Lab: Infection Flashcards
reactive bone formation
What are the two osteogenic layers in bone?
Periosteum and endosteum
What is a physiological example of reactive bone formation?
Gluteal tuberosity on femur forming due to physiological stress from attachments
What is a pathological example of reactive bone formation?
Spinal tuberculosis making woven bone (woven bone is often pathological)
reactive bone formation
Is the formation of a gluteal tuberosity physiological or pathological?
Physiological
reactive bone formation
Is spinal tuberculosis making woven bone physiological or pathological?
Pathological (woven bone is often pathological)
osteomyelitis
What is an abscess?
Pocket of pus: necrosis contained by connective tissue
osteomyelitis
What is the term for a pocket of pus in bone or necrosis contained by connective tissue?
Abscess
osteomyelitis
What is a sequestrum?
Devascularized bone separated from remainder of bone due to chronic osteomyelitis
osteomyelitis
What is the term for devascularized bone separated from the remainder of bone due to chronic osteomyelitis?
Sequestrum
osteomyelitis
What is an involucrum?
Layer of new bone growth outside existing sequestrum
osteomyelitis
What is the term for the layer of new bone growth outside an existing sequestrum?
Involucrum
osteomyelitis
What is a cloaca?
Gap in cortex of the bone that allows drainage of pus/material from the bone adjacent tissues due to chronic osteomyelitis
osteomyelitis
What is the term for the gap in a cortex of bone that allows drainage of pus/material from the bone into adjacent tissues due to chronic osteomyelitis?
Cloaca
What is the cause of osteonecrosis?
Ischemia
Is this dystrophic or metastatic calcification?
Dystrophic (local)
What term describes inflammation of the periosteum?
Periostitis
At the cellular level, what is causing bone formation beneath the periosteum?
Is this always pathological/due to disease process?
Osteoprogenitor cells become osteoblasts which form bone
This is not always pathological
Would a periosteal reactive response appear radiolucent or radiopaque on a radiograph?
Radiopaque/radiodense
In the case of osteomyeleitis, reactive formation that surrounds a sequestrum is called ___
involucrum
Other than the periosteum, what other tissue layer in bone tissue is considered osteogenic?
Endosteum
Given what you know about what causes periosteal bone formation, what type of event do you think would produce an “onion skin” or multi-layered appearance?
Continous/repeated periosteal lifting
View:
Anatomy:
Alignment:
View: lateral lumbar spine
Anatomy: vertebrae and discs
Alignment: misaligned, kyphotic lumbar curve
spondylodiscitis/vertebral osteomyelitis
What can be noted about bone, cartilage, and soft tissue of this lumbar spine?
Bone has necrosis in vertebral bodies
Cartilage/soft tissue demonstrates necrosis to intervertebral disc
vertebral osteomyelitis
Is this most likely a case of tuberculosis or vertebral osteomyelitis?
Why?
Vertebral osteomyelitis
Discs affected means bacterial (staphylococcus aureus)
mycobacterium (TB) is too big to infect discs directly
What is the most likely cause of the vertebral damage seen? Why?
Tuberculosis; vertebral body necrosis without damage to discs
View:
Anatomy:
Alignment:
View: lateral lumbar spine (thoracolumbar junction)
Anatomy: lower thoracic and lumbar vertebrae
Alignment: hyperkyphosis at TL junction (Gibbus deformity)
tuberculosis
What notes can be made about the bone in this thoracolumbar junction?
Necrotic T12-L2 in vertebral bodies
tuberculosis
What cellular changes or events would explain this deformity and necrosis?
Granulomas due to mycobacterum produce caseous necrosis
tuberculosis
What pathology is this presentation commonly associated with?
Tuberculosis
Gibbus deformity
What is another name given for this thoracolumbar hyperkyphosis?
Gibbus deformity
tuberculosis
How might a patient with this condition present in your office?
Pus on skin if sinus has formed, rubor, dolor, calor, tumor
chronic osteomyelitis
What lab results would you expect for ESR/CRP? Alkaline phosphatase?
All increased/elevated due to inflammation and osteoblastic activity
chronic osteomyelitis
osteomyelitis
Label the following:
1. ___
2. ___
3. ___
4. ___
- Sinus
- Involucrum
- Sequestrum
- Abscess
osteomyelitis
What has happened in the more virulent infection that has not occurred in the less virulent infection?
Sequestrum, involuvrum, and sinus
What is indicated by the red arrows?
What pathology is associated with these areas of eroded bone due to necrosis?
Gumma due to syphilis
What is the etiology of the pathology causing these erosions/necrosis?
STD/venereal or transplacental contraction: treponema pallidum
syphilis
What are the clinical manifestations that may come with this presentation?
- Saddle nose
- Gummas (pictured)
- Bone erosion/destruction
- Neurological symptoms
- Altered bone growth: short and deformed (congenital)
- Hutchinson teeth (congenital)
- Saber shin (congenital)
syphilis
A 30 year-old male initially presented with leg weakness and some mild back discomfort. Lab tests revealed that the patient was positive for mycobacterium tuberculosis.
Alignment:
Bone:
Alignment: sharp thoracolumber kyphosis
Bone: vertebral body fracture
A 30 year-old male initially presented with leg weakness and some mild back discomfort. Lab tests revealed that the patient was positive for mycobacterium tuberculosis.
There is a slight compression of the spinal canal (red arrow). How could this contribute to symptoms?
Neurologic symptoms
A 30 year-old male initially presented with leg weakness and some mild back discomfort. Lab tests revealed that the patient was positive for mycobacterium tuberculosis.
What cellular events led to this fracture?
Necrosis, lysis, infection (not in that order)
A 5 year-old male is taken to the emergency room by his father. The father explains that the boy fell from a swing set earlier in the day and has been experiencing pain in his right knee. There is a visible wound in the skin. The father reports cleaning the area and removing debris from the wound. The area is swollen and very sensitive when touched and the patient registers a temperature of 100.2 F (37.8 C). When asked to flex his knee, he cannot move the joint well and reports further pain. Blood work and radiographs are ordered.
Are there discontinuities in the cortex?
What are the patient’s relevant signs and symptoms?
What pathologies can you rule out?
No discontinuities in the cortex
Relevant signs and symptoms are reduced range of motion, inflammation, and fever
Can rule out fracture
The blood work for the patient comes back and you examine the additional findings considering your radiographic observations. Alkaline phosphatase is normal, and HLA-27B and RF factor are negative. However, due to an error in processing the ESR results are missing.
What would you expect for the ESR and CRP to be for this patient?
Increased/elevated ESR and C reactive protein
osteomyelitis
A 20 year-old male presents to the emergency room following an injury during a football game. The patient reported pain in both limbs with more severe pain around the left ankle. Radiographs were taken for both the right and left legs to confirm the extent of the injuries. Based upon the radiographic findings, the patient was diagnosed with a simple, incomplete spiral fracture of the left tibia, which required a cast. An interesting finding was also noted on the radiographs of the right leg.
What type of bone response is indicated by the radiolucent area at the red arrow?
Reactive bone surrounds and contains infection
Brodie’s abscess
A 20 year-old male presents to the emergency room following an injury during a football game. The patient reported pain in both limbs with more severe pain around the left ankle. Radiographs were taken for both the right and left legs to confirm the extent of the injuries. Based upon the radiographic findings, the patient was diagnosed with a simple, incomplete spiral fracture of the left tibia, which required a cast. An interesting finding was also noted on the radiographs of the right leg.
What does the blue arrow surrounding the lesion indicate?
Sclerotic lesion
A 20 year-old male presents to the emergency room following an injury during a football game. The patient reported pain in both limbs with more severe pain around the left ankle. Radiographs were taken for both the right and left legs to confirm the extent of the injuries. Based upon the radiographic findings, the patient was diagnosed with a simple, incomplete spiral fracture of the left tibia, which required a cast. An interesting finding was also noted on the radiographs of the right leg.
Is this a bone forming or bone resorbing process?
Bone forming
Brodie’s abscess
When asked about their right leg, the patient reported that the pain he mentioned upon intake in that leg seemed to begin prior to their recent injury but was mild. He also states that he may have experienced some swelling in this area over the past couple of months as well but assumed that this was due to overtraining. The patient registers a temperature of 99.1 F (37.3 C).
What pathology might account for the observations based on the patient’s signs and symptoms, and radiography?
Brodie’s abscess
A 4 year-old male was admitted to your office complaining of bilateral shin pain and swelling. The patient’s temperature was 98.4 F (36.8 C). The patient was still ambulatory and did not appear to have any issues with mobility. Radiographs of the legs were taken.
What changes are seen in the cortex?
Are observations unilateral or bilateral?
Increased bone density in cortex bilaterally
A 4 year-old male was admitted to your office complaining of bilateral shin pain and swelling. The patient’s temperature was 98.4 F (36.8 C). The patient was still ambulatory and did not appear to have any issues with mobility. Radiographs of the legs were taken.
What can be observed in the cortex of the tibiae?
Are these changes osteoblastic or osteolytic activity?
Increased bone density in anterior cortex
Both osteoblastic and osteolytic activity
sabre shin
A 4 year-old male was admitted to your office complaining of bilateral shin pain and swelling. The patient’s temperature was 98.4 F (36.8 C). The patient was still ambulatory and did not appear to have any issues with mobility. Radiographs of the legs were taken.
What pathology is this individual most likely experiencing?
Congenital syphilis (sabre shin)
A 4 year-old male was admitted to your office complaining of bilateral shin pain and swelling. The patient’s temperature was 98.4 F (36.8 C). The patient was still ambulatory and did not appear to have any issues with mobility. Radiographs of the legs were taken.
What cellular events would explain the findings for these bones?
Medullary cavity filled with infiltrate of lymphocytes, plasma cells, and spirochetes, replacing normal marrow
congenital syphilis
A 4 year-old male was admitted to your office complaining of bilateral shin pain and swelling. The patient’s temperature was 98.4 F (36.8 C). The patient was still ambulatory and did not appear to have any issues with mobility. Radiographs of the legs were taken.
What are some other signs and symptoms common with this pathology?
- Saddle nose
- Palate and skull bone erosion and destruction (gummas)
- Hutchinson teeth
- Neurological symptoms
congenital syphilis
A 4 year-old male was admitted to your office complaining of bilateral shin pain and swelling. The patient’s temperature was 98.4 F (36.8 C). The patient was still ambulatory and did not appear to have any issues with mobility. Radiographs of the legs were taken.
What would be expected lab results for ESR and alkaline phosphatase?
Increased ESR because of inflammation
Osteoblasts produce more alkaline phosphatase
congenital syphilis
A 4 year-old male was admitted to your office complaining of bilateral shin pain and swelling. The patient’s temperature was 98.4 F (36.8 C). The patient was still ambulatory and did not appear to have any issues with mobility. Radiographs of the legs were taken.
What could you do to confirm your suspected diagnosis?
Screen mother and/or blood test child for congenital syphilis
