Week 3 Flashcards
_______________ is the most common arthropathy and is a leading cause of pain and disability in the Western world.
Osteoarthritis (OA)
Osteoarthritis (OA) is a condition characterised by the ______________ and _____________ of the underlying bone.
progressive loss of articular cartilage
remodelling
Osteoarthritis is traditionally thought of as a ‘_____________’ disease which occurs as we age.
wear and tear
The pathogenesis of Osteoarthritis involves a __________ of _______ and remodelling of bone due to an active response of ____________ in the articular cartilage and the inflammatory cells in the surrounding tissues.
degradation; cartilage
chondrocytes
In osteoarthritis
The release of enzymes from these cells break down ________ and _________, destroying the articular cartilage. The exposure of the underlying subchondral bone results in ___________, followed by reactive remodelling changes that lead to the formation of _______ and _________________.
The joint space is ———————- over time.
collagen and proteoglycans
sclerosis
osteophytes; subchondral bone cysts
progressively lost
Risk factors for primary OA include ___________,_________,__________, and __________
obesity, advancing age, female gender, and manual labour occupations.
Clinical features of OA include _________ and __________ , worsened with _________* and relieved by ______.
pain and stiffness in joints
activity; rest
_______ in OA tends to worsen throughout the day, whereas ________ tends to improve.
Pain
stiffness
Prolonged OA results in ________ and a _______________.
deformity
reduced range of movement
On examination in OA, inspect for deformity; there are some common characteristic findings depending on the joint affected, such as __________ (swelling of PIPJs) or ____________ (swelling of DIPJs) in the hands, and _____________ deformity or varus malalignment in the knees.
Bouchard nodes
Heberden nodes
fixed flexion
Joint stiffness and pain that improves with activity is characteristically seen in ___________ arthropathies (e.g. ________________
inflammatory
rheumatoid arthritis
Osteomyelitis is defined as ________________, either _______ or ________.
an infection of bone
acute or chronic
Osteomyelitis In adults, the _________ are the most commonly affected bones, whilst in children, __________ are more commonly affected.
vertebrae
long bones
Most cases of osteomyelitis are ________ and ________ in origin, however it can also be _————- and rarely can even be __________ in origin.
acute and bacterial
chronic; fungal
Osteomyelitis can be caused by 3 main routes:
—————————— spread
_________________ into the bone (e.g. following _____________)
_________ spread from _____________ (e.g. adjacent _____________)
Haematogenous
Direct inoculation of micro-organisms ; an open fracture
Direct; nearby infection ; septic arthritis
The most common causative organisms for osteomyelitis include _________ (most common), —————- , Enterobacteur spp.,___________,______________ (especially in intravenous drug users), and __________ (especially in patients with sickle cell disease)
S. aureus
Streptococci
H. Influnzae ; P. aeruginosa
Salmonella spp.
In chronic cases of osteomyelitis , the infection can lead to —————- of the affected bone, resulting in _________ and __________ of the surrounding bone.
devascularisation
necrosis; resorption
In chronic osteomyelitis, after devascularization of the dead bone, it leads to a “ _________ ” piece of dead bone, termed a ___________, which acts as a __________ for infection (and cannot be penetrated by antibiotics, as it is ————-).
floating; sequestrum
reservoir; avascular
In chronic osteomyelitis, An ____________ can also form, following the sequestrum formation, whereby the region becomes ________ in a _________ of ___________ bone.
involucrum
encased; thick sheath
new periosteal
Risk factors for developing osteomyelitis include —————-, ___________ (such as long term steroid treatment or AIDS), _______________ or_____________
diabetes mellitus
immunosuppression
alcohol excess, or intravenous drug use.
Osteomyelitis and the Diabetic Foot
______ infections occur frequently in diabetic patients, these infections are often due to minor trauma, but due to a combination of _________ and _________ disease, infection often develops quickly and can initially go unnoticed.
__________ infection can therefore increase the risk of osteomyelitis developing.
Foot
neuropathy; small vessel
Soft tissue
It is important to suspect osteomyelitis in any diabetic patient with a ________ or __________ infection. Any suspected case should have an MRI scan to confirm the diagnosis.
deep or chronic foot
Clinical Features of osteomyelitis
Patients will usually present with ___________* in the affected region and associated _____________________.
severe pain
low grade pyrexia
Clinical features of osteomyelitis
Pain is (constant or intermittent?) and can be worse at ________. Cases may present with non-specific symptoms or possibly with a previous history of recent trauma.
On examination, the site will be ________, with potential overlying ________ and ________. If the lower limb is affected, the patient may be unable to __________.
Ensure you examine for potential sources of the infection, such as _______________________ from intravenous drug use, cellulitic areas, penetrating wounds, or stigmata of concurrent infection in another body system.
Constant ; night
tender; swelling and erythema
weight bear
pock marks or sinuses
The main differentials for suspected cases of osteomyelitis include _____________, _________ injuries (including soft tissue injury or fractures), and primary or secondary bone tumours.
septic arthritis
traumatic
Potts disease is an infection of the ________ and ____________ by _____________.
Patients will present with __________ +/- neurological features, with associated _________ and non-specific infective symptoms.
vertebral body; intervertebral disc
Mycobacterium tuberculosis
back pain; low grade fever
Pott’s disease
The infection will initially start in the __________ before spreading to the —————- regions, typically affecting the ______________ region of the spine.
intervertebral disc
para-discal
thoraco-lumbar
Pott’s disease
_____________ is the gold-standard investigation for suspected cases. Most cases will require a prolonged course of anti-TB medication, however surgical intervention may be required for abscess drainage in the case of extensive spinal destruction.
MRI imaging
Management of osteomyelitis
If the patient is clinically well, patients will require ___—-term ——————- therapy (>4 weeks), tailored to any cultures available or otherwise following local antimicrobial protocols. This is usually the mainstay of treatment for osteomyelitis, with no surgical intervention is needed.
However, in cases where the patient clinically deteriorates or imaging shows progressive bone destruction, then surgical management may be required. At this stage, _______________ of the infected bone is required, ensuring any samples are sent for culture and sensitivity. In severe or chronic cases, large debridements and complex reconstruction may be needed.
long; intravenous antibiotic
surgical debridement
Complications of osteomyelitis
Poorly managed acute osteomyelitis may lead to ______ and even mortality. Associated _________ or soft tissue infections may occur.
Children may develop ______ disturbances as a result of _____________. _______________ is rarely required in modern practice.
Recurrence of infection can occur, often associated with premature cessation of antibiotics. Chronic osteomyelitis can occur in immunocompromised patient, under-treated patients, or virulent or resistant organisms.
sepsis; septic arthritis
Growth; premature physeal closure
Amputation
Chronic Osteomyelitis
Patients with chronic osteomyelitis will present with localised ongoing ________ and non-specific infection symptoms (e.g. malaise or lethargy). There may be a draining sinus tract and they may have difficulties in mobility.
bone pain
Septic arthritis refers to the ______________. It requires a _____ index of suspicion and can affect both ________ and _____________.
infection of a joint
high
native and prosthetic joints
The main causative organisms that lead to septic arthritis are __________ (most common in adults), __________ spp., _______ (more common in sexually active patients), and _________ (especially in those with sickle cell disease).
S. aureus; Streptococcus
Gonorrhoea; Salmonella
Septic arthritis
Bacteria will ‘seed’ to the joint from a —————- (e.g. recent cellulitis, UTI, chest infection), a direct inoculation, or spreading from _____________.
bacteraemia
adjacent osteomyelitis
Septic arthritis can cause irreversible articular cartilage damage leading to severe ____________.
osteoarthritis
Risk Factors
The main risk factors for developing septic arthritis are increasing _____, any ___________ disease (e.g. rheumatoid arthritis), diabetes mellitus or immunosuppression, chronic kidney disease, hip or knee joint ___________, or intravenous drug use
age; pre-existing joint
prosthesis
Clinical Features of septic arthritis
Patients will most commonly present with a __________ joint causing severe pain. ________ will be in around 60% of affected individuals (although its absence should not rule out septic arthritis).
single swollen; Pyrexia
