Hematologic and Vascular

Question 0

AVN most common epiphyseal predisposition

Answer 0

Femur head and humeral head

Question 1

Synonyms for AVN

Answer 1

Osteonecrosis, ischemic necrosis, osteochondrosis

Question 2

AVN MC etiological catergory

Answer 2

Spontaneous/idiopathic

Question 3

Other etiological for AVN

Answer 3

Surgery, trauma, alcoholism, and corticosteroids

Question 4

Most serious age for AVN

Answer 4

8 years old

Question 5

Timeframe for AVN to heal?

Answer 5

2-8 years

Question 6

Four stages of avascular necrosis

Answer 6

Avascular, revascularization, repair (clinically evident), deformity.

Question 7

Which phase of AVN: obliteration of epiphyseal blood supply » osteocytes and bone marrow death

Answer 7

Avascular phase

Question 8

Which phase of AVN: deformity is most likely, mottled bone, creeping substitution, fracture under cortex possible

Answer 8

Revascularization phase

Question 9

Which phase of AVN: bony deposition replacing resorption, modeled bone and possible deformity.

Answer 9

Repair and remodeling phase

Question 10

Which phase of AVN: restitution of epiphysis to normal with varying deformity

Answer 10

Deformity phase

Question 11

Residual deformity is due to what?

Answer 11

How much compressive force is exerted on the necrotic bone during revascularization and repair phases.

Question 12

What are the general radiological features of an epiphyseal infarction. (6)

Answer 12

1. Collapse of articular cortex (step defect)
2. Fragmentation
3. Mottled trabecular pattern
4. Sclerosis (whiteness)
5. Subchondral cysts
6. Subchondral frature (crescent or rim sign)

Question 13

Articular cortex collapse (step defect) is most likely to happen where?

Answer 13

In the superior joint compartment (region of max stress).

Question 14

Which radiological feature of epiphyseal infarction do radiolucent clefts appear.

Answer 14

Fragmentation

Question 15

Which phases is the mottled appearance MC?

Answer 15

Revascularization and repair phases.

Question 16

Patchy well circumscribed areas rarefaction?

Answer 16

Subchondral cysts

Question 17

Separation of articular cortex from cancellous bone.

Answer 17

Crescent or rim sign

Question 18

AVN in adults is known as_______?
Male or female MC?
Bilateral and symmetrical T/F

Answer 18

Chandler’s disease
Male predominant 4:1- age 30-70
F: bilateral but asymmetrical 50% of time

Question 19

4 signs of AVN

Answer 19

Snow cap sign
Crescent sign
Mushroom/healed deformity
Hanging rope sign.

Question 20

Which sign is part of the healing phase?

Answer 20

Snow cap sign

Question 21

Articular deformity, acetabular dysplasia, hanging rope sign, trochanteric overgrowth are all associated with.

Answer 21

Healed AVN

Question 22

Which MRI scan shows a loss of marrow signal?

Answer 22

T1 weighted

Question 23

AVN of femoral capital epiphysis before closure/ <age 20

Answer 23

Perthes disease

Question 24

Perthes disease is most common in boys/girls, what age, | bilateral %, resolves is how many years, trauma in what %.

Answer 24

Boys 5:1, 4-8 years old, bilateral 10-20%, resolves in 2-8 years, trauma in 25%.

Question 25

How long for each stage of Perthes disease. | Avascular _______, revascularization ________, repair and remodeling ___________.

Answer 25

Avascular 0-12 months, revascularization 6 mo - 4years, repair and remodeling 1-2 years.

Question 26

Soft tissue signs of hip joint disease? (3)

Answer 26

Capsular swelling, small obturator (hip flexion), increased TDD

Question 27

Osteochondrosis clinical: age_____, gender_______, MC location______, symptoms___________?

Answer 27

Age 11-20, M>F, knee MC, clicking locking limited motion.

Question 28

Locations for osteochondrosis.

Answer 28

Knee MC: medial femoral condyle (85%) lateral (15%) bilateral (20-30%) humeral head Capitulum of elbow Medial talus (superior)

Question 29

Associated with aged knee, idiopathic, and medial meniscal lesions

Answer 29

Spontaneous osteonecrosis.

Question 30

Fragmentation of the apophositis of tibial tuberosity. MC traumatic rather than necrosis.

Answer 30

Osgood schlatter's disease.

Question 31

Inferior pole of the patella

Answer 31

Sindig-Larsen-Johanssen disease.

Question 32

Self limiting painful disorder, 11-15 years old, m>f, pain and swelling over tibial tubercle, usually self resolve by 18yrs.

Answer 32

Osgood schlatter's disease.

Question 33

AVN of MTP joint (usually MTP 2, 80%), MC Females (high heels) age 13-18?

Answer 33

Freiberg's disease

Question 34

AVN of lunate, associated with manual labor, 20-40 yrs, M>F, Ulnar variance 75%.

Answer 34

Kienbock's disease

Question 35

Navicular, MC normal variant LC vascular insufficiency, before puberty?

Answer 35

Kohler's disease

Question 36

Abnormal discovertebral junction, teenagers, chronic back pain and early DDD.

Answer 36

Scheuermann's disease or juvenile discogenic disease

Question 37

How many contiguous vertebrae for JDD.

Answer 37

3 contiguous vertebrae (MC thoracic and lumbar)

Question 38

5° ant wedge, irregular end plates, increased disc space, schmorl's nodes.

Answer 38

Scheuermann's disease, JDD

Question 39

Sclerosis and fragmentation of the calcaneal apophysis, before puberty MC, NOT a necrosis?

Answer 39

Traction apophositis (severs disease)

Question 40

Serpiginous regions of calcification within bone medulla, associated with arteriosclerosis. Differential diagnosis tumor (enchondroma, chondrosarcoma). Only shows up after it heals.

Answer 40

Calcified medullary infarct.

Question 41

MC hemolytic anemia, 1:600 African Americans, hands and feet syndrome, predisposition to salmonella osteomyelitis

Answer 41

Sickle cell anemia

Question 42

Imaging signs for sickle cell anemia

Answer 42

``` Marrow hyperplasia Coarse trabeculation Osteopenia Long bone undertubulation Hair on end (also in thalassemia) Osteonecrosis/H shaped vertebrae/Lincoln log ```

Question 43

Erlenmeyer flask deformity is associated with?

Answer 43

Sickle cell anemia undertubulation of long bones secondary to marrow hyperplasia

Question 44

Other names for "H" vertebrae of sickle cell anemia?

Answer 44

Reynold's phenomenon or Lincoln log vertebra

Question 45

Thalassemia is also known as?

Answer 45

Cooley's anemia

Question 46

Abnormal hemoglobin, Mediterranean origin, marrow hyperplasia, maxillary overgrowth (rodent facies), hair on end skull, extrameduallary hematopoeisis.

Answer 46

Thalassemia

Question 47

Where is Erlenmeyer flask deformity commonly seen?

Answer 47

Metaphyseal/diaphyseal junction.

Question 48

X chromosome linked bleeding disorder, female carrier but manifest usually in males?

Answer 48

Hemophilia

Question 49

Unique radiograph findings: | Square femoral condyles, epiphyseal overgrowth

Answer 49

Hemophilia

Question 50

MC malignancy of children and young adults

Answer 50

Leukemia

Question 51

Radiolucent submetaphyseal bands, easily bruised, spontaneous bleeding, malignant proliferation of WBC's

Answer 51

Leukemia

Question 52

What inhibits ONLY hematogenous spread?

Answer 52

Growth plates