Test #3 Flashcards
1
Q
Bone death d/t inadequate blood supply. M/C hematologic condition of bone
A
Osteonecrosis
2
Q
What are AKAs for osteonecrosis?
A
Ischemic necrosis
Aseptic necrosis
3
Q
Osteonecrosis that has juxtaarticular involvement
A
Avascular necrosis
4
Q
Osteonecrosis that has metaphyseal or diaphyseal involvement
A
Medullary bone infarct
5
Q
Small fragment of bone that’s necrotic
A
Osteochondritis dissecans
6
Q
What are 4 causes of in bone infarction?
A
Intraluminal obstruction
Arterial wall disease
Vascular compression
Physical disruption of vessel
7
Q
What are causes of osteonecrosis?
A
(VINDICATE) Vascular - Sickle cell anemia INfection - septic emboli Drugs - alcoholism/corticosteroids Inflammatory - Pancreatitis Congenital - Gaucher's dx Autoimmune - SLE, RA Trauma - Radiation, fx, dysbarism Endocrine - Cushing's dx
8
Q
Central area of necrosis surrounded by ischemic & healing tissue indicates what type of infarction?
A
Metaphyseal-Diaphyseal infarction
9
Q
What’s the M/C type of Metaphyseal-Diaphyseal infarction?
A
Medullary
10
Q
Cortical involvement in metaphyseal-diaphyseal infarction indicates what condition?
A
Sickle cell
11
Q
What are the M/C locations for metaphyseal-diaphyseal infarcts?
A
Dist. femur
Prox. tibia
Prox humerus
12
Q
What is the procedure of choice to detect metaphyseal-diaphyseal infarcts?
A
MRI followed by bone scintigraphy
13
Q
What is the 1st radiographic sign of metaphyseal-diaphyseal infarcts?
A
Area of rarefaction (area is osteopenic)
14
Q
What are the M/C locations of epiphyseal necrosis (AKA Avascular necrosis, bone-end necrosis)?
A
Femoral & humeral head
Dist. femur
15
Q
What are the 4 pathologic stages of epiphyseal necrosis?
A
Avascular
Revascularization
Remodeling & repair
Deformity
16
Q
Which part of a ball & socket joint undergoes necrosis?
A
The convex surface
17
Q
What is the most reliable finding for avascular necrosis (AKA epiphyseal necrosis, bone-end necrosis)?
A
Subchondral fx AKA Crescent sign
18
Q
What is the earliest radiographic manifestation of avascular necrosis (AKA epiphyseal necrosis, bone-end necrosis)?
A
A little bit of sclerosis
19
Q
What is the radiographic staging system for rating avascular necrosis?
A
FICAT
20
Q
Osteonecrosis of the hip is known as what in the adult?
A
Chandler’s disease
21
Q
What age/gender is affected by osteonecrosis of the hip AKA Chandler’s disease?
A
M:F 4:1, 30-70 yrs of age
22
Q
What is the typical distribution of osteonecrosis of the hip AKA Chandler’s disease?
A
50% bilateral & asymmetrical
23
Q
What shape is the necrotic area of osteonecrosis of the hip AKA Chandler’s disease and what region does it affect?
A
Wedged shaped; anterosuperior weight-bearing region
24
Q
What signs are assoc. w/ osteonecrosis of the hip AKA Chandler’s disease??
A
Snowcap sign (sclerosis) Crescent sign (subchondral fx) - Most reliable Bite sign (wedged or semilunar shape) Step defect (cortical collapse)
25
What is SONK?
Spontaneous OsteoNecrosis of the Knee
26
What is the M/C site for SONK?
Medial condyle of dist. femur
| Lateral condyle
27
Age/gender most affected by SONK?
slight female predominance usually 60+
28
What are the clinical signs of SONK?
Acute sudden onset of pain
Gradual increase in intensity
Tenderness over involved area
29
How long does it take for radiographic manifestations of SONK to show up?
5 weeks to months
30
What are some radiographic signs of SONK?
```
Altered articular contour (flattening)
Altered bone density
Crescent sign
May see loose bodies
Articular changes
```
31
3 Categories of osteochondrosis
1st - True AVN's - Legg Calve Perthe
2nd - Osteochondrosises d/t trauma - Osgood-Schlatters
3rd - Growth variants - Kohler's disease
32
AVN of the humoral head is known as?
Hass's disease
33
M/C cause of Hass's disease
predisposing factors (fx, dislocations)
34
AVN of scaphoid is known as?
Preiser's disease
35
M/C cause of Preiser's?
secondary to fx (usually through the neck)
36
AVN commonly of the 2nd metatarsal head?
Freiberg's disease
37
Age/gender M/C affected by Freiberg's?
F>M, 13-18 yrs of age
38
Freiberg's is usually assoc. w/ what?
Shoes, high heels
39
What are radiographic signs of Freiberg's?
May have loose body
Metatarsal head may by more splayed out or flattened
Can see crescent sign
40
AVN of carpal lunate?
Keinboch's disease
41
Age/gender M/C affected by Keinboch's?
M:F 9:1, 20-40 yrs of age
42
M/C cause of Keinboch's?
Trauma or repetitive work
43
What is the normal variant assoc. w/ Keinboch's?
75% of pts have (-) ulnar variants (ulnar too short)
44
AVN of the capitulum?
Panner's Disease
45
Panner's disease usually affects who?
Kids in throwing sports (males 4-10yoa)
46
AVN of tarsalnavicular?
Kohler's Disease
47
What age is affected by Kohler's?
~5 yrs of age
48
AVN of the femoral capital epiphysis. AKA as Coxa Plana
Legg-Calve-Perthe
49
Age/gender M/C affected by Legg-Calve-Perthe?
Males, 3-12 yrs, peak age 5-7
50
Legg-Calve-Perthe is assoc. w/ what signs?
```
Waldenstrom sign (increased med. joint space)
Crescent sign (subchondral fx)
Snow-cap sign (sclerosis)
Gage's sign (shortening of femoral neck)
Sagging Rope Sign - Other side of femoral head projected differntly d/t deformity
```
51
This "disease" is characterized by soft tissue changes, displaced skin lines, patella lig. thickening, & blurring of Hoffa's fat.
Osgood-Schlatter's Disease
52
Age/gender M/C affected by Osgood-Schlatter's?
Males 11-15 yrs of age
53
Clinical signs of Osgood-Schlatters?
Pain, swelling over ant. tuberosity
| Pain that is made worse in tendon against resistance
54
This is AKA vertebral epiphysitis, juvenile kyphosis, & osteochondrosis juvenilis dorsi
Scheuermann's Disease
55
Age/gender M/C affected by Scheuermann's?
Males 13-17
56
What spinal region is Scheuermann's M/C seen?
75% in mid-thoracic
57
What are the 3 radiographic criteria for Scheuermann diagnosis?
1. Ant. wedging involving at least 3 contiguous vertebrae
2. Irregular endplates d/t Schmorl's nodes
3. Decreased disc height
58
This is characterized by a small necrotic segment of subchondral bone
Osteochondritis Dissecans AKA Koenig's disease
59
What are some causes of Osteochondritis Dissecans AKA Koenig's disease?
History of trauma may or may not elicit
| Shearing, rotatory forces may initiate
60
Age/gender M/C affected by Osteochondritis Dissecans AKA Koenig's disease?
Males 11-20 yrs of age
61
What is the M/C locations of Osteochondritis Dissecans AKA Koenig's disease?
Lat. aspect of med. condyle
| Dome of talus
62
What is the best view to see Osteochondritis Dissecans AKA Koenig's disease?
Intercondylar view
63
Growth variant that affects the secondary center of ossification of calcaneous?
Sever's (sp) disease
64
This is characterized by deficiencies of various clotting factors leading to bleeding into joints & bones
Hemophilia
65
Hemophilia is M/C caused by lack of which factors?
```
Factor VIII (Hemophilia A, Classic)
Factor IX (Hemophilia B, Christmas disease)
```
66
M/C locations to see hemophilia, clinically?
Knee
Ankle
Elbow
67
What are the stage of hemophilic arthropathy?
1. Soft tissue swelling
2. Osteoporosis
3. Osseous lesions
4. Cartilage destruction
5. Joint disorganization
68
What are the radiographic features of hemophilia in the knee?
Enlarged epiphysis
Widened intercondylar notch
Squared inferior patella
69
What "deformity" is assoc. w/ hemophilia in the ankle?
Tibiotalar slant deformity
70
What are the 4 M/C causes of tibiotalar slant deformity?
1. Hemophilia
2. Sickle cell anemia
3. JRA
4. Metaphysial/Epiphysial dysplasia (MED)
71
Pseudotumors in the femur & pelvis are d/t what?
Intraosseous hemorrhage
72
This is congenital hemolytic anemia charac. by abnormal genetically transmitted hemoglobin
Sickle cell anemia
73
What is the most symptomatic type of sickle cell anemia?
Homozygous form HbS-S
74
What age range does onset of sickle cell usually occur?
6 months - 2 years
75
This is painful swelling of the fingers & toes during the 1st several years of life assoc. w/ sickle cell
Dactylitis (Hand-Foot syndrome)
76
Infections assoc. w/ sickle cell are caused by what organism?
Salmonella
77
What are the 4 M/C causes of generalized osteopenia, radiographically?
1. Osteoporosis
2. Osteomalacia
3. Hyperparathyroidism
4. Infiltrative disease
78
What radiographic sign is seen w/ sickle cell in the spine?
Reynold's sign or H-shaped vertebra
79
What radiographic appearance does sickle cell have in the skull?
Hair on end appearance (more common in thalassemia)
80
What are radiographic features of sickle cell in the hands & feet?
Destructive bone lesions as a result of infarction &/or Salmonella infection
81
What are radiographic features of sickle cell in the long bones?
Changes related to infarction & infection
AVN of femoral & humeral heads
Tibiotalar slant deformity
82
What are radiographic features of sickle cell in the pelvis & spine?
Sclerotic changes are common
83
What are radiographic features of sickle cell in the soft tissues?
Extramedullary hematopoiesis
Cholelithiasis
Punctate splenic calcification after infarction
84
This is a hereditary disorder of hemoglobin synthesis leading to anemia
Thalassemia
85
What is thalassemia AKA?
Cooley's anemia
| Mediterranean anemia
86
What are the 3 forms of thalassemia?
Major
Intermediate
Minor
87
What are clinical features of thalassemia?
```
Onset - last half of 1st year
Survival beyond 3rd decade rare
Pallor, underdevelopment, organomegaly
Altered facies
Decreased hemoglobin
```
88
What are some radiographic features assoc. w/ thalassemia?
Coarse trabeculation (honeycomb appearance)
Hair-on-end in skull
Sinuses obliterated (rodent facies)
Cardiomegaly
Erlenmeyer flask deformity (d/t undertubulation)
89
Infection of bone & marrow?
Osteomyelitis
90
Implies a septic process of the joint itself?
Septic arthritis
91
Contamination of cutaneous, subcutaneous, tendinous, ligamentous, & bursal structures?
Soft tissue infection
92
Type of osteomyelitis M/C caused by staph aureus?
Suppurative osteomyelitis
93
Type of osteomyelitis M/C caused by TB (Mycobacterium tuberculosis)?
Non-suppurative osteomyelitis
94
Risk factors for osteomyelitis?
```
Immunosuppressed individuals
Alcoholics
Newborns
IV drug users
Diabetes
Sickle-cell
Post-surgical
Vascular insufficiency
```
95
What organisms other than M. tuberculosis are assoc. w/ Non-Suppurative Osteomyelitis?
```
Treponema pallidum (syphilis)
Actinomycosis (fungal)
Coccidioidomycosis (fungal)
```
96
What are routes of contamination for infection?
Hematogenous
Contiguous Source
Direct Implantation
Postoperative Infection
97
95% of pyogenic infections involve what part of the skeleton?
Appendicular skeleton
98
What bones of the appendicular skeleton are most often affected by infection?
Femur (M/C)
Tibia
Humerus
Radius
99
What is the M/C age group affected by infections?
2-12 yrs of age (mostly males)
100
What are the clinical manifestations of bone infection in childhood & infancy?
Sudden onset of high fever
Localized pain & swelling
Chills
Loss of limb function
101
What are the clinical manifestations of bone infection in the adult?
Insidious onset
Fever & malaise
Edema, erythema, & pain
102
Bone infection is frequently assoc. w/ pre-existing infections of what other systems?
Genitourinary
Skin
Respiratory
103
What are the M/C organisms assoc. w/ Mainliner's Syndrome?
Staph. aureus
| Pseudomonias
104
Mainliner's Syndrome frequently involves what joints?
```
SC joint
Spine
SI joints
Pubic Symphysis
(S Joints)
```
105
What spinal region are most infections found?
T/L junction
106
What spinal region is M/C affected by Mainliner's Syndrome?
Csp
107
What are lab features assoc. w/ bone infection?
Elevated white cell count
Schilling shift to the left (increase in neutrophils & band cells)
Elevated ESR
(+) blood cultures w/ hematogenous
108
What path. features of the infantile pattern of vascular supply?
Vessels may penetrate the physis
| Higher incidence of septic arthritis
109
What path. features of the childhood pattern of vascular supply?
Epiphyseal supply is separate
| Hematogenous osteomylelitis affects the metaphysis more often & not physis or epiphysis
110
What path. features of the adult pattern of vascular supply?
Metaphyseal vessels gradually penetrate the physis
| Increased incidence of septic arthritis secondary to osteomyelitis
111
What is the mechanism assoc. w/ hematogenous dissemination?
Usually direct extension from extravascular sites of infection
112
Necrotic bone d/t infarction, looks chalky?
Sequestrum
113
Bony collar from periosteal new bone, b/co new cortex?
Involucrum
114
Defect in involucrum leads to discharge. Most often assoc. w/ chronic osteomyelitis
Cloaca
115
This is a squamous cell carcinoma assoc. w/ Cloaca?
Marjolin's ulcer
116
Time before osseous changes are evident radiographically in the extremity? Spine?
Extremity - about 10 days
| Spine - about 21 days
117
What are imaging features seen in the extremity assoc. w/ infection?
```
Soft tissue changes (earliest findings)
M/C in metaphysis
Moth-eaten or permeative pattern of destruction
Medullary & cortical destruction
Periosteal response (Codman's triangle)
```
118
What are late changes seen in extremity during infection?
Sequestrum
Invlucrum
Cloaca
Sclerosis
119
What are imaging features seen in the spine <20 yrs assoc. w/ infection?
Initial disc involvement --> disc narrowing
Paraspinal edema
Endplate destruction
Osteolysis
120
What are imaging features seen in the adult spine assoc. w/ infection?
Begins in vert. body then disc
Vertebrae destruction, collapse, paraspinal swelling
Bony ankylosis may be seen
121
Localized, aborted suppurative osteomyelitis. M/C staph aureus. Often assoc. w/ hx of previous infection. Localized pain worse at night relieved by aspirin
Brodies Abscess
122
What age/gender is Brodies Abscess seen in?
Young, male, children
123
Where are the M/C skeletal locations for Brodies Abscess?
```
Metaphysis
Distal tibia
Prox. tibia
Fibula
Dist. radius
```
124
What is the radiographic features of a Brodies Abscess?
Oval, elliptical, or serpiginous radiolucency w/ rim of sclerosis
125
What are the general charac. of septic arthritis?
M/C below age 30
M/C monoarticular
M/C caused by staph aureus
M/C knee & hip
126
What are clinical features of septic arthritis?
Restricted ROM
Erythema
Fever
Labs typical infection
127
What are radiographic features of septic arthritis?
```
Soft tissue changes in about 3 days
Loss of subchondral white line
Juxta periarticular osteopenia
Destruction of articular ends
Bony or fibrous ankylosis
```
