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Skel Rad 4 written
Skel Rad 4 written final
| Question | Answer |
|---|---|
| MC benign bone tumor | osteochondroma |
| MC benign bone tumor of hands/feet | enchondroma |
| MC benign bone tumor of ribs | fibrous dysplasia |
| MC benign bone tumor of spine | hemangioma |
| MC primary bone malignancy | Osteosarcoma (multiple myeloma) |
| MC bone malignancy | metastatic disease |
| Three ways Mets ---> to bone | Tumor emboli, direct extension, retrograde venous blood flow |
| List 5 cancers that often Metastasize to bone | Breast, Prostate, Lung, Colon, Stomach, Bladder, Uterus, Rectum, Thyroid, Kidney |
| In what type of marrow does bone mets occur | Red Marrow (axial skeleton) |
| Bone Mets does not show up on plain film until _____ destruction has occurred | 30-50% bone destruction |
| Bone mets is typically seen proximal to the _______ & ________ | Elbows and Knees |
| What are 3 clinical features of bone Mets | Pain, Neurological sign/symptoms, Hypercalcema |
| Bone pain is suggestive of Mets in a person with? | a Known Primary Cancer |
| Types of bone Mets and their % | Osteolytic 70%, Osteoblastic 20%, Mixed 10% |
| Common sign with Rib mets | Extrapleural sign (soft tissue mass) |
| Vertebra destruction, missing pedicle, vertebra plana occur with ________Mets | osteolytic mets |
| DDxs for missing pedicle sign | agenesis, lytic mets, osteoblastoma, ABC, neurofibroma |
| MRI T1 signal will show ______ compression fx _______ path compression fx | (High) normal marrow compression fx, but LOW signal Path Fx |
| Chronic osteoporotic comp fx vs Path comp fx for Anterior body Height: | BOTH Loss of Anterior body height |
| MRI T2 signal will show ______ compression fx _______ path compression fx | (Low) Normal marrow compression fx, but HIGH signal Path Fx |
| MRI T1 & T2 path compression fx? | LOW, HIGH |
| Two Primary Cancers that cause EXPANSILE Mets | Renal cell & thyroid carcinoma |
| Two Primary Cancers that cause ACRAL Mets | Renal cell & Lung carcinoma |
| MC cause of osteoblastic Mets | Prostate cancer |
| Common causes of osteoblastic Mets | Prostate cancer, Breast Cancer (especially treated), Bladder Cancer |
| Ivory Vertebra is seen in which DDxs | OsteoBlastic Mets, Paget's, Hodgkin's |
| Imaging sensitive for marrow infiltration | MRI most sensitive, Bone Scan (nearly as sensitive as MRI) |
| Which imaging method can discriminates types of lesions | MRI |
| Clinical features (C.C) in Multiple Myeloma | Pain, Fatigue, Infections, Weight Loss |
| Fatigue in Multiple Myeloma is due to | normochromic, normocytic anemia from marrow infiltration |
| Pain in Multiple Myeloma is due to | path fx, irritation of nerve ending in endosteum and periosteum |
| CBC Lab finding in Multiple Myeloma | Normochromic, normocytic anemia |
| Immunoelectrophoresis Lab finding in Multiple Myeloma | IgG spike 50%, IgA spike 25% |
| Chemistries Lab finding in Multiple Myeloma | Increase Calcemia, Increase Uricemia |
| Finding in urinalysis for Multiple Myeloma | Bence-Jones protein |
| which condition has reversed albumin and elevated blood urea nitrogen | Multiple Myeloma |
| Radiographic Features of Multiple Myeloma | Osteopenia, Punched-out Lesions, Path fx, Endosteal scalloping, "Rain-drop" skull, Increase in retropharyngeal &or retrotracheal spaces |
| TorF Osteopenia may be the only sign of Multiple Myeloma in some patients | True, may be only sign in 25% of patients |
| Why aren't Bone scans used in Multiple Myeloma? | May not show uptake due to inadequate reactive bone and Kidneys are already compromised (inability to clear radionuclide material) |
| T or F Punched out lesions in Multiple Myeloma are Geographic and surrounded by sclerotic rim | False, Geographic but NOT surrounded by sclerotic rim |
| Solitary form of Multiple myeloma | Plasmacytoma |
| Characteristics of Plasmacytoma | Soap-bubbly, expansile |
| Osteosarcoma age incidence | 10-25 & >50 |
| Regions affected by Osteosarcoma | Long bones, esp. Metaphyseal regions around the KNEE (rarely spine) |
| osteosarcoma type of pain | Insidious onset, Focal pain |
| Osteosarcoma physical findings | Redness, heat and bruit, soft tissue swelling, Limp if LE is involved |
| Osteosarcoma lab values | Alkaline phosphatase (increase suggests lung mets) LDH |
| (6) Radiographic features of osteosarcoma | "Cumulus cloud" appearance, Wide zone transition, periosteal reactions, Codman's triangle, cortical violation, soft tissue mass |
| Treatments for Osteosarcoma | Neoadjuvant chemo, careful staging, wide en blox excision, Van Ness rotationplasty |
| Prognosis is worse for PT with high levels of | Alkaline phosphatase and/or LDH levels |
| Secondary Osteosarcoma develops in pre-existing conditions such as | Paget's, irradiated bone, HME, Ollie's, osteochondroma, enchondroma |
| Chondrosarcoma age incidence | >40 unless pre-existing disorders (HME, Ollier's, Maffucci's syndrome) |
| Chondrosarcoma affects: | Flat bones (pelvis, ribs, scapula, humerus), Proximal long bones (femur, humerus) |
| Lytic lesions w/ Large soft tissue mass containing scattered calcification in RINGGS AND ARCS is seen in | Chondrosarcoma |
| Ewing's sarcoma age incidence | btw ages of 5-30 |
| Ewing's sarcoma is hard to distinguish from | osteomyelitis, osteosarcoma, lymphoma of bone |
| Ewing's sarcoma affects: | red marrow bones (diaphyses of long ones, Pelvis, Ribs) |
| Clinical features of Ewing's | Elevated ESR, leukocytosis, anemia, pain, redness, swelling, infection |
| Ewing's sarcoma pattern of bone destruction | Permeative or moth-eaten, lytic lesion w/ wide zone, onion-skin periosteal response w/ Codman's triangle, bone to bone mets |
| What is formerly termed the "Reticulum cell sarcoma" & "non-Hodgkin's lymphoma of bone" | Primary lymphoma of bone |
| Primary lymphoma age incidence | 2-88 years |
| Area involved in 1' lymphoma of bone | Diaphyses of long bone (but any area can be affected) |
| Radiographic Features of 1' lymphoma of bone | moth-eaten and/or Permeative bone destruction, cortical violation, periosteal response, path fx |
| Chordoma develops in primitive cell rests of ________ _________ | embryonic notochord |
| How prevalent is Chordoma | Rare |
| Areas in which Chordoma occurs | SACRUM> clivus >spine, especially C2 |
| Chordoma symptoms | nonspecific local pain, constipation (if in sacrum) |
| Chordoma findings | bone destruction, Bulky soft tissue mass w/ calcifications |
| Neurofibromatosis is what type of disorder | autosomal dominant (50% from spontaneous mutations) |
| Of the two subtypes of NF (1 & 2) which is central? | NF2 (10% of cases) |
| What is associated w/ NF2 | CN8 Acoustic neuromas (hearing loss, balance problems) |
| What is associated w/ NF1 | Skin manifestations, Lisch nodules in iris, Neurofibromas, Osseous lesions, CNS tumors |
| Also known as Von Recklinghausen's | NF1 |
| What type of skin manifestations ass. w/ NF1 | 6 or more café-au-lait spots, Axillary and or Inguinal freckling, Fibroma molluscm |
| Café-au-lait (CAL) spots are ass. w/ NF1 or NF2 and what type of margins | NF1 w/ smooth margins (Coast-of-CA) |
| What size are CAL spots in prepubertal vs postpubertal individuals | >0.5cm pre, >1.5cm post |
| McCune Albright Syndrome appearance vs NF1 CAL spots | MCAS coast of Maine, NF1 coast of California |
| Describe the appearance of a Fibroma molluscm seen in NF1 | Raised, fleshy, pedunculated |
| Spinal findings in NF1 | Kypho-scoliosis, post VB scalloping, Dumb bell tumor, IVF enlargement, pedical erosion/destruction |
| What type of imaging is necessary to see Dumb bell tumor in NF1 | CT and MRI only |
| Paget's disease age of incidence | >45years old (rarely younger) |
| Is Paget's disease more common in females or males | Males 2:1 |
| Paget's disease is rarely seen in which parts of the world? | Asia and middle East |
| Clinical findings associated with Paget's disease | Bone pain MC, Path fx, Increase in HAT size, Deformities |
| Lab finding in Paget's | Increase in alkaline phosphatase |
| Three phases of Paget's | Lytic (osteoclastic), Mixed, Blastic (sclerotic) |
| In the lytic phase of Paget's, osteoporosis circumscripta is seen in | the Skull (aka geographic skull) |
| What 2 areas show radiographic feature in the lytic phase of Paget's | Skull (osteoporosis circumscripta), Long bones ("Blade of Grass", "flame" sign) |
| What is the Blade of Grass"/"Flame" sign and how long does this typically show up for | Lucent line encroaching from end to end of long bones, 14 days window |
| In which phase of Paget's does bone start to heal | Mixed phase |
| Which phase is characterized by Patchy sclerosis w/ Osteopenia | |
| In the blastic phase of paget's what areas show radiographic features | Skull, Long bones, Spine, Pelvis |
| What are the radiographic features in the blastic phase of Paget's | Skull -> "cotton wool" appearance, Long bones-> cortical thickening w/ bowing, Spine-> Ivory vertebra, Pelvis-> thickening of iliopectineal line |
| What are some complication associated w/ Paget's | Bowing, Basilar impression, Path fx, Paget's sarcoma, Block vertebrae, High-output cardiac failure |
| What form of High output cardiac failure occurs in Paget's | Polyostotic |
| Which line is used to evaluate basilar impression | McGregor's line |
| McGregor's line is from __________ to _________ | back of hard palate to back of occiput |
| When evaluating basilar impression dens should not protrude above line > than ___ | 4.5 mm |
| What are some medical tx for Paget's | Bisphosphanates & Calcitonin |
| How do Bisphosphanates help with Paget's | Inhibits osteoclastic activity, binds to hydroxyapatite mineral |
| Paget's disease w/ high alkaline phosphatase is indicative of | malignant degeneration-> paget's sarcoma |
| Which is slightly different: AVN ischemic and aseptic necrosis, osteonecrosis, bone infarcts | Bone infarcts are same pathophysiologically but occur in Diaphysis or Metaphysis |
| What are some risks for AVN | Trauma, Sickle cell anemia, Systemic lupus erythematosus, steroids, Dysbaric phenomena, Storage disease (gaucher's), alcoholism |
| What is the dysbaric phenomena is seen in | Scuba divers, astronauts (Nitrogen emboli) |
| What is the "T" and 6 "S"s in AVN | Trauma,sickle cell anemia, SLE, Steroids, Scuba divers, Sterno abusers, Storage diseases |
| LCP and adult AVN is seen/specific to which area of the body | HIP |
| Kienböck's and Preiser's is AVN in which area of the body | Wrist |
| Hass' disease is AVN in which area of the body | Shoulder (proximal humeral head) |
| Osteochondritis dissecans, SONK, Blount's disease is AVN in which area of the body | Knee |
| Freiberg's and Köhler's are AVN in which area of the body | Foot |
| Scheuermann's is associated with AVN in which area of the body | Spine |
| Leg-Calvé-Perthe's age of incidence | 2-12 (earlier onset=better outcome) |
| Leg-Calvé-Perthe's is more common in males or females | 3:1 male predominance |
| T or F Leg-Calvé-Perthe's can be bilateral even if only one side is symptomatic | True (det. By MRI) |
| Which line is used to evaluate Leg-Calvé-Perthe's | Shenton's line, also evaluate teardrop distance |
| The crescent sign (femoral head) is indicative of | subchondral fracture |
| Is the concave or convex portion of the joint surface MC involved in AVN | Convex |
| What is a risk factor for Kienböck's | Negative ulnar variance |
| T or F Dense& collapse lunate is seen on plain film in AVN wrist | True (MRI shows decrease signal) |
| Preiser's disease involves which carpal bone | scaphoid |
| 70% of scaphoid fractures occur in which region of the bone | waist (thus increasing risk for AVN) |
| Preiser's disease = AVN of the distal or proximal fracture fragment | Proximal fragment |
| T or F Whether blood supply, nutrient artery to that particular region of the scaphoid has been compromised can be seen on plain films | FALSE |
| SONK is located | medial portion of the medial femoral condyle |
| Blount's disease affects what parts | Affects the medial growth plate, medial epiphysis and medial metaphysis, Tibial Vara |
| What is Freiberg's infraction | flattening and fragmentation of head of Metatarsal (usually 2nd metatarsal) |
| Why is Freiberg's more common in young women | High heels |
| What does Köhler's disease affect | Navicular (flat & increase in density) |
| Prognosis for köhler's | usually heals without problems |
| What is characterized by multiple schmorl's nodes, enplate irregularities, increase kyphosis, decrease disc height | Scheuermann's |
| Wavy, serpiginous calcifications MC in knee is associated w/ | Medullary bone infarcts |
| If malignant degeneration occurs in Medullary bone infarcts = | Malignant fibrous histiocytoma |
| Common type of soft tissue cancer | Malignant Fibrous Histiocytoma (MFH) |
| T or F Pre-existing bone infarcts can give rise to MFH in bone | TRUE |
| T or F Osteopenia may be the first sign of Multiple Myeloma | True, may be the only sign for 25% of patients |
| MC Primary bone malignancy in children | Osteosarcoma |
Created by:
kfrancis
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