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CP3 MDD > Infection of locomotor tissue + bone disease > Flashcards

Infection of locomotor tissue + bone disease Flashcards

1
Q

mortality rate septic arthritis

A

10%

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2
Q

Where does septic arthritis common originate

A

Skin/resp tract

then haematogenous spread

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3
Q

RF septic arthritis (5)

A 
Extremes of age 
Pre-existing joint disease 
IVDU
DM/immunosupp
Recent op
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4
Q

Most common organism septic arthritis

A

Staph aureus

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5
Q

Most common organism septic arthritis - young adults

A

Disseminated gonococcal infection

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6
Q

Most common organism septic arthritis - child

A

Step pneumonia

H influenza

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7
Q

What is osteomyelitis

A

Infection of the bone

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8
Q

Where does osteomyelitis classically target children

A

Metaphyseal plates of long bones

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9
Q

Where does osteomyelitis classically target immunosuppressed adults?

A

Spine

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10
Q

PS bone/joint sepsis (4)

A

Monoarthritis
Hot, swollen, erythematous joint
Loose pack
Knee/hip commonly

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11
Q

O/E joint/bone sepsis (4)

A

Fever + systemic upset
Demonstrable effusion
Decr ROM
Extreme pain in passive movement

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12
Q

DDx septic arthritis

A

Crystal arthritis
Osteomyelitis
Reactive arthritis
Cellulitis

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13
Q

Ix septic arthritis (6)

A

Joint aspiration

Bloods - culture, FBC, ESR/CRP, uric acid, clotting

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14
Q

Mx septic arthritis (8)

A 
A-E + Sepsis 6
Admit under ortho 
Aspirate joint 
2g IV fluclox 6hrly for 2-3 weeks followed by 6w PO 
Monitor ESR/CRP to guide Abx 
Pain relief 
Washout in theatre 
Early active rehab
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15
Q

Use of Xrays in acute septic arthritis?

A

No value in acute diagnosis

Maybe some soft tissue swelling @ fortnight

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16
Q

Xray findings post septic arthritis

A

Narrow joint space

B/c cartilage = destroyed

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17
Q

Pathology osteomyelitis

A

Inflamm –> Incr intraosseous P + pain
Supparation –> pus in medulla –> abscess/sinus
Necrosis
New bone formation

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18
Q

Mx osteomyelitis

A

ABx

+ Controlled interosseous P

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19
Q

When does viral arthropathy tend to occur?

A

During prodromal phase

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20
Q

Is viral arthropathy symmetrical or asymmetrical

A

Symmetrical

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21
Q

Ix viral arthropathy

A

viral titre/antigens

RF

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22
Q

Def Osteoporosis

A

Decr bone mineral density >2.5 SD below that of young adult male

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23
Q

What % of Post-menopausal women will suffer an osteoporotic fracture?

A

50%

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24
Q

T score osteopenia

A

-1 - -2.5

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25
T score osteoporosis
< -2.5
26
RF Osteoporosis (7)
``` Age Female Genetics Low peak bone mass Disuse Smoking CCS use ```
27
Secondary causes osteopororsis (8)
``` 1' HyperPTH Thyrotoxicosis Steroid induced Cushings Anorexia nervosa Malabsorpative conditions Chronic inflammatory disease Malignancy ```
28
PS OP (5)
``` Mostly asymp If Sx : Fragility fractures Back pain Height loss Kyphosis ```
29
Ix OP (8)
DEXA scan Hx (predisposing cause) Exam - endocrine + inflamm disease Bloods: Se Ca, PO4, TFT, ESR,
30
What is a T score
How many SD below a young adult male
31
What is a Z score
How many SD below age-matched control
32
How to calculate probability of fragility fractures for OP patients
FRAX tool (for pt over 50)
33
Low FRAX (<5.0)
Reassure
34
Moderate FRAX (5-7.5)
DEXA
35
High FRAX (>7.5)
DEXA + Tx
36
Mx of pt w/ osteopenia
Lifestyle advice e.g. stop smoking/alcohol Increase Ca + exercise Repeat DEXA scans
37
Medical Mx of established OP
Vit D + Ca Weekly bisphosphonates Denusomab S/C every 6 months HRT if pre-mature menopause
38
1st line weekly bisphosphonates - OP
Alendronic acid
39
How does alendronic acid work
Decreases bone resportion | Allows mineralisation to increase
40
If Alendronic acid is not tolerated, what bisphosphonate is 2nd line?
Risdronate
41
What is Denusomab
Monoclonal AB that inhibits osteoclast activity
42
SE Aldendronic acid
GI/Ulcer | Jaw necrosis
43
What is Osteomalacia
Normal bone tissue but inadequate bone mineralisation
44
Cause osteomalacia
Vit D deficiency
45
What is Rickets
Syndrome resulting from osteomalacia in growing skeleton
46
Deformities in Rickets (2)
Knock knee | Bow legs
47
Why does low Vit D lead to loss of Ca and PO4 from bone
Norm: Vit D --> Incr Ca uptake from intestines + decr Ca excretion If Low Ca - PTH secreted --> 2' hyperPTH Stims osteoclastic bone resportion, decr Ca excretion _ Incr PO4 excretion
48
RF vit D deficiency (5)
``` Inadequate intake Inadequate synthesis (house bound) Renal disease Liver disease Drugs ```
49
PS Osteomalacia
Bone pain Fragility + # Insidious - malaise + weakness
50
Ix Vit D deficiency/Osteomalacia (+results) (6)
``` U+E ALP incr Plasma Ca - low/norm Se PO4 = low PTH = high Se Vit D = low ```
51
XR features osteomalacia (3)
Norm Or looser zones Children - widening epiphyseal plate
52
Mx osteomalacia
PO VIt D High dose 4 w then maintenance Activated vit D if hepatic/renal disease
53
What is the difference between osteoporosis + osteomalacia
OP - decr bone mass w/ norm ratio mineral: matrix | OM - Mineral to matrix ratio = decreased
54
Who gets Paget's disease of hte bone
elderly
55
Pathophysiology Paget's disease of the bone
XS uncontrolled resportion of bone by large multinucleated osteoclasts Destruction of cortical + trabecular bones in waves Each wave = followed by osteoblastic response
56
Bone changes Pagets
XS resorption + destruction --> defective bone architechture w/ incr bone bulk + weaker New bone is woven, non-lamellar + fibrous
57
What % of Pagets are asymp
80%
58
Sx Pagets
Waxing + waning bone pain Bone deformities CN palsy Cardiac failure
59
Classic textbook PS Pagets
Bone pain Patho # Deafness
60
Which CN is classically affected in Pagets?
CN VIII
61
Which 2 bones are classically affected by deformites in Pagets
Tibia (bowing) | Skull
62
Which other condition does Pagets greatly (x30) increase your risk of developing?
Osteogenic Sarcoma
63
Ix Pagets (5)
``` Bloods ALP - incr Ca/PO4 norm Urine: incr Hydroxyproline XR - lytic/sclerotic Bone Scan ```
64
Tx Pagets (3)
Analgesia Bisphosphonates Monitor Se ALP
65
When is surgery indicated in Paget's Tx (2)
Joint disease | Neuro complications
66
What is osteonecrosis
Ischaemic bone necrosis | Due to BM cells dying within 12hrs
67
What is osteonecrosis called if in the shaft
Bone infarction
68
What is osteonecrosis called in the epiphysis of the bone
Avascular necrosis
69
Common causes osteonecrosis
Interupted blood supply - # | Interrupted vv drainage - thrombus/BM swelling
70
RF osteonecrosis (6)
``` # e.g. NOF/Scaphoid Idiopathic - Perthe's, AVN femoral head BM infiltration - malignancy Alcohol Cushings/CCS Infection - septic arthritis ```
71
Target sites osteonecrosis (4)
Head of femur Proximal scaphoid Lunate Body of talus
72
PS Osteonecrosis (4)
Well advanced at PS Pain Stiffness Swelling in joint
73
Ix osteonecrosis (2)
XR - incr density | MRI/Radionucleotide scan
74
How long does it take for osteonecrosis to show up on XR
6 months
75
Mx Osteonecrosis (3)
ID + eliminate cause Prevent complications - W relief + splinting Surgery
76
Osteopenia - Ca, PO4, ALP, PTH levels
Ca norm PO4 norm ALP norm PTH norm
77
Osteopetrosis - Ca, PO4, ALP, PTH levels
Ca norm PO4 norm ALP elevated PTH norm
78
Osteomalacia/Rickets - Ca, PO4, ALP, PTH
Ca decr PO4 decr ALP incr PTH incr
79
Paget's disease of the bone - Ca, PO4, ALP, PTH
Ca norm PO4 norm ALP variable PTH norm

CP3 MDD (13 decks)

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