray 
USS 
Aspiration 
Isotope bone scan
Labelles white cell scan 
MRI
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9
Q

What is the differential diagnosis of acute osteomyelitis?

A 
Acute septic arthritis 
Trauma 
Acute inflammatory arthritis 
Transient synovitis 
Soft tissue infection
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10
Q

What is the treatment of acute osteomyelitis?

A

Rest and splintage
Antibiotics
Supportive treatment for pain and dehydration
Surgery

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11
Q

What are the indications for surgery in acute osteomyelitis?

A

Aspiration of pus for diagnosis and culture
Abscess drainage
Debridement of dead/infected/ contaminated tissue

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12
Q

What are the complications of acute osteomyelitis?

A 
Septicaemia, death 
Metastatic infection 
Pathological fracture 
Septic arthritis 
Altered bone growth 
Chronic osteomyelitis
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13
Q

What is subacute osteomyelitis?

A

Increased host resistance/ lowered bacterial virulence or antibiotic usage

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14
Q

What are the clinical features of subacute osteomyelitis?

A 
Long history 
Pain 
Limp 
Local swelling/warmth occasionally 
Tenderness
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15
Q

What are the clinical features of Brodie’s abscess?

A

Older children
Painful limp, no systemic features
Radiographic lucency in long bone metaphysis

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16
Q

What is the treatment for subacute osteomyelitis?

A

Prolonged course of antibiotics

Surgery- curettage

17
Q

What is the pathology of chronic osteomyelitis?

A

Cavities, possibly sinuses
Dead bone (retained sequestra)
Involucrum

18
Q

What is the treatment of chronic osteomyelitis?

A 
Long term antibiotics 
Eradicate bone infection- surgically 
Treat soft tissue problems 
Reconstruction 
Amputation
19
Q

What are the complications of chronic osteomyelitis?

A 
Chronically discharging sinus and flare up 
Ongoing infection 
Pathological fracture 
Growth disturbances and deformities 
Squamous cell carcinoma
20
Q

What is the route of infection of acute septic arthritis?

A

Direct invasion
Eruption of bone abscess
Haematogenous

21
Q

What are the common organisms that cause acute septic arthritis?

A

Staph aureus
Haemophilus influenzae
Strep pyogenes
E coli

22
Q

What is the pathology of acute septic arthritis?

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Complete destruction of the articular cartilage

23
Q

What are the clinical features of acute septic arthritis in a neonate?

A

Irritability
Resistant to movement
Ill

24
Q

What are the clinical features of acute septic arthritis in a child?

A

Acute pain in a single large joint
Reluctant to move the joint
Increased temperature and pulse
Increase tenderness

25
Q

What are the clinical features of acute septic arthritis in an adult?

A

Often involves superficial joint

26
Q

What investigations should be made for acute septic arthritis?

A

FBC, WBC, CRP, ESR, blood cultures
X ray
USS
Aspiration

27
Q

What is the differential diagnosis of acute septic arthritis?

A 
Acute osteomyelitis 
Trauma 
Irritable joint 
Haemophilia 
Rheumatic fever 
Gout 
Gaucher's disease
28
Q

What is the treatment for acute septic arthritis?

A

General supportive measures
Antibiotics (3-4 weeks)
Surgical drainage and lavage

29
Q

What are the clinical features of tuberculosis in bones?

A 
Insidious onset and general ill health 
Contact with TB 
Pain, esp at night, swelling, loss of weight 
Low grade pyrexia 
Joint swelling 
Decrease range of movement 
Ankylosis 
Deformity
30
Q

What is the pathology of TB with regards to bone?

A

Primary complex (in the lung or gut)
Secondary spread
Tuberculous granuloma

31
Q

What signs on examination and investigation would help make a diagnosis of TB?

A 
Long history 
Involvement of single joint 
Marked thickening of the synovium 
Marked muscle wasting 
Periarticular osteoporosis
32
Q

What investigation should be used when making a diagnosis of TB?

A 
FBC, ESR
Mantoux test 
Sputum/ urine culture 
XRAY 
Joint aspiration and biopsy
33
Q

What is the differential diagnosis of TB?

A

Transient synovitis
Monoarticular rheumatoid arthritis
Haemorrhagic arthritis
Pyogenic arthritis

34
Q

What is the treatment for TB?

A

Initially rifampicin, ethambutol and isoniazid (8 weeks)
Then rifampicin and isoniazid (6-12 months)
Rest and splintage

Musculoskeletal (27 decks)

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