Osteomyelitis Quiz
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Questions and Answers

Which structure is NOT directly involved in osteomyelitis?

  • Medullary cavity
  • Cortical bone
  • Articular cartilage (correct)
  • Periosteum
  • Osteomyelitis classified as 'exogenous' originates from which source?

  • The bloodstream
  • Trauma or surgery (correct)
  • Tuberculosis infection
  • A distant site of infection
  • Why are children aged 2-12 more susceptible to osteomyelitis?

  • They have weaker immune systems compared to adults.
  • Their bones are less dense and more prone to injury.
  • They have increased metabolic bone turnover compared to adults. (correct)
  • They experience more trauma and open fractures.
  • Which condition commonly predisposes individuals to osteomyelitis due to foot injuries and sores?

    <p>Diabetes mellitus (C)</p> Signup and view all the answers

    Why are individuals with sickle cell anemia at higher risk of developing osteomyelitis?

    <p>Due to increased susceptibility to gram-negative organisms like <em>Salmonella</em> spp. (A)</p> Signup and view all the answers

    What is the most frequent location of acute osteomyelitis in children?

    <p>Metaphysis of rapidly growing long bones (C)</p> Signup and view all the answers

    Which age group is most likely to present osteomyelitis with a history of urinary tract infection or urological procedure?

    <p>Older adults (B)</p> Signup and view all the answers

    What diagnostic finding is commonly associated with acute osteomyelitis?

    <p>Leucocytosis (B)</p> Signup and view all the answers

    Which imaging technique is considered the MOST sensitive for detecting osteomyelitis?

    <p>Magnetic Resonance Imaging (MRI) (B)</p> Signup and view all the answers

    In cases of suspected tuberculous osteomyelitis where initial tests are negative, what is the MOST appropriate next step in diagnosis?

    <p>Perform a nuclear medicine scan (A)</p> Signup and view all the answers

    What is the MOST common site affected by tuberculous osteomyelitis?

    <p>Lumbar spine (B)</p> Signup and view all the answers

    What is a PRIMARY difference between tuberculous osteomyelitis and pyogenic osteomyelitis?

    <p>Tuberculous osteomyelitis is more resistant to treatment. (A)</p> Signup and view all the answers

    What percentage of osteomyelitis cases yield positive results in blood cultures?

    <p>50-70% (D)</p> Signup and view all the answers

    Besides systemic antibiotics, what additional treatment is often required for chronic osteomyelitis?

    <p>Surgical debridement (D)</p> Signup and view all the answers

    What is the PRIMARY route of infection for tuberculous osteomyelitis?

    <p>Hematogenous spread from a pulmonary focus (D)</p> Signup and view all the answers

    Which measure is important in the PREVENTATIVE care of osteomyelitis?

    <p>Appropriate diagnosis and treatment of bacterial infections (B)</p> Signup and view all the answers

    Flashcards

    Osteomyelitis

    An infection of bone involving periosteum, cortical bone, and medullary cavity.

    Pyogenic bacteria

    Bacteria that cause pus-forming infections, key in osteomyelitis.

    Acute osteomyelitis

    A sudden onset of bone infection with severe symptoms.

    Chronic osteomyelitis

    A long-lasting bone infection with persistent symptoms.

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    Hematogenous route

    Infection spread through the bloodstream.

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    Exogenous route

    Infection caused by external factors like trauma or surgery.

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    Common pathogens in infants

    Metaphysis of long bones is often infected; notable in young children.

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    Diabetes and osteomyelitis

    Diabetic patients are at higher risk due to foot injuries.

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    CBC (WBC count)

    A blood test measuring white blood cells, used for diagnosing infections.

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    Blood culture

    A test to detect the presence of bacteria in the bloodstream.

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    Magnetic resonance imaging (MRI)

    An imaging modality, most sensitive for diagnosing osteomyelitis.

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    Acute osteomyelitis treatment

    Prolonged antibiotic therapy and possibly surgical debridement.

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    Chronic osteomyelitis symptoms

    Persistent symptoms including pain, swelling, and possible fever.

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    Tuberculous osteomyelitis

    A type of bone infection mainly affecting children & young adults, caused by tuberculosis.

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    Routes of infection

    Hematogenous spread or direct extension from nearby infections.

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    Prevention of osteomyelitis

    Involves appropriate diagnosis and treatment of bacterial infections and effective wound management.

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    Study Notes

    Bone Infections (Osteomyelitis)

    • Suppurative bone infections, also known as osteomyelitis, are infections of the bone tissue.
    • The periosteum, cortical bone, and medullary cavity (marrow cavity) can be involved.
    • Common etiologic agents are pyogenic bacteria, and Mycobacterium tuberculosis.

    Learning Outcomes

    • Students will be able to define suppurative bone infections (osteomyelitis).
    • Students will be able to describe common pathogens causing bone infections.
    • Students will be able to list common pathogens causing bone infections in various age groups.
    • Students will be able to describe laboratory methods used to diagnose osteomyelitis.
    • Students will be able to explain the pathogenesis of osteomyelitis.

    Classification of Osteomyelitis

    • Based on duration and type of symptoms: acute or chronic
    • Based on route of infection: hematogenous (via blood stream), exogenous (trauma or surgery), or direct spread
    • Based on causative agent: specific (e.g., TB), or non-specific (most common, organisms other than TB)

    Predisposing Factors

    • Age: More common in children (2-12 years) and less common in adults, with possible increased occurrences in older adults.
    • Sex: Boys are more susceptible than girls.
    • Trauma: Injuries can introduce pathogens.
    • Immunodeficiency: Conditions like AIDS.
    • Diabetes Mellitus: Patients are susceptible to foot injuries and sores from chronic complications, which may become infected leading to osteomyelitis
    • Renal dialysis & malnutrition: weaken the body’s ability to fight infection.
    • Sickle Cell Anemia: Presence of septic foci (e.g., otitis media, tonsillitis, abscesses).
    • Intravenous drug abusers: introducing pathogens through injection.

    Organisms Commonly Isolated in Osteomyelitis Based on Age

    • Infants (<1 year): Group B-β hemolytic streptococci, Staphylococcus aureus, Escherichia coli
    • Children (1 to 16 years): Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae (50% in children <4 yrs), Kingella kingae.
    • Adults (>16 years): Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, E. coli. (Staphylococcus aureus is responsible for 80-90% of cases)

    Routes of Infection

    • Hematogenous: Infection spreads through the bloodstream from another site (e.g., infected tooth, sinus). This is most common.
    • Direct extension: Infection spreads directly from neighboring infected tissues (e.g., a tooth abscess).
    • Direct inoculation: Infection introduced during surgical procedures or trauma

    Sites of Osteomyelitis

    • Occurs in the metaphysis of long bones (distal femur, proximal humerus, proximal tibia, distal radius) due to high vascularity.
    • Other sites include vertebrae, clavicle, and ribs.

    Pathogenesis of Acute Osteomyelitis (stages)

    • Microorganisms enter the bone and are phagocytosed.
    • Phagocytes release enzymes to lyse (break down) the bone.
    • Pus spreads into vascular channels.
    • Raising intraosseous pressure impairs blood flow in the bones. This causes chronic ischemic necrosis. As a result, large devascularized fragments are separated (sequestra).
    • New bone formation, called involucrum, surrounds the area.

    Acute Hematogenous Osteomyelitis

    • Most common type in children under 12 years old.
    • Often caused by a history of trauma.
    • Males are more commonly affected.
    • The metaphysis of rapidly growing long bones are most frequently involved.

    Clinical Picture of Acute Osteomyelitis (Symptoms)

    • Infant: History of septic focus, failure to thrive, drowsiness, irritability, metaphyseal tenderness, decreased range of movement (especially around the knee).
    • Adult: History of UTI, immunosuppression, old age, diabetes, local pain, redness, tendernss, reluctance to move, fever, malaise, toxemia, leucocytosis, pus discharge.

    Diagnosis

    • Clinical: Based on patient's symptoms and physical examination.
    • Laboratory: CBC (White Blood Cell count), ESR (Erythrocyte Sedimentation Rate), CRP (C-reactive protein), Blood culture (identifies pathogens), X-ray (initial evaluation), tissue samples (bone biopsy, smear), culture & sensitivity.
    • Imaging: Bone scan, CT (computed tomography), MRI (magnetic resonance imaging) is highly sensitive.

    Treatment of Osteomyelitis

    • Acute: Prolonged antibiotic therapy (weeks or months). Surgical debridement may be required.
    • Chronic: Systemic antibiotics and surgical treatment.

    Tuberculosis of Bone (Tuberculous Osteomyelitis)

    • Affects children and young adults.

    • Insidious onset and chronic course.

    • More destructive than pyogenic osteomyelitis, and resistant to treatments.

    • Affects the spine (50% of cases), followed by the hips and knees.

    • Routes of Infection: hematogenous spread (from a focus of active pulmonary disease), direct extension (from caseous focus in lung to surrounding tissues.. or lymph nodes to vertebrae)

    • Symptoms: Fever, chills anorexia, Weight loss, local swelling

    • Treatment: The same anti-TB medications used for pulmonary TB.

    Laboratory Findings in Tuberculous Osteomyelitis

    • CBC: anemia, Leukocytosis.
    • ESR, CRP increased.
    • Blood culture.
    • Tuberculin skin test.
    • MRI spine
    • If initial tests are negative but suspicion is high: nuclear medicine scan, CT guided bone biopsy, histological examination.

    Prevention of Osteomyelitis

    • Appropriate diagnosis and treatment of bacterial infections.
    • Effective wound management.

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    Bone Infections 2025 PDF

    Description

    Test your knowledge on osteomyelitis, including its causes, at-risk populations, and diagnostic methods. This quiz covers essential information about the condition and its implications, especially in children and individuals with certain health issues.

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