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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
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%
26
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
27
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
28
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
29
Synovial fluid joint with PMNs containg organisms. What stain is being used?
Wright Giemsa Stain Neutrophils and organism look blue
30
Identify the organism in the picture?
Gram Positive cocci (GPC) in pairs Strep pneumoniae
31
Identify the organisms in the picture?
Gram positive cocci in chains Group B strep Group A strep beta hemolytic catalase negative
32
Identify the organism in the picture
Gram positive cocci in clusters or clumps Staphylococcus Catalase positive
33
Identify the organism in the image
Gram negative cocci in pairs Neisseria gonorrheae
34
Identify the organism in the image
Gram negative bacilli Psudomonos aerginosa Oxidase positive doesnt ferment glucose or lactose
35
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
36
Septic arthritis in the age group of 15-25 is mainly caused by which organism?
Neisseria gonorrhoeae Part of Disseminated Gonococcal infection (DGI)
37
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)
38
What areas of the body does Neisseria Gonorrhea typically spread to?
**S** - Synovitis (knee) **T** - Tenosynovitis (Hand) **D** - Dermatitis (skin pustules)
39
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
40
Which type of agar is Neisseria goorrheae grown on?
Chocalate Agar
41
Identify the organism in the picture
N. gonorrheae Gram negative kidney bean cocci in pairs females \> males
42
Septic arthritis in sickle cell patients in mainly caused by which organism?
Salmonella most common cause for osteomylitis as well
43
Haemophilus influenza mainly causes septic arthritis in which age group?
\< 2 years old
44
Psuedomonas aeruginosa mainly causes septic arthritis in which population group?
IV drug users
45
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
46
What is the definitive diagnosis of a spetic arthritis infection?
Arthrocentesis with analysis, culture, and gram stain of joint fluid (Identification and isolation)
47
Treatment for septic arthritis?
Antibiotics 4-6 wee p.o or IV MRSA: Vancomycin Psudomonas: Ceftazidime Drainage oof joint space
48
Inflammation of bone and bone marrow?
Osteomyelitis
49
Mechanism of infection for osteomyelitis
exogenous (extension from contiguous site or direct implantation (trauma/surgery)) or hematogenous (most common in children)
50
What is the host response for Osteomyelitis?
acute neutophilic
51
Location of infection in children vs adults
Children = long bones Adults = vertebrae/disc
52
What complications can lead to Osteomyelitis?
Open fracture Surgical procedures Chronic foot infections in diabetic
53
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
54
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
55
What is the arrow pointing at?
Soft tissue sweling Known as the **Periosteal Reaction** Done destruction (10-12 days)
56
What is the site of acute Hematogenous Acute Osteomyelitis
Metaphysis increased rich nutrient arteries and relatively fewer phagocytic cells than physis or diaphysis
57
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)
58
Acute Osteomyelitis associated with joint prosthesis
Early Onet: Stap aureus \> GNB Later onset (\>3mo): **coagulase negative staph** \> enterococcus
59
Acute Ostemyelitis associated with a Hx of UTI?
Gram negative bacteria E. Coli, Klebsiella
60
Newborm acute osteomyelitis
Step agalactia (GPC in chains) \> GNB (e.coli)
61
Pediatric Acute Osteomyelitis causative agent
Saph aureus \> strep pneumo, Kinella kingae
62
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
63
Ingestion of unpasteurized goat milk
Chronic Osteomyelitis (Brucellosis) due to Brucella melitensis Middle East and Mediterranean
64
Osteomyelitis from Contigenous spread
Peridontal, decubitis, sacral ulcers, diabetic foot ulcers May be polymicrobial
65
Osteomyelitis from direct inoculation
Post-traumatic 3-30% infected open fractures Impalnt related
66
Acute Osteomyelitis Irregular edges to trabecular bone next to PMNs
67
Acute OSteomyelitis
68
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
69
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
70
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)
71
Inteoasseous absces focus of subacute pyogenic osteomyelitis
Brodie Abscess
72
Chronic Osteomyelitis A= New bone B = Sequestrum
73

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