Med Testing

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kdarnell
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Med Testing
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2012-04-01 19:48:34
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  1. Test and Measures for Ortho (6)
    1. observation/functional activity

    2. examine all areas of symptoms

    3. neuro exam

    4. exam/clear spine

    5. exam/clear joint above/below

    6. palpate all areas of symptoms
  2. When are diagnostic tests needed? (4)
    sometimes patient history

    in the absence of appropriate response to PT

    if response not consistent with prognosis

    positive findings will influence decision making
  3. When are diagnostic tests NOT needed? (2)
    injury responds with prognosis

    if diagnosis suggests surgery and pt does not want/can't have surgery
  4. mechanism behind radiographs
    ionizing radiation passed thru body, attenuates thru tissue based on radio-density captured onto image receptor
  5. what are radiographs useful in seeing?
    useful to detect avulsions and simple-->complex fractures and later stage stress fractures
  6. what are radiographs NOT useful for?
    not useful for early detection of stress fractures because the fracture line or periosteal reaction may not be evident for up to 6 weeks

    limited sensitivity for tumor or infections, tendons, muscles, ligaments
  7. mechanism of fluroscopy?
    dynamic or continuous radiographic examination

    similiar to a radiographic movie

    viewing of physiological function or medical procedure in real time
  8. what are fluoroscopys useful for?
    barium x-rays, cardiac catheterization, IV placement, image guided injections
  9. what is an angiography?
    injection of contrast into blood supply to find obstructions
  10. what is an arteriography?
    injection into specific artery to demonstrate blood flow
  11. what is a barium swallow?
    shows upper GI tract
  12. what is an arthrography?
    contrast injected into joint
  13. what is a myelography?
    contrast injected into subarachnoid space to look at spinal cord, nerve roots and dura mater
  14. mechanism behind CT
    x-ray tube that creates cross sectional images taken in parallel planes

    tomo= layers/sections
  15. Positives about CT
    good at defining cortical and trabecular bone

    good detail of spinal segments showing osteophytes and stress fractures

    less complex and expensive than MRI
  16. negatives about CT
    limited ability to differentiate btwn types of soft tissues (tendon/ligaments)

    higher doses of radiation and higher cost than conventional radiographs

    MRI is challenging CT for diagnosing bone pathology
  17. mechanism of nuclear imaging
    use of radiopharmaceuticals for diagnosis and therapy

    radiographic tracers absorbed by organs/tissues based on metabolic activity...increased uptake=pathology or change in metabolism
  18. SPECT=

    what is it good for?
    Single Photon Emission Computed Tomography

    localizes small abnormalities in bone, cardiac perfusion, brain, liver
  19. PET =

    what is it good for?
    Positron Emission Tomography

    shows normal/abnormal function of cells, used in cardiology and oncology to detect and stage tumors.
  20. how does bone scan work?

    another name for bone scan...
    Scintigraphy

    radiopharmaceutical substance injected into bone to detect areas of hyperfunction or increased mineral turnover
  21. in a bone scan....areas that appear dark or "hot" = ______

    what does it suggest?
    areas with more uptake of substance = hot/dark

    suggests bone is healing after fracture/neoplasm/infection
  22. mechanism behind MRI
    uses radio frequency waves in a magnetic field to create images of soft tissue and bone

    waves produce changes in atoms which align in direction of magnetic field
  23. T1 = _______


    T2= ________
    bone

    fluid
  24. Positives about MRI
    superior to CT in delineating combinations of soft tissue and bone insults

    better at showing bone marrow abnormalities
  25. What diagnostic test is the gold standard in detecting bone stress injuries?
    MRI
  26. mechanism of T1 MRI
    subacute hemorrhage and fat = bright intensity

    bone = bright intensity due to high fat content

    good at delineating architecture of soft tissues
  27. mechanism of T2 MRI
    fluids have high signal intensity

    bursa, inflamed tendons, tumors and abscesses= high signal intensity

    reveal less details than T1 tissue structure
  28. negatives of MRI
    intolerance due to claustrophobia

    patient often does not remain still

    expensive
  29. absolute contraindications to MRI
    ferro magnetic implants or objects such as cerebral aneurysm clips, pacemakers, shrapnel, unstable ortho hardware
  30. mechanism of diagnostic ultrasound
    images created by tissues reflecting sound waves
  31. what are ultrasounds good at?
    useful for superficial soft tissue structures like muscle, tendon, ligament, nerve

    good at detecting cysts, soft tissue tumors and blood flow
  32. positives of US
    assessing real time muscle contraction, tendle gliding, and muscle size
  33. negatives of US
    image highly dependent on skill of examiner

    more useful in thin patients

    bone and metal reflect sound and not adequately imaged
  34. ABC'S of imaging
    Alignment

    Bone Density

    Cartilage Spaces

    Soft Tissues
  35. what is the responsibility of the collimator in radiographs?
    controls size and shape of x-ray field exiting tube
  36. what is the responsibility of the attenuation of radiographs?
    interaction of x-rays and matter or tissues
  37. not easily penetrated by x-rays which make them appear white on radiograph= ______

    easily penetrated by x-rays which makes them appear black on radiograph= ______
    white= radiopaque

    black= radioluscent
  38. substances based on radiolucency

    increasing radiolucency (going from dark to white)
    air--fat--water--bone--metal
  39. thickness and radiodensity
    thicker = increased radiodensity relative to thinner object
  40. curves and radiodensity:

    object parallel to the beam= _____ x-ray beam

    object perpendicular to beam= _____ x-ray beam
    parallel = less x ray beam



    perpendicular = more x ray beam
  41. how many views at minimum needed for radiograph?
    at least 2
  42. what is the purpose of markers?
    denote patient information and anatomic side
  43. normal cortical bone is?
    dense

    provides strength to long bones
  44. normal trabecular bone is?
    spongy

    provides supportive cushioning
  45. True/False: intra-articular fractures produce different types of effusion
    TRUE
  46. what is lipohemarthrosis?
    mixture of fat and blood from marrow enter joint space through break in bone
  47. What is the FBI sign?
    Fat-blood interface

    fat floats on surface of blood

    interface can be seen on radiograph and should alert you to intra-articular fracture
  48. what is the solid type of periosteum?
    benign process, fracture healing, and osteomyelitis
  49. what is the laminated or onion skin type of periosteum?
    repetitive injury, sarcomas
  50. what is the spiculated or sunburst type of periosteum?
    malignant bone lesions
  51. what is the codman's triangle type of periosteum?
    tumor, subperiosteal hemorrhage, battered child syndrome
  52. what is an osteolytic lesion?
    bone destroyed by osteoclastic activity

    bone destroys itself
  53. what is an osteoblastic lesion?
    new reparative or reactive bone is present
  54. what type of border is suggestive of slow growing or benign lesion?
    sharp, clearly defined, scleroti borders
  55. what type of lesion is suggestive of fast growing or malignant lesions?
    wide, poorly defined borders with minimal or absent reactive sclerosis
  56. Yes/No: do tumors that are malignant or benign cross joint spaces or epiphyseal growth plates?
    NO
  57. What type of condition causes destruction of bone on both sides of the joint?
    RA
  58. what is a buttressing type of bony reaction?
    formation of bony exostosis or osteophytes to strengthen architecture of joint
  59. progression of RA
    involves small joints of wrists, hands and feet

    later stages cause joint deformities, contractures and ankylosis of large and small nonWB and WB joints
  60. clinical features of RA (4)
    pain and swelling of joint

    decreased ROM

    progressive deformities

    loss of function
  61. radiologic signs of RA:

    alignment
    bilateral joint involvement

    MCP sublux and ulnar deviation

    swan neck and boutonniere deformity of IPs

    acetabular profusion of hip
  62. radiologic signs of RA

    bone density
    periarticular rarefaction

    generalized osteoporosis
  63. radiologic signs of RA

    cartilage space
    symmetrical, concentric joint space narrowing

    subchondral erosions

    subchondral cysts
  64. radiologic signs of RA

    soft tissue
    periarticular swelling

    fusiform swelling
  65. types and causes of OA
    primary=idiopathic

    secondary=result of injury
  66. clinical features of OA
    joint pain with movement and/or weight bearing

    limited function over time
  67. radiologic signs of OA

    alignment
    unilateral involvement of synovial or cartilaginous joints

    nodes

    valgus/varus at knees

    subluxation and joint misalignment
  68. Heberden's Nodes are where? ______

    Bouchard's Nodes are where? _______
    Heberden's = DIP


    Bouchard's = PIP
  69. radiologic signs of OA

    bone density
    usually absence of osteoporosis
  70. radiologic signs of OA

    cartilage space
    asymmetric, irregular joint space narrowing

    sclerotic subchondral bone

    osteophytes at joint margins

    subchondral cysts

    intra-articular loose bodies
  71. radiologic signs of OA

    soft tissues
    joint effusion during acute exacerbations
  72. 7 elements to describing fractures
    • 1. anatomic site
    • 2. type (complete/incomplete)
    • 3. alignment of segments
    • 4. direction of fracture line
    • 5. special features (avulsion/impaction)
    • 6. presence of abnormalities such as dislocated joints
    • 7. special types (stress/pathological)
  73. Salter Harris fractures
    Type 1-complete physeal fracture

    Type 2-physeal fracture that impacts metaphysis

    Type 3- physeal fracture extends thru epiphysis

    Type 4- physeal fracture plus epiphyseal and metaphyseal

    Type 5-compression fracture of growth plate
  74. fracture quality pain: acute/chronic point tenderness?
    ACUTE
  75. most commonly missed fractures
    C1-C2, C6-C7

    scaphoid fracture

    femoral neck fracture
  76. how are CT images viewed?
    look up from supine patient's feet
  77. 10 Good things about CT Scan

    1-5
    1. identifying subtle/complex fractures

    2. best for degenerative changes

    3. injuries to bone and soft tissue can be seen from 1 imaging series

    4. excels in eval of spinal stenosis

    5. combined with diskogram to give inevitable info about IVD
  78. 10 good things about CT

    6-10
    6. best modality for eval of loose bodies in joint

    7. less time consuming than MRI/US

    8. allows accurate measurement of osseous alignment

    9. less expensive than MRI

    10. easier on claustrophobic patients
  79. limits of CT
    limited in differentiating between tissues of similar radiodensities

    high radiation exposure
  80. longitudinal magnetization of MRI
    protons lined up like bar magnets
  81. transverese magnetization in MRI
    protons aligned in transverse plane to absorb energy from radiofrequency pulse
  82. how is the image of an MRI made?
    protons realign and release the energy absorbed from radiofrequency pulse which creates current in a receiver coil
  83. T1 recovery =

    T2 decay =
    recovery--reutrn of protons to longitudinal magnetization

    decay-relaxation of transverse magnetization
  84. repetition time (TR) and echo time (TE) in conjunction with T1 and T2
    T1 has a short TR and short TE


    T2 has long TR and long TE
  85. nutshell explanation for MRI
    different protons in body tissue give off different signals in reaction to RF pulses
  86. what type of MRI is good for showing anatomical details?

    also has fat, bone marrow and subacute hemorrhage show up bright
    T1
  87. what type of MRI has less detail of soft tissues?

    also has fluids showing up bright
    T2
  88. what do proton density weighted MRI's show?
    favor water and fat tissue and used to eval orthopedic trauma
  89. what is a spin echo?
    90 deg pulse followed by T1 relaxation and T2 decay
  90. what is a fast spin echo?
    90 deg pulse followed by 180d pulses

    2x as fast as conventional spin echo
  91. what is a STIR and what is it good at detecting?
    Short Tau Inversion Recovery

    detects soft tissues and marrow pathology
  92. what conditions do gadolinium containing contrasts detect?
    anterior inferior labral tears

    bankhart lesions

    fractures of glenoid

    hill-sachs lesions

    SLAP lesions
  93. radiology describes anatomy in terms of _________


    MRI results are described in terms of _______ of various tissues
    radiodensity



    signal intensity
  94. Advantages of MRI (5)
    detecting changes in bone marrow

    display soft tissues in detail

    replaced invasive procedures

    best at diagnosing disk herniations

    stage neoplasms in bone and soft tissue
  95. disadvantages of MRI (3)
    long time

    expensive

    contraindications of ferro magnetic implants
  96. advantages of MRI over CT (4)
    greater contrast resolution for soft tissue imaging

    greater ability to image organs surrounded by bone

    no ionizing radiation

    less risk of missing disease process
  97. frequency of US
    3.5 to 15 MHz
  98. as intensity is increased in US what happens? (3)
    depth of penetration increases

    strength of echo increases

    potential to generate biological effects increases with tissues
  99. amount of reflection in US is determined by what? (4)
    1. degree to whih tissues reflect sound waves

    2. difference in acoustic impedance of 2 tissues forming interface

    3. smoothness of reflecting interfaces

    4. angle of reflection (be as close to perpendicular as possible)
  100. what is acoustic enhancement?
    increase in amplitude of US echo coming from structure that lies behind a weak attenuated structure such as fluid filled cavity (bladder)
  101. what is acoustic shadowing?
    sound wave echo reduced behind strong, attenuating structure

    waves hit something that blocks their path and everything blocking structure appears black
  102. what is reverberation?
    multiple reflections and is result of US echoes bouncing between tissue layers and the transducer
  103. what does hyperechoic mean and is it associated with bone or fat?
    reflects much energy.

    produce bright images

    BONE
  104. what does hypoechoic mean and is it associated with bone or fat?
    reflects little energy

    produce dark images

    FAT
  105. are these hyperechoic or hypoechoic?
    bone
    tendons
    ligaments
    fat
    muscle
    bursae
    hyaline cartilage
    fibrocartilage
    nerve tissue
    cysts
    cortical bone-echogenic bright echo

    bone-hypoechoic

    tendons-hyperechoic

    ligaments-hyperechoic

    fat-hypoechoic

    muscle-hypoechoic

    bursae-hypoechoic

    hyaline cartilage-hypoechoic

    fibrocartilage-hyperechoic

    nerve tissue-hypoechoic

    cyst-dark space
  106. structures that are hyperechoic
    tendons, ligaments, fibrocartilage
  107. structures that are hypoechoic
    bone, fat, muscle, bursae, hyaline cartilage, nerve tissue
  108. advantages of US (9)
    • 1.higher resolution
    • 2. low cost
    • 3. no known hazards
    • 4. ready comparison of opposide side
    • 5. put affected joint in symptom provoking position
    • 6. perform MMT or stretching to find tear
    • 7. apply traction of compression
    • 8. stress test ligaments
    • 9. palpate for tenderness and apply probe over area
  109. disadvantages of US (6)
    • 1. limited ability to show joint surfaces and intra-articular structures
    • 2. only shows cortical outline of bone
    • 3. does not cross air filled interfaces
    • 4. more operator dependent than other modalities
    • 5. obeses patients not imaged well
    • 6. metal not imaged well

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