Diagnostic Imaging (Irene Gold) Part II and III Flashcards
Who are all Benign Bone Tumors (BBT) referred to?
Orthopedist
What are the four characteristics of all Benign Bone Tumors (BBT)?
Short zone of transition
Incidental finding
Geographic lesion
Encapsulated
What is the name of the most common Benign Bone Tumor (BBT) of the appendicular skeleton?
Osteochondroma
What are two types of Osteochondromas?
Pedunculated (Coat Hanger Exostosis/Cauliflower like)
Sessile
What is the name for multiple Osteochondromas?
Hereditary Multiple Exostosis (HME)
What percentage of Hereditary Multiple Exostosis (HME) undergo malignancy?
20%
What is another name for a Unicameral Bone Cyst (UBC)?
Simple Bone Cyst (SBC)
What is the location of a Simple Bone Cyst (SBC)?
Diaphyseal/Metaphyseal
Centrally Located
What age is a Simple Bone Cyst (SBC) usually seen in?
Under the age of 20 years old
What are the common locations of a Simple Bone Cyst (SBC) to appear?
Proximal:
Tibia
Fibula
Humerus
What Radiographic sign is associated with a Simple Bone Cyst (SBC)?
Fallen Fragment Sign
What is the location of a Aneurysmal Bone Cyst (ABC)?
Diaphyseal/Metaphyseal
Eccentrically Located
What age and gender is an Aneurysmal Bone Cyst (ABC) usually seen in?
Females under the age of 20
What is the location of a Giant Cell Tumor (GCT)?
Epiphyseal/Metaphyseal
What age range usually has a Giant Cell Tumor (GCT)?
20-40 year olds
What “classification” do 20% of Giant Cell Tumors become?
Quasi-Malignant
What are five “characteristics” of a Quasi-Malignant tumor?
Non-Expansible Pain and Swelling present Pathological fracture Reduce after surgery Can come back
What kind of appearance is seen on x-ray of a Giant Cell Tumor (GCT)?
Soap Bubble (Saponaceous)
What is the location of a Chondroblastoma?
Epiphyseal/Metaphyseal
What age would you commonly see a Chondroblastoma?
Younger than the age of 20
What two Benign Bone Tumors (BBT) have night pain relieved by aspirin?
Osteoid Osteoma
Brodie’s Abscess (Chronic Osteomyelitis)
What is another name for a Brodie’s Abscess?
Chronic Osteomyelitis
What is the x-ray appearance for a Osteoid Osteoma and Brodie’s Abscess?
Radiolucent central “nidus” with severe reactive sclerosis
What is the most common Benign Bone Tumor (BBT) of the hand?
Enchondroma
What kind of appearance with an Enchondroma have?
Stippled
Cortical thinning
What is the name of the condition that is multiple Enchondromas?
Ollier’s Disease
What percentage of people with Ollier’s Disease may have malignant degeneration?
10%-50%
What two things will patients with Ollier’s Disease have?
Predisposed to fracture
Permanent Deformities
If a patient has soft tissue calcification and Enchondromas what is the condition called?
Maffucci’s Syndrome
What is the most common Benign Bone Tumor (BBT) of the spine?
Hemangioma
What is another name for a Hemangioma?
Vascular Neoplasm
What is the appearance of a Hemangioma on x-ray?
Vertical Striations
Corduroy Cloth Appearance
What is the name of the Benign Bone Tumor (BBT) that appears as a round/oblong radiopaque lesion; Bone Island?
Enostoma
What is it called when there are multiple Enostomas?
Osteopoikilosis
What is the name of the Benign Bone Tumor (BBT) that most commonly affects the neural arch?
Osteoblastoma
What vertebral level is most commonly effected by a Osteoblastoma?
Atlas, C1
What is the most common Benign Bone Tumor (BBT) to affect the skull?
Osteoma
In what part of the skull is an Osteoma most commonly found?
Frontal Sinuses
What x-ray view is best to see an Osteoma?
Caldwell Projection
What Benign Bone Tumor (BBT) has a monostotic form, is dark on x-ray and must have deformed bone?
Fibrous Dysplasia
What x-ray sign is associated with Fibrous Dysplasia; Monostotic form (70%)?
Rind Sign
In the condition of Fibrous Dysplasia what physiologically replaces normal bone?
Fibrous Tissue
What are four Characteristics and/or Appearances of Fibrous Dysplasia?
Saber Shin Tibia
Sheppard’s Crook (Hip)
“Ground Glass” appearance
Jagged “Café Au Lait” spots (“Coast of Maine”)
What Benign Bone Tumor (BBT) has a familial history?
Neurofibromatosis
What are eight Characteristics and/or Appearances of Neurofibromatosis?
- Patient may present with:
- Scoliosis
- Cervical Kyphosis
- Posterior Vertebral Scalloping, with Intervertebral Foramen (IVF) enlargement
- Straight “Café Au Lait” spots (“Coast of California”)
- Genetic Malformation
- Rib Deformity
- Lisch nodules; Growth on the iris of the eye, looks like a freckle
What is another name for Multiple Myeloma?
Plasma Cell Sarcoma
What age is Multiple Myeloma often seen in?
50 years old
What are three characteristics are seen in Multiple Myeloma?
-Cachexia (Weakness or wasting of the body, from chronic disease)
-Weight Loss
Anemia
What is the most common primary malignancy of bone?
Multiple Myeloma
What part of the bone is effected in the condition of Multiple Myeloma?
Plasma Cells of Bone Marrow
What two “Terms/Names” are associated with Multiple Myeloma?
“Punched Out Lesions” (Multiple Dark Densities)
“Rain Drop Skull”
What additional condition is can be seen in Multiple Myeloma?
Pathological collapse of a vertebra (Vertebral Plana)
What are four lab findings in Multiple Myeloma?
M Spike on the Immunoelctrophoresis
Reversal of the Albumin/Globulin (A/G) Ratio
Bence-Jones Proteinuria
Elevated Erythrocyte Sedimentation Rate (ESR)
What Special Test is ordered for Multiple Myeloma and what is the outcome of the Special test?
Special Test: Bone Scan
Outcome/Result: Cold
What is the most common malignant tumor of bone?
Metastatic Disease (Lytic and Blastic)
What is the age that is associated with Lytic Metastatic Disease?
Older than 40
What two symptoms are often seen in a patient with Lytic Metastatic Disease?
Recent Unexplained weigh loss
Skeletal Pain worse at night
What are the x-ray appearance of Lytic Metastatic Disease?
Moth eaten
Permeative pattern
“Eats” away pedicle
“Swiss Cheese” Skull
What lab will be ordered for both Lytic/Blastic Metastatic Disease?
Alkaline Phosphatase
What Special Test and result/outcome are ordered for a patient with both Lytic/Blastic Metastatic Disease?
Special Test: Bone Scan
Result/Outcome: Hot
What are the three conditions that have an Ivory White Vertebrae (IWV) on x-ray?
MPH
Metastatic Disease (Blastic)
Paget’s
Hodgkin’s Disease
What is the most common age and gender for the condition of Hodgkin’s Disease?
Males
20-40 years old
Along with an Ivory White Vertebrae (IWV) what other x-ray finding is seen in a Hodgkin’s Disease patient?
Anterior Scalloping of the vertebral body
What will be seen on the P-A chest film of a patient with Hodgkin’s Disease?
Unilateral hilar lymphadenopathy
How is Hodgkin’s Disease confirmed?
Biopsy
What does the presence of Reed-Sternberg Cells indicate?
Hodgkin’s Lymphoma
What age is Blastic Metastatic Disease seen in?
Over the age of 40
Where does Blastic Metastatic Disease metastases to and from?
Starts in the Prostate and goes to the Lumbar Spine (Through the Valves of Batson)
What is another name for Paget’s Disease?
Osteitis Deformans
What age and gender is the condition Osteitis Deformans often seen in?
Males over the age of 50
What are the four stages of Paget’s Disease?
Lytic or Destructive
Combined
Sclerotic
Malignant (Osteosarcoma)
What six thing are caused on x-ray with a patient with Paget’s Disease?
Cortical Thickening Picture Frame Vertebrae Bone Expansion Increased Bone Density Coarsened Trabeculae Bowing Deformities
What Lab and Result/Outcome is ordered for a patient with Paget’s Disease or Osteosarcoma?
Lab: Alkaline Phosphatase
Result/Outcome: Increased
What Special Test and Result/Outcome is ordered for a patient with Paget’s Disease or Osteosarcoma?
Special Test: Bone Scan
Result/Outcome: Hot
What is the most common malignancy found in children?
Osteosarcoma
In what area of the bone is Osteosarcoma seen?
Diaphyseal
What age group is Osteosarcoma seen in most commonly?
10-30
What kind of reaction is seen in Osteosarcoma?
Periosteal Reaction
Speculated
Radiating
Sunburst
What two conditions are seen in patients over the age of 40, that have a periosteal reaction (Speculated/Radiating/Sunburst) reaction of bone?
Chondrosarchoma
Fibrosarcoma
What condition of bone is often seen in patients aged 10-25 years old?
Ewing’s Sarcoma
In what area of the bone is Ewing’s Sarcoma often found in?
Diaphysis of Long Bones
What type of Periosteal Reaction is seen in Ewing’s Sarcoma?
Multi-Paralleled Onion Skin (Laminated)
What are three other x-ray findings associated with Ewing’s Sarcoma?
Bone expansion
Codman’s Triangle
Saucerization
What is the name of the condition see in patients over 40 years old, that is described as “Aberrant notochordal Cell tumor”?
Chordoma
What are the two most common locations for a Chordoma?
Most Common- Sacrum
2nd Most Common- Skull
What age and gender range are most effected by scoliosis?
Females
13-19
How is scoliosis named?
For the side of major Convexity
What is the most common type of Scoliosis?
Right Thoracic Convex Idiopathic Scoliosis
In Rotatory Scoliosis to which side do the Spinous Processes deviate?
Concavity
In Simple Scoliosis what way do the Spinous Processes deviate?
Convexity
What two lines are used to measure Scoliosis?
Cobb’s
Resser Ferguson’s
What is the treatment of a patient that has a scoliosis that measures under 20 degrees?
Adjust and Monitor
Scoliosis: What range (in degrees) would you send a patient to an orthopedist for a Milwaukee Brace?
21-40 degrees
Over how many degrees is a patient with scoliosis referred to a surgical consultant?
Over 40 degrees
If a patient has a scoliosis of over 50 degrees what are to complications to be worried about?
Cardio-Pulmonary Compromise
Degenerative Joint Disease (DJD)
What are three way to monitor scoliosis?
Risser’s Sign
Left wrist films (Best)
Tanner’s Staging
What is Rheumatoid Arthritis called in Children?
Still’s Disease
What are seven x-ray finding in a patient with Rheumatoid Arthritis (RA)?
- Symmetrical Distribution
- Bilateral uniform loss of joint space
- Rat bite erosions
- Pannus formation
- Periarticular Osteoporosis (Localized)
- Distal Interphalangeal (DIP) joint spared
- Atlanto-Axial Instability
What four signs seen in the hands of a patient with Rheumatoid Arthritis (RA)?
Haygarth’s nodes (Metacarpal Phalangeal (MCP) Joints)
Swan Neck deformity
Boutonniere Deformity
Ulnar or Fibular deviation (Lanois Deformity)
With a patient with Rheumatoid Arthritis (RA), what is the associated condition described as “Benign swelling of the semimembranosus bursa”?
Baker’s Cyst (Popliteal Fossa)
What four Labs with be positive in a patient with Rheumatoid Arthritis (RA)?
RA Latex
FANA
Erythrocyte Sedimentation Rate (ESR)
C Reactive Protein (CPR)
What type of anemia is seen in a Patient with Rheumatoid Arthritis (RA)?
Normocytic Normochromic Anemia
What is the name of the condition that is seen in a patient with Rheumatoid Arthritis (RA) and also has dry eyes and mouth?
Sjogren’s
What is another name for Ankylosing Spondylitis (AS)?
Marie Stumpell
Who would you co-manage patients with Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE) and Ankylosing Spondylitis (AS)?
Rheumatologist
What age and gender does the condition of Ankylosing Spondylitis (AS) affect?
Male
15-35 years of age
Where does Ankylosing Spondylitis (AS) start?
Sacroiliac (SI) joint
What is an early sign of Ankylosing Spondylitis (AS)?
Low Back Pain (LBP) with morning stiffness
What condition is Ankylosing Spondylitis (AS) associated with?
Anterior Uveitis (Iritis)
What three orthopedic test are performed on a patient with Ankylosing Spondylitis (AS)?
Chest expansion
Forester’s Bowstring
Lewin Supine
What is the radiographic finding of the Sacroiliac (SI) joint in Ankylosing Spondylitis (AS)?
Bilateral Sacroiliac (SI) joint fusion (Ghost Joints)
What are the seven radiographic findings in Ankylosing Spondylitis (AS)?
Shiny Corner Sign (Early) Bilateral marginal syndesmophytes Squaring of the vertebral bodies Bamboo spine Dagger Sign Trolley Track Sign Poker Sign
What two labs will be positive/increased in Ankylosing Spondylitis (AS)?
HLA B27
Erythrocyte Sedimentation Rate
What condition looks identical to Ankylosing Spondylitis (AS), in the pelvis but Gastrointestinal dysfunction?
Enteropathic Arthropathy
What are two other names for Enteropathic Arthropathy?
Crohn’s Disease
Ulcerative Colitis
What is the age and gender that the condition of Psoriatic Arthritis is seen?
Males
20-50 years of age
What three signs will be present in a patient that has Psoriatic Arthritis?
Silver Scale lesion on extensors
Pitted nails
Cocktail sausage digits
What are six radiographic findings in a patient with Psoriatic Arthritis?
Non-marginal syndesmophytes of the spine Increased joint space Mouse ear deformities Pencil in Cup deformity Ray Sign Atlanto-Axial instability
What lab will be positive in a patient with Psoriatic Arthritis?
HLA B27
What is another name for Reiter’s Disease?
Reactive Arthritis
What gender and age does the condition of Reactive Arthritis commonly affect?
Males
20-30 (+/-)
What are three symptoms are seen in patients with Reiter’s Disease?
Can’t see, Can’t pee, Can’t Dance with me
Conjunctivitis
Urethritis
Arthritis (Heel Spur)
What Venereal disease is usually the cause of Reactive Arthritis?
Chlamydia
What are three radiographic findings seen in Reiter’s Disease?
Non-Marginal Syndesmophytes of the spine
Calcaneal Spur (Heel Spur)
Fluffy Periostitis
What lab will be positive in the condition of Reactive Arthritis?
HLA B27
What gender is Systemic Lupus Erythematosus (SLE) most commonly seen in?
Females
What are the five signs/symptoms of Systemic Lupus Erythematosus (SLE)?
Malar/Butterfly rash (Sunlight precipitates a skin rash) Oral ulcers Discoid lesions Alopecia Raynaud's phenomenon
In what condition will Ulnar Deviation straighten out?
Systemic Lupus Erythematosus (SLE)
What Labs will be increased/positive in the condition of Systemic Lupus Erythematosus (SLE)?
LE Prep
FANA
Erythrocyte Sedimentation Rate (ESR)
Anti-DNA
What two things will be decreased in Systemic Lupus Erythematosus (SLE)?
Leukopenia (Decrease in White Blood Cells (WBC))
Thrombocytopenia (Decrease Thrombocyte)
What Is another name for Scleroderma?
Progressive Systemic Sclerosis
What gender and age is the condition of Progressive Systemic Sclerosis most commonly effect?
Females
30-50 years old
What symptom is associated with Scleroderma?
Erosion of the distal tufts of the phalanges
What condition has CREST syndrome?
Progressive Systemic Sclerosis
What is CREST Syndrome?
C- Calcinosis (Calcium deposits in the skin)
R- Raynaud’s Phenomenon
E- Esophageal Dysmotility (Difficulty Swallowing)
S- Sclerodactyly (Tightening of skin of fingers or toes)
T- Telangiectasia (Dilation of capillaries)
Seen in the condition of Progressive Systemic Sclerosis
What Labs will be increased/positive in Scleroderma?
FANA RA Latex (30%)
What is another name to Osteitis Condensans Ilia?
Osteitis Triangularis
What population is Osteitis Condensans Ilia seen in?
Multiparous Female
20-40 years of age
What condition has no labs and is self resolving?
Osteitis Condensans Ilia
What is the case management Osteitis Triangularis?
Trochanteric Belt for stability
What is the joint space on the x-ray in Osteitis Condensans Ilia?
Normal
What is the radiographic finding in Osteitis Triangularis?
Bilateral/Symmetrical triangular sclerosis areas on the lower half of the ilium
What is the most common joint affecting the knee?
Synoviochondrometaplsia
What condition is seen with “multiple loose bodies within the joint that are round or oval in shape”?
Synoviochondrometaplsia
What is another name for Neurogenic Arthropathy?
Charcot’s Joint
What four conditions do you often see Charcot’s Joints?
Diabetes
Tabes Dorsalis
Syphilis
Syringomyelia
What are the 6 D’s in weight bearing joints?
Distension Density of Subchondral sclerosis Debris within the joint Dislocation Disorganization Destruction of the bone
What are two other names for the condition of Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
Forestier’s Disease
Ankylosing Hyperostosis
What is the gender and age often seen is Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
Male
Over the age of 40 years old
What symptom is seen in Ankylosing Hyperostosis?
Neck stiffness or pain on swelling
What other condition is commonly seen/associated Diffuse Idiopathic Skeletal Hyperostosis?
Diabetes Mellitus
Hemoglobin, A1c, Fasting Blood Sugar (FBS)
What ligament is ossified in Forestier’s Disease?
Ossification Posterior Longitudinal Ligament (OPLL)
What are the radiographic finding of Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
Four (4) contiguous segments involved
Flowing hyperostosis (Anterior Bridging)
Candle wax dripping
Disc space is preserved
What is the treatment for Forestier’s Disease?
Adjust; as long as no facet involvement, no inflammation
The HLA B27 lab will be positive in what percentage of patient’s with Ankylosing Hyperostosis?
30%
What is another name for Degenerative Joint Disease (DJD)?
Osteoarthritis
Is Degenerative Joint Disease (DJD) inflammatory or non-inflammatory disease?
Non-inflammatory
What are the most commonly involved joints in Degenerative Joint Disease (DJD)?
Weight Bearing Joints (Hip or Knee)
What is a common associated finding with Degenerative Joint Disease (DJD)?
Subchondral cyst
What condition usually become more stiff with rest and improves movement with activity?
Degenerative Joint Disease (DJD)
What are two complications of Degenerative Joint Disease (DJD)?
Spinal Canal Stenosis Intervertebral Foramen (IVF) Encroachment
What is the most common area of the spine effected by Degenerative Joint Disease (DJD)?
C5/C6
What three findings will you see in a patient’s spine with Degenerative Joint Disease (DJD)?
Intervertebral Disc (IVD) narrowing
Osteophytes
Endplate Sclerosis
What are four finding of the hand seen in patients with Degenerative Joint Disease (DJD)?
- Non-uniform loss of Joint space
- Heberden’s Nodes seen at the Distal Interphalangeal (DIP) Joint
- Decreased joint space with sclerosis
- Asymmetrical Distribution
What is the x-ray finding of the hip in Degenerative Joint Disease (DJD)?
Decreased superolateral joint space with sclerosis
What is the radiographic finding of the knee in Degenerative Joint Disease (DJD)?
Decreased medial joint space with the lateral space preserved
What are three possible etiologies of Degenerative Joint Disease (DJD)?
Sports Injury
Unrelated Microtrauma
Genetic
What are the eight conditions classified as Inflammatory Arthritdes?
Rheumatoid Arthritis (RA)
Systemic Lupus Erythematosus (SLE)
Scleroderma
Osteitis Condensans Ilia
Psoriatic Arthritis
Enteropathic Arthropathy
Ankylosing Spondylitis
Reactive Arthritis (Reiter’s)
What are the four conditions classified as Degenerative Arthritdes?
Degenerative Joint Disease (DJD) (Osteoarthritis)
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Neurogenic Arthropathy
Synoviochondrometaplsia
What are the four conditions classified as Metabolic Arthritdes?
- Gout
- Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD)
- Hydroxyapatite Deposition Disease (HADD)
- Septic Arthritis
What age and gender is Gout often seen in?
Males
Older the 40 years of age
What causes the condition of Gout?
Overproduction of uric acid
What are the signs/symptoms of Gout?
Extremely painful, red, hot and swollen joint(s)
What is the most common joint for the condition of Gout to effect?
Metatarsal Phalangeal (MTP) joint of the big toe
Gout is mono-articular
What is the term for a “swollen first metatarsal phalangeal (MTP) joint”?
Podagra
In the condition that has tophi crystals often the ear?
Gout
What are the two radiographic findings in Gout?
Overhanging Margin
Juxta-articular erosion
What labs will be positive/increased in the condition in Gout?
Increased Uric Acid
Positive Erythrocyte Sedimentation Rate (ESR)
What Special Test will be done in the condition of Gout?
Joint Aspiration
What is the pharmacologic approach to help patients with Gout?
Acute Gout: Colchicine
Chronic Gout: Allopurinol
Who is a patient with Gout referred to?
Rheumatologist
What is something a patient with Gout can do to decrease the symptoms?
Dietary Changes
Don’t consume Red Wine and Cheese, purines are bad