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Rad final PCC

Rad final

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