Slide Exam Prep Flashcards
1
Q
DISH main radiographic features
A
At least 4 contiguous vert. bodies with marginal syndesmophytes
Normal: disc height, subchondral bone, facets
NO HVLA. Refer for medical management (medication?)
2
Q
Ankylosing Spondylitis main radiographic features
A
Romanus lesions (corner erosion)
Shiny corner sign
B/L symmetrical sacroilitis (bead sign, sclerosis (+/- star sign), ghost sign (complete fusion))
BL symmetrical marginal syndesmophytes (fine, multilevel, bamboo spine, osteoporosis, carrot stick fracture
Dagger sign, trolley track sign
NO HVLA. Refer to GP for medical management,
3
Q
Psoriatic Arthritis
A
Non-marginal asymmetrical syndesmophytes:
Increased ADI
U/L or B/L Asymmetrical sacroilitis
** Same radiographic findings as Reactive Arthritis in the spine **
NO SMT
4
Q
Reactive Arthritis
A
** Same radiographic findings as Psoriatic Arthritis in spine **
+finger signs for next slide exam
NO SMT (double check?)
5
Q
Osteitis Condensans Ilii
A
Isolated to SIJ, B/L triangle sclerosis in ilium subchondral bone (only ilium side)
NO erosions or joint space change
CAN HVLA but not likely to be useful
6
Q
Osteitis Pubis
A
- erosions, motheaten, wider pubic symphysis
- local osteoporosis
** Can’t tell appart from Infection off radiograph only **
No SMT?
7
Q
CPPD
A
Small linear horizontal calcification in disc at multiple levels
*meniscus calcification
Can SMT
8
Q
HADD
A
Small calcification anterior to C2
Calcification of longus colli muscle
Can SMT?
9
Q
Hypertrophic Osteoarthropathy
A
B/L symmetrical long bone periostitis
Presents as: digital clubbing, often secondary to cardiopulmonary, GIT, endocrine, hematologic, and inflammatory conditions
No HVLA until primary condition not determined. Refer to GP for blood tests
10
Q
Differentials for B/L symmetrical sacroiliitis
A
AS
Enteropathic Arthritis
Osteitis Condensans Ilii
11
Q
Differential for U/L sacroiliitis
A
Rheumatoid A.
Infection
DJD
Also Reactive / PA
12
Q
Differential for B/L asymmetrical sacroiliitis
A
PA / Reactive
13
Q
Differential for non-marginal syndesmophytes
A
- DJD
- DISH
- PA / Reactive
14
Q
Differential for Marginal syndesmophytes
A
-Ankylosing spondylitis
More?
15
Q
Paget’s
A
Cortical thickening Expansion Coarsened trabeculae Sclerosis / Ivory Pahological fractures
Spine:
-picture frame vertebra
Pelvis:
- lost kohlers teardrop
- thick pubis
- brim sign
- acetabulae protrusio
Skull:
…
Long bones:
- bade of grass defect-pseudofractures
- more..
NO SMT
16
Q
Differential for Ivory vertebra
A
Pagets (+ expansion)
Bastic mets
Hodgkins (+ anterior erosio / scallop)
17
Q
Fibrous Dyslasia
A
Large geographic lucency with separations, haziness
NO HVLA because weakened bone
18
Q
Neurofibromatosis
A
Nerve sheath overgrowth (neoplasm)
-cortex intact
- posterior scalloping
- short angular scoliosis
- kyphosis
- IVF very large (means its in the IVF)
- scalloped ribs
-asymmetrically elongated phalanges
No SMT
19
Q
Differential for posterior scalloping
A
Neurofibromatosis Marfans Ehlers Danlos Achondroplasia Osteogenesis imperfecta
20
Q
Differential for lucent benign lesions
A
Haemangiona Non-ossifying fibroma, Fibrocortical defect SBC, ABC, GCT Osteobastoma, Chondroblastoma Enchondroma, Ollier’s disease
21
Q
Differential for sclerotic malignant lesion
A
Osteosarcoma
-Parosteal osteosarcoma
Metastasis
22
Q
Differential for mixed sclerotic and lucent malignant lesion
A
Osteosarcoma
Mets
23
Q
Differential for lucent malignant lesion
A
Plasmacytoma Chordoma Ewing’s sarcoma Malignant GCT Chondrosarcoma Fibrosarcoma Non-Hodgkins Lymphoma Hodgkins Lymphoma Multiple Myeloma Mets
24
Q
Gardner’s Syndrome
A
Multiple osteomas (skull + hands and feet)
Can HVLA. Refer to investigate for systemic signs (epidermal cysts, colonic polyps)
25
Hereditary Multiple Exostoses
Multiple osteochondromas (bony growths off the cortex of long bones)
Could HVLA but with caution as they can fracture.
26
Osteoblastoma
Sclerotic periosteal rim around lucent nidus >25mm diameter, expansive, thins cortex
-posterior elements of spine, C1 SP
DDx: Osteoid osteoma (smaller), ABC (more expansion + no sclerotic rim)
NO HVLA because weakened bone fracture risk
27
Ollier’s Disease
Multiple enchondromas
28
Marfucci’s Syndrome
Very rare
29
Chondroblastoma
One of the few tumours that are in the epiphysis
30
Parosteal Osteosarcoma
Lobulated juxtacortical sessile mass, lytic portions
| DDx: osteoma (much smoother and less messy)
31
Plasmacytoma
```
Geographic lucent soap bubbly, expansive
Fades away bone areas (erased)
Targets: mandible, ilium, vertebra, ribs, prox femur, scapula, sacrum
DDx: Chordoma, Malignant GCT
REFER because malignant
```
32
Chordoma
Invades surrounding STs, large, crosses disc space
85% sacrococcygeal or spheno-occipital
Malignant
DDx: Infection
33
Hodgkins Lymphoma
-vertebral body
- anterior scalloping of vert body
- ivory vertebra
DDx:
- Multiple myeloma
- Pagets
34
Jefferson’s fracture
APOM: lateral masses shift past articular processes C2
-say transverse ligament rupture if masses displaced >7mm
35
Hangman’s fracture
- B/L pedicle fracture
- Lateral view
-hyperextension injury
36
Differential for increased ADI
- agenesis dens
- agenesis posterior arch
- RA
- PA
- trauma
- Downs
- Marfans
- Ehllers Danlos
- Morquio’s
37
C1 posterior arch fracture
(study some images)
38
Pillar fracture
Wider, altered shape
| study some images
39
Posterior ponticle
Bridging C1 poaterior arch and occiput
Can SMT
40
Uncinate fracture
- tiny triangle on AP view
| - rare
41
Differential for blurry C1 SP
Malignant:
- chordoma
- plasmacytoma
- lytic mets
Benign
- osteoblastoma
- ABC
- GCT
42
Differential for missing pedicle on AP view
Lytic mets
Osteobastoma
Chordoma
*multiple myeloma spares the pedicle
43
Differential for vertebral body destruction
| Disc space intact
Lytic mets
Chordoma
Plasmacytoma
44
Differential for posterior elements destruction
Infection
Lytic mets
45
Differential for triangular ossific density anterior to the disc space
- Limbic bone (smaller than defect)
- Intercalary bone (in front and no defect)
- Teardrop fracture (exact missing piece)
- Ring epiphysis (widespread)
- Compression fracture (ish)
46
Differential for bony fragment posterior to C7
- clay shovelers fracture perfect match and displaced a bit)
- persistent apophysis (smaller)
- nuchal bone (vertical)
47
Agensis dens
- can’t see odontoid
| - triangular anterior arch + bigger + more sclerotic
48
TVP fracture
C7 TVP
| Lumbar TVP
49
Sacral fractures
- usually also pelvic fractures
| - not on SLIDE exam 1?
50
Differential for single non-marginal syndesmophyte
Highly likely Psoriatic arthritis
DJD
DISH
51
Picture frame vertebra
Pagets
52
Sandwich vertebrae
Bone-in bone look
Osteopetrosis
53
Rugger Jersey spine
Hyperparathyroidism
54
What are the elements in the description of a scoliosis?
1. Convex side
2. Start and end
3. Cobb angle
4. Apex
5. Rotation: grade, side, span
6. Skeletal maturity: Risser’s or epyphysis visible
7. Obvious cause
8. Secondary consequences (DJD)
55
Grade rotation of a scoliosis
1+ pedicle bit to midline (other overlaps with edge of vert)
2+ pedicle 2/3 midline (other barely visible)
3+ pedible midline (other not visible)
4+ pedicle past midline (other not visible)
56
Risser Sign grading
1. 25% grown
2. 50%
3. 75%
4. 100% visible
5. Fused to ilium (closed)
57
Where is most degenerative spondylolysthesis? And Isthmic ? Dysplastic?
DJD spondy : L4
Pars fracture: L5
Congenital: L5
58
C1 posterior arch agenesis
C2 megaspinous, C1 anterior arch hypertrophy
DDx: occipitalisation
NO HVLA until proven stable. Refer for flexion extension views
59
Agenesis pedicle
- winking owl
- sclerotic C/L pedicle
DDx:
- Lytic mets
- rotation
Yes SMT. Stable
60
Agenesis articular process
Check images
Yes SMT. Stable
61
Hemivertebra
Check images
-short angular scoliosis
NO SMT
62
Caudal Regression Syndrome
- sacral agenesis
| - 2 lia articulate
63
Os odontoideum
- lucent gap
- failure of fusion of dens to body
- instable
DDx:
- mach effect
- fracture
NO SMT. Unstable
64
Ossiculum Terminale
-lucent gap at tip of dens
Yes SMT. Insignificant
65
Spondyloschisis
SBO at C1
APOM: follow cortical lines of lamina
Lateral: no spinolamina junction line
DDx bifid vertebra
No HVLA because instability
66
Clasp Knife deformity
- SBO at S1
| - long L5 SP
67
Butterfly Vertebra
- AP
- triangular endplate lines
Yes SMT. Insignificant
68
Occipital vertebrae
Epitransverse
Paracondylar
Paramastoid
*check images
NO SMT
69
Occipitalisation
- C1 fused to occiput
- atlantoaxial instability
NO SMT
70
Congenital block vertebrae
- wasp waist
- posterior elements maybe fused too
Can maybe SMT
71
Acquired block vertebrae
Barrel shape
| DDx: infection, DJD, malignancy, surgical
72
Lumbosacral transational segment
Can SMT but different mechanics
73
Basilar impression
-dens passes McGregors line >45mm
DDx:
- occipitalisation
- spondyloschisis
- abnormal dens or atlas
- klippel-fail
- osetomalacia, tumour...
NO SMT
74
Eagles syndrome
- stylohyoid ligaments calcified
- looks like phalanx bones
NO SMT
75
Facet Tropism
Asymmetrical facet orientation
DDx: rotation
Can SMT. Changes biomechanics
76
Schmorl’s Nodes
-clear corticated circular depression
DDx:
- compression fracture
- nuchal impression
Can SMT. Insignificant
77
Nuclear Impressions
- smooth indentation in endplate
- AP: cupids bow
DDs: lateral flexion
Can SMT. Insignificant
78
Venous Channel of Hahn
-horizontal sclerosis in anterior middle of vertebra
Can SMT. Insignificant
79
Omovertebral Bone
Bone from cervical spine to scapula
SMT??
80
Klippel-Feil Syndrome
1. Block vertebrae
2. Basilar impression
3. Scoliosis
4. Sprengel’s deformity
Presents as: short neck, limited neck mobility
NO Cervical HVLA due to possible instability
81
Achondropplasia
- bullet-nose vertebrae
- posterior scalloping
- short pedicle (stenosis)
- large spinal curves
- basilar impression
- ping pong paddle ilium
NO SMT
82
Cleidocranial Dysplasia
- small or no clavicle
- small scap
- biconvex vertebrae
- SBO
- hemivertebrae
- large curves
- small pelvis
- small dens
NO SMT
83
Spondyloepiphyseal Dysplasia
Widespread platyspondyly, bulbous vertebrae, large spinal curves, short ilium, widespread skeletal changes
NO cervical HVLA because of atlanto-axial instability. Can treat else wear. Refer to examine for associated systemic dysfunctions.
84
Holr-Oram Syndrome
- heart hand syndrome
- sprengles deformity
+ more
No SMT?
85
Fibrodysplasia Ossificans Progressiva
- striate muscle calcification
- torticolis
- osteomalacia
- pathological fractures
NO manual therapy at all
86
Marfan’s Syndrome
- tall vertebra
- posterior scalloping
- thin cortex
- scoliosis
NO SMT because lax dense?
87
Metaphyseal Dysplasia
- widespread platyspondyly
- erlenmeyer flask deformity
No SMT?
88
Nai-Patella syndrome
Not realy spine
89
Ehlers Danlos Syndrome
- widespread platyspondyly
- posterior scalloping
- large spinal curves
- early DJD
NO SMT. Weak bones
90
Hurler’s Syndrome
- short vertebrae
- round vertebrae
- small dens
- paddle ribs
- flair ilia
- osteoporosis
NO SMT
91
Morquio’s Syndrome
- widespread platyspondyly
- centrall beaking vertebral bodies
- large curves
-small dens
NO SMT
92
Osteogenesis Imperfecta
```
Biconcave vertebrae
Platyspondyly
Osteoporosis
Multiple fractures
Large spinal curves
```
Presents with: blue sclerae, multiple frequent fractures with little trauma, bone deformities
NO HVLA
93
Melorheostosis
- hyperostosis under periosteum along side of long bones
- candle wax dripping
Can SMT. Insignificant unless huge
94
Osteopathia Striata
- B/L
- vertical linear opacities from metaphysis to diaphysis
Cinicaly insignificant
95
Osteopoikilosis
- widespread small round opacities
- B/L, symmetrical, uniform
DDx:
-mets
Clinicaly insignificant
96
Osteopetrosis
-dense brittle bones
- generalised sclerosis
- bone within bone / sandwich vertebrae
-erlenmeyer flask deformity
NO SMT
97
Differential of widespread platyspondyly
Multiple myeloma
Osteoporosis
Spondyloepiphyseal dysplasia
Meta[hyseal dysplasia
Ehlers Danlos
Morquio’s
98
Differential for posterior scalloping
Single:
Neurofibromatosis
```
+??
Widespread:
Achondroplasia
Ehers Danlos
Marfans
```
99
Differential for widespread bullet nose vertebrae
Achondroplasia
Spondyloepiphyseal dysplasia
Hurlers disease
100
What are the elements of a radiographic description of a fracture?
1. Location (in body)
2. Orientation (horz, vert obli)
3. List cortices broken
4. Alignment (distal frag to prox)
5. Apposition (good, partial, none)
6. Rotation
7. Joint space and ST involvement
101
Compression fracture
- step defect
- wedge deformity
- linear zone of condensation
- lucent line
- paraspinal swelling
- compression or pathalogical
- new or old
102
Burst fracture
Like compression fracture but more central and increase AP diameter
103
Odontoid fracture
Type 1:
- oblique tip
- stable
Type 2:
-dense base
Type 3:
-odontoid onto body
2 and 3 not stable
104
Chance fracture
- horizontal splitting of spine and neural arch
| - L1 to 3
105
Degenerative Joint Disease
Osteophytes, subchondral sclerosis and cysts
Facets: Bubble like (AP view), IVF narrowing (Oblique view)
IVD: decreased height, vacuum phenomenon, intercalary bone
Uncinate: cat ears, pseudofractures (Lateral view)
Can HVLA (unless suspect instability), no referral needed (unless suspect instability)
106
Rheumatoid arthritis
- dens erosion
- >ADI
- stepladder spondylolysthesis
NO SMT
107
Differential of irregular endplates
-compression fracture
- nuclear impressions
- schmorls nodes
- lateral flexion
-butterfly vertebrae
+more?
108
Spondylitis
- starts anterior superior corner of vertebra
- moves up disc into next endplate
- decrease disc space
- ST density in disc space
- ST involvement around
- ankylosis
-can be posterior elements
- paraspinal abscess
- psoas abscess
- paraspinal swelling on AP
Suppurative: less severe
Nonsuppurative:
- TB
- gibbus deformity
NO SMT if active.
Can SMT if old??
109
Osteomalacia
Lucencies between trabeculae / checkerboard
Double cortex (thin too)
Concave endplates / bowing
Pseudofractures (ribs, pubic and ischial rami, scapula)
Protusio acetabuli (PORT)
NO SMT, refer to GP for blood tests and medical management
110
Osteoporosis
Pencilled cortices, generalised decrease density, vertical trabecular
Empty box, wedging, vertebra plana, biconcave, hyperkyphosis
DDx:
Multiple myeloma
Post-scheurmans
NO SMT, refer to GP for DEXA and medical management
111
Hyperparathyroidism
```
Rugger jersey spine, concave endplates
Subperiosteal resorption of outer cortex (frayed look)
Blurred cortices **Hallmark**
Accentuated trabeculae
Salt and pepper / granular skull
ST calcifications
Clavicle resorption (MSHIRT)
Brown tumours: jaw, femur. Pelvis
```
NO HVLA, refer to GP for medical management
112
Rickets
-osteomalacia in child
Radiographic features like adult + growth impairment
NO SMT
113
Features of a benign tumour
Cortex:
- thinning, scalloping, expansion
- thickening
- clear margins
- solid periosteal reaction
GEOGRAPHIC
114
Features of a malignant bone tumour
- motheaten
- permeative
- cortical destruction
- wide transition zone
-laminated or spiculated periosteal reaction
115
Osteoma
-skull
116
Osteoid osteoma
Sclerotic pedicle with acute angle scoliosis around it
Might see the small lucent nidus
Cortical thickening
Presents as: pain relieved by aspirin
DDx: Brodies abscess, stress fracture with healing response
117
Osteosarcoma
Wide tranzition, fracture, cortex destruction
Sclerotix or mixed
Periosteal reaction, ST involvement
DDx: Ewings sarcoma (kids), Non-Hodgkins (elderly)
118
Metastasis
- diffuse opacities or densities or both
- assymmetrical, non-uniform
- NO expansion, cortex destruction, periosteal reaction
- accross multiple bones
119
Enchondroma
- geographic
- bit expansive
- metaphyseal
- endosteal scaloping
-matrix calcification
120
Haemangioma
-vertical trabeculations
DDx:
-osteoporosis
121
Nonossifying fibroma
- diametaphyseal
- cortical, eccentric
- oval
- thin cortex
- hazy / smoky
-2-7cm
DDx:
- fibrous dysplasia (bigger)
- osteomyelitis
- brodies abscess
122
Fibrocortical defect
- diametaphyseal
- cortical /eccentric
- thin cortex
- hazy /smoky
<2cm
123
Simple Bone Cyst
-fragment sign *Hallmark**
- truncated, central
- septations
- mild expansion
- endosteal scalloping
DDx:
- ABC
- ++??
124
Aneurysmal Bone Cyst
- extreme expansion
- eggshell cortex
- buttressing
- septation
DDx:
-SBC
125
Giant Cell Tumour
- up to joint lint *Hallmark**
- epiphysis
DDx:
-Malignant GCT
126
Malignant GCT
-expansive distal radius
GCT became expansive now
-other place too
127
Ewings Sarcoma
-kids
- cortical saucer
- diaphyseal
really looks like Osteosarcoma
DDx:
- Osteomyelitis
- Osteosarcoma (ST mass)
- Non-Hodgkins Lymphoma (ST mass)
128
Non-Hodgkins Lymphoma
-elderly
- permeative / motheaten
- medullary
- patchy
- ST mass
DDx:
- Osteosarcoma
- Ewings (kids)
129
Chondrosarcoma
- calcific densities
- expansion
- meta/diaphysis
- scalloping
- septations
-ST mass
130
Fibrosarcoma
-huge ST mass
131
Multiple Myeloma
- circumscribed
- uniform size multiple circular lytic lesions
- endosteal scalloping
- decerae density
- vertebra plana
DDx:
- Osteoporosis (looks same)
- Lytic Mets
132
What tumours mostly go to the spine?
Hemangioma
Mets
Multiple Myeloma
Osteoid Osteoma
Sacrum:
- Plasmacytoma
- Chordoma
+more?
133
Scheurmann’s Disease
At least 3 consecutive vertebra with at least 2 of:
- schmorls nodes
- anterior wedging
- increased AP diameter
- increased kyphosis
- decreased disc height
*must be in a child or teen
Post scheurmans DDx:
-osteoporosis
134
Differential for hyperlucency in a chest x-ray
- Pneumothorax
- COPD
- Bulla
-mastectomy
135
Pneumothorax:
- mediastinal shift
- absent lung markings
- shriveled up lung
136
COPD
- B/L generalised hyperlucent lungs
- big lung size: flat diaphragm, heart lifted off it
- Ephysema
137
Bulla
- still lung markings
- thin wall of density around
- circular
-can be with emphysema
138
Differential for hyperdense area on chest x-ray
- Pleural effusion (bottom)
- Atelectasis (uniform, pulls mediastinum)
- Pneumonia (lobe shape, NO mediastinum shift)
- Coin lesion (pulls mediastinum)
- Interstitial fibrosis
- Miiary shadows (TB, Mets, sarcoidosis)
- Pleural plaques
- Mesothelioma
139
Pleural effusion
- lung base
- meniscus sign
- blunt costophrenic angle
140
Atelectasis
Uniform:
- lobe shape
- pulls mediastinum
- no lung markings left
Linear:
- 1-3cm above diaphragm
- horizontal
141
Pneumonia
- lobe shape
- blurry borders
- NO mediastinum shift
- air bronchogram sign: fluid black white circles
142
DDx for Coin lesions on chest Xray
Mets (spiculated, lobulated, multiple)
Bronchial carcinoma (one mass)
Pleural plaques
143
DDx for Interstitial fibrosis on a chest xray
Pneumoconiosis
TB
Sarcoidosis, RA, SLE
*Mediastinal shift toward lesion (if U/L)
144
DDx for Miliary shadows on a chest xray
TB (apical lobe)
Sarcoidosis (middle lobe)
Mets (lower lobe)
(Spotty, similar densities)
No HVLA if Mets (weakened bone=fracture risk), refer to GP for blood tests and medical management
145
Pleural Plaques
Thickness around lung periphery
Crosses structures (not defined by lobes)
Often B/L
Refer to GP for blood tests and management
146
Mesothelioma
Lobulated triangular opacity from border of the thoracic cage, pointing towards the lungs
Decreased lung size because it buldges onto lung field
*Refer to GP for CT to accurately stage disease and begin management
147
Differential for unilateral hilar enlargement
- tumour
| - infection
148
Differential for bilateral hilar enlargement
Sarcoidosis
Mets
Infection
149
Signs of cardiomegaly on chest Xray
Cardio-thoracic ratio > 1/3
Heart border close to spine on lateral thoracic view
Double contour to the right heart border and splaying of the carina
150
Abdomina perforation
Air under diaphragm
151
Inguinal Hernia
Air under inguinal ligament
152
Hepatomegaly
Liver shadow over ilium and or midline
153
Bowel obstruction
Air fluid levels
Small intestine visible
Stripes over bowels
154
Retroperitoneal fluid
-blurred psoas lines
155
Kidney stones
Stag horn
DDx gallstones
156
Pancreatic calcification
- spotty pancreas shape
| - L and R oblique shape
157
Gall stones
- sclerotic rim
- grapes
- on the R
158
Ureteric calculi
larger than phleboliths or uterus fibroids
159
Splenic artery aneurysm
The only time u see the spnelic artery
Looks like single gallstone (but on the L)
160
Thoracic/Lumbar trauma indicators that justify an xray
Multiple of the following: female >65, make >75, osteoporosis Hx, chronic corticosteroid use, severe trauma, contusion
161
Knee trauma indicators that justify an xray
```
>55
Tender fib head or patella
Can't flex to 90 degrees
Can't walk at least 4 steps
Pain > 7 days
```
162
Ankle trauma indicators that justify an xray
Tender distal 6cm of fib or tib, or malleoli
Can't weight bear
Elderly + malleoli pain
Elderly + swelling
163
Midfoot trauma indicators that justify an xray
```
Tender base of 5th metatarsal
Tender navicular
Can't weight bear
Pain >10 days
Toe trauma
```
164
Hip indicators that justify an xray (non traumatic)
```
> 4 weeks failed conservative care
Hx uninvestigated trauma
Lost mobility
Acute onset locking
Palpable enlarging mass
```
165
Shoulder trauma indicators that justify an xray
```
Serious trauma
Shape, mass, deformity
Severe mobility loss
Epileptic seizure or electric shock
First time dislocation
```
166
Wrist/hand trauma indicators that justify an xray
```
Deformity
Painful active or passive ROM
Tender + oedema
Painful grip or supination
Pain at snuffbox or on longitudinal thumb compression
```
167
Elbow trauma indicators that justify an xray
Inability to fully extend
Forearm pain
Instability
Localised elbow pain
168
Features that justify a Cervical xray because you suspect spondyloarthropathy
Chronic pain (>3months) + risk factors:
- insidious onset <40yrs
- improves with exercise, NSAIDS
- night pain
- family Hx
- extremity articular symptoms
- systemic symptoms (psoriasis, IBD, uveitis)
169
Features that justify a Thoracic xray because you suspect a scoliosis
Child or adolescent with:
- positive Adams test
- rib humping
Adult with acute onset or sudden progression of a scoliosis curve
170
Non-traumatic features that justify a Hip, Knee, Ankle, Foot, Shoulder or Elbow xray
```
Non change with conservative care >4 weeks
Red flags (unrelenting, night pain, not related to movement, fever, unexplained weight loss)
Significant activity limitation
Swelling, mass, deformity
```
171
Differential diagnosis of Acro-osteolysis
```
Psoriatic arthritis
Scleroderma, sarcoidosis
Hyperparathyroidism
Injury
Raynaud's disease
Thermal (extreme cold/ heat)
(PSHIRT)
```
