Infection in Bone and Joints

Question 1

Causative organisms of osteomyelitis?

Answer 1

Staph aureus, Group B streptococci, E. coli, Strep pyogenes, Haemophilus influenza, coagulase negative staphylococci Propionibacterium spp Streptococcus pyogenes, Mycobacterium tuberculosis, Pseudomonas aeroginosa

Question 2

Clinical features acute osteomyelitis?

Answer 2

Fever, tachycardia, malaise, N+V, severe pain worse on weight bearing, toxaemia, backache,

Question 3

Complications of acute osteomyelitis

Answer 3

Sepsis, fracture, septic arthritis

Question 4

Investigations of acute osteomyelitis

Answer 4

Exam,
Raised WCC, ESR, CRP
Culture, biopsy, x-ray, MRI

Question 5

Treatment of acute osteomyelitis

Answer 5

Rest, splinter, analgesics, antibiotics, surgery, debride

Question 6

DDx of acute osteomyelitis

Answer 6

Cellulitis, necrotising fasciitis, gas gangrene, toxic shock, septic arthritis, tumour, inflammatory arthritis

Question 7

Treatment for chronic osteomyelitis

Answer 7

Long term antibiotics
Surgery
Amputation
Reconstruction

Question 8

Acute septic arthritis organism

Answer 8

staph aureus, haemophilus influenzae, streptococcus pyogenes, e.coli

Question 9

Acute septic arthritis clinical features

Answer 9

Superficial joint
Acute pain in single joint
Reluctant to move
Increase temp and pulse, increase tenderness

Question 10

Acute septic arthritis investigations

Answer 10

FBC, WBC, ESR, CRP, blood cultures

X-ray, ultrasound, aspiration

Question 11

Acute septic arthritis treatment?

Answer 11

General supportive measures
Antibiotics (3-4weeks)
Surgical drainage and lavage

Question 12

Tuberculosis clinical features

Answer 12

Insidious onset, general ill health
Contact with TB
Pain, swelling, loss of weight
low grade pyrexia
Joint swelling
Decrease ROM
Ankylosis 
Deformity

Question 13

Tuberculosis investigation

Answer 13

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

Question 14

Tuberculosis DDx

Answer 14

Transient synovitis
Monoarticular RA
Haemorrhage arthritis
Pyogenic arthritis

Question 15

Tuberculosis treatment

Answer 15

Chemotherapy (as normal TB)
Rest and splint age
Operative drainage rarely necessary

Question 16

Risk factors for osteomyelitis

Answer 16

Recent fracture
Injured or wound
Artificial hip
Surgery on bone
Weakened immune system
Previous 
DM