Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DXI II > Exam 2: [Intro, Herniations & Fissures] > Flashcards

Exam 2: [Intro, Herniations & Fissures] Flashcards

1
Q

MC Cause of work disability among U.S. adults

A

Articular Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cost of Articular Disease in 2013 Annually & % of Adults with Doctor-Diagnosed Articular Disease

A

> $14 Billion
22.7% of Adults (1 in 7 people)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Articular Disease: % of Population Affected (18-44 years old)

A

7.3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Articular Disease: % of Population Affected (45-64 years old)

A

30.3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Articular Disease: % of Population Affected
(> 65 years old)

A

49.7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Articular Disease: % of Population Affected (Males)

A

48.3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Articular Disease: % of Population Affected (Females)

A

51.7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

4 things to look at while making Diff Dx’s for Articular Disease

A

1) Anatomy of Involved Joints
2) Pathophysiology
3) Clinical Features
4) Key X-Ray Findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Arthropathies managed “Daily” in Practice

A

DJD (osteoarthritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Arthropathies managed “Monthly” in Practice

A
  • Ankylosing Spondylitis
  • CPPD crystal deposition (pseudo-gout)
  • Osteitis Condensans Ilii
  • Psoriatic Arthritis
  • Rheumatoid Arthritis
  • Synoviochondrometaplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Arthropathies managed “Yearly” in Practice

A
  • Gout
  • Infection
  • Lupus
  • Reiter’s Syndrome
  • Scleroderma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Examples of Fibrous Joints

A
  • Cranial Sutures
  • Syndesmoses (tib/fib) & (radius/ulna)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examples of Cartilaginous Joints

A
  • Symphysis Pubis
  • IVD’s
  • Manubriosternal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Examples of Synovial Joints

A
  • Facet Joints
  • SI Joints
  • Hips
  • Knees
  • Shoulders
  • Fingers & Toes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is there a lack of periosteal response in synovial joints?

A

Generally, there is no periosteum found around the intracellular cortices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ABCDE’S Acronym for Arthropathies

A

Alignment
Bone
Cartilage
Distribution
Erosions
Soft Tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Imaging Considerations for Arthritis: Alignment

A
  • Occurs secondary to ligament laxity
  • With or Without Erosions

Non-Uniform Cartilage Wearing:
- Swan Neck
- Boutonnière
- Pencil in Cup
- Valgus/Varus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Imaging Considerations for Arthritis: Bone (Inflammatory Arthritides)

A

Osteopenia secondary to Inflammation & Hyperemia (osteoclast activity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Imaging Considerations for Arthritis: Bone (osteoarthritis)

A
  • Reactive Bone formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Imaging Considerations for Arthritis: Bone (General)

A

Enthesophytic Changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Imaging Considerations for Arthritis: Cartilage (Inflammatory)

A

Pannus Promoting Proteolytic Destruction of Cartilage in UNIFORM PATTERN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Imaging Considerations for Arthritis: Cartilage (osteoarthritis)

A

NON-UNIFORM Cartilage Loss along lines of stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Imaging Considerations for Arthritis: Distribution

A
  • Mono, Oligo, or Polyarticular
  • Symmetry
  • Specific Joint Involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Imaging Considerations for Arthritis: Erosions (Inflammatory)

A
  • Focal subcortical bone loss
  • Marginal (bare areas)
  • Subchondral bone loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Imaging Considerations for Arthritis: Erosions (Crystal Deposition Disease)

A

Non-marginal bone loss with overhanging margin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Imaging Considerations for Arthritis: Erosions (Non-Inflammatory)

A

Subchondral Bone Loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Imaging Considerations for Arthritis: Soft Tissues (Rheumatoid Arthritis)

A
  • Fusiform swelling
  • Sometimes ST calcifications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Imaging Considerations for Arthritis: Soft Tissues (Psoriatic arthritis)

A
  • Diffuse Swelling (sausage digit)
  • Sometimes ST calcifications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Imaging Considerations for Arthritis: Soft Tissues (Gout)

A
  • Asymmetric “lump-bumpy” swelling
  • Sometimes ST calcifications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Non-Inflammatory Arthropathy Diseases

A

1) DJD (degenerative joint disease)
2) DDD (degenerative disc disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Inflammatory Arthropathies

A

1) Ankylosing Spondylitis (seronegative)
2) Psoriatic Arthiritis (seronegative)
3) Reactive Arthritis (seropositive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Metabolic/Depositional Arthropathies

A

1) Gout
2) Calcium Pyrophosphate
3) Hydroxyapatite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Degenerative Arthropathies

A

1) DJD
2) DDD
3) DISH
4) OPLL
5) Neuropathic Osteoarthropathy
6) SOC/SCM
7) Erosive Osteoarthritis (EOA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Key Radiographic features of Degenerative Arthropathies

A
  • Asymmetrical
  • NON-UNIFORM loss of joint space
  • Osteophytes
  • Subchondral sclerosis & cysts
  • intra-articular loose bodies
  • Joint deformity & subluxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Inflammatory Arthropathies

A

1) RA & JIA
2) Ankylosing Spondylitis
3) Enteropathic Arthropathy
4) Psoriatic arthritis
5) Reactive arthritis
6) Scleroderma/PSS
7) Lupus (SLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Key Radiographic Features of Inflammatory Arthropathies

A
  • ST Swelling (1st sign)
  • Symmetric
  • UNIFORM loss of joint space
  • Marginal bone erosion
  • juxta-articular osteopenia
  • Periostitis (occasionally)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Metabolic (Depositional) Arthropathies

A

1) Gout
2) CPPD
3) HADD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Key radiographic features of Metabolic Arthropathies

A
  • ST swelling adjacent to joints
  • +/- well-marginated bone lesions
  • non-marginal location of lesions
  • preservation of joint spaces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

T1 Weighted MR Imaging features

A
  • fat sensitive (hyper intense)
  • fluid (hypointense)
  • muscle (intermediate intensity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

T2 Weighted MR Imaging features

A
  • Fluid sensitive (hyper intense)
  • fat (hyper intense)
  • Muscle (intermediate intensity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

PD Weighted MR Imaging features

A
  • Fluid & Fat (hyper intense)
  • Muscle & Hyalin Cartilage (intermediate intensity)
  • Fibrocartilage (hypointense)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

STIR Weighted MR Imaging features

A
  • Fluid sensitive (hyper intense)
  • Fat suppressed (hypointense)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Degenerative Joint Disease: General Info

A
  • most frequent articular affliction
  • progressive & non-inflammatory
  • Unknown cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Precipitating factors of secondary DJD

A

1) Trauma/altered biomechanics
2) Congenital
3) Inflammatory & Metabolic Arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Onset of DJD

A

[Insidious]
- Aching
- Pain
- Stiffness
- Swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Populations affected in DJD

A

Males over 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Clinical Features of DJD

A
  • Crepitus
  • Decreased ROM
  • Palpable Excrescences
  • Adjacent Muscle Atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Clinical Features of Spinal DJD

A

Signs of Stenosis & Nerve Entrapment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Common Joint Locations of DJD

A

1) Zygapophyseal
2) Uncovertebral
3) Discovertebral
4) Costovertebral/Costotransverse
5) Extremity Joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What exists among the extent of radiologic changes & clinical signs of DJD?

A

Poor Correlation between the two.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the Synovial Joints of the Spine?

A

1) Facets
2) Uncovertebral
3) Atlantodental Interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Degeneration of the Facets, Uncovertebral Joints, & the Atlantodental Interval is what?

A

Osteoarthrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What type of joints are the IVD’s?

A

Fibrocartilaginous

54
Q

Degeneration at the IVD’s is called…

A

Discogenic Spondylosis

55
Q

Spondylosis Deformans Radiologic Features

A
  • Annular degeneration
  • minimal disc space loss
  • prominent Osteophytes
  • annular vacuum clefts
56
Q

Intervertebral Osteochondrosis (IVOC) radiologic features

A
  • Nuclear degeneration
  • prominent disc space loss
  • minimal Osteophytes
  • nuclear vacuum phenomenon
57
Q

1st detectable sign of degenerative changes to the IVD nucleus

A

Loss of Water/Loss of Proteoglycan substance

58
Q

MC Cervical Joints to undergo Degeneration

A

Facet, Uncovertebral & Intervertebral of
C5/C6 & C6/C7

59
Q

Atlantoaxial Joint Arthrosis is best seen on what modality?

A

CT

60
Q

Atlantoaxial Joint Arthrosis: Symptoms & Radiographic Features

A

[Often Asymptomatic}
- Loss of joint space
- Osteophytes
- Subchondral Sclerosis

61
Q

Facet Arthrosis: Radiographic features

A
  • Loss of joint space
  • Subchondral sclerosis
  • osteophyte formation
62
Q

Facet arthrosis can lead to…

A

Degenerative Spondylolisthesis

63
Q

Uncovertebral Arthrosis: Common where?

A

Lower cervical spine

64
Q

Uncovertebral Arthrosis: Radiographic Features

A
  • Osteophyte can cause “pseudo-fx” appearance on Cervical Lateral view
  • Sharpening Uncinate Processes
  • Lateral projection of Uncinates
65
Q

Why do we Image Uncovertebral Arthrosis?

A

[Uncinate = Ant. Border of the IVF]
It can curl into IVF > neuro symptoms

66
Q

Spondylosis: MC where? & What is it?

A
  • MC: C5/C6
  • IVD Degeneration
67
Q

Spondylosis: Radiographic Features

A
  • Disc height loss
  • Osteophyte
  • Endplate Sclerosis
  • Vacuum Phenomenon
68
Q

At what measurement of the Sagittal canal do you refer? And what do you refer for?

A

< 12mm
MRI Referral

69
Q

Posterior Osteophytes may…

A

Project into the spinal canal causing central canal stenosis -> myelopathy

70
Q

What are Intercalary Bones

A

Calcification within the annular fibers

71
Q

What are Intercalary bones Indicative of?

A

DDD

72
Q

Thoracic Spine Degeneration: Radiographic features

A
  • involves typically 3 articulations
  • IVD’s: spondylophytes, narrowing, endplate sclerosis
  • Facet Joints: uncommon location
  • Costovertebral/Costotransverse lower segments
73
Q

What joints in the Lumbar spine undergo Degenerative changes?

A

1) Facets
2) IVD’s

74
Q

What Lumbar Disc Space is typically the largest?

A

L4/L5

75
Q

Hemispheric Spondylosclerosis: Characteristic Sign & What is it?

A
  • Peripheral Convex Border
  • Localized sclerotic focus adjacent to endplate
76
Q

Degenerative Osteophytes: Traction

A

Typically non-marginal & horizontal

77
Q

Degenerative Osteophytes: Claw

A

Non-marginal & horizontal BUT curve Sup/Inf and taper

78
Q

Degenerative Spondylolisthesis: MC Sites

A

MC = L4
MC in C Spine= C7

79
Q

Translation & Angulation Measurements Associated with Cervical Spine Instability

A

Translation: > 3.5mm
Angulation > 11 degree change

80
Q

Translation Measurements Associated with Thoracic Spine Instability

A

Translation: > 2.5mm

81
Q

Translation & Angulation Measurements Associated with Lumbar Spine Instability

A

Translation: > 4.5mm

Angulation: > 15 degree change
L4-L5: >20 degree change
L5-S1: >25 degree change

82
Q

Synovial Cysts: WHat is it? & MC Site

A

Synovial fluid-filled cysts continuous w/ facets
MC: L4-L5

83
Q

Synovial Cysts can lead to…

A

Spinal canal or neural foramen stenosis

84
Q

Synovial Cysts: Modality & What do they mimic?

A

Only visible on MRI
Can Mimic Disc herniation SSx

85
Q

Baastrup Syndrome: a.k.a & what is it?

A

“Kissing Spine” Syndrome
- Hypertrophy, approximation & sclerosis of the spinous process

86
Q

Baastrup Syndrome: Best Modality

A

MR (may demonstrate interspinous friction bursa)

87
Q

Progression of Disc Disease Order

A

1) Less nuclear matrix (proteoglycans)
2) less nuclear water
3) less pressure holding endplate apart
4) Less disc space
5) less annular fiber tension -> laxity + more motion
6) Osteophytes, endplate sclerosis
7) further Nucleus Degradation
(Start back @ 1)

88
Q

What stage of Disc Disease does MR start to show changes?

A

1) Less nuclear matrix (proteoglycans) &
2) Less nuclear water

89
Q

What stage of Disc Disease does X-Ray start to show changes?

A

4) Less disc space

90
Q

What type of Modic change is seen on X-Ray?

A

Type 3 (sclerosis)

91
Q

What is Type 1 Modic Change?

A

Para-Endplate Bone Marrow Edema & Inflammation

92
Q

What is Type 2 Modic Change?

A

Para-Endplate Fatty degeneration of Marrow

93
Q

What is Type 3 Modic Change?

A

Para-Endplate Bony Sclerosis

94
Q

Modic Type 1 Effect on T1 & T2 Weighted Images

A

Decreased T1 & Increased T2

95
Q

Modic Type 2 Effect on T1 & T2 Weighted Images

A

Increased T1 & Neutral T2

96
Q

Modic Type 3 Effect on T1 & T2 Weighted Images

A

Decreased T1 & T2

97
Q

Herniation Definition

A

Displacement of disc material beyond the normal disc margins by 2mm or more

98
Q

Who standardized the nomenclature for disc herniation?

A

ASNR

99
Q

Classification of disc herniation requires…

A

Viewing BOTH axial & Sagittal images

100
Q

Disc Bulge: Associated with? & What is it?

A
  • Associated w/ degeneration
  • Asymmetric or Symmetric disc extension beyond margin less than 3mm
101
Q

How much of the circumference does a disc bulge effect?

A

Greater than 25% of the circumference

102
Q

What is a Disc Protrusion?

A

Focal extension of disc beyond the vertebral body margin posteriorly

103
Q

Disc Protrusion: Features

A
  • Base is greater than depth in both Sagittal & Axial dimensions
  • Does not extend above or below adjacent end plates
104
Q

Disc Protrusion: Symptoms & % of Population affected

A
  • Often Asymptomatic
  • 1/3-2/3 of people
105
Q

Disc Extrusion: Features

A
  • Nuclear material not contained by annulus
  • maintains continuity of the parent disc
  • base is narrower than the depth in both Sagittal & Axial planes
106
Q

Disc extrusion can look like…

A

A protrusion in one plane and an extrusion in the other
(If one view looks like an extrusion it is NOT a protrusion)

107
Q

Acute Extrusion may show ___________ on ____ and ____-_________ _________due to _____________

A

High Intensity
T2
Post-contrast enhancement
Surrounding Granulation Tissue

108
Q

What % of Disc Extrusions w/ radiculopathy are managed w/o surgery?

A

90% with aggressive conservative management

109
Q

Pain is most likely caused by what in a disc extrusion?

A

A Chemical Cause rather than mechanical compression

110
Q

Sequestered Fragment: What is it?

A
  • Uncontained disc material NOT connected to the parent disc
111
Q

Sequestered Fragment: Where can it migrate?

A

[In the Spinal Canal]
- usually about 5mm
- but can be 2-3 levels
- can affect multiple nerve roots

112
Q

Acute Sequestration on MRI Appearance

A

May have surrounding high T2 & post-contrast enhancement due to vascular granulation tissue

113
Q

Sequestered Fragment: Treatment

A

Generally requires an Open Procedure

114
Q

Disc Herniation Locations

A

92% are Central or Subarticular
4% foraminal
4% extraforaminal

115
Q

Disc Herniation MC Locations in Lumbar Spine

A

L4/L5 & L5/S1

116
Q

Disc Herniation MC Locations in Cervical Spine

A

C5/C6 & C6/C7

117
Q

What location of Cervical Disc Herniations affect the exiting roots?

A
  • Central
  • Subarticular
  • Foraminal
118
Q

What location of Lumbar Disc Herniations affect the TRANSITING nerve roots?

A

[In the Lateral Recess]
- Central
- Subarticular

119
Q

What location of Lumbar Disc Herniations affect the EXITING nerve roots?

A

Foraminal

120
Q

3 Examples of what nerve roots are affected by herniations:

A

1) C5/C6 Subarticular hits C6 root
2) L4/L5 Subarticular hits L5 root
3) L4/L5 Foraminal hits L4 root

121
Q

Management of Disc Herniations

A
  • 90% managed w/ conservative care
  • spontaneous reduction
122
Q

Lumbar Disc herniation commonly lead to…

A

Radiculopathies

123
Q

Pain in Disc Herniations

A

Frequently more related to inflammation rather than nerve compression

124
Q

Annular Fissures: What shows on MRI?

A
  • DOES NOT necessarily represent traumatic etiology
  • Focal high signal on T2/STIR in the Annular Fibers
125
Q

Annular Fissures: a.k.a.’s & MC Location

A

“Annular Tears” & “High intensity zones”
MC in Posterior Disc

126
Q

Transverse Annular Fissure: What is it?

A

Separation of disc’s peripheral annulus (Sharpey’s) fibers at the Endplate
(No clinical significance)

127
Q

Transverse Annular Fissure: Seen on what modalities?

A
  • Seen as vacuum cleft on plain film
  • Rarely seen on MRI
128
Q

Concentric Annular Fissures: What is it & Symptoms

A
  • Vertical oriented separation between annular layers
  • no evidence of symptoms
129
Q

Radial Annular Fissures: What is it?

A

Longitudinal fissuring from nucleus through multiple annular layers

130
Q

Radial Annular Fissures can allow for…

A

Significant Nuclear Migration

131
Q

Radial Annular Fissures: Symptoms

A

-Associated w/ symptoms of Discogenic Pain
1) growth of vascularized granulation tissue
2)chemical & mechanical irritation of outer annulus

DXI II (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions