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Flashcards in Mahoney case III Deck (48)
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1

2 X-ray stress tests to specifically test Lisfranc's

- abduction stress test: step off of the 2nd met intermediate cuneiform joint

- adduction stress test: 1st met-cuneiform and 2nd met cuneiform widen

2

What is found with the adduction and abduction stress tests?

- abduction stress test: step off of the 2nd met intermediate cuneiform joint

- adduction stress test: 1st met-cuneiform and 2nd met cuneiform widen

3

Osteoporosis: imaging exams for diagnosis (4)

- DXA
-VFA
-IFA
-Quantitative Ultrasound scanner

4

Explain:
DXA-
VFA-
IFA
-Quantitative ultrasound scanner

DXA: dual photon X-ray absoptiometry. Gold standard to assess bone mineral density and detect early osteo.
----2 energy X-rays shot at the bone and subtract the soft tissue component

VFA: x-ray taken of the spine, looking for an old fracture of the vertebra. Patient with the correct demographic features and positive VFA or IFA means positive for osteoporosis.

IFA: same as VFA

Quantitative Ultrasound scanner: popular prescreening tool to rule out osteoporosis. Need a DXA evaluation in order to rule in

5

Definition of T-scores

Standard deviation that shows how much a patient's bone density is higher or lower than the bone density of a healthy 30 year old adult

6

Definition of Z- score

Standard deviation that compares patient bone density to what is normal in someone in their own age and body size.

7

T-score: use in what patient population

T-score used in older adults such as postmenopausal women and men over 50

8

Z-score: use in what patient population

useful in children, teens, younger men and women still having periods

9

Normal T-score and Z-score

T-score: above -1 is normal

Z-score above -2 is normal

10

T-scores:

--normal value

-- Low bone density (osteopenia)

--Osteoporosis

-Normal bone density: -1 and above

-Low bone density (osteopenia): between -1 and -2.5

-Osteoporosis: below -2.5

11

Non-pharmacological treatment options for osteoporosis (3)

-behavioral modifications: stop tobacco, alcohol, and caffeine consumption

-Balanced diet: adequate calcium and Vitamin D intake

-Regulatory exercise program

12

MOA for estrogen

control activity of osteoblasts and osteoclasts. Will keep osteoclast numbers low and low activity as well

13

MOA calcium

increased bone mineralization

14

MOA vitamin D

increases calcium absorption in the GI tract

15

MOA Calcitonin

hormone directly inhibits osteoclastic bone resorption

16

MOA bisphosphonates

bind permanently to mineralized bone surfaces and inhibit osteoclastic activity

17

MOA raloxifene

will inhibit trabecular and vertebral bone loss by blocking the activity of cytokines which stimulate bone resorption

18

Definition of FRAX

can be used as an assessment modality for the prediction of fractures on the basis of clinical risk factors

19

Wilson Katz: stress fracture Type I

-what will be seen on X-ray

fracture line with no evidence of endosteal callus or periosteal reaction

-will see a radiolucent line through bone

20

Wilson Katz: stress fracture Type II

-what will be seen on X-ray

focal sclerosis and endosteal callus (occurs in cancellous bone)

-Will see a radiosclerotic at the metaphysis (in the metaphysis of the heads and bases)

21

Wilson Katz: stress fracture type III

-What will be seen on X-ray

Periosteal reaction and external reaction. Will see this mainly on the shaft

-Will see a callus lump.

22

Wilson Katz: stress fracture type IV

mixed combo of type 1,2,3

23

Fundamentals of MRI physics.

TR and TE values for T1 and T2

T1: Short TR and short TE

T2:long TR and long TE

24

What are the fat image and water image in MRI

Fat image is T1

Water image is T2

25

Gadolinium and its use in MRI

it will identify acute inflammation and infection.

-Will improve visibility of inflammation, tumours, blood vessels and blood supply

26

What disease will Gadolinium cause (2)

-Nephrogenic systemic fibrosis

-Gadolinium retention (in the brain)

27

What is the "magic angle effect"

-An MRI artifact which occurs on sequences with a short TE.

- It is confined to regions of tightly bound collagen at 54.74 degrees from the main magnetic field and appears hyperintense, thus potentially being mistaken for tendinopathy

28

What are the 5 stages for hemorrhage

-hyperacute

-Acute(1-2days)

-Early subacute (2-7days)

-Late subacute (7-14days)

-Chronic (14-28 days)

29

What are the imaging characteristics of hyperacute stage

-isointense on T1 and isointense to hyperintense on T2.

- Due to intracellular oxyhaemoglobin

30

What are the imaging characteristics of acute stage

-T2 signal intensity drops. T1 remains intermediate to low.

-Due to intracellular deoxyhaemoglobin