Infective (Septic and Osteomyelitis)

Question 1

What is Septic Arthritis (EMERGENCY)

Answer 1

Bacterial infection of joints by direct access or haeamatogenous spread

Question 2

How does a septic arthritis patient present

Answer 2

Acutely inflamed joint w/fever
Extreme Pain
Can destroy joint in 24 hrs

Question 3

What are the causative organisms for Septic Arthritis

Answer 3

S Aureus (MC)
H Influenzae (Children)
N Gonorrhea
E Coli and Pseudomonas in IVDU

Question 4

Why is H Influenzae now an uncommon cause for Septic arthritis in Children

Answer 4

Vaccine available

Question 5

A patient has septic arthritis of a prosthetic joint, what is the most likely causative

Answer 5

S Epidermidis

-Negative Staph

Question 6

What are the RF for Septic Arthritis

Answer 6

IVDU
Immunosuppressed
Recent surgery/ trauma
Prosthetic joints

Question 7

How is septic arthritis investigated

Answer 7

Urgent Joint Aspirate w/ MC+S and polarised light MS
Raised ESR/CRP
Blood culture (Gonococcal cause?)
Sexual health review (Gonorrhea cause?)

Question 8

How is Septic arthritis managed

Answer 8

Joint aspirate/drain w/ ABx
Stop Methotrexate/Anti TFN
Double Prednisolone (If taking)
Analgesia w/ NSAIDs

Question 9

If Septic arthritis is caused by Gram Negative bacteria, what must be given to the patient alongside joint aspirate

Answer 9

Flucloxacillin

Question 10

If Septic arthritis is caused by MRSA/ Gram Positive bacteria, what must be given to the patient alongside joint aspirate

Answer 10

Vancomycin

Question 11

If Septic arthritis is caused by Gonorrhea, what must be given to the patient alongside joint aspirate

Answer 11

IM Ceftriaxone and Azithromycin

Question 12

What drugs must be stopped when treating Septic arthritis

Answer 12

Methotrexate

Anti TFN

Question 13

What is Osteomyelitis

Answer 13

Acutely Inflamed Bone Marrow due to haematogenous/ local spread from infection/trauma

Question 14

Who is most prone to osteomyelitis

Answer 14

Children via haematogenous spread

Question 15

What are the causative organisms of Osteomyelitis

Answer 15

S Aureus

Salmonella in SCD

Question 16

Why is SCD a RF for Osteomyelitis

Answer 16

Salmonella typically affects them more in Osteomyelitis

Question 17

What are the RF for Osteomyelitis

Answer 17

IVDU
Immunosupressed
PVD/DM/SCD
Inflammatory arthritis 
Trauma and infection

Question 18

What is the Pathology of Osteomyelitis

Answer 18

Direct/ Local/ Haematogeous spread of infection = Inflammation and Bone OEDEMA

Question 19

What can severe inflammation and bone oedema in osteomylytis lead to

Answer 19

Sequestra (Necrotic bone in pus)

Involucrum (Thick sclerotic bone around sequestra to compensate)

Question 20

What is Sequestra

Answer 20

necrotic bone found in pus and can be surrounded by Involucrum

Question 21

What is Involucrum

Answer 21

Thick sclerotic bone compensating sequestra

Question 22

What are the presentations of Osteomyelitis

Answer 22

Dull Bony Pain that is Hot and Swollen
Worse with moving
Deep ulcers (Sequestra Sx)

Question 23

What is a differential for Osteomyelitis

Answer 23

Charcot joint

• Diabetic foot as a result of nerve loss to diabetic neuropathy
• Weight bearing joint degradation
• Bony Destruction

Question 24

How is Osteomyelitis Investigated

Answer 24

BM Biopsy w/ Culture and MC+S
Xray = Osteopenia
MRI = BM Oedema
Raised ESR/CRP

Question 25

Why is MC+S done for Osteomyelitis

Answer 25

To Identify the causative organism

Question 26

How is Osteomyelitis managed

Answer 26

Immobilise and ABx

Question 27

What ABx should be given to an Osteomyelitis patient suffering from MRSA/S Aureus

Answer 27

Vancomycin

Question 28

What ABx should be given to an Osteomyelitis patient suffering from S Aureus

Answer 28

Flusidic acid

Question 29

What ABx should be given to an Osteomyelitis patient suffering from Salmonella

Answer 29

Flucloxacillin