Bone and soft tissue infection

Question 1

What is osteomyelitis?

Answer 1

Bone infection

Question 2

What is septic arthritis?

Answer 2

Joint infection

Question 3

Does acute osteomyelitis mostly affect girls or boys?

Answer 3

Boys

Question 4

What are some sources of an acute osteomyelitis infection?

Answer 4

Haematogenous
Local spread from contiguous infection site
Secondary to vascular insufficiency

Question 5

What is the most common source of osteomyelitis infection for children and the elderly?

Answer 5

Haematogenous

Question 6

What are some common causative organisms in acute osteomyelitis?

Answer 6

Staph aureus
Group B streptococci
Strep pyogenes
Haem influenzae

Question 7

What is the sequence of events in the pathology of osteomyelitis?

Answer 7

Metaphysis (Trauma?)
Vascular stasis
Acute inflammation
Increased pressure
Suppuration
Release of pressure
Necrosis of bone
New bone formation
Resolution/Not

Question 8

How may acute osteomyelitis present in infants?

Answer 8

Failure to thrive
Drowsy
Irritable
Metaphysal tenderness
< ROM

Question 9

How may acute osteomyelitis present in a child?

Answer 9

Severe pain
Reluctant to move
Tender fever
Tachycardia
Malaise
Toxaemia

Question 10

How may acute osteomyelitis present in an adult?

Answer 10

Thoracolumbar spine
Backache
History of UTI or urological procedure
Diabetic/elderly

Question 11

What are some useful tests for acute OM diagnosis?

Answer 11

FBC
WBC
ESR
CRP
Blood cultures
U&Es

Question 12

What are some useful imaging techniques for acute OM diagnosis?

Answer 12

X-ray
US
Aspiration
Isotope bone scan
Labelled white cell scan
MRI

Question 13

How is acute OM treated?

Answer 13

Supportive for pain and dehydration
Rest splintage
IV/Oral Fluclox + BenzylPen

Question 14

How may OM become chronic?

Answer 14

Following operation
Following open wound
Immunosuppressed
Repeated breakdown of healed wounds

Question 15

What are some routes of infection in acute septic arthritis?

Answer 15

Haematogenous
Eruption of bone abscess
Direct invasion

Question 16

What are some common causative organisms in acute septic arthritis?

Answer 16

Staph aureus
Haemophilus influenzae
Strep pyogenes
E. coli

Question 17

What is the pathological process in acute septic arthritis?

Answer 17

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

Question 18

How common are multiple lesions in TB patients?

Answer 18

1/3 patients affected

Question 19

What are some clinical features of TB?

Answer 19

Insidious onset
Contact with TB
Pain
Swelling
Weight loss
Low grade pyrexia
< ROM
Ankylosis

Question 20

What is ankylosis?

Answer 20

Immobility and consolidation of a joint due to disease, injury, or surgical procedure

Question 21

What are some diagnostic features of TB?

Answer 21

Long history
Involvement in single joint
Marked thickening of synovium
Marked muscle wasting
Periarticular osteoperosis

Question 22

What are some useful investigations for TB?

Answer 22

FBC
ESR
Mantoux test
X-ray
Joint aspiration and biopsy

Question 23

What would an x-ray highlight in TB?

Answer 23

Soft tissue swelling
Periarticular osteopaenia
Articular space narrowing

Question 24

How is TB treated?

Answer 24

Chemotherapy
Rifampicin
Isoniazid
W/ ethambutol for 8 weeks then just the other 2 for 6-12 months
Rest and splintage
Drainage if necessary