radiology 4

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radiology 4
2013-03-17 17:30:40

spring 2013
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  1. key muscles attaching to the iliac crest
  2. key muscles attaching to the ASIS
    • sartorius
    • tensor fascia latae
  3. key muscle attaching to the AIIS
    rectus femoris
  4. key muscle attaching to the greater trochanter
    hip rotators
  5. key muscle attaching to the lesser trochanter
  6. key muslces attaching to the IT
  7. key muscles attaching to body of pups and inf pubic ramus
    • adductors
    • gracilis
  8. classic appearance of stress fractures
    condesnation of cancellous bone (like sclerosis) perpendicular to the long bone
  9. 2 types of stress fractures and their descriptions
    • fatigue: normal bone undergoing abnormal stress
    • insufficiency: abnormal bone undergoing normal stress
  10. where are stress fractures most common in the femoral neck, and why? who?
    • inf more common than sup bc inf has "compressive trabeculae" while the sup is the "tensile side"
    • runners and military trainees
  11. the big deal about a femoral neck fracture?
    the blood supply runs thru the neck, so disruption may lead to avascular necrosis of the femoral head
  12. best way to view a fem neck stress fx?
    bc plain films are often neg, get an MRI or bone scan (they're more sensitive)

    (and if you suspect a stress fracture and the plain films are neg, tell the pt to be non-wt-bearing til there's an MRI)
  13. lipohemarthrosis - def, appearance on a film
    mixture of fat & blood in a joint following a trauma (intra-articular fracture)

    if the area is horizontal the fat will float above the fluid (blood) and there'll be a straight line in between
  14. looking at a knee joint in the lateral view, how/where will you see the ACL
    it's visible when you're looking more at the lateral side - as you get more medial it fades, and now you see the PCL
  15. what kind of contraction is most likely to rupture the quad/patellar tendon
    how will the patella appear
    • eccentric
    • it'll be elevated (pat tend rupt)
    • tilted (quad tend rupt)

    <you ninny, quad tendon is sup, pat tendon is inf> 
  16. 4 most common sites of stress fractures
    • 2nd & 3rd metatarsals
    • calcaneus
    • distal tib
  17.  periosteal reaction def
    •  formation of new bone in response to injury or other stimuli of the periosteum surrounding the bone
    • it is most often identified on X-ray films of the bones.
  18. how will a stres fx look in metatarsal vs calcaneus & distal tibia?
    • metatarsals: periosteal reaction (bone growth surrounding the fx
    • calc & distal tib: linear sclerosis
  19. 4 non-mechanical ways to get stress fxs
    • infection
    • arthritsi
    • metabolic (hyperparathyroidism)
    • neoplastic
  20. 2 things to look for in bones for infection
    • periosteal reaction
    • destruction
  21. in bones infection gives a periosteal reaction or destruction. Other signs of infection?
    • soft tissue swelling
    • ulcers
    • subuctaneous air
    • skin thickening
    • cellulitis
    • abscesses fistulas
  22. what do you call an infection when it involves a joint (as opposed to bone)
    septic arthritis
  23. name of infection when it involves bone
    osteomyelitis (it's septic arthritis if it's at a joint)
  24. what kind of scan to use when looking for infection?
    • radiographs first, but it's often negative until at least 7 days
    • MRI - more sensitive
    • nuclear medicine bone scan, dunno when
  25. what to look for on an MRI if you're looking for infection
    abnormal fluid collections and marrow edema (bright on fat-sat T2, dark on T1 ... it's fluid...)
  26. degenerative arthritis = secondary arthritis = osteoarthritis ... what's the basic progression
    loss of articular cartilage --> joint space narrowing --> osteophyte formation

    then there's sclerosis, subchondral cysts

    on a film it's bone-on-bone at the joint, and the bone around there looks fuzzy
  27. where gets hit most by degenerative arthritis / secondary arthritis / osteoarthritis
    hips and knees

    • hands are less common, but when there it's in DIPs & PIPs & CMCs
    • rarely shoulders
    • ... it goes after wt bearing jts
  28. rheumatoid arthritis
    • chronic autoimmune inflammatory disease
    • char by jt swelling, pain, destruction
    • synovial inflammation
  29. arthritises -
    1) which has a swollen inflamed synovium --> bone erosion
    2) which has cartilage erosion --> bone ends rubbing
    • 1) rheumatoid (tho it seems you get eroded cartilage and bone rubbing here too - it's just not the primary issue)
    • 2) osteoarthritis
  30. 7 diagnostic criteria for RA (need 4/7 to have it)
    • morning stiffness at least an hour
    • swelling of 3 or more jts
    • swelling of wrist MCP, or PIP jts
    • symmetric involvement
    • typical radiographic changes
    • rheumatoid nodules
    • positive serum rheumatoid factor
  31. the american college o rheumatology/euorpean league against rhumatism made a classification for pts w at least one joint w synovitis that isn't better explained by some other pathology. what are the 5 things looked at on this scale?
    • number of joints involved
    • serology (for ACPA)
    • acute phase reactants (whether there's abnormal C-reaction protein CRP or erythrocyte sedimentation rate ESR)
    • duration of symptoms (more or less than 6 weeks)
  32. 5 radiographic findings for RA
    • soft tissue swellign
    • osteoporosis
    • jt space narrowing
    • marginal erosions (away from wt-bearing portion of the joint)
    • in hands, proximal process that is bilat & symmetrical
  33. basically what's happening in gout
    hyperuricemia --> deposition of monosodium urate crystals
  34. primary vs secondary gout (the usual diff)
    • primary: congenital 2/2 inborn error of metabolism
    • secondary: 2/2 other disorders affecting urate metabolism (alcoholism...)
  35. presentation of acute vs chronic gout
    • acute: jt swelling & pain mimicking septic arthritis (films show soft tissue changes, no bony changes)
    • chronic: Tophi eroding into bone --> bony changes
  36. tophus def
    • nodular mass of uric acid crystals.
    • characteristically deposited in different soft tissue areas of the body in chronic (tophaceous) gout,  
    • commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, they can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, in the vocal cords, and around the spinal cord.
  37. common sites for gout
    • 1st MTP joint involve 90% of the time
    • metatarsotarsal jts
    • olecranon bursits
  38. radiographic findings for gour
    • eccentric soft tissue swelling (tophi)
    • erosiongs w overhanging edges (reactive bone around tophus)
    • jt space preserved
    • can be near or far from jt
    • no jt space narrowing
  39. why is the jt space preserved in gout?
    bc deposition in articular cartilage is focal, so narrowing only occurs late

    so basically, no jt narrowing!