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Musculoskeletal - Pathology > Osteomyelitis > Flashcards

Osteomyelitis Flashcards

1
Q

what causative organism in common to acute osteomyelitis at all ages

A

staph aureus

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2
Q

2 common sources of infection in adults

A

UTI and aterial line

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3
Q

3 common sources of infection in children

A

boils, skin abrasions and tonsilitis

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4
Q

1 common source of infection in infants (<1y/o)

A

infected umbilical cord

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5
Q

2 modes of infection spread in osteomyelitis

A

haematogenous and local (contiguous)

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6
Q

what age groups is haematogenous spread most common

A

children and the elderly

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7
Q

3 examples of contiguous causes of acute osteomyelitis

A

cellulitis, open fracture and surgery

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8
Q

infection from candida is most common in what immune disease

A

HIV AIDS

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9
Q

what occupation are likely to be infected by mycobacterium marinium?

A

fishermen

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10
Q

common organism in IVDA

A

pseudomonas aeruginosa

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11
Q

causative organsim of tonsilitis which will cause acute osteomyelitis in children

A

strep. pyogenes

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12
Q

which part of a long bone is usually the site of infection

A

metaphysis

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13
Q

two commonly infected joints

A

hip and and radial head

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14
Q

what is a sequestrum

A

a piece of dead bone

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15
Q

what is a involucrum

A

new bone growth outside the existing bone, in this case, outside dead bone

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16
Q

progression of infection and resolution in acute osteomyelitis

A

in medullary cavity/haversian in cortex –> acute inflammation –> increased pressure –> vascular stasis –> necrosis leading to a sequestrum –> pressure releases into joint –> blood returns to bone –> new bone growth can occur

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17
Q

presentation of acute osteomyelitis in infants under a year

A

failure to thrive
generally ill, drowsy and irritable
decreased range of movement
tenderness and swelling of bone

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18
Q

most common site of acute osteomyelitis in infants

A

knee

19
Q

presentation of acute osteomyelitis in children

A 
severe pain
holding neighbouring joints in flexed position
not weight bearing
fever
tachycardia
malaise, nausea and vomiting
20
Q

most common site of primary acute osteomyelitis in adults

A

thoracolumbar spine

21
Q

what is Pott’s Disease?

A

vertebral osteomyelitis from haematogenous spread of tuberculosis

22
Q

presentation of primary acute osteomyelitis in adults

A

backache
elderly, diabetic or immunocompromised
history of UTI

23
Q

presentation of secondary acute osteomyelitis in adults

A 
severe pain
fever
swelling, red, tender bone
pain on movement
Hx of open fracture or surgery
24
Q

what neuro symptom would you expect in someone who has bone infection secondary to diabetes

A

neuropathy

25
Q

bloods in acute osteomyelitis

A

FBC, neutrophils, ESR and CRP

26
Q

when do changes become visible on X-ray

A

after about 2 weeks, necrosis and involucrum

27
Q

Scans you can do for osteomyelitis

A 
x-ray
ultrasound
mri
isotope scan with gallium or technetium
labelled WBC scan with indium
28
Q

how do isotope scans works

A

show up at infected sites

29
Q

how many blood cultures do you need to do in haematogenous infection

A

3

30
Q

microbiology

A

blood cultures
bone biopsy
swabs or biospy from surrounding site (up to 5)

31
Q

5 differential diagnoses

A

cellulitis, erysipelas, acute septic arthritis, acute inflammatory arthritis and necrotising fasciitis

32
Q

conservative treaments for acute

A

analgesia, fluids, rest and splint

33
Q

how long does antibiotic regimen last in acute osteomyelitis

A

4-6 weeks

34
Q

how long does antibiotic regiemen last in chronic osteomyelitis

A

3-6 months

35
Q

indications for surgery in acute

A

drainage pus for diagnosis
drain abscess
debridement

36
Q

antibiotic regimen in acute

A

flucloxacillin for 6 weeks (or clindamycin if penicillin allergic) +/- fusidic acid or rifampicin for first 2 weeks.
IV then oral after 2 weeks when they’ve stabilised and inflammatory markers go down

37
Q

mortality from acute osteomyelitis before antibiotics

A

70%

38
Q

5 complications of acute osteomyelitis

A 
septicaemia
metastatic infection
pathological fracture
septic arthritis
chronic osteomyelitis
39
Q

true/false - the same organism is usually the cause of flare-ups in chronic osteomyelitis

A

true

40
Q

pattern of progression in chronic osteomyeltis

A

repeated flare-ups of breakdown of ‘healed’ wounds

41
Q

appearance of chronic osteomyelitis on histology

A

chronic inflammation

42
Q

malignant complication of chronic osteomyelitis

A

squamous cell carcinoma (0.07%)

43
Q

true/false - is it appropraite in chronic osteomyelitis to wait for culture and sensitivity results before commencing antibiotic treatment

A

true - unless severe and imminently life threatning, will reduce resistance and improve outcomes

44
Q

treatment for chronic osteomyelitis

A 
surgical debridement 
IV antibiotic for 6 weeks
gentamicin cement
deformity correction and reconstruction
amputation

Musculoskeletal - Pathology (12 decks)

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