Bone & Soft Tissue Infection & Tumours

Question 1

What is osteomyelitis?

Answer 1

It is the infection of the bone

Question 2

What is the most common causative organism of osteomyelitis?

Answer 2

Staphylococcus aureus

Question 3

What are some of the other causes of osteomyelitis?

Answer 3

E. coli
Pseudosmonas
Streptococcus

Question 4

Who tends to get osteomyelitis ?

Answer 4

Children

Question 5

What are the symptoms and signs of osteomyelitis?

Answer 5

Systemically Unwell
Bone pain
Abscess 
Drowsy
Fever
Irritable 
Reluctant to weight bear

Question 6

What are the investigations of OM?

Answer 6

Blood culture x 3
FBC, WBC, ESR, CRP
X-ray and aspiration

Question 7

What are the management options fro OM?

Answer 7

Supportive treatment
Dehydration
Antibiotics
Fluxloxacillin and benzyslpenacillin whilst waiting for blood work results
May need surgical aspiration/ pus removal

Question 8

What is septic arthritis?

Answer 8

This is a medical emergency where there is infection of the joint

Question 9

What is the causative organism? What are some of the less common ones?

Answer 9

Staphylococcus aureus

Streptococci, HI

Question 10

What are the 3 routes of infection in SA?

Answer 10

Direct infection from wound
Iatrogenic
Eruption of bone masses

Question 11

What are the KEY symptoms of septic arthritis?

Answer 11

Hot, swollen and tender joint with systemic fever, immobility and pain is septic arthritis until proven otherwise

Question 12

What are the symptoms the following groups:
Infant?
Child?
Adult

Answer 12

Irritable, failure to thrive, doesn’t want to move, septic
Acute pain in a single large joint, the child won’t weight bear, pyrexic and tachycardia
Single large superficial joint effected ie the knee

Question 13

What is the investigations of SA?

Answer 13

Aspirate the joint
Culture blood
Skin cute
High leukocyte count

Question 14

what is the management of sa?

Answer 14

Analgesics
IV benzylpenicillin and flucloxacillin 1-2 wks
Surgical drainage

Question 15

Are primary bone tumours common?

Answer 15

No they tend to be metastases

Question 16

Where are the most common metastases from?

Answer 16

Lung, BREAST, renal, prostate

Question 17

What is the definition of a sarcoma?

Answer 17

This is a malignant tumour arising from the connective tissue

Question 18

What Is an Osteosarcoma?

Answer 18

This is the most common bone malignancy in children

Question 19

Are most of the tumours in bone benign or malignant?

Answer 19

Benign

Question 20

What is the presentation of the following BENIGN bone tumours:
Osteoid osteoma
Osteochondroma
Chondroma
Giant-Cell tumour
Fibroma 
Eosinophilic granuloma

Answer 20

Form bone shaft, pain at night, young adult
Cortex of long bone, painless lump, young teenager
Cartilage of hands + feet, painless, excise
Around knee, female 20-40, X-ray and excise
Asymptomatic - children under 2
Skull, 5-10yo M, removal

Question 21

What are you going to examine about the lump?

Answer 21

Location 
Size
Fluctuant
Painful 
Consistency 
Mobility 
Temperature

Question 22

What are the CARDINAL features of a MALIGNANT TUMOUR?

Answer 22

Increasing, unexplained, deep-seated dull pain 
Difficutly weight bearing 
Deep swelling 
Night pain 
Nerve patsy 
Activity related pain 
Systemic features

Question 23

What are the investigations of bone tumours?

Answer 23

x-ray/CT/ MRI - best
May need biopsy
Full bloods

Question 24

What are the features of a chondrosarcoma?

Answer 24

ADULTS
Dull deep pain
Mets late
wide local excision

Question 25

What are the features of a osteosarcoma?

Answer 25

Children
Metaphyses around the knee
Pain, limp, limited ROM
Full Sx and management

Question 26

What are the features of a Ewing’s sarcoma?

Answer 26

Tumour from mesenchymal cells
Children
Mass swelling, systemic symtoms
Chemo is first line