Midterm Flashcards
How many bones in the appendicular skeleton? Axial skeleton?
Appendicular = 126 Axial = 80
Last bone to ossify?
Clavicle
Name the 3
Ectoderm
Mesoderm
Endoderm
T or F
Bone is derived from Ectoderm
False
Mesoderm
Where is the primary centre of ossification on a long bone?
Diaphysis
Name the site of secondary ossification on a long bone
Epiphysis
Name the 3 parts of a long bone
Epiphysis
Metaphysis
Diaphysis
What is the strongest thickest part of a long bone?
Diaphysis
What are the 2 types of bone formation processes?
Intramembranous
Endochondral
What type of bone formation do Flat bones fall under?
Intramembranous
Name the bones ossified in a membrane
Parietal Temporal Upper occipital Frontal ....
T or F
Primary ossification of long bones helps widen the bone
False
Lengthen
T or F
Secondary ossification occurs within epiphysis and apophyses
True
Endochondral ossification is associated with what bones?
Tubular bones
Vertebrae
Ethmoids
Inferior conchae
What is an apophysis?
A protuberance
Functions as the attachment site for ligaments & tendons
What is known as the site of attachment of tendons and ligaments, is highly vascularized with high metabolic activity?
Enthesis
T or F
Periosteum is visible on films
False!
You don’t see it unless it gets irritated from infection or malignancy
List the 4 functions of the periosteum
- Attaches the cortex via outer fibrous extensions called Sharpey’s Fibers
- Maintains caliber of bone by appositional bone growth
- Provides a transitional zone of attachment for muscles, ligaments, and tendons
- Serves as a source of vascular profusion for the outer third of the cortex.
Aka’s for Physis
Physeal plate
Growth plate
T or F
The blood supply to the metaphysics and distal end of a bone in a child is continuous
False
This is describing and adult.
In children vascular supply DOES NOT cross growth plate.
In an infant do any of the metaphyseal blood vessels penetrate the cartilaginous growth plate to supply the epiphysis?
Yes
name the zones of the of the growth plate from the epiphysis to the metaphysics
- Resting Zone
- Zone of Proliferation
- Zone of Hypertrophy
- Zone of Degeneration
T or F
If the resting zone is injured growth will stop
True
What zone attaches the growth plate to the epiphysis
Resting Zone
What zone is where bone lengthens due to active growth of chondrocyte?
Zone of Proliferation
What is the weakest portion of the growth plate?
Zone of hypertrophy
In what zone will Salter-Harris fractures occur?
Zone of hypertrophy
What is a function of the zone of degeneration?
Attaches growth plate to metaphysis
T or F
Cancellous bone makes up 80% of total bone mass
False
Compact!
On what bone is the coracoid process found?
Scapula
Where is the conoid process found?
Clavicle
What bone is the coronoid process on?
Ulna
Name the categories used to classify bone diseases
Congenital Arthritis Trauma Blood (hematological) Infection Tumor Endocrine, nutritional, metabolic Soft tissue
Name the 3 categories of Behaviour of Lesions
- Osteolytic
- Osteoblastic
- Mixed Lesion
What colour on a film will Osteolytic lesions appear? Osteoblastic
lytic = black colour blastic = bright white
We can further classify Osteolytic Lesions into what 3 categories?
Geographic
Motheathen
Permeative
Permeative lesions will appear how on films?
Very tiny pin holes. They appear as the tinniest of holes compared to Motheaten and Geographic
T or F
Geographic lesions are malignant
False
What type of lesions can be classified as both benign and malignant?
Motheaten
Is a geographic lesion fast or slow growing?
Slow
T or F
Geographic lesions typically have ill defined borders
False
Sharp well defined borders
T or F
Geographic lesions have a narrow zone of transition
True
Describe the borders of a moth-eaten lytic lesion
Ragged borders
2-5 mm
punched out lesions = ?
Multiple Myeloma
T or F
Permeative lytic lesions have a narrow zone of transition
False
Wide!!
Osteoblastic aka _________
Osteogenic
eccentric means?
off centre
T or F
Sharp margins = malignancy
False
Benign
Poorly defined or long zone of transition will generally signify malignancy or benign?
Malignancy
What is the most frequent imaging modality to evaluate skeletal system? Why
Plain Film Radiography
-Cheap and available
What % of bone loss needs to happen in order to see it on a plain film?
30-50%
How big does a lesion need to be to see it on a plain radiograph?
1-%cm
T or F
Plain film radiographs are specific and sensitive
False
Specific but insensitive
Advantages of Plain Film Radiography?
Readily available
Relatively inexpensive
Non-invasive
Disadvantages of Plain Film Radiography?
Lack of soft tissue discrimination
Decreased sensitivity in detecting osseous lesion
Technical artifacts
Ionizing radiation
What does DEXA stand for?
Dual Energy E-ray Absorptiometry
Why is a DEXA used?
To evaluate bone density
What is a T-Score in regards to DEXA scans?
The patients age vs. avg 30 yo
What is a Z-score
The patients score vs. avg female the same age
T or F
In Dexa scans….
> -1 = osteopenia
False
This is normal
What score would classify a patient as osteopenia with a DEXA
-1 to -2.5
What is a contrast study?
This is when injectable dye is inserted into the blood
What the disadvantages of Contrast Examinations
Invasive
Operator and interpreter dependent
Only see structural surface
May miss small lesions
What is Myelography
Exam of spine and spinal cord with an injection of contrast into the subarachnoid space.
What pathologies can be dx with Myelography?
Spinal Stenosis
Nerve Root Disease
Disc Disease
Disadvantages of Myelography?
Risk of infection
Nerve root damage and dural tears
Headaches
What does a bone scan look for?
Increased metabolic activity - infection or tumour
T or F
Bone scans are very sensitive and not very specific
True
Dark spots on a bone scan are called?
Hot Spots
T or F
For a CT scan and bone is white.
True
In regards to an MRI T1 is used to see fat or water?
Fat
What MRI is used to see fluid?
T2
In a T1 MRI do the disks look black or do they look white?
Black
What does osteopenia mean?
Osteopenia is a term used to describe general radiolucent bone. Osteopenia is loss of bone density.
Name the three types of osteoporosis.
- Generalized
- Regionalized
- Localized
List some conditions associated with generalized osteoporosis.
Malignant bone disease, senile and postmenopausal, acromegaly, alcohol, hemolytic anemia, heparin therapy, hyperparathyroidism, steroids
What loss of bone density must be present in order to see osteoporosis on x-ray?
30–50%
Typically osteoporosis is seen in females and males in what decade of life?
Emails: 5-6th decade of life.
Males: 6–7th decade of life.
What are some complications associated with osteoporosis?
Fractures – spinal compression fractures [most under diagnosed]
Increased thoracic kyphosis [spinal stenosis]
Other fractures – proximal femur humorus and radius
What is the name of the triangle in the pelvis associated with bone loss and osteoporosis?
Wards Triangle
What are the radiographica findings/features of Osteoporosis
Increased radiolucency - osteopenia
Cortical thinning - pencil thing
Altered trabecular patterns
What specific changes can be seen in the spine radiographically with osteoporosis?
Curve changes decreased bone density trabecular changes cortical thinning changes in vertebral shape
What is the major weight-bearing trabeculae?
Principle compressive group
From where does the principal compressive group run?
From the medial metaphyseal cortex to superior femoral head
What trabecular pattern runs from the lateral cortex inferior to the greater trochanter?
Principle tensile group
T or F the secondary compressive group extend in an arch-like pattern medially
False
This is describing the principle tensile group
What is it called when a bone is not strong enough to withstand normal physiological stress?
Insufficiency fracture
Where is regional migratory osteoporosis most commonly seen?
In lower extremities
What are some conditions associated with localized osteoporosis
Infection
Inflammatory arthritis
Neoplasm
What is Sudeck’s Atrophy
overactive sympathetic nervous system -> leads to immobilization = decreased osteoblastic activity and increased osteoclastic activity.
A lack of Ca++ deposited in osteoid tissue is associated with what condition?
Osteomalacia
T or F
Osteomalacia has normal bone quality and decreased bone quantity
False
This is osteopenia.
Malacia has normal quantity and decreased quality
What are some causes of Osteomalacia
Deficiency in Vit D, Calcium, Phosphorus or dietary chelators
Absorption problems - gastric abnormalities, biliary disease or enteric malabsorption.
Neoplasm
Fibrous Dysplasia
Clinical findings for Osteomalacia include…
General muscle weakness
Bone pain on palpation
Deformitites - usually weight bearing bones
Describe the Radiographic findings of osteomalacia
Decreased bone density (low bone mineral content) Mottled trabecular pattern Loss of cortical definition - thinner Pseudo fractures Deformities.
Name some of the aka’s for Pseudo-fractures
Looser lines
Milkman’s Syndrome
Umbau Zone
Where are the most common sites for pseudo fractures?
Femoral necks
Pubic and ischial rami
Ribs
Axillary border of scapulae
What are rachitic rosary?
Costochondral bumps on the anterior rib cage that are associated with Rickets.
T or F
With Rickets it is uncommon for soft tissue to swell around the growth plates.
False
T or F
A more narrow growth plate is seen with children with Ricket’s
False - widened growth plate of long bones
Describe what a “paintbrush metaphysis” looks like
Irregular, frayed and cupped metaphyseal margin
