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Year 3 MSK (JK) > Bone and soft tissue infection > Flashcards

Bone and soft tissue infection Flashcards

(55 cards)

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1
Q

Risk factors for acute osteomyelitis

A

child, boys, history of minor trauma

other illnesses eg DM, sickle cell, rheum arthritis, long term steroid use or immune compromise

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2
Q

3 sources of infection in acute osteomyelitis

A

haematogenous spread
local spread from contagious site of infection
secondary to vascular insufficiency

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3
Q

what 2 age groups does haematogenous spread of osteomyelitis occur?

A

child and elderly

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4
Q

3 examples of local spread from contagious site of infection in acute osteomyelitis

A

trauma - open fracture
bone surgery - ORIF
joint replacement

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5
Q

examples in different age groups of source of infection in acute osteomyelitis

a) infants
b) children
c) adults

A

a - infected umbilical cord
b - boils, tonsillitis, skin abrasions
c - UTI, arterial line

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6
Q

Main organism of acute osteomyelitis

A

staph aureus

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7
Q

exceptions to causative organisms

A 
mycobacterium tuberculosis 
pseudomonas aeruginosa - IVDA 
coagulase -ve strep: prostheses 
diabetic foot - mixed and anaerobes 
sickle cell - salmonella 
mycobacterium marinum - fisherman 
candida - HIV
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8
Q

3 examples of places where long bone metaphysis are involved in acute osteomyelitis

A

distal femur
proximal tibia
proximal humerus

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9
Q

2 examples of places where joints with intra-articular metaphysis are involved in acute osteomyelitis

A

hip

elbow - radial head

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10
Q

briefly describe the pathology of acute osteomyelitis

A

starts at metaphysis and vascular stasis occurs.
acute inflammation, pressure build up and pus formation
release of pressure, bone dies, new bone formation and resolution or chronic osteomyelitis

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11
Q

suppuration

A

pus formation

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12
Q

sequestrum

A

necrosis of bone

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13
Q

involucrum

A

new bone formation

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14
Q

clinical features of acute osteomyelitis in an infant

A

minimal or very ill
drowsy, irritable, malaise, fail to thrive
positional change, decrease ROM, metaphyseal tender and swelling

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15
Q

where is the most common place for acute osteomyelitis in an infant?

A

knee

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16
Q

clinical features of acute osteomyelitis in a child

A

severe pain - toxaemia - reluctant to move

tender fever - tachycardia - malaise - not weight bearing

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17
Q

clinical features of acute osteomyelitis in an adult

A

backache - UTI - elderly - DM - immunocompromised

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18
Q

most common site for primary acute OM in an adult

A

thoracolumbar spine

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19
Q

primary or secondary acute om more common?

A

secondary

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20
Q

when does secondary acute om occur?

A

after open fracture, surgery, especially ORIF

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21
Q

5 parts of diagnosing acute OM

A

history and exam - pulse and temp
FBC and diff WCC - neutrophil leucocytosis
ESR, CRP
blood cultures x3 done at peak temp - 60% +ve
U+E’s - ill, dehydrated

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22
Q

differential diagnosis for acute OM

A 
acute septic arthritis 
acute inflammatory arthritis 
trauma 
transient synovitis 
rare eg haemophilia 
soft tissue infection
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23
Q

6 investigations for acute OM

Study These Flashcards
A 
x-ray 
MRI 
USS 
aspiration 
isotope bone scan - TC-99, gallium-67
labelled WCC scan - indium - 111
24
Q

4 microbiological diagnosis of acute om

Study These Flashcards
A

blood cultures - haematogenous OM and septic arth.
bone biopsy
tissue or swabs of up to 5 sites around implant
debridement in prosthetic infections

25
why may sinus tract and superficial swabs be misleading?
contamination
26
treatment for acute om
supportive antibiotics rest and splintage
27
Why may antibiotics "fail"?
resistance - bacterial persistence - poor host defences poor drug absorption - drug inactivation by host flora poor tissue penetration - MRSA
28
4 indications for surgery in acute om
aspirate pus for diagnosis and culture abscess drainage debridement of dead/infected/contaminated tissue refractory to non op treatment for 24-48hrs
29
6 complications of acute om
septicaemia/death- metastatic infection - pathological fracture - septic arthritis - altered bone growth - chronic OM
30
organisms in chronic om
same each flare up but often mixed | staph aureus, E.coli, strep pyogenes, proteus
31
pathology of chronic om
cavities, sinuses, involucrum, dead bone
32
list some complications of chronic om
chronically discharging sinus and flare ups ongoing metastatic infection and abscesses pathological fracture growth disturbance and deformities SSC
33
treatment for chronic om
long term antibiotics - local or systemic eradicate bone infection surgically treat soft tissue problems deformity correction, reconstruction and amputation?
34
3 routes of infection for septic arthritis
haematogenous eruption of bone abscess direct invasion eg arthroscopy
35
4 main organisms causing acute septic arthritis
staph aureus - H. influenzae - strep pyogenes - E.coli
36
3 pathological steps of acute septic arthritis
acute synovitis with purulent joint effusion articular cartilage attacked by bacterial toxin and cellular enzyme complete destruction of articular cartilage
37
3 possible outcomes of acute septic arthritis
complete recovery partial loss of articular cartilage and subsequent OA fibrous or bony ankylosis
38
neonate acute septic arthritis presentation
septicaemia picture - ill, irritable, resistance to movement
39
child/adult acute septic arthritis presentation
acute pain in single large joint - reluctant to move - increase temp and pulse - tenderness
40
adult acute septic arthritis presentation
often involves superficial joint eg wrist, knee, ankle | rare in healthy adult
41
investigation of acute septic arthritis
FBC, WCC, ESR, CRP, blood cultures | x-ray, USS, aspiration
42
most common cause of acute septic arthritis in an adult
infected joint replacement
43
differential diagnosis for acute septic arthritis
acute OM, irritable joint, haemophilia, rheumatic fever | trauma,gout
44
treatment for acute septic arthritis
general supportive measures - antibiotics - surgical drainage and lavage - emergency and infected joint replacement
45
3 classifications of TB bone and joint
extra articular intra articular vertebral body
46
what fraction of patients have multiple lesions in TB bone and joint
1/3
47
clinical features of TB bone and joint
``` insidious onset and general ill health TB contact pain at night, swelling, weight loss low grade pyrexia joint swelling decrease ROM ankylosis deformity ```
48
pathology of TB bone and joint
primary in lung or gut secondary spread TB gramuloma role of nutrition and disease
49
presentation of spinal TB bone and joint
little pain with abscess or kyphosis
50
history diagnosis of TB bone and joint (5)
``` long history single joint muscle wasting marked thickening of synovium periarticular osteoporosis ```
51
investigation of TB bone and joint
``` FBC, ESR Mantoux test sputum/urine culture x-ray joint aspiration and biopsy ```
52
3 things to look for in x-ray for TB bone and joint
soft tissue swelling periarticular osteopenia articular space narrowing
53
2 things to look for in TB bone and joint aspiration and biopsy
AAFB
54
differential diagnosis for TB bone and joint
``` transient synovitis monoarticular RA tumour haemorrhagic arthritis pyogenic arthritis ```
55
treatment of TB bone and joint
chemotherapy - RIPE | rest and splintage, operation rare

Year 3 MSK (JK) (30 decks)

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