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MSK SB > Histology + Microbiology > Flashcards

Histology + Microbiology Flashcards

1
Q

what microorganism is the most common pathogen of osteomyelitis

A

s. aureus

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2
Q

what tend to inflect implanted devices

A

biofilm

  • slow growing
  • bacteria coated in protein and polysacharide
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3
Q

what are the 3 types of implant infections

A

early post-op - 0-3months
Delayed - 3-24months
Late - >24months

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4
Q

what are the features of early post-op infection

A

perioperative route

fever, effusion, warmth, drinage

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5
Q

what are the common agents of early post-op infections

A

s. aureus
strep
enterococci

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6
Q

what are the features of delayed infection

A

perioperative route

persistent pain, device loosening, fistula

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7
Q

what are the common agents of delayed infections

A

coagulase-negative
staph
p.acnes

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8
Q

what are the features of late infection

A

haematogenous spread

acute or subacute

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9
Q

what are the common agents of late infections

A

s. aureus

e. coli

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10
Q

what is the criteria for SIRS

A

two or more of:
Temperature >38 or 90 beats/min
Respiratory rate >20 breaths/min or PaCO2 12,000 cells/mm3 or

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11
Q

what is the Tx if no SIRS

A

no immediate need for antibiotic treatment

wait until culture results

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12
Q

treatment of prosthetic joint infections

A

Debridement
- Retention of prosthesis (DAIR)
- Removal of prosthesis
Antiobiotcs - IV high dose

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13
Q

what are the bacteria of acute primary infections

A

S. aureus

Streptococcus spp

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14
Q

what are the bacteria of chronic infections

A

CoNS

Propionibacteria

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15
Q

Bacteria in abscesses or biofilms are easily treated - true or false

A

false

are resistant to antibiotics

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16
Q

what is the tayside protocol for PJI

A

No antibiotic pre-operatively
Minimum three bone/ tissue/ pus samples for culture
Minimum 6 weeks antibiotics before clean surgery

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17
Q

what antibiotic is used from gram positive and what is used if they are allergic

A

flucloxacillin

- if allergic vancomycin

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18
Q

what antibiotic is used in gram positive but Meticillin resistant organism

A

tecioplanin

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19
Q

what antibiotic is used from gram negative and what is used if they are allergic

A

Cotrimoxazole

- if allergic Axoicillin

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20
Q

what is the duration of treatment

A

hips - 3months

knee - 6months

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21
Q

how is responded assessed in PJI

A

Continue treatment for 2 weeks after resolution of clinical signs of infection
Repeat MRI or CT scan

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22
Q

what is used as prophylaxis in orthopaedics

A

Co amoxiclav 1.2 g peri-op & 2 post-op doses
if allergic
Co-trimoxazole

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23
Q

where are the nuclei situated in skeletal muscle cells

A

at the periphery of the fibre just under the cell membrane

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24
Q

what is the cell membrane called in muscle cells

A

sarcolemma

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25
Q

what are fascicles

A

muscle fibres grouped into bundles

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26
Q

what are the different connective tissues of muscle cells

A

epimysium - connective tissue of muscle as a whole
perimysium - around a single fascicle
endomysium - single muscle fibre

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27
Q

what are the units of contraction

A

sarcomeres

28
Q

what do thousands of sarcomeres form

A

myofibrils

29
Q

what is a type I skeletal muscle fibre

A
  • relatively slowly contracting fibres that depend on oxidative metabolism.
  • have abundant mitochondria
  • resistant to fatigue
  • produce relatively less force.
  • Often called ‘red’ fibres.
30
Q

what is a type IIA skeletal muscle fibre

A
  • this is intermediate between the other two.
  • relatively fast contracting,
  • reasonably resistant to fatigue.
  • uncommon
31
Q

what is a type IIB skeletal muscle fibre

A
  • fast contracting fibres that depend on anaerobic metabolism.
  • few mitochondria,
  • fatigue relatively easily
  • produce relatively greater force. - Often called ‘white’ fibres.
32
Q

how is cartilage, which is avascular, nourished

A

by diffusion through the extracellular matrix

33
Q

how is bone nourished

A

blood vessels that pervade the tissue

34
Q

what cells are found in cartilage and where do they live

A

chondrocytes

- lacuna

35
Q

what are the different types of cartilage

A

hyaline
elastic
fibrocartilage

36
Q

what is the morphology of bone

A

outer shell of dense cortical bone makes up the shaft (diaphysis)
Cancellous or trabecular bone occupies the ends of the bone (the epiphyses)

37
Q

what are osteocytes

A

bone cell trapped within the bone matrix

38
Q

what are osteons

A

fundamental functional unit of much compact bone

39
Q

what is the boundary of an osteons called

A

cement lines

40
Q

what are osteoprogenitor cells

A

located on bone surfaces, for example under the periosteum, these cells serve as a pool of reserve osteoblasts

41
Q

what are osteoblasts

A

bone forming cells

found on surface of developing bone

42
Q

what are osteoclasts

A

responsible for bone reabsorption

found on surface of bone

43
Q

pathway for bone remodelling

A
  • osteoclasts drill into bone forming a tunnel
  • blood vessel grows into tunnel
  • osteoblasts follow
  • they lay new lamellar bone
  • continues until only the space of a Haversian canal remains.
44
Q

what is the basic multicellular unit

A

The collection of osteoclasts and osteoblasts that participate in bone remodelling

45
Q

what do osteoblasts secrete

A

collagen, glyocsaminoglycans, proteoglycans

collectively termed osteoid

46
Q

what is woven bone

A

during development or following a break
rather than having collagen fibres orientated all in one direction, as occurs in lamellar bone, the collagen fibres are laid down in a haphazard fashion

47
Q

which is stronger - woven or lamellar bone

A

lamellar

48
Q

what is brodie’s abscess

A

seen on x-ray

sign of subacute osteomyelitis

49
Q

what is osteomyelitis

A

inflammation of bone or bone marrow

can be acute or chronic

50
Q

how can acute osteomyelitis be acquired

A

inoculation - mostly post-trauma/open #

haematogenous - children or immunosuppressed

51
Q

common bugs of osteomyelitis

A

staph aureus - fluxocillin

haemophilus - in children

52
Q

Tx for osteomyelitis

A

aspirate pus

then give antibiotics

53
Q

hows does chronic osteomyelitis occur

A

bone abscess, pus seeks its way out, either goes under periosteum or under joint.
when is goes under periosteum - becomes devascularise area
will try and compensate for dying central bone and will form bone on the outside i.e. involucrum

54
Q

Ix for chronic osteomyelitis

A

plain X-rays - 1st line

MRI

55
Q

what is ivolucrum

A

layer of new bone growth outside existing bone

56
Q

how can septic arthritis be contracted

A

metaphyseal spread
inoculation
direct haematogenous

57
Q

Tx for cellulitis

A

Flucoxacillin

Benzylpenicillin

58
Q

common organisms of cellulitis

A

staph

strep

59
Q

what is Necrotising fasciitis

A

life-threatening subcutaneous soft-tissue infection

60
Q

symptoms/signs of NF

A 
severe pain
cellulitis
fever
systemic symptoms
nausea and vomiting
crepitations
61
Q

Tx of NF

A

surgical debridement - get rid of dead tissues

target antibiotics or empirical if unknown organism

62
Q

what is infectious arthroplasty

A

infection of prosthetic joint

deep infection

63
Q

Ix for infected arthroplasty

A

CRP
joint aspiration
Bone scan - Tech 99
X-ray

64
Q

what prophylaxis is done is surgery to prevent infection

A 
Clean air theatres
Local antibiotics
Systemic antibiotics
Duration of surgery
Laminar flow
65
Q

which bugs commonly cause infected arthroplasty

A 
staphylococcus aureus (SA)
staphylococcus epidermidis (SE)

MSK SB (15 decks)

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