Pathology Skeletal Flashcards
Patient history indicates pt has chronic inflammation in both hands and feet. Dr orders x-rays of bilateral hands and feet. What is the most likely diagnosis?
What would be seen on the x-ray that would indicate the pt does indeed have rheumatoid arthritis?
i) Rheumatoid arthritis
* **involves joint in both hands and both feet, but will affect all joints eventually
ii) destruction of joint spaces
Ankylosis of joints
White sclerotic lines
14 year old pt complains of ongoing inflammation within his joints. This might be indicative of which disease process?
Juvenile rheumatoid arthritis
An elderly gentlemen enters the ER department and indicates pain in his right knee only with decreased ROM. He also indicates he has been running for many years. What would be the most likely diagnosis?
What would you see on the x-ray to support this diagnosis?
Osteoarthritis
Narrowing of joint space, loss of articular cartilage
Knee x-ray shows destruction of joint spaces with osteoporosis on either side of the joints. What likely diagnosis might this be?
Rheumatoid arthritis or Osteoarthritis and indicate what supports your decision?
Rheumatoid arthritis
Osteoarthritis is not indicative of bone loss
PP - Skeletal - infectious and inflammatory
Patient attends the ER and complains of pain in spine, hips and knees and the x-ray indicates presence of an absess. This patient also has had tuberculosis in his lungs about 1 month ago. What possible diagnosis could be given for the pain in his joints?
What supports your decision?
Tuberculous Arthritis
PP Skeletal - infectious and inflammatory
***Please notice that patients normally would have pain in one joint only (not all spine hips and knees). However Tuberculous Arthritis is most commonly seen in the joints of hips, knees and spine
Pathology (Eisenberg) p. 106 and PP
Patient enters the ER with Fever, swelling and tenderness of the lower leg. Lab results indicate bacterial infection of bone and marrow. What possible diagnosis may be given?
What supports your decision?
Osteomyelitis
Patient enters the ER with Fever, swelling and tenderness of the lower leg. X-ray shows localized edema, bone erosion and elevation of periosteum. Dr is also worried about sequestra present within the bone.
What possible diagnosis may be given?
Osteomyelitis
sequestra - areas of necrotic bone
Patient goes to her dr and hears that she’s had a decrease in amounts of calcium, vitamin D or phosphorus and therefore insufficient mineralization of bones. Patient hx also indicates liver disease, regional ileitis and chronic renal failure.
What is the most likely bone disorder diagnosis for this person?
Osteomalacia
Bones that are softened by osteomalacia may bend or give way as a result of weight bearing.
PP - Skeletal - Metabolic disorder
Pt lab results indicates an increase in uric acid. What type of skeletal disorder may this cause and what type of xray could be done to confirm its diagnosis? What type of identifiers would you look for on the x-ray?
Gout
Primarily seen in first metatarsalphalangeal joint therefore a foot x-ray would possibly be recommended.
RA joint effusion, crystal deposits and in advanced stage destructive lesions “rat bites”
Radiologist has identified cotton wool appearance within the pelvis, spine and skull of the patient. What diagnosis may this indicate?
Paget’s disease
*** Know the difference and appearance of both the osteolytic and osteoblastic stages
Which modality is best to detect ischemic necrosis of bone?
Nuclear medicine and MRI
It is idiopathic avascular necrosis of the femoral head (3 – 10 years of age)
Legge-calve perthe’s
If the requisition was questioning Rheumatoid Arthritis of the hands, which projection is recommended to use diagnose RA?
AP oblique projection - ball catcher’s position
p. 123 Merrills 1
It is the continuation of the perpendicular plate of the ethmoid bone.
above - crista galli
At was year of age do each of the carpal bones ossify?
Capitate ~1 Hamate ~ 2 Triquetral ~ 3 Lunate~ 4 Scaphoid ~ 5 Trapezium ~ 6 Trapezoid ~ 7 Pisiform ~10-12 (clockwise on Right PA)
What can you see on a lateral projection of the bladder?
Anterior, posterior walls & base of bladder,
filled with contrast
if reflux ~ distal ureters
Which position would be used to see reflux of the bladder within the ureters?
Any position, AP/PA Axial, Obliques, Lateral
Which projection would be used to visualize the frontal sinuses and anterior ethmoid air cells?
Caldwell
Merrils 2 pg 372
Herniated spinal contents seen as soft tissue mass posterior to the spine on a lateral spine x-ray could indicate what disease?
a) spondylisis
b) spondylolithesis
c) spina bifida
d) spondylitis
c) spina bifida
Green binder digestive system
Question 83
Metabolic bone disease that presents with either generalized or localized deficiency of the bone matrix in which the mass of bone per unit volume is decreased in amount but normal in composition is called what?
Osteoporosis
Green binder digestive system
Question 84
A malignant bone tumor occuring in the end of long bones, seen in persons between 10-25 years and having early mets to the chest is usually what?
Osteogenic Sarcoma
Green binder digestive system
Question 86
What characteristics are true in regards to rheumatoid arthritis :
a) chronic inflammation
b) affects the synovial membranes
c) degenerative joint disease
d) loss of joint cartilage
a) chronic inflammation
b) affects the synovial membranes
Green binder digestive system
Question 87
Osteomyelitis is caused from :
a) increased uric acid in joints
b) bacterial infection in blood
c) metastasis to bone from lung
d) tumor in red bone marrow
c) bacterial infection in blood
Green binder digestive system
Question 88
A small fracture of bone usually the result of indirectly applied tension forces within attached ligaments and tendons is called :
a) compound
b) segmental
c) torus
d) avulsion
Avulsion
Green binder digestive system
Question 89
Large amounts of gas and fluid in uniformly dilated loops of small and large bowel, often seen after abdominal surgery is termed
a) adynamic ileus
b) localized ileus
c) colonic ileus
d) gallstone ileus
a) adynamic ileus
Green binder digestive system
Question 90
Hypertrophy of the pyloric muscle causing narrowing of the pyloric canal producing obstruction is called :
a) hypertrophic gastritis
b) regional enteritis
c) pyloric stenosis
d) gastric achalasia
c) pyloric stenosis
Green binder digestive system
Question 91
Which condition is NOT included in chronic obstructive pulmonary disease:
a) pneumoconiosis
b) emphysema
c) asthma
d) pneumonia
d) pneumonia
Green binder digestive system
Question 92
The common area of the body radiographed to determine bone age is/are :
a. skull
b. wrist
c. hand
d. both b and c
b) wrist
Eisenberg 3rd edition p. 151
Answer p. 86
What pathological condition is present is the posterior elements of one or more vertebrae fail to unite?
a. meningocele
b. spina bifida
c. myelomeningocele
d. spondylolisthesis
b) spina bifida
Eisenberg 3rd edition p. 151
Answer p. 88
In patients with advanced osteoporosis, what type of radiographic technique is preferred?
low/high kVp
long/short scale contrast
Low kVp with short scale contrast
Eisenberg 3rd edition p. 151
Answer p. 107
Aging and postmenopausal hormonal changes are the major causes or generalized :
a. osteogenesis imperfecta
b. osteoporosis
c. osteopetrosis
d. osteolmalacia
b) osteoporosis
Eisenberg 3rd edition p. 151
Answer p. 108
An inherited generalized disorder of connective tissue characterized by multiple fractures and a bluish color of the sclera of the eye is :
a. osteogenesis imperfecta
b. osteoporosis
c. osteopetrosis
d. osteomalacia
a) osteogenesis imperfecta
Eisenberg 3rd edition p. 151
Answer p. 89
Lack of vitamin D in the diet of infants and children can cause a systemic disease called :
a. achondroplasia
b. rickets
c. oseomalacia
d. osteopetrosis
b) rickets
Eisenberg 3rd edition p. 151
Answer p. 110
A disorder of metabolism causing an increased blood level of uric acid is called :
a. achondroplasia
b. rickets
c. gout
d. urasia
c) gout
Eisenberg 3rd edition p. 151
Answer p. 111
A benign projection of bone with a cartilage like cap occurring around the knee in children or adolescents is :
a. osteochondroma
b. enchondroma
c. achondroplasia
d. osteoma
a) osterochondroma
Eisenberg 3rd edition p. 151
Answer p. 118
An example of a malignant bone tumour is :
a. osteogenic sarcoma
b. chondrosarcoma
c. ewing’s sarcoma
d. all of the above
d) all of the above
Eisenberg 3rd edition p. 151
The form of non-infectious arthritis characterized by osteoporosis, soft-tissue swelling, and erosions of the metacarpophalangeal joints and ulnar styloid process is :
a. reiter’s
b. rheumatoid
c. psoriatic
d. osteoarthristis
b. rheumatoid
Eisenberg 3rd edition p. 151
Answer p. ?
What is the name applied to the fracture resulting from acute hyperextension of the head on the neck that usually affects C2-C3. a. Hangman's b. Jefferson C. Boxer's d. Monteggia
a) hangman’s
Eisenberg 3rd edition p. 151
What medical term refers to a cleft in the pars interarticularis commonly involving the 5th lumbar vertebrae?
a. spondylolisthesis
b. spondylolysis
c. spondylitis
d. A or B or C
b. spondylolysis
Eisenberg 3rd edition p. 151
Spondylolysis - without displacement
Spondylolisthesis - with displacement
What area of the spine does a CLAY SHOVELER’S fracture involve?
An avulsion fracture of a spinous process in the lower cervical or upper thoracic spine
Eisenberg 3rd edition p. 151
Answer p. 146
What pathologic condition sometimes occurs after trauma, causing an interrupted blood supply to a bone?
a. vasculitis
b. ischemic necrosis
c. cushing’s
d. stress fracture
b. ischemic necrosis
Eisenberg 3rd edition p. 151
