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NYCC Bone & Joint > (3) Septic Arthritis, Chronic Osteomyelitis, TB > Flashcards

(3) Septic Arthritis, Chronic Osteomyelitis, TB Flashcards

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1
Q

What is septic arthritis?

A

non-spinal joint infection

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2
Q

How is septic arthritis commonly spread?

A

hematogenous or direct implantation

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3
Q

What is the most common infectious organism of septic arthritis?

A

staph aureus

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4
Q

What are the clinical features of septic arthritis?

A
  • chills
  • fever
  • edema
  • pain
  • limping
  • erythema
  • ^ESR
  • ^WBC (left shift)
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5
Q

What are the imaging features of septic arthritis?

A
  • joint effusion distorts fat folds (fat pad signs)
  • rapid loss of jt space
  • loss of subchondral white line
  • aggressive bone destruction
  • Late: bony/fibrous ankylosis
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6
Q

What is the most reliable radiographic finding for septic arthritis?

A

loss of subchondral white line

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7
Q

What are the common locations of septic arthritis?

A
  • MC: knee & hip
  • MCPs (fight bite)
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8
Q

What is the most common infectious organism to cause septic arthritis in an IV drug user?

A

staph aureus

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9
Q

What is the 2nd most common infectious organism to cause septic arthritis in an IV drug user?

A

pseudomonas

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10
Q

Which organism is known to cause septic arthritis at an increased frequency in IV drug users than other populations?

A

pseudomonas

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11
Q

What is the term for septic arthritis caused by pseudomonas in an IV drug user?

A

mainliner syndrome

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12
Q

What are the preferential locations of septic arthritis is IV drug users caused by pseudomonas?

A

“S” joints:
- spine
- SI
- symphysis
- SC
- (S)acromioclavicular

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13
Q

What is chronic osteomyelitis?

A

unresolved osteomyelitis (suppurative form of bone/marrow infection)

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14
Q

What are the radiographic findings of chronic osteomyelitis?

A
  • sclerosis
  • solid wavy periosteal bone formation
  • cortical thickening
  • can be superimposed osteolysis
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15
Q

If chronic osteomyelitis undergoes malignant degeneration, what might it become?

A
  • fibrosarcoma
  • squamous cell carcinoma
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16
Q

What is the term for squamous cell carcinoma occurring along a draining sinus tract of chronic osteomyelitis?

A

Marjolin ulcer

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17
Q

Chronic inflammation of the dermis due to a draining sinus tract of chronic osteomyelitis can cause ____

A

skin ulcers
(if this becomes squamous cell carc = Marjolin ulcer)

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18
Q

What condition can predispose someone to skin ulcers and infections, osteomyelitis, and neuropathic arthropathy?

A

diabetes
(i.e., foot ulcers that go unnoticed)

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19
Q

What is gas gangrene?

A

bacterial infection (clostridium) manifesting as gas formation within the soft tissue

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20
Q

Tuberculosis (TB) and syphilis are ____ infections

A

non-suppurative

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21
Q

What populations are primarily affected by TB?

Study These Flashcards
A

immunocompromised

22
Q

What is the infectious organism of TB?

Study These Flashcards
A

Mycobacterium tuberculosis

23
Q

Describe the primary stage of TB.

Study These Flashcards
A
  • infects lungs
  • acts like simple pneumonia
  • leads to granulomatous reaction
  • may stay clinically silent for life
24
Q

Describe the secondary (post-primary) stage of TB.

Study These Flashcards
A
  • reactivation of organism (when immunocompromised)
  • spreads to other organs & bone via blood
25
What age group is primarily affected by skeletal TB?
2-30yrs (Rare in 1st yr of life)
26
What are the symptoms of skeletal TB?
- insidious/slow onset - pain - decreased ROM - focal tenderness
27
What are the 2 most common skeletal locations of TB?
- spine (50%) - hips (30%)
28
TB in the spine was formerly known as ____
Pott disease
29
TB in the spine is called ____
TB spondylodiscitis
30
What part of the spine is TB more common in?
Thoracolumbar spine
31
How do the symptoms of TB spondylodiscitis compare to suppurative spondylodiscitis?
Much lower grade
32
____ can result when the spine collapses due to TB spondylodiscitis.
Pott paraplegia
33
What are the early imaging findings of TB spondylodiscitis?
- disc space loss (slower than suppurative) - ant. vertebral body destruction - subligamentous spread - propensity to skip levels
34
What are the late imaging findings of TB spondylodiscitis?
- patho. vertebral collapse - angular kyphosis (Gibbous deformity) - calcified abscesses (retropharyngeal, paravertebral, psoas)
35
What is the term for the radiographic sign of a calcified psoas abscess?
Snowflake sign (TB spondylodiscitis)
36
What is Phemister’s triad of TB arthritis?
- progressive & slow jt space narrowing - juxta-articular osteoporosis - peripheral/marginal erosions of articular surfaces (Affecting 1 jt, vs. RA)
37
What is the term for TB in the finger creating fusiform swelling?
Spina ventosa (TB dactylitis = fusiform swelling)
38
What is the term for TB of the frontal bone with scalp abscesses?
Pott puffy tumor
39
What is the term for subgluteal infective bursitis with direct extension of TB to the ischial tuberosity?
Weaver bottom
40
What is the likely diagnosis? Give 4 radiographic findings.
Dx: Chronic osteomyelitis - atrophy - sclerosis - cortical thickening - wavy periosteum
41
Give 2 differential diagnoses.
- Chronic osteomyelitis - Paget sarcoma
42
What radiographic finding helps narrow your differentials?
Positive Waldenstrom sign = Intracapsular effusion in kids (Dx: septic arthritis)
43
What is the diagnosis?
Septic arthritis
44
What is the most likely diagnosis?
Septic arthritis
45
What is the likely diagnosis? What condition could have caused this?
Dx: septic arthritis Diabetes
46
What is the diagnosis? What radiographic sign supports your diagnosis?
Dx: TB spondylodiscitis Snowflake sign
47
What is the likely diagnosis?
Septic arthritis
48
What findings are present?
- Loss of disc space - loss of subchondral white line (Dx: spondylodiscitis)
49
What finding is present?
paraspinal edema
50
What is the diagnosis?
Chronic osteomyelitis

NYCC Bone & Joint (71 decks)

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