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SUMRAD > RAD-MSKINTRO > Flashcards

RAD-MSKINTRO Flashcards

1
Q

Are osteoblasts or osteoblasts faster?

A
  1. Osteoclasts remove bone at 20x the rate of bone formation/blasts
  2. normal bone is removed at the same rate as it is formed.
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2
Q

What is the initial tests for bone?

A

Plain films! not most definitive test, but always first

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3
Q

What’re indications for a plain film of the bone?

A
  1. -Trauma, pain, edema, decreased ROM, FB
  2. -AP, Lateral (orthogonal 90deg)
  3. -Oblique is initial 3rd view (hand, wrist, ankle, foot, etc) -
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4
Q

What’re indications for a CT?

A
  1. -Complex fractures/pre-op eval
  2. -Occult fx’s; tibia plateau
  3. -Tumors, infection
  4. -Spinal column
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5
Q

What’re some examples of a complex fracture?

A

tibial plataeu, calcaneus, talus, pelvis

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6
Q

What’re indications for an MRI?

A
  1. -Ligaments, tendons, soft tissue
  2. -Avascular necrosis
  3. -Spinal cord eval in fx
  4. -Pre-op
  5. -Occult fx’s (definitive)
  6. -Certain fx’s, infections
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7
Q

Where is a classic location for an occult fx?

A

HIP

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8
Q

What’re some plain film special views?

A
    1. sunrise view of the patella
    1. wrist in ulnar deviation for scaphoid view
    1. axial view of the calcaneus
    1. comparison views
    1. weight bearing view of the AC joint or foot
    1. perpendicular
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9
Q

What’re indications for a bone scan?

A
  1. -Occult Fractures
  2. -Stress Fractures
  3. -Bone Infection
  4. -Avascular Necrosis -
  5. Osteomyelitis-bone biopy DX!
  6. -Malignancy
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10
Q

What’re the AABCS?

A
  • A- adequacy
  • A- alignment
  • B- bones + periosteum
  • C- cartilage (joint space)
  • S- soft tissue
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11
Q

What’s the risk associated with a dislocation?

A
  • vascular/nerve injury.
  • Tx: reduction, post-reduction x-ray
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12
Q

How do we identify fractures?

A
  1. -lucent line passes through cortex
  2. -check entire cortical margin for disruption
  3. -impaction bulge, increased density
  4. -acute Fx’s linear, jagged
  5. edges not corticated
  6. -x’s should be visible on more than one view
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13
Q

What diseases might decrease joint space?

A
  1. arthritis,
  2. impacted fx dislocations
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14
Q

What diseases might increase joint space?

A
  1. -fractures, disolcations and ligamentous injury
  2. -hemarthrosis or infection
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15
Q

What soft tissue abnormalities can we identify on x-ray?

A
  1. -edema
  2. -effusion in joint
  3. -fat pads w/ blood of fluid
  4. -calcifications in soft tissue
  5. -masses -
  6. gas
  7. -FB
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16
Q

What disease processes cause generalized increased bone density?

A
  1. -Multiple/diffuse osteoblastic metastases
    • prostate CA
  3. -Osteopetrosis “marble bone dz” INC Bone
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17
Q

What disease processes cause focal INC density?

A
  1. -Impacted fracture, fracture healing -
  2. Localized osteoblastic metastases -
  3. Avascular necrosis-devascularized
  4. Paget’s disease late
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18
Q

What is Paget’s dz? What’re the 3 stages?

A

-Chronic inflammatory remodeling of bone

  • –thickening of the cortex, thick/sclerotic traebeculum
  • -bones will get bigger overal
    • pelvis, skull, spine and tibia
  • NO FIBULA

3 Phases: Early lytic, Mixed, Osteoblastic

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19
Q

A 63 yr man presents to your office. He has no major complaints, but he is concerned that his hats no longer fit him. What’s first on you ddx?

A

PAGETS

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20
Q

What disease processes commonly cause generalized lucency (decreased bone density)?

A

-Osteopenia, Osteoporosis -Endocrine/metabolic disorders, chronic steroid use, chronic disuse (CRPS) -Hyperparathyroidism, osteomalacia, rickets -Multiple Myeloma (disseminated form

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21
Q

What diseases commonly cause focal lucency?

A
  1. -Osteolytic metastases, some tumors
  2. -Bone cysts
  3. -Multiple Myeloma (solitary form)
  4. -Osteomyelitis
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22
Q

Who’s most at risk for osteopenia/osteoporosis?

A
  1. Women > men Elderly, post-menopause,
  2. ETOH, steroids,
  3. smokers,
  4. renal failure, GI dz, debilitation
  5. RISKS-Pathological fractures
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23
Q

What can hyperparathyroidism lead to?

A

hypercalcemia and increases bone resorption

  1. “stones, bones and abd groans”
  2. -Osteoporosis
  3. -Subperiosteal/cortex resorption of bone in fingers-
  4. -Subchondral resorption in distal clavicles
  5. -“brown tumors”-hemisrieon, “salt & pepper skull”
24
Q

What’re periosteal reactions?

A

Osteoblasts respond to periosteal insult (localized reaction) **within the periosteum and NOT the bone

25
Q

What’re non-aggressive periosteal reactions?

A
  1. -solid
  2. -from fx healing, repetitive trauma (child abuse)
  3. -Neoplasms (some benign)
  4. -Osteomyelitis, indolent infections
26
Q

What’re aggressive periosteal reactions?

A
  1. -Malignant tumors, infection
  2. -Interrupted pattern, onion skin, spiculated, sunburst
  3. -Codman’s triangle
27
Q

What’s Codman’s triangle?

A
  1. aggressive periosteal reaction from malignancy, osteomyelitis
  2. -Spicule of bone at edge of lesion, lifts periosteum
  3. -forms a trinagle with bone cortex
28
Q

What are OA characteristics?.

A
  1. -narrowed joint spaces
  2. -osteophytes & spurs
  3. -subchondral sclerosis
  4. -subchondral bony cysts
  5. -primary most common
  6. -secondary is after trauma and is usually unilateral (seen in young pts)
29
Q

What is Calcium pyrophosphate deposition CPPD?

A
  1. chondrocalcinosis
  2. -pseudogout -red and swollen joint with CP crystals on fluid analysis +/- symptoms
  3. -opague confluency around jt space
30
Q

Describe charcot joint.

A
  1. -hypertrophic form
  2. -denervation of joint
  3. -micro fx’s, bone fragmentation
  4. -joint destruction
    • DM pt’s MC
31
Q

What’s septic/pyogenic arthritis?

A
  1. -Hematogenous or local process
  2. -Risks: IVDU, trauma, prosthesis, steroids
  3. -Monoarticular usually
  4. -Polyarticular - rare
  5. -usually caused by Staph, GC -Articular cartilage destruction -Rapid progression
32
Q

What’s septic/non-pyogenic arthritis?

A
  1. -caused by m. tuberculosis or fungi
  2. -Risks: IVDU, DM, steroids, TB risks
  3. -Indolent, slow -Monoarticular -Osteoporosis common -Spine, knee common
33
Q

How does an infectious joint present?

A
  1. Red, hot, painful joint.
  2. Plain film late, order one first.
  3. +/-subchondral erosions, periosteal reaction
34
Q

Describe RA.

A
  1. -Narrowed joint spaces
  2. -Ulnar deviation MCP joints
  3. -Periarticular/radiocarpal erosions
  4. -Osteopenia
  5. -Subluxation
35
Q

Describe PA

A
  1. -Terminal phalanges narrow “pencil in cup” at DIP
  2. -Subchondral erosions
  3. -Typical psoriasis rash
36
Q

Describe AS.

A
  1. -Syndesmophytes: bony bridges join corners of vertebrae
  2. -“Bamboo spine” Erosions at the corners of vertebral bodies
  3. Sacroiliitis is where it starts
  4. -SI joint fuses first - ascends
  5. -HLA-B27 positive
37
Q

Describe Gout.

A
  1. -Calcium urate crystals
  2. -Sharp, sclerotic “punched out” or “rat bite” erosions near affected joint
  3. -Favors great toes (Podagra) and feet; hands/knees/elbows possible
  4. -Gouty tophi
38
Q

What’re common descriptive terms for bone tumors?

A
  1. -tumors don’t cross joints
  2. -Margin-Sclerotic/thin, well-defined vs. irregular, ragged -Shape- Longer than wide-w/in medullary or wider than long burst through cortex
    • Geographic, permeative, “moth-eaten”, expansile, “soap bubbly”
  4. -Bony reaction- Lytic, sclerotic
  5. -Periosteal reaction
39
Q

If pt is age 0-10 yr what bone tumors should you be considering?

A

Ewing’s sarcoma or neuroblastoma

40
Q

If pt is age 10-20 what bone tumors should you be considering?

A

Ewing’s sarcoma - shaft or

osteosarcoma -epiphysis:growth areas

41
Q

If pt is 20-40 what bone tumors should you be considering?

A

Osteosarcoma or giant cell tumor epiphysis

42
Q

If pt >40 yo what bone tumors should you be considering?

A
  1. Chondrosarcomas
  2. consider metastases from distant primary
43
Q

Next imageing if assessing for a bone tumor:

A

CT should be the next test for: periosteal reactions, lucencies, increased density lesions

44
Q

What should be described first for bone FX?

A
  1. Worse first- Compound or Closed
  2. Location- humerus proximal, middle,
  3. Intra articlular
  4. Fragment- comminuted>3
  5. Fractur line- spiral
  6. Aligment- Displace, angule- gap away midline is varus, shortened**
  7. Name last- look like monteggia
45
Q

What are pseudofractures?

A
  1. -nutrient vessels
  2. -sesamoid bones/accessory ossicles - cortex is key
  3. -overlapping adjacent bones
  4. -skin folds
  5. -pediatric growth plates
  6. Location, no disruption or tender area, see on one view only
46
Q

Describe open fractures.

A
  • High incidence of infection, osteomyelitis
  • Crush injury: vascular complications, infection -

Irrigated and repaired in OR < 8 hrs

-Antibiotics, Tetanus -

47
Q

Describe stress fractures.

A
  1. -Small breaks, repetitive stress exercise or impact
  2. -foot, lower leg
  3. -Initial xray often neg -Repeat 10-14 days
  4. -Bone scan sensitive within 6-72 hours
  5. -MRI
48
Q

What disease processes commonly cause pathological fractures?

A
  1. -Bone tumor
  2. -Bone cyst
  3. -Metastasis
  4. -Lytic or sclerotic changes
49
Q

What are risk with intra articular fracture?

A

degenerative arthritis

50
Q

what’re some commonly missed fractures?

A
  1. -Stress fracture
  2. -Scaphoid, elbow, radial head, midfoot, tibial plateau, hip
  3. -supracondylar and torus fractures in kids
  4. -Non-displaced and impacted fractures
  5. -Non-displaced growth plate fractures
51
Q

If you have a strong suspicion of fracture, but the x-ray is negative, what do you do next?

A
  1. -Dx: Probable fx.
  2. Immobilize
  3. -Repeat xray in 2-3 weeks looking for callous,CT, MRI or bone scan next
52
Q

What factors affect how a fracture heals?

A
  1. Pt age/health,
  2. site,
  3. number of fragments,
  4. immobilization,
  5. blood supply to site
53
Q

What’re the phases of fracture healing?

A
  1. Inflammatory Phase (5-7 d with hematoma formation)
  2. Reparative Phase (4-40 d with callus formation) 3. Remodeling phase (70% of healing time that can last up to a year when callus becomes bone)
54
Q

What are acute FX complications?

A
  1. Compartment syndrome- 5P- pulseless, pallor, pain, parasthesia, paralysis
  2. Infection-cellutis
  3. Fat embolism
  4. Hemmorhage
55
Q

What are risk of Delayed FX?

A
  1. Malunion- poor reductino, access, residual angulatin, illness
  2. Osteomyliits- focal perostial rxn
  3. AVN- done death diminished blood supply INC density white, sclerosis-FX, SCD, Legg
  4. Mysoisit ossificna- calcification in soft tissue

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