Diagnostic Imaging

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maosi9
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63302
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Diagnostic Imaging
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2011-02-09 15:56:35
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Diagnostic Imaging
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  1. Name Malignant Neoplasm
    • Multiple Myeloma
    • Metastisis- Lytic and Blastic
    • Hodgkins
    • Pagets
    • Osteo Sarcoma
    • Chondrosarcoma and Fibrosarcoma
    • Ewings Sarcoma
    • Chordoma
  2. Multiple Myeloma's AKA
    Plasma Cell Sarcoma
  3. Multiple Myeloma/ Plasma Cell Sarcoma
    • Primary Malignance of Bone
    • proliferation od plasma cells infiltrating bone marrow
    • can cause pathological collapse (vertebral Plana)
    • Associated with "rain drop skull"
    • will spare pedicle
  4. Multiple Myeloma/ Plasma Cell sarcoma
    Labs
    Special Test
    • Labs: M spike on the immunuElectroPhoresis
    • Reversal of Albumin/ Globulin Ratio (Screen Test)
    • Bense Jones Proteinuria, Elevated ESR
    • Special Test: Bone Scan - COLD
  5. Types of Metastatic Disease
    • Lytic and Blastic
    • Most common malignant tumor of bone
    • * Multiple Myeloma is the MC primary malignancy*
  6. Lytic Metastasis
    • > 40 yo
    • recent unexplained weight loss
    • skeletal pain worse at night
    • Moth eaten or permeative pattern
    • "EATS" pedicle
    • has swiss cheese appearance in skull
  7. Lytic Mets LABS/ Special test
    • LABS Increased Alk Phos
    • Speacial Test: Bone Scan- HOT
  8. Hodgkin's Disease
    • MC ages 20-40 - seen even more in <30 yo males (CAUCASION)
    • Ivory White Vertabrae with Anterior Scalloping
    • Biopsy is needed - Reed Sternberg cell
    • Does not cause bone enlargement
  9. Blastic Metastasis
    • >40 yo
    • ivory white vertabrae (OJO: does not have anterior scalloping like in Hodgkins)
    • MC cause from prostatic carcinoma
    • may cause pathological collapse
    • Metastisizes to lumbars
    • Does not cause bione enlargement
  10. Blastic Mets
    Labs/ Special test
    • LABS: Increased Alk Phos
    • Special Test: Bone scan- HOT
  11. Paget's AKA
    Osteitis Deformans
  12. Paget's / Osteitis Deformans
    • > 50 yo Males
    • Cortical Thickening
    • Bone expansion
    • picture frame vertrbrae (1st stage)
    • bowing deformities
  13. Paget's/ Osteitis Deformans
    Labs
    • Increased Alk Phose
    • Increased Urinary Hydroxyproline

    Speacial Test: Bone Scan- HOT
  14. Osteosarcoma
    • MC BONE Malignancy in CHILDREN
    • 10-30yo
    • Spiculated/ radiating/ sunburst - radiates at 90 degrees
  15. Osteosarcoma Labs and Special Test
    • Labes: Increased Alkaline Phos
    • Special Test: Bone scan- HOT
  16. Chondrosarcoma and Fibrosarcoma
    • >40yo
    • creates spiculated/ radiating/sunburst periosteal reaction of bone
  17. Ewings Sarcoma
    • 10-25+/- yo
    • MC in Diaphysis of long bones
    • multiparalleled onion skin (laminated) - Periosteal reaction
    • bone expansion
    • Codmans Triangle
  18. what will Ewings Sarcoma mimic
    an Infection
  19. Chordoma
    • >40 yo
    • Aberrant notochord cell tumor.
    • MC in Sacrum
    • 2nd MC location- Skull
  20. Who most commonly has a scoliosis
    females 13-19
  21. whohow is a scoliosis named
    by major convexity
  22. what is a rotatory scoliosis
    spinous deviate the concavity
  23. what is a simple scoliosis
    spinoues deviate to the convexity
  24. 1. what are the lines of Mensuration for scoliosis?
    2. which is best
    • 1. Cobs and Rissers Ferggusons
    • 2. Cobs is the best
  25. MC scoliosis
    females - Right thoracic convexity
  26. in refrence to scoliosis what does UNDER 20 degrees means
    adjust and monitor
  27. In refrence to scoliosis what does 21-40 degrees
    send to orthepist for bracing - Milwaukee
  28. Scoliosis measurement over 40 degrees mean what
    surgical consult
  29. scoliosis measurement over 50 degrees means what
    cardiopulmonary compromise
  30. what are the stages of Pagets/ Ostositis Deformans
    • 1. Lytic or Destructive
    • 2. Combined
    • 3. Sclerotic
    • 4. Malignant (Osteosarcoma)
  31. Pagets/ Osteitis Deformans MC causes
    Basilar Impression
  32. Pagets/ Osteitis Deformans lines of mensuration
    • for Basilar Invagination
    • McGregor's Line - Best line
    • Chamberlain's Line
  33. How do you monitor Scoliosis
    • 1. Riessors Sign - look at secondary growth centers at the iliac crest (lateral to medial)
    • 2. Wrist Films - Best way
    • 3. tanner Stages (pubertal devolpment; looks at external changes; early puberty leads to increased liklihood of curve progression
  34. if patient over 25 yo comes in with scoliosis what do you do
    evaluate and adjust
  35. What is the best way to monitor scoliosis
    radiographing the Left Wrist.
  36. How would you monitor scoliosis
    1.Risser's sign 2. Wrist films 3. Tanner Stages (pubertal dev't; looks at external changes; early puberty leads to increased liklihood of curve progression)
  37. what are they types of arthritides
    Inflammatory and Degenerative
  38. Name the types of Inflammatory Arthritides
    • Rheumatoid Arthritis
    • Ankylosing Spondylitis
    • Enterpathic Arthropathy
    • Enteropathic Arthropathy
    • Psoriatic Arthritis
    • Reiters
    • Systemic Lupus Erythematosus
    • Scleroderma
    • Osteitis Condensans Ilia
  39. Name the Degenerative Arthritides
    • Degenerative Joint Disease
    • Diffuse Idiopathic Hyperostosis
    • Neurogenic Arthropathy
    • Synoviochondrometaplasia
  40. Rheumatoid Arthritis AKA in refrence to kids
    Still's Disease
  41. what are some characteristics of RA
    • Bilateral uniform loss of joint space
    • rat bite erosions
    • symetrical
    • atlanto axial instability
    • Bouchards (PIP)
    • Haygarth (MCP)
    • DIPs are spared
    • Swan nech and boutiniere deformity
    • ulnar deviation
    • Bakers cyst
  42. What is commonly seen with RA
    • Bilateral Protrusio Acetabuli,
    • swann neck boutinniere deformaty
  43. what is a boutinniere deformity
    • Hyperextension with DIP
    • Hyperflexion with PIP
  44. What is a Swann Neck Deformity
    • DIP Hyperflexion
    • PIP Hyperextension
  45. what is a Bakers Cyst
    benign swelling of the semimembranous bursa
  46. what are the labs for RA
    +RA latex, +FANA, +ESR, +CRP and normocytic normochromic anemia
  47. What is Sjorgens
    • Dry mouth and eyes
    • seen in RA
  48. What is Ankylosing Spondylitis AKA
    MarieStrumpell Disease
  49. Ankylosing Spondylitis/ Marie Strumpell Disease
    • Also considered Autoimmune condition
    • males 15-35yo
    • starts in the SI joints
    • lbp
    • AM stiffness
  50. Ortho's test AS
    • Chest Expansion
    • Foresters Bowstring
    • Lewins supine
    • Iritis
  51. MC places for AS
    • Bilateral SI joint fusion
    • 2nd mc location T12-L1
  52. what is commonly seen with AS
    • Shiny Corner Sign, Bilateral marginal (syndesmophytes)
    • squaring of vertebral bodies
    • bamboo spine
    • dagger sign
    • trolley track sign
  53. AS Labs
    + HLA B27 and +ESR
  54. Enteropathic Arthropathy
    • Identical to AS with GI dysfunction
    • -All signs are the same
  55. Psoriatic Arthritis
    • Males 20-50, silver scaly lesions on extensors
    • pitted nails
    • cocktail sausage fingers
    • Increased in joint space
    • pencil in cup deformity, mouse ear deformity
    • ray sign
    • atlantoaxial instability
    • non-marginal syndesmophytes
  56. Psoriatic Arthritis Labs
    +HLA B27
  57. Reiters
    • Males 20-30+/-
    • urethritis
    • conjunctivitis
    • arthritis
    • calcaneal spur
    • non marginal syndesmophytes
  58. Reiters Labs
    +HLA B27
  59. Systemic Lupus Erythematosus
    • Females, photosensitive, skin rash (malar/butterfly rash)
    • alopecia
    • Raynoauds Phenomenon
    • can cause ulnar deviation of phalanges
    • non erosions of joints
  60. Systemic Lupus Erythematosus
    • +LE prep
    • +FANA
    • +RA latex
    • +ESR
  61. 1. what conditions will cause have ulnar deviation

    2. how are the different
    1. SLE and RA

    • 2. In SLE when a patient presents with Ulnar deviation and they place hand on flat surface and if it returns to normal = SLE
    • In RA patient this is not true
  62. Scleraderma aka
    Progressive Systemic Sclerosis
  63. Scleraderma
    • females 30-50yo
    • CREST Syndrome
    • erosions from distal tufts
  64. Labs for Scleraderma
    +FANA, +RA latex (30%)
  65. Osteitis Condensans Ilia aka
    Osteitis Triangularis
  66. Osietis Condensans Ilia
    • Multiparous females 20-40yo
    • bilateral and symetrical triangular sclerotic areas on the lower half of the ilium.
    • JOINT SPACE IS NORMAL
  67. In Osteitis Condensans Ilia what can be seen on film
    Para glenoid sulci - notches on the inf borders of ilia (bilateral)
  68. Degenerative Joint Disease aka
    Osteoarthritis
  69. DJD
    • Non-Inflammatory
    • MC involves finger and weight bearing joints
    • usually stiffens with rest and improves with activity; complication include spinal stenosis and IVF enchroachment
    • Asymetrical Distribution, non uniform loss of space
  70. DJD MC site
    C5/6
  71. DJD in the spine
    • IVD narrowing
    • osteophytes
    • endplate sclerosis
  72. DJD in the Hand
    • Heberden (DIP)
    • Bouchards (PIP) nodes
  73. Heberden Node
    • hard or bony swellings that can develop in the distal interphalangeal joints (DIP)
    • Sign of Osteoarthritis
  74. Bouchard Node
    • hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes.)
    • Sign of Osteoarthritis
  75. Diffuse Idiopathic Hyperostosis (DISH) AKA
    Forestiers Disease
  76. DISH/ Forestiers Disease
    • Males >40yo
    • associated with Diabetes Mellitus
    • ossification of Posterior Longitudinal Ligament (OPLL)
    • flowing hyperostosis, candle wax drippings, 4 contiguous segments
  77. Neurogenic Arthropathy aka
    Charcots Joint
  78. Charcots/ Neurogenic Arthropathy
    • Secondary to impaired sensory function in the joints
    • seen with diabetes, tabes dosalis, syphulis and syringomyelina
  79. what are the 6 D's and what Disease are they associated
    • seen most commonly in Neurogenic Arthropathy
    • Distension,
    • Density of Subchondral sclerosis,
    • Debris within joint,
    • Dislocation, and
    • Destruction of bone
  80. Synoviochondrometaplasia
    • MC joint affected is the knee
    • Results in Multiple loose bodies within the joint that are round or ovoid in shape
  81. Gout
    • males >40yo due to overproduction of uric acid (foods in high purines)
    • Recurrent Episodes of a painful, monoarticular, red hot, and swollen joint
    • Overhanging margins: Juxta-articulation erosions (above and below joint space)
  82. gout mc seen in
    • MTP of the big toe (Podagra)
    • Tophi Crystals maybe seen
  83. 1. Labs for Gout
    2. Special Tests
    • 1. Increased uric acid
    • +ESR
    • 2. Joint Aspiration
  84. Pharmacology for Gout
    • Acute-Colchinicine
    • Chronic Allopurinol
  85. Calcium Pyrophosphate Dihydrate Crystals Deposition (CPPD)/ Psuedogout
    • Thin linear calcification parallel to the articular cortex within the joint space called Chondrocalcinosis when affecting cartilage.
    • MC seen in the knee
  86. Hydroxyapatite Deposition Disease (HADD)
    • MC affects the shoulder joint
    • round oval calcificationsnear insertion of bursa or tendon
  87. Septic Arthritis
    Pt presents with a fevor, chill, history of trauma/ surgery and a warm tender, swollen joint
  88. Septic arthritis lab
    WBC
  89. Avascular Necrosis aka
    Osteonecrosis/ Osteochondrosis
  90. Avascular Necrosis
    • All AVN's are self resolving taking 8months-12years
    • all major cause is due to trauma
  91. AVN
    Labs?
    Special Tests?
    • No labs
    • Special tests" Bone scan or MRI
  92. Name AVN's
    • Preisers
    • Scherermanns
    • Legg Calves Perthes
    • Kohler
    • Keinbochs
    • Servers
    • Blounts
    • Freinbergs
    • Osteochondritis Dessicans
    • Panners
  93. Preisers
    Carpal Scaphoid - 90% thru middle MC fx of carpal
  94. Osgood Schlatters
    • no longer on AVN list
    • Tibial Apophisitis
    • Location: Tibial Tuberosity
  95. How does Osgood Schlatters present
    • kids 8-16 yo
    • pin point pain and swelling
    • usually sport playing (soccer)\hip felxion and extension
    • Cho pat brace
    • must stop all sports for 3-5weeks
  96. Location of Scheuermann's
    Vertebral End Plate Epiphysis
  97. Legg Calves Perhes location
    femoral Epiphysis
  98. Kohlers location
    Tarsal Navicular
  99. Keinbochs location
    Carpal Lunate
  100. Servers location
    Calcaneus
  101. Blounts location
    Medial Tibial Condyle
  102. Freinbergs location
    Head of 2nd Metatarsal
  103. Osteochondritis Dessicans location
    Articular surface of the medial femoral condyle (mc laterally)
  104. Panners location
    Capitellum

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