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Skel B Midterm - Spring 2015- Batenchuck > Infection SOM and NSOM and Miscellaneous > Flashcards

Infection SOM and NSOM and Miscellaneous Flashcards

1
Q

Suppurative Osteomyelitis (SOM) male to female ratio

A

3:1

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2
Q

Suppurative Osteomyelitis Peak Age range ,MC affected Bone, and what bacteria is responsible (generally)

A

2-12 y.o.a
Femur
Staph Aureus

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3
Q

Suppurative Osteomyelitis In drug addicts this bacteria is most common and likes the “S” joints

A

Psuedomonas

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4
Q

Suppurative Osteomyelitis What is the most common route of spread

A

Hematogenous

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5
Q

What are the other three routes of spread of SOM other than the most common?

A
  1. Contiguous Source (direct from another site of infection)
  2. Direct Implantation (puncture wounds, penetrating injuries, open fx’s)
  3. Post-operative
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6
Q

The following SOM clinical features are indicative of Infantile, Childhood, or Adult:

 Commonly multi-focal
 Pain and swelling in region of infection
 Infant unwilling to move affected bone
 Streptcoccus group B common, especially in humerus

A

Infantile

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7
Q

The following SOM clinical features are indicative of Infantile, Childhood, or Adult:

 Males most commonly affected
 Staph. Aureus most common organism
 Acute onset of symptoms
 Local signs of inflammation, systemic signs of infection

A

Childhood

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8
Q

The following SOM clinical features are indicative of Infantile, Childhood, or Adult:

Has a more insidious onset

 Local signs of inflammation, system signs of infection

A

Adult

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9
Q

Pathophysiology (Predilection) in SOM depends on _________________ anatomy and age.

A

Vascular

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10
Q

In Infantile predilection (SOM)
- seen in 0-1 y.o.a.
- Vessels ___________ the open growth plate
- The e ________ or m________ can be affected as well
as the joint

A

Perforate

epiphysis or metaphysis

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11
Q

In Childhood predilection (SOM)

  • Metaphysis is MC site of origin
  • Vessels do not perforate growth plate
  • seen in __ to ___ years of age and is most MC for this age
    group
A

1-16 years of age

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12
Q

In ADULT predilection (SOM)
Over 16 years of age (age depends on site of involvement)
- Vessels ____ penetrate the closed growth plate
- Epiphyseal region and metaphysis can be involved, as well as the joint

A

Do penetrate the growth plate!!!!!

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13
Q

If left untreated, describe the pathophysiological progression of the organism(s)…

Deposit where? Enter via what? breaks thru and the subperiosteal region to spread underneath what?

All that leads to a loss of ________ supply and eventually _________.

A

Deposit –> Medullary bone
Enter the cortex via the Haversian and Volkman’s Canals
break through cortex and subperiosteal region to spreads underneath the periosteum.

Leads to loss of blood supply and eventually necrosis

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14
Q

Definition: Infection of disc space, related to vertebral body osteomyelitis usually from hematogenous spread.

A

Discitis

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15
Q

Radiographic findings of DISCITIS

  • Focal endplate destruction which progresses to
    extensive
    destruction and _________collapse
  • Disc space ________
  • Will typically spare the posterior elements.

During healing - increased vertebral body sclerosis and can develop _________

A

Vertebral
Narrowing

Ankylosis

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16
Q

Necrotic bone separated from viable bone by granulation tissue is called

A

Sequestrum

17
Q

Living bone that forms around necrotic bone and attempts to wall off infection is called

A

Involucrum

18
Q

______ is an opening in involucrum that allows the infection region to decompress

A

Cloaca

19
Q

MRI Findings of Discitis

  • Bone Marrow Edema
  • Early endplate destruction, best seen on ___images
  • Changes BEGIN at endplate and EXTEND into _____
  • On T2 images paraspinal edema and _____ with
    increased focal fluid collection signal is visible
  • Contrast enhancement within disc space may be subtle
  • Can see peripheral enhancement due to infection within
    psoas, paraspinal soft tissue, or epidural space
  • MRI is most _______ and specific imaging test
  • Bone scan has ________ sensitivity compared to
    detection of osteomyelitis at other sites in body
A 
T1 
Vertebral bodies 
Phlegmon
Sensitive
Diminished
20
Q

Radiological Changes in Extremities w/ SOM

Soft Tissue Changes

  • Occur within __ days of infection
  • Localized swelling and fat plane displacement
  • _______ of fat/muscle interface
  • Disruption of normal contour of skin, if SEVERE
  • May see gas with certain organisms
A

3 days

Blurring

21
Q

Radiological Changes in Extremities w/ SOM

Osseous Changes

  • ___ day Latent period on X-ray
  • Permeative or ___ eaten pattern of bone destruction
  • ______ or Laminated periosteal reaction
  • Sequestrum, Involcrum and cloaca present
  • Spinal changes are primarily ______
A

10 day latent period
Moth-eaten
Solid Laminated Periosteal Rxn
Articular

22
Q

Describe treatment for SOM in the Extremities? What is key?

A

Early diagnosis is key to successful treatment.

Antibiotic therapy is the initial treatment of choice, often intravenous.

23
Q

What are the 5(possible) Complications of SOM in the extremities

People
Give 
Bad Advice  from
Medical Doctors
So it eventually can lead to death
  • Acronym with the Capital letters only*
    This is a joke and not me true feelings towards other healthcare professionals. LMAO
A
  1. Pathological fx’s
  2. Growth disturbances
  3. Bony ankylosis of joints
  4. Malignant degeneration to squamous cell carcinoma
  5. Septicemia (can eventually lead to death)
24
Q

A sharply outlined focus of burned out infection, which can be sterile or contain residual staph is known as what type of abscess

  • 1cm in diameter and a variable zone of reactive
    necrosis
  • Oval in shape “seripiginous lucency”
  • Likes the distal _____ and K____
A

Brodie’s Abscess

Distal Tibia and Knee

25
Q

Differential Diagnosis for Brodie’s Abscess
1.
2.

A

O.O.

Osetoblastoma

26
Q

Treatment for Brodie’s

A

Surgical Decompression and Curettage

27
Q

Non-Supprative Osteomyelitis (NSOM) aka “TB”

Most skeletal changes are _______ in nature

A

articular

28
Q 
What are the 4 Unusal Ossesous Presentations in TB
C
TD
P
W
A

Cystic TB
Tuberculous Dactylitis
Pott’s Puffy Tumor
Weaver’s Bottom

29
Q

What TB presents with round to oval lucent lesions in the appendicular skeleton. Can mimic polyostotic tumor-like conditions.

A

Cystic TB

30
Q

What TB of the tubular bones of the hands/feet (spina ventosa)

A

Tuberculous Dactylitis:

31
Q

Dactyl means

A

pertaining to fingers or toes

32
Q

TB of the skull with cold abscess of scalp

A

Pott’s Puffy Tumor

33
Q

TB of the subgluteal bursa that extends into the ischial tuberosity

A

Weaver’s Bottom

34
Q

Syphilitic Osteomyelitis: CONGENITAL

o Transmitted from ______ to _____ through the _____

A

mother to child

placenta

35
Q

Syphilitic Osteomyelitis Radiographic Features (3)

Phase 1 – Metaphysitis
 Present from \_\_\_\_\_\_\_
 Lucent metaphyseal bands, medial tibial erosions
 MC at k\_\_\_\_\_,s\_\_\_\_\_, and w\_\_\_\_\_\_
 Usually resolve spontaneously
A

Birth

Knee, Shoulder and Wrist

36
Q

Syphilitic Osteomyelitis: ACQUIRED

o Changes due to tertiary syphilis
o Extensive p_____ is MC finding, often affecting multiple bones
o Can see gummata, saber shin deformity, extensive destruction of both tables of the skull

A

periostitis

37
Q

Misc. Forms: COCCIDIOIDOMYCOSIS

o Endemic in the Southwestern US
o Skeletal involvement usually _____to ______disease
o Seen in ____% of disseminated form – can be fatal
o Primary x-ray finding is lucent destruction, with predisposition to affect ____________

A

secondary to respiratory

20%

bony prominences

38
Q

Misc. Forms: ACTINOMYCOSIS

o Osseous involvement usually due to direct extension from
a soft ________ Infection
o Likes the ______ (MC), spine, ribs, and pelvis
o In the mandible, usually follows tooth extraction or
infection
o Lytic, destructive process in the flat bones. In the spine,
bodies are usually destroyed, sparing __________.

A

tissue

mandible

the discs

39
Q

Misc. Forms: LEPROSY

o Characterized by atrophic destruction of the bones of the
____and ______
o May see nerve calcification (rare)

A

hand and feet

Skel B Midterm - Spring 2015- Batenchuck (4 decks)

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