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MSK > Bone And Soft Tissue Infection > Flashcards

Bone And Soft Tissue Infection Flashcards

1
Q

Risk factors for acute osteomyelitis?

A

Age (child),
Male,
History of trauma,
Other disease (DM, rheum arthritis, immune compromise, long term steroid, sickle cell)

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2
Q

Source of infection of acute osteomyelitis?

A

Haematogenous spread,
Local spread from contiguous site of infection,
Secondary to vascular insufficiency

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3
Q

Common source of infection of acute osteomyelitis in infants?

A

Infected umbilical cord

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4
Q

Common sources of infection of acute osteomyelitis in children?

A

Boils, tonsillitis, skin abrasions

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5
Q

Common sources of infection of acute osteomyelitis in adults?

A

UTI,

Arterial line

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6
Q

Common organisms in acute osteomyelitis in infants <1yr?

A

Staph aureus,
Group B streptococci,
E.coli

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7
Q

Common organisms in acute osteomyelitis in older children?

A

Staph aureus,
Strep pyogenes,
Haemophilus influenzae

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8
Q

Common organisms in acute osteomyelitis in adults?

A

Staph aureus,
Coagulate negative staphylococci,
Mycobacterium tuberculosis,
Pseudomonas aeroginosa

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9
Q

Other organisms cause of acute osteomyelitis

A

Salmonella (if caused by sickle cell disease),
Mycobacterium marinum (in fishermen and filleters),
Candida (HIV AIDS)

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10
Q

In what bones in acute osteomyelitis common?

A

Distal femur,
Proximal tibia,
Proximal humerus,
Joints with intra-articular metaphysis

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11
Q

Stages of acute osteomyelitis

A

There is vascular stasis,
Followed by acute inflammation which raises pressure,
Causing suppuration to release the pressure,
Followed by sequestrum,
Involucrum,
Resolution or not

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12
Q

What is sequestrum?

A

Necrosis of bone

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13
Q

What is involucrum?

A

New bone formation

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14
Q

Clinical features of acute osteomyelitis in infants?

A 
Failure to thrive, 
Drowsy, 
Irritable, 
Metaphysical tenderness and swelling, 
Decreased ROM, 
Positional change
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15
Q

Clinical features of acute osteomyelitis in children?

A 
Severe pain, 
Reluctant to move, 
Not weight bearing, 
Swinging pyrexia, 
Tachycardia, 
Malaise, 
Toxaemia
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16
Q

Clinical features of primary acute osteomyelitis in adults?

A

Backache,
History of UTI or urological procedure,
Elderly, diabetic, immunocompromised

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17
Q

Where is primary osteomyelitis seen commonly in adults?

A

Thoracolumbar spine

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18
Q

Investigations of acute osteomyelitis?

A 
FBC, 
ESR,CRP. 
Blood cultures, 
U&amp;Es,
X-ray,
US, 
Aspiration, 
Isotope bone scan, 
Labelled white cell scan,
MRI
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19
Q

Differential diagnosis of acute osteomyelitis?

A 
Cellulitis, 
Erysipelas,
Necrotising fasciitis, 
Gas gangrene,
Toxic shock syndrome, 
Acute septic arthritis, 
Acute inflammatory arthritis, 
Trauma, 
Transient synovitis, 
Sickle cell crisis, 
Rheumatic fever
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20
Q

What isotope bone scans are used in acute osteomyelitis?

A

Tc-99,

Gallium-67

21
Q

What labelled white cell scans are used in acute osteomyelitis?

A

Indium-111

22
Q

Treatment of acute osteomyelitis?

A

Supportive treatment,
Rest and splintage,
Antibiotics

23
Q

Duration and type of antibiotics used in acute osteomyelitis?

A

4-6 weeks,
Flucloxicllin,
Benzylpen

24
Q

Antibiotic failure causes?

A 
Drug resistance, 
Bacterial persistence, 
Poor host defences, 
Poor drug absorption, 
Drug inactivation by host flora, 
Poor tissue penetration
25
Q

Surgery indications in acute osteomyelitis?

A

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

26
Q

Complications of acute osteomyelitis?

A 
Septicaemia, 
Death, 
Metastatic infection, 
Pathological fracture, 
Septic arthritis,
Altered bone growth,
Chronic osteomyelitis
27
Q

Risk factors of chronic osteomyelitis

A 
Operation, 
Open fracture, 
Immunocompromised, 
Diabetics,
Elderly, 
Drug abusers
28
Q

Common organisms causing chronic osteomyelitis?

A

Staph aureus,
E.coli,
Strep pyogenes,
Proteus

29
Q

Pathological causes of chronic osteomyelitis?

A

Cavities,
Sinuses,
Retained sequestra,
Involucrum

30
Q

Complications of chronic osteomyelitis?

A 
Chronically discharging sinus/ flare up,
Ongoing infection, 
Pathological fracture,
Growth disturbance,
Growth deformities, 
Squamous cell carcinoma
31
Q

Treatment of chronic osteomyelitis?

A 
Long term antibiotics, 
Eradicate bone infection, 
Deformity correction, 
Massive reconstruction, 
Treat soft tissue problems,
Amputation
32
Q

Route of infection of acute septic arthritis

A

Haematogenous,
Eruption of bone abscess,
Direct invasion (eg penetrating wound, intra-articular injury, arthroscopy)

33
Q

Organisms that cause acute septic arthritis?

A

Staphylococcus aureus,
Haemophilus influenzae,
Streptococcus pyogenes,
E.coli

34
Q

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

35
Q

Outcome options of acute septic arthritis?

A

Complete recovery,
Partial loss of articular cartilage and subsequent OA,
Fibrous or bony ankylosis

36
Q

Acute septic arthritis presentation in neonate?

A

Present as septicaemia:
Irritability,
Resistant to movement,
Ill

37
Q

Acute septic arthritis presentation in child/adult?

A 
Acute pain in single large joint,
Reluctant to move the joint, 
Pyrexia, 
Tachycardia,
Increased tenderness
38
Q

Acute septic arthritis presentation in adult?

A

Pain in superficial joint

39
Q

Investigations of acute septic arthritis?

A 
FBC, 
WBC, 
ESR,
CRP, 
Blood cultures, 
Xray, 
US, 
Aspiration
40
Q

What is the most common cause of acute septic arthritis in adults?

A

Infected joint replacement

41
Q

Differential diagnosis in acute septic arthritis?

A 
Acute osteomyelitis, 
Trauma, 
Irritable joint, 
Haemophilia, 
Rheumatic fever, 
Gout, 
Gaucher’s disease
42
Q

Treatment of acute septic arthritis

A

Supportive measure,
Antibiotics (3-4 weeks),
Surgical drainage and lavage,
Infected joint replacements

43
Q

Classification of Tuberculosis bone and joint?

A

Extra-articular,
Intra-articular,
Vertebral body

44
Q

Clinical features of TB of the bone and joint?

A 
Insidious onset and general ill health, 
Contact with TB, 
Pain,
Night pain, 
Swelling, 
Loss of weight,
Low grade pyrexia, 
Joint swelling, 
Decreased ROM, 
Ankylosis, 
Deformity
45
Q

Presentation of TB of the spine?

A

Little pain,

Abscess or kyphosis

46
Q

Markers of TB of the bone and joint?

A

Single joint involvement,
Marked thickening of the synovium,
Marked muscle wasting,
Periarticular osteoporosis

47
Q

Investigations of TB of the bone and joint?

A 
FBC, 
ESR,
Mantoux test, 
Sputum/ urine culture, 
XRAy, 
Joint aspiration and biopsy
48
Q

TB of bone and joint differential diagnosis?

A 
Transient synovitis, 
Monoartcular RA,
Haemorrhagic Arthritis, 
Pyogenic Arthritis, 
Tumour
49
Q

Treatment of TB of bone and joint?

A

Chemotherapy,
Initial- Rifampicin, Isoniazid, Ethambutol for 8 weeks,
Then- Rifampicin and Isoniazid for 6-12 months,
Rest and splintage,
Operative drainage

MSK (40 decks)

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