*MOVED*Advanced Infection Flashcards
“Kissing sequestrum” are seen with… A. Syphilis B. Tuberculosis C. Nocardiosis D. Coccidioidomycosis
B. Tuberculosis
The most common joints affected by septic arthritis in infants, children and adults are… A. Knee and hip B. Ankle and knee C. Hip and shoulder D. Knee and shoulder
A. Knee and hip
The presence periarticular osteoporosis, marginal joint erosions and slow progressive joint space loss is known as… A. Ritter’s triad B. Phemister’s triad C. Webster’s triad D. Foley’s triad
B. Phemister’s triad
Where is hematogenous osteomyelitis encountered more frequently in adults? A. Skull B. Spine C. Long bones of the extremities D. Short tubular bones of the extremities
B. Spine
In addition to Staphylococcus aureus, which of the following agent is more likely to be involved in septic arthritis of the sternoclavicular joint in the parenteral drug abusers? A. Haemophilus influenzae B. Pseudomonas aeruginosa C. Escherichia coli D. Mycobacterium tuberculosis
B. Pseudomonas aeruginosa
Tuberculosis in long tubular bones usually originates in the? A. Epiphysis B. Metaphysis C. Diaphysis D. Two of the above
A. Epiphysis
Cellulitis… A. Affects intravenous drug addicts B. Is an acute inflammatory process of the epidermal cells C. Never affects the thorax D. Antibiotic therapy rarely improves the condition
A. Affects intravenous drug addicts
Which of the following is false concerning cystic tuberculosis? A. It is encountered much more frequently in children than in adults. B. These lesions usually affect the peripheral skeleton. C. The metaphyseal region of tubular bones is favored. D. The lesions are generally accompanied by sclerosis.
D. The lesions are generally accompanied by sclerosis.
The breakdown of soft tissue that occurs in debilitated persons who maintain a single position for long periods is referred to as a A. Callus B. Pelvic sequestrum C. Decubitus ulcer D. None of the above
C. Decubitus ulcer
Infection of the symphysis pubis can radiographically simulate… A. CPPD B. Osteitis pubis C. OCI D. Paget’s disease
B. Osteitis pubis
The visualization of a metaphyseal defect connected with the growth plate by a radiolucent tract ensures the diagnosis of… A. Fracture B. Pyogenic infection C. Non-pyogenic infection D. Aneurysmal bone cyst
B. Pyogenic infection
A sclerotic non-purulent form of osteomyelitis characterized by intense proliferation of the periosteum leading to bony deposition is termed? A. Sclerosing osteomyelitis of Garré. B. Chronic recurrent non-suppurative osteomyelitis. C. Bone abscess (Brodie’s abscess). D. Acute non-infective hyperostosis.
A. Sclerosing osteomyelitis of Garré.
Septic arthritis is more commonly… A. A polyarticular condition B. A monoarticular condition C. A sexually transmitted condition D. A disease of the sexually inactive
B. A monoarticular condition
An unusual presentation of tuberculous erosions of the humeral head A. Weaver’s bottom B. Caries sicca C. Gouge defect D. Caries humerus
B. Caries sicca
In older syphilitic children, bilateral painless effusions, especially of the knee, have been termed_ joints. A. Brown’s B. Poncet’s C. Clutton’s D. Tom Smith’s
C. Clutton’s
In which of the following age group does hematogenous osteomyelitis have a higher complication rate of growth arrest or asymmetrical growth maturation? A. Infants B. Children C. Adults D. Both b and c are correct
A. Infants
A large parrot-beak-like osteophyte has been reported as a characteristic feature of which of the following spinal infection? A. Meningococcemia B. Brucella C. Klebsiella D. Salmonella
B. Brucella
Undercooked pork or pork sushi results in infections with which organism? A. Cysticercosis B. Tuberculosis C. Staph aureus D. Pseudomonas
A. Cysticercosis
This syndrome, usually transmitted as an X-linked recessive trait, is characterized by purulent granulomatous and eczematoid skin lesions, granulomatous lymphadenitis with suppuration, hepatosplenomegaly, recurrent and persistent pneumonias, and chronic osteomyelitis; it frequently is fatal. It is know as… A. Chronic granulomatous disease B. SAPHO syndrome C. Sarcoidosis D. Carcinoid tumor
A. Chronic granulomatous disease
A cortical abscess can be radiographically visualized as a lucent lesion with surrounding sclerosis and periostitis. This appearance can simulate which of the following conditions? A. Osteoid osteoma B. Stress fracture C. Non-ossifying fibroma D. Both a and b are correct
D. Both a and b are correct
What is the primary infectious route for coccidiodomycosis? A. Respiratory B. Implantation C. Gastrointestinal D. Genitourinary
A. Respiratory
The most common neoplasm encountered in osteomyelitis is.. A. epidermoid carcinoma B. Basal cell carcinoma C. Plasmacytoma D. Angiosarcoma
A. epidermoid carcinoma
Paronychia is… A. An infection of the hair bed. B. A loculated abscess of the dermal portion of the skin. C. A subcuticular abscesses of the nail fol D. An infected mole
C. A subcuticular abscesses of the nail fol
Which of the following is not a complication of septic arthritis? A. Overgrowth of the epiphyses and apophyses B. Epiphyseal displacement C. Myositis ossificans surrounding the involved joint D. Degenerative joint disease
C. Myositis ossificans surrounding the involved joint
Brodie’s abscess are found more commonly in children, typically in boys and particularly in the… A. Femur B. Tibia C. Radius D. Humerus
B. Tibia
Sacroiliac joint infections are usually… A. Bilateral and symmetric B. Bilateral and asymmetric C. Unilateral D. Both a and b are correct
C. Unilateral
The four cardinal signs of Kanavel are used to diagnose clinically… A. Tenosynovitis of the tendon sheath of the fingers. B. Septic arthritis of the midcarpal compartment. C. Septic arthritis of the metacarpophalangeal joints of the fingers. D. Septic arthritis of the proximal interphalangeal joints of the fingers
A. Tenosynovitis of the tendon sheath of the fingers
What type of tumor occurs within the sinus tract in patients with long term chronic osteomyelitis? A. Giant cell tumor B. Osteosarcoma C. Chondrosarcoma D. Squamous cell carcinoma
D. Squamous cell carcinoma
What is the most common fungal infection of the skeleton worldwide? A. Maduromycosis B. Tuberculosis C. Coccidiodomycosis D. Candidiasis
A. Maduromycosis
What is the most commonly encountered skeletal involvement in actinomycosis? A. Mandible B. Tibial tuberosity C. Femoral diaphysis D. Spine
A. Mandible
Which of the following joints is less likely to be affected by septic arthritis in the drug abuser? A. Sacroiliac B. Sternoclavicular C. Acromioclavicular D. Ankle
D. Ankle
Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae are responsible for most cases of hematogenous osteomyelitis in which of the following age group? A. Neonate or infant. B. Children over the age of 1 year and less than 4 years. C. Children older than 4 years. D. Teenagers.
B. Children over the age of 1 year and less than 4 years.
The presence of pustulosis palmaris, sternoclavicular hyperostosis and recurrent osteomyelitis in a child should warrant further investigation to rule out… A. Chronic granulomatous disease B. SAPHO syndrome C. Sarcoidosis D. Carcinoid tumor
B. SAPHO syndrome
Gonococcal arthritis closely resembles both radiographically and clinically which of the following conditions? A. Rheumatoid arthritis B. Gout C. Psoriatic arthritis D. Reiter’s syndrome
D. Reiter’s syndrome
Wimberger’s sign is associated with A. congenital syphilis B. Tuberculosis C. Leprosy D. Coccidioidomycosis
A. congenital syphilis
Where are spinal epidural abscesses more commonly seen? A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacro-coccygeal region
B. Thoracic spine
Which of the following choices is not associated with osteomyelitis of the hand from direct implantation? A. Human bites. B. Animal bites. C. Open fractures and dislocations. D. All of the above would cause osteomyelitis by direct implantation.
D. All of the above would cause osteomyelitis by direct implantation.
Which of the following plantar muscle compartment provides a pathway by which an infection can spread from the plantar aspect of the foot into the lower leg? A. Medial B. Intermediate C. Lateral D. None of the above
B. Intermediate
The radiographic latent period for spinal osteomyelitis / spondylodiscitis is approximately A. 3 days B. 3 weeks C. 3 months D. 3 years
B. 3 weeks
Which of the following clinical presentation of hematogenously spread osteomyelitis is true? A. Childhood osteomyelitis is always associated with a sudden onset of high fever, a toxic state, and local signs of inflammation. B. As many as 50 % of children with osteomyelitis have vague complaints, including local pain of 1 to 3 months’ duration with minimal if any temperature elevation. C. In the infant, hematogenous osteomyelitis often leads to very dramatic findings, including pain, swelling, high-grade fever, nausea, an unwillingness to move the affected bones and loss of consciousness. D. The adult form of hematogenous osteomyelitis usually has a rapid onset with a relatively short period between the appearance of symptoms and signs and accurate diagnosis.
B. As many as 50 % of children with osteomyelitis have vague complaints, including local pain of 1 to 3 months’ duration with minimal if any temperature elevation.
Osteomyelitis leading to destruction of the distal tuft and diaphysis of the terminal phalanx with relative sparing of the phalangeal base is a possible complication seen with… A. A melon B. A pelon C. A felon D. A belon
C. A felon
Expansile tuberculous dactylitis has also been termed… A. Hand-foot syndrome B. Sausage digit C. Spina ventosa D. Scrofula
C. Spina ventosa
Subperiosteal abscess formation, extensive periostitis, and involucrum formation are relatively unusual manifestations of osteomyelitis in which of the following age group? A. Infants B. Children C. Adults D. People over 200 years old
C. Adults
- Spontaneous atlantoaxial subluxation that accompanies inflammation of neighboring soft tissues (rhinopharyngitis) seen mainly in children is termed? A. Grisel’s syndrome B. Jones’ syndrome C. McGreggor’s syndrome D. Julius’ syndrome
A. Grisel’s syndrome
Which of the following is false about septic arthritis? A. Rapid destruction of bone and cartilage is characteristic of bacterial arthritis. B. In tuberculous arthritis, marginal osseous erosions with preservation of joint space and periarticular osteoporosis can be prominent. C. Osseous erosions at the edges of the joint, related to the effects of diseased synovium on bone, lead to marginal defects that are similar in appearance and location to those of rheumatoid arthritis. D. Bony ankylosis of the joint is not characteristic of late stage chronic pyogenic arthritis.
D. Bony ankylosis of the joint is not characteristic of late stage chronic pyogenic arthritis.
The presence of small elongated fragments of low signal intensity on all MRI sequences associated with hypertrophied synovium in a patient afflicted with tuberculous arthritis are called… A. Green peas B. Mustard synovium C. Rice bodies D. Pepper flakes
C. Rice bodies
Acute inflammatory process of the deeper subcutaneous tissues resulting generally from a streptococcal or, less commonly, a staphylococcal infection, leading to pain or tenderness, redness, swelling, warmth, and mild to moderate fever is known as… A. Pyomyositis B. Necrotizing fasciitis C. Cellulitis D. Tenosynovitis
C. Cellulitis
Maduromycosis most commonly involves which region? A. Tarsometatarsal B. Carpometacarpal C. Glenohumeral D. Femorotibial
A. Tarsometatarsal
Infectious ischial tuberosity bursitis is also know as… A. Rider’s bone B. Weaver’s bottom C. Chronic repetitive sitting friction syndrome D. Drop the soap syndrome
B. Weaver’s bottom
The most common joints affected by skeletal tuberculosis are… A. The spine, ankle, shoulder B. The spine, hip, knee C. The shoulder, ankle, knee D. The wrist, hip, knee
B. The spine, hip, knee
The presence and extent of soft tissue infection is not commonly evaluated with A. Magnetic resonance imaging B. Computed tomography C. Biopsy D. Scintigraphy
C. Biopsy
Which of the following is not characteristic of “puffy hand syndrome” A. Infrequent in drug addicts B. May follow local injections with contaminated needles C. Related to lymphedema from lymphatic destruction and fibrosis of subcutaneous tissue D. Bilateral swelling of the dorsum of the hand
A. Infrequent in drug addicts
The earliest radiographic sign of acute hematogenous osteomyelitis in children is… A. Displacement of the adiacent fat planes. B. Obliteration of the adjacent fat planes. C. Cortical destruction. D. Localized periosteal reaction.
A. Displacement of the adiacent fat planes.
Which of the following is not seen in the clinical presentation of a patient with congenital syphilis ? A. Saddle nose B. Hutchinson’s teeth C. Saber shin deformity D. Valgus deformity of the knees
D. Valgus deformity of the knees
Guinea worm disease is also known as: A. Dracunculiasis B. Loiasis C. Moya moya D. Cryptococcosis
A. Dracunculiasis
Which of the following is not commonly seen in tuberculous arthritis: A. Soft tissue swelling B. Osteoporosis C. Fast progression D. Late joint space loss
C. Fast progression
Septic spondylitis most typically involves the A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacroiliac joints
C. Lumbar spine
An increase in the medial joint space of the hip by over 2 mm compared with the contralateral side and/or a joint space measuring more than 11 mm is known radiographically as… A. Turret’s sign B. Obturator sign C. Waldenstrom’s sign D. Gluteus medius sign
C. Waldenstrom’s sign
A metaphyseal infection of the proximal portion of the humerus spreading through the adjacent cortex can contaminate the glenohumeral joint by extending along the tendon of the… A. Supraspinatus B. Infraspinatus C. Subscapularis D. Long head of the biceps
D. Long head of the biceps
In infants, group B streptococcus typically involves a single bone, particularly the… A. Tibia B. Femur C. Humerus D. Radius
C. Humerus
Which of the following types of calcific deposits is seen in tuberculous psoas abcesses? A. Psammomatous calcification B. Conduit-wall calcification C. Teardrop-shaped calcification D. Cyst-wall calcification
C. Teardrop-shaped calcification
A slowly progressive vertebral destruction with preservation of intervertebral discs, subligamentous spread of infection with erosion of anterior vertebral margins, large and calcified soft tissue abscesses, and the absence of severe bony eburnation are the radiographic signs associated with… A. Pyogenic spondylitis B. Suppurative spondylitis C. Tuberculous spondylitis D. Staphylococcal spondylitis
C. Tuberculous spondylitis
Sequential contamination of the tendon sheath of the fifth finger, ulnar bursa, radial bursa, and first finger produces… A. The devil sign B. The U or V sign of Pimenti C. The horseshoe abscess D. The common flexor sign
C. The horseshoe abscess
Acute kyphosis of Pott’s disease is sometime associated with the presence of… A. Square vertebra B. Long vertebra C. Barrel-shaped vertebra D. Picture frame vertebra
B. Long vertebra
Localized premature fusion of the central aspect of the physes, in a bilateral and relatively symmetric distribution, resulting in a cupped or cone-shaped metaphysis with epiphyseal disintegration, bowing and angular deformities especially in the legs and limb shortening are possible complications of which of the following infection in children? A. Meningococcemia B. Brucella C. Klebsiella D. Salmonella
A. Meningococcemia
In cases of direct implantation coccidiodomycosis, which structure is most commonly affected? A. Tibial tuberosity B. Pisiform C. Olecranon D. Calcaneus
A. Tibial tuberosity
The sudden onset of lower limb paraplegia in spinal tuberculosis is referred to as A. Pott’s paraplegia B. Saunder’s paraplegia C. Phemister’s paraplegia D. Waldenstrom’s paraplegia
A. Pott’s paraplegia
The “rind” sign in computed tomographic images is described as a(n) A. Ovoid mass of increased tissue attenuation that enhances after intravenous administration B. Ovoid mass of decreased tissue attenuation that enhances after intravenous administration C. Rim of increased tissue attenuation that enhances after intravenous administration of contrast material D. Rim of decreased tissue attenuation that enhances after intravenous administration of contrast material
C. Rim of increased tissue attenuation that enhances after intravenous administration of contrast material
Which of the following agent is frequently involved in osteomyelitis or septic arthritis of the foot seen in patients walking barefoot on nails, glass and other sharp objects? This agent has a propensity for infecting cartilage. A. Streptococcus pyogenes B. Haemophilus influenzae C. Pseudomonas aeruginosa D. Salmonella
C. Pseudomonas aeruginosa
Because of the anatomic arrangement of the joint, osteomyelitis localized to the metaphysis can enter the joint by extending laterally without violating the growth plate. A. Ankle B. Knee С. Hip D. Elbow
С. Hip
Osteomylelitis on a MR T1-weighted spin echo image intensity produces a A. low signal B. high signal C. variable signal D. intermediate signal
A. low signal
Radiolucent linear or netlike collections seen on radiographs within the subcutaneous or muscular tissues should warrant further investigation for… A. Tuberculosis B. Syphilis C. Gas gangrene D. Pasteurella infections
C. Gas gangrene
When performing a scintigraphic evaluation for the presence of osteomyelitis, the advantage of the agent 67 Ga-citrate over 99m Tc-methylene diphosphonate is… A. It is sensitive to osteoblastic activity B. It binds with leukocytes C. It is dependant on the increased localized blood flow D. It is cheaper to use
B. It binds with leukocytes
Rice grain calcifications of the soft tissues are characteristic of what disease? A. Cysticercosis B. Echinococcosis C. Rubella D. Toxoplasmosis
A. Cysticercosis
Which of the following is true regarding childhood discitis? A. Hematogenous contamination of the discal tissue is possible. B. When positive, blood or bone biopsy culture most typically reveals Mycobacterium tuberculosis. C. Radiographic changes are most frequent in the cervical spine. D. Intervertebral disc space narrowing is seen radiographically after the erosion of the subchondral bone plate and osseous eburnation.
A. Hematogenous contamination of the discal tissue is possible.
Which of the following area of the foot is not a common location to observe contamination of the skin and subcutaneous tissue at pressure points, leading to infective osteitis, osteomyelitis, and septic arthritis of adjacent bones and joints in a patient with diabetes mellitus? A. Calcaneus B. Metatarsophalangeal joint C. Terminal phalanges D. Longitudinal arch of the foot
D. Longitudinal arch of the foot
Which of the following are NOT included in the fungal diseases affecting bone? A. Coccidiodomycosis B. Histoplasmosis C. Candidiasis D. Echinococcus
D. Echinococcus
Which of the following vascular anatomic description is characteristic for children over 1 year old? A. There is no vascular connection between the epiphysis and the metaphysis. B. A vascular connection between the metaphysis and epiphysis exists. C. The vascular supply of the epiphysis originates in the metaphysis. D. The vascular supply of the epiphysis originates in the growth plate.
A. There is no vascular connection between the epiphysis and the metaphysis.
The direction of contamination in hematogenous osteomyelitis is A. From the soft tissue inward toward the bone B. From the bone outward into the soft tissue C. From the growth plate into the diaphysis D. From the spinal canal to the bone
B. From the bone outward into the soft tissue
In the young patient population (infants and children), hematogenous osteomyelitis more commonly affects which of the following bones? A. Skull B. Spine C. Long bones of the extremities D. Short tubular bones of the extremities
C. Long bones of the extremities
The term osteomyelitis refers to: A. Infection of the cortical bone B. Infection of the marrow C. Infection of the bone and marrow D. Infection of the bone and adjacent soft tissues
C. Infection of the bone and marrow
Human infection with animal exposure, bites or scratches is associated with A. Brucella B. Yersinia C. Pasteurella D. Klebsiella
C. Pasteurella
Which of the following is not a radiographic sign of congenital syphilis? A. osteochondritis B. diaphyseal osteitis C. Campagnacci’s sign D. periostitis
C. Campagnacci’s sign
Muscle enlargement, abscesses, subcutaneous edema and hard, “woody” induration of the overlying skin are characteristic of… A. Pyomyositis B. Necrotizing fasciitis C. Cellulitis D. Tenosynovitis
A. Pyomyositis
When septic arthritis is considered in a differential diagnosis, which of the following diagnostic procedure should be recommended? A. Joint aspiration with subsequent culture. B. Bone scintigraphy. C. Conventional tomography. D. Computerized tomography.
A. Joint aspiration with subsequent culture.
Resorption of cortical bone due to the inflammatory reaction about a gumma frequently is termed… A. caries sicca B. caries necrotica C. caries sequestra D. caries osteoma
A. caries sicca
Metaphyseal lesions in long bones characterized by symmetry, linear areas of radiolucency ,and increased bone density, producing a longitudinally oriented striated pattern (celery stalk appearance) is seen with which of the following conditions? A. Rubella B. Syphilis C. Varicella D. Variola
A. Rubella
Profuse involucrum formation is characteristic of osteomyelitis in the… A. Infants B. Children C. Adults D. Both a and care correct
A. Infants
Subligamentous extension of an abscess associated with mild contour irregularity (gouge defects) and sparing of the intervertebral discs is classically associated with… A. Tuberculosis B. Syphilis C. Pyogenic spondylitis D. Coccidioidomycosis
A. Tuberculosis
Which of the following differential diagnosis is unlikely in a 5 year old male with ill-defined metaphyseal moth eaten pattern of bone destruction with associated aggressive periosteal reaction? A. Osteomyelitis B. Ewing’s sarcoma C. Chondroblastoma D. Osteosarcoma
C. Chondroblastoma
The combination of rapid loss of intervertebral disc height and adjacent lysis of bone is most suggestive of… A. Metastatic disease B. Multiple myeloma C. Infective spondylitis D. Osteoporosis
C. Infective spondylitis
The presence of gas in the soft tissues of the foot can be due any of the following agents but one. Which of the following agent does not produce gas as an end result of its metabolic activity? A. Clostridium perfringens B. Escherichia coli C. Staphylococcus aureus D. Klebsiella pneumoniae
C. Staphylococcus aureus
During a magnetic resonance imaging scan with gadolinium contrast performed on a patient suspected to have osteomyelitis, the presence of a ring enhancing lesion of high signal intensity on T1-weighted images with a low signal center most likely represents alan… A. Sequestrum B. Involucrum C. Cloaca D. Abscess
D. Abscess
The term infective (suppurative) osteitis refers to: A. Infection of the cortical bone B. Infection of the marrow C. Infection of the bone and marrow D. Infection of the bone and adjacent soft tissues
A. Infection of the cortical bone
In patients at age 6 months to 5 years________ is a common cause of septic arthritis. A. H. influenzae B. S. aureus C. P. aeruginosa D. E. coli
A. H. influenzae
Linear calcification of nerves with a radiographic presentation of “licked candy-stick” appearance in the feet of a patient should warrant further investigation for… A. Syphilis B. Diabetes mellitus C. Hansen’s disease D. Tuberculosis
C. Hansen’s disease
The term involucrum refers to: A. A fractured bony fragment displaced away from its parent bone caused by osteomyelitis. B. A layer of living bone that has formed around the dead bone. C. An opening between the skin surface and the bone. D. A segment of necrotic bone that is separated from living bone by granulation tissue
B. A layer of living bone that has formed around the dead bone.
The term cloaca refers to: A. An opening in the involucrum, through which pus may be discharged outside the bone. B. An opening between the skin surface and the bone. C. An opening between an infected epiphysis and an adjacent synovial joint. D. A layer of living bone that has formed around the dead bone
A. An opening in the involucrum, through which pus may be discharged outside the bone.
The clinical presentation of vascular insufficiency, neurologic deficit, soft tissue swelling and mottled osteolysis of the foot should warrant an investigation to rule out… A. Hypertrophic osteoarthropathy B. Acral metastasis C. Diabetes mellitus D. Psoriatic arthritis
C. Diabetes mellitus
The hutchinsonian triad associated with congenital syphilis does not include A. Hutchinson’s teeth B. Dry mouth C. Interstitial keratitis D. Nerve deafness
B. Dry mouth
Hematogenous osteomyelitis of children over 1 year old is encountered more frequently in which of the following portion of a bone? A. Epiphysis B. Metaphysis C. Diaphysis D. Both a and b are equal in frequency
B. Metaphysis
