Musculoskeletal 5

Question 1

Osteomyelitis

Answer 1

Inflammation of bone and marrow
- synonymous with bone infection

Question 2

3 way bacteria reaches bone (osteomyelitis)

Answer 2

1) Hematogenous spread
2) Extension from adjacent site of infection
3) Traumatic implantation from compound fractures or orthopedic procedures

Question 3

Most common osteomyelitis bacteria

Answer 3

S. Aureus

Question 4

Most common osteomyelitis bacteria in neonates

Answer 4

E. coli and Group B strep

Question 5

Osteomyelitis Bacteria Sickle cell pts

Answer 5

Salmonella

Question 6

What percent of cases of osteomyelitis are there no organisms?

Answer 6

50%

Question 7

Morphology of Osteomyelitis

Answer 7

1) Proliferation of causal bacteria inciting inflammatory response
2) Periosteal abscesses
3) Suppurative arthritis

Question 8

How do bacteria spread in osteomyelitis

Answer 8

Through haversian system

Question 9

Periosteal abscesses osteomyelitis

Answer 9

periosteum has looser attachment in children so formation more common in pediatric population
- lifting periosteum –> restricts blood supply –> ischemic necrosis

Question 10

Draining Sinus tract

Answer 10

abnormal channel from tissues of the body to the exterior

Question 11

Suppurative arthritis happens when

Answer 11

bacteria spread into a joint space

Question 12

suppurative arthritis more common in

Answer 12

infants who have epiphyseal infection that spread to adjacent joint

Question 13

Sequestrum

Answer 13

Entrapped, NON-VIABLE bone

Question 14

Involucrum

Answer 14

Sequestrum surrounded by shell of living bone

Question 15

Clinical features of Osteomyelitis

Answer 15

a) Malaise, fever, leukocytosis
b) throbbing pain over affected region

Question 16

Diagnosis of Osteomyelitis

Answer 16

a) clinical findings raise suspicion
b) Radiography
- destructive lytic focus
- poorly defined margins (radiolucency, could also be malignant neoplasia)
- surrounding edema
- sclerotic rim

Question 17

Laboratory findings osteomyelitis

Answer 17

• Blood Cultures
• Bone biopsy with culture

Question 18

Apical Periodontitis is also known as

Answer 18

CONDENSING OSTEITIS

Question 19

Jaw infection and cancer can look very similar radiographically (T/F)

Answer 19

True both have:
- poorly defined margins
- wide spread
- look irregular

Question 20

Periosteal Reaction

Answer 20

Reactive process in which new layers of bone is deposited (onion skin pattern)

Question 21

If periosteal reaction is seen you must consider these 3 things

Answer 21

1) Osteomyelitis
2) Osteosarcoma (tumor)
3) Langerhans Cell Histiocytosis (tumor)

Question 22

Fistula

Answer 22

Path of drainage for the pus (neutrophils)

Question 23

What is fistula referred to as

Answer 23

1) Sinus tract
2) Fistulous Tract
3) Abscess

Question 24

Osteomyelitis Therapy

Answer 24

Combination antibiotics
Surgical drainage

Question 25

Chronic Osteomyelitis

Answer 25

• Delayed diagnosis of acute
• Inadequate therapy (surgical or antimicrobial)
• Extensive bone necrosis

Question 26

TB osteomyelitis Favored sites of involvement

Answer 26

a) Long Bone
b) Vertebrae (Pott Disease)
- Psoas muscle abscesses may develop
c) Synovium
- Common site due to high oxygen tension