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Course 2 - Orthopedics > bone infections and oncology > Flashcards

bone infections and oncology Flashcards

1
Q

what two factors are needed to differentiate types of infections?

A

depth of involvement and presence of necrosis

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2
Q

what is osteomyelitis

A

bone infection characterized by inflammatory destruction and apposition of new bone

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3
Q

what is septic arthritis?

A

a joint infection

staph (most common), mycobacteria, spirochetes, fungi, virus

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4
Q

what category of infection does necrotizing fasciitis fall under?

A

soft tissue infections

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5
Q

what are the routes of infection spread?

A

hematogenous, contiguous (bone/bursa), direct (skin)

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6
Q

what risk factors predispose pts to bone infections?

A 
age
diabetes
immune state
RA
Cirrhosis, HIV, CRD
malignancy
obesity, ETOH/smoking
steroids
malnutrition
surgery
vascular insufficiency
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7
Q

what is the mechanism of osteomyelitis spread in peds?

A

hematogenous seeding of bacteria to metaphyseal region w sluggish flow

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8
Q

why is osteomyelitis more common in the first decade of life?

A

rich metaphyseal blood supply, immature immune system

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9
Q

what is the molecular result of OM?

A

pus, osteoblast necrosis, osteoclast activation, inflammatory factors release, thrombosis

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10
Q

where does OM happen in peds?

A

long bones (femur)

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11
Q

where does OM happen in adults?

A

vertebrae most common

spine/ribs for dialysis pt

clavicals for IVDU

foot for diabetics

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12
Q

what is the most common organism causing OM?

A

S. aureus

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13
Q

what is the mainstay of Dx for OM?

A

bone aspirate/biopsy
high CRP, ESR
MRI for early Dx, XR doesn’t show up for a while

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14
Q

under what circumstances can OM be managed by antibiotics alone?

A

no pus, acute

chronic, need surgical drainage, debridement and Abx

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15
Q

where does septic arthritis happen in kids?

A

hip, shoulder, ankle elbow (overlapping joint capsule and metaphysis)

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16
Q

where does SA happen in adults?

A

knee, then hips

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17
Q

what organisms cause SA?

A

staph, neisseria

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18
Q

what is seen on XR for SA?

A

joint space widening/effusion, periarticular osteopenia

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19
Q

what is the Tx for SA?

A

operative: incision + drainage + IV antibiotics

rarely non-op (except neisseria + gonorrhea, treat w penicillin)

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20
Q

what is the golden period in open wounds?

A

time after injury that wound can be closed w/o increasing infection risk

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21
Q

what factors indicate a wound that needs the tetanus vaccine and Ig?

A

unknown/incomplete immunization, >6hrs, irregular, devitalized tissue, gross contamination, >1cm depth, projectile and crush injury, burn/frostbite

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22
Q

what are factors that indicate a wound only needs tetanus vaccine?

A

immunization to date, no booster in 5 yrs, small wounds

23
Q

what is necrotizing fasciitis?

A

rapid progressive infection of deep fascia w secondary necrosis of sc tissue

24
Q

what organism causes NF?

A

strep group A

25
Q

how do you Dx NF?

A

biopsy for necrosis/microorganisms

26
Q

how is NF tx?

A

debridement, broad spec antibiotics, hemodynamic support, amputation if needed

  • Pen G for strep/C diff
  • Vanco if MRSA
  • Imipenem if polymicrobial
  • IVIG for strep and TSS
27
Q

an aggressive bone lesion in >40yo is likely____

an aggressive bone lesion in <40yo is likely___

A

metastatic carcinoma or myeloma

sarcoma

28
Q

what tissues can sarcoma originate from?

A

fat, muscle, cartilage, bone, nerves, blood vessel

connective tissue of mesenchymal origin

29
Q

what is the order of likely etiology of bone lesions?

A

benign>carcinoma>soft tissue sarcoma>bone sarcoma

30
Q

when can a benign lesion become deadly?

A

if subcapital, can lead to AVN

31
Q

what is the gold standard for Dx bone sarcoma?

A

biopsy

32
Q

where do sarcomas tend to metastasize?

A

bone and chest

33
Q

what is the most important predictor of survival in bone sarcoma?

A

presence of metastases

34
Q

what are the characteristics of a ewing sarcoma?

A

sheets of cells (lamellar), moth eaten look, thickening of periosteum to control tumor growth

35
Q

what is the most common bone sarcoma?

A

osteosarcoma

36
Q

where do osteosarcomas tend to occur?

A

ends of long bones

37
Q

what population tends to have chondrosarcomas?

A

40-70

38
Q

how is chondrosarcoma tx?

A

surgical (not sensitive to chemo)

39
Q

how does ewing sarcoma differ from osteo/chondrosarcomas?

A

cellular proliferation that doesn’t form bone/cartilage

40
Q

where does ewing sarcoma occur?

A

diaphysis of long bones, pelvis

41
Q

where does chondrosarcoma occur?

A

pelvis

42
Q

how does ewing sarcoma present?

A

with systemic signs present

43
Q

what is the most effective tx for ewing sarcoma?

A

BM aspirate and radiation

44
Q

what are the complications associated with expandable prosthesis?

A

joint contractures, small injuries, infections, failures

45
Q

what is epiphysiodesis

A

halt growth of oppositing growth plate in pt with growth plate tumor

46
Q

what are the types of benign bone lesions?

A

cysts, cartilage tumors, bone forming tumors, fibrous lesions, infections

47
Q

what is the most common benign bone lesion?

A

enchodroma

48
Q

what benign lesion is often mistaken for ewing?

A

osteoid osteoma

49
Q

what benign lesion is most likely to occur at the prox femur/humerus?

A

bone cysts

50
Q

why is giant cell tumor of the bone considered aggressive?

A

can destroy bone (recruit osteoclasts) even though it’s not a tumor (not life threatening)

51
Q

where do bone lesions metastases from MM tend to form?

A

spine, ribs, pelvis, femur, humerus

52
Q

where do lung/breast metastases tend to locate?

A

knee/elbow

53
Q

on x rays, benign vs. malignant

A

Benign bone lesions = well-defined borders, sclerotic rim, septations
Malignant bone lesions = poorly defined borders, periosteal reaction, cortical erosions, ST mass

54
Q

Tx for sarcoma

A

chemo, surgical resection

Course 2 - Orthopedics (7 decks)

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