Final Flashcards
Aggressive appearing lesion
- Lytic
- Cortical Destruction
- Solitary lesion
with Fever and/or increased WBC
Osteomyelitis (infection of bone)
What do you have to rule out with Osteomyelitis?
How do you do this?
Malignancy
Biopsy
What is there a risk of with osteomyelitis?
Pathologic Fracture
Who do you refer to for suspected osteomyelitis
Orthopedic Surgon
What would an MRI show in the medullary cavity of somebody with Osteomyelitis?
High signal- consistent with edema
Localized osteomyelitis=
Brodies Abscess
Sclerotic lesion with luscency <1=
> 1=
<1= Osteoid Osteoma
> 1= Brodies Abscess
With infection, If bone on both sides of a joint are involved, what is the diagnosis?
Septic Arthritis
T/F: Identifying soft tissue swelling on plain film in a single, acutely inflamed joint shoulder lead to urgent referral.
True
Significant disc space loss at a single level without signs of degenerative disease, and loss of subchondral bone (endplates) should put what at the top of the ddx list?
Infection
DDX for significant destruction of two vertebra endplates
Septic arthritis
Most joint space narrowing in the spine is due to _
Degenerative Disease (DDD/DJD)
Osteophytes in spine indicate _
Degenerative Disc Disease
T/F: Degree of Radiographic findings and clinical symptoms are poorly correlated.
True
Degenerative Joint Disease is also known as:
Osteoarthritis
T/F: OA has asymmetric distribution of joint space loss.
True
Where are the only sports you will find DJD involving the metacarpals or matatarsals
1st carpometacarpal
1st metatarsalphalangeal
What are the 4 types of arthritis?
Infectious
Degenerative
Metabolic (crystal deposition)
Inflammatory
Which type of arthritis:
Single joint, acute symptoms, fever, warmth, redness, swelling
Infectious
Which type of arthritis:
Insidious/chronic, pain, stiffness, decreased ROM, Crepitus, swelling, asymptomatic
Degenerative
Which Type of Arthritis:
Acute Symptoms, Intermittent episodes
Inflammatory
Which type of arthritis:
Acute, Chronic, or asymptomatic
Metabolic- Crystal deposition
In infectious arthritis, is the joint space loss uniform or nonuniform?
Inflammatory=
Degenerative=
Infectious=Uniform
Inflammatory= Uniform
Degenerative= Non-uniform
Who do you refer for with suspected inflammatory arthritis?
Rheumatologist
How do you treat gout?
Manage Hyperurecemia
How do you manage CPPD, HADD?
Manage Symptoms
What is Neuropathic Arthropathy?
Severe Degenerative Arthritis secondary to loss of sensory and proprioceptive
- Diabetes
- Alcoholism
- Tabes Dorsalis
- Paralysis
- Syringomyelia
What are the 6D Radiographic Findings in Neuropathic Arthropathy?
Distended Joint Density Increased Debris Dislocation Disorganization Destruction
Multiple Osteochondral bodies, intraarticular=
Synoviochondrometaplasia
- Synovial chondromatosis
- Osteochondromatosis
Digital Clubbing
Symmetric arthritis
Periostitis
may be a sign of:
Hypertrophic Osteoarthropathy
What is Hypertrophic Osteoarthropathy secondary to?
Major visceral disorder- MC Bronchogenic Carcinoma
Calcific Tendonitis is also known as_
HADD
Pencil in cup deformity is typical of _
Psoriatic Arthritis
With Sacroilitis _= Symmetric or Asymmetric
AS=
Psoriatic=
Reactive (Reiters)=
Enteropathic=
AS= Symmetric
Psoriatic= Asymmetric
Reactive (Reiters)= Asymmetric
Enteropathic= Asymmetric
What are radiographic findings of Sacroiliitis?
Erosions (pseudowidening
Reactive Sclerosis (wide indistinct borders)
Fusion (late)
Psoriatic prefers _ location
Reactive prefers _ location
Psoriatic= hands and feet
Reactive= lower extremity
Thick or thin paraspinal syndesmophytes?
DISH=
Reiters/Psoriatic=
AS/ Enteropathic Arthritis=
DISH= Thick
Reiters/Psoriatic= Thick
AS/ Enteropathic Arthritis= Thin
Type of Sacroilitis
(None, Uni/Bilateral, A/Symetrical)
AS= Enteropathic= Reiters Psoriatic= DDD= DISH=
AS= Bilateral/Sym
Enteropathic= Bilateral/Sym
Reiters= Unilateral
Psoriatic= Bilat/Asym
DDD= None
DISH=None
T/F: RA can cause upper cervical instability.
True- Any of the inflammatory arthropathies can cause upper cerical instability.
Squaring of vertebral bodies, erosions and “shiny corner sign” are a sign of +
Reactive sclerosis- due to inflammation at disc annular fiber insertion.
If you suspect AS, but the patient also has GI symptoms, what is now at the top of your DDX list?
Enteropathic Arthritis.
Asymmetric Sacroiliitis=
Psoriatic Arthritis
Reactive Arthritis
Bilateral Sacroiliitis and bilateral symmetric hip changes with uniform joint space loss=
AS most likely
Well defined, triangular areas of sclerosis on the iliac side of the SI joint without erosions=
Osteitis Condensans ilii
Acute pain and stiffness in the upper cervical with radiographic evidence of calcification=
HADD
Name 4 seronegative spondyloarthropathies
AS
Enteropathic
Psoriatic
Reactive
Besides the sacroiliac joints and lumbosacral junction, where is the most common site of involvement in the spine for seronegative spondyloarthropathies?
TL Junction
Enteropathic arthropathies are cause by which GI conditions?
Chrons
Ulcerative Colitis
Which seronegative spondyloarthropathy has unilateral asymmetrical sacroiliitis?
Reactive (reiters)
Which arthtisis do not involve the Sacroiliitis?
DISH
DJD
RA
Psoriatic
Which Arthritis have Bilateral symmetrical sacroiliitis?
AS
Enteropathic
Which seronegative spondyloarthropathy is associated with urethritis?
Reactive
Thin marginal syndesmophyts are seen with which arthritis?
AS
Coarse, nonmarginal syndesmophytes are seen typically with which two arthritides?
Psoriatic
Reactive
Which arthritic conditions are associated with Atlanto-axial instability
RA AS Psoriatic Arthritis Enteropathic Arthritis Reactive Arthritis
RA+ Sergonegative
Which two conditions may exhibit distal ungual tuft resorption?
Psoriatic
Scleroderma
Which condition exhibits Reversible deformities of the hands?
Scleroderma
TB joint infetion is associated with what?
Phemister’s Triad
What is the Triad of findings associated with Hypertrophic Osteoarthropathy?
Finger Clubbing
Bilateral joint pain and swelling
Bilateral, symmetric long bone solid periosteal response
Which arthritic condition exhibits triangular sclerosis of the iiac portion of the sacroiliac joints WITHOUT showing evidence of erosions?
Osteitis Condesans Ilii
Osteitis pubi may be difficult to differentiate from which more serious condition?
Septic (infectious) arthritis
The “Siz Ds” are a radiographic finding associated with what arthritic condition?
Neuropathic Arthropathy
What are the Siz Ds?
Density Increase Debris Destruction Dislocation Distension Disorganization
Diffuse Idiopathich Skeletal hyperostosis involves calcification/ossification of which tissue structure?
ALL
TheRadiographic features/diagnostic criteria of Diffuse idiopathich Skeletal Hyperostosis are:
Thick flowing hyperostosis, 4 levels
Preservation of Discs
No facet involvement
What metabolic disease may be associated with DISH?
Diabetes
50% of patients with DISH will likely develop what other spinal condition?
Ossification of PLL
List 4 pathways infections can spread to bone?
Hematogenous MC
Contagous source
Direct implantation
Postoperative
T/F: Osteomyelitis in adults is more insidious than in children
True
name 5 groups of people who are at higher risk of developing osteomyelitis
Diabetics New Born Drug Addicts Alcholic Immunosuppressed
The latent radiographic period for osteomyelitis of the extremities is
10 days
The latent radiographic period for osteomyelitis of the spine is
3 weeks
The earliest radiographic changes of bone and joint infection are often seen where
Soft Tissues
Acute osteomyelitis often must be differentiated from what other serious pathology?
Primary Malignancy
Brodies abscess clinically presents like what neoplasm
Osteoid Osteoma
List two important radiographic findings associated with septic arthritis.
Rapid, uniform joint space loss
Loss of subchondral bone
