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Bone and Soft Tissue Infections Flashcards

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1
Q

Acute osteomyelitis is most common in which groups?

A

Children
Boys
History of tumour

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2
Q

What conditions are associated with Acute osteomyelitis?

A 
Diabetes
Rheumatoid Arthritis
Immunocompromisation
Long-term steroids
Sickle cell
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3
Q

What are the sources of infection in Acute osteomyelitis?

A

Haematogenous spread
Spread from contiguous site of infection
Vascular insufficiency

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4
Q

What are the most common sources of spread infection in Acute osteomyelitis in children?

A

Boils
Tonsillitis
Skin abrasions

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5
Q

What are the most common sources of spread infection in Acute osteomyelitis in infants?

A

Infected umbilical cord

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6
Q

What are the most common sources of spread infection in Acute osteomyelitis in adults?

A

UTI

Arterial line

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7
Q

What is the most common organism infant acute osteomyelitis?

A

Staph aureus
Group B strep
E. coli

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8
Q

What is the most common organism childhood acute osteomyelitis?

A

Staph aureus
Strep pyogenes
Haemaphilius influenza

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9
Q

What is the most common organism adult acute osteomyelitis?

A

STAPH AUREUS

TB
Pseudomonas aeroginosa
Coag -ve staph
Propionibacterium spp

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10
Q

What organisms are associated with prosthetic acute osteomyelitis?

A

Coag -ve staphylococci

Propionibacterium spp

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11
Q

What organisms are associated with acute osteomyelitis due to penetrating foot injuries, IVDA?

A

Pseudomonas aeroginosa

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12
Q

What organisms are associated with acute osteomyelitis with diabetes?

A

Mixed - including anaerobes

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13
Q

What organisms are associated with acute osteomyelitis with sickle cell disease?

A

Salmonella spp.

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14
Q

What organisms are associated with acute osteomyelitis with fishermen?

A

Mycobacterium marinum

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15
Q

What organisms are associated with acute osteomyelitis with Immunosuppression?

A

Candida

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16
Q

Which part of the bone is typically affected in Acute Osteomyelitis of long bones?

A

Metaphysis:
Distal femur
Proximal tibia
Proximal humerus

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17
Q

Which part of the bone is typically affected in Acute Osteomyelitis of joints with intra-articular metaphysis?

A

Hip

Elbow (radial head)

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18
Q

What is the pathological process of acute osteomyelitis?

A 
Metaphysis - vascular stasis
Acute inflammation 
Suppuration
Release of pressure
Necrosis of bones (sequestrum)
New bone formation (involcrum)
Resolution or progression to chronic
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19
Q

What are the clinical features of Acute Osteomyelitis in infants?

A 
Minimal --> very ill
Failure to thrive
Drowsy/irritable
Metaphyseal tenderness/swelling
Decreased ROM
Positional change
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20
Q

Where isAcute Osteomyelitis most common in infants?

A

Knee

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21
Q

What are the clinical features of Acute Osteomyelitis in children?

A 
Severe pain
Reluctant to move
Not weight bearing
Tender fever + tachycardia
Malaise 
Toxaemia
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22
Q

What are the clinical features of Acute Osteomyelitis in adults?

A

Backache

UTI/urological procedure

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23
Q

Where is primary acute osteomyelitis most common in adults?

A

Thoracolumbar spine

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24
Q

How is acute osteomyelitis diagnosed?

Study These Flashcards
A 
History + exam
FBC + WBC
ESR + CRP 
Blood cultures x3 (at peak temp)
U+E
X-ray, USS
Aspirate
Isotope bone scan
White cell scanW
25
What DDx is associated with acute osteomyelitis?
``` Soft tissue infection Acute Septic Arthritis Acute Inflammatory Arthritis Trauma Transient Synovitis ```
26
What rare DDx is associated with acute osteomyelitis?
Sickle cell crisis Gaucher's disease Rheumatic fever Haemophilia
27
What is sequestrum?
Late osteonecrosis
28
What is involucrum?
Late periosteal new bone formation
29
How does acute osteomyelitis present radiologically?
``` Early - minimal change 10-20days - periosteal changes Medullary changes Lytic areas Osteonecrosis New bone ```
30
Which scans are used in acute osteomyelitis?
Technetium 99 Gallium 67 citrate Indium-111 (WBC scan) MRI
31
How is microbiology used in Acute Osteomyelitis?
Blood cultures in septic arthritis/haematogenous infection Bone biopsy Tissue swabs 5 sites
32
Why are sinus tracts no use in Acute Osteomyelitis diagnosis?
Contamination with skin commensals
33
How is Acute Osteomyelitis treated?
Supportive Rest + splintage Antibiotics (IV/oral switch 7-10 days) - 4-6 weeks Surgery
34
Why are antibiotics weak in treating Acute Osteomyelitis?
Drug resistance Bacterial persistence Poor host defences Poor drug absorption
35
What are the indications for surgery in Acute Osteomyelitis?
Aspiration of pus for Dx Abscess drainage Debridement Infected joint replacements
36
What complications are associated with Acute Osteomyelitis?
``` Septicaemia, death Metastatic infection Pathological fracture Septic arthritis Altered bone growth Chronic osteomyelitis ```
37
What are the causes of Chronic Osteomyelitis?
``` Acute osteomyelitis De novo: - Operation - Immunosuppression, diabetes, etc Repeated wound breakdown ```
38
Which organisms are associated with Chronic Osteomyelitis?
``` Mixed Same each flare-up Staph. aureus E. coli Strep. pyogenes Proteus ```
39
What complications are associated with Chronic Osteomyelitis?
``` Chronic pus discharge Metastatic infection Pathological fracture Growth disturbance Squamous cell carcinoma ```
40
How is Chronic Osteomyelitis treated?
``` Antibiotics (local/systemic) Surgical Treat soft tissue problems Correct deformity Amputation ```
41
What is the route of infection of Acute Septic Arthritis?
Haematogenous Eruption of bone abscesses Direct invasion
42
Which are the common organisms in Acute Septic Arthritis?
Staph aureus H. influenzae Strep pyogenes E. coli
43
What is the pathological process of Acute Septic Arthritis?
Acute synovitis with purulent effusion Articular cartilage attacked by bacterial toxin Destruction of cartilage
44
What sequelae are associated with Acute Septic Arthritis?
Complete recovery Partial loss of articular cartilage - osteoarthritis Fibrous/bony ankylosis
45
How does Acute Septic Arthritis present in neonates?
(Septicaemia) Irritability Resistant to movement Illness
46
How does Acute Septic Arthritis present in children?
Pain in single large joint Reluctant to move Raised temp + pulse Tenderness
47
How does Acute Septic Arthritis present in adults?
Superficial joint
48
How is Acute Septic Arthritis investigated?
``` FBC, WBC ESR, CRP Blood cultures X-ray Ultrasound Aspiration ```
49
What is the most common cause os septic arthritis in adults?
Infected joint replacement
50
What is the differential diagnosis of Acute Septic Arthritis?
``` Acute ostemyelitis Trauma Irritable joint Haemophilia Rheumatic fever Gout Gaucher's disease ```
51
How is Acute Septic Arthritis treated?
Supportive Antibiotics 3-4 weeks Surgical drainage & lavage
52
What is the classification of bone/joint TB?
``` Vertebral body (most common) Extra-articular (epiphyseal bones) Intra-articular (large joints) ```
53
How does bone/joint TB typically present?
``` Multiple lesions Insidious onset Pain/swelling/weight loss Low grade pyrexia Joint swelling Decreased ROM Ankylosis ```
54
How does spinal TB present?
Little pain Abscess Kyphosis
55
How is bone/joint TB diagnosed?
``` Long history Single joint involved Synovium thickening Marked muscle wasting Periarticular osteoporosis ```
56
How is bone/joint TB investigated?
``` FBC, ESR Mantoux test Sputum/urine culture X-ray Joint aspiration and biopsy ```
57
How does bone/joint TB present on X-ray?
Soft tissue swelling Periarticular osteopaenia Articular space narrowing
58
What DDx is associated with bone/joint TB?
``` Transient synovitis Monoarticular RA Haemorrhagic arthritis Pyogenic arthritis Tumour ```
59
How is Tuberculosis treated?
``` Isoniazid Rifampicin Ethambutol (8 weeks) Rifampicin + Isoniazid (12 months) Rest and splintage Operative drainage (rare) ```

*MSK (25 decks)

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