Non-inflammatory MS Flashcards
Joint that allows free range of motion?
Synovial Joint “free movable didrthroses”
A synovial joint is between which two structures?
Between bones formed by enchondral ossification
What is a synovial membrane?
A membrane that surrounds the joint and produces synovial fluid. Bathes and protects articular cartilage
What is Synarthroses?
When there is not joint space Fibrous synarthroses and Cartilaginous Synarthroses
What type of synarthroses forms at the cranial sutures and bonds between root of teeth and jaw?
Fibrous synarthroses
Define Cartilaginous synarthroses?
symphyses (manubriosternalis and pubic)
Synovial membrane?
forms boundary of joint space and is firmly anchored to the capsule Contains a smooth contour except has numerous villous folds near osseous insertion
What does the synovial lines lack?
a basement membrane
What overlies the vascularized loose connective tissue storm and allows for quick exchange between blood and synovial fluid?
Synovial membrane
Synoviocytes
lacks keratin not epithelium 1-4 cells deep over synovial membrane Fibroblast like cells also associated with macrophages Not present over articular cartilage P
What produces proteins and hyaluronic acid in the synovial joint?
Synoviocytes
What is the content of hyaline cartilage
Type 2 collage Water - 70% Proteoglycans 8% Chondrocytes
What lacks a blood supply, no lymphatics, has no innervation and cushions long bone?
Hyaline cartilage
Which part of the hyaline cartilage is the thickest?
Thickest at periphery of concave surfaces and in central portions of convex surfaces
I secrete inactive enzymes and enrich matrix with enzyme inhibitors. Who am I?
Chondrocyte
This structure is composed of type 1 collagen and is between muscle and bone
Tendon
Ligament are between bones. What type of collagen are they made of?
Type 1 collagen
How does one get septic arthritis?
Bacteria seed the joint during bacteremia or direct spread
Contiguous spread of septic arthritis from epiphyseal osteomyelitis typically occurs in which population?
Neonates/infants/young children This is down by hematogenous spread
What pathogens cause septic arthritis?
Staphlococcus > streptococcus > haemophilus influenza, GNB (E. coli, Salmonella, and Psuedomonas)
A staph aureus septic arthritis infection is typically seen in which population?
Older children and adults
15-25 mainly get septic arthritis from which pathogen?
Neisseria gonorrhea
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?
lytic lesions that may have periosteal elevations
What are the systemic symptoms of septic arthritis?
fever, leukocytosis, increased ESR, and increased CRP
This condition typically affects a single knee (monoarthritis), with the knee joint being most common?
Septic arthritis also affects the hip > shoulder, elbow, wrist vs multiple joints in 22%
T/F Septic arthritis pain gets better when moving?
Severe pain with movement along with swelling) “Warm to touch” Pt will also experience fatigue and generalized weakness
What is Arthrocentesis?
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
What is the most likely diagnosis?
What is the workup on this patient?
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
Synovial fluid joint with PMNs containg organisms.
What stain is being used?
Wright Giemsa Stain
Neutrophils and organism look blue
Identify the organism in the picture?
Gram Positive cocci (GPC) in pairs
Strep pneumoniae
Identify the organisms in the picture?
Gram positive cocci in chains
Group B strep
Group A strep
beta hemolytic
catalase negative
Identify the organism in the picture
Gram positive cocci in clusters or clumps
Staphylococcus
Catalase positive
Identify the organism in the image
Gram negative cocci in pairs
Neisseria gonorrheae
Identify the organism in the image
Gram negative bacilli
Psudomonos aerginosa
Oxidase positive
doesnt ferment glucose or lactose
Septic arthritis is mainly caused by which two organisms?
Staphylococcus and Streptococcus
over 90%
Staph > Strep in chains > Group A strep > Group B strep
Associated with cellulitis
Septic arthritis in the age group of 15-25 is mainly caused by which organism?
Neisseria gonorrhoeae
Part of Disseminated Gonococcal infection (DGI)
What deficiency makes a person more susceptable to Disseminated Gonococcal Infection hence septic arthritis?
people with a deficiency component of complement membrane attack complex (C5-C7)
What areas of the body does Neisseria Gonorrhea typically spread to?
S - Synovitis (knee)
T - Tenosynovitis (Hand)
D - Dermatitis (skin pustules)
T/F
Women to tend to suffer are more at risk for DGC?
True, discharged sometimes go unoticed and symptoms become worse
female > males
Symptoms al exacerbate at time of menses in female
Which type of agar is Neisseria goorrheae grown on?
Chocalate Agar
Identify the organism in the picture
N. gonorrheae
Gram negative kidney bean cocci in pairs
females > males
Septic arthritis in sickle cell patients in mainly caused by which organism?
Salmonella
most common cause for osteomylitis as well
Haemophilus influenza mainly causes septic arthritis in which age group?
< 2 years old
Psuedomonas aeruginosa mainly causes septic arthritis in which population group?
IV drug users
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?
Pasteurela multocida
What is the definitive diagnosis of a spetic arthritis infection?
Arthrocentesis with analysis, culture, and gram stain of joint fluid
(Identification and isolation)
Treatment for septic arthritis?
Antibiotics 4-6 wee p.o or IV
MRSA: Vancomycin
Psudomonas: Ceftazidime
Drainage oof joint space
Inflammation of bone and bone marrow?
Osteomyelitis
Mechanism of infection for osteomyelitis
exogenous
(extension from contiguous site or direct implantation (trauma/surgery))
or
hematogenous (most common in children)
What is the host response for Osteomyelitis?
acute neutophilic
Location of infection in children vs adults
Children = long bones
Adults = vertebrae/disc
What complications can lead to Osteomyelitis?
Open fracture
Surgical procedures
Chronic foot infections in diabetic
How do you treat Osteomyelitis?
Drainage via needle aspiration
Prolonged IV Abx (>6weeks)
Splinting and cast imobilization (often in children)
Surgery debridement/removal of dead bone
What is typically seen in an x-ray from a patient who has osteomyelitis?
ill defined lytic lesions (moth eaton) - early stage
Well defined lytic lesion (later
Continous periosteal thickning/elevation
What is the arrow pointing at?
Soft tissue sweling
Known as the Periosteal Reaction
Done destruction
(10-12 days)
What is the site of acute Hematogenous Acute Osteomyelitis
Metaphysis
increased rich nutrient arteries and relatively fewer phagocytic cells than physis or diaphysis
Acute Osteomyletis due to S. aureus is treated by ___________ but is Methicillin Resistant it is treated by __________?
Naficilin/Oxacillin or Cefazolin
Vancomycin
(mecA gene detected on PCR)
Acute Osteomyelitis associated with joint prosthesis
Early Onet: Stap aureus > GNB
Later onset (>3mo): coagulase negative staph > enterococcus
Acute Ostemyelitis associated with a Hx of UTI?
Gram negative bacteria
E. Coli, Klebsiella
Newborm acute osteomyelitis
Step agalactia (GPC in chains) > GNB (e.coli)
Pediatric Acute Osteomyelitis causative agent
Saph aureus > strep pneumo, Kinella kingae
How does acute osteomyelitis typicall spread in children?
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
Ingestion of unpasteurized goat milk
Chronic Osteomyelitis (Brucellosis)
due to Brucella melitensis
Middle East and Mediterranean
Osteomyelitis from Contigenous spread
Peridontal, decubitis, sacral ulcers, diabetic foot ulcers
May be polymicrobial
Osteomyelitis from direct inoculation
Post-traumatic 3-30% infected open fractures
Impalnt related
Acute Osteomyelitis
Irregular edges to trabecular bone next to PMNs
Acute OSteomyelitis
Workup for Osteomyelitis
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
What is the Histologic hallmark for Chronic Osteomyelitis?
Necrotic Dead bone (sequestrum)
Reactive new bone
Lympocytes, histocytes, plasma cells, residual neutrophils
fibrosis
>6wks nonsuppurative bone inflammation
What are the complications for Chronic Osteomyelitis?
Squamous cell carcinoma in draining sinus tract
Septic arthritis
Reactive new bone deopositing on sequestrum
pathological fracture
Secondary amyloidosis
Infective endocarditis
Sepsis Osteosarcoma (rare)
Inteoasseous absces focus of subacute pyogenic osteomyelitis
Brodie Abscess
Chronic Osteomyelitis
A= New bone
B = Sequestrum
