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86 Cards in this Set
- Front
- Back
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What is the first imaging that should be done when Kidney involvement is suspected?
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KUB
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How is US used to evaluate the kidney
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Renal size
DDX renal cyst vs neoplasm Hydornephrosis |
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How is CT used to evaluate the kidney
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Renal masses (gross hematuria w/flank pain)
renal trauma Renal calicul (still should start with KUB) |
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What is MRI of kidneys used for
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invasion of carcinoma into other structures
Staging Mets Primary dx of cancer |
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What are the possible congenital lesions of the UT
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Horseshoe kidney
Duplications Crossed ectopy |
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What are possible obstrucitve UT lesions
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Most common urinary calculi
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What are acute xray sings of urinary calculi
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delayed visualized on IVU
dilation of collecting system caliectasis |
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Chronic signs of calculi
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hydronephrosis
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How do we approach chronic pyelonephritis
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tx w/o imaging and if sx improve fine, if things don't improve evaluate with imaging
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Xray signs of chronic pyelonephritis
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cortical irregularity
irregular calyceal clubbing inc kidney size |
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How does TB present on imaging
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Can be called "putty kidney
infundibular stricture cavitation urethral strictres papillary necrosis |
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What population are renal cysts common in
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elderly
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Describe imaging that would reveal renal cysts
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Mass lesion seen on IVU (contrast doesn't appear where it should) --> U/S unless hematuria then use CT
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What advantage does CT have to KUB
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can see neovascularties w/tumors in the kidneys.
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What is an angiomyolypomas
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fatty tumor in the kidney
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What% of hypertension is caused by renal vascular lesions?
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1 to 4 %
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How are vascular lesions in the kidneys 1st evaluated for cause of HTN
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nuclear imaging - if positivite need surgery and must do renal angiography
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How is a renogram done
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Inject ace inhibitor then inject captopril - watch for a change
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What is the search pattern for musculoskeltal imaging
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Alignment
Bone Cartilage Soft Tissue |
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What are the main types of fractures
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Oblique (long axis)
Spiral (around) Transverse (right angle to long axis) |
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What is an incomplete fracture
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bone broken on 1 side of cortex only.
Most common in children < 10 Greenstick (bending) Torus (buckling - bulge in bone) |
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What is a Salter-Harris fracture
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Involves active growth plate (kids)
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What is a Comminuted fracture
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More than 2 fragments (crush fracture)
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What is an Impaction fracture
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part of bone driven into adjacent bone (overlapping)
- compression fracture (cortico bone overlaps) - depressed racture - cortex driven into the spongy bone |
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What is an Avulsion fracture
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bone torn away from bone by lig or tendon. Common type of fracture
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What is a chip fracture
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bone chipped off by direct blow
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What are common aspects of a stress fracture
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usually lower extremity - 2nd and 3rd metatarsal bone most common = march fracture
Can progress to frank fracture if activity continues |
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What are the types of stress fractures
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fatigue fracture - abnormal repetitive stress to healthy bone
insufficiency fracture - normal stress to abnormal bone |
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What is an occult fracture
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doesn't show up right away. Can show up 7-10 days later
Suspect if mechanism of injury is pressent and clinical sx |
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What are common sites fo occult fracture
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ribs & scaphoid
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What is a Pseudofracture and what is another name for it?
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Looser's zones - band of uncalcified osteoid or fibrous tissue. Conves side of bone at right angle to bone. Can be caused by osteomalacia, rickets and padgets
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What is the progression of fracture healing
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Day 1-5 inflammation, hematoma, clot --> tissue begins to replace clot
Day 6-16 capilary beds grow primary callus formation - coarsely woven bone laid down calci density seeing 3-4 wks on xray post trauma |
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Complications of Fractures
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Non-union
Osteomyelitis Reflex Sympathetic Dystrophy Syndrome Early DJD |
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What are the classic Axial Compression fractures
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Jefferson fracture (C1)
Lateral mass fracture (force more to one side than with Jefferson) Burst fracture (below C3-C7) |
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What are common flexion-extension fractures
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Pillar fracture - most common C6; sx of radiculopathy; best seen on pilar view
Clay shoveler's fracture - avulsion of C7 d/t rapid flexion of neck against contracted trap and rhomboid mm; best seen on lateral view; stable fracture |
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What are the typical injuries that can damage the thoracolumbar spine
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Compression fracture
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How might a new fracture in the thoracolumbar region present
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step defect
zone of condensation facture line at end plate |
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What are classic characteristics of a compression fracture
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- usually T12-L1
- a bone scan can show age of fracture |
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Classic characteristics of a rib fracture
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often occult (not seen for 7-10 d)
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Possible complications of a rib fracture
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hemorrhage into pleural space
hematoma soft tissue emphysema - tension pnumothorax Need to view with oblique view |
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What is the most commonly fractured carpal bone & how does it usually occur
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scaphoid bone - wrist hyperextension w/ radial deviation; commonly occult
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How is a scaphoid fracture best dx
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There will be pinpoint pain in the anatomical snuff box take ulnar deviation view
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What is the main concern with a scaphoid fracture
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10-15% develop avascular necrosis
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What is a Colle's fracture
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fracture of distal metaphysis of the radius from a fall on an outstretched hand; may also have associated fracture of the ulnar styloid process
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Who most commonly gets a colle's fracture
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osteoporotic women and kids
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What is the most common elbow fracture in adults and how does it usually occur
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radial head or neck fracture when fall on outstretched hand
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What is the sale sign
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This is when the anterior fat pad pops out into view on an xray d/t swelling ( can occure with fracture or inflammatory arthritis)
Sign is only valid with lateral view at 90 deg |
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What are possible locations of a femoral neck fracture
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Subcapital location (base of femoral head)
Midcervical (middle of femeral head) Basicervical (distal femoral neck) Intertrochanteric |
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What is the most common type of fracture of the distal fibula
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lateral malleolus usually from an inversion sprain
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If there is external rotation what type of fracture can occur
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spiral fracture that extends superiorly - may not be seen on AP view if undisplaced, best seen on oblique
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What is a Jones' fracture
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fracture of the 5th metatarsal d/t inversion sprain with plantar flexion. It is a transverse fracture.
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What is DJD
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A (generally) non-inflammatory condition of wear and tear of the articluar cartilage, bone, ligaments, and tendons.
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What are xray signs of DJD
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dec joint spacing
Asymmetrical loss of spacing osteophytes subchodral sclerosis subchondral cysts (pseudocysts) osseous joint misalignments |
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What must be done to r/o pars defect
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need to do oblique view
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How does DJD typically affect the spine
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Affects disc spacing, facet joints adn uncovertebral joints
SI joint |
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How does DJD typically affect the Hip
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Greatest dec articular spacing sup
May see large subchondral cysts |
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What are the 4 types of dz that affect the SI joints
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Psoriatic arthritis, Reactive arthritis, AS and enteropathic arthritis
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How does DJD typically affect the knees
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most common joint in extremities affected by DJD
medial compartment most common May involve patellofemoral joint |
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What part of the foot is most commonly affected by DJD
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Big toe
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What areas of the hand are typically affected by DJD
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proximal and distal IP joints
base of thumb osteophytes on dorsal spect of PIPs Bouchard's nodes Heberden's nodes |
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What is DISH
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Diffuse Idiopathic Skeletal Hyperostosis - bridging btw the vertebral bodies along the anterior surface.
Can also affect extremities |
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What is the etiology of DISH and who does it effect most often
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It has an unknown etiology. Mainly effects people over 50.
Significant correlation with DM |
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What is seen in xray of DISH
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-syndesmophytes along lateral and anterior aspects
-at least 4 adjacent vertebra - spares lower 2/3 of SI joints -not usually symetrical -may include post leg - pinal stenosis |
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What is OPLL
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Ossified Posterior Longitudinal Ligament - this is same as DISH except it affects the posterior long ligament
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What other condition is OPLL associated with
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DISH - 85% of cases of OPLL occur with DISH; 50% of DISH pts have OPLL.
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What are details of OPLL
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usually covers 3-4 vert
cortical bone 1-5 mm thick usually effects cervical spine may cause myelopthay - do MR if present - may need laminectomy |
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When does AS most commonly occur and to what population
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males in their teens or 20s
90% of cases have HLA- B27 |
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Where is the most common initial site of AS and how does it progress
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SI joints - start in the lower 2/3 of the joint
Progresses up, may skip thoracolumbar junc then rest of lumbar spine |
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What does AS involve
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anterior longitudinal ligament
anterior aspect of annulus fibrosis facet joint Affects synovial joints |
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How does AS present in xray
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this delicate bridge btw vertebrae usually symmetrical
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What vertebrae is spared by AS
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C1 - can involve the rest of the spine
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Does AS only involve the skeletal system
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No it can also affect the connective tissue of the body - heart lungs eyes
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What is enteropathic arthritis
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GI dz is cause (UC, Crohn's, IBS)
Affects SI joints like AS Attacks correlate with bowel inflammation |
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What is RA and what does it affect
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inflamm arthritis - affects connective tissue. Highest affinity for synovial joints. Can also affect heart lungs, nervous system, blood vessels
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What are the most common ages affected by RA
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20-60, 30s most common - RA + 70%
<16 y/o - juvenile RA - RA + 30% |
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What are xray signs of RA
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soft tissue swelling
dec involve joint space marginal erosion at articular bone periarticular osteoporosis pseudocysts of bone BL symetrical fibrosis causing deformities - can straighten joings |
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Describe Psoriatic Arthritis
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25% of people with psoriasis
B/L asymmetircal distal IP joints no periarticular osteoporosis ankylosis of involved joints SI in 50% C1-2 in 45% syndesmophyes in lumbar spine |
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Reactive arthritis - what is it and what is another name for it
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Reiter's syndrome - can't see can't pee can't dance with me.
Reaction to infection possible 2ary to chlamydia, salmonella... Males > Females Age 18-40 Lower extremities and spine - T/L junc, SI's and CI-2 Identical looking to psoriatic in spine |
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Gouty Arthritis
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males > 40
inflammatory arthritis hyperuricimia tophus postmenopausal women on diuretics initial attack usually in 1st metatarsalphalangeal joint overhanging margins xray signs not until 5-10 yrs after clinical sx joint space preserved until later in dz punche out lesions hand knee elbow SI joints |
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Where can heel spurs occure
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plnatar fascitis
psoriatid arthirits Reacitve arthritis RA AS DISH Idiopathic |
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What are the characteristics of benign neoplasms
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begins before bone is mature
may be painful, usually not bony cortex intact clarly marginated geographic patern spares soft tissue |
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What is the most common benign neoplasm of bone and when is it typically found
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Osteochondroma age 10-25
Extends off cortex and is continuous w/ host bone - stalk pointing away from nearest joint |
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What is enchondroma and what part of the body does it affect
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it is a benign tumor of the hand
short tubular bones before bone maturity stippled calcifications malignant deg when closer to axial skelton |
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What is ollier's dz
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it is multiple enchondromas
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What is a hemangioma and what appearance does it have on xray
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corduroy cloth appearance - most common benign tumor of the spine
develops after puberty coarsened vertical trabeculateion of vertebral body or pedicle extension of tumor into canal |
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Where does giant cell tumor occur and what does it look like
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sacrum
soap bubble appearance in flat bones most benign, 20 % become malignant 20-40 yrs old metaphysis adn estends into epipysis radiolucent appearance tubular bone articular margin of bone most benign tumor of sacrum |
