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Bone Path 4 > Notes > Flashcards

Notes Flashcards

1
Q

Congenital/dysplasia atlantoaxial instability (5)

A 
Occipitalization
Odontoid agenesis
Os odontoideum
Down's
Marfan's
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2
Q

Trauma atlantoaxial instability (2)

A

Type 2 dens fx

Transverse ligament rupture

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3
Q

Arthritis causing atlantoaxial instability (6)

A 
RA
AS
PSA
Reiter's
SLE
Gout
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4
Q

Infection causing atlantoaxial instability

A

Osteomyelitis

Postpharyngeal infection

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5
Q

Air is ___ on an xray

A

Black

Fat = dark gray

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6
Q

Epiphyseal tumors (3)

A

GCT
ABC
Chondroblastoma

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7
Q

Dipahyseal tumors (3)

A

Ewings
Nonhodgkins lymphoma
MM

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8
Q

Meatphyseal tumors

A

Everything else besides GCT/ABC/chondroblastoma (epiphyseal); ewings/nhl/MM (diaphyseal)

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9
Q

Age group of GCT

A

20-40

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10
Q

Prepubertal

A

ABC

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11
Q

Age group of ewings

A

10-25

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12
Q

Cortex

A

Osteoosteoma

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13
Q

MC arthritis of wrist

A

OA
RA
CPPD

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14
Q

Congenital anomalies rule 1

A 
Congenital anomalies in the spine occur MC at transitional areas.
Occipital cervical (occipitalization)
Cervical thoracic (extra rib)
Thoraco lumbar (diastometayelia)
Lumbosacral
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15
Q

Congenital anomalies 2

A

Skeletal/spinal anomalies may be isolated entities but are frequentaly associated with other skeletal/spinal anomalies
Therefore look for other osseous abnormalities on the radiograph

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16
Q

Congenital anomalies rule 3

A 
VATER SYNDROME = 
Vertebral.vascular anomalies
Anal atresia
Tracheo-esophageal fistual
Esophageal atresia
Renal and radial dysplasia
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17
Q

Dark CSF

A

T1

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18
Q

Only reason you’ll have a C2 megaspinous

A

Posterior arch at C1

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19
Q

Anterior arch sclerosis

A

Spina bifida
Os odontoideum
Posterior arch agenesis

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20
Q

Arcuate foramen

A

Posterior ponticle (15% of population)

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21
Q

Unfused secondary growth center after age 12

A

Os terminale

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22
Q

Limbus bones often occur with

A

Large schmorles nodes

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23
Q

Congenital blocks MC at

A

C2-3 and C5-6

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24
Q

Wasp waist
Vestigial disc
Posterior elements

A

Congenital block

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25
Q

Multiple congenital blocks

A

Klippel file

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26
Q

Signs of klippel file (5)

A 
Low hairline
Short neck
Decreased aROM (d/t block vertebrae)
GU anomalies (kidney malformation: horseshoe) thus do IVP
Occipitalization
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27
Q

Types of spondy

A
  1. Congenital
  2. Isthumus (MC L5) - stress, elongated pars, acute trauma
  3. Degenerative
  4. Traumatic (Bi pedicle fx) C2 MC (hangman)
  5. Pathological
  6. Iatrogenic
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28
Q

2 MC types of spondy

A

2 and 3

Isthumus and degenerative

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29
Q

Spondylolysis

A

Pars interarticularis defect with or without slippage (spondylolisthesis)

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30
Q

90% of all spondies involve what segment

A

L5

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31
Q

13x increased incidence of what with spondy spondy

A

SBO
Asymmetric facets.
Only 2-3% patients with spondy over 25 show progressive dipalcement

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32
Q

Clinical features of spondylolisthesis

A

Pain maybe
Pain is usually present at onset of lysis of pars interarticularis
Hyperlordosis and gait changes may be seen
Only neuro sign = referred pain to lower extremity
Palpable “step-off” defect

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33
Q

Management for spondylolisthesis (for type 2-3)

A

Conservative care initially
Asymptomatic - no contraindications for sport etc
Spondy spondy at fresh stress fx stage may be treated with boston overlap brace (antilordotic)

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34
Q

Progression of spondy between

A

5-15 years of age

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35
Q

Spondy’s mc in what gender

A

2x mc with females

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36
Q

Displaced risk increased with associated what

A

SBO

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37
Q

Trapezoidal shaped L5 and dome shaped SI may lead to

A

Increased slippage

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38
Q

SI may what anteriorly to stabilize L5?

A

Buttress

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39
Q

Dysplastic/congenital features

A

L5 facets/posterior arch/upper sacral malformation

Often accompanying SBO

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40
Q

Type 2 mc at what level

A

L5
Young active individuals (extension activities)
3 subtypes. C = rare; b = giraffe neck

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41
Q

Etiology of isthmic

A 
Repetitive microtrauma
Acute fx
Not recorded in infants
Congenitally slender pars = predisposes
Hyperlordosis. 
Nonunion d/t lack of immobilization (not diagnosed fast enough)
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42
Q

Inverted napoleon’s hat sign or bowline of brailsford

A

Seen with significant anterolisthesis (seen in type 3 and above)

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43
Q

Napoleon’s hat sign

A

spondy

Achondroplasia

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44
Q

This is recommended for patients exhibiting clinical signs of a stress fx but have negative plain films

A

SPECT bone scan

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45
Q

Imaging if pain at 6months and follwed by what

A

X ray

CT (spect

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46
Q

What imaging if trauma?

A

CT.

Can find out if new or old. Assessing spinal canal. Healing

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47
Q

George’s line

A

Posterior body line
Or draw ulman’s line
To determine spondy and grading

48
Q

6 distal radius fx’s

A 
Colles
Smiths
Bartons
Chauffers
Torus
Slipped radial epiphysis
49
Q

2 distal ulna fx’s

A

Ulnar styloid

Nightstick

50
Q

Fischer’s fx

A

Triquetrum

51
Q

8 hand fx’s

A 
Boxer's/barroom
Metacarpal shaft
Metacarpal base
Bennet's (thumb)
Rolando's  (thumb)
Transverse (thumb)
Gamekeeprs' (thumb)
Phalangeal
52
Q

Duck head

A

Colle’s fx

Look at angle of articular surface

53
Q

Pie sign

A

Lunate dislocation

54
Q

MC spinal levels for fx

A

C1-2
C5-7
T12-L2

55
Q

Measurements of spine

A 
ADI
ST retropharyngeal/tracheal
Anterior body line
Posterior body line (george's line)
Spinolaminar jx line
Spinous processes
56
Q

ADI for adults and children

A

3 mm

5 mm )children

57
Q

St retropharyngeal

A

10 mm C1
6 mm at C2
22 mm at c6

58
Q

Offset greater than 7 mm indicates what in jefferson fx

A

Transverse ligament rupture

59
Q

Posterior arch fracture

A

Refer

60
Q

MC least stable dens fx

A

Type 2

61
Q

Tumors of diaphysis

A

Ewings, lymphoma, mm

62
Q

Metaphyseal tumors

A

Everything but ewings, lymphoma and mm; gct, chondroblastoma and abc

63
Q

Epiphyseal tumors

A

Gct (starts in metaphysis but crosses after growth plate closes thus look at 20-40 years of age)
Chondroblastoma
Abc (only benign tumor that can growh into growth plate at young age)

64
Q

Most grow in ___ part of bone. Why?

A

Metaphyseal/ d/t metabolic activity

65
Q

These 2 tumors are eccentric

A

Osteosarcoma and GCT

66
Q

Most malignancies are MC in vertebral body or neural arch?

A

Vertebral body b/c more vascular

67
Q

MC in spine

A

Chordoma

68
Q

MC benign in spine

A

Hemangioma

69
Q

Sclerosis of osteoid osteoma is d/t

A

Nidus

70
Q

3 patterns of lesions

A

Moth eaten
Geographic
Permeative

71
Q

Vertebral neoplasms: body (7)

A 
Mets
Mm
Lymphoma
Chordoma
Ewings
Osteosarcoma
Hemangioima
72
Q

Vertebral neoplasm: posterior elements(4)

A

Expansile lytic: ABC, osteoblastoma, GCT

Sclerotic: osteoid osteoma

73
Q

3 common malignant spinal neoplasms

A

Mets (lytic, blastic, mets)
Mm
Lymphoma

74
Q

Less common malignant spinal neoplasms (5)

A 
Ewings
Osteosarcoma
Chordoma
Chondrosarcoma
GCT (quasi)
75
Q

3 aggressive lesions: children

A

Osteosarcoma
Ewings
Infection

76
Q

4 aggressive lesions: 20-40

A

Lymphoma
Gct
Chondrosarcoma
Infection

77
Q

3 aggressive lesions: 40-70 years

A

Mets
Mm
Infection

78
Q

IHOP

A

Hodgkins lymphoma (atnerior body scalloping)
Osteoblastic mets
Pagets

79
Q

Osteoblastic mets common sites

A 
Male = prostate
Female = breast (although mets = lytic. Rare to have blastic mets)
80
Q

WINKING OWL SIGN

A

Missing pedicle. Opposite pedicle doesn’t look sclerotic which would indicate it’s been there long. Ifi both pedicles are gone = blind owl

81
Q

MC reason for bony stenosis of IVF

A

Uncovertebral DJD
Super common finding
Vip to pick out so don’t call fx

82
Q

How much translation is too much in cervical and lumbar spine for instability?

A

C2 down = 3.5mm in cx; 4mm in lx

83
Q

5 cx’al lines in spinous spaces

A 
Spinolaminar jx
Georges
Anterior body line
Ullman's line
...
84
Q

MR T1 color; MRI T2

A

T1 black CSF

T2 white CSF

85
Q

Shepards crook

A

Pagets

86
Q

Sabers shin

A

Pagets

87
Q

Tuft resorption. Ddx

A

Scleroderma
Sle
Psoriatic
Hpt

88
Q

Small lyticnlesions all same size

A

Mm

89
Q

Ddx for cortical disruption, lytic masses, moth eaten, periosteal response

A

Ewings
Infx
Osteosarcoma
If infx on ddx mustrefer to ER

90
Q

TERRY thomas sign

A

Gap tooth…scapholunate dissociation

91
Q

3 consecutive levels
Irregular end plates
Body wedging

A

Schermmans

92
Q

The triangle ilia thing

A

Oci. Mc in females of weight bearing age.

Know female if paraglenoid sulcus

93
Q

Aa greater than what is no good

A

3.5 cm

94
Q

Transitional tp

A

Lumarization

95
Q

Dagger sign

Trolley tracks

A

As

96
Q

Butterfly vertebra often hand in hand with what

A

Sbo

97
Q

Thoracic ribs go what direction

A

Up. Cxal ribs go down

98
Q

Pes excavatum associated with

A

Marfans

99
Q

4 ankle ossicles

A

Os trigonum, os peroneum, os tibial externum, os supranaviculare.
Msk, u/s mri would show st swelling if symptomatic or bone edema

100
Q

Ant limbus bone in cxal

A

Teardrop. Unstable!

101
Q

Risers sign

A

Young pt. Ilia growth plates unfused

102
Q

3+ levels of schmorls nodes and nuclear impression

A

Schermanns. Ask about trauma as a kid

103
Q

Mc plac for tarsal coalition

A

Calcaneus and navicular

104
Q

Puttis triad

A

Slanted roof
Displacd femur
Absent epiphysis

105
Q

Rhomboid fossa

A

Inferior part of clavicle

106
Q

Supracondylar processes point which way

A

Towardsj joint. Osteochondroma go away

107
Q

Serbs anomaly

A

1st and 2nd rib synostosis

108
Q

Management of hyperflexion injury

A

Neurosurgical consult.

109
Q

What must we rule out with pancake plana?

A

Mets and MM

110
Q

What are signs of new compression fx

A

Step defect and zone of condensation

111
Q

Duck poop sign

A

Triquetrium fx

112
Q

Spotty carpal sign

A 
GSRAT
Gout
Pseudoexatrophy (CRPS)
RA
TB
113
Q

Opposite sided fractures in pelvis; same side

A

Bucket

Malgaine

114
Q

Obturator internus fat pad

A

Acetabular head fx

Broken kohler’s teardrop

115
Q

Mc type of patellar fx

A

Horizontal

116
Q

Klein’s line

A

Femur

Surgery

Bone Path 4 (3 decks)

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