Non-inflammatory MS Flashcards

1
Q

Joint that allows free range of motion?

A

Synovial Joint “free movable didrthroses”

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2
Q

A synovial joint is between which two structures?

A

Between bones formed by enchondral ossification

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3
Q

What is a synovial membrane?

A

A membrane that surrounds the joint and produces synovial fluid. Bathes and protects articular cartilage

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4
Q

What is Synarthroses?

A

When there is not joint space Fibrous synarthroses and Cartilaginous Synarthroses

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5
Q

What type of synarthroses forms at the cranial sutures and bonds between root of teeth and jaw?

A

Fibrous synarthroses

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6
Q

Define Cartilaginous synarthroses?

A

symphyses (manubriosternalis and pubic)

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7
Q

Synovial membrane?

A

forms boundary of joint space and is firmly anchored to the capsule Contains a smooth contour except has numerous villous folds near osseous insertion

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8
Q

What does the synovial lines lack?

A

a basement membrane

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9
Q

What overlies the vascularized loose connective tissue storm and allows for quick exchange between blood and synovial fluid?

A

Synovial membrane

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10
Q

Synoviocytes

A

lacks keratin not epithelium 1-4 cells deep over synovial membrane Fibroblast like cells also associated with macrophages Not present over articular cartilage P

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11
Q

What produces proteins and hyaluronic acid in the synovial joint?

A

Synoviocytes

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12
Q

What is the content of hyaline cartilage

A

Type 2 collage Water - 70% Proteoglycans 8% Chondrocytes

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13
Q

What lacks a blood supply, no lymphatics, has no innervation and cushions long bone?

A

Hyaline cartilage

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14
Q

Which part of the hyaline cartilage is the thickest?

A

Thickest at periphery of concave surfaces and in central portions of convex surfaces

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15
Q

I secrete inactive enzymes and enrich matrix with enzyme inhibitors. Who am I?

A

Chondrocyte

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16
Q

This structure is composed of type 1 collagen and is between muscle and bone

A

Tendon

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17
Q

Ligament are between bones. What type of collagen are they made of?

A

Type 1 collagen

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18
Q

How does one get septic arthritis?

A

Bacteria seed the joint during bacteremia or direct spread

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19
Q

Contiguous spread of septic arthritis from epiphyseal osteomyelitis typically occurs in which population?

A

Neonates/infants/young children This is down by hematogenous spread

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20
Q

What pathogens cause septic arthritis?

A

Staphlococcus > streptococcus > haemophilus influenza, GNB (E. coli, Salmonella, and Psuedomonas)

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21
Q

A staph aureus septic arthritis infection is typically seen in which population?

A

Older children and adults

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22
Q

15-25 mainly get septic arthritis from which pathogen?

A

Neisseria gonorrhea

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23
Q

Patient comes in to review their x-ray from their last appointment. Ashe was diagnosed with Septic arthritis. What was seen in the radiology report?

A

lytic lesions that may have periosteal elevations

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24
Q

What are the systemic symptoms of septic arthritis?

A

fever, leukocytosis, increased ESR, and increased CRP

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25
Q

This condition typically affects a single knee (monoarthritis), with the knee joint being most common?

A

Septic arthritis also affects the hip > shoulder, elbow, wrist vs multiple joints in 22%

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26
Q

T/F Septic arthritis pain gets better when moving?

A

Severe pain with movement along with swelling) “Warm to touch” Pt will also experience fatigue and generalized weakness

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27
Q

What is Arthrocentesis?

A

sticking a needle into the joint fluid and aspirating content out

This obtained for evaluation

Analysis of WBC, viscocity

A culture is also done on the fluid

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28
Q

What is the most likely diagnosis?

What is the workup on this patient?

A

Septic Arthritis

Labs - CBC, ESR, CRP

X-ray - to identify within joint and/or in surrounding tissues

Arthrocentesis

Other imaging: nuclear scans, MRI, CT scan are the most common

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29
Q

Synovial fluid joint with PMNs containg organisms.

What stain is being used?

A

Wright Giemsa Stain

Neutrophils and organism look blue

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30
Q

Identify the organism in the picture?

A

Gram Positive cocci (GPC) in pairs

Strep pneumoniae

31
Q

Identify the organisms in the picture?

A

Gram positive cocci in chains

Group B strep

Group A strep

beta hemolytic

catalase negative

32
Q

Identify the organism in the picture

A

Gram positive cocci in clusters or clumps

Staphylococcus

Catalase positive

33
Q

Identify the organism in the image

A

Gram negative cocci in pairs

Neisseria gonorrheae

34
Q

Identify the organism in the image

A

Gram negative bacilli

Psudomonos aerginosa

Oxidase positive

doesnt ferment glucose or lactose

35
Q

Septic arthritis is mainly caused by which two organisms?

A

Staphylococcus and Streptococcus

over 90%

Staph > Strep in chains > Group A strep > Group B strep

Associated with cellulitis

36
Q

Septic arthritis in the age group of 15-25 is mainly caused by which organism?

A

Neisseria gonorrhoeae

Part of Disseminated Gonococcal infection (DGI)

37
Q

What deficiency makes a person more susceptable to Disseminated Gonococcal Infection hence septic arthritis?

A

people with a deficiency component of complement membrane attack complex (C5-C7)

38
Q

What areas of the body does Neisseria Gonorrhea typically spread to?

A

S - Synovitis (knee)

T - Tenosynovitis (Hand)

D - Dermatitis (skin pustules)

39
Q

T/F

Women to tend to suffer are more at risk for DGC?

A

True, discharged sometimes go unoticed and symptoms become worse

female > males

Symptoms al exacerbate at time of menses in female

40
Q

Which type of agar is Neisseria goorrheae grown on?

A

Chocalate Agar

41
Q

Identify the organism in the picture

A

N. gonorrheae

Gram negative kidney bean cocci in pairs

females > males

42
Q

Septic arthritis in sickle cell patients in mainly caused by which organism?

A

Salmonella

most common cause for osteomylitis as well

43
Q

Haemophilus influenza mainly causes septic arthritis in which age group?

A

< 2 years old

44
Q

Psuedomonas aeruginosa mainly causes septic arthritis in which population group?

A

IV drug users

45
Q

Person comes in complaining of symptoms related to septic arthritis. After obtain a full history you note that she has a old wound that is starting to heal. After further investigation you find out the wound is from a cat bite. What organism has infected the wound to cause septic arthritis?

A

Pasteurela multocida

46
Q

What is the definitive diagnosis of a spetic arthritis infection?

A

Arthrocentesis with analysis, culture, and gram stain of joint fluid

(Identification and isolation)

47
Q

Treatment for septic arthritis?

A

Antibiotics 4-6 wee p.o or IV

MRSA: Vancomycin

Psudomonas: Ceftazidime

Drainage oof joint space

48
Q

Inflammation of bone and bone marrow?

A

Osteomyelitis

49
Q

Mechanism of infection for osteomyelitis

A

exogenous

(extension from contiguous site or direct implantation (trauma/surgery))

or

hematogenous (most common in children)

50
Q

What is the host response for Osteomyelitis?

A

acute neutophilic

51
Q

Location of infection in children vs adults

A

Children = long bones

Adults = vertebrae/disc

52
Q

What complications can lead to Osteomyelitis?

A

Open fracture

Surgical procedures

Chronic foot infections in diabetic

53
Q

How do you treat Osteomyelitis?

A

Drainage via needle aspiration

Prolonged IV Abx (>6weeks)

Splinting and cast imobilization (often in children)

Surgery debridement/removal of dead bone

54
Q

What is typically seen in an x-ray from a patient who has osteomyelitis?

A

ill defined lytic lesions (moth eaton) - early stage

Well defined lytic lesion (later

Continous periosteal thickning/elevation

55
Q

What is the arrow pointing at?

A

Soft tissue sweling

Known as the Periosteal Reaction

Done destruction

(10-12 days)

56
Q

What is the site of acute Hematogenous Acute Osteomyelitis

A

Metaphysis

increased rich nutrient arteries and relatively fewer phagocytic cells than physis or diaphysis

57
Q

Acute Osteomyletis due to S. aureus is treated by ___________ but is Methicillin Resistant it is treated by __________?

A

Naficilin/Oxacillin or Cefazolin

Vancomycin

(mecA gene detected on PCR)

58
Q

Acute Osteomyelitis associated with joint prosthesis

A

Early Onet: Stap aureus > GNB

Later onset (>3mo): coagulase negative staph > enterococcus

59
Q

Acute Ostemyelitis associated with a Hx of UTI?

A

Gram negative bacteria

E. Coli, Klebsiella

60
Q

Newborm acute osteomyelitis

A

Step agalactia (GPC in chains) > GNB (e.coli)

61
Q

Pediatric Acute Osteomyelitis causative agent

A

Saph aureus > strep pneumo, Kinella kingae

62
Q

How does acute osteomyelitis typicall spread in children?

A

Heamtogenous spread

ex. Child had otitis media

Primary involvement is the metaphysis -> spread though growth plate into epiphysis (affeect limb growth)

Potential spread to joint space = Abscess and suppurative arthritis

63
Q

Ingestion of unpasteurized goat milk

A

Chronic Osteomyelitis (Brucellosis)

due to Brucella melitensis

Middle East and Mediterranean

64
Q

Osteomyelitis from Contigenous spread

A

Peridontal, decubitis, sacral ulcers, diabetic foot ulcers

May be polymicrobial

65
Q

Osteomyelitis from direct inoculation

A

Post-traumatic 3-30% infected open fractures

Impalnt related

66
Q
A

Acute Osteomyelitis

Irregular edges to trabecular bone next to PMNs

67
Q
A

Acute OSteomyelitis

68
Q

Workup for Osteomyelitis

A

Lab test (also if supsect septic arthritis)

CBC (increased WBC >11,000, PMNs dominate)

ESR (increased ESR > 30mm/hr)

CRP (increased CRP >10mg/dL)

Culture/need spiration

69
Q

What is the Histologic hallmark for Chronic Osteomyelitis?

A

Necrotic Dead bone (sequestrum)

Reactive new bone

Lympocytes, histocytes, plasma cells, residual neutrophils

fibrosis

>6wks nonsuppurative bone inflammation

70
Q

What are the complications for Chronic Osteomyelitis?

A

Squamous cell carcinoma in draining sinus tract

Septic arthritis

Reactive new bone deopositing on sequestrum

pathological fracture

Secondary amyloidosis

Infective endocarditis

Sepsis Osteosarcoma (rare)

71
Q

Inteoasseous absces focus of subacute pyogenic osteomyelitis

A

Brodie Abscess

72
Q
A

Chronic Osteomyelitis

A= New bone

B = Sequestrum

73
Q
A