Pathology Skeletal Flashcards
Patient history indicates pt has chronic inflammation in both hands and feet. Dr orders x-rays of bilateral hands and feet. What is the most likely diagnosis?
What would be seen on the x-ray that would indicate the pt does indeed have rheumatoid arthritis?
i) Rheumatoid arthritis
* **involves joint in both hands and both feet, but will affect all joints eventually
ii) destruction of joint spaces
Ankylosis of joints
White sclerotic lines
14 year old pt complains of ongoing inflammation within his joints. This might be indicative of which disease process?
Juvenile rheumatoid arthritis
An elderly gentlemen enters the ER department and indicates pain in his right knee only with decreased ROM. He also indicates he has been running for many years. What would be the most likely diagnosis?
What would you see on the x-ray to support this diagnosis?
Osteoarthritis
Narrowing of joint space, loss of articular cartilage
Knee x-ray shows destruction of joint spaces with osteoporosis on either side of the joints. What likely diagnosis might this be?
Rheumatoid arthritis or Osteoarthritis and indicate what supports your decision?
Rheumatoid arthritis
Osteoarthritis is not indicative of bone loss
PP - Skeletal - infectious and inflammatory
Patient attends the ER and complains of pain in spine, hips and knees and the x-ray indicates presence of an absess. This patient also has had tuberculosis in his lungs about 1 month ago. What possible diagnosis could be given for the pain in his joints?
What supports your decision?
Tuberculous Arthritis
PP Skeletal - infectious and inflammatory
***Please notice that patients normally would have pain in one joint only (not all spine hips and knees). However Tuberculous Arthritis is most commonly seen in the joints of hips, knees and spine
Pathology (Eisenberg) p. 106 and PP
Patient enters the ER with Fever, swelling and tenderness of the lower leg. Lab results indicate bacterial infection of bone and marrow. What possible diagnosis may be given?
What supports your decision?
Osteomyelitis
Patient enters the ER with Fever, swelling and tenderness of the lower leg. X-ray shows localized edema, bone erosion and elevation of periosteum. Dr is also worried about sequestra present within the bone.
What possible diagnosis may be given?
Osteomyelitis
sequestra - areas of necrotic bone
Patient goes to her dr and hears that she’s had a decrease in amounts of calcium, vitamin D or phosphorus and therefore insufficient mineralization of bones. Patient hx also indicates liver disease, regional ileitis and chronic renal failure.
What is the most likely bone disorder diagnosis for this person?
Osteomalacia
Bones that are softened by osteomalacia may bend or give way as a result of weight bearing.
PP - Skeletal - Metabolic disorder
Pt lab results indicates an increase in uric acid. What type of skeletal disorder may this cause and what type of xray could be done to confirm its diagnosis? What type of identifiers would you look for on the x-ray?
Gout
Primarily seen in first metatarsalphalangeal joint therefore a foot x-ray would possibly be recommended.
RA joint effusion, crystal deposits and in advanced stage destructive lesions “rat bites”
Radiologist has identified cotton wool appearance within the pelvis, spine and skull of the patient. What diagnosis may this indicate?
Paget’s disease
*** Know the difference and appearance of both the osteolytic and osteoblastic stages
Which modality is best to detect ischemic necrosis of bone?
Nuclear medicine and MRI
It is idiopathic avascular necrosis of the femoral head (3 – 10 years of age)
Legge-calve perthe’s
If the requisition was questioning Rheumatoid Arthritis of the hands, which projection is recommended to use diagnose RA?
AP oblique projection - ball catcher’s position
p. 123 Merrills 1
It is the continuation of the perpendicular plate of the ethmoid bone.
above - crista galli
At was year of age do each of the carpal bones ossify?
Capitate ~1 Hamate ~ 2 Triquetral ~ 3 Lunate~ 4 Scaphoid ~ 5 Trapezium ~ 6 Trapezoid ~ 7 Pisiform ~10-12 (clockwise on Right PA)
What can you see on a lateral projection of the bladder?
Anterior, posterior walls & base of bladder,
filled with contrast
if reflux ~ distal ureters
