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Skel Rad 2
Midterm
| Question | Answer |
|---|---|
| Line from posterior margin of hard palate to inferior surface of occiput | McGregor's Line |
| Xray view of McGregor's Line | LCN |
| Values of McGregor's Line | Odontoid should not be above line by more than 8mm in males and 10mm in females |
| Use McGregor's line is most reliable for what indication | Basilar Impression |
| Line from posterior margin of the hard palate to posterior aspect of foramen magnum | Chamberlain's Line |
| Xray view of Chamberlain's Line | LCN |
| Values of Chamberlain's Line | Odontoid process should not be above line by more than 3mm. 7mm is most likely abnormal |
| Use Chamberlain's Line is most reliable for what indication | Basilar Impression |
| Which line is used more for basilar impression | McGregor's Line |
| Distance between the posterior margin of the anterior arch of C1 to the anterior cortex of the dens | ADI space |
| Values of the ADI space | 3mm in adults and 5mm in kids with no difference between flexion and extension |
| Increased ADI space indicates what? | Rupture or laxity of transverse ligament |
| Lines along posterior aspect of vertebral bodies and connecting superior and inferior body corners | George's Line |
| Indications of George's Line | Anterolisthesis and Retrolisthesis! |
| Divide superior surface of S1 into four quadrants | Myerding's Grading Scale |
| Value of Myerding's Grading scale | Posterior corner of L5 should align with posterior corner of S1 |
| Indications of Myerding's Grading scale | Spondylolisthesis graded 1-5 of L5 |
| Grade 5 spondylolisthesis is called what | spondyloptysis(completely fallen off) |
| First line drawn parallel and through sacral base with 2nd line perpendicular to first at anterior margin of the sacral base? | Ullmann's line |
| Normal range of Ullmann's Line | L5 should lie posterior or just contact this line |
| Ullmann's Line is used to indicate what? | Look for subtle spondylolisthesis |
| Advanced imaging that determines areas of metabolic activity and is very sensitive but not very specific | Bone Scintigraphy(Bone Scan) |
| Bone Scan confirms the presence of what? | Acute Fx, Stress Fx, Metastasis, Infection, Paget's Disease, Child Abuse |
| Tracer used for a bone scan | Tc 99 |
| What are patients injected with in a PET scan? | Glucose |
| PET scans are very sensitive to detecting what | cancer, coronary heart disease, brain disorders such as Parkinson's, Alzheimer's, Seizures |
| Advanced imaging that adds anatomical information to physiologic information | PET scan |
| Advanced imaging that uses ionizing radiation to obtain cross-sectional images while patient lies within a gantry(tube) with the x-ray traveling around them | CT scan |
| CT Scan's shows the cortex of bone to be what color | white |
| CT Scan is good in identifying what | Fine bony detail, liver, GI-GU Tracts, Acute head trauma |
| Advanced imaging that is most widely used method to measure bone mineral density | DEXA scan |
| Comparison of bone from the patient to a young adult of the same gender, with peak bone density. | T Score |
| T score levels | -1 is normal -1 to -2.5 is osteopenia >-2.5 is osteoporosis |
| Comparison of bone between patient and other people within the same gender, not used to diagnose | Z Score |
| Advanced imaging that measures the unpaired protons/neutrons spin of angular momentum, which element is used and why? | MRI; H+ because they are highly magnetic and abundant |
| Explain how and MRI works | First external magnet causes protons to line up on the horizontal plane, second external magnet flips the protons into the transverse plane, protons than give up their energy as a RF signal |
| Times between RF Pulses | Repetition Time(TR) |
| Times between RF Pulse and Measurement of Energy Released | Echo Time(TE) |
| T1 weighted images | <1000 TR and <20 TE |
| T2 weighted images | >1000 TR and >100 TE |
| On films what refers to the amount of blackness | Density |
| On films what refers to the shades of grey | Contrast |
| Underexposed films are what? | White |
| Overexposed films are what? | Black |
| Low contrast films are what? | Have more shades of grey |
| Flattening of the skull base, how is it diagnosed? | Platybasia; MRI |
| Associated anomalies of Platybasia | basilar impressioin, occipitalization, block vertebrae, Klippel-Feil |
| Causes of Platybasia | skeletal dysplasia or bone softening disorder |
| Superior position of upper cervical vertebrae with relation to the skull | Basilar Impression; Congenital |
| Causes of Basilar Impression | congenital and bone softening |
| When Basilar Impression is congenital what's its associated with? | occipitalization of atlas, spina bifida occulta of atlas, odontoid abnormalaties, cervical block |
| Symptoms and when does somebody notice basilar impression? | 3-4 decades; occiptal headaches, visual disturbances, dysphagia, facial pain, unsteady gait |
| Basilar impression is diagnosed how? | Abnormal McGregor's Line and Chamberlain's Line as well as an MRI |
| What's diagnosed by MRI or CT and the findings are low-lying cerebellar tonsils, trianguler shaped cerebellar tonsils, and kinking of the 4th ventricle? | Arnold-Chiari Malformation Type 1 |
| Congenital synostosis(fusion) of the atlas to the occiput secondary to failure of separation of the most inferior occipital sclerotome | Occipitalization of the Atlas |
| Most common anomaly of the craniovertebral junction | Occipitalization of the Atlas |
| Presentation of Occipitalization of the Atlas | low hairline, short neck, restricted ROM; neck pain, dysfunction at 30-40 yrs |
| Occipitalization is most common to what gender | Males 5:1 |
| Most inferior somite of the occipital bone fails to unite and remains as an ossicle | Occipital Vertebrae |
| Occipital Vertebrae may form what? | 3rd condyle, paramastoid, epitransverse process, occipital ossicles |
| Midline bony projection bridging the anterior aspect of the foramen magnum with the apex of the odontoid process or anterior arch of the atlas. | 3rd Condyle |
| Originates at the jugular process of the occiput and articulates with the TP of C1 and projects downward on an X-Ray | Paramastoid Process |
| Originates slightly medial and anterior to the paramastoid process and articulates with the TP of C1 and projects downward on an X-Ray | Paracondylar Process |
| Originates from the TP of C1 projecting superiorly articulating with the occiput and projects upward on an X-Ray | Epitransverse Process |
| Which occipital vertebrae is generally asymptomatic but may produce muscle spasms and neck pain | Epitransverse process |
| Small bony ossicles occurring in the atlanto-occiptal space | Occipital Ossicles |
| Cleft in the posterior arch of C1, to unilateral agenesis, to complete agenesis. Dense CT is present at the site of bone agenesis | Agenesis of Posterior Arch of Atlas |
| Union of the posterior arch is typically visible by age ____ | Age 6 |
| Posterior arch may join SP of C2 | Mega spinous sign |
| Hypoplasia of the posterior arch may present as a thin arch or a short arch | Central Stenosis |
| Failure of mid line ossification of the neural arch, gap is filled with fibrous tissue | Posterior/Anterior Spina Bifida Occulta of the Atlas AKA Posterior/Anterior Spondyloschisis |
| When anterior SB Occulta of the atlas is associated with posterior SB Occulta there may be an offset of what? | Lateral Masses of C1 on C2 |
| Ossification of the oblique portion of the atlanto-occipital membrane | Posterior Ponticle of the Atlas |
| Posterior Ponticle of the Atlas may be associated with what? | VBI, Barre-Lieou Syndrome, Chronic upper Cervical Syndrome |
| Failure of the apical ossification center of the dens to unite with the body of the dens, should unite by what age? | Ossiculum Terminale Persistens of Bergmann; 12-13 years of age |
| Non-union of the odontoid process with C2 body | Os Odontoideum |
| Odontoid is considered hypoplastic when its height is less than what? | 12mm |
| Hypoplasia of the Odontoid Process is associated with what? | Downs Syndrome, occipitalization, Klippel Feil, skeletal dysplasia and atlanto-axial instability |
| Fusion of 2 or more vertebrae from failure of somite segmentation in the 3-8 weeks of development | Block Vertebrae |
| Block Vertebrae is most often seen at where? | C5/C6, C2/C3, T12/L1, L4/L5 |
| Failure of the scapula to descend during fetal development and more common in m/f bilaterally/unilaterally | Sprengels Deformity; females;unilaterally |
| Sprengels is associated with | omovertebral bone |
| Cartilaginous/fibrous band running from C5/C6 SP to the posterior angle of the scapula | Omovertebral Bone |
| Omovertebral Bone is associated with | Sprengles, Raised Scapula, Scoliosis, Hemivertebrae, block vertebrae, cervical rib, SB Occulta |
| From a cleft in the posterior arch @ C6 and may be mistaken for fracture when found on X-Ray post trauma, asymptomatic | Cervical Spondylolisthesis |
| Cervical Spondylolisthesis is associated with what? | SB Occulta |
| Flat/Squished appearing vertebrae | Platyspondyly |
| 2 nerve roots exit from one large foramen, more common inc ____ spine then ____ spine then ____ spine but most common at ____ | Absent Pedicle; Cervical; Lumbar; Thoracic; C6 |
| Elongated Anterior Tubercles with Accessory Joint is most common where? | C5/C6 |
| What causes dysphagia, feeling of fullness in throat, facial pain and what is this called? | Stylohyoid ligament ossification; Eagles Syndrome |
| Stylohyoid Ligament Ossification may put pressure on what and best seen on what x-ray views? | external carotid artery; lateral/oblique views |
| When less than 80% of the discovertebral junction between two levels is fused in a block vertebra of the thoracic and lumbar spine | Unsegmented bar |
| Anterior unsegmentation + unsegmented bars in a block vertebra of the thoracic and lumbar spine | kyphotic deformity |
| Increase in the interpedicular distance | Diastematomyelia(Split Spinal Cord) |
| Sagittal Cleft in a vertebral body | Butterfly Vertebra |
| Butterfly Vertebra is most common where and may produce what? | thoracolumbar jxn; kyphoscoliosis |
| Failure of ossification of half of a vertebra, triangular shaped and may be located ventrally, dorsally, laterally. | Hemivertebra |
| Adjacent endplates are altered to conform the hemivertebra | Incarcerated Hemi |
| Adjacent endplates are straight resulting in scoliosis | Non-Incarcerated Hemi |
| Fusion of hemivertebra + adjacent segment, no separation | Non-Segmented Hemi |
| Herniation of disc material into vertebral body, most likely during adolescence on immature endplates | Schmorls Node |
| Cause of Schmorls Nodes | Weaked cartilaginous endplates and subchondral bone |
| Schmorls Nodes are more common in ____ @ ____ | males; thoracolumbar jxn |
| Multiple levels of Schmorls Nodes in the mid thoracic spine and lumbar spine | Scheuerman's Disease; Juvenile Discogenic Disease |
| Disc material herniates through the growth center of the ring apophysis, isolating the apophysis from the vertebral body | Limbus Bones |
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