xray

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werika
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99508
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xray
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2011-09-03 17:24:31
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NBCE
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NBCE xray
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  1. Osteochondroma
    • MC BBT of the APPENDICULAR SKEL
    • pedunculate (aka: coat hanger)
    • sessile
  2. hereditary multiple exostosis HME
    • multiple osteochondromas
    • 20% undergo malignancy
  3. unicameral bone cyst (UBC) aka: Simple Bone Cyst
    • diaphyseal/metaphyseal
    • centrally located
    • <20 yo, fluid filled
    • "FALLEN FRAGMENT" sign
  4. Aneurysmal bone cyst (ABC)
    • diaphyseal/metaphyseal
    • eccentrically located
    • < 20 yo, BLOOD FILLED
  5. Giant Cell
    • epiphyseal
    • 20-40 yo
    • 20% quasi-malignant
    • soap-bubble
  6. osteoid osteoma
    • night pain= relieved by aspirin
    • radiolucent central nidus
    • severe reactive scoliosis
  7. Brodies Abcess (Aka Chronic osteomyelitis)
    night pain releived by aspirin, appears like osteoid
  8. Enchondroma
    • MC BBT of the HAND
    • may have stippled appearance
    • multiple enchondroma's= ollier's disease
    • with soft tissue calcification is known as Maffucci's Syndrome
  9. Hemangioma
    • MC BBT of the SPINE
    • vertical striations
    • corduroy cloth appearance
  10. Enostoma
    • bone island, round or oblong radiopaque
    • hands, feet, pelvis
  11. Osteopoikilosis
    mltpl bone islands
  12. Osteoblastoma
    • MC BBT of the Neural Arch
    • 10-30 YO
  13. OSteoma
    • MC BBT to affec the skull
    • MC in frontal sinus: caldwell projection
  14. Fibrous dysplasia
    • monostotic- 70% associated with Rind Sign, polyostotic 30%
    • resoptoin of bone replaced w/ fibrous tissue
    • deformities: saber shin tibia, sheppards crook
    • * ground glass
    • * cafe au lait w/ cost of maine (jagged edges)
  15. Neurofibromatosis
    • family history
    • scoliosis
    • cervical kyphosis, vert body scalloping, IVF enlargement
    • *cafe au lait w/ Coast of Cali. (smooth edges)
  16. Multiple Myeloma
    • > 50yrs old cachexia, weight loss
    • aplastic anemia
    • MC 1* malignancy of bone
    • malignant proliferation of plasma cells infiltrating bone marrow
    • Mtpl dark densities that are similar in size (punched out lesion)
    • *vertebra plana
    • *Rain drop skull
    • Labs: M spike on immuno electrophoresis
    • :reversal of A/G ratio, Bence jones urinalysis, elevated ESR,
    • Bone Scan: COLD
  17. Mets
    MC malignant tumor of bone
  18. lytic mets
    • > 40 yo, unexplained weight loss, skeletal pain at night
    • trabeculare reabsorbed= dark bone
    • moth eaten/permeative pattern
    • swiss cheese appearance in the skull
    • lab: alk phosphotase
    • Bone Scan: hot
  19. hodgkins
    • MC mets in 20-40 yo
    • ivory white vertebrae w/ ant. body scalloping
    • unilateral hilar lymphadenopathy
    • Xray: PA chest
    • lab: reed sternberg cells on biopsy
  20. Blastic Mets
    • > 40, ivory white vertebrae
    • porostatic carsinoma
    • labs: increased alk phos
    • bone scan: hot
  21. pagets
    • males over 50
    • basilar invagination : (chamberlines/mcgregors lines)
    • stages: lytic/destructive, combo, sclerotic, malignant (stage 4)
    • cortical thickening, bowing deformities, coarsened trabeculae, bone expansion
    • picture frame vertebra
    • labs: increased alk phos, urinary hydroxyproline
    • bone scan: hot
  22. osteosarcoma
    • MC malignancy found in kids 10-30
    • periosteal reaction: spiculated/radiating/sunburst
    • labs: incr. alk phos,
  23. chondrosarc/fibrosarc
    .40, spiculated appearance
  24. ewing's sarcoma
    • 10-25yo, MC in diaphysis
    • permeative lesion
    • onion skin (laminated)
    • bone expansion, codmans triangle
    • saucerization
    • *mimics infection
  25. Chordoma
    • > 40 yo aberrant notochordal cell tumor
    • MC in Sacrum
    • 2nd MC in skull
  26. Ivory verts
    pagets, hodgkins, blastic mets
  27. Scoliosis
    • females 13-19
    • named for the side of CONVEXITY
  28. Rotary Scoliosis
    SPs rotate to the concavity
  29. Simple Scoliosis
    SPs deviate to the convexity
  30. Scoliosis measurements
    • 25 yo and younger
    • under 20 degrees: adjust/monitor
    • 21-40 deg: send to orthopedist for milwaukee bracing
    • 40+: surgical consult
    • 50+ cardiopulmonary compromise
  31. Monitor scoliosis
    • rissers sign: iliac crests
    • wrist films: best method, L wrist
    • Tanner stages: pubertal development
  32. RA (Stills in kids)
    • bilateral loss of jt space
    • rat-bite erosions
    • pannus
    • symmetrical
    • bouchards and haygarths nodes
    • swan neck/boutonniere/ular deviation
    • labs: +RA latex, +FANA, +ESR, +CRP
  33. AS (aka marie strumpell)P
    • males 15-35 yo, low back pain/AM stiffness
    • SI jt: bilateral fusion (ghost jt)
    • + chest expansion, foresters bowstring, iritis, lewins
    • spine: shiny corner sign, bilateral syndesmophytes, squaring off vert body, bamboo spine, dagger sign, trolley track
    • labs: +HLA B27, +ESR
  34. Enteropathic arthropathy
    • females MC
    • AS w/ GI dysfunction
  35. Psoriatic arthritis
    • Males 20-50 yo
    • silver scales, pitted nails, sausage digits, auspitz sign
    • Spine: pencil in cup, mouse ear, ray sign
    • Lab: +HLA B27
  36. Reiters
    • males 20-30
    • urethritis, conjuctivitis (chlamydia) calcaneal spur, non-marg. syndesmo
    • labs:+HLA B27
  37. SLE
    • females
    • sunlight precipitates a rash
    • malar/butterfly rash
    • alopecia
    • raynauds, ulnar dev
    • labs: LE prep, FANA RA latex, ESR, leukopenia, thrombocytopenia, anti-dna
  38. Sleroderma (progressive systemic sclerosis)
    • females 30-50, CREST syndrome, erosions of the distal tufts
    • Labs: +FANA, RA latex (30%)
  39. osteitis condesans ilia (osteitis triangularis)
    • multiparous females 20-40
    • bilateral/symmetric triangular sclerotic area
    • self resolving
    • no labs
    • treatment: trochanteric belt
  40. DJD/ OA
    • non-inflammatory
    • MC on finger and weight bearing jt
    • stiffness- improves w/ activity
    • MC C5/C6
    • Spine: ivd narrowing, osteophystes, endplate sclerosis
    • Hand: heberden's, bouchard's
  41. DISH
    • males > 40
    • DM association
    • ossification of the PLL (OPLL)
    • Spine: flowing hyperostosis, candle wax, 4+ segments
  42. synoviochondrometaplasia
    • MC jt affected is the knee
    • multiple loose bodies w/in jt round/ovoid shape
  43. HLAB-27 +
    • PEARS:
    • Psoriatic
    • Enteropathic
    • AS
    • Reiters
    • Ulcerative colitis/chron's
  44. Gout
    • males > 40yo
    • overproduction of uric acid
    • recurrent episodes, pain, monarticular, hot/red/swollen jt
    • MC site is the MTP of the big toe
    • labs: uric acid, ESR, jt aspiration
    • Rx: acute-colchicine, chronic-allopurinol
  45. CPPD/Pseudogout
    • thin linear calcification
    • chondrocalcinosis when in cart
    • MC at knee
  46. hydroxyapatite deposition disease (HADD)
    • MC in shoulder
    • round/oval calcification near insertion of tendon/burs
  47. Septic arthritis
    • fever, chills, hx of trauma/surgery
    • warm, tender, swollen jt
    • lab: WBC count
  48. AVN
    • self resolving 8mos-2 yrs
    • Trauma!
    • no labs
    • MRi is best, Bone scan
  49. preiser's
    AVN: carpal scaphoid
  50. Osgood Schlatter
    tibial tuberosity/avulsion/apophositis AVN
  51. Scheurermann's
    AVN vert endplate
  52. Legg calve perthes
    AVN femoral epiphysis
  53. kohlers
    AVN of tarsal navicular "cold" feet
  54. keinbochs
    carpal lunate avn ("kind hands")
  55. severs
    avn of calcaneus
  56. blount's avn
    medial tibial condyle
  57. freibergs
    avn of head of 2nd mtp
  58. osteochondritis dessicans
    • avn of medial femoral condyle
    • 16-25 yo athlete, knee locks on ext
  59. panner's avn
    capitellum
  60. scheuermann's dx
    • mc b/n 10-16 yo males, mtpl shmorls nodes
    • radiographic signs:
    • 1) slight loss of ant body height
    • 2) mtple end plate irrecularieties
    • lab; none, special test; MRI
  61. Legg calve perthes
    • boys 4-9 yo
    • avn of femoral head
    • fragmentation crescent sign, snow capped
    • refer to orthopedist--> A brace
    • stop physical activity & adjust
  62. Slipped capital femoral epiphysis
    • boys 10-16 yo, salter harris type 1 frx
    • refer to orthopedist
    • femoral head slides inferior and medial/femoral neck slides sup/lat
    • lines: klein's, shentons, skinners
  63. congenital hip dysplasia
    • Putti's Triad: 1) hypoplastic femoral head, 2) shallow acetabular shelf, 3) femoral head outside acetabulum
    • + orthos: ortolani's, barlows, allis
  64. Protrusio acetabuli
    • axial migration of the femoral head- uniform loss of space
    • MC w/ RA
    • bilateral: otto's pelvis
    • radio sign: obliteration of kohlers teardrop
  65. avulsion frx
    bone torn away by mm or lig
  66. comminuted frx
    2 or more fragments
  67. diastasis
    displacement or separation of a slightly movable jt
  68. compound/open racture
    skin ruptured/ open skin
  69. greenstick/hickory stick
    incomplete frx in kids
  70. torus/buckling fracture
    incomplete frx, one side of cortex affected
  71. impaction frx
    bone fragments driven into one another
  72. occult fracture
    • clinically evident but not visualized on xray
    • may become evident in 10 days
  73. stress/fatigue fracture
    insufficiency or repetititve stress causing a fracture
  74. Bonnett's
    fracture of the 1st metacarpal
  75. boxers frx
    2/3rd metacarpal
  76. bar room frx
    4/5th metacarpal
  77. Scaphoid
    MC frx carpal bone
  78. night stick frx
    proximal ulna
  79. monteggia
    frx of ulna, radial head displacement
  80. galeazzi
    frx of the distal 1/3 of radius w/ dislocation of the distal radioulnar jt
  81. colles
    frx of distal radius w/ posterior displacement of distal fragment
  82. smith's frx
    distal radius w/ anterior displacement
  83. bathroom frx
    distal phalynx
  84. march frx
    stress frx of the 2/3/4th metatarsal
  85. jones frx/ aka: dancers
    transverse frx of the proximal 5th metatarsal
  86. hangman's frx
    bilateral pedical frx of C2 w/ hyper ext injury
  87. clay shovelers
    • avulsion frx of SP
    • MC at C6-T1
    • hyper flextion injury
  88. jefferson/bursting frx
    • anterior (rust sign) and post arches of atlas
    • due to axial compression
  89. odontoid fractures
    • type 1) avulsion of the tip
    • type 2) fracture through the base of dens. MC and Most severe
    • type 3) fracture through the body of C2
  90. teardrop
    • avulsion frx of the ant inf aspect of the vert body
    • MC at C2
    • acute ant cervical cord syndrome *instable*
  91. Most severe cervical fracture
    • teardrop- avulsion of the anterior aspect of the vert. body
    • anterior cervical cord syndrome
  92. Salter harris
    • type 1) horizont frax through growth plate
    • 2) growth plate and metaphysis *MC*
    • 3) plate and epiphysis
    • 4) plate, epiphysis and metaphysis
    • 5) compression eformity of the growth plate *Most Severe*
  93. most common salter harris
    type 2- growht plate and metaphysis
  94. most severe salter harris
    type 4- compression deformity of the growth plate
  95. osgood schlatter
    • tibial apophysitis
    • cho-pat brace
    • 10-16 yo, soccer player
    • hip flex/knee ext
  96. riders bone
    • avulsion of the ichial tuberosity
    • MC in horseback riders, herdlers, cheerleaders
  97. chance/seatbelt frx
    • horizontal frx through single body and post arch
    • MC at L1-L3: lapbelt MVA
  98. malgaigne
    • ipsilateral double vertical fracture of the superior pubic/ ischiopubic rami
    • si jt dislocation/fracture
  99. duverny
    fracture of the iliac wing
  100. buckle handle frx
    sup. pubic ramus & ischiopubic jxn frx contralateral to impact
  101. straddle frx
    • bilateral dble vertical fractures
    • superior pubic rami & ischiopubic jucntions
  102. MC treatment for frx in neck
    hard collar
  103. MC dislocated carpal
    • lunate
    • associated w/ pie sign
  104. Terry thomas sign
    Scaphoid, 2nd mc dislocated carpal bone
  105. signet ring sign
    associated with scaphoid dislocation
  106. SLAP
    • sup labrum ant to post
    • glenoid labral tear
    • instability
  107. GH jt
    • bankhart avulsion
    • hill sacks/hatchet deformity
  108. posterior ponticle
    • arcuate foramen
    • atlanto-occipial lig calcification
    • *transmits the sub-occipital nerve and artery
  109. downs syndrome
    • 20% born without the transverse lig
    • increased ADI/ instability
    • stress films before treatment
  110. os odontoideum
    normally developed part of dens is not fused with C2 body
  111. dens fracture: what brace?
    philedelphia collar
  112. congenital block
    • adj vert fused from birth
    • wasp waist
    • hypoplastic disc
  113. klippel-feil syndrome
    • webbed neck, low hairline, decreased ROM
    • congenital blocks
    • sprengles deformity: unilateral non-descended scapula
    • omovertebral bone: calc of rhomboid mm
  114. pedical agenesis
    contralateral pedical hypertrophy and sclerosis
  115. butterfly vert
    failure of the center of the body to ossify
  116. spina bifida
    • failure of lamina to fuse
    • increased alpha-fetoproitein, folic acid deficiency
  117. transitional vert
    • sacralization- l5 tps fuse, form jts w/ sacrum
    • lumbarization: 6 lumbars
  118. facet tropism
    • asymmetric articular plates
    • MC L5/S1
  119. Knife clasp
    • spina bifida at S1 w/ L5 enlargement
    • pain on extension
    • folic acid deficiency (B9)
  120. coxa vara
    less than 120*
  121. coxa valga
    greater than 120*, mikulicz line
  122. madelungs deformity
    • shortened distal radius
    • prominency of ulnar styloid
    • post. sublux of distal ulna
  123. negative ulnar variance
    • ulna is shorter than radius
    • seen with: scapholunate dislocation
  124. pelligrini steida
    calcification of the medial collateral lig
  125. myositis ossificans
    • calc of the mm belly
    • MC at biceps and quads, hx of trauma
  126. AAA
    • MC distal to renal arteries
    • sits in front of L2-4
    • radiographic signs: aortic dilation, curvilinear calcification, fusiform appearance
    • tests: doppler, ultrasound, ultrasonography
    • test: MRA, angiogram
  127. AAA
    • 3.8-5cm refer to vascular specialist
    • over 5 cm send to ER
  128. Cholelisthiasis
    • females, fat, forty, fertile, flatulant
    • gallstones at L1-L2 pain referral to the inf. border of R scapula
    • *murphys sign: inspiratory arrest
    • test: barium swallow, ultra sound
  129. uterine fibroid
    • MC benign tumor in females
    • fibroid cyst/leiomyoma (tumor of smooth mm)
  130. Calcified prostate
    • males < 50
    • psa, acid phosphatase, mets, alk phos, painless
    • prostatitis: painful and boggy
    • carcinoma: painless, hard, nodular
  131. phleboliths
    • calcification within veins asymptomatic
    • MC incidental finding on an xray
  132. fat pads
    • elbow: radial head fracture
    • seen on lateral view
  133. Sickle cell anemia
    hair on end appearance
  134. H shaped vertebra
    sickle cell
  135. thalassemia
    • cooleys anemia, mediterranean anemia
    • erlenmeyer flask deformity
  136. hyperparathyroidism
    • females 30-50
    • over active parathyroid gland
    • calcium increase, phosphorus decrease
    • salt and pepper skull
    • rugger jersey spine
  137. salt and pepper skull and rugger jersey spine
    hyperparathyroidism
  138. osteoporisis
    • herediatary
    • absence of marrow
    • anemia
    • bone within a bone (early)
    • sandwich vertebrae (late)
  139. rickets
    • def. of vitamin D, Ca+ or phophorus
    • seen at growth plates
    • mm tetany/weakness
    • paintbrush metaphysis
  140. CT scan
    • different planes
    • uses contrast
    • 10x better than plain film
    • LUNG
    • measured in HOUNSFIELD UNITS
  141. MRI: Spinal cord or brain
    • 100 x better soft tissue than CT
    • no radiation dose, gadolinium
    • T1: fatty pathology
    • T2: water density
  142. dexa scan
    • measures bone density
    • osteoporosis
  143. bone scan (scintigraphy)
    • injection of radioactive substance: technetium 99
    • hot is positive: avn's, mets, pagets, hodgkins, fractures
    • scan whole body at once
    • most invasive, least specific
  144. basilar angle aka: martins basilar angle
    • nasion to center of sella turcica. basion (ant. foramen magnum) to sella turcica.
    • angle >152* indicates platybasia
  145. mcgregors line
    • hard palate to base of occiput
    • odontoid is >8mm above the line in males or >10mm above in females, indicates basilar impression
    • *most accurate line for basilars*
  146. chamberlains line
    • hard palat to opishtion (post FM)
    • odontoid >7mm above indicates basilar impression
  147. macre's line
    • anterior FM (basion) to posterior FM (opisthion)
    • indicates basilar impression if occ is above it
  148. atlantodental interspace
    • c1 ant tubercle to odontoid
    • > 3mm in adults, >5mm in kids indicates transv lig instability
  149. georges line
    post. body alignment: should be smooth
  150. post cervical line
    • line drawn at spinolam jxn
    • discontinuous line indicate A to P malposition: anterolisthesis/retrolisthesis
  151. stress lines in c-spine
    • drawn at post bodies of C2/C7
    • flexion should intersect at C5/6
    • ex should intersect at C4/5
    • altered by mm spasm, jt fixation, disc degen
  152. prevertebral soft tissue space
    • retropharyngeal >7mm
    • retrolaryngeal >14mm
    • retrotracheal >22mm
  153. Cobbs method
    • scoliosis measurement
    • preferred method
  154. risser ferguson method
    values are 25% below cobb method
  155. sacral inclination
    • normal: 30-72*
    • average: 46
  156. lumbosacral angle: sacral base, fergesons angle
    • normal 26-57*
    • average: 41*
  157. meyerding grading of spondylolisthesis
    determines degree of anterolisthesis
  158. ullmanns line: garland thomas line
    • line drawn parallel and through sacral base. perp line drawn from sacral promatory
    • l5 beyond perp. line- spondlo
  159. eisensteins method for sagittal canal measurement
    <15mm: spinal canal stenosis
  160. canal/body ratio
    • ratio: 1x2/3x4
    • higher the ratio, smaller canal
    • >1.6 at L3-5 canal stenosis indicated
  161. lumbosacral disc angle
    normal 10-15*
  162. lumbar gravity line
    • ferguson's line
    • line should intersect the sacral base
    • line ant to sacrum: possible hyperlordosis
    • line post to sacrum: possible hypolordosis
  163. macnabs line
    • parallel and through the inferior end plate
    • line intersects the sup. articular process of the vert below: extension malpositon
    • facet imbrication suspected
  164. hadleys S curve
    should be smooth, interruption of the line indicates subluxation or facet invovlement
  165. kohlers line
    pelvic inlet to outer aspect of obturator
  166. shentons line
    • smooth line drawn along inf femoral neck to obturator
    • interrupted line indicates dislocation, neck frx or SCFE
  167. iliofemoral line
    • smooth line from outer ilium across jt onto femoral neck
    • bilateral asymmetry indicates SFCE, dislocation, frx or dysplasia
  168. femoral angle (mikulicz angle)
    • normal 120-130*
    • coxa vara <120
    • coxa valga >130
  169. skinners line
    • parallel and through femoral shaft, perp line tangential to tip of gr. trochanter
    • fovea capitis should be above or at the level of the line, below the line indicates frx, sfce, coxa vara
  170. kleins line
    • line drawn along outer margin of femoral neck
    • femoral head should intersect the line
    • failure to intersect indicates SCFE
    • *best line for SCFE*
  171. patellar position
    patellar lengthe and tendon length should be about equal
  172. patellar alta-
    • patella moved superior
    • tendon >20% longer than the tendon
  173. patella bana
    patella moved inferior
  174. heel pad measurement
    • >25mm in males, >23mm in females increased thickness
    • often indicates acromegaly
  175. boehlers angle
    • 3 highes pts on the sup aspect of the calcaneous connected
    • normal is 28-40*
    • < 28* indicates calcaneal fracture of dysplastic calcaneus

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