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Mahoney EBM > Christman chapter 19 > Flashcards

Christman chapter 19 Flashcards

1
Q

Causes of Monoarticular joint disease (7)

A

OCTOPIS

  • Osteonecrosis
  • Crystal induced
  • Trauma
  • Osteochondroma
  • Pigmented villonodular synovitis
  • Infectious disease (septic arthritis)
  • Systematic disease (RA, psoriatic arthritis, reactive arthritis)
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2
Q

Causes of polyarticular joint disease (2 categories)

A

Inflammatory causes:

  • Chronic tophaceous gout
  • Rheumatoid arthritis
  • Seronegative spondyloarthritis
  • —-psoriatic arthritis
  • —-ankylosing spondylitis
  • —-Reactive arthritis

Noninflammatory:

  • primary OA
  • Charcot arthropathy
  • Pigmented villonodular synovitis
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3
Q

Categories of joint disease:underlying pathology (2)

A

Degenerative and inflammatory

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4
Q

Degenerative joint disease: another word for it

A

osteoarthritis

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5
Q

Inflammatory: 4 types

A
  • Rheumatoid arthritis
  • Seronegative:
  • –Psoriatic arthritis
  • –reactive arthritis
  • –ankylosing spondylitis
  • Septic arthritis
  • Metabolic
  • –gouty arthritis
  • –pyrophosphate arthropathy
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6
Q

Categories of joint disease : based on radiographic features (2)

A
  • hypertrophic joint disease: subchondral sclerosis and osteophyte formation at the joint margin
  • Atrophic joint disease: loss of bone substance through erosion and joint space narrowing
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7
Q

Hypertrophic joint disease (2)

A 
-osteoarthritis
-
Detritus arthritis 
---tarsus and midfoot charcot arthropathy
---posttraumatic arthritis
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8
Q

Atrophic joint disease (5)

A

-Rheumatoid arthritis

  • Seronegative spondyloarthritis
  • –psoriatic arthritis
  • –ankylosing spondylitis
  • –reactive arthritis
  • Septic arthritis
  • Forefoot charcot osteoarthropathy
  • Lumpy-bumpy
  • –gouty arthritis
  • –multiple reticulohistiocytosis
  • –pigmented villonodular synovitis
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9
Q

Primary radiographic changes (4)

A
  • Osteophyte
  • Erosion
  • Subchondral resorption
  • Arthritis mutilans
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10
Q

Osteophyte: definition and examples

A

Definition:

  • a spur at the margin of a joint
  • also known as dorsal flag, lipping and beaking

Pathognomonic of OA

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11
Q

Erosion: definition and examples

A

Definition:

  • a localized wearing away of bone that begins along its outer surfaace
  • Primary feature of all joint disorders affecting the foot except for OA

Examples:
-Rheumatoid arthritis

  • Seronegative spondyloarthritis
  • –psoriatic arthritis
  • –ankylosing spondylitis
  • –reactive arthritis

-gouty arthritis

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12
Q

Subchondral resorption: definition and examples

A

Examples:

  • Charcot arthropathy
  • Septic arthritic
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13
Q

Arthritis Mutilans: definition and examples

A

Definition:
-erosions that involve both margins

-Most commonly called the “pencil-in-cup”

Examples:

  • Psoriatic arthritis
  • Charcot neuropathic osteo
  • Rheumatoid arthritis (5th MPJ)
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14
Q

Bone producing secondary radiographic findings (5)

A
  • Diffuse sclerosis
  • periostitis
  • Whiskering
  • Ivory Phalanx
  • Overhanging margin of bone
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15
Q

Diffuse sclerosis: association?

A

association with the repair and remodeling phase of Carcot arthropathy

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16
Q

Periostitis:association?

A

associated with seronegative arthritis, septic arthritis, and forefoot Charcot arthropathy

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17
Q

Whiskering: association?

A

Seen with psoriatic arthritis

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18
Q

Ivory phalanx: association?

A

associated with psoriatic arthritis

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19
Q

Overhanging margin of bone: association

A

associated with gouty arthritis

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20
Q

Secondary radiographic findings that result in joint space alteration (2 categories)

A

Even joint space narrowing:
—inflammatory arthritis

Uneven joint space narrowing:
—OA/trauma

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21
Q

Osteoarthritis:

-Joints to be worried about (5)

A
  • Hallux interphalangeal
  • First MPJ
  • Second met cuneiform
  • Intermediate naviculocuneiform
  • Talonavicular
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22
Q

OA Radiographic features: 6

A
  • Primary finding is osteophyte
  • uneven joint space narrowing
  • subchondral sclerosis (eburnation)
  • geode with sclerotic margins (subchondral cyst)
  • Detritus
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23
Q

OA: targets what column

A

Targets the medial column especially the first MPJ

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24
Q

Rheumatoid arthritis classification criteria

A
  • Joint involvement
  • Serology
  • Acute phase reactants
  • Duration of symptoms
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25
Q

RA: first joint to be affected

A

5th MPJ is the first

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26
Q

Classic presentation of Rheumatoid Arthritis (5)

A
  • Bilateral and symmetric
  • Medial erosions at the 1st through 4th ray
  • Lateral erosion of the 5th
  • Uniform joint space narrowing at affected joints
  • Fibular deviation
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27
Q

More specific presentations for RA

A
  • increased soft tissue density and volume
  • joint space widening (initially)
  • Para-articular osteopenia
  • Geode
  • Erosion (medial sides except for lateral at the 5th)
  • Joint space narrowing (to end with)
  • Digital misalignment
  • Ankylosis
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28
Q

Psoriatic arthritis:clinical presentations (5)

A
  • predominant distal interphalangeal joint involvement
  • Assymetric MPJ involvement with associated swelling (sausage toe)
  • Spondylitis
  • Arthritis mutilans
  • Psoriatic onychopachydermoperiostitis
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29
Q

Psoriatic arthritis: radiographic changes(7)

A
  • Primary: erosion/arthritis mutilans
  • Periostitis (adjacent to affected joint line)
  • Whiskering/ Ivory phalanx
  • Sausage toe
  • Acro-osteolysis
  • Lack of juxta-articular osteopenia
  • Enthesitis
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30
Q

Reactive arthritis: what causes it (2)

A

Shigella/ Chlamydia

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31
Q

Reactive arthritis: radiographic features (4)

A
  • Primary finding: erosion
  • Joint space narrowing and widening
  • Sausage toe
  • Periostitis adjacent to affected joint
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32
Q

Gouty arthritis: stages (3)

A

1) asymptomatic hyperuricemia
2) acute intermittent gout
3) advanced (chronic tophaceous) gout

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33
Q

Gouty arthritis:radiographic features (5)

A
  • Primary finding: erosion which tends to be periarticular withan overhanging margin (Martel sign)
  • Normal joint space
  • Soft tissue mass (tophus)
  • Rarefaction in bone occurs secondary to intraosseous tophus
  • Occasional calcification of tophus
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34
Q

Charcot osteoarthropathy: Characterized by?

A

characterized by early inflammation and affects the bones and joints

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35
Q

Charcot osteoarthropathy (classification)

A

Eichenholz
1) Development

2) Coalescence
3) Reconstruction phase

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36
Q

Charcot osteoarthropathy (three target areas)

A

According to Cofeld

1) MPJ’s
2) Tarsometatarsal joint
3) Combination of: Talonavicular, Naviculocuneiform, and intercuneiform

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37
Q

Unique presentation of Forefoot charcot osteoarthropathy (2)

A

Subchondral resorption or arthritis mutilans

Periostitis

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38
Q

Unique presentation of rearfoot charcot osteoarthopathy (3)

A
  • subchondral resorption
  • loss of joint apposition (subluxation/dislocation)
  • Detritus
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39
Q

Unique presentation of septic arthritis

A
  • Primary finding is subchondral resorption
  • Joint space widening
  • Will progress to osteolysis
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40
Q 
What pathology results in:
Regional osteopenia (2)
A
  • Disuse and immobilization

- Complex regional pain syndrome

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41
Q

What pathology results in generalized osteopenia (5)

A
  • Osteoporosis
  • Osteomalacia
  • Hypophosphatasia
  • Hyperparathyroidism
  • Renal osteodystrophy
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42
Q

What pathology results in: epiphyseal region abnormality (2)

A
  • Scurvy

- Rickets

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43
Q

What pathology results in: altered bone architecture (4)

A
  • Paget disease
  • fibrous dysplasia
  • sickle cell anemia
  • thalesemia
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44
Q

What pathology results in: altered bone form (7)

A
  • acromegaly
  • gigantism
  • hereditary multiple exostoses
  • echondromatosis
  • osteogenesis imperfecta
  • hypoparathyroidism
  • Albright hereditary osteodystrophy
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45
Q

What pathology results in: generalized sclerosis (7)

A
  • Osteopetrosis
  • osteopoikilosis
  • Melorheostosis
  • osteopathia striata
  • pyknoidysostosis
  • fluorosis
  • hypervitaminosis D
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46
Q

What pathology results in: Generalized periostitis (5)

A
  • hypertrophic osteoarthropathy
  • venous stasis
  • hypervitaminosis A
  • thyroid acropachy
  • tuberous sclerosis
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47
Q

Osteopenia: when does it occur and when is it seen on x-rays

A
  • occurs when bone resorption exceeds bone formation

- when 30-50% of bone mass is lost X-rays reveal osteopenia

48
Q

Radiographic Patterns of chronic osteopenia (3)

A
  • endosteal resorption
  • intracortical tunneling
  • subperiosteal resorption

Endosteal+subperiosteal resorption = cortical thinning

49
Q

Primary radiographic feature of acute osteopenia

A

Primary radiographic feature is spotty loss of bone density

50
Q

Definition of osteoporosis

A

progressive loss of bone mass due to increased resorption as well as decreased bone production.

-Results in normal bone composition but reduced amount of bone present per unit volume

51
Q

Gold standard for detection of early osteoporosis

A
  • DXA scan

- –Dual x-ray absorptiometry

52
Q

Differential diagnoses for generalized osteoporosis

A

ViNDICaTE

  • Vascular: anemia
  • Nutritional: scurvy, malnutrition, calcium deficiency
  • Drugs: steroids and heparin
  • Idiopathic
  • Congenital: osteogenesis imperfecta
  • Toxic: alcoholism, chronic liver disease, cirrhosis
  • Endocrine/Metabolic
53
Q

Radiographic features of chronic osteopenia (3)

A
  • thinning of the cortices
  • prominent primary trabeculations
  • intracortical striations
54
Q

Osteomalacia: histologic findings

A

Histological disorder with excessive amounts of uncalcified osteoid.

55
Q

Osteomalacia: amount of time to osteoid synthesis

A

Normally: 5-10 days

With osteomalacia: 2-3 months

56
Q

Radiographic sign AND other changes seen in osteomalacia

A
  • Primary radiographic sign is osteopenia
  • Bowing deformity of long tubular bones may occur
  • Transversely oriented incomplete radiolucency (pseudofracture)
  • Lucent line may be bordered by sclerosis and is located along compressive side of bone
  • Looser zone found in inner cortex
57
Q

Hypophosphatasia: definition of

A

characterized by reduced levels of alkaline phosphatase

58
Q

Hypophosphatasia: radiographic presentations (5)

A
  • bowing
  • shortening of long tubular bones
  • Osteochondral spurring
  • Chondrocalcinosis articularis
  • Looser zone seen on the outer cortex (tensile side)
59
Q

Hyperparathyroidism: definition

A

refers to increaed levels of PTH which indirectly leads to increased osteoclastic activity and leads to removal of calcium from bone into blood

60
Q

Definition of primary hyperparathyroidism

A

due to a parathyroid abnormality and leads to hypercalcemia.

  • May be in response to low calcium levels as well.
  • Associated with hyperuricemia and gout
  • TUMOR
61
Q

Definition of secondary hyperparathyroidism

A

various situations that cause Vitamin D deficiency

62
Q

Definition of tertiary hyperparathyroidism

A

results from hyperplasia of the parathyroid glands and a loss of response to serum calcium levels

-dialysis patients

63
Q

Hyperparathyroidism radiographic features (7)

A
  • Primary is subperiosteal bone resorption
  • periarticular resorption
  • intracortical resorption
  • endosteal resorption
  • subchondral resorption
  • entheseal resorption
  • acral osteolysis
64
Q

Hyperparathyroidism hisological features

A

fibrous tissue replaces bone that is removed in a process known as osteitis fibrosis cystica

65
Q

Hyperparathyroidism: what may resemble metastatic lesions?

A

Brown tumors: geographic radiolucent lesions corresponding to hot spots within the same bone on bone scans

66
Q

Renal osteodystrophy:

subtype of?

Radiographic features

A

subtype of hyperparathyroidism

-will see a lot of soft tissue calcifications

67
Q

Ricket’s: reason for pathology

A

-failure of osteoid to calcify in a growing person

68
Q

Ricket’s radiologic signs (4)

A
  • widening of the physis
  • decreased density at the zone of provisional calcification
  • Fraying and paint-brush appearance at the zone of provisional calcification
  • widening and cupping of the metaphysis
69
Q

Scurvy: causes

A

Insufficient dietary vitamin C intake

70
Q

Scurvy: radiographic characteristics at the metaphysis (3)

A
  • White line of scurvy: increased density bordering the growth plate
  • Scurvy line: transverse line of decreased density by the metaphyseal line
  • Small beak-like outgrowths of the zone of provisional calcification along its margins
71
Q

Scurvy: radiographic characteristics at the epiphysis (just 1)

A

Epiphysis appears as an eggshell appearance: appears as an outer shell of increased density surrounding a central lucency.

72
Q

Scurvy: 2 more radiographic changes

A
  • Coroners sign

- Extensive periostitis may be seen along the entire length of bone

73
Q

Acromegaly cause

A

Increase in GH and IGF 1

-most commonly due to a pituitary adenoma

74
Q

Acromegaly: radiographic changes (4)

A
  • Very thick heel pad >25mm

- Met shafts thickened, enthuses and spurring

75
Q

Acromegaly arthropathy

A

resembles osteoarthritis and may find osteophytes, eburnation, subchondral geode, joint space narrowing

76
Q

Osteochondromatosis: what is it?

A

It is a skeletal dysplasia resulting from disturbances in chondroid production resulting in heterotropic proliferation of epiphyseal chondroblasts

77
Q

Osteochondromatosis: radiographic finding

A

Exostosis is found adjacent to the metaphysis and is attached to the bone by a stalk or pedicle

78
Q

Echondromatosis (Ollier disease): what is it?

A

abnormality is due to multiple benign cartilage tumors within bone

79
Q

What is Maffucci syndrome

A

name given to multiple enchondromas associated with hemangiomas

80
Q

Echondromatosis radiographic findings?

A

geographic destructive (lucent lesion)

81
Q

Osteogenesis imperfecta what is it

A
  • result of abnormal metaphyseal and periosteal ossification caused by deficient osteoid disease
  • referred to as brittle bone disease
82
Q

Osteogenesis imperfecta (four types)

A
  • Type I: most common, mild form that demonstrates fractures with no dwarfing.
  • Type II: neonatal and lethal
  • Type III: rare and demonstrates dwarfing and extremely fragile bone

Type IV: variable findings

83
Q

Osteogenesis imperfecta : -Referred to as?

  • due to:
  • Radiographic findings
A
  • Referred to as brittle bone disease
  • due to deficient osteoid production
  • Radiographically will see -diffuse osteopenia
  • diminished bone girth
  • flared metaphyses which give Erlenmeyer flask deformity
84
Q

Hypoparathyroidism

  • cause
  • resulting findings
  • radiographic findings
A
  • caused by deficient or absent PTH, and is due to surgical exicision of all parathyroid tissue
  • Results in hypocalcemia, hyperphosphatemia and hypercalciuria

Radiographic findings: osteosclerosis of bones and soft tissue calcification

Pathognomonic: brachymetaphalangea (shortened and widened out)

85
Q

Albright hereditary osteodystrophy

  • what is it
  • Features
  • Radiographic findings
A
  • PTH resistant hypocalcemia and hyperphosphatemia along with an unusual constellation of developmental and skeletal defects
  • features: short stature, round face, brachydactyly, obesity,
  • radiographically: short mets and phalanges, exostoses, widening bones
86
Q

Paget disease: osteitis deformans

  • occurence
  • marked by what bony changes
  • associated with elevated serum?
A

-second most common aging bone disorder

  • blade of grass
  • flame appearance
  • Sabre shins
  • cortical thickening

-associated with elevated serum ALP and hydroxyproline

87
Q

Paget disease

  • marked by?
  • abnormal serum levels
  • Radiographic changes
A
  • Marked by excessive and abnormal remodeling of bone
  • Serum ALP and hydroxyproline become elevated

-Radiographic changes:
Lucent wedge, blade of grass appearance, flame appearance.

  • —Sabre shins
  • —Cortical thickening
88
Q

Paget disease: earliest imaging modality

A

bone scintigraphy demonstrates increaed uptake of radionuclide before radiographic changes found

-CT better to visualize trabecular thickening.

89
Q

Pathognomonic signs of Paget

A

bone enlargement, cortical and trabecular thickening

90
Q

Anemia: change in bone and change in soft tissue

A
  • cause sclerotic lesions in bone

- soft tissue:dachtyly

91
Q

Thalassemia

A

will see the Erlenmeyer flask deformity in bone

92
Q

Osteopetrosis: other synonyms for this

A

stone bone, and marble bone disease

93
Q

Lower limb deformities seen with osteopetrosis (4)

A

coxa vara

  • genu valgum
  • genu varum
  • clubfoot
94
Q

Radiographic presentation in osteopetrosis (3)

A
  • diffuse bone sclerosis: known as “bone within a bone”
  • Transverse band of sclerosis
  • Erlenmeyer flask deformity
95
Q

Radiographic presentation seen in Melorheostosis

A
  • flowing hyperostosis along the cortex of tubular bone

- Candle wax disease

96
Q

Osteopoikilosis radiographic presentation

A

-multiple bone islands

—also known as enostosis

97
Q

Osteopathia striata radiographic findings

A

-linear and regular fine bands of increased and decreased density that extend from the metaphysis

98
Q

Pyknodysostosis radiographic findings

A

recurrent fractures and dwarfism

-acryl osteolysis

99
Q

Hypervitaminosis A, Hypervitaminosis D, fluorosis common findings

A

will cause excessive bone formation

100
Q

Venous stasis insufficiency 2 characteristic findings

A
  • indurated cellulitis

- periostitis

101
Q

Pulmonary hypertrophic osteoarthropathy findings (4)

A
  • dactylitis
  • periostitis
  • clubbing of the fingernails
  • acryl osteolysis
102
Q

Tuberous sclerosis: triad, and soft tissue finding

A
  • mental retardation
  • hamartomas
  • epilepsy

soft tissue: periungual fibromas

103
Q

Metabolic disorders that result in periostitis (5)

A
  • hypervitaminosis A
  • hyperthyroidism
  • tuberous sclerosis
  • venous stasis
  • pulmonary hypertrophic osteoarthropathy
104
Q

Metastatic soft tissue calcification:definition and example

A
  • the soft tissue is normal, but the bone metabolism is abnormal
  • seen in renal osteodystrophy
105
Q

Generalized soft tissue calcification: definition and example

A
  • Soft tissue is normal and the bone metabolism is normal

- seen in tumoral calcinosis

106
Q

Tumoral calcinosis definition and testing

A
  • soft tissue calcification that usually occurs on the dorsum of the foot over the extensor tendons.
  • Must biopsy
107
Q

Dystrophic calcification definition and areas it is usually seen in

A

-soft tissue metabolism is abnormal, but bone metabolism is normal

  • Seen in:
  • –plantar fasciitis
  • –Achilles tendinitis
  • –Monckeberg’s : medial calcific sclerosis seen in diabetic vessel calcification of the tunica media
  • –Fleboliths in venous stasis
  • – Atherosclerotic plaques
108
Q

What is Monckeberg’s

A

medial calcific sclerosis of the tunica media of blood vessels that occurs with Diabetics

109
Q

What are Fleboliths

A

they are calcifications of the surrounding soft tissue seen in venous stasis

110
Q

Example of heterotopic calcification:

A

Myositis ossificans in tendon or muscle

111
Q

How to histologically differentiate myositis ossificans from osteogenic sarcoma

A
  • Myositis ossificans circumscripta: osteoid production occurs in the periphery of the bone mass
  • Osteogenic sarcoma: osteoid production begins in the center of the bone mass.
112
Q

Which disease processes exhibit dachtylitis (3)

A
  • psoriatic arthritis
  • sickle cell disease
  • pulmonary hypertrophic osteoarthropathy
113
Q

Diseases that result in acryl osteolysis (4)

A
  • Psoriatic arthritis
  • hyperparathyroidism
  • Pyknodysostoss
  • Pulmonary hypertrophic osteoarthropathy
114
Q

Diseases that result Erlenmeyer flask deformity (3)

A
  • Osteogenesis imperfecta(brittle bone disease)
  • Thalassemia
  • Osteopetrosis (marble bone disease)
115
Q

Charcot Classification (zones)

A

Sanders and Frykberg

116
Q

Sanders and Frykberg Classification (5 zones)

A
  • Zone 1: Distal and proximal interphalangeal joints and MPJ’s
  • Zone 2: Tarsometatarsal joints ( Lisfranc)
  • Zone 3: Naviculo-cuneiform joints, talonavicular and calcaneocuboid
  • Zone 4: Ankle joint and subtalar joint

Zone 5: Calcaneus

Mahoney EBM (3 decks)

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