Pathology Ch. 4

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Pathology Ch. 4
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2012-02-14 15:37:36
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Pathology Ch. 4
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  1. The purpose of radiographic evaluation is:
    Assess abnormalities resulting from trauma or bone disease
  2. The purpose of radiographic evaluation should include:
    • Correlation with clinical findings, mechanisms of injury, patient’s age and physical condition
    • Anatomic alignment and position of involved bones.
    • Assessment of entire bone, involved joints including:
    • * Articular surface (cartilage)
    • *Cortex
    • *Medullary canal
    • *Periosteum
    • *Epiphyseal growth plates—children
    • Comparison views can be very helpful in final diagnosis
    • Low to mid kVp range generally the best – need higher (shorter) contrast scale
  3. 2 types of non-trauma skeletal pathologies:
    • Osteolytic – loss of bone ( ex – bone metastases, multiple myeloma)
    • Osteoblastic – bone addition (example – osteopetrosis)
  4. 2 important points regarding fractures:
    • Include at least one joint for alignment purposes
    • Two views – 90 degrees from each
  5. 2 special radiographic signs of fractures:
    • Positive fat pad sign
    • *Elbow – definite fracture radial head
    • *Knee – possible fracture, definite joint effusion
    • Positive drawer sign
    • *Stress views of ankle- radiographic signs of ligament tear (include):
    • 1. AP position = widening of the ankle mortise
    • 2. Lat position = talus moves forward
  6. 3 main x-rays that are ordered for trauma are:
    • Chest
    • Abd/pelvis
    • Lateral C/S
  7. Define compound fracture
    If the overlying skin is disrupted and the fracture is open
  8. Define comminuted fracture
    Composed of more than two fragments
  9. Define greenstick fracture
    An incomplete fracture with the opposite cortex intact
  10. Trauma: priorities to triage:
    • Pulmonary function (breathing)
    • Cardiovascular function (heart)
    • CNS function (nervous system)
    • GU function (kidneys)
    • Orthopedic function
    • Hemorrhage is the predominant cause of shock in trauma
  11. Difference between osteoarthritis and rheumatoid arthritis
    Osteoarthritis is the aging process and rheumatoid arthritis is an autoimmune process
  12. Bones consist of which 2 inorganic salts?
    • Calcium
    • Phosphate
  13. Primary ossification appears in the:
    Diaphysis
  14. Secondary ossification appears in the:
    Epiphyses (the end of long bones)
  15. Osteogenesis imperfecta
    • Brittle bone, inherited disorder
    • Multiple fractures
    • Severe osteoporosis, thin cortices, sutures in the skull, callus formation when healing
  16. Rheumatoid arthritis
    • Autoimmune disease
    • Noninfectious inflammatory arthritis of the small joints of the hands and feet
    • Women are affected about 3 times more than men, 40+ years of age
    • Joint effusion, periarticular osteoporosis, narrowing of the joint space
  17. Legg-Calve-Perthes disease
    • a. group of disorders know as Osteochondroses which are typically characterized by degeneration and regeneration of the growing end of a bone. The growing end of the upper portion of the femur bone is affected.
    • b. Clinical patient symptoms: limp with or without pain in the hip, knee, thigh, and/or groin, muscle spasms, delayed maturation of the femur, mild short stature, and/or limited movements of the affected hip. Typically affects pediatrics.
    • c. Radiographic signs/appearances of pathology: Slight widening of the hip joint, superimposed joint changes, loss of structural integrity of the femoral head, flattening, sclerosis, and fragmentation of the femoral head.
    • An AP pelvis or hip best demonstrates this pathology. CT, MRI, and ultrasound can also demonstrate the pathology.
  18. Osteoarthritis
    • a. Osteoarthritis is an extremely common generalized disorder characterized pathologically by loss of joint cartilage and reactive new bone formation. Part of the wear and tear of the aging process, degenerative joint disease tends to affect predominantly the weight-bearing joints (spine, hip, knee, ankle) and the interphalangeal joints of the fingers.
    • b. Clinical patient symptoms: pain in the affected joints after repetitive use, swelling, warmth, stiffness, and creaking of the affected joints. It usually affects older adults due to the wear and tear of the aging process.
    • c. Radiographic signs/appearances of pathology: narrowing of the joint space, development of small bony spurs along the margins of the articular edges of the bones, erosion of the articular cortex which may produce typical irregular, cystlike lesions with sclerotic margins in the subchondral bone near the joint.
    • d. Best radiographic view/exam to demonstrate the pathology of alternative exams: MRI. Conventional radiographs provide little information. Arthrography enables a more direct assessment of cartilaginous integrity, but MRI is considered to be the initial imaging study of choice.
  19. Osteogenic sarcoma
    • a. Definition of term: a malignant tumor in the bone which generally occurs in the end of a long bone in the metaphysic. This tumor consists of osteoblasts, which produce osteoid and spicules of calcified bone.
    • b. Clinical patient symptoms: local pain and swelling, fever, weight loss, and secondary anemia. Typically affects person between 10 and 25 years old.
    • c. Radiographic signs/appearances of pathology: a mixed destructive and sclerotic lesion associated with a soft tissue mass, irregular periosteal reaction, and reactive new bone formation. In the classic sunburst pattern, horizontal bony spicules extend in radiation fashion into the soft tissue mass.
    • d. Best radiographic view/exam to demonstrate the pathology of alternative exams: CT scans are beneficial in demonstrating this pathology as is MRI.
  20. Osteoporosis
    • a. Definition of term: a generalized or localized deficiency of bone matrix in which the mass of bone per unit volume is decreased in amount but normal in composition. It is usually caused by accelerated resorption of bone, although decreased bone formation may lead to osteoporosis.
    • b. Clinical patient symptoms: backache. Gradual loss of height and an accompanying stooped posture, fractures of the spine, wrist, or hip. Osteoporosis can affect anyone, age or sex.
    • c. Radiographic signs/appearances of pathology: cortical thinning, with irregularity and resorption of the endosteal surfaces. As the bone density of a vertebral body decreased, the cortex appears as a relatively dense and prominent thin line producing the typical picture-frame pattern
    • d. Best radiographic view/exam to demonstrate the pathology of alternative exams: CT scan accurately demonstrates levels of bone mass and determines the rate of bone decay which can demonstrate this pathology well.
  21. Osgood Schlatter Disease
    • a. Definition of term: a painful condition characterized by tiny, microfractures of the bony hump in the lower leg bone where the ligament from the kneecap inserts into the tibia.
    • b. Clinical patient symptoms: usually localized pain. It affects early teenagers.
    • c. Radiographic signs/appearances of pathology: enlarged tibial tubercle and present ossicle, soft tissue swelling, overlying bursa.
    • d. Best radiographic view/exam to demonstrate the pathology of alternative exams: lateral radiographs are used best to demonstrate soft tissue findings as well as bony changed, such as ossicle formation. CT and MRI may also be used to demonstrate this pathology.
  22. Ankylosing Spondylitis
    • a. Definition of term: a progressive inflammatory disease that primarily involves the sacroiliac joints and the axial skeleton. Aka bamboo sign
    • b. Clinical patient symptoms: lower back and hip pain, stiffness of affected regions, limited ability to expand the chest to take a deep breath if the joints in the ribs with the spine are affected. Affects people of early to mid adulthood (15-30 years) and young men.
    • c. Radiographic signs/appearances of pathology: bony morphology and subtle calcifications and ossifications.
    • d. Best radiographic view/exam to demonstrate the pathology of alternative exams: radiographs are best to demonstrate this pathology but CT and MRI is also useful.
  23. Paget’s Disease
    • a. Definition of term: Paget’s disease is one of the most common chronic metabolic diseases of the skeleton. Destruction of bone, followed by a reparative process, results in weakened, deformed, and thickened bony structures that tend to fracture easily.
    • b. Clinical patient symptoms: bone pain, secondary osteoarthritis, bony deformity, excessive warmth, and neurologic complications. The disease, seen most commonly during middle life, affects men twice as often as women and has been reported to occur in about 3% of all persons older than 40 years.
    • c. Radiographic signs/appearances of pathology: Cotton-wool appearance. In the skull, Paget’s disease begins as an area of sharply demarcated radiolucency that represents the destructive phase of the disease. In the spine, Paget’s disease characteristically causes enlargement of the vertebral body. In the pelvis, there is coarsening of the trabeculae along the iliac margins, which causes thickening of the pelvic brim. In the long bones, the destructive phase begins at one end of the bone and extends along the shaft for a variable distance before ending in a typical, sharply demarcated, V-shaped configuration.
    • d. Best radiographic view/exam to demonstrate the pathology of alternative exams: It depends on which body part. Nuclear medicine helps demonstrate cold spots within a hot spot in the skull. Radionuclide bone scans is the most efficient method to visualize multicentric lesions. MRI and CT provide the most accurate imaging if osteosarcoma is suspected.
  24. Multiple Myeloma
    • a. Definition of term: Multiple myeloma is a disseminated malignancy of plasma cells that may be associated with bone destruction, bone marrow failure, hypercalcemia, renal failure, and recurrent infections.
    • b. Clinical patient symptoms: Bone pain, weakness and fatigue, and weight loss. The disease affects primarily persons between 40 and 70 years of age.
    • c. Radiographic signs/appearances of pathology: Multiple punched out osteolytic lesions scattered throughout the skeletal system. In the spine, decreased bone density and destructive changed in multiple myeloma are usually limited to the vertebral bodies, sparing the pedicles.
    • d. Best radiographic view/exam to demonstrate the pathology of alternative exams: For skulls, this pathology is best seen in the lateral view. The preferred imaging exam for this pathology is the skeletal bone survey.
  25. Avulsion fracture:
    Small fragments torn from bony prominences
  26. Depressed fracture:
    Occurs in the skull or tibial plateau
  27. Torus fracture:
    One cortex is intact with buckling or compaction of the opposite cortex
  28. Define malunion
    Healing of fracture fragments in a faulty position
  29. Define delayed union
    Any fracture that takes longer to heal than the average fracture at that anatomical location
  30. Define nonunion
    Condition in which the fracture healing process has completely stopped and the fragments remain ununited even with prolonged immobilization
  31. Colle's fracture
    • Transverse fracture through the distal radius with dorsal (posterior) angulation and often overriding of the distal fracture fragment.
    • Usually caused by a fall on the outstretched hand and is the most common fracture of the wrist.
  32. Navicular fractures
    • The most common fracture of the carpal bones.
    • They are usually transverse and occur through the central part of the bone.
  33. Monteggia fracture
    Isolated fracture of the shaft of the ulna associated with anterior dislocation of the radius at the elbow
  34. Galeazzi fracture
    Combination of a fracture of the shaft of the radius and a dorsal (posterior) dislocation of the ulna at the wrist
  35. Pott's fracture
    Involves both malleoli with dislocation of the ankle joint
  36. Jone's fracture
    One of the most frequent injuries of the foot and is a transverse fracture at the base of the 5th metatarsal
  37. Jefferson's fracture
    Comminuted fracture of the cervical spine at the ring of the atlas
  38. Hangman's fracture
    • Result of hyperextension of the head on the neck.
    • It appears as a fracture of the arch of C2 anterior to the inferior facet and is usually associated with anterior subluxation of C2 and C3.
  39. Clay's shoveler's fracture
    Avulsion fracture of a spinous process in the lower cervical or upper thoracic spine.
  40. Seat belt fracture
    Transverse fracture of a lumbar vertebra that is often associated with significant visceral injuries.
  41. Common fractures and dislocations
    • Colle's
    • Navicular
    • Boxer's
    • Monteggia
    • Galeazzi
    • Jone's
  42. Common spinal disorders
    • Disk herniation (c/s and l/s regions)
    • Scoliosis (lateral curvature)
    • Spondylolysis and spondylolisthesis (5th lumbar vertebra, lumbosacral junction)
  43. Aging and postmenopausal hormaonal changes are the major causes of generalized_______
    A. osteogenesis imperfecta
    B. osteopetrosis
    C. osteomalacia
    D. osteoporosis
    D. osteoporosis
    (this multiple choice question has been scrambled)
  44. A benign projection of bone with a cartilate-like cap occuring around the knee in children or adolescents is ___________
    A. osteochondroma
    B. enchondroma
    C. achondroplasia
    D. osteoma
    A. osteochondroma
    (this multiple choice question has been scrambled)
  45. The form of noninfectious arthritis characterized by osteoporosis, soft tissue swelling, and erosions of the metacarpophalangeal joints and ulnar styloid processes is ________
    A. osteoarthritis
    B. psoriatric arthritis
    C. Reiter's syndrome
    D. rhematoid arthritis
    D. rhematoid arthritis
    (this multiple choice question has been scrambled)
  46. The extrememly common form of arthritis that is characterized by loss of joint cartilage and reactive new bone growth and that is part of the normal wear and tear is __________
    A. Reiter's syndrome
    B. rhematoid arthritis
    C. psoriatric arthritis
    D. osteoarthritis
    D. osteoarthritis
    (this multiple choice question has been scrambled)
  47. In what type of fracture is the skin broken?
    A. comminuted
    B. butterfly
    C. compound
    D. both a and c
    C. compound
    (this multiple choice question has been scrambled)
  48. What is the name for the type of fracture that can occur from falling on the outstretched hand and that involves the distal portion of the radius?
    A. Colles'
    B. pathologic
    C. stress
    D. Pott's
    A. Colles'
    (this multiple choice question has been scrambled)
  49. What name is applied to a fracture involving both malleoli?
    A. Pott's
    B. stress
    C. Colles'
    D. pathologic
    A. Pott's
    (this multiple choice question has been scrambled)
  50. What is the name applied to the fracture resulting from acute hyperextension of the head on the neck that usually affects C2 and C3?
    A. Monteggia
    B. boxer's
    C. hangman's
    D. Jefferson
    C. hangman's
    (this multiple choice question has been scrambled)
  51. What area of the spine does a clay shoveler's fracture involve?
    A. lumbar only
    B. lower thoracic and upper lumbar
    C. cervical only
    D. lower cervical and upper thoracic
    D. lower cervical and upper thoracic
    (this multiple choice question has been scrambled)
  52. What medical term refers to a cleft in the pars interarticularis commonly involving the 5th lumbar vertebra?
    A. spondylolisthesis
    B. spondylitis
    C. spondylolysis
    D. a or b or c
    C. spondylolysis
    (this multiple choice question has been scrambled)
  53. Osteomalacia
    • Insufficient mineralization of the adult skeleton
    • Radiographically osteomalacia appears as a loss of bone density

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