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Slide Exam Prep Flashcards

1
Q

DISH main radiographic features

A
  • At least 4 contiguous vert. bodies with hyperostosis
  • Marginal syndesmophytes
  • Lucency btw ossification and vert body

Normal:

  • disc height
  • subchondral bone
  • facets

NO SMT

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2
Q

Ankylosing Spondylitis main radiographic features

A
  • Romanus lesions (corner erosion)
  • Shiny corner sign

Symmetrical BL sacroilitis

  • bead sign
  • sclerosis (+/- star sign)
  • ghost sign (complete fusion)

Marginal syndesmophytes

  • fine, multilevel
  • BL symmetrical
  • Bamboo spine
  • osteoporosis
  • carrot stick fracture
  • dagger sign
  • trolley track sign

NO SMT

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3
Q

Psoriatic Arthritis

A

Syndesmophytes:

  • non-marginal
  • asymmetrical

Increased ADI

U/L or B/L Asymmetrical sacroilitis
-bead sign, sclerosis

** Same radiographic findings as Reactive Arthritis in the spine **

NO SMT

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4
Q

Reactive Arthritis

A

** Same radiographic findings as Psoriatic Arthritis in spine **

+finger signs for next slide exam

NO SMT (double check?)

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5
Q

Osteitis Condensans Ilii

A
  • isolated to SIJ
  • B/L triangle sclerosis in ilium subchondral bone
  • just ilium side
  • no erosions or joint space change
  • just sclerosis

CAN SMT but not useful

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6
Q

Osteitis Pubis

A
  • erosions, motheaten, wider pubic symphysis
  • local osteoporosis

** Can’t tell appart from Infection off radiograph only **

No SMT?

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7
Q

CPPD

A

Small linear horizontal calcification in disc at multiple levels

*meniscus calcification

Can SMT

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8
Q

HADD

A

Small calcification anterior to C2

Calcification of longus colli muscle

Can SMT?

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9
Q

Hypertrophic Osteoarthropathy

A
  • long bone periostitis
  • digital clubbing
  • B/L symmetrical

SMT?

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10
Q

Differentials for B/L symmetrical sacroiliitis

A

AS
Enteropathic Arthritis
Osteitis Condensans Ilii

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11
Q

Differential for U/L sacroiliitis

A

Rheumatoid A.
Infection
DJD

Also Reactive / PA

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12
Q

Differential for B/L asymmetrical sacroiliitis

A

PA / Reactive

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13
Q

Differential for non-marginal syndesmophytes

A
  • DJD
  • DISH
  • PA / Reactive
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14
Q

Differential for Marginal syndesmophytes

A

-Ankylosing spondylitis

More?

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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

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16
Q

Differential for Ivory vertebra

A

Pagets (+ expansion)
Bastic mets
Hodgkins (+ anterior erosio / scallop)

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17
Q

Fibrous Dyslasia

A

-rare in the spine

+ more on other areas
+add later

NO SMT

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18
Q

Neurofibromatosis

A

Nerve sheath overgrowth (neoplasm)

  • cortex intact
  • no other changes
  • posterior scalloping
  • short angular scoliosis
  • kyphosis
  • IVF very large (means its in the IVF)

-scalloped ribs

No SMT

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19
Q

Differential for posterior scalloping

A 
Neurofibromatosis
Marfans
Ehlers Danlos
Achondroplasia
Osteogenesis imperfecta
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20
Q

Differential for sclerotic benign lesions

A

Osteoma
-gardner’s syndrome

Osteoid osteoma

Osteochondroma
-Hereditary multiple exostoses

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21
Q

Differential for lucent benign lesions

A

Haemangiona

Non-ossifying fibroma
Fibrocortical defect

Simple bone cyst
Aneurysmal bone cyst
Giant cell tumour

Osteobastoma

Enchondroma

  • Ollier’s disease
  • Marfucci’s syndrome

Chondroblastoma

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22
Q

Differential for sclerotic malignant lesion

A

Osteosarcoma
-Parosteal osteosarcoma

Metastasis

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23
Q

Differential for mixed sclerotic and lucent malignant lesion

A

Osteosarcoma

Mets

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24
Q

Differential for lucent malignant lesion

A

Plasmacytoma
Chordoma

Ewing’s sarcoma
Malignant GCT

Chondrosarcoma
Fibrosarcoma

Non-Hodgkins Lymphoma
Hodgkins Lymphoma

Multiple Myeloma
Mets

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25
Gardner’s Syndrome
- multiple osteomas (skull + hands and feet) - multiple solid osseous growth off cortex (Not really spine) Can SMT?
26
Hereditary Multiple Exostoses
Multiple osteochondromas -not realy spine Can SMT?
27
Osteoblastoma
- sclerotic periosteal rim around lucent nidus >25mm diameter - expansive, thins cortex - posterior elements of spine - C1 SP -scoliosis DDx: - Osteoid osteoma (smaller) - ABC (more expansion + no sclerotic rim) Can SMT?????
28
Ollier’s Disease
Multiple enchondromas
29
Marfucci’s Syndrome
Very rare
30
Chondroblastoma
- epiphyseal | - not realy spine
31
Parosteal Osteosarcoma
- lobulated sessile mass - lytic portions - juxtacortical (bone surface) DDx: osteoma (smoother) Not really spine, -posterior femur distal metaphysis
32
Plasmacytoma
- geographic lucent soap bubbly - expansive - fades away bone areas DDx: - chordoma - malignant GCT - mandible, ilium, vertebra, ribs - prox femur, scapula, sacrum
33
Chordoma
- invades surrounding STs - large - crosses disc space DDx: infection - rare - 85% sacrococcygeal or spheno-occipital
34
Hodgkins Lymphoma
-vertebral body - anterior scalloping of vert body - ivory vertebra DDx: - Multiple myeloma - Pagets
35
Jefferson’s fracture
APOM: lateral masses shift past articular processes C2 -say transverse ligament rupture if masses displaced >7mm
36
Hangman’s fracture
- B/L pedicle fracture - Lateral view -hyperextension injury
37
Differential for increased ADI
- agenesis dens - agenesis posterior arch - RA - PA - trauma - Downs - Marfans - Ehllers Danlos - Morquio’s
38
C1 posterior arch fracture
-look at images
39
Pillar fracture
- wider, altered shape | - look at images
40
Posterior ponticle
Bridging C1 poaterior arch and occiput Can SMT
41
Uncinate fracture
- tiny triangle on AP view | - rare
42
Differential for blurry C1 SP
Malignant: - chordoma - plasmacytoma - lytic mets Benign - osteoblastoma - ABC - GCT
43
Differential for missing pedicle on AP view
Lytic mets Osteobastoma Chordoma *multiple myeloma spares the pedicle
44
Differential for vertebral body destruction | Disc space intact
Lytic mets Chordoma Plasmacytoma
45
Differential for posterior elements destruction
Infection Lytic mets
46
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)
47
Differential for bony fragment posterior to C7
- clay shovelers fracture perfect match and displaced a bit) - persistent apophysis (smaller) - nuchal bone (vertical)
48
Agensis dens
- can’t see odontoid | - triangular anterior arch + bigger + more sclerotic
49
TVP fracture
C7 TVP | Lumbar TVP
50
Sacral fractures
- usually also pelvic fractures | - not on SLIDE exam 1?
51
Differential for single non-marginal syndesmophyte
Psoriatic arthritis DJD? DISH? **
52
Picture frame vertebra
Pagets
53
Sandwich vertebrae
Bone-in bone look Osteopetrosis
54
Rugger Jersey spine
Hyperparathyroidism
55
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)
56
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)
57
Risser Sign grading
1. 25% grown 2. 50% 3. 75% 4. 100% visible 5. Fused to ilium (closed)
58
Where is most degenerative spondylolysthesis? And Isthmic ? Dysplastic?
DJD spondy : L4 Pars fracture: L5 Congenital: L5
59
C1 posterior arch agenesis
- C2 megaspinous - C1 anterior arch hypertrophy DDx: occipitalisation NO SMT until proven stable
60
Agenesis pedicle
- winking owl - sclerotic C/L pedicle DDx: - Lytic mets - rotation Yes SMT. Stable
61
Agenesis articular process
Check images Yes SMT. Stable
62
Hemivertebra
Check images -short angular scoliosis NO SMT
63
Caudal Regression Syndrome
- sacral agenesis | - 2 lia articulate
64
Os odontoideum
- lucent gap - failure of fusion of dens to body - instable DDx: - mach effect - fracture NO SMT. Unstable
65
Ossiculum Terminale
-lucent gap at tip of dens Yes SMT. Insignificant
66
Spondyloschisis
- APOM: follow cortical lines of lamina - Lateral: no spinolamina junction line SBO at C1 DDx bifid SMT???
67
Clasp Knife deformity
- SBO at S1 | - long L5 SP
68
Butterfly Vertebra
- AP - triangular endplate lines Yes SMT. Insignificant
69
Occipital vertebrae
Epitransverse Paracondylar Paramastoid *check images NO SMT
70
Occipitalisation
- C1 fused to occiput - atlantoaxial instability NO SMT
71
Congenital block vertebrae
- wasp waist - posterior elements maybe fused too Can maybe SMT
72
Acquired block vertebrae
-barrel shape DDx: - infection - DJD - malignancy - surgical
73
Lumbosacral transational segment
Can SMT but different mechanics
74
Basilar impression
-dens passes McGregors line >45mm DDx: - occipitalisation - spondyloschisis - abnormal dens or atlas - klippel-fail - osetomalacia, tumour... NO SMT
75
Eagles syndrome
- stylohyoid ligaments calcified - looks like phalanx bones NO SMT
76
Facet Tropism
Asymmetrical facet orientation DDx: rotation Can SMT. Changes biomechanics
77
Schmorl’s Nodes
-clear corticated circular depression DDx: - compression fracture - nuchal impression Can SMT. Insignificant
78
Nuclear Impressions
- smooth indentation in endplate - AP: cupids bow DDs: lateral flexion Can SMT. Insignificant
79
Venous Channel of Hahn
-horizontal sclerosis in anterior middle of vertebra Can SMT. Insignificant
80
Omovertebral Bone
Bone from cervical spine to scapula SMT??
81
Klippel-Feil Syndrome | **
1. Block vertebrae 2. Basilar impression 3. Scoliosis 4. Sprengel’s deformity No SMT??
82
Achondropplasia
- bullet-nose vertebrae - posterior scalloping - short pedicle (stenosis) - large spinal curves - basilar impression - ping pong paddle ilium NO SMT
83
Cleidocranial Dysplasia
- small or no clavicle - small scap - biconvex vertebrae - SBO - hemivertebrae - large curves - small pelvis - small dens NO SMT
84
Spondyloepiphyseal Dysplasia
- widespread platyspondyly - bulbous vertebrae - large curves - short ilium
85
Holr-Oram Syndrome
- heart hand syndrome - sprengles deformity + more No SMT?
86
Fibrodysplasia Ossificans Progressiva
- striate muscle calcification - torticolis - osteomalacia - pathological fractures NO manual therapy at all
87
Marfan’s Syndrome
- tall vertebra - posterior scalloping - thin cortex - scoliosis NO SMT because lax dense?
88
Metaphyseal Dysplasia
- widespread platyspondyly - erlenmeyer flask deformity No SMT?
89
Nai-Patella syndrome
Not realy spine
90
Ehlers Danlos Syndrome
- widespread platyspondyly - posterior scalloping - large spinal curves - early DJD NO SMT. Weak bones
91
Hurler’s Syndrome
- short vertebrae - round vertebrae - small dens - paddle ribs - flair ilia - osteoporosis NO SMT
92
Morquio’s Syndrome
- widespread platyspondyly - centrall beaking vertebral bodies - large curves -small dens NO SMT
93
Osteogenesis Imperfecta
-brittle bone disease - biconcave vertebrae - platyspondyly - osteoporosis - multiple fractures - large curves NO SMT
94
Melorheostosis
- hyperostosis under periosteum along side of long bones - candle wax dripping Can SMT. Insignificant unless huge
95
Osteopathia Striata
- B/L - vertical linear opacities from metaphysis to diaphysis Cinicaly insignificant
96
Osteopoikilosis
- widespread small round opacities - B/L, symmetrical, uniform DDx: -mets Clinicaly insignificant
97
Osteopetrosis
-dense brittle bones - generalised sclerosis - bone within bone / sandwich vertebrae -erlenmeyer flask deformity NO SMT
98
Differential of widespread platyspondyly
Multiple myeloma Osteoporosis Spondyloepiphyseal dysplasia Meta[hyseal dysplasia Ehlers Danlos Morquio’s
99
Differential for posterior scalloping
Single: Neurofibromatosis ``` +?? Widespread: Achondroplasia Ehers Danlos Marfans ```
100
Differential for widespread bullet nose vertebrae
- Achondroplasia - Spondyloepiphyseal dysplasia - Hurlers
101
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
102
Compression fracture
- step defect - wedge deformity - linear zone of condensation - lucent line - paraspinal swelling - compression or pathalogical - new or old
103
Burst fracture
Like compression fracture but more central and increase AP diameter
104
Odontoid fracture
Type 1: - oblique tip - stable Type 2: -dense base Type 3: -odontoid onto body 2 and 3 not stable
105
Chance fracture
- horizontal splitting of spine and neural arch | - L1 to 3
106
Degenerative Joint Disease
- osteophytes - subchondral sclerosis - subchondral cysts Facets: - AP view - bubble like - Oblique: IVF narrowing - spondylolysthesis IVD: - less height - vacuum phenomenon - intercalary bone Uncinate: - cat ear - IVF stenosis - Lateral view: pseudofracture
107
Rheumatoid arthritis
- dens erosion - >ADI - stepladder spondylolysthesis NO SMT
108
Differential of irregular endplates
-compression fracture - nuclear impressions - schmorls nodes - lateral flexion -butterfly vertebrae +more?
109
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??
110
Osteomalacia
- lucencies between trabeculae / checkerboard - double cortex (thin too) - concave endplates / bowing - pseudofractures (ribs, pubic and ischial rami, scapula) NO SMT
111
Osteoporosis
- pencilled cortices - generalised decrease density - vertical trabeculae - empty box - wedging, vertebra plana - biconcave - hyperkyphosis DDx: Multiple myeloma Post-scheurmans NO SMT
112
Hyperparathyroidism
- rugger jersey spine - concave endplates - subperiosteal resorption of outer cortex (frayed look) - blurred cortices **Hallmark** - accentuated trabeculae - salt and pepper / granular - ST calcifications - clavicle resorption - Brown tumours: jaw, femur. Pelvis NO SMT
113
Rickets
-osteomalacia in child Radiographic features like adult + growth impairment NO SMT
114
Features of a benign tumour
Cortex: - thinning, scalloping, expansion - thickening - clear margins - solid periosteal reaction GEOGRAPHIC
115
Features of a malignant bone tumour
- motheaten - permeative - cortical destruction - wide transition zone -laminated or spiculated periosteal reaction
116
Osteoma
-skull
117
Osteoid osteoma
- sclerotic pedicle with acute angle scoliosis around it - small lucent nidus maybe - cortical thickening
118
Osteosarcoma
- wide tranzition, fracture, cortex destruction - sclerotix or mixed - periosteal reaction - ST involvement DDx: - Ewings sarcoma (kids) - Non-Hodgkins (elderly)
119
Metastasis
- diffuse opacities or densities or both - assymmetrical, non-uniform - NO expansion, cortex destruction, periosteal reaction - accross multiple bones
120
Enchondroma
- geographic - bit expansive - metaphyseal - endosteal scaloping -matrix calcification
121
Haemangioma
-vertical trabeculations DDx: -osteoporosis
122
Nonossifying fibroma
- diametaphyseal - cortical, eccentric - oval - thin cortex - hazy / smoky -2-7cm DDx: - fibrous dysplasia (bigger) - osteomyelitis - brodies abscess
123
Fibrocortical defect
- diametaphyseal - cortical /eccentric - thin cortex - hazy /smoky <2cm
124
Simple Bone Cyst
-fragment sign *Hallmark** - truncated, central - septations - mild expansion - endosteal scalloping DDx: - ABC - ++??
125
Aneurysmal Bone Cyst
- extreme expansion - eggshell cortex - buttressing - septation DDx: -SBC
126
Giant Cell Tumour
- up to joint lint *Hallmark** - epiphysis DDx: -Malignant GCT
127
Malignant GCT
-expansive distal radius GCT became expansive now -other place too
128
Ewings Sarcoma
-kids - cortical saucer - diaphyseal really looks like Osteosarcoma DDx: - Osteomyelitis - Osteosarcoma (ST mass) - Non-Hodgkins Lymphoma (ST mass)
129
Non-Hodgkins Lymphoma
-elderly - permeative / motheaten - medullary - patchy - ST mass DDx: - Osteosarcoma - Ewings (kids)
130
Chondrosarcoma
- calcific densities - expansion - meta/diaphysis - scalloping - septations -ST mass
131
Fibrosarcoma
-huge ST mass
132
Multiple Myeloma
- circumscribed - uniform size multiple circular lytic lesions - endosteal scalloping - decerae density - vertebra plana DDx: - Osteoporosis (looks same) - Lytic Mets
133
What tumours mostly go to the spine?
Hemangioma Mets Multiple Myeloma Osteoid Osteoma Sacrum: - Plasmacytoma - Chordoma +more?
134
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
135
Differential for hyperlucency in a chest x-ray
- Pneumothorax - COPD - Bulla -mastectomy
136
Pneumothorax:
- mediastinal shift - absent lung markings - shriveled up lung
137
COPD
- B/L generalised hyperlucent lungs - big lung size: flat diaphragm, heart lifted off it - Ephysema
138
Bulla
- still lung markings - thin wall of density around - circular -can be with emphysema
139
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
140
Pleural effusion
- lung base - meniscus sign - blunt costophrenic angle
141
Atelectasis
Uniform: - lobe shape - pulls mediastinum - no lung markings left Linear: - 1-3cm above diaphragm - horizontal
142
Pneumonia
- lobe shape - blurry borders - NO mediastinum shift - air bronchogram sign: fluid black white circles
143
Coin lesions
Mets: - spiculated - lobulated - multiple - hilar enlargement Bronchial carcinoma
144
Interstitial fibrosis
Mediastinal shift toward lesion Pneumoconiosis TB Sarcoidosis, RA, SLE
145
Miliary shadows
Spotty, similar densities TB - apical Sarcoidosis: middle Mets: lower
146
Pleural Plaques
- thickness around lung periphery - crosses structures - BL often
147
Mesothelioma
- decreased lung size because buldges onto lung field | - lobulated
148
Differential for unilateral hilar enlargement
- tumour | - infection
149
Differential for bilateral hilar enlargement
Sarcoidosis Mets Infection
150
Cardiac enlargement
Lateral thoracic AP thoracic
151
Mediastinal enlargement
,
152
Abdomina perforation
Air under diaphragm
153
Inguinal Hernia
Air under inguinal ligament
154
Hepatomegaly
Liver shadow over ilium and or midline
155
Bowel obstruction
Air fluid levels Small intestine visible Stripes over bowels
156
Retroperitoneal fluid
-blurred psoas lines
157
Kidney stones
Stag horn DDx gallstones
158
Pancreatic calcification
- spotty pancreas shape | - L and R oblique shape
159
Gall stones
- sclerotic rim - grapes - on the R
160
Ureteric calculi
larger than phleboliths or uterus fibroids
161
Splenic artery aneurysm
The only time u see the spnelic artery Looks like single gallstone on the L

Diagnostic Imaging (4 decks)

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