Dx Imaging Ii Exam 2

Front 1

SEQUESTRUM
- remaining dead bone
- the center of the infection (initial target)
- sequestrum is surrounded by involucrum

Back 1

Front 2

what is an involucrum?

Back 2

the body's attempt to wall off the infected bone (bone may be larger in measurement)
_ often MR and CT can demonstrate a draining sinus

Front 3

what is the opening to a draining sinus (from osteomyelitis)

Back 3

cloaca

Front 4

What is this?

Back 4

mariolin's ulcer - squamous cell carcinoma (a potential complication of osteomyelitis)
(if chunk of bone is coming out of hole in skin, then osteomyelitis)

Front 5

what are 2 possibilities when you see local lucency

Back 5

tumor or infection

Front 6

what is the fundamental difference between tumor and infection

Back 6

the speed of progression
- infection - days to weeks
- tumor - months to years

Front 7

respects boundaries

Back 7

tumor

Front 8

doesn't give a crap for any boundaries

Back 8

infection

Front 9

how much bone loss can you assume before any changes are seen on plain film

Back 9

30-50%

Front 10

what is the ideal imaging tool to recognize infection

Back 10

MRI

Front 11

Back 11

codman's triangle

Front 12

Back 12

codman's reactive triangle and osteosarcoma of the proximal tibia

Front 13

what is codman's cuff or triangle

Back 13

raised periostium
*worry about aggressive process first
*area will be warm, red, hyperemic, painful, tumor (swollen mass of infected tissue)

Front 14

diabetic presenting with low back pain

Back 14

sponylodiscitis

Front 15

L4-L5 MRI
T2 weighted

Back 15

spondylodiscitis

Front 16

pubic diastasis

Back 16

Front 17

features of osteomyelitis

Back 17

-corticomedullary jxn should be clear
-moth eaten (the step after permeative)
-permeative - pinholes
-loss of cortex
**if cortical destruction, can't be benign
***must put infection first
WBC and ESR probably elevated if infection

Front 18

OSTEOMYELITIS OF THE ISCHIOPUBIC CHONDROSIS AP Pelvis

Back 18

Front 19

what is going on here

Back 19

osteomyelitis of clavicle

Front 20

what is the most common cause of osteomyelitis in the lower extremity

Back 20

diabetes

Front 21

2 common conditions on lower extremities

Back 21

1- neurotrophic joint disease (atrophic or hypertrophic)
2- osteomyelitis

Front 22

bone scan for an infection is "hot"
what does a bone scan for tumor show as?

Back 22

looks normal

Front 23

2 categories of infection

Back 23

bacterial (suppurative)
non suppurative (tb, syphilitic)

Front 24

80-90% of all bone/jt infx are traced back to

Back 24

staph aureus

Front 25

pseudomonas has a reputation for affecting which joints

Back 25

the "S" joints
spine, sacrum, sc, symphisi pubis

Front 26

infant presents with an infection involving the humerus.

Back 26

streptococcus (as opposed the staph)

Front 27

may show as bilateral symmetric.. passed from mother during birth

Back 27

syphilitis

Front 28

Back 28

hypertrophic pattern neurotrophic jt disease..pt has syphilis

Front 29

Back 29

syphilis neurotrophic joint dis. atrophic pattern

Front 30

Back 30

neurotrophic
atrophic pattern
diabetic foot

Front 31

Back 31

lumbar neurotrophic jt disease
syphilis

Front 32

Back 32

brodies abscess

Front 33

what the heck is brodie's abscess

Back 33

suppurative
lucency w/in the medullary cavity
walled off suppurative infx (ie staff)
tx is to dig it out
aspirin provides relief

Front 34

night pain relieved by aspirin

Back 34

brodies abscess or osteoid osteoma.
need MRI to distinguish
(brodies-intramedullary, osteoid osteoma-periosteal)

Front 35

target sign, bull's eye sign

Back 35

ie: proximal tibia
subtle lucency that is magnified on bone scan and MRI

Front 36

use of coca and crack is exacerbating the problem with

Back 36

resistant strains of TB

Front 37

TB will effect lung or bone first

Back 37

lung - upper lobe (pulmonary nodules and ghon complex)

Front 38

primary skeletal sight for TB

Back 38

TL jxn

Front 39

TB suppurative or non-suppurative

Back 39

nonsuppurative

Front 40

Back 40

potts paraplegia
progressive myelopathy (cord damage)

Front 41

what happens when TB invades and damages tissue

Back 41

distrophic calcification

Front 42

tubercular dactylitis

Back 42

Front 43

facts assoc with TB dactylitis

Back 43

inflamm of fingers and toes, resulting in sausage shaped appearance of digits
soft tissue swelling
looks like infx but long duration of symptoms

Front 44

Back 44

TB gibbus deformity

Front 45

wimberger's signs of syphilis

Back 45

erosion of medial, proximal part of tibia
(wimberger's sign of scurvey--epiphysis has a bright white ring)

Front 46

saber shin
(syphilis)

Back 46

the organism weakens the bone -> anterior bowing of the tibia

solid periosteal reaction that ossifies and adds to the impression of diameter increase

Front 47

stages of syphilis

Back 47

periostitis
metaphysitis
osteitis

Front 48

Back 48

blastomycosis

Front 49

blastomycosis

Back 49

Front 50

blastomycosis

Front 51

blastomycosis

Back 51

blastomycosis

Front 52

mostly found on us canadian border

starts in the lungs

Back 52

blastomycosis

Front 53

coccidiomycosis

Back 53

dry climates of SW
starts in lung and disseminates to skeleton
attacks bony projections
remember that poodles leg pic he showed in class

Front 54

histoplasmosis

Back 54

not a skeletal complaint
polk-a-dots in the chest
mississippi river valley
lung, liver, and spleen are prime targets

Front 55

most frequent form of osteoporosis

Back 55

post menopausal

Front 56

_____ will soon replace post menopausal osteoporosis as life expectancy increases

Back 56

senile osteoporosis

Front 57

w/ osteoporosis what structurally stands out

Back 57

accentuation of the vertical trabeculae

Front 58

most frequent site of compression fracture

Back 58

T12, T11, L1
compression fractures at unusual locations are a possible sign of pathology

Front 59

facts about regionalized osteoporosis

Back 59

reflex sympathetic dystrophy
(RSD)
unilateral
trab bone loss in phalanges, metacarpals
raynauds
translucent skin
tactile sensitivity
suicide is frequent cause of death
smiths or colles fx common
no known tx, but chiro can help

Front 60

most common benign tumor of the spine

Back 60

hemangioma
(corduroy vertebra)
thickened trab bone due to coalescence

Front 61

bowed long bones
zpc is blended with surrounding bone
rosary bead appearance (bumps at costochondral junctions)

Back 61

rickets

Front 62

rickets rarifies the zpc and _____ sclerosis the zpc

Back 62

scurvy

Front 63

sandwich vertebra

Back 63

osteopetrosis

Front 64

rugger jersey spine

Back 64

hyperparathyroid

Front 65

primary hyperparathyroidism

Back 65

tumor
metastatic calcification

Front 66

secondary hyperparathyroidism

Back 66

kidney disease

Front 67

tertiary hyperparathyroidism

Back 67

end stage renal failure
pt on dialysis (dialysis wastes calcium)
pt should be on Ca & vit D otherwise too much Ca is taken from the bones

Front 68

lantern jaw

Back 68

prognathism
assoc w/ acromegaly

Front 69

lead intoxication

Back 69

in growing bone, lead is easily integrated
*very dense zpc

Front 70

examples and facts about histiocytosis x

Back 70

eosinophilic granuloma
silver dollar sign in the spine
spontaneous resolution is common
missing bone appearance
--expect it to self resolve and fill in on its own

Front 71

3 patterns of osteopenia

Back 71

generalized
regionalized
localized

Front 72

generalized

Back 72

osteopenia affecting the majority of the skeleton
senile ost..
post menopausal
hpt
cushings
wide spread malignancy

Front 73

regionalized

Back 73

osteopenia affecting one limb or section of the body
disuse atrophy
reflex sympathetic dystrophy
transient regional osteo
regional migratory osteo

Front 74

localized

Back 74

focal osteopenia in one or multiple discrete locations in bone (most worrisome)
lytic metastasis
osteomyelitis
inflammatory arthritides

Front 75

ant aspect of vertebral body is smaller than the post portion

Back 75

wedged shaped fx

Front 76

uniform vertebral body height
aggressive pattern of collapse
most either tumor or infx

Back 76

vertebra plana

Front 77

angular end plate deformity (aka check sign)

Back 77

most are path fx
a small # are simple benign compression deformity, but must first rule out the aggressive diagnosis

Front 78

as the femur is devoid of visible trabeculae, we lose the sight of

Back 78

ward's triangle
(lucent triangle formed by 3 diff tab pattern in the femur)