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Skel Rad 4 written

Skel Rad 4 written final

QuestionAnswer
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