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Medical Sciences B > Infections and vascular diseases of bone > Flashcards

Infections and vascular diseases of bone Flashcards

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USMLE® Step 1 flashcards
1
Q

List the infections of bone?

A
  • suppurative osteomyelitis
  • Brodies’ abscess
  • TB of bone
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2
Q

List the diseases of vascular influences?

A
  • osteochondrosis = epiphyseal

* osteonecrosis = aseptic necrosis = avascular necrosis

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3
Q

What is suppurative osteomyelitis?

A
  • infection of bone marrow
  • pus
  • except for TB bacteria
  • localized or generalized
  • acute or chronic
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4
Q

What is the pathology of suppurative osteomyelitis?

A
  • Organism seeds into medullary tissue -> vascular and cellular response -> swelling -> compression and infarction of surrounding tissue -> further inflammation -> progression of infection -> dead bone -> collar of new periosteal bone
  • drainage tract can form to bone surface
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5
Q

sequestrum

A

dead bone

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6
Q

involucum

A

collar of new periosteal bone

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7
Q

What are the clinical features of suppurative osteomyelitis?

A

Kids: acute tenderness, swelling, pyrexia

  • adults more chronic
  • extremities
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8
Q

What is Mainliner’s syndrome?

A
  • intravenous drug users predisposed to suppurative osteomyelitis
  • S joints: spine, SI, pubic symphysis, SC
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9
Q

What are the complications of suppurative osteomyelitis?

A
  • septicaemia or pyaemia
  • extension to adjacent joint (septic arthritis)
  • retardation of growth
  • pathological fracture
  • Marjolin’s ulcer
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10
Q

What is Marjolin’s ulcer?

A

malignant degeneration of cells lining cloaca

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11
Q

What investigations can we do for suppurative osteomyelitis?

A
  • blood culture positive

* ESR increased

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12
Q

What is Brodie’s abscess?

A
  • form of chronic suppurative osteomyelitis
  • insidious
  • deep boring pain
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13
Q

What is chronic bone abscess?

A

another name for Brodie’s abscess

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14
Q

What are the aetiologies of bone TB?

A

a) hematogenous spread from lungs
b) direct extension from adjacent focus
c) immunodeficient patients

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15
Q

What are the common sites for bone TB?

A
  • vertebral bodies
  • adjacent joints
  • long bone
  • hand or foot

Vetebral TB
Tubercular Arthritis

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16
Q

What is the pathology of bone TB?

A
  • insidious and chronic onset and progression
  • bone destroyed ad replaced by granulation tissue
  • TB abscess
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17
Q

What is vertebral TB?

A

Pathology:
• anterior subchondral vertebral endplate, blocks conducting arteriole/venule
• caseous necrosis of surrounding tissue
• infection into disc
• vertebral collapse
• tracks down to next vertebrae spinal canal

Features:
• initially pain and stiffness
• severe pain with vertebral collapse
• later fever, night sweats, ill health

18
Q

What is Tubercular Arthritis? (pathology and features)

A

Pathology: metaphysal portion of bone with secondary joint involvement

  • tenderness, swelling, stiffness, heat at joint
  • atrophy, deformity
  • lesion elsewhere
  • Dx made with history, clinical features, x-ray findings
19
Q

What are the aetiologies of epiphyseal disorders?

A

• unknown, but 3 groups

Osteonecrosis
Trauma
Normal growth variants

20
Q

What are predisposing factors to osteonecrosis?

A
  • genetic predisposition
  • environmental factors
  • thrombotic predisposition
  • acute or repeated trauma
  • embolism
  • copper deficiency
  • infection
  • mechanical factors
21
Q

What is the pathology of epiphyseal disorders?

A

• Avascular necrosis in the ossification centres
• degeneration of epiphyseal osseous nucleus due to:
-interference with blood supply
-failure of bony centrum to enlarge

22
Q

List the epiphyseal disorders

A
  • Legg-Calve-Perthes
  • Osgood-schlatter
  • Kienboch’s
  • Freiberg’s
  • Scheuermann’s
  • Kohler’s
  • Osteochondritis
  • Sinding-Larsen-Johanson
  • Sever’s
23
Q

Legg-Calve-Perthes

A
  • femoral capital epiphysis
  • osteonecrosis
  • male 4-10yrs
  • short Hx of painful limp
  • referred knee pain
24
Q

Osgood-schlatter

A
  • tibial tubercle
  • trauma
  • males 11-15
  • pain & swelling
  • Hx of repetitive knee flex/ext.
25
Q

Kienboch’s

A
  • lunate
  • trauma + osteonecrosis
  • males 20-40yrs
  • worsening pain, disability
  • Hx of heavy tool operation (vibration and force)
26
Q

Freiberg’s

A
  • metatarsal head
  • trauma + osteonecrosis
  • females 15-18yrs
  • pain & swelling with activity
27
Q

Scheuermann’s

A
  • vertebral endplate epiphysis
  • trauma
  • males 15-17
  • pain & fatigue, hyperkyphosis
28
Q

Kohler’s

A
  • navicular
  • trauma + ON or growth variant
  • 6-9yrs
  • boys
  • pain and swelling
29
Q

Osteochondritis dissecans

A
  • distal femoral condyle
  • trauma
  • males 11-20yrs
  • pain, swelling, locking
30
Q

Sinding-Larsen-Johanson

A
  • secondary patella centre
  • trauma
  • same as stood shlatter
31
Q

Sever’s

A
  • calcaneus
  • growth variant
  • boys > girl
  • 9-11yrs
  • pain with activity
32
Q

What investigations do we do for epiphyseal disorders?

A

X-ray:
• lost contour
• increased density
• fragmentation

33
Q

What is aseptic necrosis?

A

another name for osteonecrosis

34
Q

What is avascular necrosis?

A

another name for osteonecrosis

35
Q

What is osteonecrosis? aetiology? clinical features?

A
  • death of localized portion of bone, and marrow
  • idiopathic or secondary
  • trauma, repetitive
  • high dose corticosteroids
  • radiotherapy
  • decompression sickness
  • sickle cell disease
  • absence of infection
  • referred pain, swelling, lost ROM, muscle atrophy
  • maybe asymptomatic
36
Q

What is a common site of osteonecrosis?

A

head of femur
head of humerus
scaphoid

37
Q

What investigations can we do for osteonecrosis?

A
  • x-rays (maybe not apparent for weeks)

* MRI -most sensitive

38
Q

In what situation would an epiphyseal fracture be likely to occur?

A

extreme forces in children

39
Q

What are the routes of infection for acute suppurative osteomyelitis?

A

1) Haematogenous: via organisms that have gained access to the blood stream
2) Contiguous: via direct spread from local infection (eg. cellulitis)
3) Penetrating trauma: via open fracture or surgical operations in which organisms gain entry directly

40
Q

List and describe 3 types of osteochondroses occurring in the lower limb

A

1) Osgood shlatters: tibial tuberosity -trauma from repeated flex/ext of knee
2) Kholers: Navicular -trauma or osteonecrosis and trauma
3) Sinding-Larsen-Johanson: -secondary patella centre, trauma same as os good shlatter

41
Q

What are common sites to get suppurative osteomyelitis?

A

S joints:

  • spine
  • SI
  • pubic symphysis
  • SC

Medical Sciences B (23 decks)

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