Bone and Soft tissues infections

Question 1

bone infection

Answer 1

osteomyelitis

Question 2

joint infection

Answer 2

septic arthritis

Question 3

acute osteomyelitis is common in

Answer 3

children

Question 4

sources of infection:

Answer 4

haematogenous spread

local spread from site (bone fracture, bone surgery, joint replacement)

secondary to vascular insufficiency

Question 5

organisms causing the infection in infants

Answer 5

staph aureus

group B strep

E.coli

Question 6

organisms causing the infection in children

Answer 6

staph aureus

haemophilus influenzae

strep pyogenes

Question 7

organisms causing the infection in adults

Answer 7

staph aureus

TB

pseudomonas aeruginosa

Question 8

clinical features of acute osteomyelitis in infants

Answer 8

failure to thrive

possible drowsiness or irritable

metaphyseal tenderness or swelling

decreased range of motion

Question 9

clinical features of acute osteomyelitis in children

Answer 9

severe pain

reluctant to move

tender fever (swinging pyrexia)

malaise

Question 10

how do you diagnose acute osteomyelitis?

Answer 10

history and clinical exam (pulses and temp)

FBC/ WBC

blood culture

ESR/ CRP

X-ray

USS

aspiration

isotope bone scan

labelled white cell scan

MRI

blood cultures

bone biopsy is gold standard in pathogen identifying

Question 11

differential diagnosis for acute osteomyelitis

Answer 11

acute septic arthritis

acute inflammatory arthritis

trauma

transient synovitis

Question 12

what is cellulitis?

Answer 12

deep infection of the subcutaneous tissues

group A strep

Question 13

name some common soft tissue infections:

Answer 13

cellulitis

erysipelas

necrotising fasciitis

gas gangrene

toxic shock syndrome

Question 14

sequestrum

Answer 14

dead bone

usually found in chronic bone disease

Question 15

involucrum

Answer 15

layer of new bone outside the existing bone

Question 16

how do you treat acute osteomyelitis?

Answer 16

supportive for pain and dehydration

rest and splint-age

antibiotics

Question 17

ESR that is faster than normal ESR can show what?

Answer 17

there is inflammation

Question 18

osteomyelitis complications

Answer 18

septicemia, death

metastatic infection

pathological fracture

septic arthritis

chronic osteomyelitis

altered bone growth

Question 19

most common organisms that cause chronic OM

Answer 19

staph aureus

E coli

strep pyogenes

Question 20

route of infection for septic arthritis

Answer 20

haematogenous

eruption of bone abscess

direct invasion (injury etc)

Question 21

organisms responsible for acute septic arthritis

Answer 21

Staph aureus

haemophilus influenzae

strep pyogenes

e coli

Question 22

2 key pathologies that occur in acute septic arthritis:

Answer 22

acute synovitis with purulent joint effusion

complete destruction of articular cartilage

Question 23

synovitis

Answer 23

inflamed synovial membrane

Question 24

ankylosis

Answer 24

abnormal stiffening and immobility of a joint due to fusion of the bones

Question 25

3 outcomes of sequelae occurring in acute septic arthritis

Answer 25

complete recovery partial loss of the articular cartilage and subsequent OA fibrous or bony ankylosis

Question 26

acute septic arthritis is more common in

Answer 26

children

Question 27

how do you investigate acute septic arthritis?

Answer 27

FBC - WBC, ESR, CRP, blood cultures X-ray USS aspiration

Question 28

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

Answer 28

infected joint replacement

Question 29

differentials for acute septic arthritis

Answer 29

acute osteomyelitis trauma irritable joint haemophilia rheumatic fever gout

Question 30

arthroplasty

Answer 30

surgical reconstruction or replacement of a joint

Question 31

how do you treat acute septic arthritis?

Answer 31

general supportive measures antibiotics (3-4 weeks) surgical drainage and lavage (emergency - never let the sun set on pus) infected joint replacement

Question 32

clinical features of TB in the bones and joints

Answer 32

insidious onset and general ill health pain (esp at night), swelling, loss of weight low grade pyrexia decreased range of motion ankylosis deformity

Question 33

what is tuberculosis of the bones a type of?

Answer 33

specific osteomyelitis

Question 34

how do you identify the pathogen in osteomyelitis?

Answer 34

bone biopsy is the gold standard

Question 35

differentials for TB:

Answer 35

monoarticular rheumatoid arthritis transient synovitis tumour

Question 36

how would you investigate TB in the bones and joints?

Answer 36

Mantoux test FBC/ ESR sputum/ urine culture X-ray (soft tissue swelling, articular space narrowing) Joint aspiration and biopsy

Question 37

how do you treat TB of the bones?

Answer 37

chemo rest and splint-age

Question 38

in a neonate- if they are ill, reluctant to move and irritable - what does this strongly indicate?

Answer 38

septicaemia