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Skeletal Rad > Test #3 > Flashcards

Test #3 Flashcards

1
Q

5 types of degenerative disorders?

A

OA (DJD), Erosive OA, DISH, Neurotropic Arthropathy, Synoviochondrometaplasia

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2
Q

4 types of inflammatory disorders?

A

RA, JRA, SLE, Scleroderma

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3
Q

4 types of Rheumatoid variants of inflammatory disorders?

A

Ankylosis Spondylitis, Enteropathic Arthropathy, Psoriatic Arthropathy, Reiter’s Syndrome

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4
Q

Rheumatoid variants will be positive for what & negative for what?

A

Positive for HLA-B27 & negative for RF

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5
Q

4 types of endocrine & metabolic related disorders?

A

Gout, CPPD crystal deposition disease (Pseudogout), calcium hydroxyapatite crystal deposition disease, ochronosis

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6
Q

2 types of primary synovial disorders?

A

Synoviochondrometaplasia & pigmented villonodular synovitis

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7
Q

2 types of infectious arthritis?

A

Pyogenic (septic) arthritis & non-pyogenic arthritis

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8
Q

Pyogenic arthritis is m/c caused by what organisms?

A

Staph. aureus

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9
Q

Non-pyogenic arthritis is m/c caused by what?

A

Tuberculosis

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10
Q

Motion at synarthrosis joint?

A

fixed or rigid

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11
Q

Motion at amphiarthrosis joint?

A

Slightly moveable

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12
Q

Motion at diarthrosis joint?

A

Freely moveable

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13
Q

Fibrous joints are composed of what type of tissue?

A

Interposed fibrous connective tissue

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14
Q

Cartilaginous joints are composed of what type of tissue?

A

Usually hyaline or fibrocartilage

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15
Q

Synovial joints are composed of what type of tissue?

A

Articular cavity is lined w/ synovial tissue

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16
Q

What is the procedure of choice for making diagnosis for arthritides?

A

Conventional Radiography

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17
Q

ABCDS of arthritis stands for what?

A

Alignment, Bony mineralization, Cartilage Space, Distribution, Soft Tissue

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18
Q

What type of imaging is used to evaluate degenerative & inflammatory changes in a joint & to document & assess spinal stenosis?

A

CT

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19
Q

What is bone scintigraphy used for?

A

Differentiate active disease from arthritis in remission

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20
Q

What is one use for MRI & arthritis?

A

Demonstrates rheumatoid nodules & synovial abnormalities

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21
Q

What is a negative for MRI & arthritis?

A

Can’t distinguish b/w inflammatory & non-inflammatory fluid

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22
Q

What are routine lab studies for arthritis?

A

Auto antibodies (RF, ANA) Uric acid, ESR, C-Reactive protein

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23
Q

What labs are not part of a routine study?

A

Histocompatability antigen (HLA-B27, HLA-DR4) & joint fluid aspiration

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24
Q

According to Resnick, radiographic diagnosis is based on what 2 fundamental parameters?

A

Morphology & distribution

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25
Q

Radiographic presentation is dependent upon what?

A

Type & stage of the disease

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26
Q

What type of changes occur when articular cartilage is site of original insult?

A

Degenerative changes

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27
Q

What type of changes occur when synovial membrane is site of original insult?

A

Inflammatory changes

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28
Q

What are 4 morphologic changes seen on xray?

A

Abnormalities of opposing joint margins
Changes in the radiographic joint space
Malalignment
Evidence of intra-articular disease

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29
Q

What is (Willy) Sutton’s Law?

A

When diagnosing, one should first consider the most obvious.

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30
Q

Types of appendicular arthritis from M/C to L/C?

A 
OA
RA
CPPD
Gout
Septic artritis
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31
Q

Types of axial arthritis from M/C to L/C

A 
OA
DDD
DISH
RA
Ankylosing spondylitis 
CPPD
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32
Q

Original site of injury for DJD is what?

A

Cartilage

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33
Q

DJD is AKA?

A

OA, OA spondylosis, DDD

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34
Q

What is the M/C form of arthritis?

A

DJD/OA

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35
Q

What are risk factors for DJD?

A

Heredity, gender, diet, obesity, age, physical activity

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36
Q

DISH is AKA

A

Forestier Disease

Senile Ankylosing hyperostosis

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37
Q

This is a generalized articular disorder w/ an axial predilection characterized by ligamentous ossification

A

DISH (Diffuse idiopathic skeletal hyperostosis

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38
Q

What is the etiology of DISH?

A

Unknown

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39
Q

What are some possible diseases assoc. w/ DISH?

A

Diabetes (30% of pts)
Dyslipidemia
Alcohol intake
Poor dietary habits postulated

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40
Q

Who does DISH M/C affect?

A

> 50yr old, caucasian males

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41
Q

What are some clinical manifestations of DISH?

A 
Intermittent spinal stiffness
Restricted ROM that's worse in morning, after activity, or cold weather
Pain related to enthesitis, tendonitis
Dysphagia
Increased predisposition to fx
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42
Q

What is occasionally the initial presenting complaint of DISH?

A

Dysphagia

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43
Q

What occurs mainly in the C-spine of approx. 50% of pts w/ DISH that may lead to neural compromise?

A

Ossification of the PLL

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44
Q

What is the definitive criteria for the spine on a imaging study of DISH?

A

Calcification/ossification along anterolateral aspect of 4 contiguous vertebrae
Relative preservation of disc height
Absence of pos. joint & SI joint ankylosis

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45
Q

What differentiates DISH from ankylosing spondylitis?

A

Absence of pos. joint & SI joint ankylosis

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46
Q

Where is DISH M/C frequently seen in the C-spine?

A

C4-C7, anteroinferior margin, extending down

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47
Q

Horizontal radiolucent clefts on an xray in the C-spine of a pt w/ DISH may result from?

A

Ant. disc bulges

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48
Q

Fxs in a DISH pt M/C occur in what spinal region?

A

Cervical

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49
Q

What is the M/C site of involvement for DISH in the thoracic region?

A

T7-T11

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50
Q

DISH in the lumbar region?

A

Upper segments & extends upwards

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51
Q

This has a definite assoc. w/ DISH

A

OPLL

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52
Q

What ethnicity is predisposed to develop OPLL?

A

Japanese

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53
Q

What age group is OPLL M/C seen in?

A

> 50 yr old

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54
Q

What ratio does OPLL affect men vs. women?

A

Men 2:1

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55
Q

What is the M/C complaint w/ OPLL?

A

Difficulty in walking d/t cord compression

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56
Q

What are typical signs of an upper motor neuron lesion?

A

Spastic weakness
Hyperreflexia w/ clonus
Pathological reflexes

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57
Q

What is the typical sign of a lower motor neuron lesion?

A

Spasm

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58
Q

What is the best clue for OPLL on an xray?

A

Flowing multilevel ossification pos. to the vertebral bodies

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59
Q

What are two specific radiographic features of OPLL?

A

Minimal disc disease

Absent facet ankylosis

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60
Q

Where does OPLL M/C occur?

A

Cervical spine (C3-C5)

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61
Q

How is asymptomatic OPLL managed?

A

observation, non-operative

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62
Q

How is symptomatic OPLL managed?

A

Decompression laminectomy

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63
Q

What is a lab test that can tell if a pt has DISH?

A

HLA-B8

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64
Q

After what age does primary DJD occur?

A

age 50

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65
Q

What is the main clinical manifestation of OA in the spine?

A

Neural deficits

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66
Q

What are common causes of canal stenosis?

A

DDD & facet arthrosis

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67
Q

Where are the M/C locations in the skeleton for OA?

A 
Hips & knees
Spine
1st MTP joint
AC joint
1st Metacarpal-trapezium
DIP & PIP
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68
Q

What are hallmarks for DJD in the extremities?

A

Reduced joint space (non-uniform)
Osteophyte formation
Subchondral sclerosis
Subchondral cysts

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69
Q

What are 4 hallmarks for DDD?

A

Reduced joint space (non-uniform)
Osteophyte formation
Subchondral sclerosis
Vacuum phenomena

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70
Q

What are the M/C radiographic features of DJD in the hip?

A

Sup. joint space compartment & subchondral cysts

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71
Q

What are subchondral cysts of the hip called?

A

Egger’s cysts

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72
Q

What are advanced changes in the hip for DJD?

A

Coxarthrosis
Malum coxae
Senilis

73
Q

Narrowing of axial compartment is a red flag for what?

A

Inflammatory process, not degeneration

74
Q

What is the primary etiology of DJD in the knee?

A

Chronic microtrauma

75
Q

What are secondary joint disorders that cause DJD in the knee?

A

Previous trauma
Joint instability
AVN

76
Q

What is the clinical profile for DJD in the knee?

A

Pain w/ utilization of joint
Variable joint swelling
Catching, locking, grinding in older pt

77
Q

What is the M/C radiographic features of the knee w/ DJD?

A

Narrowing of med. femorotibial joint space

78
Q

What are radiographic features of the knee w/ DJD?

A 
Small osteophytes
Mild subchondral sclerosis
Subchondral cysts <10%
Varus or valgus deformity 
Osteochondral bodies
Patellar tooth sign
79
Q

What is degenerative enthesopathy AKA?

A

Patellar tooth sign

80
Q

If only the patellofemoral joint compartment is involved, it’s not which type of OA?

A

Not primary OA

81
Q

What is indicated by patellofemoral joint pain & crepitus accentuated by knee flexion?

A

Chondromalacia patella

82
Q

Chondromalacia patella may be idiopathic or secondary to what?

A

Patellar trauma

83
Q

Chondromalacia patella occurs most often in who?

A

Adolescents & young adults

84
Q

What conditions predispose people to chondromalacia patella?

A

Patella alta
Increased valgus angle
Femoral condyle hyperplasia

85
Q

What is the best imaging procedure for chondromalacia patella?

A

MRI

86
Q

DJD in the ankle is usually secondary to what?

A

Trauma

87
Q

What joint in the foot is M/C affected by DJD?

A

1st MTP joint

88
Q

Osteophytes of the MTP M/C grow where?

A

Dorsal & medial aspect

89
Q

Is a valgus or varus deformity common in MTP joints w/ DJD

A

Valgus deformity

90
Q

M/C joint for DJD in the shoulder?

A

AC joint

91
Q

Ant. displacement of humeral head into the acromial process indicates what?

A

Rotator cuff injury, typically supraspinatus

92
Q

M/C location for DJD in the hands?

A

DIPs

93
Q

Heberden’s nodes are located by which joints?

A

DIPs

94
Q

Bouchard’s nodes are located at which joints?

A

PIPs

95
Q

Nodes are caused by what?

A

Osteophytes

96
Q

M/C location for degenerative spine disease?

A

C5-C7
T6-T12
L4-S1

97
Q

Degenerative changes may involve the spine at which sites?

A 
Synovial joints
Intervertebral disc
Vertebral bodies & annulus fibrosus
Fibrous articulation ligs.
Sites of lig. attachment
98
Q

Degenerative changes in the vert. bodies & annulus fibrous is called what?

A

Spondylosis deformans

99
Q

Degenerative changes in the fibrous articulations, ligs, sites of lig. attachment is known as what?

A

DISH

100
Q

If osteophyte is projecting off the endplate of a vert. body its called what?

A

Spondylophyte

101
Q

Radiographic features of degenerative spine disease in synovial joints?

A

Decreased joint space
Eburnation
Osteophytes

102
Q

Eburnation is AKA?

A

Subchondral sclerosis

103
Q

Not common, but can cause occipitocervical pain?

A

Atlantoaxial arthrosis

104
Q

Facet joint involvement is M/C in what part of the spine?

A

Mid & lower cervical & lower lumbar spine

105
Q

Best views to see facet involvement in degenerative spine disease?

A

AP & oblique

106
Q

M/C location for costovertebral involvement w/ degenerative spine disease?

A

Lower thoracic

107
Q

Syndrome where a person w/ costovertebral degeneration that gives rise to symptoms suggesting pt has a GI disorder?

A

Robert’s Syndrome

108
Q

Lower thoracic facet arthrosis that causes pain to be projected or radiated down into lower lumbar area?

A

Maigne’s syndrome

109
Q

Nuclear vacuum is pathoneumonic to what?

A

DDD

110
Q

Radiographic findings of DDD?

A 
Loss of disc height
Osteophytes
Eburnation
Vaccuum phenomena
Subluxation
111
Q

This is due to uncovertebral joint arthrosis & facet joint arthrosis at the same time

A

Hour glass appearance to IVF

112
Q

Kissing spinouses is AKA?

A

Baastrup’s Syndrome

113
Q

Degenerative spondylolisthesis is M/C in the C-spine at what level & M/C in the spine overall at what level?

A

C7; L4

114
Q

Osteophytes that have turned up or down?

A

Claw osteophytes

115
Q

Thought tot be caused by tears in Sharpey’s fibers?

A

Annular vacuum phenomena

116
Q

Nuclear vacuum phenomena tells you what 3 things?

A

Pt has DDD, doesn’t have infection, & the segment moves

117
Q

Ant. & lat. osteophytes d/t ant. & anterolateral disc herniation initiated by abnormalities of peripheral fibers of annulus & vert. body?

A

Spondylosis Deformans

118
Q

Degeneration of innermost portion of annulus, dehydration of nucleus, breakdown of cartilage plate?

A

Intervertebral chondrosis/osteochondrosis

119
Q

Where do osteophytes occur in SI joints that are degenerating?

A

Ant. aspect of synovial portion at sup. or inf. aspect

120
Q

This is a clinical & radiographic variant of DJD that is AKA inflammatory osteoarthritis?

A

Erosive Osteoarthritis

121
Q

Erosive osteoarthritis is M/C in who?

A

Middle aged females

122
Q

What symptoms manifest clinically w/ erosive osteoarthritis?

A

Episodic acute inflammation of DIP & PIP
Symmetric
Pain, edema, redness, nodules, decreased ROM

123
Q

What type of laboratory manifestations are encountered w/ erosive osteoarthritis?

A

Normal to slightly elevated ESR

Negative for rheumatoid factor

124
Q

What are two pathological features of erosive osteoarthritis?

A

Cartilage degeneration

Synovial proliferation

125
Q

What radiographic sign is assoc. w/ erosive osteoarthritis?

A

Gull wings sign

126
Q

What is the Gull Wings Sign?

A

central erosion proximal & peripheral erosions distal

127
Q

What are some radiographic manifestations of erosive osteoarthritis?

A

Osteophytes, loss of joint space, sclerosis

Erosions, periostitis, ankylosis

128
Q

Destructive arthropathy which occurs when pain & proprioception are diminished & mobility maintained is known as what?

A

Neurotrophic Arthropathy

129
Q

What is neurotrophic arthropathy AKA?

A

Charcot joint

130
Q

What are some underlying conditions assoc w/ neurotrophic arthropathy?

A 
Diabetes mellitus (M/C)
Syphilis
Syringomyelia
Congential indifference to pain
Spina bifida
131
Q

What are clinical manifestations of Neurotrophic Arthropathy?

A 
Recurrent painless effusions
Relatively painless instability
Enlargement, crepitus, "bag of bones"
Gait disturbances
Loss of DTRs, pain insensitivity
132
Q

Where is neuortrophic arthropathy manifest in diabetes?

A

Ankle, subtalar joints, feet

133
Q

Where does neuortrophic arthropathy manifest in syphilis?

A

Lumbar, knee, ankle

134
Q

Where does neuortrophic arthropathy manifest in alcoholism?

A

Tarsals, metatarsals

135
Q

Where does neuortrophic arthropathy manifest in syringomyelia?

A

Shoulder, elbow, wrist

136
Q

What are two types of neuortrophic arthropathy seen on xrays?

A

Hypertrophic & atrophic

137
Q

What are the 6 D’s of hypertrophic neuortrophic arthropathy?

A 
Distention
Density
Debris
Disorganization
Dislocation
Destruction
138
Q

Where is hypertrophic neuortrophic arthropathy most pronounced?

A

In weight-bearing joints

139
Q

What are terms assoc. w/ neuortrophic arthropathy?

A 
Bag of bones
Licked candy stick
Tumbling building block spine
Jigsaw spine
Surgical amputation
140
Q

What are the top DDx for neuortrophic arthropathy?

A

Pyogenic infections
Non-pyogenic infections
DDD
Hemophilia

141
Q

This is a benign arthropathy where synovial tissue undergoes metaplastic transformation to produce foci of cartilage

A

Synoviochondrometaplasia

142
Q

Where is the M/C location for Synoviochondrometaplasia?

A

Knee

143
Q

Secondary Synoviochondrometaplasia is often seen in cases of what?

A

DJD

144
Q

Who does Synoviochondrometaplasia affect more, males or females?

A

Males 3,2:1

145
Q

What age group is most affected by Synoviochondrometaplasia?

A

third to fifth decade (20-40yrs)

146
Q

What are some radiographic manifestations of Synoviochondrometaplasia?

A 
Joint effusion (Hoffa's fat is obliterated)
Many radiopaque joint bodies
147
Q

What is the best imaging method to see Synoviochondrometaplasia?

A

CT

148
Q

What are skeletal locations affected by Synoviochondrometaplasia?

A 
Knee (M/C)
Hip
Elbow
Ankle
Shoulder
Wrist
149
Q

Chronic & progressive autoimmune system inflammatory disorder that primarily affects the synovium & characterized by destruction of bone & cartilage; M/C chronic inflammatory arthritide

A

RA

150
Q

What is the most frequently assoc. human leukocyte antigen w/ the development of RA?

A

HLA-DR4

151
Q

What is the ratio of males to females affected by RA?

A

3:1 females to males

152
Q

What age group is M/C affected by RA?

A

20-60 yrs w/ a peak b/w 40-60 yrs

153
Q

RA increases a pt’s risk of developing what diseases?

A

Cardiovascular disease, lymphoma, leukemia

154
Q

What are some typical clinical symptoms assoc. w/ RA?

A

Stiffness in morning & at times of inactivity (Jelling Phenomenon)
Often bilateral & symmetric joint involvement
Joint deformity
Malaise, weakness, weight loss, myalgias, fever
Neuropathy median & ulnar nerve distribution
Non-tender rheumatoid nodules (20%)

155
Q

In this syndrome a pt has RA, dry eyes, & dry mouth?

A

Sjogren’s syndrome

156
Q

In this syndrome a pt has RA, leukopenia, & splenomegaly

A

Felty’s syndrome

157
Q

In this syndrome, a pt has RA & pneumoconiosis

A

Caplan’s syndrome

158
Q

MCP joint nodes are called what?

A

Hagar’s nodes

159
Q

What lab results would a person w/ RA have?

A 
\+RF test
Normochromic, normocytic anemia
Increased ESR
\+ANA
C-reactive protein
160
Q

Acute synovitis in RA leads to what?

A

edema, effusion hyperemia

161
Q

Synovial proliferation in RA leads to what?

A

Pannus that spreads over the articular surface

162
Q

Pannus plus “bare areas” leads to what in RA?

A

Marginal erosions

163
Q

In RA, articular cartilage breaks down d/t what?

A

Pannus enzymes & interference w/ nutrition

164
Q

In RA, intraosseous pannus &/or synovial fluid leads to what?

A

Synovial cysts

165
Q

Where is the M/C location to see early manifestations of RA?

A

Hand & wrist, specifically 2nd & 3rd MCP joints, 2nd & 3rd prox. phalangeal joints

166
Q

Approx. 80% of pts w/ RA that shows up in the hands have involvement in what area of the spine?

A

C-spine

167
Q

What is the M/C imaging procedure to assess suspected cases of RA?

A

X-ray

168
Q

What are the earliest radiographic findings of RA?

A

Soft tissue swelling & osteopenia

169
Q

What is MRI good for w/ RA?

A

Sensitive in detection of erosions & synovial proliferation

170
Q

What is the main radiographic manifestation of RA?

A

bilateral symmetry (may by unilateral initially)

171
Q

What are some radiographic manifestations of RA?

A 
Periarticular soft tissue swelling
Juxta-articular osteoporosis
Uniform loss of joint space
Marginal erosion (rat bite)
Juxta-articular periostitis
Subchondral cysts
Deformity
Ankylosis
172
Q

Where is the earliest place to see marginal erosion?

A

bare areas, where synovium contacts bone

173
Q

What is the M/C radiographic manifestations of RA in the C-spine?

A

Atlantoaxial instability (PADI less than 14mm)

174
Q

This is d/t loss of disc height, apophyseal joint disease, & lig. laxity

A

Stepladder or doorstep deformity

175
Q

This is bilateral protusion of acetabulum; M/C cause is RA

A

Otto’s pelvis

176
Q

This deformity is caused by extension of the DIP joint & flex at the PIP joint; typically seen in thumb

A

Boutonniere Deformity

177
Q

This deformity is caused by flexion at the DIP & extension at the PIP

A

Swan neck deformity

178
Q

What is the main ddx for spotty carpal sign?

A

Gout

179
Q

Seronegative chronic arthritis is AKA

A

Still’s disease

Skeletal Rad (5 decks)

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