Foot - Diagnostic studies/imaging Flashcards
bone tumors
chondromyxoid fibroma
these do not cross the physeal plate. Radiographically: are well-defined, eccentric, elongated, radiolucent lesions. A common appearance is a bubbly, expansile, eccentric, elongated, metaphyseal, lytic lesion. The lesions can extend into the diaphysis but do not cross the physeal plate.
bone tumor
chondroblastoma
most often affects the ends of the long bones, near the growth plate, in the arms at the shoulder, and in the legs at the hip and knee; it most commonly occurs in children and young adults.
bone tumors
giant cell tumors
These are benign tumors with potential for aggressive behavior and capacity to metastasize. These benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations; hence its capacity to invade the physes. It is characterized by the presence of many multi- nucleated giant cells.
bone tumor
clear cell sarcoma
sarcoma of tendons and aponeuroses is a rare, high grade malignant soft tissue tumor resembling melanoma and soft tissue sarcomas.
bone scan
Following injection of radioactive leukocytes, an indium -111 bone scan is performed after what length of time?
24 hours
bone scan
*if cellulitis, what are the technetium/gallium scan results?
tech (-), gallium (+)
EXPLANATION: A useful breakdown on how bone scans will differentiate infections: Tc-99: If positive in Phase 3, Indicative of OM, If Negative in Phase 3, excludes osteo /// Ga-67: Diffuse uptake: Soft tissue infection /// In-111: Acute OM: Positive, Chronic OM: Negative /// Yet another break down: Acute OM: Positive Tc-99, Positive Gallium /// Septic Arthritis: Positive Tc-99, Positive Gallium /// Chronic Osteomyelitis: Positive Tc-99, Negative Gallium /// Cellulitis: Negative Tc-99, Positive Gallium
bone tumor
*blood filled lesion
Aneurysmal bone cyst. EXPLANATION: ABCs are composed of cavernous blood-filled spaces with thin fibrous walls. Most occur in patients younger than 20 years old. There is a slight female predominance. The typical radiographic appearance is an eccentric well-defined expanding lesion without matrix and a sclerotic border may be present. ABCs most commonly occur in the metaphyses of large bones (esp femur and tibia)and the dorsal elements of the spine. Giant cell tumors are more common in females and the lesions most commonly occur in patients between the ages of 20 and 40 years old. The most common sites are the ends of long bones (esp the distal femur and radius and proximal tibia) and the sacrum. There is no sclerotic border present. Chondroblastomas are more common in males and 80% are in the second and third decades of life. The talus and calcaneus are the preferred sites when the lesion occurs in the foot or ankle. Osteoblastomas more commonly occur in males and most patients are in the second and third decade of life. The lesion may resemble an osteiod osteoma except for its increased size. Osteoid osteomas are more commonly found in males. The femur and tibia are the most common sites. The symptoms are significant with pain, commonly worse at night. Pain is commonly relieved by aspirin or nonsteroidal anti-inflammatory medications.
bone tumor
classic radiographic findings of multiple myeloma
classic radiographic appearance of multiple, small, well-circumscribed, lytic, punched-out, round lesions.
rx
xanthine oxidase inhibitor
allopurinol
gout
acute gout tx
Pharmacological therapy for acute gout aims to achieve an absence of pain and resolution of joint inflammation as rapidly as possible.
First-line treatment options are nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and colchicine.
gout
chronic gout tx
Chronic gout treatment should aim to prevent gout progression and further gout flares, to eliminate any urate deposits, and to reverse tophus formation.** Xanthine oxidase inhibitors (allopurinol)** are commonly a first-line treatment and uricosuric agents often the second.
peds
thurston Holland sign is seen in what SALTER HARRIS category?
type II
Salter-Harris classification o
* Type 1- physeal separation
* Type 2- fracture traverses physis and exits metaphysis * most common type * Thurston Holland fragment
* Type 3- fracture traverses physis and exits epiphysis
* Type 4- fracture passes through epiphysis, physis, metaphysis
* Type 5- crush injury to physis
bone scans
bone scan results for chronic osteomyelitis
Technetium (+), gallium (-)
xr
least radio-opaque to most
- Air, as found, for example, in the trachea and lungs, the stomach and intestine, and the paranasal sinuses.
- Fat.
- Soft tissues, e.g., heart, kidney, muscles (these are all approximately the density of water).
- Calcific (due to the presence of calcium and phosphorus), for example, in the skeleton.
- Enamel of the teeth.
- Dense foreign bodies, for example, metallic fillings in the teeth. Also, radio-opaque contrast media, such as a barium meal in the stomach or intravascular contrast.”
what is: a segment of necrotic bone that is separated by granulation tissue from surrounding living bone
sequestrum
what is: new bone that has formed around dead bone; can become perforated by tracts
involucrum
the openings in the involucrum are referred to as cloaca.
cloaca
test that is sensitive for sarcoidosis
Kveim test
(largely a historical test that is not routinely performed in most hospital settings. It is still routinely seen in multiple educational and medical board settings.)
multilobulated “cloud-like” calcifications; multiple painless plantar lumps; associated with renal failure
calcinosis
tx: calcium and phosphorus diet restriction
(involves dietary phosphate restriction, noncalcemic phosphate binders and intensification of dialysis treatment using a low-calcium dialysate, parathyroidectomy in patients with high PTH levels due to tertiary hyperparathyroidism. Surgical excision is an option for persistent symptomatic lesions.
