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MSK > MSK Infections > Flashcards

MSK Infections Flashcards

1
Q

Define osteomyelitis.

A

Inflammation of the bone and medullary cavity.

Usually located in one of the long bones.

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2
Q

What is a contiguous infection?

A

located adjacent to where infections started

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3
Q

What is the medullary cavity?

A

the elongated region of the diaphysis, contains bone marrow.

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4
Q

What is the gold standard diagnostic test for osteomyelitis?

A

bone biopsy

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5
Q

In the treatment of osteomyelitis, do you await lab confirmation of antimicrobials, or start empirical treatment?

A

await anti-microbial results, antibiotics given for 6 weeks.

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6
Q

Which classification of infection would an open fracture be?

A

contiguous

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7
Q

What is a clinical clue of osteomyelitis due to an open fracture?

A

non-union and poor wound healing

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8
Q

What is the treatment of an infected open fracture?

A

early management key: aggressive debridement, fixation and soft tissue cover.

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9
Q

What are the likely organisms found in an open fracture osteomyelitis?

A

stap aureus and aerobic gram negative bacteria

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10
Q

What is diagnostic tool for diabetes/vascular insufficiency induced osteomyelitis?

A

probe to bone

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11
Q

what is the treatment for diabetic ulcer induced osteomyelitis?

A

acute & antibiotic naive -> fluclox 2g daily IV

acute & non-antibiotic naive -> vancomycin IV 15-20mg/l

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12
Q

Who gets haematogenous osteomyelitis?

A

prepubertal children
PWID
central lines/dialysis/elderly

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13
Q

Causative organisms in PWID haematogenous osteomyelitis?

A

staphlyococcus, streprococci

unusual pathogens - candida, pseudomonas, eikenella corrodes (needle lickers), mycobacterium tuberculosis.

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14
Q

What is the most common pathogen in a dialysis patient who acquired osteomyelitis?

A

staph aureus

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15
Q

What are some unusual sites of infection due to haematogenous spread?

A

osteitis pubis - urogynae procedures predispose to bacterial causes

clavicle osteo - risk factors are neck surgery and subclavian vein catheterisation

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16
Q

What are the pathogens found in sickle cell osteomyelitis?

A

salmonella and staph aureus

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17
Q

What is Gaucher’s disease?

A

a lysosomal storage disorder, may mimic a bone crisis, often affects the tibia.

sterile if bone crisis, staph aureus if infected.

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18
Q

SAPHO and CRMO, what are they and who gets them?

A

SAPHO - Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis - Adults

CRMO - Chronic Recurrent Multifocal Osteomyelitis - Children

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19
Q

What are the most common sites involved in SAPHO/CRMO?

A

chest wall
pelvis
spine
lower limb

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20
Q

What is the typical number of active lesions seen per patient with SPAHO/CRMO?

A

5

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21
Q

Most likely classification of vertebral osteomyelitis?

A

haematogenous

22
Q

Epidural abscess would be located where?

A

anterior to the spinal cord

23
Q

What is the imaging used fo vertebral infection?

A

MRI or Ga-67 scan (FDG-PET)

24
Q

clinical signs of vertebral osteomyelitis?

A

50% have fever
90% insidious pain and tenderness
90% raised inflammatory markers

15% neurological signs/symptoms
<50% raised WCC
32% abnormal plain film

25
Q

treatment of vertebral osteomyelitis?

A

drainage of large para-vertebral/epidural abscesses

antimicrobials for 6 weeks

26
Q

What are the clinical results you would expect to see upon treating vertebral osteo?

A

> 50% decrease in ESR

decrease in inflammatory markers and pain

27
Q

What are the indications for repeated MRI post-treatment of vertebral osteo?

A

unexplained increase in inflammatory markers
increasing pain
new anatomically related signs/symptoms

28
Q

What test should be offered to all adults who are diagnosed with skeletal tuberculosis?

A

HIV test

29
Q

What is the pathophysiology of Pott’s disease?

A

Haematogenous spread of TB from e.g. the lungs to vertebrae.
Infection spreads from 2 adjacent vertebrae to intervertebral disc. If only one vertebra is affected, the disc will be normal, but if 2 are involved, the avascular disc cannot receive nutrients so collapses.

Caseous necrosis: disc tissue dies leading to vertebral narrowing and eventually vertebral collapse and spinal damage.

30
Q

What needs to be checked in kids with skeletal TB?

A

check reduced receptors for IFN-gamma R1, IL-12 beta-1

31
Q

what are the risk factors for prosthetic joint infection?

A

RA
diabetes
obesity
malnutrition

32
Q

What are the potential mechanisms of prosthetic joint infection?

A

direct inoculation at time of surgery

manipulation of joint at time of surgery

seeding of joint at a later time

33
Q

What are the timing differences of early vs. late joint infections?

A 
early = within a month
late = after one month
34
Q

What are the 3 main symptoms of PVL producing Staph aureus infections?

A
  1. skin infections
  2. necrotising pneumonia
  3. invasive infections, e.g. bacteraemia, septic arthritis
35
Q

What is the treatment of PVL producing staph aureus?

A

FLucloxacillin, clindamycin, linezolid

36
Q

What are some of the diagnostic tests for prothetic joint infections?

A

culture - preoperative tissue (multiple) - if same organism grows from multiple samples, increases significance.

CRP - helps along with clinical history
radiology - might show joint loosening

37
Q

What is the treatment for an infected prosthetic joint?

A

remove prosthesis and cement
antimicrobials for at least 6 weeks
re-implantation of joint after aggressive antibiotic therapy.

38
Q

Which pathogen would be seen in an infected upper limb prostheses?

A

Propionibacterium acnes

39
Q

What are the main pathogens in infected prostheses?

A

gram positives - staph aureus and sth epidermidis

40
Q

Coagulase Negative Staphylococci is part of normal flora. In which circumstances could it cause an infection?

A

It has low virulence and can only cause infection if prosthetic material is present.

41
Q

What is the most common member of coagulase negative staphylococci group?

A

staph epidermidis

42
Q

What is the virulence factor of staph epidermidis?

A

slime

43
Q

what is the initial antibiotic therapy of staph epidermidis?

A

vancomycin

44
Q

What is the immediate treatment of septic arthritis? And which case is the exception and alternative?

A

FLUCLOXACILLIN (high doses)

< 5 y/o add Ceftriaxone (for H influenzas cover)

45
Q

What is pyomyositis?

A

Bacterial infection of muscle caused by infalmmation.

46
Q

Describe the pathogen in Tetanus.

A

Clostridium tetani
Gram +ve strictly anaerobic rods.
Spores - found in soil, gardens etc.

47
Q

What is the incubation period of clostridium tetani?

A

4 days - several weeks.

48
Q

Why does spastic paralysis occur in Tetanus?

A

It is a neurotoxin - binds to inhibitory neurones, preventing release of neurotransmitters. (ACh)

49
Q

What is the classical shape of the terminal spore in clostridium tetani?

A

drumstick shaped

50
Q

What is the treatment of tetanus?

A 
surgical debridement
antitoxin
supportive measures
antibiotics.... penicillin/metronidazole
booster vaccination - toxoid

MSK (7 decks)

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