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Advanced diagnostics > Week 6 > Flashcards

Week 6 Flashcards

1
Q

Plain films of the pelvis usually include what view?

A

AP view

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2
Q

What is the shape of the male pelvis?

A

Male pelvis has a triangular (android) shape

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3
Q

What is the shape of the female pelvis?

A

Female pelvis has a rounded (ovoid) shape

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4
Q

Why shouldn’t the SI view of the pelvis be ordered often?

A

Due to the increase of radiation exposure

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5
Q

What are the special views of the pelvis to order in the case of a trauma, when there is a suspicion of a Fx?

A
  • Inlet view: defines AP translation

* Outlet view: defines cephalad/ caudad translation

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6
Q

What is the best secondary image of choice when a xray doesn’t show a fx when we suspect there is one and why?

A

CT, it defines osseous anatomy extremely well

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7
Q

How much space between the pubis is considered as abnormal?

A

Widening of the symphysis pubis > 1 cm

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8
Q

True or False

The pelvis is a ring and fractures usually occur in more than one area

A

True, the pelvis is a ring and fractures usually occur in more than one area

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9
Q

What can pelvis FX’s lead to?

A
  • Pelvic hematomas

* Possible urethral and bladder injuries.

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10
Q

What is the criteria for determining the presence of a pelvis fx?

A
  • Age: > 3 yrs
  • No impairment of consciousness
  • No other major distracting injuries
  • No complaint of pelvic pain
  • No signs of fracture on inspection
  • Painless compression of iliac or pubic symphysis
  • Pain free hip rotation and flexion
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11
Q

What does it mean when a pt meets all the criterias for a pelvic fx?

A

The likelihood of a pelvic fx is zero. If only one is not met, then you can’t completely rule out a fx

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12
Q

What is paget’s disease?

A

A benign lesion of the pelvis, characterized by increased sclerosis and enlargement of the entire right hemi-pelvis.

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13
Q

What are the malignant tumors that affect children and adults in the pelvis?

A
  • Child – Ewing’s sarcoma
  • Adult – chondrosarcomas

Metastasis are also common

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14
Q

What is the presentation of a child with a pelvic stress fx?

A 
• History of overuse
• Relief w non-weight bearing
• Insidious in nature
• Local pain, tenderness, swelling
• Typical site in the pelvis is the
pubic ramus
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15
Q

How is a pelvic stress fx diagnosed?

A

Bone scan is diagnostic early

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16
Q

What are some of the things that a pt with a pelvic stress fx will complain of?

A
  • Change in work out activity

* Increases with WB activity and relieves with a rest period

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17
Q

Why would the xray of a pelvic stress fx be read as normal?

A

It takes a period of time for a stress fx to show up on normal imaging

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18
Q

___ is a typical site of a pelvic stress fx

A

The left inferior pubic ramus is a typical site of a pelvic stress fx

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19
Q

What are the types of pelvic stress FXs?

A
  • When abnormal stresses are put on normal bone

* When normal stresses are put on abnormal bone, and are considered insufficiency fractures

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20
Q

What is the honda sign indicative of on a radiograph of the pelvis?

A

A sacral insufficiency fx

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21
Q

What radiograph views is usually ordered of the hip?

A

AP view and “frog leg” view

abducted

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22
Q

Why may the hip axial lateral view be ordered?

A

If the normal AP or frog leg view don’t allow adequate visualization of the femoral neck

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23
Q

What is the most common hip dislocation?

A

Posterior dislocation

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24
Q

What is the usual cause of a hip dislocation?

A

The result of MVA’s

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25
Q

What are the high yield areas to examine for hip trauma?

A
  • Widening of joint space
  • Femoral neck or intertrochanteric fractures
  • Pelvis or acetabular fractures
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26
Q

In what direction does the femoral head displace in an anterior dislocation?

A

Head displaced inferiorly and medially.

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27
Q

What are the most common hip FX?

A
  • Fx’s of the femoral neck

* Fx’s of the intertrochanteric region

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28
Q

What is a fx of the femoral neck often due to?

A

Often due to osteoporosis

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29
Q

True or False

Stress fx’s of the femoral neck may appear sclerotic

A

True, Stress fx’s of the femoral neck may appear sclerotic

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30
Q

What is a fx of the intertrochanteric region often due to?

A

Often due to trauma

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31
Q

What is the best way to evaluate a nondisplaced hip fx?

A

A MRI

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32
Q

___ is the most common cause of chronic hip pain.

A

Osteoarthritis is the most common cause of chronic hip pain.

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33
Q

In what direction does the femoral head displace in an posterior dislocation?

A

Superior and lateral to the acetabulum.

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34
Q

What is the presentation of an intertrochanteric region fx?

A

Shortened leg with internal rotation

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35
Q

What is the pt presentation of hip OA?

A

Patient presents with pain and loss of mobility, starting with internal rotation

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36
Q

What do DJD changes of the hip include?

A
  • Joint space narrowing
  • Subchondral cysts
  • Sclerotic/white looking borders
  • Osteophytes.
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37
Q

The Altman criteria has 2 test cluster and is used to classify hip OA. What are the components of test cluster 1?

A
  • Hip Pain
  • Hip IR < 15
  • Hip flexion < 115
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38
Q

The Altman criteria has 2 test cluster and is used to classify hip OA. What are the components of test cluster 2?

A

If hip IR > 15
• Painful w IR
• Age > 50 yrs
• Morning stiffness less than 60 minutes

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39
Q

What are the items on the CPR of a hip OA in individuals with unilateral hip pain?

A
  • Patient reported squatting as an aggravating factor
  • Flexion ROM caused lateral hip pain
  • Scour test with adduction caused lateral or groin pain
  • Extension ROM caused pain
  • IR less ≤ 25°
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40
Q

What is the physical presentation of an aseptic necrosis of the hip?

A

Femoral head is flattened, irregular and sclerotic

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41
Q

What is the best way to visualize an aseptic necrosis of the hip?

A

MRI

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42
Q

What are some of the presentations/causes that will indicate that a patient has an aseptic necrosis of the hip?

A
  • A nemia (sickle cell)
  • S teroids
  • E thanol (alcohol)
  • P ancreatitis
  • T rauma
  • I diopathic
  • C aisson’s disease
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43
Q

What is klein line?

A

A line drawn along superior border of the femoral neck,

should intersect with the femoral head (usually displaced in a SCFE)

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44
Q

What are the presentations of a femoral neck stress fx?

A
  • History of overuse
  • Relief w non-weight bearing
  • Insidious in nature
  • Local pain, tenderness, swelling
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45
Q

What are the types of femoral neck stress fx?

A
  • Compression: fx of the medial side of the femoral neck

* Tension: fx of the lateral side of the femoral neck (more serious)

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46
Q

What can be used to diagnose an early femoral neck stress fx?

A

Bone scan

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47
Q

What is the gold standard for diagnosing a femoral neck stress fx and why?

A

MRI, because it is 100% sensitive and specific

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48
Q

Why is a tension(lateral) side femoral neck stress fx more serious?

A

They don’t heal very well, because bone ends are being pulled apart and not apart

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49
Q

What are the early signs of a stress reaction that might lead to a stress fx?

A

Increased uptake/a sclerotic line

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50
Q

What are the typical views of the femur?

A

AP view and lateral view.

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51
Q

True or False

The femur is prone to tumors – benign and malignant

A

True, The femur is prone to tumors – benign and malignant

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52
Q

What are the benign lesions found in the femur?

A
  • Fibrous cortical defects
  • Fibrous dysplasia
  • Non-ossifying fibroma
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53
Q

What are the malignant lesions found in the femur?

A
  • Chondrosarcoma

* Metastases

54
Q

What are the characteristics of benign lesions found in the femur?

A
  • Small
  • No associated periosteal reaction
  • Narrow transition zone between bone and lesion
  • Thin, well defined sclerotic (white) margins
55
Q

What type of cancers can produce a lytic lesion?

A

Breast and lung cancer

56
Q

Lytic lesion w/o sclerotic margins is considered ___ until proven otherwise!

A

Lytic lesion w/o sclerotic margins is considered malignant until proven
otherwise!

57
Q

What are the characteristics of malignant lesion: chondrosarcomas?

A
  • Destructive in nature
  • Vary in appearance
  • Occur typically in the femur, pelvis and ribs.
58
Q

A periosteal reaction can either be benign or malignant. Where are they typically found?

A

Typically in long bone

59
Q

What are the causes of a periosteal reaction?

A
  • Infections
  • Osteomyelitis
  • Ewings tumor- young patients 5- 20 years, diaphysis of long bone
  • Osteogenic sarcoma- around a joint (knee)
  • Sunburst pattern- think malignancy!
60
Q

What are the presentations that is indicative of a stress fx?

A
  • Pain w activity, relief w rest.
  • Antalgic gait
  • Pain increased w all ROM, FABERS, log rolling.
61
Q

What is the AP view of the knee best for visualizing?

A

Joint space narrowing or calcification of the cartilage

62
Q

What is the lateral view with partial flexion of the knee best for visualizing?

A

Patella and joint effusions

63
Q

What is the sunrise or merchant view of the knee best for visualizing?

A

Relationship of the patella to the anterior femur or a retropatella image (done in prone)

64
Q

What is the tunnel view of the knee best for visualizing?

A

Tibial spines and femoral condyles

65
Q

What is the best way to visualize the ligaments, cartilage and tendons of the knee?

A

A MRI

66
Q

What are the CPRs for the knee?

A
  • Pittsburgh Knee rule (more sensitive than specific)

* Ottawa knee rule (more sensitive than specific)

67
Q

What are the components of the Pittsburgh knee rule?

A

Blunt trauma or a fall as mechanism of injury plus either of the following:
• Age younger than 12 or older than 50 years
• Inability to walk 4 weight-bearing steps in the ED

68
Q

According to the ottawa knee rules, what are the items that require a xray to be ordered?

A
  • Age 55 or older
  • Isolated tenderness over the patella
  • Tenderness over the fibula head
  • Unable to flex > 90 degs
  • Unable to weight bear immediately, or in the emergency room 4 steps
69
Q

What are the symptoms of knee osteoarthritis?

A
  • Pain with motion
  • Limited ROM
  • Redness
  • Swelling or visible deformity
70
Q

What are the xray findings of knee osteoarthritis?

A
  • Joint space narrowing
  • Sclerosis
  • Osteophytes
71
Q

What may happen to the cartilage in the presence of osteoarthritis?

A

The cartilage may become calcified and break off resulting in loose bodies in the joint

72
Q

___ is the calcification of the articular cartilage

A

Chondrocalcinosis is the calcification of the articular cartilage

73
Q

What are the types fx of the knee?

A
  • Patella fractures

* Fractures of the tibia, fibula, and femur

74
Q

____ is a normal variant of the knee that may appear to be a fracture

A

Bipartate patella is a normal variant of the knee that may appear to be a fracture

75
Q

What is the best view for a tibial plateau fx?

A

An AP view

76
Q

If the films of a tibial plateau fx is negative and a fx is still suspected, what is indicated?

A

A MRI is indicated

77
Q

What is a segond fracture?

A

A cortical avulsion fx off the proximal lateral tibia, just distal to the tibial plateau at the sit of insertion of the middle third f the lateral capsular ligament(LCL) resulting from excessive IR and varus stress

78
Q

What is the imaging view for a segond fracture?

A

A MRI

79
Q

What is osteochondritis dessicans?

A

Lesion involving both bone and hyaline cartilage

80
Q

What does an osteochondritis dessicans cause?

A

Causes 50% of loose bodies in the knee

81
Q

What are the causes of osteochondritis dessicans?

A
  • Traumatic
  • Ischemic
  • Abnormal ossification centers
  • Genetic or combination
82
Q

What is a loose body?

A

A piece of bone or cartilage caused by trauma that is within the joint and causes locking or swelling, pain and decreased function

83
Q

What is a fabella?

A

A variant of the sesamoid bone and is typically causes no pain and functional problem. They are smooth and often teardrop shaped

84
Q

What do we see in the radiograph of a knee with chondrocalcinosis?

A
  • The meniscus shows signs of calcification

* Cloudy lines in the joint line where the meniscus line.

85
Q

What do we find upon the physical examination of a pt with a patellar fx?

A
  • Gross effusion and edema
  • Exquisite tenderness over he fx site
  • Significant quad inhibition
86
Q

What part of the knee does an osteochondritis dessicans lesion usually affect?

A

Weight-bearing surfaces of the medial femoral condyle

87
Q

___ is the major cause of loose bodies in the knee

A

Osteochondritis dessicans is the major cause of loose bodies in the knee

88
Q

What are the typical signs of osteochondritis dessicans lesions?

A

Persistent effusion and locking of the joint

89
Q

Why might osteochondritis dessicans go undiagnosed initially?

A

Cartilage can not be visualized on a xray

90
Q

If an 11-15 year old boy complains of activity related anterior knee pain, and he points to his tibial tuberosity, what should be your number 1 differential diagnosis?

A

Osgood-Schlatter disease

91
Q

What are the characteristics of Osgood-Schlatter disease?

A
  • AKA tibial tubercle apophysitis
  • More in boys than girls
  • Usually self limiting, and will cure with rest
92
Q

___ is an analogous condition to Osgood-Schlatter disease and involves the patellar tendon and the lower margin of the patella, instead of the upper margin of the tibia

A

Sinding-Larsen-Johansson syndrome is an analogous condition to Osgood-Schlatter disease and involves the patellar tendon and the lower margin of the patella, instead of the upper margin of the tibia

93
Q

What are the imaging views for the foot and ankle?

A
  • AP view
  • Lateral view
  • Oblique
  • Mortise view(only for the ankle)
94
Q

What does ankle effusion on a radiograph appear as?

A

An anterior fat line in front of the joint space on the lateral view

95
Q

What does the most common ankle fx involve?

A

Lateral or medial malleolus

96
Q

According to the ottawa ankle rules, when should an ankle xray be ordered?

A

Pain in malleolar zone AND any of the following:
• Bone tenderness in posterior half of distal tibia or fibula (or tip of medial or lateral malleolus)
• Unable to bear weight for 4 steps immediately after injury and during exam

97
Q

According to the ottawa foot rules, when should a foot xray be ordered?

A

Pain in midfoot zone AND any of the following:
• Bone tenderness over navicular or base of 5th MT
• Unable to bear weight for 4 steps immediately after injury or during exam

98
Q

What are the psychometrics for the ottawa ankle and foot rules?

A

100% sensitive for malleolar and midfoot FXs

99
Q

What are the characteristics of the mortise view of the ankle?

A
  • Modified AP view: foot and leg are internally rotated 15-30 degs
  • Enables viewing of mortise and distal tibiofibular joint
100
Q

How does the danis-weber classification system for the ankle classifies fractures?

A

It uses the position of the level of the fibular fracture in its relationship to its height at the ankle joint

101
Q

What are the components of the danis-weber classification system?

A
  • Weber A: fracture below the ankle joint
  • Weber B: fx at level of the joint, with the tibiofibular ligaments usually intact
  • Weber C: fx above the joint level which tears the syndesmotic ligaments
102
Q

How does the lauge hansen classification describe a fracture?

A

The 1st word describes the position of the foot, the 2nd word describes the motion of the foot (talus) with respect to the leg.
Types: supination-adduction or pronation-abduction

103
Q

What is a stage 1 supination-adduction fx, according to the lauge hansen classification?

A

Transverse fx of lateral malleolus, at or below the level of anterio talo-fibular ligament or a tear of lateral collateral ligament structures with the anterior talofibular ligament disrupted most often and frequently the calcaneofibular ligament being torn

104
Q

What is a stage 2 supination-adduction fx, according to the lauge hansen classification?

A

Oblique fx of medial malleolus

105
Q

What is the most common lauge hansen classification fx?

A

Supination- external rotation

106
Q

What is a stage 1 supination-external rotation fx, according to the lauge hansen classification?

A

Rupture of anterior inferior tibiofibular ligament

107
Q

What is a stage 2 supination-external rotation fx, according to the lauge hansen classification?

A

Oblique fx or spiral fx of the lateral malleolus

108
Q

What is a stage 3 supination-external rotation fx, according to the lauge hansen classification?

A

Rupture of post tibiofibular ligament or fx of posterior malleiolus of the tibia

109
Q

What is a stage 1 supination-external rotation fx, according to the lauge hansen classification?

A

Transverse(sometimes oblique) fx of the medial malleolus

110
Q

What is a stage 1 pronation-abduction fx, according to the lauge hansen classification?

A

Rupture of the deltoid ligament or transverse fx of the medial malleolus

111
Q

What is a stage 2 pronation-abduction fx, according to the lauge hansen classification?

A

Rupture of the anterior and posterior inferior tibiofibular ligament or bony avulsion

112
Q

What is a stage 3 pronation-abduction fx, according to the lauge hansen classification?

A

Oblique fx of the fibula at the level of the syndesmosis

113
Q

What is a stage 1 pronation-external rotation fx, according to the lauge hansen classification?

A

Rupture of the deltoid ligament or transverse fx of the medial malleolus

114
Q

What is a stage 2 pronation-external rotation fx, according to the lauge hansen classification?

A

Rupture of the anterior inferior tibiotalofibular ligaments or bony avulsion

115
Q

What is a stage 3 pronation-external rotation fx, according to the lauge hansen classification?

A

Spiral/oblique fx of the fibula above the level of the syndesmosis

116
Q

What is a stage 4 pronation-external rotation fx, according to the lauge hansen classification?

A

Rupture of the posterior inferior tibiofibular ligament or fx of the posterior malleolus

117
Q

What is a stage 1 pronation-dorsiflexion fx, according to the lauge hansen classification?

A

Fx of the medial malleolus

118
Q

What is a stage 2 pronation-dorsiflexion fx, according to the lauge hansen classification?

A

Fx of the anterior lip of the tibia

119
Q

What is a stage 3 pronation-dorsiflexion fx, according to the lauge hansen classification?

A

Fx of the supramalleolar aspect of the fibula

120
Q

What is a stage 4 pronation-dorsiflexion fx, according to the lauge hansen classification?

A

Rupture of the posterior inferior tibiofibular ligament of fx of the posterio malleolus

121
Q

What is a maisonneuve fx?

A

A fx at the ankle that results from an ER force to the ankle with transmission of the force through the interosseous membrane, exiting through a proximal fibular fx

122
Q

What are some associated lesion of an ankle fx?

A

• Osteochondral defect commonly at the medial dome

123
Q

Why is a surgery used for a jones fx?

A

It is a water shed area, meaning that it has less blood circulation. Usually at the base of the 5th MT

124
Q

What is a Lisfranc fx?

A

Fx of the 2nd, 3rd, 4th, ad 5th MT with lateral dislocation

125
Q

___ is considered to be a hallmark sign of a lisfranc injury

A

Medial plantar bruising is considered to be a hallmark sign of a lisfranc injury

126
Q

What is a march fx?

A

A stress fx of the 2nd, 3rd, or 4th MT

127
Q

What structure is involved in gout?

A

The 1st MCP joint

128
Q

What is a periosteal reaction?

A

Thickening of the periosteum, which appears white on a xray

129
Q

When do we see bone and joint infections?

A

Seen in normal ealing fx, osteomyelitis, benign and malignant tumors

130
Q

What type of periosteal reaction is worrisome for malignancy?

A

A radiating periosteal reaction(sun-burst)

Advanced diagnostics (8 decks)

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