infection in bone and joints

Question 1

osteomyelitis

Answer 1

acute
chronic
specific
non specific (most common)

Question 2

source of infection

Answer 2

haematogenous spread
trauma, bone surgery, joint replacement
secondary to vascular insufficiency
infants: infected umbilical cord
children: boils, tonsilitis,
adults: UTI, arterial line

Question 3

organisms

Answer 3

infants- staph aures, group B streptococci, Ecoli
Older children: staph aureus, strep pyongenes, haemophilus influenzae
adults: staph aureus, coagulase negative staphylococci, psedomonoas aeroginosa

Question 4

special cases

Answer 4

diabetic foot and pressure sores- mixed infection
vertebral osteomyelitis- S.aureus, TB
Sickle cell disease- Salmonella
STD- gonococcus

Question 5

pathology

Answer 5

vascular stasis
acute inflammation- increased pressure
suppuration
release of pressure
necrosis of bone
new bone formation

Question 6

clinical features

Answer 6

severe pain
reluctant to move
may be tender fever
malaise (fatigue, nausea)

Question 7

differential diagnosis

Answer 7

acute septic arthritis
trauma
acute inflammatory arthritis
transient synovitis

Question 8

diagnosis

Answer 8

ultrasound
aspiration
isotope bone scan
labelled white cell scan

Question 9

radiograph of osteomyelitis

Answer 9

normal in first 10 days later shows increasing metaphyseal destruction

Question 10

osteonecrosis

Answer 10

sequestrum

Question 11

periosteal new bone

Answer 11

involucrum

Question 12

treatment

Answer 12

supportive
rest& splintage
antibiotics

Question 13

complications

Answer 13

septicemia, death
metastatic infection
pathological fracture
septic arthritis

Question 14

subacute osteomyelitis

Answer 14

long history
differential diagnosis
tumour
TB

Question 15

Brodie’s abscess

Answer 15

Subacute osteomyelitis

DDx Ewing’s sarcoma

Question 16

chronic osteomyelitis

Answer 16

often mixed infection
usually same organisms each flare up
staph aureus, ecoli, strep pyogenes, proteus

Question 17

treatment

Answer 17

long term antibiotics
local-gentamicin
systemic

Question 18

complications

Answer 18

chronicallly discharging sinus+ flare ups
ongoing metatatic infection
pathological fracture

Question 19

acute septic arthritis

Answer 19

pathology
acute synovitis with purulent joint effusion
complete destruction of articular cartilage

Question 20

treatment

Answer 20

surgical drainage & lavage

Question 21

tuberculosis clinical features

Answer 21

insidious onset
contact with TB 
pain, swelling, loss of weight
low grade pyrexia
joint swelling
decrease ROM ankylosis
deformity

Question 22

TB spinal

Answer 22

little pain

present with abscess or kyphosis

Question 23

diagnosis

Answer 23

long history
involvement on single joint
marked thickening of synovium
marked muscle wasting
periarticular osteoporosis
Ddx transient synovitis

Question 24

treatment

Answer 24

rifampicin
isoniazid
ethambutol 8 weeks
rifampicin and isoniazid 6 to 12 months