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Musculoskeletal System > Infection in Bones and Joints > Flashcards

Infection in Bones and Joints Flashcards

1
Q

Acute osteomyelitis

A

Infection in bone

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2
Q

Who tends to get acute osteomyeltitis

A

Children, males

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3
Q

History of disease in acute osteomyelitis

A

Diabetes, arthritis, immune compromise, long term steroid use, sickle cell anaemia

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4
Q

What is the usual source of infection of acute osteomyelitis

A

Usually blood borne and tends to be from a local spread of infection.

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5
Q

Usual cause of acute osteomyelitis in infants

A

Infected umbilical chord

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6
Q

Usual cause of acute osteomyelitis in children

A

Boils, tonsilitis, skin abrasions

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7
Q

Usual cause of acute osteomyeltitis in adults

A

UTI or vascular line

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8
Q

Most common organism to cause acute osteomyelitis

A

Staphylococcus Aureus

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9
Q

Organism cause of acute osteomyelitis in infants

A

Staph, group B strep and Ecoli

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10
Q

Organism cause of acute osteomyelitis in children

A

Streptococcus pyogenes and H.influenza

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11
Q

Organism cause of acute osteomyelitis in adults

A

Staph aureus, coagulase negative strep, strep pyogens

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12
Q

Mixed infection osteomyeleitis tends to occur when

A

Diabetic foot and pressure sores

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13
Q

Patients with sickle cells disease can get what organism AO

A

Salmonella

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14
Q

Describe the pathogenesis of Acute Osteomyelitis

A

The infection starts at the metaphysis resulting in vascular stasis, inflammation, suppuration and then a release of pressure (into the medulla, subperiosteal space of the joint). There is then necrosis of the bone (sequestrum). The bone then tries to heal itself by forming new bone (involcrum). If treatment is started early there can be resolution.

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15
Q

Presentation of Acute Osteomyelitis in infants

A

Failure to thrive, drowsy and irritable, metaphyseal tenderness and swelling, decreased range of movement in one limb and may be positional change

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16
Q

Presentation of Acute Osteomyelitis in Children

A

Severe pain, reluctant to move and no bearing of weight, always consider the hip if there is knee pain, fever and tachycardia, there may also be malaise

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17
Q

Presentation of Acute Osteomyelitis in Adults

A

Often in the back, back pain (keeps the patient awake during the night), history of UTI or urological procedure, elderly, diabetic. Secondary infection (after surgery or open fracture more common)

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18
Q

How is acute osteomyelitis diagnosed

A

FBC and increase WCC, raised ESR and CRP, three blood cultures taken, U+Es (ill and dehydrated), X-ray (showing metaphyseal destruction after 14 days), US, Aspiration, Isotope bone scan, labelled WCS

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19
Q

Best way to diagnose Acute Osteomyelitis

A

MRI

20
Q

State the microbiological tests conducted into Acute Osteomyelitis

A

Blood culture, bone biopsy, tissue or swabs from up to five sites around implant at debridement in prosthetic infection

21
Q

How is Acute Osteomyelitis Managed

A

Analgesia and fluids, rest and splintage, antibiotics for 4-6 weeks (the usual choice being fluxociliin and benzylpenicillin), monitor ESR

22
Q

Indications for surgical treatment in Acute Osteomyelitis

A

Aspiration of pus for diagnosis

Abscess drainage

Debridement of dea or infection tissue or bone

Refractory to non-operative treatment >24-48 hours

23
Q

Complications of acute osteomyelitis

A
  • Septicaemia
  • Metastatic infection
  • Pathological fracture
  • Septic arthritis
  • Altered bone growth
  • Chronic osteomyelitis
24
Q

Subacute osteomyelitis

A

Infection of the bone that occurs in a patient with a good immune system or a bacteria with lowered virulence

25
Q

Clinical features of subacute osteomyelitis

A

Longer history, variable symptoms in the pain or lump, localised swelling and tenderness

26
Q

Brodies Abscness

A

Subacute osteomyelitis in older children with painful limb and no systemic features

27
Q

Treatment of subacute osteomyelitis

A

Curategge and prolonged course of antibiotics

28
Q

Chronic osteomyelitis clinical features

A

Has a more slow onset, fever, pain, redness or discharge at the site of infection. May be periods of remission

29
Q

State the main organisms in chronic osteomyelitis

A

Staph aureus, E.coli, strep pyogenes, proteus

30
Q

Pathology of chronic osteomyelitis

A

Cavitis, sinuses, alongside areas of sequestra.

31
Q

Treatment of chronic osteomyelitis

A

Multiple debridement, local and systemic antibiotics (gentamicin cement and oral or IV antibiotics)

32
Q

Complications of chronic osteomyelitis

A

Chronically discharging sinus and recurrent flare ups, ongoing infection, pathological fractures, growth disturbances and deformities, squamous cell carcinoma

33
Q

Acute Septic Arthritis

A

Inflammation of a joint caused by infection

34
Q

How does septic arthritis occur

A

Direct invasion from a penetrating wound, intra-articular injury, arthroscopy, eruption of bone abscesses or haematological spread

35
Q

State the common causative organisms of septic arthritis

A
  • Staph aureus
  • H.influenza
  • Strep.pyogens
  • E.coli
36
Q

Pathology of acute septic arthritis

A

Acute synovitis with purulent joint effusion. The articular cartilage is attakced by bacterial toxin and cellular enzymes resulting in complete destruction of it

37
Q

Presentation of septic arthritis in neonates

A

Septicaemia

38
Q

Presentation of septic arthritis in children

A

Acute pain in a single largely swollen joint in which the patient is reluctant to move, increased temperature and pulse.

39
Q

Presentation of septic arthritis in adults

A

Superficial joint involvement

40
Q

Investigations of septic arthritis

A

FBC, WBC, EST, CRP, blood cultures. The X-ray tends to not show very much; ultrasound will show intense effusion within the joint. Aspiration is often helpful in diagnosing the organism responsible.

41
Q

Treatment of septic arthritis

A

Antibiotics, surgical drainage and lavage

42
Q

Clinical Features of bone TB

A

insidious onset and general ill health, contact with TB, pain, swelling, loss of weight, low grade pyrexia, joint swelling, decreased range of movement, ankyloses and deformity

43
Q

Spinal TB presentation

A

Little pain, presents with abscess of kyphosis

44
Q

Investigation of BONE TB

A

FBC, ESR, mantoux test, sputum/urine culture. May see changes on X-ray – soft tissue swelling, periarticular osteopaenia and articular space narrowing.

45
Q

Treatment of bone TB

A

It tends to involve mainly chemotherapy: rifampicin, isoniazid, ethambutol for 8 weeks then rifampicin and isoniazid for six to twelve months

Musculoskeletal System (34 decks)

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