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Year 3 MSK (JK) > Bone and soft tissue infection > Flashcards

Bone and soft tissue infection Flashcards

1
Q

Risk factors for acute osteomyelitis

A

child, boys, history of minor trauma

other illnesses eg DM, sickle cell, rheum arthritis, long term steroid use or immune compromise

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2
Q

3 sources of infection in acute osteomyelitis

A

haematogenous spread
local spread from contagious site of infection
secondary to vascular insufficiency

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3
Q

what 2 age groups does haematogenous spread of osteomyelitis occur?

A

child and elderly

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4
Q

3 examples of local spread from contagious site of infection in acute osteomyelitis

A

trauma - open fracture
bone surgery - ORIF
joint replacement

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5
Q

examples in different age groups of source of infection in acute osteomyelitis

a) infants
b) children
c) adults

A

a - infected umbilical cord
b - boils, tonsillitis, skin abrasions
c - UTI, arterial line

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6
Q

Main organism of acute osteomyelitis

A

staph aureus

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7
Q

exceptions to causative organisms

A 
mycobacterium tuberculosis 
pseudomonas aeruginosa - IVDA 
coagulase -ve strep: prostheses 
diabetic foot - mixed and anaerobes 
sickle cell - salmonella 
mycobacterium marinum - fisherman 
candida - HIV
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8
Q

3 examples of places where long bone metaphysis are involved in acute osteomyelitis

A

distal femur
proximal tibia
proximal humerus

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9
Q

2 examples of places where joints with intra-articular metaphysis are involved in acute osteomyelitis

A

hip

elbow - radial head

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10
Q

briefly describe the pathology of acute osteomyelitis

A

starts at metaphysis and vascular stasis occurs.
acute inflammation, pressure build up and pus formation
release of pressure, bone dies, new bone formation and resolution or chronic osteomyelitis

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11
Q

suppuration

A

pus formation

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12
Q

sequestrum

A

necrosis of bone

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13
Q

involucrum

A

new bone formation

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14
Q

clinical features of acute osteomyelitis in an infant

A

minimal or very ill
drowsy, irritable, malaise, fail to thrive
positional change, decrease ROM, metaphyseal tender and swelling

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15
Q

where is the most common place for acute osteomyelitis in an infant?

A

knee

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16
Q

clinical features of acute osteomyelitis in a child

A

severe pain - toxaemia - reluctant to move

tender fever - tachycardia - malaise - not weight bearing

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17
Q

clinical features of acute osteomyelitis in an adult

A

backache - UTI - elderly - DM - immunocompromised

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18
Q

most common site for primary acute OM in an adult

A

thoracolumbar spine

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19
Q

primary or secondary acute om more common?

A

secondary

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20
Q

when does secondary acute om occur?

A

after open fracture, surgery, especially ORIF

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21
Q

5 parts of diagnosing acute OM

A

history and exam - pulse and temp
FBC and diff WCC - neutrophil leucocytosis
ESR, CRP
blood cultures x3 done at peak temp - 60% +ve
U+E’s - ill, dehydrated

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22
Q

differential diagnosis for acute OM

A 
acute septic arthritis 
acute inflammatory arthritis 
trauma 
transient synovitis 
rare eg haemophilia 
soft tissue infection
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23
Q

6 investigations for acute OM

A 
x-ray 
MRI 
USS 
aspiration 
isotope bone scan - TC-99, gallium-67
labelled WCC scan - indium - 111
24
Q

4 microbiological diagnosis of acute om

A

blood cultures - haematogenous OM and septic arth.
bone biopsy
tissue or swabs of up to 5 sites around implant
debridement in prosthetic infections

25
Q

why may sinus tract and superficial swabs be misleading?

A

contamination

26
Q

treatment for acute om

A

supportive
antibiotics
rest and splintage

27
Q

Why may antibiotics “fail”?

A

resistance - bacterial persistence - poor host defences
poor drug absorption - drug inactivation by host flora
poor tissue penetration - MRSA

28
Q

4 indications for surgery in acute om

A

aspirate pus for diagnosis and culture
abscess drainage
debridement of dead/infected/contaminated tissue
refractory to non op treatment for 24-48hrs

29
Q

6 complications of acute om

A

septicaemia/death- metastatic infection - pathological fracture - septic arthritis - altered bone growth - chronic OM

30
Q

organisms in chronic om

A

same each flare up but often mixed

staph aureus, E.coli, strep pyogenes, proteus

31
Q

pathology of chronic om

A

cavities, sinuses, involucrum, dead bone

32
Q

list some complications of chronic om

A

chronically discharging sinus and flare ups
ongoing metastatic infection and abscesses
pathological fracture
growth disturbance and deformities
SSC

33
Q

treatment for chronic om

A

long term antibiotics - local or systemic
eradicate bone infection surgically
treat soft tissue problems
deformity correction, reconstruction and amputation?

34
Q

3 routes of infection for septic arthritis

A

haematogenous
eruption of bone abscess
direct invasion eg arthroscopy

35
Q

4 main organisms causing acute septic arthritis

A

staph aureus - H. influenzae - strep pyogenes - E.coli

36
Q

3 pathological steps of acute septic arthritis

A

acute synovitis with purulent joint effusion
articular cartilage attacked by bacterial toxin and cellular enzyme
complete destruction of articular cartilage

37
Q

3 possible outcomes of acute septic arthritis

A

complete recovery
partial loss of articular cartilage and subsequent OA
fibrous or bony ankylosis

38
Q

neonate acute septic arthritis presentation

A

septicaemia picture - ill, irritable, resistance to movement

39
Q

child/adult acute septic arthritis presentation

A

acute pain in single large joint

  • reluctant to move
  • increase temp and pulse
  • tenderness
40
Q

adult acute septic arthritis presentation

A

often involves superficial joint eg wrist, knee, ankle

rare in healthy adult

41
Q

investigation of acute septic arthritis

A

FBC, WCC, ESR, CRP, blood cultures

x-ray, USS, aspiration

42
Q

most common cause of acute septic arthritis in an adult

A

infected joint replacement

43
Q

differential diagnosis for acute septic arthritis

A

acute OM, irritable joint, haemophilia, rheumatic fever

trauma,gout

44
Q

treatment for acute septic arthritis

A

general supportive measures - antibiotics - surgical drainage and lavage - emergency and infected joint replacement

45
Q

3 classifications of TB bone and joint

A

extra articular
intra articular
vertebral body

46
Q

what fraction of patients have multiple lesions in TB bone and joint

47
Q

clinical features of TB bone and joint

A 
insidious onset and general ill health 
TB contact 
pain at night, swelling, weight loss 
low grade pyrexia 
joint swelling 
decrease ROM 
ankylosis 
deformity
48
Q

pathology of TB bone and joint

A

primary in lung or gut
secondary spread
TB gramuloma
role of nutrition and disease

49
Q

presentation of spinal TB bone and joint

A

little pain with abscess or kyphosis

50
Q

history diagnosis of TB bone and joint (5)

A 
long history 
single joint 
muscle wasting 
marked thickening of synovium 
periarticular osteoporosis
51
Q

investigation of TB bone and joint

A 
FBC, ESR 
Mantoux test 
sputum/urine culture 
x-ray 
joint aspiration and biopsy
52
Q

3 things to look for in x-ray for TB bone and joint

A

soft tissue swelling
periarticular osteopenia
articular space narrowing

53
Q

2 things to look for in TB bone and joint aspiration and biopsy

54
Q

differential diagnosis for TB bone and joint

A 
transient synovitis 
monoarticular RA 
tumour 
haemorrhagic arthritis 
pyogenic arthritis
55
Q

treatment of TB bone and joint

A

chemotherapy - RIPE

rest and splintage, operation rare

Year 3 MSK (JK) (30 decks)

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