Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A2 ME3031 MSK > W09 - BONE AND SOFT TISSUE INFECTION; OSTEOARTHRITIS AND MGMT > Flashcards

W09 - BONE AND SOFT TISSUE INFECTION; OSTEOARTHRITIS AND MGMT Flashcards

1
Q

Outline the bacteriological and pathological basis of bone infection

A
  • non-spec most common
  • haematogenous spread (children & elderly)
  • infants: infcd umbilical cord
  • children: boils, tonsilitis, abrasions
    adults: UTI, arterial line
  • 2º to vascular insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Compare acute and chronic osteomyelitis

A

ACUTE
children, M > F
trauma hx
adults: DM, R.Arth., imm compr., LT steroid, sickle cell

  • start @ metaphysis, vasc. stasis, inflamm and suppuration and release
  • bone necrosis
  • INVOLUCRUM = resolution

CHRONIC
*nil resolution and continued infection
*DE NOVO d/t operation or open # = rpt breakdown of healed wounds
*risk groups: DM, elderly, drug abusers
Staph. Aureus, E. Coli, Strep. pyogenes, Proteus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Able to describe the clinical features, RF, and differential diagnosis of a patient with osteomyelitis

A

specific (e.g. TB) vs non-sepc. (most common)

*DM, imm suppr., xs alcohol, IVDU

severe pain in the affected region and associated low grade pyrexia. Pain is constant and can be worse at night

ACUTE SEPTIC ARTHRITIS

TRAUMA

ACUTE INFLAMM ARTHRITIS

TRANSIENT SYNOVITIS

SOFT TISS. INFECTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Understand the investigations and expected results of patients with osteomyelitis, (and their interpretation)

A 
temp
FBC + diff. WBC = neutr. leucocytosis
ESR, CRP
Cultures x3
UEs, dehydration, systemic ill
  • XR = 14d minimal change > periosteal changes > medullary lysis
  • CULTURES*
  • BONE BIOPSY*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Understanding of the principles of management of bone infections

A

> pain and dehydration support

> rest & splintage

> abx: empirical while waiting (Fluclox + BenzylPen)

  • IV/oral 7-10d
  • 4-6w depends on response

> Sx: abscess, debridement

  • chronic
  • acute refractory to abx
  • infected prosthetic joint or foreign body
  • post-trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Understand the possible complications of bone infections

A
  • late osteonecrosis = sequestrum
  • late peristeal new bone = involucrum
  • METS infectioon
  • fracture
  • SEPTIC ARTHRITIS
  • SEPTICAEMIA
  • ALTERED BONE GROWTH

*CHRONIC DEVELOPMENT
=> hronic discharging sinus
=> abscess
=> SCC (0.07%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common organisms in acute osteomyel.

A

INFANTS:
s. aureus, group b strept., e. coli

OLDER CHILDREN
s. aureus, strep pyogenes, haemophilus influenza (imms!)

ADULTS
s. aureus, mycobact. tuberculosis, pseudomonas aeroginosa

coag neg. staph, propionibacterium spp (prostheses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Special cases of organisms for acute osteomyel

A

DM: mixed infection

Vertebral osteo.: s. aureus, TB

Sickle cell: salmonella spp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Paediatric presentation of osteomyelitis

A

Children:

  • minimal signs
  • drowsy/irritable
  • metaphyseal tenderness+swelling
  • common around the knee + long bones+ mult. sites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Adult presentation of osteomyelitis

A

1º OM seen in thoracolumbar spine
backache
UTI hx or urological procedure

*elderly, diabetic, immunocompr.

2º OM more common d/t open fracture/sx
mix of pathogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Differential Dx of OM: Soft Tissue Infection

A

CELLULITIS (gp A strep): deep infection of subcut.

ERYSIPELAS (gp a strep): superficial infection, red raised plaque

NECROTISING FASCIITIS (gp a strep, clostridia): aggy fascial infection

GAS GANGRENE (clostridium perf.)

TOXIC SHOCK SYNDROME (s. aureus): 2º wound colonisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is sequestrum

A

A bony sequestrum (pl. sequestra) is a piece of devascularised bone that becomes separated from the remainder of the bone in chronic osteomyelitis and acts as a nidus for ongoing infection

  • d/t breaking off and losing vascular supply
  • often is surrounded by new bone: INVOLUCRUM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Acute Septic Arthritis Aetiology

A

Sources:

  • haematogenous
  • bone abscess eruption
  • direct invasion: wound; intra-articular injury; arthoscopy

*Staphylococus aureus
Haemophilus influenzae
Streptococcus pyogenes
E. coli

INFECTED JOINT REPLACEMENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Able to describe the clinical features of a patient with septic arthritis

A

METAPHYSEAL SEPTIC FOCUS (septic arthritis or osteomyelitis)

*single swollen joint!

  • acute synovitis w/ purulent joint effusion
  • articular cartilage attacked (bact. toxin and cellular enzyme)
    = destruction of articular cartilage

=> recovery / partial loss / subsequent OA / fibrous bony ankylosis

CHILDREN: septic; swelling superficial; not erythematous; febrile; tender
ADULT: superficial joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Identify the investigations required for a diagnosis of septic arthritis and expected results

A 
FBC, WBC, ESR, CRP, blood cultures
X ray
Ultrasound
MRI
aspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Understand the principles of management of septic arthritis

A

Supportive

Abx

Sx drainage & lavage
- open or arthroscopic lavage

Join repl = revisions or abx only

17
Q

Differential Dx of Pt. w/ Septic Arth. Presentation

A

ACUTE OSTEOMYELITIS

TRAUMA

IRRITABLE JOINT

RHEUMATIC FEVER

GOUT

18
Q

Understand the potential diagnosis of tuberculosis of bone and its clinical setting.

A

insidious onset w/ general illness

*NIGHT PAIN, SWELLING, WT LOSS

  • spinal TB = abscess or kyphosis
  • SINGLE JOINT w/ SYNOVIUM THICKENING + musc. wasting

*ESR, Mantoux, XR, aspiration and biopsy

19
Q

DDx of Bone TB

A
  • transient synovitis
  • monoarticular RArth
  • haemorrhagic arthritis
  • pyogenic arthr.
20
Q

TB Mgmt

A

RIFAMPICIN
ISONIAZID (8w)
Ethambutol

THEN rifampicin & isoniazid

REST & SPLINT

+op. drainage rare

21
Q

Understanding of the definition and classification of OA into primary and secondary

A

Activity-related joint PAIN + nil morning stiffness or stiffness lasting no longer than 30 mins (30min+ = inflamm)
+rapid deterioration
+hot, swelling

1º - unknown cause

2º - caused by another disease, infection, injury, or deformity

22
Q

OA Aetiologyy & Path

A

Persistent heavy activty; obesity in COMBO with musc wakness, ligmnt injury, abn anatomy

Degenerative joint condition, mainly affecting the knee

23
Q

OA Clinical Features

A

45y/o+

Joint pain
Stiffness: typically, worse after activity and at the end of the day
Limitation in day-to-day activities

24
Q

Investigating OA

A

Serum CRP/ESR NORMAL

XR:
L oss of joint space
O steophytes
S ubchondral sclerosis
S ubchondral cysts
25
Q

Mgmt of OA

A
  1. Holistic; conservative: wt loss, exercise, knowledge
  2. NON-PHARMA: thermo; electro; aids

PHARMA: analgesiacs, topical NSAIDS / capsaicin cream for knees, hands

  1. Sx (for refractory to non-sx; substantial impact)
    - joint replacement
    -
26
Q

DDx of OA

A

Gout

Inflamm arthritides

Septic arthrits

Malignancy

A2 ME3031 MSK (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions