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MSK > Osteomyelitis > Flashcards

Osteomyelitis Flashcards

1
Q

What is osteomyelitis?

A

inflammation of bone and medullary cavity, usually located in one of the long bones

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2
Q

What is the treatment for osteomyeltisi?

A

debridement and antimicrobials

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3
Q

what type of infection is an open fracture?

A

contiguous infection

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4
Q

What are the symptoms of infection of an open fracture?

A

non-union and poor wound healing

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5
Q

What organisms are implicated in open frcature infections?

A

staph. aureus; aerobic gram negatve bacteria

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6
Q

What causes osteomyelitis with diabetic/venous ulceration?

A

contiginous infection

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7
Q

How is the depth of the infection in an infected ulcer?

A

probe to the bone

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8
Q

What is the rule of 2?

A

if the ulcer has been there for 2 months and >2 months then check for osteomyelitis and if can see tendon or bone

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9
Q

What are the indications for an x-ray with an ulcer?

A

if the ulcer is:

  • chronic, indolent or deep
  • there is a +ve probe-to-bone test
  • increased levels of inflam markers
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10
Q

What is required to diagnose definitive osteo?

A

bone biospy for histology and culture

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11
Q

What should be avoided with antibiotic therapy in osteomyelitis?

A

empirical therapy- a biospy should always be done

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12
Q

When should empirical therapy be give?

A

if have sepsis or skin and soft tissue involvement

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13
Q

What empirical therapy would be given?

A

flucloxacillin

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14
Q

Who is haematogenous osteomyelitis seen in?

A

prepubertal children; PWID; central lines/ dialysis/ eldery

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15
Q

What bug is the infecting microbe if someone steps on a nail typically?

A

pseudomonas

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16
Q

What are the main organisms seen with PWIDs?

A

staph; strep

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17
Q

What are the main pathogens seen in dialysis patients?

A

staph aureus; aerbic gram negatives

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18
Q

What should you do if a patient with an IV has a positivie blood culture?

A

remove the IV line and repeat cultures until negative

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19
Q

What should be done if a patient has persistent positive blood cultures?

A

an echo

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20
Q

What predisposes to osteitis pubis?

A

urogynae procedures

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21
Q

What are the risk factors for clavicle osteo?

A

neck surgery and subclavian vein catheterisation

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22
Q

What pathogens are seen with sickle cell osteo?

A

salmonella and staph. aureus

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23
Q

Where is is sickle cell osteo seen in the body?

A

long bones

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24
Q

What is gauchers disease?

A

lysosomal storage disorder

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25
Q

What is SAPHO?

A

synovitis acne pustulosis hyperostosis osteitis

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26
Q

What is CRMO?

A

chronic recurrent multifocal osteomyelitis

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27
Q

What is the difference between SAPHO and CRMO?

A

SAPHO is seen in adults whereas CRMO is seen with children

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28
Q

What are SAPHO and CRMO?

A

osteomyeltiis like lesions-mulitfocal osteitis which is self-limited

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29
Q

How is osteo myeltiis excluded in SAPHO and CRMO?

A

history plus cultures

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30
Q

What is seen on investigations with SAPHO and CRMO?

A

raised inflam markers and lytic lesions on x-ray

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31
Q

What is the presentation of SAPHO and CRMO?

A

fever, weight loss, maliase, 5 or so active lesions in strange places- chest wall, pelvis

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32
Q

What might vertebral osteomyelitis be associated with?

A

epidural or psoas abscess; PWID; IV site infections; GU infections:SSTI; post-op

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33
Q

What are the features of vertebral osteomyelitis?

A

fever; insidious pain and tenderness; neurogloical signs; raised inflam markers; raised WBCs

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34
Q

What is the treatment for vertebral osteo?

A

draingae of large paravertebral/epidural abscesses; antimicrobials for 6 weeks

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35
Q

Why would an MRI be repeated in vertebral ostea?

A

unexplained increase in inflam marker; increasing pain; new anatomically related signs/symptoms

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36
Q

What is vertebral TB also known as?

A

Pott’s disease

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37
Q

What is seen in patients with vertebral TB?

A

often NO systemic symptoms; half have skin and soft tissue infections and less than half have pulmonary TB

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38
Q

What should always be offered for in adults with skeletal TB?

A

HIV test

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39
Q

What should be checked in kids with vertebral TB?

A

reduced receptors for IFN-gamma; R1 etc

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40
Q

What are the risk factors for a prosthetic joint infection?

A

RA; diabetes; malnutrition; obesity

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41
Q

What are the mechanisms for infection of a prosthetic joint?

A

direct inoculation at time of surgery
manipulation of joint at time of surgery
seedingb of joint at a later time

42
Q

What causes an early infection in prosthetic joints?

A

wound sepsis/haematoma- within one month

43
Q

What causes a late infection in prosthetic joints?

A

contamination at the time of operation

44
Q

Whhat local infections does S. aureus cause?

A

impetigo; funuculosis; cavitating pneumonia; osteomyelitis; septic arthritis

45
Q

What systemic infections does staph. aureus cause?

A

bacteraemia; metastatic abscess; endocarditis; line-related sepsis

46
Q

What toxin mediated diseases can staph. aureus cause?

A

acute gastroenteritis; toxic shock syndrome; scalded skin syndrom

47
Q

What is PVL?

A

a toxin called panton-valentine-leukocidin that kills WBCs

48
Q

What are the symtpoms of having a PVL producing Staph, aureus

A

skin infections; necrotising pneumonia; invasive infections eg bacteraemia, septic arthritis

49
Q

What is a planktonic bacteria?

A

one that causes bacteraemia

50
Q

What is sessile bacteria?

A

when planktonic bacteria undergo phenotypic transformation and form a biofilm with an ECM

51
Q

How is infection of prosthetic joints diagnosed?

A

from mltiple cultures of perioperative tissue

52
Q

What is the treatment for an infection of prosthetci joints?

A

removal of prosthesis and cement and antibiotic therapy fro at least 6 weeks and then re-implantation of the joint

53
Q

What are the main pathogens that can cause infections of prosthetics?

A

staph. aureus, staph, epidermidis mainly

54
Q

What is the significanve of prosthetic material with coagulase negative staph (staph. epi)

A

they have a low virulence and can only cause infection if prosthetic material is presnet

55
Q

What is needed to treat PVL infection?

A

fluclox and an anti-toxin antibiotic- clindamycin or linezolid

56
Q

what is the side effecto f clindamycin?

A

C. diff infections

57
Q

What is the sie effevt of linexolid?

A

bone marrow failure

58
Q

What antibiotic is used t/o treat cog negative staph?

A

vancomycin

59
Q

What is the virulence factor in staph. epi?

A

slime which allows it to bind to plastic and form biofilms

60
Q

How can septic arthritis occur?

A

haematogenous spread; direct invasion through a penetrating wound; spread from infectious focus (cellulitis, abscess) in adjacent soft tissues; spread from focus of osteomyelitis in adjacent bone

61
Q

What is septic arthritis?

A

inflammation of the joint space caused by infection

62
Q

What organisms cause septic arthritis?

A

staph. aureus; strep; coag neg staph. - prosthetic joints; neisseria gonorrhae- sexually active; haemophilus0 pre-school

63
Q

What is the clinical presentation of septic arthritis?

A

sever pain, red, hot swollen plus limited movement, fever (if haematogenous)

64
Q

What are the empirical antibiotics given for septci arthritis?

A

fluclox; ceftriaxone- in under 5s

65
Q

What viruses can cause viral arthritis?

A

hep B; rubella; parvovirus; alphavirus

66
Q

what is pyomyositis?

A

pussy muscle

67
Q

What causes pyomyositis?

A

90% are staphylococcal but it depends on the site

68
Q

How is pyomyositis treated?

A

wide debridement- removal of the infected muscles

69
Q

What causes tetanus?

A

clostridium tetani

70
Q

What is clostridium tetani?

A

gram positive strictly anaerobic rods- drumstick shapes

71
Q

Where are tetenus spores found?

A

soil; gardens etc

72
Q

How does tetanus cause illness?

A

the organism itself isnt invasive, illness is caused by a neurotoxin

73
Q

What does tetanus do?

A

causes spastic paralyiss by binding to inhibitory neurones, preventing release of neurotransmitters

74
Q

What is the incubation period for tetanus?

A

4 days to several weeks

75
Q

what causes lock jaw with tetanus?

A

muscles spasming

76
Q

What kills you with tetanus?

A

go into resp arrest as resp msucles are in spasm

77
Q

What is the treatment for tetanus?

A

surgical debridement; antitoxin; supportive measures; antibtiocs; booster vaccination- toxoid

78
Q

What is myositis?

A

viruses; protozoa; fungal infections

79
Q

What is a myositis caused by protozoa associated with?

A

eosinophilia

80
Q

What happens to the bone in osteomyelitis?

A

exudation of pus lifts up the periosetum interrupting blood supply to underlying bone and necrotic fragments of bone may form (sequestration. New bone formation created by the elevated periosteum forms an involcrum. Pus may dischanrge into joint spaces or via sinuses to the skin

81
Q

What are the radiographic changes associated with osteomyelitis?

A

haziness+/- loss of density of afffectedf bone, then subperiostal reaction, and later, sequestrum and involcrum

82
Q

What has reduced the prevalence of haemophilus influenzae osteo in children?

A

vaccine

83
Q

what are sequestra?

A

infected dead bone

84
Q

What are the signs of bone TB?

A

local pain, swelling, cold abscess formation +/- joint effusion; pain on movement and muscle wasting- if includes joint; wt lossl malaise; fever; lethargy

85
Q

Who typically gets osteo in their feet?

A

diabetics

86
Q

Who typically gets osteo in their vertebra?

A

IVDU

87
Q

What types of bone tends to get infected in children?

A

vascular bone - long bone metaphyses

88
Q

What are the signs of infection?

A

rubor; calor; dolor; tumour; functio laesa

89
Q

What is important in the treatment of bone and joint infection?

A

dont start antibiotics until you know what youre treating

90
Q

What does the technetium scan show?

A

osteoblast activity

91
Q

What is the most common cause of acute osteomyelitis?

A

post-trauma/ open fractures

92
Q

What causes acute osteomyelitis in children and immunosuppresssed?

A

haematogenous spread

93
Q

What is the most common organism in acute osteomyelitis?

A

staph. aureus

94
Q

What bug causes acute osteomyelitis in children?

A

haemophilus influenzae

95
Q

What causes haematogenous osteomyelitis?

A

there is a clot in the blood vessel of the bone- which acts like an agar plate fro bacteria. blood flow in bone is already slow, if there is trauma this can damage the vessel wall- virchows triad

96
Q

What imaging is used in diagnosing chronic osteomyelitis?

A

x-rays and MRI

97
Q

What bugs should be covered in cellulitis?

A

staph and strep- fluclox and benzylpenicillin

98
Q

What can be felt on palpation with necrotising fasciitis?

A

bubble wrap- organisms produce gas

99
Q

What suggests an infected arthroplasty in the history?

A

if there has been poor wound healing and if the joint has always been painful

100
Q

How are prosthetic infectiosn prevented during surgery?

A

clean air theatre; local antibiotics; systemic antibiotics; and a reduced duration of surgery

101
Q

Which bugs infect prosthetics?

A

staph aureus and staph. epi (coag neg staph CNS)

MSK (39 decks)

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