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EBM > Mahoney Study Guide > Flashcards

Mahoney Study Guide Flashcards

1
Q

Examples of monoarticular joint diseases (6)

A
  • Trauma
  • infection
  • crystal deposition (gout, CPPD)
  • Rheumatoid -monoarthritis
  • PVNS
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2
Q

Examples of polyarticular inflammatory diseases

A
  • OA
  • RA
  • Seronegatives
  • Charcot
  • Chronic gout
  • reticular histiocytosis
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3
Q

Degenerative joint disease

A

Osteoarthritis

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4
Q

Inflammatory joint disease

A
  • Rheumatoid arthritis
  • Seronegative arthritis
  • Psoriatic arthritis
  • Reiters disease
  • Ankylosing spondylitis
  • Septic arthritis
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5
Q

Metabolic joint diseases

A

Gouty arthritis

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6
Q

Hypertrophic joint diseases

A

Means more bone growth

  • osteoarthritis
  • Detritus arthritis (post-traumatic arthritis and Charcot)
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7
Q

Atrophic joint diseases

A

means loss of bone growth… Primarily by erosion

  • inflammatory arthritities
  • forefoot charcot
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8
Q

Osteophyte formation found in:

A

osteoarthritis

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9
Q

Definition of erosion, and different presentations

A
  • bare areas

- pannus, dot-dash and skipping

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10
Q

Bone erosion a primary feature in what?

A

Bone erosion is a primary feature of all joint disorders except OA, Charcot and Septic arthritis

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11
Q

Subchondral resorption is a primary finding in what?

A

Charcot and septic arthritis

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12
Q

Arthritis mutilans definition and where is it found

A

Definition: erosions that involve both margins of any MPJ, or interphalangeal joint

-psoriatic, RA and Charcot

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13
Q

Predominant feature of hypertrophic joint disease

A

bone production

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14
Q

Characteristic radiographic findings of OA

A

-osteophytosis and subchondral sclerosis (eburnation)

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15
Q

Periostosis is found in what ?

A

inflammatory processes

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16
Q

What are the characteristic radiographic findings of seronegative arthritis

A
  • periostitis
  • whiskering
  • cortical and trabecular thickening
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17
Q

Type of joint space seen in OA:

A

assymmetrical joint space narrowing

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18
Q

Type of joint space seen in RA

A

symmetrical narrowing

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19
Q

type of joint space seen in psoriatic

A

widening

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20
Q

Type of joint space seen in gout

A

normal joint space

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21
Q

Underlying biochemistry changes seen in Gout

A
  • Calcifications
  • Martel’s sign
  • increased monosodium rate crystals that precipitate and are found periarticular next to erosions
  • negatively birefringent crystals
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22
Q

Underlying biochemistry changes seen in pseudogout

A
  • calcium pyrophosphate deposition disease
  • chondrocalcinosis
  • cartilage will calcify
  • – joint surfaces will have parallel calcifications
  • —hyaline cartilage calcifies
  • Will see positively birefringent rhomboids
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23
Q

Underlying biochemistry changes seen in hydroxyapatite crystal deposition disease

A

Will find extra-articular calcification that will be within joint capsule or found within a tendon or bursae

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24
Q

Osteoarthritis: target joint

A

First MPJ

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25
Q

Rheumatoid arthritis: target joints

A

-less MPJ’s and hallux IPJ

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26
Q

Psoriatic arthritis: target joints

A

Lesser MPJ’s and IPJ’s (really varies )

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27
Q

Gouty arthritis: target joints

A

first MPJ

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28
Q

Neuropathic arthropathy: target joints

A

Tarsometatarsal joints

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29
Q

Osteoarthritis: bone production

A

Osteophyte and subchondral sclerosis

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30
Q

Rheumatoid arthritis: bone production

A

NONE

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31
Q

Psoariatic arthritis: bone production

A

occasionally

  • periostitis
  • whiskering
  • Ivory phalanx
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32
Q

Gouty arthritis: bone production

A

overhanging edge

—–Martel’s sign

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33
Q

Neuropathic arthropathy: bone production

A

Diffuse sclerosis

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34
Q

Osteoarthritis : erosions

A

NONE

—some of the subchondral bone cyst may mimic erosion

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35
Q

Rheumatoid arthritis: erosions

A

medial aspects

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36
Q

Psoriatic arthritis: erosions

A

Medial/lateral/central

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37
Q

Gouty arthritis: erosions

A

medial (more common)

-can also have lateral margins

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38
Q

Neuropathic arthropathy: erosions

A

subchondral resorption

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39
Q

Osteoarthritis: joint spacing

A

Nonuniform narrowing

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40
Q

Rheumatoid arthritis: joint spacing

A

uniform narrowing

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41
Q

psoriatic arthritis: joint spacing

A

widening (relative)

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42
Q

Gouty arthritis: joint spacing

A

normal

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43
Q

neuropathic arthropathy: joint spacing

A

Narrowing or relative widening

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44
Q

Osteoarthritis:soft tissue swelling

A

NONE

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45
Q

rheumatoid arthritis: soft tissue swelling

A

not significant

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46
Q

Psoriatic arthritis: soft tissue swelling

A

diffuse: sausage toe

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47
Q

Gouty arthritis: Soft tissue swelling

A

Lumpy-bumpy

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48
Q

Neuropathic arthropathy: soft tissue swelling

A

diffuse

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49
Q

Osteoarthitis: soft tissue calcification/ossification

A

Losse osseous body (joint mouse)

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50
Q

Rheumatoid: soft tissue calcification/Ossification

A

NONE

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51
Q

Psoriatic arthritis: soft tissue calcification/ ossification

A

None

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52
Q

Gouty arthriti: soft tissue calcification/ ossification

A

small, punctate calcifications

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53
Q

Neuropathyic arthropathy : soft tissue calcification/ ossification

A

fragmentation of bon

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54
Q

Osteoarthritis: positional deformity

A

associated with hallux abductovalgus

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55
Q

Rheumatoid arthritis: positional deformity

A

deviation of toes laterally; subluxation

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56
Q

Psoriatic arthritis: positional deformity

A

nothing specific

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57
Q

Gouty arthritis: positional deformity

A

NO

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58
Q

Neuropathic arthropathy: positional deformity

A

subluxation/dislocation

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59
Q

Osteoarthritis: bilateral symmetry

A

no

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60
Q

Rheumatoid arthritis: bilateral symmetry

A

YES

61
Q

Psoriatic arthritis: bilateral symmetry

A

NO

62
Q

Gouty arthritis: bilateral symmetry

A

NO

63
Q

Neuropathic arthropathy: bilateral symmetry

A

NO

64
Q

RA: will it exhibit juxta-articular osteopenia

A

yes

65
Q

psoriatic arthritis: will it exhibit juxta-articular osteopenia

A

NO

66
Q

Define osteopenia

A

Non specific radiographic finding of decreaed bone density

67
Q

Define osteoporosis

A

metabolic disease where amount of bone present per unit volume is reduced but composition is normal

68
Q

Define osteomalacia

A

metabolic disease of increased amount of uncalcified osteoid found on histology

69
Q

X-ray findings of chronic osteopenia (3)

A
  • cortical thinning by endosteal/subperiosteal resorption
  • increased primary trabeculations
  • intracortical tunneling
70
Q

X-ray findings for acute osteopenia

A

spotty or regional osteoporotic from disuse

71
Q

X-ray findings for general osteoporosis (3)

A
  • prominent primary trabeculations
  • cortical thinning
  • cortical tunneling
72
Q

X-ray findings for osteomalacia (5)

A
  • Bowing deformity of long tubular bones
  • Transverse incomplete radiolucency (milkman fracture)
  • bordered by sclerosis on the compressive side/medial side/inner side of bone
  • Widening of the physis (paint brush appearance)
  • Cupping and widening of the metaphysis
73
Q

Etiology of hypophosphatasia

A

reduced levels of alkaline phosphatase in serum, bone and other tissues due to mutations in tissue non-specific

74
Q

X-ray findings of hypophosphatasia (4)

A
  • bowing and shortening of long tubular bones
  • Osteochondral spurring
  • Chondrocalcinosis aricularis
  • losser zone (outer cortex/ tension side)
75
Q

Hyperparathyroid etiology

A

increased levels of parathyroid hormone= increased osteoclastic activity= removal of calcium from bone which then enters the blood

76
Q

Hyperparathyroid: 3 forms

A

1) Primary- due to tumor which results in hypercalcemia and vitamin D deficiency…. assciated with hyperuricemia and overt gout
3) tertiary- hyperplasia of parathyroid glands and a loss of response to serum calcium levels. Occurs in chronic renal failure

77
Q

Hyperparathyroid readiographic findings (4)

A
  • subperiosteal resorption
  • Other sites of bone resorption (periarticular, intracortical, endosteal, subchondral and entheseal)
  • Acral Osteolysis
  • Radiolucent lesions: hot spots-brown tumors
78
Q

Hypoparathyroidism- what do you see in the digits

A

brachymetaphalangea

79
Q

Renal osteodystrophy etiology

A
  • seen in chronic renal failure

- Chronic kidney disease= hyperphosphatemia= increase in PTH= osteoclastic activity

80
Q

Renal osteodystrophy: X-ray findings

A

calcifications of soft tissue and vessels

81
Q

Etiology of Rickets

A

vitamin D deficiency or hypophosphatemia during open growth plate stages

82
Q

Etiology of Scurvy

A

deficiency of Vitamin C

83
Q

X-ray findings of Rickets (5)

A
  • osteopenia
  • bowing deformity of long tubular bones
  • widening of the physis
  • decreased density at the zone of provisional calcification (fraying/paint brush appearance)
  • widening/cupping of the metaphysis
84
Q

X-ray findings of scurvy

-in the metaphysis (4)

A
  • White line of scurvy: increased density bordering the growth plate (sclerotic)
  • transverse line of decreased density adjacent to the line of increased density on its metaphyseal side
  • Scurvy line: radiolucent
  • Radiolucency at margins of metaphysis or epiphysis
85
Q

X-ray findings of scurvy

-in the epiphysis

A

-outer shell of increased density surrounding a central lucency dye to atrophy of central spongiasa, sclerotic ring around epiphysis

86
Q

X-ray findings of scurvy

-periosteal

A
  • bleeding found under the periosteum that may elevate along the long axis of the bone
87
Q

Identify the type of osteoporosis/osteopenia seen in a patient who is immobilized in a cast for 8 weeks.

A
  • Regional osteoporosis with spotty osteopenia
  • multiple radiolucent spots.
  • Transverse bands of decreased desnity and subperiosteal resorption
88
Q

Define and describe the etiology in acromegaly

A
  • There is an increased GH and IGF-1 production.
  • this results in increased osteoblast proliferation.
  • There is an initial increased bone formation followed by an increased bone resorption
89
Q

X-ray findings in acromegaly

A
  • high levels of osteoporosis.
  • Increased bone turnover and appendicular cortical bone mass
  • Heel pad thickness increased >25mm
  • Joint space is widened due to cartilage thickening
  • bone is more prominent, met heads and distal phalanx ungal tuberosities are enlarged
  • met shafts are thickened
  • spurring at entheses
90
Q

Osteogenesis imperfecta aka brittle bone disease: etiology

A
  • abnormal metaphyseal and periosteal ossification caused by deficient osteoid production
  • abnormal maturation of collagen in mineralized and nonmineralized tisseus
91
Q

X-ray findings in osteogenesis imperfecta (3)

A
  • Diffuse osteopenia, diminished bone girth, flared metaphyses
  • Complication: fractures
  • Bottom of metaphyses flares out (Erlenmeyer flask deformity)
92
Q

Describe the X-ray changes of Paget’s disease (osteitis deformans)

A
  • Excessive and abnormal remodeling of bone
  • Tibia has anterior bowing (sabre-shin deformity)
  • Flame lesions (radiolucent)
  • Blades of grass
93
Q

Diseases that present with generalized sclerosis (5)

A
  • osteopetrosis
  • melorheostosis
  • osteopoikilosis
  • osteopathia striata
  • pyknodysostosis
94
Q

X-ray findings with osteopetrosis (2)

A

bone in bone

-erlenmeyer flask

95
Q

X-ray findings in melorheostosis (2)

A

candle wax

hyperostosis

96
Q

X-ray findings in osteopoikilosis

A

multiple bone islands

97
Q

X-ray findings osteopathia striata

A

striations parallel to the long axis

98
Q

X-ray findings for pyknodyostosis (3)

A
  • acral osteolysis
  • narrowing of medullary canal
  • sclerosis
99
Q

What x-ray finding is found with fluorosis

A

generalized sclerosis

100
Q

What x-ray finding is found with hypervitaminosis D

A

generalized sclerosis

101
Q

What is metastatic calcification and provide examples of it (2)

A
  • Results from disturbances in calcium or phosphorus metabolism
  • occurs in hyperparathyroidism and renal osteodystrophy
102
Q

What is generalized calcinosis and provide example of it (1)

A
  • Presents as calcium deposition in the skin or subq in the presence of normal calcium metabolism.
  • tumoral calcinosis is an example
103
Q

What is Dystrophic calcification and provide examples (2)

A
  • calcium is deposited in damaged or devitalized tissue in the absence of abnormal calcium metabolism
  • tumors or trauma are n exmple
104
Q

What is Myositis ossificans circumscripta

A

develops in sites of trauma

attaches to cortex of bone and radiographically it looks like a form of osteogenic sarcoma

105
Q

Histologically what is the difference between myositis ossificans circumscripta and osteogenic sarcoma

A
  • Myositis ossificans circumscripta has bone formation beginning in the periphery
  • Sarcoma bone production appears in the center of tumor
106
Q

Dexa: what does it tell you?

A

Dexa is the gold standard for measuring bone mineral density.

  • does so through T-score measurements
107
Q

VFA and IVA what does it tell you

A

Will tell you if there is an old fracture of the vertebra.

A positive finding on VFA and IFA will trump the results of a DXA scan

108
Q

Specifics about T scores

Definition

Units

Ranges

A

Definition: your bone density compared with what is normally expected in a healthy adult of your sex.

Measured in units of standard deviations that your bone density is above or below the average

Range:
-1 and above: bone density is considered normal

–1: -2.5: sign of osteopenia, a condition in which bone density is below normal and may lead to osteoporosis

–2.5 and below: bone density indicates osteoporosis

109
Q

What age range are T-scores useful in?

A

Postmenopausal women and men over 50

110
Q

Z- scores

Definition and range

A

Number of standard deviations above or below what’s normally expected for someone of your age, sex, weight, and ethnic or racial origin

  • If Z-score is -2 or lower, it may suggest that something other than aging is causing abnormal bone loss.
111
Q

What age range is z-score useful in

A

Z-scores are useful in premenopausal women and men under age of 50

112
Q

FRAX score: when should you consider treatment

A

Patient should receive treatment:
If low bone mass… T-score between -1 and -2.5 at the femoral neck or spine.

  • 10-year probability of a hip fracture at >3%
  • 10 year probability of a major osteoporosis related fracture >20%
113
Q

What are the factors that go into calculating FRAX score

A
  • Age
  • Height
  • Weight
  • BMD- femoral neck and spine
  • Smoking
  • Alcohol
  • Glucocorticoid
  • RA
  • Spine fracture
  • Family history
  • Gender
  • Ethnicity
114
Q

How much bone loss occurs with every change in SD of the T-score

A

For every 1 standard deviation away from normal bone, patient will have 10% less bone density

115
Q

Non-pharmaceutical types of therapy that should be used to treat osteoporosis (2)

A
  • Behavioral changes (smoking, alcohol consumption and diet changes)
  • exercise: weight training
116
Q

OTC drugs that should be used to treat osteoporosis

A

Calcium: 1000-1200mgs daily

Vitamin D:800-1000 International units daily

117
Q

Bisphosphonates

  • MOA
  • Biggest side effect to look out for

How to prevent against side effects

A

MOA- inhibits bone reabsorption.

Side effect: can cause a typical femur fracture and osteonecrosis of the jaw with long term use

Also watch out for GI symptoms such as GERD.

Take the medications in the morning before food with a glass of water and upright for 30 minutes.

Avoid in people with chronic kidney disease

Take a drug holiday!!!

118
Q

What are the 4 big bisphosphonates and administration

A
  • Alendronate (Fosamax): oral
  • Risedronate (Actonel, Atelvia): oral
  • Ibandronate (Boniva): oral
  • Zolendronic acid (Reclast): IV
119
Q

Hormonal therapy that can be used in patients with osteoporosis

A

Estrogen can be used in postmenopausal women.

However there is an increased risk of breast, ovarian, and uterine cancers.

120
Q

Raloxifene (Evista) MOA and are there risks to consider?

A

Evista mimics estrogen’s beneficial effects on bone density in postmenopausal women.

  • Is not associated with the cancer risks that are seen in regular estrogen.
121
Q

Denosumab (Prolia)

  • MOA
  • Comparison to bisphosphonates
  • Administration
A

Inhibits bone resorption by neutralizing RANKL

  • compared with bisphosphonates denosumab produces similar or better bone density results and reduces the chance of all types of fractures
  • Delivered via a shot under the skin every 6 months
122
Q

Teriparatide (Forteo)

  • MOA
  • Comparison with parathyroid
  • Administration and length of time
A

Builds bone

  • powerful drug similar to parathyroid hormone and stimulates new bone growth.
  • Given by daily injections under the skin, and after 2 years of treatment with teriparatide another osteoporosis drug is taken to maintain new bone growth.
123
Q

Wilson-Katz classification used for?

A

Stress fractures

124
Q

Wilson-Katz type I

A

WIll see a radiolucent fracture line.

No evidence of endosteal callus or periosteal reaction.

_ similar to a jones fracture presentation

125
Q

Wilson-Katz type II

A

Will see a focal sclerotic line and endosteal callus

  • will only occur in cancellous bone
  • Will see white line everywhere but shaft
126
Q

Wilson-Katz type III

A

Periosteal reaction and external callus seen.

  • Will visualize a callus lump here
  • Mainly seen on shaft and subjected to more movement and irritate periosteum
127
Q

Wilson-Katz type IV

A

combination of all types: I,II,III.

-May see dreaded black line. Inability to heal

128
Q

AP X-ray signs of a Lisfranc injury

A

Lateral step-off at the second tarsometatarsal joint is accepted as the most common and reliably detected abnormality seen in Lisfranc injuries with diastasis of 2 mm or more indicating instability

129
Q

Lateral X-ray signs of a Lisfranc injury

A

there should be no step-off at the dorsal margins of the tarsometatarsal joints

-Plantar surface of the medial cuneiform should project dorsal to the plantar aspect of M5

130
Q

Oblique X-ray signs of a Lisfranc injury

A

the lateral margins of C2-M2 and C3-M3 should align

131
Q

Hardcastle classification for Lisfranc injury (5)

A

Type A: Total incongruity, with mets 1-5 medially or laterally displaced

Type B1: Partial incongruity with Medial dislocation of the 1st Met cuneifrom, and no displacement of the rest of the forefoot

Type B2: Partial incongruity, but lateral dislocation of the all mets 2-5 or some of them.

Type C1: divergent
Partial displacement with 1st travelling medial and some of 2-5 travelling lateral

Type C2: Total displacement with 1st going medially and all 2-5 going laterally

132
Q

Nunley classification for Lisfranc injury (3)

A

Stage 1: sprain- looks normal on x-ray with <2mm of displacement and arch height remains unchanged. SURGERY

Stage 2: 2-5mm diastasis on AP x-ray between first and second and arch height remains unchanged. SURGERY

Stage 3: 2-5mm of displacement loss of arch height and SURGERY

133
Q

Tc99 carrier molecule and sites of uptake

A

-Methylene diphosphate. taken up by hydroxyapetite crystal laid down by osteoblast

134
Q

Ceretec/ Tc99 HMPAO carrier molecule and sites of uptake

A

carrier molecule is WBC and will lay down at acute osteomyelitis

135
Q

Te99 Sulfur colloid carrier molecule and sites of uptake

A

taken up by macrophage, reticular endothelial cells in bone marrow.

136
Q

Indium 111 uptake

A

acute inflammation (acute charcot and acute cellulitis)

137
Q

What Disease processes result in acryl osteolysis (4)

A
  • psoriatic arthritis
  • Hyperparathyroidism
  • Pyknodysostosis
  • Pulmonary hypertrophic osteoarthropathy
138
Q

What disease processes result in Erlenmeyer Flask deformity (3)

A
  • osteopetrosis
  • Thalassemia
  • osteogenesis imperfecta
139
Q

What disease processes result in dachtylitis (3)

A
  • psoriatic arthritis
  • sickle cell anemia
  • Pulmonary hypertrophic osteoarthropathy
140
Q

Arendt Grade I Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

A

X-ray will be normal findings

Bone scan will have poorly defined area of increased activity

MRI will have positive results on STIR

To treat: 3 week rest

141
Q

Arendt Grade II Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

A

X- ray: Normal findings

Bone scan: More intense but still poorly defined

MRI: will have positive STIR and T-2 weighted images

To treat will do 3-6 weeks resting

142
Q

Arendt Grade III Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

A

X-ray will show discrete line with discrete periosteal reaction

Bone scan: sharply marginated area of increased activity

MRI: positive T1 and T2 weighted images but without definite cortical break

To treat: 12-16 weeks of rest

143
Q

Arendt Grade IV Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

A

X-ray: fracture or periosteal reaction

Bone scan: more intense transcortical localized uptake

MRI: postive T1 and T2 weighted images of the fracture line

Treatment: >16 weeks rest

144
Q

Saxena Type 1

How to treat

A

CT shows a fracture line through the dorsum of the navicular

TX: NWB 6 weeks followed by gradual weightbearing in a boot for 2-6 weeks.

145
Q

Saxena Type 2

How to treat

A

CT shows a fracture line from the dorsum of the navicular into the body

TX: ORIF

146
Q

Saxena Type 3

How to treat

A

CT shows a fracture line through both cortices of the navicular (dorsal and plantar)

TX: ORIF

147
Q

Saxena type .5

A

Stress reaction, MRI will show a reaction

148
Q

Torg recommended what treatment plan for Navicular stress fracture

A

NWB cast for 6-8 weeks followed by gradual weightbearing in a boot for 2-6 weeks

149
Q
  • Length of time till bone stress reaction on MRI for stress fracture
  • Length of time until fracture line is seen on a stress fracture
A
  • 5-6 weeks

- 6-weeks

EBM (1 decks)

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