Term
| In which type of patients is acute osteomyelitits most common? |
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Definition
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Term
| What are the S & S of Acute Osteomyelitits? |
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Definition
+/- Hx of trauma
Limp, secondary to bone pain
Fever, chills, diaphoresis
Swelling & Heat to Soft Tissue |
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Term
| What is the MC pathogen causing Acute Myelitis? |
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Definition
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Term
| What should be used to treat acute osteomyelitis? |
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Definition
| Antibiotics including Oxacillin, Cefazolin or Clindamycin |
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Term
What illness is shown in the image below?
[image] |
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Definition
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Term
| How is acute osteomyelitis diagnosed? |
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Definition
MRI - Can show subtle changes and can help identify the acute osteomyelitis - but is complicated as it just shows bone marrow edema and is not conclusive for acute osteomyelitis
Bone Scan = Can aid in early diagnosis
x-ray = may not show changes for up to a month |
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Term
| In adults what is the first noticeable symptom of acute osteomyelitis? |
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Definition
| limitation to joint movement |
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Term
| What medical conditions can lead to acute osteomyelitis? |
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Definition
| Malnutrition, Immunosuppression, Alcoholism |
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Term
| What pathogens can cause acute osteomyelitis other than S. aureus? |
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Definition
TB - Pott's Disease (Spine)
Fungal
Rickettsial |
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Term
| What is the MC reason for sending a pt to surgery for acute osteomyelitis? |
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Definition
| No reaction to treatment, measured using Serial ESR and C-reactive protein |
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Term
| In adults, what should be done to treat acute osteomyelitis? |
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Definition
CONSULT IMMEDIATELY with Ortho and Infectious Dx
- Aspirate pus
-Bone Eval
- IV Antibiotics |
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Term
| What are the indications for surgery with acute osteomyelitis? |
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Definition
Evidence of abscess on imaging
Failure of response to antibiotics
Involvement of major joint |
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Term
| What grade is a diabetic foot ulcer that has no open lesion, where the foot is "at risk" for developing ulcer (no breakdown yet!), has a deformity that puts pt at risk for developing the ulcer? |
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Definition
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Term
| What is the treatment for a Grade 0 Diabetic Ulcer? |
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Definition
Proper Foot Wear, Surgical Correction of bone
TREAT AGGRESSIVELY to prevent move from Grade 0 to Grade 1 |
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Term
| Which type of diabetic ulcer is described as a superficial ulcer that affects the skin only? |
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Definition
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Term
| What is the treatment for a Grade 1 diabetic ulcer? |
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Definition
Outpatient Dressing Changes
Pt Wound Care |
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Term
| Which grade of diabetic ulcer is described as a deep ulcer that has lesions involving underlying tendons, bones or ligaments? |
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Definition
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Term
| What is the treatment for a grade 2 diabetic ulceration? |
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Definition
Hospitalization
Surgical Debridement and Aggressive Wound Care
IV Antibiotics |
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Term
| Which grade of diabetic ulcer is described as an abscess osteitis, abscess or osteomyelitis presents as a complication? |
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Definition
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Term
| How is a grade 3 diabetic ulcer treated? |
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Definition
ER Surgery (drainage for acute infection)/ Hospitalization
Wound left open w/dressing changes (Closure or amputation later) |
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Term
| Which grade of diabetic ulcer is described as a gangrenous foot present in toes and/or forefoot? |
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Definition
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Term
| What is the treatment for a grade 4 and 5 diabetic foot ulcers? |
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Definition
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Term
| Which grade of diabetic ulcer is described as gangrene of the entire foot? |
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Definition
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Term
| What injury most commonly causes chronic osteomyelitis? |
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Definition
| Open Fracture or wound of lower extremity |
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Term
| What are the S&S of chronic osteomyelitis? |
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Definition
S/P open Fx
Fever
Pain
Soft tissue swelling/inflammation, cellulitis |
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Term
| What is the radiologic appearance of chronic osteomyelitis on x-ray? |
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Definition
Irregular sclerotic bone destruction w/severe areas of radiolucency
Involucrum - dead bone surrounded by new shell of bone |
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Term
| If chronic osteomyelitis is caused by an implant, what should be done as a part of the tx? |
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Definition
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Term
| What is the treatment for chronic osteomyelitis? |
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Definition
Preventive - clean and debris open fracture
Consult to Ortho (Surgical Referral)
I & D
Radical Debridement (Surgical - Dead bone MUST be removed)
Anti-biotics for 4 - 6 weeks |
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Term
| What type of patients are affected most commonly by Septic Arthritis? |
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Definition
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Term
| What type of joints are MC affected by Septic Arthritis? |
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Definition
| Large Peripheral Joint - knee or hip |
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Term
| What are the MC pathogens of Septic Arthritis in adults, children and IV drug users? |
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Definition
Adults - S. Aureus
Children - H. Influenzae
IV Drug Users - Gram Neg Rods |
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Term
| What are the S&S of Septic Arthritis? |
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Definition
Pain in joint (with ANY Movement)
Warm, swollen, diffusely tender joint
Limp, 2nd to weight bearing
Passive ROM tenderness |
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Term
| What is the confirmatory test for septic arthritis? What are the key findings? |
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Definition
| Joint Aspiration - fluid cloudy, purulent, decrease glucose, increased WBC (over 50,000) |
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Term
| What is the treatment for Septic Arthritis? |
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Definition
ORTHO Consult (Surgical Referral for Wash out)
IV antibiotics |
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Term
| What are the S&S of Gonococcal Septic Arthritis? |
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Definition
Polyarthritis (or Monoarthritis)
Tenosynovitis
Dermatitis |
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Term
| How is Gonococcal Septic Arthritis Diagnosed? |
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Definition
Joint Aspiration - Positive
Blood Cultures are usually negative |
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Term
| What is the treatment for gonococcal septic arthritis? |
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Definition
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Term
| What is the MC fibrous or cartilignous tumor of the hand? |
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Definition
|
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Term
| What is the MC benign fibrous or cartilignous tumor? |
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Definition
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Term
| What are the MC sites where the Osteochondroma are found? |
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Definition
| Metaphysis of distal femur or proximal tibia |
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Term
| What is the MC soft tissue mass of the hand, that is most commonly found in the dorsum of the hand? |
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Definition
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Term
| What is the tx for a ganglion cyst? |
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Definition
40 -50% resolve on their own
Aspirate w/18 gauge needle and compression for 48 - 72hrs
Injection of steroid compoun
Excision |
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Term
| What is the most useful test for detecting malignant bone lesions? |
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Definition
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Term
| What is the MC primary tumor of the bone? |
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Definition
| Multiple Myeloma ("punched out" lesions) accounts for 45% of all malignant tumors |
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Term
| What is the MC locations where Osteosarcomas are found? |
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Definition
| originate in the metaphysis (50% - 60% are found around the knee) distal femur is most common |
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Term
| What are the S & S of osteosarcoma? |
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Definition
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Term
| What disease are osteosarcoma sometime found with? |
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Definition
|
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Term
| What is the x-ray finding of osteosarcoma? |
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Definition
lytic destruction with cortical defects (does not cross the growth plate)
Starburst Pattern |
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Term
| What are the S & S of Ewing's Sarcoma? |
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Definition
Painful soft tissue mass
Midshaft of a long bone
Weight loss
Fever
Lethargy
Extensive destruction |
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Term
| What is the x-ray finding of Ewing's sarcoma on x-ray? |
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Definition
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Term
| What is the MC non-inflammatory arthritis? |
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Definition
|
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Term
| What are the distinct radiologic findings of osteoarthritis? |
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Definition
1 - Joint Space Narrowing
2 - Spur Formation
3 - Sclerosis
4 - Subchondral Cyst |
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Term
| What are the S & S of osteoarthritis? |
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Definition
Pain
Joint Stiffness
Joint Findings (Swollen, warm, tender, red) |
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Term
| What is the MC metabolic disease? |
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Definition
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Term
| What is the MC location for osteoporotic hip fractures? |
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Definition
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Term
| How should osteoporosis be detected? |
|
Definition
Bone Density Measurements
DEXA Scan |
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Term
| What is a T-score mean with a BMD? |
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Definition
| It is a statistical comparison to the bone mass of a healthy young female |
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Term
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Definition
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Term
| What does a T-score between 1 - 2.5 SD indicative of? |
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Definition
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|
Term
| What is a T-score greater than 2.5 SD indicative of? |
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Definition
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Term
| What is the treatment for osteoporosis (and osteopenia)? |
|
Definition
Lifestyle/Diet Changes
HRT (Hormone Replacement Therapy)
Calcitonin (Inhibits Reabsorption)
Biphosphonates (Inhibits bone mineralization and resorption. |
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