Joint Dz / Infxns - handorf

Question 1

What is ganglion/synovial cyst?

Answer 1

mobile masses that are neither cysts or ganglia, nothing to do w/ synovium as well.

• space is lined w/ myxoid material, recurrence is common
• these are the most common tumors of the hand

Question 2

What is giant cell tumor of tendon sheath?

Answer 2

1. 2nd most common tumor of hand
2. yellow b/c filled w/ lipid laden macs
3. multinucleated giant cells w/ background of histiocytes

Question 3

What is pigmented vilionodular synovitis?

Answer 3

localized, destructive, and affects single joint

• it’s a proliferation of synovium, hemosiderin pigmentation
• clonal, excise it!

Question 4

What is a stress fracture?

Answer 4

bone fracture after repeated extra stress

Question 5

What is an incomplete fracture?

Answer 5

bone is cracked but not broken – Greenstick fracture

Question 6

what is a closed (simple fracture)?

Answer 6

overlying tissues are intact

Question 7

what is a compound (open, complicated) fracture

Answer 7

bacteria have a route from surface to bone

Question 8

what is a multifragmented fracture (comminuted)

Answer 8

bone is broken

Question 9

what is a complex fracture

Answer 9

ends of bone fragment have done serious damage to surrounding tissue

Question 10

what is a pathologic fracture

Answer 10

due to intrinsic dz of bone - force wouldn’t have broken a normal bone

Question 11

What are the steps involved in a callus formation to heal a broken bone?

Answer 11

1. fractured bone is bleeding and clot forms w/ dead bone
2. after several days - recruitment and ingrowth of neovascularization and fibroblasts = organize clot
3. ingrowth of osteocytes and new/woven bone formation - cartilage produced at surface of callus
4. after many months - continued remodeling of bone w/ reduction of

Question 12

What is a healing fracture

Answer 12

shows resolving hemorrhage, fractured bony spicule (dark pink) and new osteoid (light pink)

Question 13

What is fibrous nonunion

Answer 13

bone healing when ends of fractured bones don’t align w/ each other to form callus. Can now be fixed w/ pins, nails, and screws!

Question 14

What is osteonecrosis?

Answer 14

Osteonecrosis is a disease caused by reduced blood flow to bones in the joints.

Question 15

What parts of the bone are more likely to become necrotic and why?

Answer 15

1. spongy bone is more likely b/c of it’s end-artery patten of vascularization
2. shaft part of the bone is less likely b/c of collateral circulation

Question 16

What areas of the bone will be spared in osteonecrosis?

Answer 16

overling cartilage, synovium and joint space but convex of joint will not be.

Question 17

What are some risk factors for osteonecrosis?

Answer 17

1. SCD: have painful crises that can lead to infarcts
2. decompression sickness
3. femoral neck fractures
4. Alcohol abuse
5. glucorticoid use

Question 18

What will the infarct in bone look like?

Answer 18

white, peripheral and wedge shaped

Question 19

What is the composition of normal bone marrow?

Answer 19

50% fat and 50% marrow cells

Question 20

what happens to the composition of bone marrow in SCD

Answer 20

hyperceullar - 100% marrow -> interferes w/ normal blood flow in marrow causing an infarct and necrosis

Question 21

What is hand foot syndrome?

Answer 21

soft tissue swelling w/ perisoteal formation and moth eaten lytic process

Question 22

What is osteomyelitis?

Answer 22

bone infxn usually caused by a pyogenic organism. Staph Aureus in 90%

Question 23

How can bone infxn spread?

Answer 23

kids - hematogenously b/c of growing bone

adults - continguous spread

Question 24

What happens to PMNS in osteomyelitis?

Answer 24

never cross the endothelium

Question 25

What is the cause of osteomyelitis in SCD?

Answer 25

salmonella

Question 26

What can happen in long standing chronic osteomyelitis?

Answer 26

squamous cell carcinoma can develop in bone or sinus tract

Question 27

Where in the actual bone can osteomyelitis spread to?

Answer 27

1. spreads internally via medullary cavity and sinusoids
2. spreads externally:
   - involucrum - subperiosteal formation of viable new bone (reactive)
   - sequestrum - inner native necrotic cortex

Question 28

How can you tell is bone is dead?

Answer 28

If the lacunae are empty meaning that there are no osteocyte nuclei

Question 29

What is osteomyelitis common w/?

Answer 29

DM – can cause small vessel disease of DM

Question 30

What is Pott’s dz?

Answer 30

TB spondylitis - affects vertebral bodies and joint spaces. Pts can have sever kyphosis and spinal compression

Question 31

What is the cause of syphilis?

Answer 31

spirochetes – Treponema Pallidum

Question 32

What is primary syphilis?

Answer 32

due to sexual contact, skin lesion is at point of contact called chancre – firm, painless skin ulceration that heals spontaneously

Question 33

what is secondary syphilis?

Answer 33

• 1-6 mos after primary infxn, many presentations!
• symmetrical reddish-pink, non-itchy rash on trunk,ext, hands and soles of feet!
• most contagious in this phase

Question 34

what is tertiary syphilis?

Answer 34

1-10 yrs after infxn. soft-tumor like granuloma form. Neuropathic joint dz - loss of sensation an dfine position sense

Question 35

What is congential syphilis?

Answer 35

passed from mother to kid. Saber shin and saddle nose