Part 17

Question 1

AVN of lunate

Answer 1

Keinbock’s disease

Question 2

who gets Keinbock’s?

Answer 2

people who do manual labor

Question 3

what is keinbock’s associated with?

Answer 3

negative ulnar variance

progressive pain + soft tissue swelling of wrist

Question 4

radiographic features of Keinbock’s

Answer 4

initially increase in density of lunate
later fragmentation and collapse
mixture of sclerosis and radiolucent
flattening, collapse and fragmentation
altered joint congruity and biomechanics precipitates DJD

Question 5

what is the possible treatment for Keinbock’s?

Answer 5

silastic implants

Question 6

tarsal navicular AVN

Answer 6

Kohler’s

Question 7

signs and symptoms of Kohler’s

Answer 7

localized pain, swelling

navicular patchy, homogenous sclerosis, collapse fragmentation

Question 8

scheuermann’s disease etiology

Answer 8

in question, probably doesn’t represent a necrosis, likely TRAUMA

Question 9

what is scheuermann’s disease?

Answer 9

abnormality of the discovertebral junction
usually in teens
chronic back pain, deformity and early DDD

Question 10

radiology of scheuermann’s

Answer 10

thoracic and lumbar spine
3 continguous vertebra
5 degree anterior body wedging
irregular end plates
decreased disc space
increased kyphosis
schmorl's nodes

Question 11

etiology of juvenile discogenic disease

Answer 11

failure of embryonic vascular channels, centrum defects, notochord clefts to disappear, leaving endplate defects

Question 12

juvenile discogenic disease produces?

Answer 12

early degeneration, segmental dysfunction, associated pathology of the facet joint

Question 13

sever’s disease

Answer 13

NOT a necrosis
sclerosis and fragmentation of the calcaneal apophysis represents normal anatomy
correlate clinically

Question 14

calcified medullary infarct

Answer 14

serpiginous regions of calcification within the bone medulla

usually associated with arteriosclerosis

Question 15

DDx of serpiginous regions of calcification within bone medulla

Answer 15

1. enchondroma
2. chondrosarcoma
3. calcified medullary infarct

Question 16

MC hemolytic anemia

Answer 16

sickle cell

Question 17

what demographic MC gets sickle cell anemia?

Answer 17

african americans

Question 18

signs/symptoms of sickle cell anemia

Answer 18

pain and swelling in hands and feet
infarct of bowel following obstruction of mesenteric arteries (abdominal crisis)
osseous changes related to infarction, AVN, marrow hyperplasia and retarded growth

Question 19

those with sickle cell anemia are predisposed to what?

Answer 19

salmonella osteomyelitis

gallstone problems

Question 20

radiographic findings of sickle cell anemia

Answer 20

marrow hyperplasia
coarse trabeculation
osteopenia
long bone undertubulation
hair on end skull
osteonecrosis/infarct
H shaped vertebra

Question 21

thalassemia AKAs?

Answer 21

cooley’s anemia

medeterranean thalassemia

Question 22

presentation of thalassemia

Answer 22

fatigue due to chronic anemia
splenomegaly
cardiomegaly
gallstones
marrow hyperplasia
extramedullary hematopoiesis
maxillary overgrowth (rodent faces)

Question 23

radiology of thalassemia

Answer 23

coarsened trabeculation (honecomb/lace like)
osteopenia
erlenmeyer flask deformity

Question 24

background of hemophilia

Answer 24

X chromosome linked bleeding disorder

female the carrier usually manifest in males

Question 25

imaging for hemophilia

Answer 25

``` intra-articular soft tissue swelling radiodense effusion osteopenia square femoral condyles degeneration epiphyseal overgrowth erosions ```

Question 26

clinical features of hemophilia

Answer 26

joint pain | hemophilic arthropathy

Question 27

background for leukemia

Answer 27

malignant proliferation of WBCs

Question 28

imaging for leukemia

Answer 28

``` radiolucent submetaphyseal bands osteopenia osteolytic destruction of long bone metaphysis and diaphysis periosteal reactions growth arrest lines ```

Question 29

clinical features for leukemia

Answer 29

``` fever malaise joint pain easily bruised spontaneous bleeds ```

Question 30

cellulitits

Answer 30

infection of skin, subcutaneous fat or connective tissue

Question 31

osteomyelitis

Answer 31

infection of bone (marrow spaces)

Question 32

septic arthritis

Answer 32

infection of joint

Question 33

those who are at risk for infection

Answer 33

``` immunosuppressed diabetics post-surgical vascular insufficiency sickle-cell anemia IV drug users ```

Question 34

where are drug addicts prone to getting infection?

Answer 34

spine sacroiliac symphysis pubis sternoclavicular

Question 35

what is the most common organism for an infection?

Answer 35

staph aureus

Question 36

modes of infection

Answer 36

``` trauma/post surgerical UTI pneumonia skin infections open wounds or cellulitis heel sticks in infants ```

Question 37

routes of dissemination

Answer 37

hematogenous (MC) direction extension direct implantation postoperative

Question 38

infants and young adults may present with what when they have an infection?

Answer 38

``` fever chills pain swelling loss of limb function elevated ESR elevated WBC ```

Question 39

adult patterns of infection

Answer 39

``` fever malaise edema erythema pain ```

Question 40

50% of those with infection previously had?

Answer 40

skin, respiratory or genitourinary tract infections

Question 41

suppurative osteomyelitis

Answer 41

2-12 years | males

Question 42

infantile pattern of vasuclar anatomy

Answer 42

metaphyseal and diaphyseal vessels may penetrate the physis (septic arthritis and osteomyelitis)

Question 43

childhood pattern of vascular anatomy

Answer 43

1 year to physis closure, metaphyseal blood flow is slow and turbulent, metaphyseal vesself don't penetrate physis, separate epiphysis blood supply

Question 44

adult pattern of vascular anatomy

Answer 44

metaphyseal vessels penentrate the vanishing physis, reestablishing communication with the subarticular bone end (osteomyelitis and septic arthritis)

Question 45

most common locations of hematogenous infection

Answer 45

``` knee hip ankle (distal tibia) shoulder spine ```

Question 46

two major categories of infections

Answer 46

suppurative (pus)- staph | non-suppurative (TB)

Question 47

suppurative osteomyelitis

Answer 47

``` bone marrow infection by (pyogenic) non tubercular organism (anything but TB) staph aureus strep pneumoniae e coli pseudomonas ```

Question 48

clinical features of acutre infections

Answer 48

``` edema lyphadenopathy warm skin cellulitis joint pain ```

Question 49

4 radiographic stages of osteomyelitis

Answer 49

``` latent stage (1-10 days) early stage (10-21 days) middle stage (weeks) late stage (months) ```

Question 50

early stage of osteomyelitis

Answer 50

spinal lesion may approach 3 weeks soft tissue edema osteopenia

Question 51

middle stage of osteomyelitis

Answer 51

``` permeative or lytic moth eaten descruction perosteal responase (solid laminated, codman's triangle) ```

Question 52

buttressing/solid periosteal reaction

Answer 52

when additional layers of new bone are added to the exterior creating an expended osseous contour usually associated with slow growing lesions

Question 53

laminated/layered/onions skin

Answer 53

multiple layers of new layers of bone alternating layers of lucency and opacity with alternating growth can be thick or thin can be seen in slow or aggressive lesions classically associated with ewing's

Question 54

spiculated

Answer 54

linear radiating spicules of new bone

Question 55

hair on end

Answer 55

when spiculated bone is perpendicular to the bone

Question 56

sunburst

Answer 56

when the spiculated bone is radiating from a central focus

Question 57

codman's triangle

Answer 57

triangular elevation of periosteum seen at the periopheal lesion cortex junction is one of themost aggressive forms of periosteal reaction may be seen also with benign tumors, infections or other disorders

Question 58

late stage osteomyelitis

Answer 58

``` cortical destruction draining sinus involucrum cloaca sequestrum sclerosis debris loss of joint space ankylosis chonic incomplete resolution immune deficient ```

Question 59

sequestrum

Answer 59

chalky, white area representing isolated dead bone | cortical and medullar infarcts

Question 60

involucrum

Answer 60

"bony collar" (chronic periosteal response | pus lifts the periosteum and causes new bone formation, trying to wall off the infection

Question 61

cloaca

Answer 61

rare compilation is to devlop a squamous cell carcinoma within the channel of the cloaca

Question 62

malignant transformation of cloaca

Answer 62

Majolin's ulcer