Orthopaedics - Septic Orthopedics (Ny!)

Front 1

What is the most common microorganism, which is responsible for postoperative infections?
- Staphylococcus aureus
- Actinomycetes
- Staphylococcus coagulase negative
- Chlamydia trachomatis

Back 1

What is the most common microorganism, which is responsible for postoperative infections?
- Staphylococcus aureus+
- Staphylococcus coagulase negative+

Front 2

Select the true statement(s) about osteomyelitis:
- a transition from acute to chronic phase is not frequent
- the most frequent microbial agent is Staphylococcus aureus
- during neonatal period OM does not occur
- osteomyelitis is an inflammatory disease of the cortical bone and bone marrow

Back 2

Select the true statement(s) about osteomyelitis:
- the most frequent microbial agent is Staphylococcus aureus+
- osteomyelitis is an inflammatory disease of the cortical bone and bone marrow+

Front 3

Select the true statement(s) about osteomyelitis:
- the disease is classified as either acute or chronic or subacute, depending on the length of time the infection or symptoms persist
- acute hematogenous osteomyelitis is mainly in childhood period
- clinical symptoms of acute hematogenous osteomyelitis does not arise from full health
- fever is not typical clinical symptom of acute hematogenous osteomyelitis

Back 3

Select the true statement(s) about osteomyelitis:
- the disease is classified as either acute or chronic or subacute, depending on the length of time the infection or symptoms persist+
- acute hematogenous osteomyelitis is mainly in childhood period+

Front 4

Select the false claim about an acute hematogenous osteomyelitis:
- it is predominantly a disease of childhood
- progress of acute hematogenous osteomyelitis is not different in different ages and there is no differences in disease progress according to the vascular supply of the bone
- in the neonatal period is most commonly affected the proximal humerus
- in the early stages of the disease is significantly influenced by the general patient condition, the disease can remind septic arthritis

Back 4

Select the false claim about an acute hematogenous osteomyelitis:
- progress of acute hematogenous osteomyelitis is not different in different ages and there is no differences in disease progress according to the vascular supply of the bone+
- in the neonatal period is most commonly affected the proximal humerus+

Front 5

Septic arthritis can often occur:
- according to hematogenous infection (oral cavity)
- iatrogenically – resulting from the activity of physicians (e.g. joint puncture)
- according to aerogenic spread of infection
- the most common cause is pleural metastasis, inflammation

Back 5

Septic arthritis can often occur:
- according to hematogenous infection (oral cavity)+
- iatrogenically – resulting from the activity of physicians (e.g. joint puncture)+

Front 6

Acute septic arthritis (for example gonitis):
- can be caused by iatrogenic activity
- cannot be caused by iatrogenic activity
- CRP (C-reactive protein) is often around 200 mg/l in lab tests
- CRP (C-reactive protein) is often around 20 mg/l in lab tests

Back 6

Acute septic arthritis (for example gonitis):
- can be caused by iatrogenic activity+
- CRP (C-reactive protein) is often around 200 mg/l in lab tests+

Front 7

Open fractures with soft tissue defects:
- indication for acute surgery
- the administration of antibiotics will wait at least until the first microbiological cultivation results to prevent the rising of microbial resistance
- there is high risk of infection (almost Gram positive)
- immediately after transferring to hospital, to ambulance is necessary to remove temporary wound cover, perform basic debridement, to prevent the spread of pathological microorganisms (bacteria, viruses), this procedure is done before entering operating theatre

Back 7

Open fractures with soft tissue defects:
- indication for acute surgery+
- there is high risk of infection (almost Gram positive)+

Front 8

Patient with 2 days fever (38 Celsius), right knee pain with swelling:
- indications for a joint puncture and send a sample for histological examination
- indications for joint puncture and send a sample for microbiological and biochemical tests
- indications for essential laboratory screening, including CRP, WBC, procalcitonin
- primary indications for ultrasound examination to exclude a septic fluid inside the joint

Back 8

Patient with 2 days fever (38 Celsius), right knee pain with swelling:
- indications for joint puncture and send a sample for microbiological and biochemical tests+
- indications for essential laboratory screening, including CRP, WBC, procalcitonin+

Front 9

Septic loosening of the total hip replacement:
- can be caused by infection focus (for example focus in oral cavity)
- cannot be caused by hematogenous spreading
- typical changes can be demonstrated on X-ray films
- septic loosening cannot lead to bony structural changes around prosthesis

Back 9

Septic loosening of the total hip replacement:
- can be caused by infection focus (for example focus in oral cavity)+
- typical changes can be demonstrated on X-ray films+

Front 10

The clinical signs of inflammation are from ancient Rome (Celsus):
- rubor – redness, one of the cardinal signs of inflammation
- tumor – swelling, linked to increased blood volume and subsequent extravasation of fluid into surrounding tissues
- abscess – cavity formed by the inflammatory process, usually filled with pyogenic fluid
- gangrene – necrosis, modified by secondary changes

Back 10

The clinical signs of inflammation are from ancient Rome (Celsus):
- rubor – redness, one of the cardinal signs of inflammation+
- tumor – swelling, linked to increased blood volume and subsequent extravasation of fluid into surrounding tissues+

Front 11

Twenty-eight-years old woman patient, after previous diarrhea, knee pain for three days puncture was done by physician. After that fever 38 Celsius, increasing knee pain. CRP 200 mg / l. Microbial test culture was negative. What are the possibilities for a differential diagnosis?
- pyogenic (septic) arthritis
- reactive arthritis – Reiter's syndrome
- acute lesions of LCA – anterior ligament cruciatum
- TBC arthritis

Back 11

Twenty-eight-years old woman patient, after previous diarrhea, knee pain for three days puncture was done by physician. After that fever 38 Celsius, increasing knee pain. CRP 200 mg / l. Microbial test culture was negative. What are the possibilities for a differential diagnosis?
- pyogenic (septic) arthritis+
- reactive arthritis – Reiter's syndrome+

Front 12

In suspected hip prosthesis loosening:
- we can use radionuclide methods (a combination of bone scintigraphy and leucoscan) that help us to distinguish whether the septic or aseptic loosening
- first of all is indicated PET CT examination to differentiate aseptic or septic loosening
- there is no typical X-ray signs for septic or aseptic loosening prosthesis, we make a decisions for revision surgery based on the objective findings and laboratory results
- control X-ray film is indicated, where you can find typical changes particularly around the prosthesis (change in position of the prosthesis)

Back 12

In suspected hip prosthesis loosening:
- we can use radionuclide methods (a combination of bone scintigraphy and leucoscan) that help us to distinguish whether the septic or aseptic loosening+
- control X-ray film is indicated, where you can find typical changes particularly around the prosthesis (change in position of the prosthesis)+

Front 13

Sequester is:
- part of the necrotic bone without blood supply
- part of bone where bacterial population can persist
- newly formed bone, resulting in secondary fracture healing
- bone fragment with a residual vascular supply

Back 13

Sequester is:
- part of the necrotic bone without blood supply+
- part of bone where bacterial population can persist+

Front 14

Select the true statement of the nonunion, pseudoarthrosis:
- nonunion can be caused by adverse biomechanical conditions in the fracture
- cannot be caused by infection
- nonunion is a definite condition in which reparative processes are completed and healing without therapeutic surgery is not possible
- prolonged healing time of is known as nonunion

Back 14

Select the true statement of the nonunion, pseudoarthrosis:
- nonunion can be caused by adverse biomechanical conditions in the fracture+
- nonunion is a definite condition in which reparative processes are completed and healing without therapeutic surgery is not possible+

Front 15

TBC – specific inflammation of the bones and joints:
- cold abscesses are not gathered together into a musculoskeletal TBC
- the most common entry point into the body are the lungs
- the most affected part of the musculoskeletal system is spine, followed by knee joint
- characteristic laboratory findings are high levels of CRP over 200 mg/l

Back 15

TBC – specific inflammation of the bones and joints:
- the most common entry point into the body are the lungs+
- the most affected part of the musculoskeletal system is spine, followed by knee joint+

Front 16

Acute hematogenous osteomyelitis:
- typical X-ray findings are swelling, osteolysis, sequester formation
- the therapy is based surgical procedure (incision, evacuation, drainage, removal sequester), intravenous usage of ATB
- sequester is not a typical for acute hematogenous osteomyelitis
- the characteristic is a slow and gradual onset of disease, fever is not typical clinical symptom

Back 16

Acute hematogenous osteomyelitis:
- typical X-ray findings are swelling, osteolysis, sequester formation+
- the therapy is based surgical procedure (incision, evacuation, drainage, removal sequester), intravenous usage of ATB+

Front 17

Staphylococcus aureus:
- gram positive
- gram negative
- the most common microorganism, which is responsible for postoperative infections
- pathogens attacks only human hosts

Back 17

Staphylococcus aureus:
- gram negative+
- the most common microorganism, which is responsible for postoperative infections+

Front 18

Olecranon bursitis („student's elbow“ or „baker's elbow“):
- cannot be caused by repeated injury of olecranon bursa
- typical clinical signs are manifested by swelling, rubor, fluctuations around the olecranon
- it can also occur iatrogenically by a puncture
- olecranon bursitis is indicated only for conservative treatment

Back 18

Olecranon bursitis („student's elbow“ or „baker's elbow“):
- typical clinical signs are manifested by swelling, rubor, fluctuations around the olecranon+
- it can also occur iatrogenically by a puncture+

Front 19

Coxitis (septic arthritis of the hip):
- the hip joint fluid collection (effusion) is not a typical clinical sign
- an ultrasound scan is essential for diagnosis, it is necessary to compare both hip joints to assess effusion
- X-ray changes can be seen with delay
- affects only the pediatric population

Back 19

Coxitis (septic arthritis of the hip):
- an ultrasound scan is essential for diagnosis, it is necessary to compare both hip joints to assess effusion+
- X-ray changes can be seen with delay+

Front 20

Hip joint pain in childhood must be considered in terms of occurrence in the differential diagnosis with:
- coxitis (septic arthritis of the hip)
- transient synovitis of the hip (also called toxic synovitis)
- Gaucher´s disease
- neuropathic joint

Back 20

Hip joint pain in childhood must be considered in terms of occurrence in the differential diagnosis with:
- coxitis (septic arthritis of the hip)+
- transient synovitis of the hip (also called toxic synovitis)+