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ICM Unit 4 MSK > Diagnostic Evaluations in Musculoskeletal Cond. > Flashcards

Diagnostic Evaluations in Musculoskeletal Cond. Flashcards

1
Q

Ionizing radiation is..

known to..

A

Bad
Produce cellular mutations - cancer, teratogenic

only medically necessary dx exams using X-ray/CT

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2
Q

Ionizing radiation include..

A

Radiography
Computed Tomography
Nuclear Scintigraphy

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3
Q

Non-ionizing radiation

A

Magnetic Resonance
Echocardiography

Not harmful; not teratogenic (other ex= UV light, visible light, electromag waves)

Dont break bonds or alter molecules

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4
Q

Interchangeable terms with plain film x-ray

A

Radiograph
Image
Film

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5
Q

Image …

A

any type of rendering of a radiological exam

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6
Q

X-ray other terms

A

radiograph/film/image

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7
Q

Cassette

A

holds the film or digital plate (more common)

goes behind anatomic site to capture and put on digital form

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8
Q

Computed radiography

A

most basic
cheaper

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9
Q

Digital Radiography

A

more expensive
no cassette for this sys (auto loads onto digital)

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10
Q

PACS

A

Picture Archiving and Communication System

“mac daddy” of radiology
provides off site interpretation

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11
Q

The “Colors” of Radiology

A

Radiopaque (radiodense)
Radiolucent
In between

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12
Q

Radiopaque (radiodense) appears,,

A

white

ex) bone, foreign objects

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13
Q

Radiolucent appears

A

black

ex) air, fx lines in bones

Less x-ray absorbed and more penetrating

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14
Q

In n between appears

A

gray

ex) subQ fat, tissue

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15
Q

X-ray/plain films

term used for “white”

A

Increased density:
opaque or radiopaque

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16
Q

x-ray/plain films

terms used for “black”

A

decreased density
Lucent or radioloucent

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17
Q

Computed Tomography

Terms used for “white”

A

Increased attenuation:
hyperintense or hyperdense

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18
Q

Computed Tomography

Terms used for “black”

A

Decreased attenuation
Hypodense

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19
Q

Magnetic resonance imaging (MRI)

Terms used for “white”

A

increased signal intensity

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20
Q

Magnetic resonance imaging (MRI)

Terms used for “black”

A

decreased signal intensity

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21
Q

Ultrasound (US)

terms used for “white”

A

increased echogenicity
(sonodense)

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22
Q

Ultrasound (US)

terms used for “black”

A

decreased echogenicity
(sonolucent)

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23
Q

Nuclear Medicine

terms used for “white”

A

increased tracer uptake

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24
Q

Nuclear Medicine

terms used for “black”

A

decreased tracer uptake:
photopenic

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25
Q

Barium studies

terms used for “white”

A

radiopaque

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26
Q

Barium studies

terms used for “black”

A

nonopaque; radiolucent

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27
Q

Radiopaque materials

A
  • resist passage of x-rays

ex) lead shield - no x-ray will penetrate so will absorb almost all

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28
Q

Radiopaque “shadows” material appear

A

white on plain films

on x-ray WHITE = DENSE = RADIOPAQUE

29
Q

Fab 5 densities of plain film

A

Radiopaque (white)
Radiolucent (black)
“shades of gray” most intermed. density tissues

air, fat, soft tissue/fluid, bone, FB

30
Q

X-ray : Radiolucent = BLACK

explain penetration/passage of x-rays

A

lot of penetration of x-rays b/c they are thin/lucent substances

super penetration of x-rays

31
Q

the most radiolucent of plain film is

A

air

32
Q

Radiolucent “shadows” appear

A

DARK on film

33
Q

MC x-ray orders

A

P/A and lateral views

34
Q

Contrast: Fabricated radiopacity

A

“dye” in laymans terms

use word “contrast” as medical professional

Good for vascular pathological findings - better with IV contrast

Think about renal func of pt (BUN and Cr first)

35
Q

IV Contrast contraindications

A

Metformin - held day of to prevent Lactic acidosis

CRF - baseline Cr level (IV contrast can shut kidneys down - MUST KNOW level)

Allergies : iodine, shellfish (b/c contain I)

36
Q

IV contrast example

A

Omnipaque or Isovue-300

37
Q

“plain films” imply

A

regular x-ray

38
Q

“study” or “examination” = …

A

imaging test you are ordering (not specific)

39
Q

Contrast material or “dye” many forms

A

oral
IV
can use both - abd CT for ex

40
Q

Obtain what when doing x-rays

A

MULTIPLE VIEWS

can appear normal in just one view
the more the better

41
Q

X-ray views for everything (how many?)

A

2

knee, chest, elbow, hip, tib/fib

b/c only so many ways to move these joints

42
Q

how many views do you obtain of wrist and ankle down?

A

3

(A/P, lateral, and oblique)
wrist down = wrist, hand, fingers
ankle down = ankle, foot, toes

43
Q

3 basic rules of approach to radiology

A

1) point where two DIFF radiographic densities meet, there is a border/interface/line = BILL

2) on plain x-ray, diff colored shadows represent diff radiographic densities-period ; point where they meet is “BILL”

3) at the point where 2 materials of SAME radiography density meet, no “BILL”

44
Q

if two materials of the same radiographic density meet…

A

any pre-existing border, interface, or line disappears

45
Q

When to use plain x-ray

A
  • direct trauma or blow to appendicular skeleton
  • arthritic changes, gout, suspicion of osteomyleitis
  • ALWAYS on lacerations pts to r/o FB
46
Q

dont use plain x-ray for

A

suspected soft tissue injury (MCL, ACL)

head/trauma/spine trauma - not good enough

47
Q

When to use CT

A

Significant trauma to axial skeleton

  • ED : head injury w/ LOC/neuro deficit (skull fx concern or traumatic head bleed)
  • maxilliofacial trauma
  • ED: C/T/L spine column
48
Q

When to use MRI

A

specialist/ primary care

  • stable pt w/ - plain films, ongoing joint discomfort
  • no mechanism of direct blow to joint but pt symptomatic (“twisting” mechanisms of injury or overuse)
49
Q

use plain film to R/O RB before close lac

A

wood hard to ID on plain film (or non-metallic items)

explore wound with naked eye

50
Q

Recognizing fractures

what to do…

A

trace around cortex of bone and notice any change in BILL

open fractures are an EMERGENCY

51
Q

X-rays for almost ALL MSK complaints start but

A

cannot see ENTIRE circum. of tubular bone (despite obtaining multiple views)

not sensitive for soft tissue abnormalities

52
Q

what radiology tests can see entire bone circumference including internal matrix?

A

CT and MRI

MRI it the BEST study for soft tissue and bone marrow

53
Q

effect of bone physiology on the appearance

A
  • reflect general metabolic status
  • continuously undergoing remodeling
  • osteoclastic/blastic activity depend on presence of viable blood supply to bring cells to bone
  • respond to mechanical forces
54
Q

Decreased density on x-ray

Focal :

A

localized osteolytic metastasis
Multiple myeloma
Osteomyelitis

55
Q

Decreased density on x-ray

Duffuse:

A

osteoporosis
hyperparathyroidism
Rickets
osteomalacia

56
Q

Increased density on X-ray

Focal:

A

localized osteolytic metastasis
AVN of bone (avascular necrosis)
Paget dz

57
Q

Increased density on X-ray

Diffuse:

A

Diffuse osteoblastic metastasis
Osteoporosis (rare) - “marbling” of bone

58
Q

Findings associated w/ osteomyelitis

A
  • focal cortical bone destruction
  • periosteal new bone formation
  • inflamm changes assoc: soft tissue swelling
  • adults, infxn usually in joint spaces

order MRI if pt symptomatic and x-ray looks normal

59
Q

metastatic bone lesions distal to knee or elbow indicates

A

METS

pt eaten up w/ cancer (usually from breast or lung CA)

60
Q

what is study choice of bone density?

A

DEXA (dual energy x-ray)

b/c conven. radiographs insensitive for detecting osteoporosis ; 50% mass must be LOST b4 recognized on x-ray!

61
Q

Arthrocentesis indications

A
  • to obtain synovial fluid for analysis to differeniate joint dz from crystal induced arthritis or septic arthritis
  • dz of ligamentous or bone injury
  • therapuetic
62
Q

Arthrocentesis contraindications

A

Absolute : infxn in tissues overlying puncture site

Relative: known bacteremia may lead to hematogenous spread

63
Q

Arthrocentesis complications

A

infxn
bleeding
allergic rxn to local anesthetic

64
Q

Arthrocentesis interpretation of results

orders

A

orders = cell count, culture, crystal analysis, protein, uric acid, lactate, glucose

65
Q

Arthrocentesis interpretation of results

WBC >50,000/mm3 highly sugg. of

A

septic joint

can be seen w/ gout ; but + crystals, no bacteria on culture, clin pres that makes sense

66
Q

Arthrocentesis interpretation of results

high & of neutrophils on diff suggest

A

septic joint

67
Q

Arthrocentesis interpretation of results

joint fluid to serum glucose ratio of __ suggests

A

50%

septic joint

68
Q

Arthrocentesis interpretation of results

crystal analysis

A

gout from uric acid crystals have - bifringence

pseudogout from Ca crystals have + bifringence

ICM Unit 4 MSK (5 decks)

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