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Flashcards in Infection Deck (60):
1

Osteomyelitis on MR T1-weighted spin echo image intensity produces a

a. low signal
b. high signal
c. variable signal
d. intermediate signal

low signal

2

Which of the following vascular anatomic description is characteristic for children over 1 year old?

a. There is no vascular connection between the epiphysis and the metaphysis.

b. A vascular connection between the metaphysis and epiphysis exists.

c. The vascular supply of the epiphysis originates in the metaphysis.

d. The vascular supply of the epiphysis originates in the growth plate.

a. There is no vascular connection between the epiphysis and the metaphysis.

3

Radiolucent linear or netlike collections seen on radiographs within the subcutaneous or muscular tissues should warrant further investigation for...

a. Tuberculosis
b. Syphilis
c. Gas gangrene
d. Pasteurella infections

c. Gas gangrene

4

The presence of pustulosis palmaris, sternoclavicular hyperostosis and recurrent osteomyelitis in a child should warrant further investigation to rule out...

a. Chronic granulomatous disease
b. SAPHO syndrome
c. Sacoidosis
d. Carinoid tumor

b. SAPHO syndrome

5

Osteomyelitis leading to destruction of the distal tuft and diaphysis of the terminal phylanx with relative sparing of the phalangeal base is a possible complication seen with...

a. a melon
b. a pelon
c. a felon
d. belon

c. a felon

6

The direction of contamination in hematogenous osteomyelitis is

a. from the soft tissue inward toward the bone
b. from the bone outward into soft tissue
c. from the growth plate into the diaphysis
d. from the spinal canal to the bone

b. from the bone outward into soft tissue

7

The term sinus tract refers to:

a. An opening in the involucrum, through which pus may be discharged outside the bone

b. An opening between the skin surface and the bone

c. An opening betweenan infected epiphysis and an adjacent synovial joint.

d. A segment of necrotic bone that is separated from living bone by granulation tissue

b. an opening between the skin surface and the bone

8

Which of the following clinical presentation of hematogenously spread osteomyelitis is true?

a. Childhood osteomyelitis is always associated with sudden onset of high fever, a toxic state, and local signs of inflammation.

b. As many 50% of children with ostermyelitis have vague complaints, including local pain of 1 to 3 months' duration with miminal if any temperature elevation.

c. In the infant, hematogenous ostemyelitis often leads to very dramatic findings, including pain, swelling, high-grade fever, nausea, an willingness to move the affected bones and loss of consciousness.

d. The adult form of hematogenous ostemyelitis usually has a rapid onset with a relatively short period between the appearance of symptoms and signs and accurate diagonsis.

b. As many 50% of children with ostermyelitis have vague complaints, including local pain of 1 to 3 months' duration with miminal if any temperature elevation.

9

The breakdown of soft tissue that occurs in debilitated persons who maintain a single position for long periods is referred to as a

a. callus
b. pelvic sequestrum
c. decubitus ulcer
d. none of the above

b. pelvic sequestrum

10

In the young patient population (infants and children), hematogenous ostemyelitis more commonly affects which of the following bones?

a. skull
b. spine
c. long bones of the extremities
d. short tubular of the extremities

c. long bones of the extremities

11

A slowly progressive vertebral destruction with preservation of intervertebral discs, subligamentous spread of infection with erosion of anterior vertebral margins, large and calcified soft tissue abscesses, and the absence of severe bony eburnation are the radiographic signs associated with

a. pyogenic spondylitis
b. suppurative spondylitis
c. tuberculous spondylitis
d. staphylococcal spondylitis

c. tuberculous spondylitis

12

The term osteomyelitis refers to:

a. infection of the cortical bone
b. infection of the marrow
c. infection of the bone and marrow
d. infection of the bone and adjacent soft tissues

c. infection of the bone and marrow

13

Spotaneous atlantoaxial subluxation that accompanies inflammation of neighboring soft tissues (rhinopharyngitis) seen mainly in children is termed?

a. Grisel's syndrome
b. Jones' syndrome
c. McGreggor's syndrome
d. Julius' syndrome

a. Grisel's syndrome

14

Staphylococcus aureus, group B streptococcus, and Escherichia coli are the bone isolates recovered most frequently in osteomyelitis affecting which of the following age group?

a. Neonate or infant
b. Children over the age of 1 year and less than 4 years
c. Children older than 4 years
d. Teenagers

a. Neonate or infant

15

Human infection with animal exposure, bites, or scratches is associated with

a. Brucella
b. Yersinia
c. Pasteurella
d. Klesiella

c. Pasteurella

16

Broodie's abscess are found more commonly in children, typically in boys and particularly in the

a. femur
b. tibia
c. radius
d. humerus

b. tibia

17

Which of the following is true regarding childhood discitis?

a. Hematogenous contamination of the discal tissue is possible.

b. When positive, blood or bone biopsy culture most typically reveals Mycobacterium tuberculosis.

c. Radiographic changes are the most frequent in the cervical spine.

d. Intervertebral disc space narrowing is seen radiographically after the erosion of the subchondral bone plate and osseous eburnation.

a. Hematogenous contamination of the discal tissue is possible.

18

A sharply delineated focus of active/subacute infection usually surrounded by eburnated bone is termed?

a. Sclerosing osteomyelitis of Garre
b. Chronic recurrent ostemyelitis
c. Bone abscess (Brodie's abscess)
d. Acute infective hyperostosis

c. Bone abscess (Brodie's abscess)

19

Because of the anatomic arrangement of the ___ joint, osteomyelitis localized to the metaphysis can enter the joint by extending laterally without violating the growth plate.

a. ankle
b. knee
c. hip
d. elbow

c. hip

20

Pott's puffy tumor refers to...

a. An indolent soft tissue swelling of the scalp that is due to osteoyelitis of frontal bone

b. An osteomyelitis of the maxillary bone resulting from maxillary sinusitis

c. An expansile focus of tuberculous osteomyelitis of the spine

d. Both a and b are correct

a. An indolent soft tissue swelling of the scalp that is due to osteoyelitis of frontal bone

21

The radiographic latent period for spinal osteomyelitis/spondylodiscitis is approximately

a. 3 days
b. 3 weeks
c. 3 months
d. 3 years

b. 3 weeks

22

The term infective (suppurative) osteitis refers to:

a. infection of the cortical bone
b. infection of the marrow
c. infection of the bone and marrow
d. infection of the bone and adjacent soft tissues

a. infection of the cortical bone

23

The most common joints affected by septic arthritis in infants, children and adults are...

a. knee and hip
b. ankle and knee
c. hip and shoulder
d. knee and shoulder

a. knee and hip

24

Sequential contamination of the tendon sheath of the fifth finger, ulnar bursa, radial bursa, and first finger produces...

a. The devil sign
b. The U or V sign of Pimenti
c. The horseshoe abscess
d. The common flexor sign

c. The horseshoe abscess

25

The presence of gas in the soft tissues of the foot can be due any of the following agents but one. Which of the following agent does not produce gas as an end result of its metabolic activity?

a. Clostridium perfringens
b. Escherichia coli
c. Staphylococcus aureus
d. Klebsiella pneumoniae

c. Staphylococcus aureus

26

Subperiosteal abscess formation, extensive periostitis, and involucrum formation are relatively usual manifestations of osteomyelitis in which of the following age group?

a. Infants
b. Children
c. Adults
d. People over 200 years old

c. Adults

27

Radiographic signs of activty in chronic osteomyelitis

a. thin, linear periostitis
b. sequestration
c. poorly defined areas of osteolysis
d. all of the above

d. all of the above

28

In patients with sickle cell disease, what organism is seen with higher incidence over the general populace?

a. Klebsiella
b. Salmonella
c. Shigella
d. Pseudomonas

b. Salmonella

29

The term involucrum refers to:

a. A fractured bony fragment displaced away from its parent bone caused by osteomyelitis.

b. A layer of living bone that has formed around the dead bone.

c. An opening between the skin surface and the bone.

d. A segment of necrotic bone that is separated from living bone by granulation tissue.

b. A layer of living bone that has formed around the dead bone.

30

The clinical presentation of vascular insufficiency, neurologic deficit , soft tissue swelling and mottled osteolysis of the foot should warrant an investigation to rule out...

a. Hypertrophic osteoarthropathy
b. Acral metastasis
c. Diabetes mellitus
d. Psoriatic arthritis

c. Diabetes mellitus

31

Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae are responsible for most cases of hematogenous osteomyelitis in which of the following age group?

a. Neonate or infant
b. Children over the age of 1 year old and less than 4 years
c. Children older than 4 years
d. Teenagers

b. Children over the age of 1 year old and less than 4 years

32

Which of the following is not commonly seen in tuberculous arthritis?

a. soft tissue swelling
b. osteoporosis
c. fast progression
d. late joint space loss

c. fast progression

33

An increase in the medial joint space of the hip by over 2 mm compared with the contralateral side and/or a joint space measuring more than 11 mm is known radiographically as...

a. Turret's sign
b. Obturator sign
c. Waldenstrom's sign
d. Gluteus medius sign

c. Waldenstrom's sign

34

Muscle enlargement, abscesses, subcutaneous edema and hard, "woody" induration of the overlying skin are characteristic of...

a. pyomyositis
b. necrotizing fasciitis
c. cellulitis
d. tenosynovitis

a. pyomyositis

35

A sclerotic non-purulent form of osteomyelitis characterized by intense proliferation of the periostrum leading to bony deposition is termed?

a. sclerosing osteomyelitis of Garre
b. chronic recurrent non-suppurative osteomyelitis
c. bone abscess (Brodie's abscess)
d. acute non-infective hyperostosis

a. sclerosing osteomyelitis of Garre

36

The combination of rapid loss of intervertebral disc height and adjacent lysisof bone is most suggestive of...

a. metastatic disease
b. multiple myeloma
c. infective spondylitis
d. osteoporosis

c. infective spondylitis

37

Cutaneous, sinus, and dental infections are three important sources for which of the following contamination route?

a. hematogenous
b. spread from a contiguous source
c. occasional contamination
d. direct implantation

b. spread from a contiguous source

38

A metaphyseal infection of the proximal portion of the humerus spreading through the adjacent cortex can contaminate the glenohumeral joint by extending along the tendon of the...

a. Supraspinatus
b. Infraspinatus
c. Subscapularis
d. Long head of the biceps

d. Long head of the biceps

39

Septic arthritis is more commonly...

a. a polyarticular condition
b. a monoarticular condition
c. a sexually transmitted condition
d. a disease of the sexually inactive

b. a monoarticular condition

40

Expansile tuberculous dactylitis has also been termed...

a. hand-foot syndrome
b. sausage digit
c. spina ventosa
d. scrofula

c. spina ventosa

41

Sacroiliac joint infections are usually...

a. bilateral and symmetric
b. bilateral and asymmetric
c. unilateral
d. Both a and b are correct

c. unilateral

42

Hematogenous ostemyelitis of children over 1 year old is encountered more frequently in which of the following portion of a bone?

a. epiphysis
b. metaphysis
c. diaphysis
d. both a and b are equal in frequency

b. metaphysis

43

During a magnetic resonance imaging scan with gadolinium contrast performed on a patient suspected to have ostemyelitis, the presence of a ring enhancing lesion of high signal intensity on T1-weighted images with a low signal center most likely represents a/an...

a. sequestrum
b. involucrum
c. cloaca
d. abscess

d. abscess

44

Acute inflammatory process of the deeper subcutaneous tissues resulting generally from a streptococcal or, less commonly, a staphylococcal infection, leading to pain or tenderness, redness, swelling, warmth, and mild to moderate fever is known as...

a. pyomyositis
b. necrotizing fasciitis
c. cellulitis
d. tenosynovitis

c. cellulitis

45

Septic spondylitis most typically involves the

a. cervical spine
b. thoracic spine
c. lumbar spine
d. sacroiliac joints

c. lumbar spine

46

When septic arthritis is considered in a differential diagonsis, which following diagnostic procedure should be recommended?

a. joint aspiration with subsequent culture
b. bone scintigraphy
c. conventional tomography
d. computerized tomography

a. joint aspiration with subsequent culture

47

Paronychia is...

a. an infection of the hair bed
b. a loculated abscess of the dermal portion of the skin
c. a subcuticular abscesses of the nail fold
d. an inflected mole

c. a subcuticular abscesses of the nail fold

48

When performing a scintigraphic evaluation for the presence of osteomyelitis, the advantage of the agent 67 Ga-citrate over 99 mm Tc-methylene diphosphonate is

a. It is sensitive to osteoblastic activity
b. It binds with leukocytes
c. It is dependent on the increased localized blood flow
d. It is cheaper to use

b. It binds with leukocytes

49

The term cloaca refers to:

a. an opening in the involucrum, through which pus may discharged outside the bone

b. an opening between the skin surface and the bone

c. an opening between an infected epiphysis and an adjacent synovial joint

d. a layer of living bone that has formed around the dead bone

a. an opening in the involucrum, through which pus may discharged outside the bone

50

The term sequestrum refers to:

a. A fractured bony fragment displaced away its parent bone caused by osteomyelitis

b. A layer of living bone that has formed around the dead bone

c. A connection between two infected organs

d. A segment of necrotic bone that is separated from living by granulation tissue

d. A segment of necrotic bone that is separated from living by granulation tissue

51

The presence periarticular osteoporosis, marginal joint erosions and slow progressive joint space loss is know as...

a. Ritter's triad
b. Phemister's triad
c. Webster's triad
d. Foley's triad

b. Phemister's triad

52

Which of the following does not represent a contamination route for osteomyelitis?

a. Hematogenous
b. Spread from a continguous source
c. Occasional contamination
d. Direct implantation

c. Occasional contamination

53

Which of the following is false about septic arthritis?

a. Rapid destruction of bone and cartilage is characteristic of bacterial arthritis

b. In tuberculous arthritis, marginal osseous erosions with preservation of joint space and periarticular osteoporosis can be prominent.

c. Osseous erosions at the edges of the joint related to the effects of diseased synovium on bone, lead to marginal defects that are similar in appearance and location to those of rheumatoid arthritis.

d. Bony ankylosis of the joint is not characteristic of late stage chronic pyogenic arthritis.

d. Bony ankylosis of the joint is not characteristic of late stage chronic pyogenic arthritis.

54

Which of the following choices does not represent a possible complication of osteomyelitis?

a. Growth disturbances
b. Neoplasms
c. Amyloidosis
d. All of the above are possible complications

d. All of the above are possible complications

55

The ulcerative channel and malignant transformation found with chronic osteomyelitis is referred to as a(n)

a. Phemisters pathway
b. cloaca
c. Marjolin's ulcer
d. sinus tract

c. Marjolin's ulcer

56

Which of the following joints is less likely to be affected by septic arthritis in the drug abuser?

a. sacroiliac
b. sternoclavicular
c. acromioclavicular
d. ankle

a. ankle

57

A cortial abscess can be radiographically visualized as a lucent lesion with surrounding sclerosis and periostitis. This appearance can stimulate which of the following conditions?

a. Osteoid osteoma
b. Stress fracture
c. non-ossifying fibroma
d. Both a and b are correct

d. Both a and b are correct

58

Vascular patterns of hematogenous infection in tubular bones of a child typically involve(s) the

a. epiphysis and metaphysis
b. epiphysis
c. diaphysis and metaphysis
d. none of the above

c. diaphysis and metaphysis

59

The sudden onset of lower limb paraplegia in spinal tuberculosis is referred to as

a. Pott's paraplegia
b. Saunder's paraplegia
c. Phemister's paraplegia
d. Waldenstrom's paraplegia

a. Pott's paraplegia

60

The most common joints affected by skeletal tuberculosis are...

a. The spine, ankle, shoulder
b. The spine, hip, knee
c. The shoulder, ankle, knee
d. The wrist, hip, knee

b. The spine, hip, knee