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Rad final PCC
Rad final
| Question | Answer |
|---|---|
| Death of osseous cellular and marrow component of bone | Avascular necrosis |
| Which part of the bone is predisposed to AVN? | Epiphysis |
| Epiphyseal necrosis becomes clinically evident with what? | Articular surface collapse |
| Common etiologies for avns | Idiopathic, trauma, surgery, alcholism, corticosteroids |
| Example of external vessel compression (avn) | Trauma, steroids, infections, gaucher's disease, hyperlipidemia |
| Examples of vessel wall disorders : avn | SLE, radiation, polyarthritis nodosa |
| Thrombo-embolic disorders : avn | Alcoholism, steroid, trauma, sickle cell, caisson's |
| 4 stages of AVN | 1. Avascular 2. Revascularization 3. Repair 4. Deformity |
| General radiological features of epiphyseal infarction | 1. collapse of articular cortex 2. fragmentation 3. mottles trabecular pattern 4. sclerosis 5. subchondral cysts 6. subchondral fracture |
| With collapse of the articular cartilage you loose what? | Smooth contour of bone |
| Manifestation of resorption and weakening...radiolucent clefs appear | Fragmentation |
| Patchy well circumscribed areas of rarefaction identical to DJD ones | Subchondral cysts |
| Examples of subchondral fractures signs | Rim Sign, Cresant sign |
| Common areas for metaphyseal and diaphyseal infarcts | Distal femur, proximal tibia and proximal humerus |
| Metaphyseal infarcts are ___ than ___ and ___ configuration with central ____ | 1. Longer 2. Wide 3. Serpiginous 4. Sclerosis |
| AVN of the adult femoral head aka | Chandler's disease |
| What is chandler's? | avn of femoral head of an adult |
| Chandler's: who's at risk? Unilateral? | 1. men more than woman 2. Bilateral but assymetrical |
| Chandler's: Necrotic area has what shape? | Wedged or semilunar ... bite sign |
| "signs" of AVN | 1. Snow cap 2. Crescent 3. Mushroom deformity 4. Hanging tope |
| The crescent sign is indicative of what? | Subchondral bone collapse |
| What is Legg-Calve-Perthes disease? Who does it affect? How does it heal? | 1. AVN of femoral capital epiphysis before closure 2. Boys 4 to 8 3. Self limiting, resolves in 2-8 years |
| Causes for LCP disease | Heridity, trauma, endorcine, inflammation, nutrition, altered circulatory hemodynamics, disturbed venous drainage, intraosseus hypertension |
| Characteristics of the avascular stage of LCP disease | 0-12 months, capsular distention, increased joint space, increased TDD, small epiphysis |
| Characteristics of revascularization stage of LCP disease | 6 month to 4 years, flattened, small epiphysis, fragmentation, homogenous sclerosis (snow cap), increased cortical density, patchy sclerosis, crescent sign, wide short neck |
| Characteristics of repair and remodeling phase for LCP disease | 1-2 years, gradual reconstructing of density and configuration, COXA VERA, enlarged femoral head (COX MARGNA), flattened head ( MUSHROOM DEFORMITY), large greater trochanter |
| LCP diseas radiographic findings | Soft tissue swelling, SMALL epiphysis, LATERAL displacement of OSSIFICATION center, metaphyseal WIDENING and FORESHORTENED, wide irregular PHYSIS, intraepiphyseal GAS |
| SOft tissue signs of hip joint disease | Capsular swelling, small obturator (hip flexion), increased TDD |
| Who has a poorer prognosis in LCP disease? | Girls |
| Occurs at bone-cartilage junctions | Osteochondrosis dissecans |
| OD represents a ___ ____ infarction of ___ bone | 1. Focal subchondral 2. Sub-articular |
| Free floating bone can be due to what? | Osteochondrosis dessicans |
| Who is affected by OD? | Children and teens (11-20), males more than females |
| Where does OD manifest? Signs? | 1. Knee MC, humeral head, capitulum of elbow and medial surface of talus 2. Clicking, locking and limitation of motion |
| Where in the knee does it present MC? | 1. Medial femoral condyle close to fossa 2. Lateral aspect medial femoral condyle |
| In OD, defects usually ___ and mesures ____. You may also have __ ___. | 1. Concave 2. less than 2cm 3. Joint mice |
| Diagnostic term applied to the aged knee... associated with ___ ___ lesions | 1. Spontaneous osteonecrosis 2. Medial meniscal |
| Fragmentationof the apophysis of the tibial tuberosity | Osgood Schlatter's disease |
| Fragmentationof the apophysis of the tibial tuberosity with the involvement of the inferior pole of the patella | Sindig-Larsen-Johanssen disease |
| Who gets OSD? Fragmentation may be anomalous development | Males more than females ages 11-15...usually clears up by 18 |
| AVN of MTP2 | Freiberg's disease |
| Freiberg's: more common in ___ possibly because of ____ | Females (13-18) because of high heel shoes |
| Avascular necrosis of lunate | Kienbock's disease |
| Associated with ____. | Ulna minus |
| Who is affected? | 20 - 40 year old males |
| Intially the lunate __ __ ___. Later ___ and ___. ___ ___ and possible treatment. | 1. Increases in density 2. Fragmentation and collapse 3. silastic implants |
| AVN of navicular | Kohler's disease |
| What's wierd about scheuermann's disease? | Usually no necrosis |
| Scheuermann's aka what? | Juvenile discogenic disease |
| Radiology of Sheuermann's: 1. What area of the spine? 2. ___ contiguous vertebra 3. ___body wedging 4. increased ____ | 1. Thoracic and lumbar 2. 3 3. 5 degree anterior 4. Kyphosis |
| The primary etiology JDD appears to be what? | Failure of embrylogic vascular channels, centrum defects and notochord clefs |
| Sclerosis and fragmentation of the calcaneal apophysis... NOT a necrosis | Severs phenomenon |
| MC hemolytic anemia. Pain and swelling where? Infarct of what? predisposition to what? | 1. Sickle cell anemia 2. Hands and feet 3. Bowel 4. Salmonella osteomyelitis |
| Radiography of sickle cell | Marrow hyperplasia, coarse trabeculation, OSTEOPENIA, long bone undertubulation, HAIR ON END skull, H shapped vertebra, AVN |
| What type of deformity in sickle cell? | Erlinmyer flask deformity |
| H shapped vertebrae | Lincoln log and reynold's phenomenon |
| Signs and defects of sickle cell | Crescent, step defect, bite sign, snow cap |
| Thalassemia aka | Cooley's anemia |
| Presentation and features of thalassemia | 1. fatigue due to chronic anemia, splenomegaly, cadiomegaly, gallstones 2. marrow hyperplasia, extramedulary hematopoiesis, maxillary overgrowth (rodent facies), HAIR ON END skull |
| Thalassemia: ____ trabeculation, OSTEOPENIA, ___ ___ deformity | 1. honeycomb 2. erlenmyer flask deformity |
| Imagin for hemophilia | Intra-articular soft tissue swelling, radiodense effusion, OSTEOPENIA, square femoral condyles, wide intercondylar notch, degeneration, epiphyseal overgrowth, erosion |
| What shape is the patella? | Square |
| Leukemia imaging | Radioluscent submetaphyseal bands, osteopenia, osteolytic destruction of long bone metaphysis and diaphysis, periosteal reactions, GROW ARREST LINES |
| Where will the damage be in leukemia | Above and below the growth plate |
| Infection of bone | Osteomyelitis |
| Infection of joint | Septic arthritis |
| Drug addicts get infections where? | S joints: spine, sacroilliacs, symphysis pubis, sternoclavicular |
| MC organism to cause infection | STAPH |
| Routes of dissimination | Hematogenous (MC), direct extension, Direct implantation, Postoperative |
| Superative osteomyletis affect who and due to what? Non suppurative? | 1. Staph : males 2-12 2. TB |
| Growth plates inhibit what type of spread? | Hematogenous only |
| MC locations for hematogenous spread and why? | 1. Knee, hip, ankle, shoulder, spine 2. Venous stasis! |
| 2 major catagories of infection | Suppurative and non-suppurative |
| Clinical features of acute infection | Lymphadenopathy, cellulitis, may be moist vs dry |
| 4 radiographic stages of infection | 1. Latent: 1-10 days 2. Early: 10-21 days 3. Middle: weeks 4. Late: months |
| In what stage do you find lytic moth eaten destruction or codman's triangle? | Middle stage |
| In what stage do you find the involcrum, cloaca and sequestrum? | Late stage |
| Isolated dead bon due to cortical and meduallry infarcts | Sequestrum |
| Laminated periosteal change = | onion skinning |
| Spiculated periosteal change = | Hair on end or sunburst |
| "bony collar" - chronic periosteal response | Involcrum |
| Pus lifts the periosteum and causes new bone formation | Involcrum |
| Draining sinus | Cloaca |
| Rare complication is to dev a squamous cell carcinoma within the channel of the cloaca | Marjolin's ulcer |
| Localized, aborted form of suppurative osteomyelitis | Brodie's abscess |
| Localized pain worse at night releive by asprin. Mimic what? Location? Lesion may be ___. Can be seen with ___ or ___ | 1. Brodies' abcsess 2. 2. osteoid osteoma 3. Metaphyseal location, esp distal tibia 4. steril 5. chronic osteomyelitis or reactive sclerosis |
| Respects growth plates and joints | Tumor |
| How does a spinla infection manifest in yougner than 20? Older than 20? | 1. Infection starts in disc cause still vascular then spreads to body 2. Starts in anterior vertebral endplates then goes to disc with vertebral collapse and soft tissue paraspinal mass |
| MC spot for spinal infection? ___ is the site of infection for IV drug users. May have a widening of ___ and ___ with paraspinal line deflection and psoas abscess | 1. Lumbars 2. SI joints 3. RTI and RPI |
| What crosses the joint space? | Osteomyelitis and septic arthritis |
| Tear drop distance more than __ is pathological | 11mm |
| When you have unilateral sacroilitis you must first think what? Which tests? | 1. Infection 2. HLA B27, CBC, ESR |
| Spine infection | Spondylitis |
| Early radiographic features of spine infection | Radip loss of disc space, endplate destruction, icreased RPI or RTI, space occupying lesion, prevertebral swelling |
| What modality is most sensitive to infection? | MRI then Bone scan then CT then Xray |
| Osteomyelitis findings on MRI: What do TI and T2 look like | T1 = decresed density T2 = increased density |
| Radiographic latency period for infection | 10 days |
| MC cause of infection related death in the world | TB |
| Skeletal involvement of TB | Spine at TL junction, weight bearing joints, Multiple levels common |
| Diffrence between primary and secondary TB | 1. Inhalation : respiratory 2. Respiratory + dessimination |
| Classical radiographic findings for TB | Similar to osteomyelitis but with multiple levels paraspinal cold abcesses with Ca |
| Gibous formation and Pott's disease associated with what? | TB |
| With tuberculosis septic arthritis you have ____ which consists of what? | 1. Phemister's triad 2. juxtarticular osteoporosis, marginal erosion and slow joint space loss |
| MC location for non suppurative infection | Spine |
| Which type of infection hase slower progression and poorer response to therapy? | Non suppurative |
| Systemic bone disease can be either ___, ___ or ___ | Metabolic, nutritional or endocrine |
| Hormones and nutrients stimulating bone production | Growth hormone, thyroid hormone, calcitonin, vitamin D and C |
| Hormones and nutrients inhibiting bone production | PTH, cortisol |
| Causes of osteopenia | Osteoporosis - MC, osteomalcia, hyperparathyroidism, rickets, scurvy, neoplasm |
Created by:
LrB
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