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Tri 6 - Tumors > 9. Infections > Flashcards

9. Infections Flashcards

1
Q

Diabetic, steroid-immunosuppressed, and
hemodialysis patients are particularly vulnerable
to

A

suppurative osteomyelitis

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2
Q

mc source/spread of osteomyelitis

A

Hematogenous

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3
Q

4 Major Pathways of Spread of Suppurative

Osteomyelitis:

A
  • Hematogenous
  • Spread from contiguous source of infection
  • Direct implantation
  • Postoperative infection (iatrogenic)
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4
Q
  • Fever
  • Chills
  • Pain
  • Swelling
  • Loss of limb function
  • Elevated WBC
  • ESR, +CRP
A

Suppurative Infection Infants/Young Children

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5
Q
  • Chronic, insidious process
  • Fever
  • Malaise
  • Edema
  • Erythema
  • Pain
A

Suppurative Infection

in Adults

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6
Q

Boys between ages 2-12 are most

susceptible to

A

suppurative osteomyelitis

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7
Q

Usually affects large tubular bones of

extremities

A

suppurative osteomyelitis

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8
Q

Diaphyseal and metaphyseal vessels penetrate physis to enter epiphysis

A

Infantile Vascular Pattern of infection

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9
Q

Physis becomes effective barrier around age

A

8-18 months

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10
Q

High incidence of septic arthritis with epiphyseal

involvement in

A

infantile osteomyelitis

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11
Q

Slow turbulent blood flow in metaphysis
rendering great environment for infection
with no metaphyseal vessels penetrating the
physis

A

Childhood Vascular Pattern of infection

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12
Q

In adults communication between epiphysis and

metaphysis occurs via

A

blood vessels that

gradually penetrate physis as it fuses

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13
Q

Increased intramedullary pressure in bone due to

A

pus formation

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14
Q

Hyperemia adjacent to infarction that stimulates

osteoclastic activity resulting in

A

regional osteoporosis

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15
Q

Infection penetrates endosteum entering Haversion systems crossing cortex to the

A

subperiosteal space

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16
Q

Few Sharpe’s fibers attaching periosteum to cortex in children, thus periosteum is easily stripped away
from cortex which results in

A

periostitis aka periosteal reaction

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17
Q

Cortical and medullary infarcts result in

A

Sequestrum

Dead bone

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18
Q

to wrap or cover

A

involucrum

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19
Q

defect in involucrum which decompresses bone by discharging inflammatory products
from bone

A

Cloaca

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20
Q

Associated with chronic osteomyelitis and allows seeding of adjacent soft tissues

A

Cloaca

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21
Q

Chronic ulcer with draining sinus, that has

become malignant

A

Marjolin Ulcer

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22
Q

defined as the

malignant degeneration of a chronic wound or scar

A

Marjolin’s Ulcer

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23
Q

On biopsy Marjolin’s Ulcer have been most commonly identified as

A

squamous cell and basal cell carcinomas

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24
Q

If even remote clinical suspicion of bone

infection, do

A

bone scan or MRI

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25
Q

MRI with and without Gd contrast is Excellent for Detecting

A

Infection

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26
Q

Soft tissue findings on plain film may be seen within

__ days of bacterial contamination of bone

A

3

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27
Q

Bone sequestrum occurs ~3-6 weeks after onset usually appear

A

sclerotic

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28
Q

90% of infections involve

A

extremities

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29
Q

Highest incidence of suppurative spondylitis occurs in

A

debilitated patients (50-60)

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30
Q

cortical erosion and

intramedullary sequestrum seen in

A

Chronic Osteomyelitis

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31
Q

mc complaint in spinal infection

A

Back pain

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32
Q

what % of the time is spinal infection misdiagnosed?

A

33%

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33
Q
  • < 20
  • Loss of disc height
  • Paraspinal edema (abscess)
  • Endplate destruction patchy lysis of vertebral body
A

disc infection

34
Q

Initial focus of Irregularity and radiolucency at anterior vertebral endplate

A

Adult Spondylitis

35
Q

a spreading diffuse

inflammatory process with formation of suppurative/purulent exudates or pus.

A

Phlegmon

36
Q

Localized aborted form of suppurative osteomyelitis

A

Brodies Abscess

37
Q

Presentation mimics osteoid osteoma with localized limb pain that is nocturnal; alleviated by aspirin

A

brodies abscess

38
Q

Usually have had distant infection that has seeded to bone and mc male children

A

Brodies Abscess

39
Q

what is mc found with Brodies Abscess,

however lesion may be sterile

A

Staphylococcus Aureus

40
Q

Oval, elliptical, serpiginous, radiolucency with

margin of heavy reactive sclerosis usually >1.0cm

A

Brodies Abscess

41
Q

Brodies abscess MRI findings

A

Variable signal internally, with low signal of marginal sclerosis
(penumbra sign)

42
Q

Eccentrically located
radiolucent lesion crossing
the epiphyseal plate

A

Brodies Abscess:

Subacute osteomyelitis

43
Q

Proper ID of pathogen is essential for TX of

A

Chronic Osteomyelitis (MC Staphylococcus aureus)

44
Q

Sclerosis, cortical thickening, periosteal reaction

(laminated or solid), lysis, sequestra

A

Chronic Osteomyelitis

45
Q

Why might antibiotics not help much for chronic osteomyelitis?

A

blood supply
is separated from organisms due to bone
fragmentation

46
Q

Leading cause of death in Western Society at

beginning of 20th Century from Inhalation of Mycobacterium tuberculosis

A

Non-Suppurative Osteomyelitis:

Tuberculosis (TB)

47
Q

Infection of the musculoskeletal system from TB is

commonly caused by

A

hematogenous spread of primary pulmonary focus

48
Q

Insidious back pain, decreased ROM, focal
tenderness NOT accompanied by fever,
night sweats, toxicity, or prostration

A

Non-Suppurative Osteomyelitis:

Tuberculosis (TB)

49
Q

sudden onset of lower limb paraplegia

A

Pott’s Paraplegia

50
Q

70% of TB patients are

A

<5yo

51
Q

Pott’s Paraplegia is associated with

A

TB

52
Q

Tubercular Spondylitis, aka

A

Pott’s Disease

53
Q

Pott’s Disease is mc in

A

lower thoracic and upper lumbar spine

54
Q

Pott’s Disease spreads via

A

Batson’s venous plexus

55
Q

What is initially involved, in Pott’s disease?

A

Subchondral anterior vertebral endplate

56
Q

Tubercular Spondylitis: Pott’s Disease, spreads by into the disc by

A

direct extension into disc as vertebral body

collapse occurs

57
Q
  • Abscess formation
  • Subligamentous dissection
  • Granulomatous formation
  • May cause Pott’s paraplegia
A

Paravertebral soft tissue involvement from Pott’s Disease

58
Q

Calcification of psoas abscess indicates

A

healing of abscess in muscle and inactivity of

infection

59
Q

Computed tomographic scan of the abdomen showing a left iliopsoas abscess (arrow) that likely originated from

A

tuberculous osteomyelitis

60
Q

Extensive paraspinal abscess formation with little osseous involvement

A

Subligamentous Dissection

61
Q

Produces shallow erosion of anterior vertebral body that resembles lymph node or aortic aneurysm erosion

A

Subligamentous Dissection

62
Q

Subligamentous extension may lead to Pott’s disease (disc space narrowing with vertebral
collapse) resulting in

A

Gibbus Deformity

63
Q

Subligamentous extension may lead to Pott’s disease (disc space narrowing with vertebral
collapse) resulting in

A

Gibbus Deformity

64
Q

Advanced TB causing multiple level collapse with infection and disc deterioration

A

Pott’s Paraplegia

65
Q

75% of Tubercular Arthritis affect

A

hip and knee

66
Q

Initial lesions of Tubercular Arthritis simulate

A

RA since affects bare

areas of joint initially

67
Q

– Nonuniform destruction of joint
– Cartilage and bone destruction with sequestrum
formation

A

Tubercular Arthritis

68
Q

Low grade TB results in hyperemia which causes

A

localized osteoporosis

69
Q

21 days latent radiographic period, Early changes include lytic destructive lesion
places in anterior corner of vertebral endplate,
coupled with loss of disc space height

A

Tubercular Spondylitis

70
Q

Displacement of paraspinal line (extrapleural sign)

and Usually affects TL junction, usually L1

A

Tubercular Spondylitis

71
Q

Pear shaped configuration that frequently calcifies

A

Tubercular Spondylitis

72
Q

Vertebral body lysis results in pathologic vertebral
body collapse, coupled with disc destruction and
inability to visualize discs

A

Tubercular Spondylitis

73
Q

Angular kyphotic deformity aka

A

Gibbus Deformity

74
Q

Gibbus Deformity may cause ____ vertebra

A

tall

75
Q

tubercular arthritis shoes early

A

joint widening due to effusion

76
Q
  • Early joint widening due to effusion
  • Subchondral bone destruction
  • Articular cartilage destruction
  • joint space
    narrowing
  • periarticular osteoporosis
A

Tubercular Arthritis:

77
Q

End stage tubercular spondylitis is

A

fibrous ankylosis of joint

78
Q

Bony ankylosis and periosteal reaction is common in

A

pyogenic infection

79
Q

Management of skeletal TB includes

A

debridement and arthrodesis

80
Q

Diffuse soft tissue swelling, bone expansion, and thinning of cortex

A

spina ventosa in Tuberculous Dactylitis

Tri 6 - Tumors (12 decks)

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