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Mahoney EBM > Mahoney case III > Flashcards

Mahoney case III Flashcards

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1
Q

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

A
  • abduction stress test: step off of the 2nd met intermediate cuneiform joint
  • adduction stress test: 1st met-cuneiform and 2nd met cuneiform widen
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2
Q

What is found with the adduction and abduction stress tests?

A
  • abduction stress test: step off of the 2nd met intermediate cuneiform joint
  • adduction stress test: 1st met-cuneiform and 2nd met cuneiform widen
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3
Q

Osteoporosis: imaging exams for diagnosis (4)

A
  • DXA
  • VFA
  • IFA
  • Quantitative Ultrasound scanner
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4
Q 
Explain:
DXA-
VFA-
IFA
-Quantitative ultrasound scanner
A

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

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5
Q

Definition of T-scores

A

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

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6
Q

Definition of Z- score

A

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

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7
Q

T-score: use in what patient population

A

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

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8
Q

Z-score: use in what patient population

A

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

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9
Q

Normal T-score and Z-score

A

T-score: above -1 is normal

Z-score above -2 is normal

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10
Q

T-scores:

–normal value

– Low bone density (osteopenia)

–Osteoporosis

A
  • Normal bone density: -1 and above
  • Low bone density (osteopenia): between -1 and -2.5
  • Osteoporosis: below -2.5
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11
Q

Non-pharmacological treatment options for osteoporosis (3)

A
  • behavioral modifications: stop tobacco, alcohol, and caffeine consumption
  • Balanced diet: adequate calcium and Vitamin D intake
  • Regulatory exercise program
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12
Q

MOA for estrogen

A

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

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13
Q

MOA calcium

A

increased bone mineralization

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14
Q

MOA vitamin D

A

increases calcium absorption in the GI tract

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15
Q

MOA Calcitonin

A

hormone directly inhibits osteoclastic bone resorption

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16
Q

MOA bisphosphonates

A

bind permanently to mineralized bone surfaces and inhibit osteoclastic activity

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17
Q

MOA raloxifene

A

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

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18
Q

Definition of FRAX

A

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

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19
Q

Wilson Katz: stress fracture Type I

-what will be seen on X-ray

A

fracture line with no evidence of endosteal callus or periosteal reaction

-will see a radiolucent line through bone

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20
Q

Wilson Katz: stress fracture Type II

-what will be seen on X-ray

Study These Flashcards
A

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
Q

Wilson Katz: stress fracture type III

-What will be seen on X-ray

Study These Flashcards
A

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

-Will see a callus lump.

22
Q

Wilson Katz: stress fracture type IV

Study These Flashcards
A

mixed combo of type 1,2,3

23
Q

Fundamentals of MRI physics.

TR and TE values for T1 and T2

Study These Flashcards
A

T1: Short TR and short TE

T2:long TR and long TE

24
Q

What are the fat image and water image in MRI

Study These Flashcards
A

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
31
What are the imaging characteristics of early subacute stage
- T1 signal gradually increases to become hyperintense. | - Due to intracellular methaemoglobin
32
What are the imaging characteristics of late subacute stage
-extracellular methaemoglobin leads to increase in T2 signal
33
What are the imaging characteristics of chronic stage
- periphery is low on T1 + T2. | - Center is isointense on T1 and hyperintense on T2.
34
Stages of bone healing and time line (5)
1) Inflammation (1-4days): hematoma formation 2) Induction(day 1-?) 3) Soft callus (4-4weeks) 4) Hard callus (4 weeks- 4months) 5) Remodeling(4 months-2 years)
35
What effect does pH and O2 have on bone healing
- pH: better when alkyline - High O2 better early on in bone healing - Low O2 better later on in bone healing
36
Hardcastle classification for Lisfranc's injuries
Type A: Total displacement A1: Lateral displacement A2: Dorsoplantar displacement Type B: Partial displacement B1: Medial dislocation 1st met B2: Lateral dislocation lesser mets Type C: Divergent (1st met medially while lesser mets go laterally) C1: 1st met displaced medially with some lesser mets laterally displaced C2: 1st met displaced medially with all lesser mets laterally displaced
37
Myerson classification of Lisfranc's injuries
Type A: Total displacement in any plane or direction Type B1: Medial displacement of 1st met Type B2: Lateral displacement of 1 or more lesser mets Type C1: Partial displacement of 1st met medially and lesser mets laterally Type C2: Total displacement with a divergent pattern with total incongruity
38
AP X-ray findings for Lisfranc's ligaments
flex sign: avulsion at base of 2nd met cuneiform step off: widening of the 1st interweb space
39
Oblique X-ray findings for Lisfranc's ligaments
lateral margins of 2nd met-cuneiform and 3rd met-cuneiform should align
40
Lateral X-ray findings for Lisfranc's ligaments
will look for dorsoplantar subluxation or angulation and loss of medial plantar arch - medial plantar archis determined by medial cuneiform and 5th met
41
Nunley Classification of Lisfranc's injuries (3stages)
Stage I: pain at the Lisfranc complex and were nondisplaced radiographically, but demonstrates increased uptake on bone scan. TX-nonoperative Stage II: M1-M2 diastasis 1-5mm greater than the uninjured foot but no loss to arch height TX- operative Stage III: More than 5mm M1-M2 diastasis and arch height loss TX- operative
42
External bone growth stimulators (the two types)
Electrical stimulator and ultrasound stimulator
43
Electrical bone stimulator details
to stimulate need to use negative electric current. -to resorb need to use positive electric current.
44
Ultrasonic osteogenesis stimulator detail
stimulates receptor of osteoblasts to start producing osteoprogenitor material -not through the previously believed mechanism of mechanical stimulation
45
Sudeck atrophy
metabolic bone changes that occur with CRPS
46
Causes of Normocytic anemia (4)
Acute blood loss Bone marrow failure Chronic disease Destruction (hemolysis)
47
Causes of Macrocytic anemia (8)
- Alcohol (liver disease) - B12 deficiency - Compensatory reticulocytosis - Drug/Dysplasia - Endocrine (hypothyroid) - Folate deficiency/Fetus
48
Causes of Microcytic anemia (4)
Thalassemia Iron deficiency Chronic disease Sideroblastic anemia

Mahoney EBM (3 decks)

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