Mahoney Study Guide Flashcards Preview

Mahoney EBM > Mahoney Study Guide > Flashcards

Flashcards in Mahoney Study Guide Deck (149):
1

Examples of monoarticular joint diseases (6)

-Trauma
-infection
-crystal deposition (gout, CPPD)
-Rheumatoid -monoarthritis
-PVNS

2

Examples of polyarticular inflammatory diseases

-OA
-RA
-Seronegatives
-Charcot
-Chronic gout
-reticular histiocytosis

3

Degenerative joint disease

Osteoarthritis

4

Inflammatory joint disease

-Rheumatoid arthritis
-Seronegative arthritis
-Psoriatic arthritis
-Reiters disease
-Ankylosing spondylitis
-Septic arthritis

5

Metabolic joint diseases

Gouty arthritis

6

Hypertrophic joint diseases

Means more bone growth

-osteoarthritis
-Detritus arthritis (post-traumatic arthritis and Charcot)

7

Atrophic joint diseases

means loss of bone growth... Primarily by erosion

-inflammatory arthritities

-forefoot charcot

8

Osteophyte formation found in:

osteoarthritis

9

Definition of erosion, and different presentations

-bare areas

-pannus, dot-dash and skipping

10

Bone erosion a primary feature in what?

Bone erosion is a primary feature of all joint disorders except OA, Charcot and Septic arthritis

11

Subchondral resorption is a primary finding in what?

Charcot and septic arthritis

12

Arthritis mutilans definition and where is it found

Definition: erosions that involve both margins of any MPJ, or interphalangeal joint

-psoriatic, RA and Charcot

13

Predominant feature of hypertrophic joint disease

bone production

14

Characteristic radiographic findings of OA

-osteophytosis and subchondral sclerosis (eburnation)

15

Periostosis is found in what ?

inflammatory processes

16

What are the characteristic radiographic findings of seronegative arthritis

-periostitis

-whiskering

-cortical and trabecular thickening

17

Type of joint space seen in OA:

assymmetrical joint space narrowing

18

Type of joint space seen in RA

symmetrical narrowing

19

type of joint space seen in psoriatic

widening

20

Type of joint space seen in gout

normal joint space

21

Underlying biochemistry changes seen in Gout

-Calcifications
-Martel's sign
-increased monosodium rate crystals that precipitate and are found periarticular next to erosions
-negatively birefringent crystals

22

Underlying biochemistry changes seen in pseudogout

-calcium pyrophosphate deposition disease
-chondrocalcinosis
-cartilage will calcify
--- joint surfaces will have parallel calcifications
----hyaline cartilage calcifies
-Will see positively birefringent rhomboids

23

Underlying biochemistry changes seen in hydroxyapatite crystal deposition disease

Will find extra-articular calcification that will be within joint capsule or found within a tendon or bursae

24

Osteoarthritis: target joint

First MPJ

25

Rheumatoid arthritis: target joints

-less MPJ's and hallux IPJ

26

Psoriatic arthritis: target joints

Lesser MPJ's and IPJ's (really varies )

27

Gouty arthritis: target joints

first MPJ

28

Neuropathic arthropathy: target joints

Tarsometatarsal joints

29

Osteoarthritis: bone production

Osteophyte and subchondral sclerosis

30

Rheumatoid arthritis: bone production

NONE

31

Psoariatic arthritis: bone production

occasionally
-periostitis
- whiskering
-Ivory phalanx

32

Gouty arthritis: bone production

overhanging edge

-----Martel's sign

33

Neuropathic arthropathy: bone production

Diffuse sclerosis

34

Osteoarthritis : erosions

NONE

---some of the subchondral bone cyst may mimic erosion

35

Rheumatoid arthritis: erosions

medial aspects

36

Psoriatic arthritis: erosions

Medial/lateral/central

37

Gouty arthritis: erosions

medial (more common)

-can also have lateral margins

38

Neuropathic arthropathy: erosions

subchondral resorption

39

Osteoarthritis: joint spacing

Nonuniform narrowing

40

Rheumatoid arthritis: joint spacing

uniform narrowing

41

psoriatic arthritis: joint spacing

widening (relative)

42

Gouty arthritis: joint spacing

normal

43

neuropathic arthropathy: joint spacing

Narrowing or relative widening

44

Osteoarthritis:soft tissue swelling

NONE

45

rheumatoid arthritis: soft tissue swelling

not significant

46

Psoriatic arthritis: soft tissue swelling

diffuse: sausage toe

47

Gouty arthritis: Soft tissue swelling

Lumpy-bumpy

48

Neuropathic arthropathy: soft tissue swelling

diffuse

49

Osteoarthitis: soft tissue calcification/ossification

Losse osseous body (joint mouse)

50

Rheumatoid: soft tissue calcification/Ossification

NONE

51

Psoriatic arthritis: soft tissue calcification/ ossification

None

52

Gouty arthriti: soft tissue calcification/ ossification

small, punctate calcifications

53

Neuropathyic arthropathy : soft tissue calcification/ ossification

fragmentation of bon

54

Osteoarthritis: positional deformity

associated with hallux abductovalgus

55

Rheumatoid arthritis: positional deformity

deviation of toes laterally; subluxation

56

Psoriatic arthritis: positional deformity

nothing specific

57

Gouty arthritis: positional deformity

NO

58

Neuropathic arthropathy: positional deformity

subluxation/dislocation

59

Osteoarthritis: bilateral symmetry

no

60

Rheumatoid arthritis: bilateral symmetry

YES

61

Psoriatic arthritis: bilateral symmetry

NO

62

Gouty arthritis: bilateral symmetry

NO

63

Neuropathic arthropathy: bilateral symmetry

NO

64

RA: will it exhibit juxta-articular osteopenia

yes

65

psoriatic arthritis: will it exhibit juxta-articular osteopenia

NO

66

Define osteopenia

Non specific radiographic finding of decreaed bone density

67

Define osteoporosis

metabolic disease where amount of bone present per unit volume is reduced but composition is normal

68

Define osteomalacia

metabolic disease of increased amount of uncalcified osteoid found on histology

69

X-ray findings of chronic osteopenia (3)

-cortical thinning by endosteal/subperiosteal resorption

-increased primary trabeculations

-intracortical tunneling

70

X-ray findings for acute osteopenia

spotty or regional osteoporotic from disuse

71

X-ray findings for general osteoporosis (3)

-prominent primary trabeculations

-cortical thinning

-cortical tunneling

72

X-ray findings for osteomalacia (5)

-Bowing deformity of long tubular bones

-Transverse incomplete radiolucency (milkman fracture)

-bordered by sclerosis on the compressive side/medial side/inner side of bone

-Widening of the physis (paint brush appearance)

-Cupping and widening of the metaphysis

73

Etiology of hypophosphatasia

reduced levels of alkaline phosphatase in serum, bone and other tissues due to mutations in tissue non-specific

74

X-ray findings of hypophosphatasia (4)

-bowing and shortening of long tubular bones

-Osteochondral spurring

-Chondrocalcinosis aricularis

- losser zone (outer cortex/ tension side)

75

Hyperparathyroid etiology

increased levels of parathyroid hormone= increased osteoclastic activity= removal of calcium from bone which then enters the blood

76

Hyperparathyroid: 3 forms

1) Primary- due to tumor which results in hypercalcemia and vitamin D deficiency.... assciated with hyperuricemia and overt gout

3)tertiary- hyperplasia of parathyroid glands and a loss of response to serum calcium levels. Occurs in chronic renal failure

77

Hyperparathyroid readiographic findings (4)

-subperiosteal resorption

-Other sites of bone resorption (periarticular, intracortical, endosteal, subchondral and entheseal)

-Acral Osteolysis

-Radiolucent lesions: hot spots-brown tumors

78

Hypoparathyroidism- what do you see in the digits

brachymetaphalangea

79

Renal osteodystrophy etiology

-seen in chronic renal failure

-Chronic kidney disease= hyperphosphatemia= increase in PTH= osteoclastic activity

80

Renal osteodystrophy: X-ray findings

calcifications of soft tissue and vessels

81

Etiology of Rickets

vitamin D deficiency or hypophosphatemia during open growth plate stages

82

Etiology of Scurvy

deficiency of Vitamin C

83

X-ray findings of Rickets (5)

-osteopenia

-bowing deformity of long tubular bones

-widening of the physis

-decreased density at the zone of provisional calcification (fraying/paint brush appearance)

-widening/cupping of the metaphysis

84

X-ray findings of scurvy

-in the metaphysis (4)

-White line of scurvy: increased density bordering the growth plate (sclerotic)

-transverse line of decreased density adjacent to the line of increased density on its metaphyseal side

-Scurvy line: radiolucent

-Radiolucency at margins of metaphysis or epiphysis

85

X-ray findings of scurvy

-in the epiphysis

-outer shell of increased density surrounding a central lucency dye to atrophy of central spongiasa, sclerotic ring around epiphysis

86

X-ray findings of scurvy

-periosteal

- bleeding found under the periosteum that may elevate along the long axis of the bone

87

Identify the type of osteoporosis/osteopenia seen in a patient who is immobilized in a cast for 8 weeks.

-Regional osteoporosis with spotty osteopenia

-multiple radiolucent spots.

-Transverse bands of decreased desnity and subperiosteal resorption

88

Define and describe the etiology in acromegaly

- There is an increased GH and IGF-1 production.

-this results in increased osteoblast proliferation.

-There is an initial increased bone formation followed by an increased bone resorption

89

X-ray findings in acromegaly

-high levels of osteoporosis.

-Increased bone turnover and appendicular cortical bone mass

- Heel pad thickness increased >25mm

-Joint space is widened due to cartilage thickening

- bone is more prominent, met heads and distal phalanx ungal tuberosities are enlarged

-met shafts are thickened

- spurring at entheses

90

Osteogenesis imperfecta aka brittle bone disease: etiology

- abnormal metaphyseal and periosteal ossification caused by deficient osteoid production

- abnormal maturation of collagen in mineralized and nonmineralized tisseus

91

X-ray findings in osteogenesis imperfecta (3)

-Diffuse osteopenia, diminished bone girth, flared metaphyses

-Complication: fractures

-Bottom of metaphyses flares out (Erlenmeyer flask deformity)

92

Describe the X-ray changes of Paget's disease (osteitis deformans)

-Excessive and abnormal remodeling of bone

-Tibia has anterior bowing (sabre-shin deformity)

-Flame lesions (radiolucent)

-Blades of grass

93

Diseases that present with generalized sclerosis (5)

-osteopetrosis

-melorheostosis

-osteopoikilosis

-osteopathia striata

-pyknodysostosis

94

X-ray findings with osteopetrosis (2)

bone in bone

-erlenmeyer flask

95

X-ray findings in melorheostosis (2)

candle wax

hyperostosis

96

X-ray findings in osteopoikilosis

multiple bone islands

97

X-ray findings osteopathia striata

striations parallel to the long axis

98

X-ray findings for pyknodyostosis (3)

-acral osteolysis
-narrowing of medullary canal
-sclerosis

99

What x-ray finding is found with fluorosis

generalized sclerosis

100

What x-ray finding is found with hypervitaminosis D

generalized sclerosis

101

What is metastatic calcification and provide examples of it (2)

-Results from disturbances in calcium or phosphorus metabolism

-occurs in hyperparathyroidism and renal osteodystrophy

102

What is generalized calcinosis and provide example of it (1)

-Presents as calcium deposition in the skin or subq in the presence of normal calcium metabolism.

-tumoral calcinosis is an example

103

What is Dystrophic calcification and provide examples (2)

-calcium is deposited in damaged or devitalized tissue in the absence of abnormal calcium metabolism

- tumors or trauma are n exmple

104

What is Myositis ossificans circumscripta

develops in sites of trauma

attaches to cortex of bone and radiographically it looks like a form of osteogenic sarcoma

105

Histologically what is the difference between myositis ossificans circumscripta and osteogenic sarcoma

-Myositis ossificans circumscripta has bone formation beginning in the periphery

-Sarcoma bone production appears in the center of tumor

106

Dexa: what does it tell you?

Dexa is the gold standard for measuring bone mineral density.

- does so through T-score measurements

107

VFA and IVA what does it tell you

Will tell you if there is an old fracture of the vertebra.

A positive finding on VFA and IFA will trump the results of a DXA scan

108

Specifics about T scores

Definition

Units

Ranges

Definition: your bone density compared with what is normally expected in a healthy adult of your sex.

Measured in units of standard deviations that your bone density is above or below the average

Range:
-1 and above: bone density is considered normal

--1: -2.5: sign of osteopenia, a condition in which bone density is below normal and may lead to osteoporosis

--2.5 and below: bone density indicates osteoporosis

109

What age range are T-scores useful in?

Postmenopausal women and men over 50

110

Z- scores

Definition and range

Number of standard deviations above or below what's normally expected for someone of your age, sex, weight, and ethnic or racial origin

- If Z-score is -2 or lower, it may suggest that something other than aging is causing abnormal bone loss.

111

What age range is z-score useful in

Z-scores are useful in premenopausal women and men under age of 50

112

FRAX score: when should you consider treatment

Patient should receive treatment:
If low bone mass... T-score between -1 and -2.5 at the femoral neck or spine.

- 10-year probability of a hip fracture at >3%

-10 year probability of a major osteoporosis related fracture >20%

113

What are the factors that go into calculating FRAX score

-Age
-Height
-Weight
-BMD- femoral neck and spine
-Smoking
-Alcohol
-Glucocorticoid
-RA
-Spine fracture
-Family history
-Gender
-Ethnicity

114

How much bone loss occurs with every change in SD of the T-score

For every 1 standard deviation away from normal bone, patient will have 10% less bone density

115

Non-pharmaceutical types of therapy that should be used to treat osteoporosis (2)

-Behavioral changes (smoking, alcohol consumption and diet changes)

-exercise: weight training

116

OTC drugs that should be used to treat osteoporosis

Calcium: 1000-1200mgs daily

Vitamin D:800-1000 International units daily

117

Bisphosphonates

-MOA

-Biggest side effect to look out for

How to prevent against side effects

MOA- inhibits bone reabsorption.

Side effect: can cause a typical femur fracture and osteonecrosis of the jaw with long term use

Also watch out for GI symptoms such as GERD.

Take the medications in the morning before food with a glass of water and upright for 30 minutes.

Avoid in people with chronic kidney disease

Take a drug holiday!!!

118

What are the 4 big bisphosphonates and administration

-Alendronate (Fosamax): oral

-Risedronate (Actonel, Atelvia): oral

-Ibandronate (Boniva): oral

-Zolendronic acid (Reclast): IV

119

Hormonal therapy that can be used in patients with osteoporosis

Estrogen can be used in postmenopausal women.

However there is an increased risk of breast, ovarian, and uterine cancers.

120

Raloxifene (Evista) MOA and are there risks to consider?

Evista mimics estrogen's beneficial effects on bone density in postmenopausal women.

- Is not associated with the cancer risks that are seen in regular estrogen.

121

Denosumab (Prolia)

-MOA

-Comparison to bisphosphonates

-Administration

Inhibits bone resorption by neutralizing RANKL

-compared with bisphosphonates denosumab produces similar or better bone density results and reduces the chance of all types of fractures

-Delivered via a shot under the skin every 6 months

122

Teriparatide (Forteo)

-MOA

-Comparison with parathyroid

-Administration and length of time

Builds bone

-powerful drug similar to parathyroid hormone and stimulates new bone growth.

-Given by daily injections under the skin, and after 2 years of treatment with teriparatide another osteoporosis drug is taken to maintain new bone growth.

123

Wilson-Katz classification used for?

Stress fractures

124

Wilson-Katz type I

WIll see a radiolucent fracture line.

No evidence of endosteal callus or periosteal reaction.

_ similar to a jones fracture presentation

125

Wilson-Katz type II

Will see a focal sclerotic line and endosteal callus

- will only occur in cancellous bone

-Will see white line everywhere but shaft

126

Wilson-Katz type III

Periosteal reaction and external callus seen.

-Will visualize a callus lump here

-Mainly seen on shaft and subjected to more movement and irritate periosteum

127

Wilson-Katz type IV

combination of all types: I,II,III.

-May see dreaded black line. Inability to heal

128

AP X-ray signs of a Lisfranc injury

Lateral step-off at the second tarsometatarsal joint is accepted as the most common and reliably detected abnormality seen in Lisfranc injuries with diastasis of 2 mm or more indicating instability

129

Lateral X-ray signs of a Lisfranc injury

there should be no step-off at the dorsal margins of the tarsometatarsal joints

-Plantar surface of the medial cuneiform should project dorsal to the plantar aspect of M5

130

Oblique X-ray signs of a Lisfranc injury

the lateral margins of C2-M2 and C3-M3 should align

131

Hardcastle classification for Lisfranc injury (5)

Type A: Total incongruity, with mets 1-5 medially or laterally displaced

Type B1: Partial incongruity with Medial dislocation of the 1st Met cuneifrom, and no displacement of the rest of the forefoot

Type B2: Partial incongruity, but lateral dislocation of the all mets 2-5 or some of them.

Type C1: divergent
Partial displacement with 1st travelling medial and some of 2-5 travelling lateral

Type C2: Total displacement with 1st going medially and all 2-5 going laterally

132

Nunley classification for Lisfranc injury (3)

Stage 1: sprain- looks normal on x-ray with <2mm of displacement and arch height remains unchanged. SURGERY

Stage 2: 2-5mm diastasis on AP x-ray between first and second and arch height remains unchanged. SURGERY

Stage 3: 2-5mm of displacement loss of arch height and SURGERY

133

Tc99 carrier molecule and sites of uptake

-Methylene diphosphate. taken up by hydroxyapetite crystal laid down by osteoblast

134

Ceretec/ Tc99 HMPAO carrier molecule and sites of uptake

carrier molecule is WBC and will lay down at acute osteomyelitis

135

Te99 Sulfur colloid carrier molecule and sites of uptake

taken up by macrophage, reticular endothelial cells in bone marrow.

136

Indium 111 uptake

acute inflammation (acute charcot and acute cellulitis)

137

What Disease processes result in acryl osteolysis (4)

-psoriatic arthritis
-Hyperparathyroidism
-Pyknodysostosis
-Pulmonary hypertrophic osteoarthropathy

138

What disease processes result in Erlenmeyer Flask deformity (3)

-osteopetrosis
-Thalassemia
-osteogenesis imperfecta

139

What disease processes result in dachtylitis (3)

-psoriatic arthritis
-sickle cell anemia
-Pulmonary hypertrophic osteoarthropathy

140

Arendt Grade I Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

X-ray will be normal findings

Bone scan will have poorly defined area of increased activity

MRI will have positive results on STIR

To treat: 3 week rest

141

Arendt Grade II Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

X- ray: Normal findings

Bone scan: More intense but still poorly defined

MRI: will have positive STIR and T-2 weighted images

To treat will do 3-6 weeks resting

142

Arendt Grade III Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

X-ray will show discrete line with discrete periosteal reaction

Bone scan: sharply marginated area of increased activity

MRI: positive T1 and T2 weighted images but without definite cortical break

To treat: 12-16 weeks of rest

143

Arendt Grade IV Navicular stress fracture will show:

X-ray

Bone scan

MRI

What is the treatment

X-ray: fracture or periosteal reaction

Bone scan: more intense transcortical localized uptake

MRI: postive T1 and T2 weighted images of the fracture line

Treatment: >16 weeks rest

144

Saxena Type 1

How to treat

CT shows a fracture line through the dorsum of the navicular

TX: NWB 6 weeks followed by gradual weightbearing in a boot for 2-6 weeks.

145

Saxena Type 2

How to treat

CT shows a fracture line from the dorsum of the navicular into the body

TX: ORIF

146

Saxena Type 3

How to treat

CT shows a fracture line through both cortices of the navicular (dorsal and plantar)

TX: ORIF

147

Saxena type .5

Stress reaction, MRI will show a reaction

148

Torg recommended what treatment plan for Navicular stress fracture

NWB cast for 6-8 weeks followed by gradual weightbearing in a boot for 2-6 weeks

149

-Length of time till bone stress reaction on MRI for stress fracture

-Length of time until fracture line is seen on a stress fracture

-5-6 weeks

-6-weeks