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Part 4 Boards X-ray > Neutral Lateral Cervical > Flashcards

Neutral Lateral Cervical Flashcards

1
Q

Soft tissue front of spine

A

Retropharyngeal - C4 - 7mm
Retrolaryngeal space - 14mm
Retrotracheal space - C6 - 21/22mm

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2
Q

If soft tissue is larger than vertebral body

A

Soft tissue swelling due to trauma, infection, malignancy

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3
Q

ADI space

A

Normal ADI 1-3mm adult

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4
Q

If ADI is the size of the anterior tubercle

A

Increased ADI - transverse ligament laxity

Brace the neck and refer out

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5
Q

Compare spinolaminar of C1 to C2

A

Atlas moved anterior or posterior

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6
Q

Atlas moved anterior

A

Increased ADI
Fractured dens
Non-union of the dens
Agenesis of the dens

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7
Q

Atlas moved posterior

A

Fractured dens
Non-union of the dens/unstable odontoidium
Agenesis of the dens

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8
Q

Check the front of the bodies

A

Syndesmophytes
Hyperostosis
Lipping/spurring

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9
Q

Marginal syndesmophytes

A

AS
Pushed up against front of the vertebral bodies and disc space
BILATERAL

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10
Q

Non-marginal syndesmophytes

A

Reactive arthritis - +STD panel, vinereal disease, arthritis, iritis, conjunctivitis, urethritis
PA - silver scales, pitted nails, cocktail sausage digits

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11
Q

AS aka

A

Marie strumpell’s disease

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12
Q

AS about

A

Most commonly males 15-35
LBP with morning stiffness
Iritis/uveitis

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13
Q

AS orthos

A

Chest expansion
Forrestier’s bowstring
Lewin’s supine

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14
Q

Radiographic signs AS

A

Bilateral SI joint fusion - ghost joints/star sign
Erosion of vertebral corner - Romanus lesion
Spine - shiny corner sign, bilateral marginal syndesmophytes, thin eggshell calcif around disc, squaring of vertebral bodies, bamboo spine, dagger sign, trolley track sign, poker spine, andersson lesion

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15
Q

AS labs

A

+HLA-B27
-Rheumatoid
+ESR

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16
Q

Case management AS

A

Co-treat with Rheumatologist

Can adjust but avoid areas that are actively inflamed or involved

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17
Q

Non-marginal syndesmophytes description

A

Flows out into the soft tissue (unilateral or bilateral)
Reiter’s disease
PA

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18
Q

Reiter’s disease aka

A

Reactive arthritis

Vinereal disease

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19
Q

Reiter’s description

A 
20-30
Conjunctivitis
Urethritis
Iritis
Arthritis
Ulcers on feet
Apthous stomatitis
Calcaneal spur (lover’s heel)
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20
Q

Reiter’s caused by

A

Chlamydia

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21
Q

Reiter’s labs

A

HLAB27

+STD panel

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22
Q

REiter’s is like DISH but

A

Facets are fused

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23
Q

Case management reiter’s

A

Refer to PCP or Rheumatologist

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24
Q

PA description

A 
20-50
Silver scaly lesions on extensors
Pitted nails
Cocktail sausage digits
Auspitz sign
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25
Q

Lab PA

A

HLA B27

-Rheumatoid

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26
Q

Case management PA

A

Refer to Rheumatologist

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27
Q

DISH aka

A

Anterior spinal bridging

Exostosis of 4 or more segments

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28
Q

Hyperostosis

Candle wax drippings

A

DISH

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29
Q

DISH description

A

Males >40
Neck stiffness
Pain on swallowing

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30
Q

Radiographic findings DISH

A 
Flowing hyperostosis
Candle wax drippings
4 continuous segments involved
Disc space preserved
Facets preserved
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31
Q

Long-term DISH

A

Postural deformity and loss of proper motion - early onset DJD

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32
Q

DISH associated with

A

Diabetes mellitus - eye exam and labs for diabetes

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33
Q

DISH can cause ossification of the

A

PLL

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34
Q

Case management DISH

A

Endocrinologist referral
Orthopedist referral
You can adjust but no audibles

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35
Q

Lipping and spurring

A

DJD

Infection

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36
Q

DJD

A

Ant vertebral body comes out to meet like pursing lips
Lipping and spurring (osteophytes)
Decreased disc space
Subchondral sclerosis of endplates

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37
Q

Usually stiffens with rest and improves with activity

A

DJD

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38
Q

DJD complications

A

Spinal stenosis

IVF encroachment

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39
Q

Only condition that alters the disc space in size and/or color and affects the surrounding endplates

A

Infection

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40
Q

Pt presents with a fever, chills, possible hx of trauma/surgery, and a warm, tender, swollen joint

A

Infection

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41
Q

Infection case management

A

Refer out
Chest x-ray
Sputum culture
WBC count

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42
Q

Avulsion fractures aka

A

Teardrop fracture

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43
Q

Avulsion fracture

A

Avulasion of the anterior inferior aspect of the vertebral body from a hyperextension trauma/whiplash

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44
Q

Avulsion fracture associated with

A

Acute anterior cervical cord syndrome

Loss of motor, pain, and temperature

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45
Q

Avulsion fractures are most common in

A

Cerivcal spine

Most commonly seen at C2

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46
Q

Case management avulsion fracutre

A

Flex/ext

Immediate referral for orthopedic surgical consult

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47
Q

Compression fracture

A

Loss of 25% or more body height

MOP IT

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48
Q

MOP IT

A 
Malignancy
Osteoporosis
Pagets
Infection
Trauma
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49
Q

Malignancy

A

Destroys both ant and post body height

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50
Q

Osteoporosis

A

Only ant body height destroyed - esp thoracic

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51
Q

Infection

A

Fever

WBC

52
Q

Trauma

A

Hx trauma

53
Q

Check the base of the dens for a radiolucent line

A

Fractured Dens
Non-union of the dens (os odontoidium)
Agenesis of the dens
Mach line

54
Q

Fractured dens

A 
Bone displaced from itself
Jagged edges
Acute
Hx trauma
Pain
THIN
DISPLACEMENT
55
Q

Non-union of the dens (os odontoidium)

A 
Smooth edges
Cortical margins around united pieces
Chrnoic
No displacement
No hx trauma - usually asymptomatic
Anterior tubercle gets white
Smooth edges
THICK lines
REFER orthopedist
56
Q

Agenesis of the dens

A

Missing ADI

Color of where dens should be is similar to the color of the C2 body

57
Q

Mach line

A

Rule out other three - fractured dens, non-union of the dens, agenesis of the dens

58
Q

Approximate the dens for

A

Height
Alignment
Color

59
Q

Height dens

A

Majority of dens should be below base of occiput - if not = basilar invagination - paget’s fibrous dysplasia, tauma
Similar to height of C2 body

60
Q

Mensuration lines height dens

A

McGregor’s

Chamberlains

61
Q

McGregors

A

Back of hard palate to base of occiput
8mm male
10mm female

62
Q

Chamberlains

A

Back hard palate to posterior foramen magnum

No more than 7mm above line

63
Q

Alignment dens

A 
Should be in line with C2 body - no = fx
Jagged and displaced
Brace the neck 
Refer to orthopedic surgeon
Leaning dens = sign of fx or os but usually fx
64
Q

Color dens

A

Color of where dens is should be whiter than the body

If dens is missing color is similar to C2 body

65
Q

Check the bodies for alterations of color and shape

A

Color - darker/lighter

Shape - PFC

66
Q

Color darker

A

Lytic mets

Multiple myeloma

67
Q

Multiple myeloma aka

A

Plasma cell sarcoma

68
Q

Multiple myeloma description

A 
Aplastic anemia
Thrombocytopenia
>50
Weight loss 
Anemia
Chachexia
Plasma cell leukemia
Bone pain worse at night
Nothing palliative/provocative
69
Q

Most common primary malignancy in adults

A

Multiple myeloma

70
Q

Multiple dark densities that are similar in size (punched out lesions) in extremities
Can cause pathological collapse (vertebra plana)

A

Mm

71
Q

Rain drop skull

A

Multiple myeloma

72
Q

Labs mm

A 
Reversal of AG ratio
IgM spike on immune-electrophoresis
Bence jones proteinuria
ESR
Aplastic anemia aka normochormic normocytic anemia
73
Q

Special test mm

A

COLD on bone scan

Refer to oncologist

74
Q

Pathological compressions

A

Vertebrae plana

Dec in post body height but will spare the pedicles (lytic mets will not)

75
Q

Lytic mets

A 
Signs of malignancy
>40
Recent unexplained weight loss
Skeletal pain worse at night
Cachexia
Nothing palliative/provocative
76
Q

Lytic mets description

A

Moth eaten or permeative pattern of destruction - all holes different sizes
Eats away bone
Eats pedicles
Vertebra plana, winking owl, swiss cheese appearance

77
Q

Lab lytic mets

A

Alkaline phosphatase

78
Q

Special test lytic mets

A

HOT on bone scan - destruction will be hottest part

79
Q

Whiter color bodies

A

Hodgkin’s
Blastic mets
Paget’s

80
Q

Hodgkins

A

Cervical only
Cortical thickening/enlargement/deformity
Most common form of mets in ages 20-30

81
Q

Ivory white vertebrae with anterior body scalloping

Unilateral hilar lymphadenopathy in white males seen on PA chest view

A

Hodgkin’s

82
Q

Confirm hodgkin’s by

A

Biopsy

Reed sternberg cells

83
Q

Blastic mets

A

Obviously whiter but not bigger
>40
Ivory white vertebrae no cortical thickening or enlargement

84
Q

Labs blastic mets

A

Increased alkaline phosphatase

85
Q

Special test blastic mets

A

Bone scan

86
Q

Paget’s aka

A

Osteitis deformans

87
Q

Paget’s

A

Male >50

88
Q 
Causes cortical thickening 
Picture frame vertebrae
Increased bone density
Coarsened trabeculae
Bone enlargement
Basilar invagination
A

Paget’s

89
Q

Labs paget’s

A

Increased alkaline phosphatase

Urinary hydroxyproline

90
Q

Special test paget’s

A

Bone scan

91
Q

Alteration of shape

A

PFC

92
Q

PFC

A

Paget’s
Fractures
Congenital

93
Q

Paget’s

A

Cortical thickening
Enlargement
Deformity

94
Q

Fractures

A

Loss of anterior body height 25% or more

Vertebral plana - pathological collapse = loss of both anterior and posterior body height

95
Q

Most common cause fx

A

Mm

Mets

96
Q

Congenital anomalies

A

Congenital block

Klippel-feil syndrome

97
Q

Congenital block

A

Two segments fused together from birth
Wasp waise appearance
Hypoplastic disc/rudimentary disc/remnant disc
Fusion posterior aspects

98
Q

Klippel-feil syndrome

A

Multiple congenital blocks
Sprengle’s deformity
Omovertebral bone - calcification of the rhomboids

99
Q

DJD aka

A

DDD
Spondylosis
Arthritis

100
Q

Lipping and spurring (osteophytes)
Decreased disc space
Subchondral sclerosis of endplates
Vacuum phenomenon

A

DJD

101
Q

Vacuum phenomenon aka

A

Knuson’s phenomenon
IVOC
Phantom disc

102
Q

Infection aka

A 
Infective arthritis
Infective spondylitis
Septic arthritis
Osteomyelitis
Pott’s disease
103
Q

Check the posterior arch of atlas

A

Missing

Vertical radiolucency

104
Q

Missing posterior arch atlas

A

Surgery
Malignancy
Agenesis

105
Q

Missing post arch C1 - surgery

A

Must see signs of surgery on film like staples, wires

106
Q

Missing post arch C1 - malignancy

A

M/c lytic mets teeth marks/jagged

107
Q

Missing post arch C1 - agenesis

A

Smooth borders
Clean margins
Enlargement
Whiter ant tubercle

108
Q

Vertical radiolucency post arch atlas

A

Fracture

Non-union

109
Q

Check teh pedicles of C2 for fractures

A

Hangman’s fracture - bipedicular fracture - posterior type 4 spondylolisthesis
Hyperextension trauma - whiplash

110
Q

Posterior bodies - height and destruction

A

Decreased ant and post = pathological fx
Teeth marks in bone = lytic mets
MOP IT

111
Q

Pathological fx

A

Vertebral plana
Pancake vertebrae
Wafer thin vertebrae
Coin on end vertebrae

112
Q

Pedicles

A

Check for slipping bodies - subluxation or dislocation

113
Q

Slippage of VB ant or post by 10-15% with facets still lining up
Break in George’s line

A

Subluxation pedicles - slipping bodies

114
Q

Slippage of the vertebral body ant or post by 25% or more with face perching and spinous fanning
Brace the neck
Refer to orthopedic surgeon/ER

A

Pedicle - dislocation

115
Q

Facets

A

Dislocation
Destruction
Fusion

116
Q

Dislocation facets

A

Trauma or ligament instability

117
Q

Destruction facets

A

Facet arthrosis whiter in facet area - teeth marks - rat bite erosinos in RA

118
Q

Fusion facets

A

Congenital or acquired

119
Q

Congenital fusion facets

A

Two facets fused as one - megaspinous with one spinolaminar line

120
Q

Acquried fusion facets

A

Facets fused with separate distinct spinal laminar lines

RA or AS

121
Q

Two conditions cause acquired fusion of the facets

A

AS - marginal syndesmophytes and thin eggshell calcification

RA - only affects synovial joints

122
Q

Check spinolaminar lines and spinouses

A

Congenital surgical malignancy

123
Q

Fractures

A

Bone displaced from itself
C6,C7, T1
Clay shoveler’s fractures
Hyper-flexion trauma

124
Q

Double spinous sign seen on AP view

A

Spinous fx

125
Q

Missing spinolaminar line is a

A

Spina bifida on the lateral view
B9 deficiency
C1 = spondyloschisis

Part 4 Boards X-ray (22 decks)

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