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*MSK > Bone and Soft Tissue Infections > Flashcards

Bone and Soft Tissue Infections Flashcards

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?

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
Q

What DDx is associated with acute osteomyelitis?

A 
Soft tissue infection
Acute Septic Arthritis
Acute Inflammatory Arthritis
Trauma
Transient Synovitis
26
Q

What rare DDx is associated with acute osteomyelitis?

A

Sickle cell crisis
Gaucher’s disease
Rheumatic fever
Haemophilia

27
Q

What is sequestrum?

A

Late osteonecrosis

28
Q

What is involucrum?

A

Late periosteal new bone formation

29
Q

How does acute osteomyelitis present radiologically?

A 
Early - minimal change
10-20days - periosteal changes
Medullary changes
Lytic areas
Osteonecrosis
New bone
30
Q

Which scans are used in acute osteomyelitis?

A

Technetium 99
Gallium 67 citrate
Indium-111 (WBC scan)
MRI

31
Q

How is microbiology used in Acute Osteomyelitis?

A

Blood cultures in septic arthritis/haematogenous infection
Bone biopsy
Tissue swabs 5 sites

32
Q

Why are sinus tracts no use in Acute Osteomyelitis diagnosis?

A

Contamination with skin commensals

33
Q

How is Acute Osteomyelitis treated?

A

Supportive
Rest + splintage
Antibiotics (IV/oral switch 7-10 days) - 4-6 weeks
Surgery

34
Q

Why are antibiotics weak in treating Acute Osteomyelitis?

A

Drug resistance
Bacterial persistence
Poor host defences
Poor drug absorption

35
Q

What are the indications for surgery in Acute Osteomyelitis?

A

Aspiration of pus for Dx
Abscess drainage
Debridement
Infected joint replacements

36
Q

What complications are associated with Acute Osteomyelitis?

A 
Septicaemia, death
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
37
Q

What are the causes of Chronic Osteomyelitis?

A 
Acute osteomyelitis
De novo:
 - Operation
 - Immunosuppression, diabetes, etc
Repeated wound breakdown
38
Q

Which organisms are associated with Chronic Osteomyelitis?

A 
Mixed
Same each flare-up
Staph. aureus
E. coli
Strep. pyogenes
Proteus
39
Q

What complications are associated with Chronic Osteomyelitis?

A 
Chronic pus discharge
Metastatic infection
Pathological fracture
Growth disturbance
Squamous cell carcinoma
40
Q

How is Chronic Osteomyelitis treated?

A 
Antibiotics (local/systemic)
Surgical
Treat soft tissue problems
Correct deformity
Amputation
41
Q

What is the route of infection of Acute Septic Arthritis?

A

Haematogenous
Eruption of bone abscesses
Direct invasion

42
Q

Which are the common organisms in Acute Septic Arthritis?

A

Staph aureus
H. influenzae
Strep pyogenes
E. coli

43
Q

What is the pathological process of Acute Septic Arthritis?

A

Acute synovitis with purulent effusion
Articular cartilage attacked by bacterial toxin
Destruction of cartilage

44
Q

What sequelae are associated with Acute Septic Arthritis?

A

Complete recovery
Partial loss of articular cartilage - osteoarthritis
Fibrous/bony ankylosis

45
Q

How does Acute Septic Arthritis present in neonates?

A

(Septicaemia)
Irritability
Resistant to movement
Illness

46
Q

How does Acute Septic Arthritis present in children?

A

Pain in single large joint
Reluctant to move
Raised temp + pulse
Tenderness

47
Q

How does Acute Septic Arthritis present in adults?

A

Superficial joint

48
Q

How is Acute Septic Arthritis investigated?

A 
FBC, WBC
ESR, CRP
Blood cultures
X-ray
Ultrasound
Aspiration
49
Q

What is the most common cause os septic arthritis in adults?

A

Infected joint replacement

50
Q

What is the differential diagnosis of Acute Septic Arthritis?

A 
Acute ostemyelitis
Trauma
Irritable joint
Haemophilia
Rheumatic fever
Gout
Gaucher's disease
51
Q

How is Acute Septic Arthritis treated?

A

Supportive
Antibiotics 3-4 weeks
Surgical drainage & lavage

52
Q

What is the classification of bone/joint TB?

A 
Vertebral body (most common)
Extra-articular (epiphyseal bones)
Intra-articular (large joints)
53
Q

How does bone/joint TB typically present?

A 
Multiple lesions
Insidious onset
Pain/swelling/weight loss
Low grade pyrexia
Joint swelling
Decreased ROM
Ankylosis
54
Q

How does spinal TB present?

A

Little pain
Abscess
Kyphosis

55
Q

How is bone/joint TB diagnosed?

A 
Long history
Single joint involved
Synovium thickening
Marked muscle wasting
Periarticular osteoporosis
56
Q

How is bone/joint TB investigated?

A 
FBC, ESR
Mantoux test
Sputum/urine culture
X-ray
Joint aspiration and biopsy
57
Q

How does bone/joint TB present on X-ray?

A

Soft tissue swelling
Periarticular osteopaenia
Articular space narrowing

58
Q

What DDx is associated with bone/joint TB?

A 
Transient synovitis
Monoarticular RA
Haemorrhagic arthritis
Pyogenic arthritis
Tumour
59
Q

How is Tuberculosis treated?

A 
Isoniazid
Rifampicin
Ethambutol
(8 weeks)
Rifampicin + Isoniazid (12 months)
Rest and splintage
Operative drainage (rare)

*MSK (25 decks)

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