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MSK > Bone and Soft Tissue Infection > Flashcards

Bone and Soft Tissue Infection Flashcards

1
Q

Are adults or children more susceptible to acute osteomyelitis?

A

Children

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2
Q

Are boys or girls more likely to get acute osteomyelitis?

A

Boys

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3
Q

What history can increase the chances of somone getting acute osteomyelitis?

A 
History of trauma
Diabetes
Rheumatoid arthritis
Immunocompromised
Long term steroid treatment
Sickle cell
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4
Q

What can cause osteomyelitis?

A

Haematogenous spread
Local spread from contiguous site of infection - trauma, bone surgery, joint replacement
Secondary to vascular insufficiency

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5
Q

What can be a source of infection in infants?

A

Infected umbilical cord

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6
Q

What are sources of infection in children?

A

Boils
Tonsilitis
Skin abrasions

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7
Q

What are sources of infection in adults?

A

UTI

Arterial line

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8
Q

What is the most common infecting organism in acute osteomyelitis?

A

Staph aureus

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9
Q

What is likely to be an infective organism in acute osteomyelitis in patients with diabetic foot and pressure sores?

A

Mixed infection with anaerobes

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10
Q

What is the likely causative organism in acute osteomyelitis in a patient with sickle cell disease?

A

Salmonella species

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11
Q

What are common places to be affected by acute osteomyelitis?

A 
Distal femur
Proximal tibia
Proximal humerus
Hip joint
Elbow - radial head
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12
Q

What is the progression of acute osteomyelitis?

A 
Starts at metaphysis
Vascular stasis
Acute inflammation - increased pressure
Formation of pus
Release of pressure
Necrosis of bone
New bone formation
Resolution or not? May lead to chronic
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13
Q

What are clinical signs of acute osteomyelitis in infants?

A 
May be very ill
Failure to thrive
Possibly drowsy or irritable
Metaphyseal tenderness and swelling
Decrease range of movement
Positional change
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14
Q

What are clinical features of acute osteomyelitis in children?

A 
Severe pain
Reluctant to move - not weight bearing
Fever and tachycardia
Malaise
Toxaemia
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15
Q

What are clinical features of acute osteomyelitis in adults?

A

Primary infection seen commonly in thoracolumbar spine
Backache
History of UTI
Secondary is much more common

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16
Q

How is acute osteomyelitis diagnosed?

A 
History and clinical examination
FBC + WBC
ESR,CRP
3xblood cultures
U&Es
X-Ray/ultrasound
Aspiration
Isotope bone scan
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17
Q

What are differential diagnoses for acute osteomyelitis?

A 
Acute septic arthritis
Acute inflammatory arthritis
Trauma
Transient synovitis
Soft tissue infection
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18
Q

How is acute osteomyelitis treated?

A

Supportive treatment for pain and dehydration
Rest and splintage
Antibiotics 4-6 weeks

19
Q

What can cause antibiotics to fail to treat something?

A 
Drug resistance
Bacterial persistence
Poor host defences
Poor drug absorption
Drug inactivation by host flora
Poor tissue penetration
20
Q

What are indications for surgery in acute osteomyelitis?

A

Aspiration of pus for diagnosis
Abscess drainage
Debridement of dead/infected tissue
Refractory to non operative treatment

21
Q

What are complications of acute osteomyelitis?

A 
Septicaemia/death
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
22
Q

What can cause chronic osteomyelitis other than following an acute case?

A

Following an operation
Diabetic
Immunosuppressed
Elderly

23
Q

What are the most common causative organisms of chronic osteomyelitis?

A

Staph aureus
E Coli
Strep pyogenes

24
Q

What are complications of chronic osteomyelitis?

A

Chronically discharging sinus and flare-ups
Pathological fracture
Growth disturbance and deformities
Squamous cell carcinoma

25
Q

How is chronic osteomyelitis treated?

A 
Long-term antibiotics
Eradicate bone infection
Treat soft tissue problems
Correct deformities
Reconstruction
Amputation?
26
Q

What are routes of infection in acute septic arthritis?

A

Haematogenous
Eruption of bone abscess
Direct invasion

27
Q

What are common causative organisms of acute septic arthritis?

A

Staph aureus
Haemophilus influenzae
Strep pyogenes
E coli

28
Q

What is the progression of acute septic arthritis?

A

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

29
Q

What are features of acute septic arthritis in neonates?

A

Irritability
Resistant to movement
ill

30
Q

What are features of acute septic arthritis in children and adults?

A

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

31
Q

What investigations are done into acute septic arthritis?

A

FBC, WBC, CRP, etc
Blood cultures
X-ray/ultrasound
Aspiration

32
Q

How is acute septic arthritis treated?

A

General supportive measures
Antibiotics 3-4weeks
Surgical drainage

33
Q

What is sequestrum?

A

Necrosis of bone

34
Q

What is involucrum?

A

Growth of new bone layer outside of existing bone

35
Q

What are the classifications of tuberculosis in bone and joint?

A

Extra-articular (epiphyseal)
Intra-articular (large joints)
Vertebral body

36
Q

What are clinical features of Tuberculosis?

A 
Insidious onset and general ill health
Contact with TB
Pain, swelling, weight loss
Low grade pyrexia
Joint swelling
Decrease range of movement
Ankylosis
Deformity
37
Q

What are features of spinal tuberculosis?

A

Little pain

Presents with abscess or kyphosis

38
Q

How is tuberculosis diagnosed?

A 
Long history
Involvement of a single joint
Marked thickening of the synovium
Marked muscle wasting
Periarticular osteoperosis
39
Q

What investigations can be done into TB?

A 
FBC, ESR
Mantoux test
Sputum/urine culture
Xray
Joint aspiration and biopsy
40
Q

What would you expect to see in an Xray with TB?

A

Soft tissue swelling
Periarticular osteopaenia
Articular space narrowing

41
Q

What is Mantoux test?

A

Intradermal injection of tuberculin and immune response is measured 48-72 hours later

42
Q

What are differential diagnoses for TB?

A 
Transient synovitis
Monoarticular rheumatoid arthritis
Haemorrhagic arthritis
Pyogenic arthritis
Tumour
43
Q

How is TB treated?

A

Chemotherapy
Rest and splintage
Operative drainage rarely necessary

44
Q

What drugs are used for chemotherapy of TB?

A 
For 8 weeks :
Rifampicin
Isoniazid
Etjambutol
Then Rifampicin and isoniazid for 6-12 months

MSK (30 decks)

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