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MSK Cramming > Bone Structure and Healing, Osteomyelitis, Septic Arthritis > Flashcards

Bone Structure and Healing, Osteomyelitis, Septic Arthritis Flashcards

1
Q

Formation of flat bones

A

Intramembranous ossification directly from mesenchyme

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2
Q

Mutation in flat bone formation that leads to cleidocranial dysplasia

A

RUNX2 / Cbfa1

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3
Q

Formation of short bones

A

Endochondral ossification (same as long bones)

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4
Q

Portion of bone supplied by the nutrient artery

A

Inner 2/3 of cortex and the medulla

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5
Q

Portion of bone supplied by the periosteal artery

A

Outer 1/3 of cortex

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6
Q

Portion of bone supplied by the metaphyseal artery

A

Metaphyseal junction (poor supply in the 5th metacarpal –> fracture)

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7
Q

Organization structure of cortical bone

A

Osteon/Haversian system

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8
Q

Origin tissue of osteoblasts

A

Mesenchyme

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9
Q

Products of osteoblasts

A

RANK
Alkaline phosphatase
TYPE 1 COLLAGEN (for bone formation)
osteocalcin (activity marker)

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10
Q

Origin tissue of osteoclasts

A

Hematopoietic cells

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11
Q

Products of osteoclasts

A

Tartrate resistant phosphatase (TARP)

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12
Q

MoA of osteoprotegrin

A

Prevents bone resorption by binding and inhibiting RANK ligand produced by osteoblasts.
Prevents activation of osteoclasts.

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13
Q

MoA of RANK-L

A

Produced by osteoblast cells to activate clasts and resorb bone

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14
Q

Effect of PTH on bone

A

High, continuous levels of PTH result in bone resorption

Pulsed levels of PTH results in bone formation

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15
Q

MoA of forteo

A

Acts as an artificial PTH, given in pulses to stimulate bone growth in osteoporosis

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16
Q

MoA of denosumab

A

Anti-RANK-L antibodiy –> reduced bone resorption

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17
Q

Forces that bone is weakest against

A

shear, then tension (strongest in compression)

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18
Q

Fracture pattern seen in tensile forces or pure bending

A

Transverse

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19
Q

Fracture pattern seen in compression

A

Oblique

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20
Q

Fracture pattern seen in bending with an axial load

A

Butterfly with two oblique fractures on the side of compression.

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21
Q

Fracture pattern seen with bone torsion

A

Spiral

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22
Q

Types of epiphyses

A

Pressure and traction

23
Q

Traction epiphysis

A

FOrms at insertions of tendons

Does not lenghten bone but does influence shape

24
Q

Pressure epiphysis

A

FOrmes at areas of joint articulation

Lengthens bones

25
Q

THe three major zones of the epiphysis

A

Reverse zone
Proliferative zone
Hypertrophic zone

26
Q

Function of the reverse zone

A

Mainly anoxic

Produces and stores cartilaginous matrix

27
Q

Function of the proliferative zone

A

High levels of O2 and chondrocyte division

Production of ECM matrix

28
Q

Function of the hypertrophic zone

A

Preparation and calcification of matrix from the proliferative and reverse zones
At the end of the hypertrophic zone, cells are no longer viable due to calcification and anoxia

29
Q

Types of epiphyseal injury most associated with future growth abnormalities

A

III, IV, and V (Crush)

30
Q

Type III epiphyseal fracture

A

fracture through the epiphysis and physis only

31
Q

Type IV epiphyseal fracture

A

Fracture through the physis, eipphysis and underlying bone

32
Q

Type V epiphyseal fracture

A

crush

33
Q

Type II epiphyseal fracture

A

fracture through physis only, often due to a chip of bone

34
Q

Type I epiphyseal fracture

A

Sliding of the epiphysis off of the physis (ex: hip dysplasia)

35
Q

Difference between osteopenia, osteomalacia, and osteoporosis

A

Osteopenia: decreased bone density during immobility
Osteomalacia: decreased bone QUALITY due to poor mineralization
Osteoporosis: decreased bone density (but bone of normal quality)

36
Q

Risk factors for developing osteoporosis

A

smoking (estrogens are protective?)

37
Q

Most common agents of osteomyelitis in adults

A

Staph and GNR

38
Q

Most common agents of osteomyelitis in children

A

Strep and staph

39
Q

Joints most commonly affected by osteomyelitis in children

A

growth plates

40
Q

Joints most commonly affected by osteomyelitis in adults

A

Spine, SI, sternoclavicular joints

41
Q

Most common agents of osteomyelitis in prosthetics

A

S. epidermidis

42
Q

Most common agents of osteomyelitis in bites or fist injuries related to the mouth

A

Streptococcus or anaerobes

43
Q

Most common agents of osteomyelitis in pressure or diabetic ulcers

A

Strep or anaerobes

44
Q

Most common agents of osteomyelitis in SCD

A

Salmonella

45
Q

Most common agents of osteomyelitis in trauma or diabetic lesions

A

Anaerobes

46
Q

Most common sources of Pseudomonas osteomyelitis

A

Tennis shoe
Otitis (malignant)
IV drug abuse

47
Q

Limitations of sinus tract culture in osteomyelitis

A

Only finds aerobes

Not necessarily correlated to organism causing osteomyelitis

48
Q

Treatment of CCO

A

Surgery is the only curative option

In patients who should not get surgery, suppression with antibiotics can be done

49
Q

Treatment of acute osteomyelitis

A

Can be cured with antibiotics

50
Q

Empiric therapy of osteomyelitis

A

NOT GIVEN, must get biopsy first

51
Q

Septic arthritis therapy for patients without risk factors

A

Nafcillin

52
Q

Septic arthritis therapy for patients with risk factors

A

Nafcillin + (FQ or aminoglycoside)
OR
2nd generation cephalosporin (cefuroxime, cefoxitin)
Should also cover anaerobes

53
Q

Differences in reactive gonococcal arthritis and septic

A

REACTIVE: Multiple joints, rash, involves wrists/hands
(can’t pee, can’t see, can’t climb a tree)
SEPTIC: Single joint, knee/hip, no rash (may have lesion on joint)

54
Q

Most common joints for SA in adults and children

A

Adults: Knee
Children: Hip

MSK Cramming (9 decks)

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