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Skeletal Rad II > Test #3 > Flashcards

Test #3 Flashcards

1
Q

Bone death d/t inadequate blood supply. M/C hematologic condition of bone

A

Osteonecrosis

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2
Q

What are AKAs for osteonecrosis?

A

Ischemic necrosis

Aseptic necrosis

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3
Q

Osteonecrosis that has juxtaarticular involvement

A

Avascular necrosis

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4
Q

Osteonecrosis that has metaphyseal or diaphyseal involvement

A

Medullary bone infarct

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5
Q

Small fragment of bone that’s necrotic

A

Osteochondritis dissecans

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6
Q

What are 4 causes of in bone infarction?

A

Intraluminal obstruction
Arterial wall disease
Vascular compression
Physical disruption of vessel

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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
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8
Q

Central area of necrosis surrounded by ischemic & healing tissue indicates what type of infarction?

A

Metaphyseal-Diaphyseal infarction

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9
Q

What’s the M/C type of Metaphyseal-Diaphyseal infarction?

A

Medullary

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10
Q

Cortical involvement in metaphyseal-diaphyseal infarction indicates what condition?

A

Sickle cell

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11
Q

What are the M/C locations for metaphyseal-diaphyseal infarcts?

A

Dist. femur
Prox. tibia
Prox humerus

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12
Q

What is the procedure of choice to detect metaphyseal-diaphyseal infarcts?

A

MRI followed by bone scintigraphy

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13
Q

What is the 1st radiographic sign of metaphyseal-diaphyseal infarcts?

A

Area of rarefaction (area is osteopenic)

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14
Q

What are the M/C locations of epiphyseal necrosis (AKA Avascular necrosis, bone-end necrosis)?

A

Femoral & humeral head

Dist. femur

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15
Q

What are the 4 pathologic stages of epiphyseal necrosis?

A

Avascular
Revascularization
Remodeling & repair
Deformity

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16
Q

Which part of a ball & socket joint undergoes necrosis?

A

The convex surface

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17
Q

What is the most reliable finding for avascular necrosis (AKA epiphyseal necrosis, bone-end necrosis)?

A

Subchondral fx AKA Crescent sign

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18
Q

What is the earliest radiographic manifestation of avascular necrosis (AKA epiphyseal necrosis, bone-end necrosis)?

A

A little bit of sclerosis

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19
Q

What is the radiographic staging system for rating avascular necrosis?

A

FICAT

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20
Q

Osteonecrosis of the hip is known as what in the adult?

A

Chandler’s disease

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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

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22
Q

What is the typical distribution of osteonecrosis of the hip AKA Chandler’s disease?

A

50% bilateral & asymmetrical

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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

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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)
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25
Q

What is SONK?

A

Spontaneous OsteoNecrosis of the Knee

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26
Q

What is the M/C site for SONK?

A

Medial condyle of dist. femur

Lateral condyle

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27
Q

Age/gender most affected by SONK?

A

slight female predominance usually 60+

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28
Q

What are the clinical signs of SONK?

A

Acute sudden onset of pain
Gradual increase in intensity
Tenderness over involved area

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29
Q

How long does it take for radiographic manifestations of SONK to show up?

A

5 weeks to months

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30
Q

What are some radiographic signs of SONK?

A 
Altered articular contour (flattening)
Altered bone density
Crescent sign
May see loose bodies
Articular changes
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31
Q

3 Categories of osteochondrosis

A

1st - True AVN’s - Legg Calve Perthe
2nd - Osteochondrosises d/t trauma - Osgood-Schlatters
3rd - Growth variants - Kohler’s disease

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32
Q

AVN of the humoral head is known as?

A

Hass’s disease

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33
Q

M/C cause of Hass’s disease

A

predisposing factors (fx, dislocations)

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34
Q

AVN of scaphoid is known as?

A

Preiser’s disease

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35
Q

M/C cause of Preiser’s?

A

secondary to fx (usually through the neck)

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36
Q

AVN commonly of the 2nd metatarsal head?

A

Freiberg’s disease

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37
Q

Age/gender M/C affected by Freiberg’s?

A

F>M, 13-18 yrs of age

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38
Q

Freiberg’s is usually assoc. w/ what?

A

Shoes, high heels

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39
Q

What are radiographic signs of Freiberg’s?

A

May have loose body
Metatarsal head may by more splayed out or flattened
Can see crescent sign

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40
Q

AVN of carpal lunate?

A

Keinboch’s disease

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41
Q

Age/gender M/C affected by Keinboch’s?

A

M:F 9:1, 20-40 yrs of age

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42
Q

M/C cause of Keinboch’s?

A

Trauma or repetitive work

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43
Q

What is the normal variant assoc. w/ Keinboch’s?

A

75% of pts have (-) ulnar variants (ulnar too short)

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44
Q

AVN of the capitulum?

A

Panner’s Disease

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45
Q

Panner’s disease usually affects who?

A

Kids in throwing sports (males 4-10yoa)

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46
Q

AVN of tarsalnavicular?

A

Kohler’s Disease

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47
Q

What age is affected by Kohler’s?

A

~5 yrs of age

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48
Q

AVN of the femoral capital epiphysis. AKA as Coxa Plana

A

Legg-Calve-Perthe

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49
Q

Age/gender M/C affected by Legg-Calve-Perthe?

A

Males, 3-12 yrs, peak age 5-7

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50
Q

Legg-Calve-Perthe is assoc. w/ what signs?

A 
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
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51
Q

This “disease” is characterized by soft tissue changes, displaced skin lines, patella lig. thickening, & blurring of Hoffa’s fat.

A

Osgood-Schlatter’s Disease

52
Q

Age/gender M/C affected by Osgood-Schlatter’s?

A

Males 11-15 yrs of age

53
Q

Clinical signs of Osgood-Schlatters?

A

Pain, swelling over ant. tuberosity

Pain that is made worse in tendon against resistance

54
Q

This is AKA vertebral epiphysitis, juvenile kyphosis, & osteochondrosis juvenilis dorsi

A

Scheuermann’s Disease

55
Q

Age/gender M/C affected by Scheuermann’s?

A

Males 13-17

56
Q

What spinal region is Scheuermann’s M/C seen?

A

75% in mid-thoracic

57
Q

What are the 3 radiographic criteria for Scheuermann diagnosis?

A
  1. Ant. wedging involving at least 3 contiguous vertebrae
  2. Irregular endplates d/t Schmorl’s nodes
  3. Decreased disc height
58
Q

This is characterized by a small necrotic segment of subchondral bone

A

Osteochondritis Dissecans AKA Koenig’s disease

59
Q

What are some causes of Osteochondritis Dissecans AKA Koenig’s disease?

A

History of trauma may or may not elicit

Shearing, rotatory forces may initiate

60
Q

Age/gender M/C affected by Osteochondritis Dissecans AKA Koenig’s disease?

A

Males 11-20 yrs of age

61
Q

What is the M/C locations of Osteochondritis Dissecans AKA Koenig’s disease?

A

Lat. aspect of med. condyle

Dome of talus

62
Q

What is the best view to see Osteochondritis Dissecans AKA Koenig’s disease?

A

Intercondylar view

63
Q

Growth variant that affects the secondary center of ossification of calcaneous?

A

Sever’s (sp) disease

64
Q

This is characterized by deficiencies of various clotting factors leading to bleeding into joints & bones

A

Hemophilia

65
Q

Hemophilia is M/C caused by lack of which factors?

A 
Factor VIII (Hemophilia A, Classic)
Factor IX (Hemophilia B, Christmas disease)
66
Q

M/C locations to see hemophilia, clinically?

A

Knee
Ankle
Elbow

67
Q

What are the stage of hemophilic arthropathy?

A
  1. Soft tissue swelling
  2. Osteoporosis
  3. Osseous lesions
  4. Cartilage destruction
  5. Joint disorganization
68
Q

What are the radiographic features of hemophilia in the knee?

A

Enlarged epiphysis
Widened intercondylar notch
Squared inferior patella

69
Q

What “deformity” is assoc. w/ hemophilia in the ankle?

A

Tibiotalar slant deformity

70
Q

What are the 4 M/C causes of tibiotalar slant deformity?

A
  1. Hemophilia
  2. Sickle cell anemia
  3. JRA
  4. Metaphysial/Epiphysial dysplasia (MED)
71
Q

Pseudotumors in the femur & pelvis are d/t what?

A

Intraosseous hemorrhage

72
Q

This is congenital hemolytic anemia charac. by abnormal genetically transmitted hemoglobin

A

Sickle cell anemia

73
Q

What is the most symptomatic type of sickle cell anemia?

A

Homozygous form HbS-S

74
Q

What age range does onset of sickle cell usually occur?

A

6 months - 2 years

75
Q

This is painful swelling of the fingers & toes during the 1st several years of life assoc. w/ sickle cell

A

Dactylitis (Hand-Foot syndrome)

76
Q

Infections assoc. w/ sickle cell are caused by what organism?

A

Salmonella

77
Q

What are the 4 M/C causes of generalized osteopenia, radiographically?

A
  1. Osteoporosis
  2. Osteomalacia
  3. Hyperparathyroidism
  4. Infiltrative disease
78
Q

What radiographic sign is seen w/ sickle cell in the spine?

A

Reynold’s sign or H-shaped vertebra

79
Q

What radiographic appearance does sickle cell have in the skull?

A

Hair on end appearance (more common in thalassemia)

80
Q

What are radiographic features of sickle cell in the hands & feet?

A

Destructive bone lesions as a result of infarction &/or Salmonella infection

81
Q

What are radiographic features of sickle cell in the long bones?

A

Changes related to infarction & infection
AVN of femoral & humeral heads
Tibiotalar slant deformity

82
Q

What are radiographic features of sickle cell in the pelvis & spine?

A

Sclerotic changes are common

83
Q

What are radiographic features of sickle cell in the soft tissues?

A

Extramedullary hematopoiesis
Cholelithiasis
Punctate splenic calcification after infarction

84
Q

This is a hereditary disorder of hemoglobin synthesis leading to anemia

A

Thalassemia

85
Q

What is thalassemia AKA?

A

Cooley’s anemia

Mediterranean anemia

86
Q

What are the 3 forms of thalassemia?

A

Major
Intermediate
Minor

87
Q

What are clinical features of thalassemia?

A 
Onset - last half of 1st year
Survival beyond 3rd decade rare
Pallor, underdevelopment, organomegaly
Altered facies
Decreased hemoglobin
88
Q

What are some radiographic features assoc. w/ thalassemia?

A

Coarse trabeculation (honeycomb appearance)
Hair-on-end in skull
Sinuses obliterated (rodent facies)
Cardiomegaly
Erlenmeyer flask deformity (d/t undertubulation)

89
Q

Infection of bone & marrow?

A

Osteomyelitis

90
Q

Implies a septic process of the joint itself?

A

Septic arthritis

91
Q

Contamination of cutaneous, subcutaneous, tendinous, ligamentous, & bursal structures?

A

Soft tissue infection

92
Q

Type of osteomyelitis M/C caused by staph aureus?

A

Suppurative osteomyelitis

93
Q

Type of osteomyelitis M/C caused by TB (Mycobacterium tuberculosis)?

A

Non-suppurative osteomyelitis

94
Q

Risk factors for osteomyelitis?

A 
Immunosuppressed individuals
Alcoholics
Newborns
IV drug users
Diabetes
Sickle-cell
Post-surgical 
Vascular insufficiency
95
Q

What organisms other than M. tuberculosis are assoc. w/ Non-Suppurative Osteomyelitis?

A 
Treponema pallidum (syphilis)
Actinomycosis (fungal)
Coccidioidomycosis (fungal)
96
Q

What are routes of contamination for infection?

A

Hematogenous
Contiguous Source
Direct Implantation
Postoperative Infection

97
Q

95% of pyogenic infections involve what part of the skeleton?

A

Appendicular skeleton

98
Q

What bones of the appendicular skeleton are most often affected by infection?

A

Femur (M/C)
Tibia
Humerus
Radius

99
Q

What is the M/C age group affected by infections?

A

2-12 yrs of age (mostly males)

100
Q

What are the clinical manifestations of bone infection in childhood & infancy?

A

Sudden onset of high fever
Localized pain & swelling
Chills
Loss of limb function

101
Q

What are the clinical manifestations of bone infection in the adult?

A

Insidious onset
Fever & malaise
Edema, erythema, & pain

102
Q

Bone infection is frequently assoc. w/ pre-existing infections of what other systems?

A

Genitourinary
Skin
Respiratory

103
Q

What are the M/C organisms assoc. w/ Mainliner’s Syndrome?

A

Staph. aureus

Pseudomonias

104
Q

Mainliner’s Syndrome frequently involves what joints?

A 
SC joint
Spine
SI joints
Pubic Symphysis
(S Joints)
105
Q

What spinal region are most infections found?

A

T/L junction

106
Q

What spinal region is M/C affected by Mainliner’s Syndrome?

A

Csp

107
Q

What are lab features assoc. w/ bone infection?

A

Elevated white cell count
Schilling shift to the left (increase in neutrophils & band cells)
Elevated ESR
(+) blood cultures w/ hematogenous

108
Q

What path. features of the infantile pattern of vascular supply?

A

Vessels may penetrate the physis

Higher incidence of septic arthritis

109
Q

What path. features of the childhood pattern of vascular supply?

A

Epiphyseal supply is separate

Hematogenous osteomylelitis affects the metaphysis more often & not physis or epiphysis

110
Q

What path. features of the adult pattern of vascular supply?

A

Metaphyseal vessels gradually penetrate the physis

Increased incidence of septic arthritis secondary to osteomyelitis

111
Q

What is the mechanism assoc. w/ hematogenous dissemination?

A

Usually direct extension from extravascular sites of infection

112
Q

Necrotic bone d/t infarction, looks chalky?

A

Sequestrum

113
Q

Bony collar from periosteal new bone, b/co new cortex?

A

Involucrum

114
Q

Defect in involucrum leads to discharge. Most often assoc. w/ chronic osteomyelitis

A

Cloaca

115
Q

This is a squamous cell carcinoma assoc. w/ Cloaca?

A

Marjolin’s ulcer

116
Q

Time before osseous changes are evident radiographically in the extremity? Spine?

A

Extremity - about 10 days

Spine - about 21 days

117
Q

What are imaging features seen in the extremity assoc. w/ infection?

A 
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
Q

What are late changes seen in extremity during infection?

A

Sequestrum
Invlucrum
Cloaca
Sclerosis

119
Q

What are imaging features seen in the spine <20 yrs assoc. w/ infection?

A

Initial disc involvement –> disc narrowing
Paraspinal edema
Endplate destruction
Osteolysis

120
Q

What are imaging features seen in the adult spine assoc. w/ infection?

A

Begins in vert. body then disc
Vertebrae destruction, collapse, paraspinal swelling
Bony ankylosis may be seen

121
Q

Localized, aborted suppurative osteomyelitis. M/C staph aureus. Often assoc. w/ hx of previous infection. Localized pain worse at night relieved by aspirin

A

Brodies Abscess

122
Q

What age/gender is Brodies Abscess seen in?

A

Young, male, children

123
Q

Where are the M/C skeletal locations for Brodies Abscess?

A 
Metaphysis
Distal tibia
Prox. tibia
Fibula
Dist. radius
124
Q

What is the radiographic features of a Brodies Abscess?

A

Oval, elliptical, or serpiginous radiolucency w/ rim of sclerosis

125
Q

What are the general charac. of septic arthritis?

A

M/C below age 30
M/C monoarticular
M/C caused by staph aureus
M/C knee & hip

126
Q

What are clinical features of septic arthritis?

A

Restricted ROM
Erythema
Fever
Labs typical infection

127
Q

What are radiographic features of septic arthritis?

A 
Soft tissue changes in about 3 days
Loss of subchondral white line
Juxta periarticular osteopenia
Destruction of articular ends
Bony or fibrous ankylosis

Skeletal Rad II (5 decks)

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