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Skel Rad A > Mid Term - Second Half of Notes > Flashcards

Mid Term - Second Half of Notes Flashcards

1
Q

Which tubular bone has 3 epiphyses?

A

Humerus

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2
Q

which tubular bone has two apophyses?

A

Femur

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3
Q

4 functions of periosteum

A
  1. attaches to cortex via shapeys fibers
  2. maintains caliber of bone by appositional bone growth
  3. provides a transitional zone for attachments
  4. serves as a source of vascualr perfusion outer third of cortex.
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4
Q

3 different systems for blood supply in bone?

A
  1. nutrient artery (70%)
  2. Epiphyseal - metaphyseal arteries (30%)
  3. periosteal arteries
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5
Q

Bone venous drainage (3)

A
  1. emissary veins
  2. cortical venous channels
  3. periosteal capillaries
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6
Q

Bone island - one lesion aka?

A

osetopoikolosis

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7
Q

bone island - many small lesions?

A

osteopoikolosis

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8
Q

Cancerous malignant bone tumor

A

osteosarcoma

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9
Q

Lucent, Geographic, moth-eaten, permeative = ?

A

Osteolytic

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10
Q

Brodies Abscess

A
  1. related to infection

2. creates hole in bone

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11
Q

Mixed?

A

Psoriatic arthritis

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12
Q

Periosteal Rx - Local

A

Fx’s , Infections , tumors

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13
Q

Periosteal Tx - Diffuse

A

Hypervitaminosis A, normal periosteal new bone in child, battered child syndrome.
HPT - hyperparathyroidism - classic ex.

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14
Q

Laminated

A

Ewings Sarcoma

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15
Q

Spiculated

A

Osteosarcoma

1. aggressive

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16
Q

Geographic

A

giant cell tumor, simple bone cyst

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17
Q

moth-eaten

A

Metastatic disease

Multiple myeloma

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18
Q

permeative

A

metastatic disease

multiple myeloma

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19
Q

Probable indicators for taking xray

A
  1. night pain

2. explainable weight loss

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20
Q

NON-indicators for taking an x-ray (why not to)

A
  1. pregnant
  2. no clinical indication
  3. pre-employment
  4. patient education
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21
Q

who discovered x-rays?

When?

A

Wilhelm Conrad Roentgen

1895

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22
Q

first nobel prize for x-ray date?

A

1901

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23
Q

5 radiographic densities

A
  1. air
  2. water
  3. fat
  4. bone
  5. metal
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24
Q

Downfall of plain film?

A

limited diagnostic sensitivity

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25
Q

% of bone loss needed on film to see on xray with naked eye?

A

30-50%

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26
Q

Advantages of plain film?

A
  1. readily available
  2. relatively inexpensive
  3. non invasive
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27
Q

Disadvantages of plain film?

A
  1. lack of soft tissue discrimination

2. decreased sensitivity

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28
Q

Which imaging is “old school” and we don’t use any more?

A

Tomography

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29
Q

Disadvantage of tomography?

A
  1. high dose radiation because
    a. creates more radiation
    b. long exposure time
    c. possible time for patient to move
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30
Q

Arthrography - contrast examination

A
  1. water soluble contrast
  2. most common joint = knee
  3. now - MRI
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31
Q

Arthrography advantage?

A

readily available

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32
Q

arthrography disadvangtage?

A
  1. invasive
  2. operator and interperter dependent
  3. only see structural surface3
  4. may miss small lesions
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33
Q

Myelography is an exam of?

A

spine and spinal cord

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34
Q

myelography needs?

A

injections of contrast into the subarachnoid space, most common at L2/3

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35
Q

Advantages of myelography ?

A
  1. good for diagnosing
    a. spinal stenosis
    b. nerve root disease
    c. disc disease
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36
Q

Disadvantages of Myelography?

A
  1. risk of infection
  2. iatrogenic complications (nerve root damage)
  3. headaches
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37
Q

Discography

Media? INto?

A

Water soluble contrast media

into IVD- under fluoroscopic control

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38
Q

what 4 aspects of disc are assessed with discography?

A
  1. volume of contrast injected
  2. pain response
  3. pattern of contrast distribution
  4. amount of resistance to injection
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39
Q

Advantages of discography?

A

Morphological analysis of disc

Function aspect of pain provocation

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40
Q

Disadvantages of discography?

A
  1. increased radiation
  2. invasive procedure
    a. risk of infection
    b. nerve damage
    c. exacerbation of pain
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41
Q

Radionuclide imaging

A

Bone Scan

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42
Q

radioactive isotope ?

A

technetium 90 - highlights metabolically active areas in the bone

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43
Q

half life of TQ 99?

A

6 hours

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44
Q

TQ excreted by?

A

kidneys

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45
Q

isotope collects in ______. may or may not light up depending on the ____ of the patient

A

“hot spots”

Age

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46
Q

Common Hot spots

A 
Metaphysis of long bone
bladder
thyroid
kidneys
sternum
spine
costochondral junctions
SI joints
at site of injection
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47
Q

Bone scan detects?

A

Skeletal metastasis
tumors
infection
arthritis

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48
Q

AVN = ?

A

Avascular Necrosis

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49
Q

advantages of bone scan?

A

only need 3-5% bone destruction to see on scan

10x more sensitive than plain film

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50
Q

disadvantages of bone scan?

A

scan of activity can by many ddx

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51
Q

bone scan is _______ but not _____

A

sensitive, specific

52
Q

Ultrasound - most common?

A

MC

53
Q

ultrasound used to diagnose abnormalities/masses in the ?

A
  1. abdomen
  2. pelvis
  3. vasculature (abdominal aorta/carotid if calcified?
54
Q

ultrasound advantages?

A
  1. non invasive
  2. no ionizing radiation
  3. can visualize soft tissues adjacent to articulation
55
Q

disadvantages of ultrasound?

A
  1. can’t see medullary cavity of bone

2. operator independent

56
Q

CT =?

A

Computed Tomography

57
Q

CT invented by whom? when?

A

Godfrey Hounsfield, london in 1972

58
Q

CT equipment?

A

X-ray source, radiation detector, and electronic devices mounted on a gantry

59
Q

CT image =

A

thin slice of anatomy, only AXIAL plane

60
Q

Two types of windows for CT scan?

A

Bone window and Soft tissue window

61
Q

Bone will always be _____ on CT scan?

A

white

62
Q

Gantry?

A

housing for all equipment for CT

63
Q

CT can evaluate?

A
  1. neoplasms
  2. metabolic diseases
  3. trauma *
  4. infections
  5. spinal syndromes
  6. chest lesions** gold standard
64
Q

advantages of CT

A

great view of bony and soft tissue anatomy

65
Q

disadvantages of CT

A 
motion artifacts
large patient - degraded image
radiation dose may be high 
longer scanning time
able to detect soft tissue difference
66
Q

Spatial resolution

A

the sharpness of an image at its interface

67
Q

contrast resolution

A

the ability to distinguish one soft tissue from another

68
Q

attenuation

A

the specific absorbed energy of an x-ray beam AFTER it passes through a given tissue

69
Q

Hounsfield Unit (HU) - goes with what scan?

A

unit of radiographic density in CT

70
Q

HU of air?

A

-1000

71
Q

HU of water?

A

0

72
Q

HU of bone?

A

+ 1000

73
Q

HU of muscle?

A

50

74
Q

HU of white matter?

A

45

75
Q

HU of blood

A

20

76
Q

HU of CSF

A

15

77
Q

HU of fat?

A

-100

78
Q

Bone window shows differences between?

A

medullary and cortical bone

79
Q

bone window, soft tissue densities appear?

A

dark grey

80
Q

Soft tissue window cant differentiate?

A

cortical and medullary bone

81
Q

Soft tissue window: bone appears but you can differentiate _____/______ as bight white?

A

cortical/medullary

82
Q

to image DENSE TISSUE what level HU is used?

A

+1000

83
Q

Indications for a spinal CT?

A
  1. trauma to the spine***
  2. osseous spinal stenosis
  3. lumbar disc herniations
  4. patient with implantable device (pacemaker) that cant have MRI
84
Q

Contradictions to CT

A

Metallic artifacts near area of interest

claustrophobia

85
Q

Reading a CT image

A

Axial slices
looking as if your looking at patients feet
slides are backwards - your right = patients left

86
Q

Gives you an idea of what your looking at so you know what level your at?

A

Scout views

87
Q

What modality uses Tchnetium 99?

A

Bone scan

88
Q

Two modalities that use radiatioN?

A

X-ray and fluoroscopy

89
Q

First MRI?

A

1977

90
Q

MRI uses?

A

magnets

91
Q

MRI magnetic strength measured in ???

A

Tesla - T

92
Q

MRI image production involves?

A

hydrogen protons + external magnetic field

93
Q

Hydrogen atoms used b/c?

A
  1. abundant in living tissue
  2. paramagnetic properties (spin with dipole)
  3. odd number of protons
94
Q

TR - repetition time?

A

the time interval between the two 99 degree pulses

95
Q

TE = echo time

A

the time between the pulse and detection of the MR signal

96
Q

T1 looks for?

A

fat (will be bright white)

97
Q

Long TR and long TE =? and looks for?

A

T2, Water (will be bright)

98
Q

Long TR and Short TE =?

A

all tissues - shows where anatomy is

99
Q

Which sequence would be produced with a long TR and a long TE?

A

T2

100
Q

Advantages of MRI

A
  1. excellent soft tissue contrast
  2. early detection
  3. dosent use radiation
101
Q

disadvantages of MRI

A
  1. claustrophobia
  2. metal in body prohibited
  3. expensive
102
Q

Most common metabolic disease of bone?

A

osteoporosis

103
Q

osteoporosis

A

increased porosity of bone

104
Q

osteoporosis spares ______ oriented stress traveculae

A

vertically

105
Q

Osteoporosis - pseudo -__________ appearance

A

pseudo- hemangiomatous (vertical is defined)

106
Q

Osteoporosis. Decrease in bone ______ but the ______ is normal.

A

quantity,

quality

107
Q

type of osteoporosis discussed in class

A

generalized

108
Q

GO (General osteoporosis) most commonly due to?

A
  1. postmenopausal women
  2. age
  3. secondary to hormone, Ca+ intake, activity level and diet
109
Q

GO decreased bone density in whole skeleton, especially >

A

vertebral bodies, pelvis, proximal long bones

110
Q

bone loss begins at_____ age?

A

35

111
Q

Bone loss begins because of?

A

decrease in hormones and stimulated esteoclastic activity

112
Q

conditions associated with GO?

A 
1. malignant bone disease
2, .senile an/or postmenopausal ***** most common 
3. acromegaly 
4. alcoholism 
5. hemolytic anemia
6. Heparin therapy 
7. hyperparathyroidism 
8. Steroids
113
Q

cortical bone loss per year?

A

1%

114
Q

trabecular bone loss per year?

A

2%

115
Q

by age 65, % of bone loss?

A

20-40%

116
Q

at menopause, bone loss increases by _____ fold

A

10

117
Q

Reduction in skeletal mass:

females: decade? before 80, after 80?
males: decade?

A 
F = 5-6th decade, 4:1, 1:1
M = 6-7th decade
118
Q

GO complications

A

FX’s - spinal compression
Most undiagnosed
anterior vertebral wedging
increased thoracic kyphosis

119
Q

radiological features of GO?

A 
increase in radiolucency 
a. osteopenia
b. 30-50% bone loss 
Cortical thinning 
a. altered trabecular patterns (vertical striations)
120
Q

Spine radiological features of GO

A
  1. curve changes
  2. decreased bone density
  3. cortical thinning
  4. changes in vertebral shapes
  5. wedged vertebra
  6. biconcave deformity
121
Q

Pelvis and femora radiological features of GO

A
  1. ostopenia
  2. trabecular changes
  3. Fx’s - pubic rami and proximal femur
  4. DJD
122
Q

Trabecular changes

A

evaluate the trabecular pattern of the proximal femur for severity

123
Q

what consists of 3 groups of trabeculae

A

Ward’s triangle

124
Q

Confluence of 3 patterns =

A

triangle radioluency

125
Q

As the osteoporosis increases in severity, wards triangle gets ______ and more _____

A

bigger, obvious

126
Q

3 Trabecular patterns of wards triangle

A
  1. principle compressive group
  2. secondary compressive group
  3. principal tensile group

Skel Rad A (1 decks)

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