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Differential Diagnosis/Imaging > Exam II > Flashcards

Exam II Flashcards

1
Q

Compartment Syndrome (5 Ps)

A

Pain: Deep, poorly localized
Paresthesia: of the sensory nerve passing through compartment
Paralysis: Permanent damage likely
Pallor: distal to the compartment involved
Pulselessness

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2
Q

Paget’s disease

A

chronic disorder that can result in enlarged and misshapen bones. Paget’s disease typically is localized, affecting just one or a few bones, as opposed to osteoporosis, for example, which affects all the bones in the body.

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3
Q

Cleidocranial dysplasia

A

condition that primarily affects development of the bones and teeth. Signs and symptoms of cleidocranial dysplasia can vary widely in severity, even within the same family. usually have underdeveloped or absent collarbones.

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4
Q

11 Predictor Variables of Bone Tumors

A
  1. Behavior of the lesion
  2. Bone/ joint involved
  3. Locus within a bone
  4. Patient demographics: age, gender, ethnicity
  5. Margin of the lesion
  6. Shape of the lesion
  7. Joint space involvement
  8. Bony reaction
  9. Matrix production
  10. Soft tissue changes
  11. Patient history
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5
Q

Bone Tumor characteristics (shape)

A

Longer than it is wide suggests slow growth/ benign
Wider than it is long suggests fast growth/ malignant
Cortical breakthrough = malignant
No cortical breakthrough = benign

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6
Q

Emergency referral

A

same day referral

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7
Q

Urgent referral

A

within 5 days (blood sugar running high recently, progressive weakness while doing PT)

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8
Q

Watchful waiting

A

Close surveillance while undergoing PT treatment as indicated; use of time before a medical intervention or other strategy is used. Referred as: “treat and refer”

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9
Q

Safety netting

A

safety netting is a management strategy used for people who may present with possible serious pathology. These strategies should include advice on which signs/symptoms to monitor, what action to take, and the time frame the action needs to be taken.

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10
Q

Red Flag Screening

A

Categorization approach
I = Suggests serious pathology outside of MSK disorder, possible immediate intervention by a specialist

II = Further patient questioning/adoption of selected examination methods/development of clusters of signs/symptoms

III = Common, require further physical examination, may alter treatment

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11
Q

Components of TIM VaDeTuCoNe

A

Trauma
Inflammation (Aseptic or Septic)
Metabolic condition
Vascular (Arterial or Venous or Lymphatic)
Degenerative
Tumor (Malignant Primary or Malignant Metastatic or Benign)
Congenital
Neurogenic/Psychogenic

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12
Q

Diaphragmatic irritation referral sites

A

Shoulder, low back

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13
Q

Heart referral site

A

Shoulder, neck, upper back, TMJ

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14
Q

Urogenital tract referral site

A

Back, inguinal region, and genitalia

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15
Q

Pancreas, liver, spleen, gallbladder referral site

A

Shoulder, midthoracic or low back

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16
Q

C7, T1–5 referral site

A

Interscapular, posterior shoulder

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17
Q

Shoulder referral site

A

Neck, upper back

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18
Q

L1, L2 referral site

A

SI joint and hip

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19
Q

Hip joint referral site

A

SI joint and knee

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20
Q

Pharynx referral site

A

ipsilateral ear

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21
Q

TMJ referral site

A

Head, neck, heart

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22
Q

Red Flags: Associated Signs and Symptoms

A

Report of confusion
-Neurologic vs drug induced vs infection
Constitutional symptoms or unusual vital signs
-Example: body temp >100 deg F
Proximal muscle weakness with change in DTRs
Joint pain with skin rashes or nodules
Clustered signs/symptoms of a particular organ system
Unusual menstrual cycle/symptoms

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23
Q

Fatigue and Malaise

A

A change resulting in fatigue that interferes with ADLs, work, school, social settings for >2-4 weeks

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24
Q

Fever, chills, sweats

A

Common in infection, cancers, connective tissue disorders such as RA

Fever of 99.5 – 101 deg of unknown origin for 3 weeks = consult

Older adults have impaired thermoregulatory systems that can result in no presence of fever with infection (pneumonia)

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25
Q

SBAR (S)

A

Situation: a concise statement of the problem

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26
Q

SBAR (B)

A

Background: pertinent and brief information related to the situation

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27
Q

SBAR (A)

A

Assessment: analysis and considerations of options, what you found/think

28
Q

SBAR (R)

A

Recommendation: action requested/recommended, what you want

29
Q

AP view of neck

A

Best view for alignment and to observe oblique fractures

30
Q

Lateral view of neck

A

Best initial view to Evaluate Alignment, also termed “lines of life”

  1. Slight lordotic curve, smooth and without step-offs.
  2. Any malalignment in any degree of neck motion should be considered evidence of bony or ligamentous injury.
31
Q

Oblique view of neck

A

Done only after fracture or dislocation injuries are ruled out, can assist with identification of neural foramina narrowing

32
Q

Open mouth view

A

Axis and atlas projected between upper and lower teeth

Demonstrates C1-2 alignment

33
Q

Stable injury

A

intact posterior spinal ligaments

34
Q

Unstable injury

A

displacement

35
Q

Lower c-spine

A

higher frequency of injury in adults

36
Q

Upper c-spine

A

higher frequency of injury in children

37
Q

Computed Tomography: Indications

A

Acute trauma in adults
Degenerative conditions
Infections of the spine
Image guidance for injections
Neoplasms
Congenital abnormalities
Developmental abnormalities
Intrathecal masses

38
Q

Degenerative Disk Disease (DDD)

A

presents on radiograph in most persons older than 60 years. Changes in the disk include dehydration, nuclear herniation, annular protrusion, and fibrous replacement of the annulus, all of which result in decrease in disk height, vertebral endplate approximation, and uncovertebral joint friction, which leads to osteophyte formation around the entire osseous margin of the endplates.

39
Q

Degenerative Joint Disease (DJD)

A

osteoarthritic changes of the facet joints.

40
Q

Foraminal encroachment

A

results from degenerative changes in adjacent structures, including DDD and DJD, that diminish the size of the intervertebral foramina.

41
Q

Spondylosis

A

the formation of osteophytes in response to DDD, but before there is obvious disk space narrowing. Osteophyte formation has been shown to be most predominant at C4–C5 and C5–C6, as a result of greater segmental mobility at these levels.

42
Q

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

A

condition characterized by bony proliferation at sites of tendinous and ligamentous insertion of the spine affecting elderly individuals. On imaging, it is typically characterized by the flowing ossification of the anterior longitudinal ligament

43
Q

Spondylolisthesis

A

forward slippage of one vertebra on the stationary vertebra below it. Increased athletic activity in adolescence or heavy labor in adulthood is often an instigating factor.

44
Q

Spinal columns assist in determining stability of fractures

A

1 column disrupted = stable spine. 2 columns disrupted = potentially unstable spine (depends on degree of injury and if middle column is intact). 3 columns disrupted = instability.

45
Q

The “big 3” signs of a compression fracture

A

step defect, wedge deformity, linear zone of impaction

46
Q

Scheuermann’s Disease

A

Adolescent boys/girls
Backache, thoracic kyphosis
Schmorl’s nodes

47
Q

Tuberculous osteomyelitis

A

aka Pott’s Disease,

Occurs secondary to tuberculous
Thoracic back pain
Kyphosis
Weight loss, fever, fatigue
Infection progresses to several vertebra

48
Q

Lumbar Spine: Signs of Degenerative Changes

A

Loss of disc space
Hypertrophic spurs
Disk calcification
Herniated/protruding disks

49
Q

Spinal Stenosis

A

Spinal stenosis is a narrowing of the spinal canal caused by degenerative joint and disk changes.
Classified into three anatomic regions:
-Stenosis of the central canal
-Stenosis of the intervertebral foramen
-Stenosis of the lateral or subarticular recesses.

More than one region may be involved at the same intervertebral level.

50
Q

Spondylosis deformans

A

Anterior disc herniation that disrupts ALL creating osteophyte formation at the anterior and lateral joint margins

51
Q

Signs of Spinal Infection

A

Destructive process that involved or crosses a disk space

Tumor will typically not involve the disc space
MRI>CT scan

Indicated
Localized pain
Elevated ESR and WBCs
Fever
+ blood culture

52
Q

Cauda Equina Syndrome

A

Compression of the 20 nerve roots that originate from the conus medullaris at the base of the spinal cord

53
Q

Cauda Equina Syndrome symptoms

A

unilateral/bilateral radicular pain, dermatomal reduced sensation, myotomal weakness with progression to changes in bowel/bladder and saddle anesthesia

54
Q

Risk Factors for insufficiency spinal fractures

A

Excessive alcohol consumption (>3 units per day)
Vitamin D deficiency
Long-term corticosteroid use (> 5 or 7.5 mg/day over a 3-month period)
Rheumatoid arthritis, diabetes, smoking (> 20 cigarettes per day)
Dietary restriction, eating disorders, and absorption problems from the gut

55
Q

Spinal Fracture clinical picture

A

Sudden onset of pain in the thoracolumbar region after a low impact trauma (slip/fall)

Severe pain, localized to area of the fracture, needs strong analgesics

Increased prominence of spinous process at the affected level, and increased kyphosis

Tender to percussion at the affected level

Most spinal fractures occur between the T8 and L4 levels.

56
Q

Spinal Malignancy

A

Bone is common site for metastases, spine is one of the earliest affected. Cancers include breast, prostate, lung, kidney, and thyroid.

Metastatic spinal cord compression can occur leading to irreversible neurological damage

57
Q

Early warning signs for metastatic spinal cord compression (could be from spinal malignancy)

A

band like back pain, escalating pain with poor response to medication, heavy legs or funny feelings, lying flat increases back pain, gait disturbances, sleep disturbances due to pain being worse at night.

58
Q

Spinal infection

A

Unlike malignancy, where symptoms wax and wane, spinal infection has a more linear progression, with back pain being the most common presenting symptom, which can progress to neurological symptoms. Spinal surgery is key risk factor.

The classic triad of clinical features comprises back pain, fever, and neurological dysfunction

59
Q

Cardiothoracic Ratio

A

Estimate of heart size on the PA radiograph.
In adults, the width of the heart should be less than half the width of the chest.

60
Q

Silhouette Sign

A

Localize water-based lesions to a specific lobe of the lung.
Refers to a loss of the normal heart or diaphragm border when a lesion is in a lobe adjacent to it.

61
Q

Lung fields abnormally white

A

pneumonia, atelectasis, pleural effusion

62
Q

Lung fields abnormally black

A

pneumothorax, COPD

63
Q

Mediastinum abnormally wide

A

aortic dissection, lymphadenopathy

64
Q

Heart abnormally shaped

A

congestive heart failure, mitral valve stenosis

65
Q

Nexus criteria

A

No posterior midline cervical spine tenderness
No evidence of intoxication
Normal level of alertness
No focal neurologic deficit
No painful, distracting injuries

If pt meets all criteria, then no radiograph, if not, radiograph

Differential Diagnosis/Imaging (4 decks)

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