Lab: Infection Flashcards by Hannah Brule

reactive bone formation

What are the two osteogenic layers in bone?

Periosteum and endosteum

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What is a physiological example of reactive bone formation?

Gluteal tuberosity on femur forming due to physiological stress from attachments

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What is a pathological example of reactive bone formation?

Spinal tuberculosis making woven bone (woven bone is often pathological)

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reactive bone formation

Is the formation of a gluteal tuberosity physiological or pathological?

Physiological

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reactive bone formation

Is spinal tuberculosis making woven bone physiological or pathological?

Pathological (woven bone is often pathological)

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osteomyelitis

What is an abscess?

Pocket of pus: necrosis contained by connective tissue

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osteomyelitis

What is the term for a pocket of pus in bone or necrosis contained by connective tissue?

Abscess

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osteomyelitis

What is a sequestrum?

Devascularized bone separated from remainder of bone due to chronic osteomyelitis

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osteomyelitis

What is the term for devascularized bone separated from the remainder of bone due to chronic osteomyelitis?

Sequestrum

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osteomyelitis

What is an involucrum?

Layer of new bone growth outside existing sequestrum

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osteomyelitis

What is the term for the layer of new bone growth outside an existing sequestrum?

Involucrum

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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

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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

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What is the cause of osteonecrosis?

Ischemia

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Is this dystrophic or metastatic calcification?

Dystrophic (local)

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What term describes inflammation of the periosteum?

Periostitis

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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

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Would a periosteal reactive response appear radiolucent or radiopaque on a radiograph?

Radiopaque/radiodense

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In the case of osteomyeleitis, reactive formation that surrounds a sequestrum is called ___

involucrum

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Other than the periosteum, what other tissue layer in bone tissue is considered osteogenic?

Endosteum

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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

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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. ___

1. Sinus 2. Involucrum 3. Sequestrum 4. 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-B27 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

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

Screen mother and/or blood test child for congenital syphilis