Question 1

A child presents to the physician with complaints of low back pain.The physician suspects either vertebral osteomyelitis or diskitis.What test is essential for this differential diagnosis?&#10;A) plain film radiography&#10;B) bone scans&#10;C) MRI&#10;D) cultures of blood and disk tissue

Accepted Answer

MRI is essential in providing a differential diagnosis when vertebral osteomyelitis is a possibility; MRI reduces diagnostic delay and may help avoid the requirement for a biopsy.

Question 2

Which of the following is indicative of mechanical loosening of a prosthetic joint?&#10;A) a wound over the surgical incision with drainage&#10;B) constant joint pain&#10;C) x-ray of the proximal component of the total joint with pathology&#10;D) complaints of pain accompanied by fever

Accepted Answer

The other choices are indicative of infection. Constant joint pain is indicative of infection, whereas mechanical loosening commonly causes pain with only motion or weight bearing. When both the distal and proximal components of a prosthetic joint demonstrate pathology on radiography, infection is more likely than mechanical loosening.

Question 3

What is a common initial site of bacterial seeding in a bone?&#10;A) epiphyseal growth plate&#10;B) cortical bone&#10;C) vascular loop&#10;D) hematopoietic marrow

Accepted Answer

The vascular loop in growing bone is a common site of bacterial seeding because arterioles form a loop and then drain into the medullary cavity without establishing a capillary bed.

Question 4

What invasive test is essential to confirm the presence of extrapulmonary TB in the spine?&#10;A) fine-needle aspiration with culture&#10;B) plain film radiography&#10;C) MRI&#10;D) computed tomography (CT)

Accepted Answer

Conventional radiographs are important in the initial detection of TB, and CT/MRI can assist in further evaluation. Confirmation of skeletal TB requires microbiologic assessment with smear and culture. In the spine, this confirmation can be accomplished with fine-needle aspiration.

Question 5

Which of the following patient populations is most likely to develop osteomyelitis?&#10;A) children&#10;B) older adults&#10;C) intravenous drug abusers&#10;D) people diagnosed with congestive heart failure

Accepted Answer

Osteomyelitis is common in groups that have a depressed immune system. Choices A, B, and C all generally have depressed immune systems.

Question 6

A patient is diagnosed with osteomyelitis after a total knee replacement.What is the intervention of choice for this particular patient?&#10;A) aggressive physical therapy&#10;B) ambulation intervention only&#10;C) surgical intervention&#10;D) intravenous (IV) and high dose antibiotic therapy

Accepted Answer

Immediate treatment is called for in acute osteomyelitis. The successful use of IV and high dose antibiotic therapy is now an accepted modality and has lessened the role of surgery in these infections. Therapy can continue but at a lower intensity.

Question 7

A patient is referred to physical therapy secondary to a diagnosis of infectious septic knee arthritis.What is the treatment of choice early in this patient's rehabilitation?&#10;A) weight-bearing exercises&#10;B) aggressive range of motion&#10;C) splinting and simple range motion&#10;D) isokinetic exercise

Accepted Answer

Early in the course of intervention the joint should be rested. This could be accomplished by splinting, traction, or casting. The splint should be removed periodically to perform simple range motion.

Question 8

What is the primary cause of prosthetic joint failure?&#10;A) infection&#10;B) poor surgical techniques&#10;C) poor adherence to home exercise program&#10;D) poor physical therapy in the acute setting

Accepted Answer

Implant infection remains the primary cause of prosthetic failure, occurring either acutely within the first month postoperatively or within 2 years after the joint replacement.

Question 9

Which of the following is considered a viral cause of septic arthritis?&#10;A) tuberculosis&#10;B) rubella&#10;C) Reiter syndrome&#10;D) lyme disease

Accepted Answer

Lyme disease and tuberculosis are both bacterial, whereas Reiter's syndrome is considered reactive septic arthritis.

Question 10

A patient has recently undergone surgery for an infection of the bursae in the hand.What is the appropriate course of rehabilitation for this patient?&#10;A) splinting and gentle passive range of motion&#10;B) early active range of motion exercise&#10;C) therapy should be delayed for 2 weeks after surgery&#10;D) ultrasound over the surgical site

Accepted Answer

Given the potential complications of surgery/immobilization and the potential for tissue loss, a comprehensive rehabilitation program is necessary to maximize function. Active range of motion exercise is initiated early as soon as the infection begins to subside and treatment appears to be successful, which is often within 48 hours.

Question 11

How does back pain associated with osteomyelitis react with patient activity?&#10;A) Back pain would diminish with activity.&#10;B) Back pain would not be present in a radicular distribution.&#10;C) Back pain would be intermittent only.&#10;D) Back pain would commonly be accompanied by spinal tenderness.

Accepted Answer

The answer of How does back pain associated with osteomyelitis...

Question 12

Which of the following tests is the most accurate in detecting early osteomyelitis?&#10;A) x-ray&#10;B) magnetic resonance imaging (MRI)&#10;C) blood test for white blood count&#10;D) culture of the suspected aspirate

Accepted Answer

The answer of Which of the following tests is the...

Question 13

What is the first step in preventing infections in an implanted prosthesis?&#10;A) preoperative antibiotics&#10;B) use of laminar flow in the operating room&#10;C) proper hand washing&#10;D) improved surgical technique

Accepted Answer

The answer of What is the first step in preventing...

Question 14

What factor(s)increase the likelihood of infection in a prosthetic implanted joint?&#10;A) prior surgery at the site of prosthesis&#10;B) recent myocardial infarction&#10;C) rheumatoid arthritis&#10;D) corticosteroid therapy

Accepted Answer

The answer of What factor(s)increase the likelihood of infection in...

Question 15

Which of the following is not considered a route of hematogenous spread of infection to an implanted prosthetic joint?&#10;A) from dental infections&#10;B) from contaminated implant material&#10;C) from the respiratory tract&#10;D) from the urinary tract

Accepted Answer

The answer of Which of the following is not considered...

Question 16

Why does osteomyelitis in the adult population lead to pathologic fracture?&#10;A) The epiphyseal growth plate is usually involved.&#10;B) The periosteum is loosely attached to bone and moves away easily.&#10;C) Osteomyelitis is rare in adults.&#10;D) Infection disrupts and weakens the cortex inside the bone without pain.

Accepted Answer

The answer of Why does osteomyelitis in the adult population...

Question 17

A purple skin rash and eyelid edema are often associated with what type of myositis?&#10;A) rhabdomyolysis&#10;B) dermatomyositis&#10;C) polymyositis&#10;D) inclusion body myositis

Accepted Answer

The answer of A purple skin rash and eyelid edema...

Question 18

Which of the following patient populations require a singledose prophylactic antibiotic before a dental procedure?&#10;A) patients with diabetes mellitus&#10;B) patients with sickle cell disease&#10;C) patients with hemophilia&#10;D) patients who have undergone joint replacement within the last 2 years

Accepted Answer

The answer of Which of the following patient populations require...

Question 19

A patient with recent total knee replacement is considered to have osteomyelitis if aspirate shows a white blood cell count of more than _____.&#10;A) 500 WBC/mL&#10;B) 1000 WBC/mL&#10;C) 1500 WBC/mL&#10;D) 2500 WBC/mL

Accepted Answer

The answer of A patient with recent total knee replacement...

Question 20

Which of the following conditions could lead to hematogenous osteomyelitis?&#10;A) puncture wound to a bone&#10;B) spread of organisms from preexisting infections&#10;C) infection extended from an overlying burn&#10;D) open fracture

Accepted Answer

The answer of Which of the following conditions could lead...

Deck 15: Infectious Diseases of the Musculoskeletal System