Studied by 2 people
What age group is commonly affected by acute osteomyelitis?
Children (<5)
What is the MC site of acute osteomyelitis?
Metaphyseal end of long bone near joints (knee common)
What is the tx for acute osteomyelitis?
IV abx 4-6 weeks
(Cefazolin, Clindamycin, Vanc, FQ -if Pseudomonas)
What are sx of acute osteomyelitis?
+ hx trauma, RA, immunocompromised, DM, sickle cell, IV drug use; limp, fever, swelling/heat/erythema to soft tissue
What is the gold standard for diagnosis of acute osteomyelitis?
Open biopsy & bone aspiration
When treating acute osteomyelitis, what should be done before giving abx?
Joint aspiration
What is the MC pathogen for acute osteomyelitis?
Staph aureus
Why do children develop acute osteomyelitis?
systemic illness
What is the MC cause of chronic osteomyelitis?
Open fx or wound of extremities
What are sx of chronic osteomyelitis?
s/p open fx, fever, pain, soft tissue swelling/inflammation, cellulitis
What would you see on an Xray showing Chronic osteomyelitis?
irregular sclerotic bone destruction w/ areas of radiolucency & involcrum (dead bone)
What is the tx for chronic osteomyelitis?
Ortho & ID consults, I&D, IV abx
What is the MC location of septic arthritis?
young, monoarticular, large peripheral joint such as knee or hip
What is the most common pathogen associated with septic arthritis in adults?
Staph aureus
What is the most common pathogen associated with septic arthritis in sexually active YA?
Neisseria Gonorrhea
What is the most common pathogen associated with septic arthritis in children?
H. influenza
What is the most common pathogen associated with septic arthritis in IV drug users?
Pseudomonas (G- rods)
What is the tx for septic arthritis?
IV abx, EMERGENT arthrotomy/I&D, serial needle aspiration & lavage, Monitor CRP levels
What is the confirmatory test for septic arthritis?
Joint aspiration (cloudy, purulent, WBC >50,000)
What is the MC soft tissue mass of the hand?
Ganglion cysts
What are ganglion cysts?
soft tissue lesions in extremities -adjacent to joint or tendon sheath
*MC to dorsum of hand
What is the tx for Ganglion cysts?
50% resolve spontaneously, needle aspiration, excision
What are the characteristics of benign bone tumors?
well-defined, nonagressive, w/o cortical destruction, periosteal rxn
What are the characteristics of malignant bone tumors?
lytic, destructive, permeative, ill-defined, aggressive, moth-eaten, cortical destruction, periosteal rxn
How do benign bone tumors typically present?
may or may not be aggressive; present in 3 stages - latent, active, aggressive
How do malignant bone tumors typically present?
dull aching pain that progresses over time
What are the 5 MC primary cancers that metastasize?
Breast, Lung, Kidney, Thyroid, Prostate
What is the most valuable imaging when assessing bone tumors?
Xrays
What medication can you give to slow benign bone tumors?
Biphosphonates
What non-surgical tx can you use for malignant tumors?
radiation & chemo
What is a simple bone cyst?
simple fluid filled cyst on the bone; common ages < 20
What is an Osteochondroma?
cartilage-capped bony spur arising on the external surface of a bone; usually long bone near knee or proximal humerus
What is an Osteochondroma look like on an XR?
bone arising from stalk or "bump" on bone
What is the MC location of a Giant Cell Tumor?
distal femur
Giant Cell Tumors are common for what age range?
20-40 yo
What age range most commonly presents with enchondromas?
15-40 yo
Where are enchondromas commonly found?
Hands/fingers, Metaphysis of long bones
What does an Enchondroma show on an XR?
lucency of hands/fingers or matrix calcification of long bones on XR, usually an incidental finding
What does Fibrous Dysplasis show on an XR?
ground-glass appearance; lytic lesions
What age range most commonly presents with osteoid osteomas?
10-35 yo
Where are osteoid osteomas commonly found?
Long bones, Posterior spine segments
How does an Osteoid osteoma present on an XR?
Sclerotic lesions with small lucent nidus
What bone tumor may present with typical night pain that is responsive to NSAIDs or ASA?
Osteoid osteoma
What is the most common primary bone tumor?
Osteosarcoma
When is Multiple Myeloma MC?
*2nd MC blood cancer that affects bone
50-70 yo
What is the tx for an osteosarcoma?
Pre-op chemo, Limb salvage
Where does Osteosarcoma most commonly METS?
lungs
How does an Osteosarcoma present on XR?
"Hair-on-end" appearance; sunray burst mixed sclerotic lesions, Codman’s triangle periosteal rxn
What are the MC locations of Ewing's sarcoma?
Femur, Pelvis, Upper arm, Ribs in diaphysis
What population most commonly presents with Ewing's sarcoma?
5-20 yo; MC- males
What type of bone tumor may mimic symptoms of osteomyelitis? (fever, pain, weight loss)
Ewing's sarcoma
What does Ewing's sarcoma show on an XR?
lytic lesions w/ "onion peel" appearance
What is the tx for Ewing's sarcoma?
Chemo, surgery, radiation
Chondrosarcoma is a cancer of cartilage that is most commonly seen in what population?
adults: 40-70 yo
Which joints does Osteoarthritis MC affect?
weight bearing joints (LEs & spine)
How does Osteoarthritis present?
stiffness, dec ROM, pain worsening w/ movement and relieved w/ rest, tender to palpation, deformity
What is the MC location of Osteoarthritis?
knee joints
What is the MC type of arthritis?
Osteoarthritis
What is the tx for Osteoarthritis?
NSAIDs, steroid injections, PT/OT, lifestyle changes, surgery
Which type of arthritis is symmetric?
RA
What demographic does RA affect more?
W > M (3:1); inc w/ age
Which joints are spared in RA?
DIP
What extraarticular manifestations can RA cause?
nodules, vasculitis, pericarditis, tenosynovitis, scleritis
How does Rheumatoid Arthritis present?
morning stiffness, symmetric swelling, nodules, +RF, radiologic changes, claw deformity of foot, ulnar drifting
What is the first line tx for RA?
NSAIDs
What else can you use to tx RA?
opioids, glucocorticoids, DMARDS, splints, surgery
What is the most common genetic factor associated with seronegative spondyloarthropathies?
+HLA-B27 antigen
What system is most commonly involved in spondyloarthropathies?
Axial skeleton
Which disease has the strongest association to HLA-B27?
*stronger association in white pts
Ankylosing Spondylitis
Ankylosing spondylitis MC affects what demographic?
M > F (3:1); begins 20-30s
What are findings of early Ankylosing spondylitis on an XR?
squaring of superior and anterior margins of vertebral bodies
What are the findings of late Ankylosing spondylitis on an XR?
ossification of the longitudinal ligaments, autofusion of fact joints → poker spine (bamboo spine)
What does Sacroiliitis show on an XR?
narrowing of SI joints
Who is MC affected by Reactive Arthritis?
young men
What causes reactive arthritis?
inflammation triggered by GI or GU infxn (STDs and dysenteric)
*Chlamydia, Gonorrhea, Shigella, Salmonella, Campylobacter
What is the triad of sx associated with reactive arthritis?
Conjunctivitis, Urethritis, Oligoarticular arthritis
(can't see, can't pee, can't climb a tree)
What antigen might be present in some pts (63%) w/ Reactive Arthritis?
HLA-B27
What does Psoriatic arthritis show on an XR?
Pencil-in-cup deformity = joint destruction; resorption of terminal phalanges
*aggressive and destructive
What demographic is most affected by Psoriatic arthritis?
M=F 1:1; onset in 30s
What is the tx for psoriatic arthritis?
DMARD- methotrexate
What differentiates Psoriatic arthritis from RA?
DIP joint involvement and absence of nodules
Gout or Pseudogout:
Bony erosions & spurs on XR
Gout
Gout or Pseudogout:
Punctate or linear calcifications of cartilage (chondrocalcinosis)
Pseudogout
Gout or Pseudogout:
Negatively birefringent urate crystals
Gout
Gout or Pseudogout:
Weakly positive birefringent rhomboid-shaped crystals
Pseudogout
Gout or Pseudogout:
Serum uric acid (+)
Gout
What is the tx for gout?
Indomethacin -1st line, Colchicine -2nd line, NSAIDs, steroids
Long term: Allopurinol or Probenecid (inc urine excretion)
What is the tx for pseudogout?
Joint aspiration, Intra-articular steroids, NSAIDs
Acute: Colchicine
What causes Osteopenia?
dec bone density, poor nutrition, low estrogen, lack of exercise, smoking, excess ETOH intake
What is a precursor to Osteoporosis?
Osteopenia
Which type of Osteoporosis is found in Post-menopausal women?
Type 1
What type of Osteoporosis is found in older (senile) pts?
Type 2
Which form of Osteoporosis is due to an agent or disease process that is causing bone loss?
Secondary
Who is more likely to get Primary Osteoporosis? Seconday?
primary: W>M
secondary: M>F
What is the GOLD standard for diagnosing osteoporosis?
DEXA
What is the FRAX too used for?
evaluate 10-yr fracture risk of pts
Normal bone density T score
+1.0 to -1.0
T scores less than ____ indicate osteoporosis
-2.5
T scores between ____ and ____ indicate osteopenia
-1.0 to -2.5
T score of -1.0 has ___x risk of fractures
2x
