Week 2: Skeletal System Pt 1

Question 1

Diploe

Answer 1

The spongy bone tissue found between the two tables of the cranial bones

Question 2

Hematopoiesis

Answer 2

The production of erythrocytes, leukocytes, and thrombocytes from the red marrow

Question 3

Hypercalcemia vs Hypocalcemia

Answer 3

-Hypercalcemia: too much calcium in the blood
-Hypocalcemia: too little calcium in the blood

Question 4

Periosteum

Answer 4

Fibrous membrane that encloses all of the bone, except at the joint surfaces of long bones, and it plays a crucial role in supplying blood to the underlying bone

Question 5

Arthropathy

Answer 5

A collective term used to denote disorders of the joints, includes, but is not limited to, arthritis, bursitis, tendonitis, and tenosynovitis

Question 6

Arthritis

Answer 6

Inflammation in which lesions are confined to the joints

Question 7

Tendinitis

Answer 7

Inflammation of a tendon

Question 8

Bursitis

Answer 8

Inflammation of the bursae of the tendons, with the subdeltoid bursa as the most common site

Question 9

Osteomyelitis

Answer 9

Inflammation of bone and bone marrow most often caused by Staphylococcus

Question 10

How many bones are in the human body? How many are axial? How many are appendicular?

Answer 10

206. 80. 126.

Question 11

Functions of the skeletal system include

Answer 11

support, protection, movement, blood cell production & storage

Question 12

What type of tissue is bone?

Answer 12

Connective tissue, but it differs from other connective tissue because of its matrix of calcium phosphate

Question 13

Another name for bone marrow is

Answer 13

Myeloid tissue

Question 14

Differentiate between compact and cancellous bone

Answer 14

The outer portion of bone is composed of compact bone (hard and dense). The inner portion, termed the medullary cavity, is made up of cancellous bone (spongy and light).

Question 15

Label the following on the image:

• diaphysis
• epiphysis
• medullary canal
• location of red marrow
• location of yellow marrow

Answer 15

Question 16

Bone remodeling: Role of Osteoblasts

Answer 16

Osteoblasts located within the periosteum are responsible for bone growth and thickening, ossification, and regeneration

Question 17

Bone remodeling: Role of Osteoclasts

Answer 17

Osteoclasts are specialized cells that break down bone to enlarge the medullary cavity and allow for bone growth. This production and breakdown of bone plays an important role in serum calcium and phosphorus equilibrium.

Question 18

What is the significance and location of the metaphysis?

Answer 18

The metaphysis refers to the growth zone between the epiphysis and the diaphysis. It is the area of greatest metabolic activity in a bone.

Question 19

Location of growth plates and radiographic appearance

Answer 19

A cartilaginous growth plate is located between the metaphysis and the epiphysis in the bone of a growing child. Radiographically, these growth areas appear radiolucent. As the body matures, this cartilage calcifies and is no longer radiographically visible in the adult.

Question 20

Significance of Wolff’s Law?

Answer 20

In a healthy person, bone grows and remodels in response to the forces placed upon it. This is known as Wolff’s Law. The more physical stress a bone is under, the more thickly the compact portion develops

Question 21

Identify and briefly describe the three types of joints

Answer 21

1. Fibrous (synarthrodial) joints form firm, immovable joints such as the sutures of the skull
2. Cartilaginous (amphiarthrodial) joints, such as those found between the vertebral bodies, are slightly movable
3. Synovial (diarthrodial) joints, such as the knee, are freely movable. The synovial joints are found at the ends of the bones, are lined with articular cartilage, and are held together by ligaments

Question 22

Osteogenesis Imperfecta:
• What is it?
• What is the etiology?
• Describe the result
• What are the 2 main clinical groups?
• Radiographic evaluation & appearance

Answer 22

• What is it? Causes brittle bones, affects the connective tissue
• What is the etiology? Most commonly the result of an autosomal dominant defect
• Describe end result: deficient and imperfect formation of osseous tissue, skin, sclera, inner ear, and teeth are noted in individuals with this disease
• What are the 2 main clinical groups?
1. Osteogenesis imperfecta congenita is present at birth. Infants with this disease usually have multiple fractures at birth that heal only to give way to new fractures. This results in limb deformities and dwarfism, and may lead to death.
2. In Osteogenesis imperfecta tarda, fractures might not appear for some years after birth and then generally stop once adulthood is reached
• Radiographic evaluation & appearance: Multiple fractures in various stages of healing and a general decrease in bone mass. The bone cortex is thin and porous, and the trabeculae are thin, delicate, and widely separated.

Question 23

Achondroplasia:
• What is it?
• What is the etiology?
• Clinical Manifestations?
• Modalities used to diagnose and monitor conditions?

Answer 23

•What is it? Most common skeletal dysplasia which results in bone deformity, decreased bone formation and disproportionate dwarfism.
• What is the etiology? Caused by autosomal dominant gene. Individuals with this gene have about a 50% chance of passing it to their offspring
• Clinical Manifestations? Results in bone deformity, decreased bone formation and disproportionate dwarfism: Normal trunk size & shortened extremities. Other signs: Kyphosis, Hyperlordosis, Spinal stenosis, Bowed legs, Bulky forehead, Narrowed foramen magnum
• Modalities used to diagnose and monitor conditions? Bone age study may be used to monitor the condition

Question 24

Osteopetrosis/Marble Bone Disease
• What is it?
• What is the etiology?
• What bones are affected?
• What radiographic adjustments should be made?

Answer 24

• What is it? Dysplasias involving increase in bone density & defective bone contour, often referred to as skeletal modeling
• What is the etiology? Genetic mutation that leads to missing or abnormal osteoclasts. Leads to abnormally dense, compact, but brittle bones
• What bones are affected? All bones are affected, but significant changes are to long bones of the extremities, vertebrae, pelvis and base of skull
• Radiographic adjustments: Radiographer must increase the technique when imaging patients with this condition

Question 25

Match the following: (A): Syndactyly; (B): Polydactyly; (C): Clubfoot; (D): Developmental Dysplasia of the Hip • Presence of an extra digit or digits - • Malformation of the acetabulum - • Bilateral frog-leg and AP views are obtained for which malformation - • Genetic syndrome that causes failure of fingers or toes to separate - • Sonography is useful to diagnose which anomaly early in life - • Webbed digits are also called as - • Which malformation is congenital and prevents normal weight bearing - • Avascular necrosis of femoral head in children is a common complication for which malformation -

Answer 25

• Presence of an extra digit or digits - **(B): Polydactyly** • Malformation of the acetabulum - **(D): Developmental Dysplasia of the Hip** • Bilateral frog-leg and AP views are obtained for which malformation - **(D): Developmental Dysplasia of the Hip** • Genetic syndrome that causes failure of fingers or toes to separate - **(A): Syndactyly** • Sonography is useful to diagnose which anomaly early in life - **(D): Developmental Dysplasia of the Hip** • Webbed digits are also called as -**(A): Syndactyly** • Which malformation is congenital and prevents normal weight bearing -**(C): Clubfoot** • Avascular necrosis of femoral head in children is a common complication for which malformation - **(D): Developmental Dysplasia of the Hip**

Question 26

Scoliosis • What is it? • Physical Characteristics of scoliosis? • Differentiate between Structural Scoliosis & Functional Scoliosis • What imaging modality and projections are used? • What radiation protection measures should radiographers have in place?

Answer 26

**• What is it?** Abnormal lateral deviation of the spine, commonly with vertebral rotation **• Physical Characteristics of scoliosis?** The lateral deviations are usually convex to the right in the thoracic region and to the left in the lumbar region of the spine **• Differentiate between Structural Scoliosis & Functional Scoliosis** **-Structural scoliosis** remains fixed and does not disappear with changes in position **-Functional scoliosis** usually presents with significant lateral deviation with little or no rotation of the vertebrae. primary issue is outside the spine. Can be the result of spinal cord injuries, unequal leg lengths, compensatory postural changes due to pain elsewhere in the body **• What imaging modality and projections are used?** Scoliosis series (PA/ AP and lateral standing x-rays, plus follow up imaging) **• What radiation protection measures should radiographers have in place?** Female should be imaged PA or use breast shields

Question 27

Match the following: (A): Spina Bifida; (B) Craniosynostosis; (C): Anencephaly •A congenital premature closure of one or more cranial sutures before the brain is fully formed is - •A congenital abnormality in most cases where the facial bones are formed, but the brain is underdeveloped and the cranial vault is incomplete – •A failure of the lamina to unite posteriorly resulting in incomplete closure of the vertebral canal is – •Ultrasonography is used to diagnose this disorder before birth -

Answer 27

•A congenital premature closure of one or more cranial sutures before the brain is fully formed is - **(B) Craniosynostosis** •A congenital abnormality in most cases where the facial bones are formed, but the brain is underdeveloped and the cranial vault is incomplete – **(C): Anencephaly** •A failure of the lamina to unite posteriorly resulting in incomplete closure of the vertebral canal is – **(A): Spina Bifida** •Ultrasonography is used to diagnose this disorder before birth - **(C): Anencephaly**

Question 28

Osteomyelitis • What is it? • Etiology? • Radiographic appearance/demonstration

Answer 28

**• What is it?** An infection of the bone marrow and surrounding bone caused by a pathogenic micro­organism spread via the bloodstream (hematogenous) from an infection within a contiguous site, or through direct introduction of the microorganism. **• Etiology?** Contagious infections. In **infants**, hematogenous osteomyelitis may also be caused by group B streptococci and Escherichia coli. In **adults,** hematogenous osteomyelitis is commonly secondary to bacteremia caused by genitourinary tract, soft tissue, or respiratory infections. As in **children**, S. aureus and streptococci are the pathogenic microorganisms primarily responsible for the infections **• Radiographic appearance/demonstration:** No specific bone changes may be demonstrated radiographically in the very early stage of infection. However, the infection spreads rapidly, with the acute stage of osteomyelitis characterized by the formation of an abscess, leading to an inflammatory reaction within the bone that causes a rise in internal bone pressure

Question 29

Osteoarticular Tuberculosis • What is it? • Etiology? • Radiographic appearance/demonstration

Answer 29

**• What is it?** Bone and joint tuberculosis (osteoarticular tuberculosis [TB]) is a chronic inflammatory disease caused by Mycobacterium tuberculosis. Bone and joint tuberculosis most commonly affects the hip, knee, and spine **• Etiology?** Mycobacterium tuberculosis. This infection usually arises secondary to pulmonary TB and tends to be more advanced and is often left untreated for a longer period compared with pulmonary tuberculosis. **• Radiographic appearance/demonstration:** The ends of the long bones display a “worm-eaten” appearance, with the disease slowly destroying the epiphyses, spreading to the articular cartilage, and, in some cases, infecting the joint space

Question 30

Pott’s Disease

Answer 30

Tuberculosis of the spine. Causes softening and eventual collapse of the vertebrae, resulting in paravertebral abscess formation and abnormal pressure on the spinal cord.

Question 31

Infectious/Septic Arthiritis • What is it? • Etiology? • Radiographic appearance/demonstration

Answer 31

**• What is it?** Arthritis caused by an infection. The infectious agents may enter the joint through a break in the skin, via extension from an adjacent infection such as osteomyelitis or an infected wound, or as a result of bacteremia. **• Etiology?** caused by a variety of pathogens including S. aureus, streptococci, and Neisseria gonorrhoeae **• Radiographic appearance/demonstration:** Early radiographic changes demonstrate soft tissue swelling and joint effusions, with joint space narrowing that is only visible approximately 2 weeks after the infection. Radiographs obtained during the healing stage demonstrate recalcification and sclerosis, which often results in joint ankylosis or joint fusion.

Question 32

Rheumatoid Arthritis (RA) • What is it? • Etiology? • Radiographic appearance/demonstration

Answer 32

**• What is it?** Chronic autoimmune disease, fluctuates in severity. Chronic inflammation and overgrowth of the synovial tissues, most often in the extremities. Commonly begins in peripheral joints (small bones of hand, feet) **• Etiology?** It is triggered by exposure of an immuno­genetically susceptible host to an arthritogenic antigen. Genetic factors may predispose individuals to this condition. **• Radiographic appearance/demonstration:** Early findings: soft tissue swelling and osteoporosis in affected bones. Joints become unstable and bones of joint become displaced, leads to deformities. Joints become ankylosed/stiffen (needs surgical intervention)

Question 33

Anklylosing Spondylitis /Marie-Strümpell Disease /“Bamboo Spine” • What is it? • Etiology? • Radiographic appearance/demonstration

Answer 33

**• What is it?** Progressive form of arthritis. Chronic inflammation of axial ligaments, progressive ankylosing mainly involving the spine. Especially the SI joints. Most commonly, an individual will report low back pain of varying intensities, often nocturnal in nature and associated with morning stiffness **• Etiology?** Believed to have a genetic predisposition because it is 20 times more common in the first-degree relatives of individuals known to have this disorder **• Radiographic appearance/demonstration:** -Early radiographic changes: “fuzziness” of SI joints then become obliterated and condition moves up the spine -Later radiographic changes: calcification of the bones of the spine and ossification of the vertebral ligaments. Articular cartilage is destroyed and fibrous adhesions develop.

Question 34

Osteoarthritis/Degenerative Joint Disease (DJD) • What is it? • Etiology? • Radiographic appearance/demonstration

Answer 34

**• What is it?** Most common type of arthritis. Disease of the cartilage. Commonly affects large, primary weight-bearing joints of the body: Hip, knees, and ankle. May also include DIP, PIP, IP joints of the hand. -Primary: Inflammatory and destructive, results from noninflammatory deterioration of the joint, normal wear & tear, may be a genetic predisposition -Secondary: Results from bone stress commonly due to trauma, congenital abnormalities, or other diseases **• Etiology?** Primary may be genetic predisposition, Secondary can be from trauma, congenital abnormalities, other diseases **• Radiographic appearance/demonstration:** Narrowing of the joint space

Question 35

Gouty Arthritis • What is it? • Etiology? • Radiographic appearance/demonstration

Answer 35

**• What is it?** One of the most common rheumatic diseases of adulthood, caused by a disorder in the metabolism of purine. Excess amounts of uric acid are produced and deposited in the joint and adjacent bone **• Etiology?** A combination of genetic, constitutional, and environmental factors, and may occur in individuals placed on long-term diuretics, for instance, to treat congestive heart failure **• Radiographic appearance/demonstration:** bone erosion can be seen with overhanging edges or "rat bitten" appearance

Question 36

The most common benign neoplasms are

Answer 36

Osteoma, osteochondroma, Osteoclastoma (Giant Cell Tumor)

Question 37

Primary malignant neoplasms are

Answer 37

Osteosarcoma, Ewing sarcoma, and multiple myeloma

Question 38

True or False • CT plays a key role in primary diagnosis of the skeletal system - • Radiographic studies do not contribute to diagnosing and managing patients with bone tumors - • Nuclear Medicine may be performed to identify possible metastatic involvement and post-treatment follow-up - • The most common benign neoplasm/bone tumor is Osteoma - • Osteoid osteomas are less than 2 cm in dimension - • Enchondroma arises in the metaphysis - • Enchondroma is a result of incomplete endochondral ossification - • Osteochondromas are often asymptomatic unless the affected long bone is traumatized, which results in a pathological fracture - • Enchondromas appear as small radiolucent lesions containing small, strippled calcifications with sharply defined margins -

Answer 38

• CT plays a key role in primary diagnosis of the skeletal system - **T** • Radiographic studies do not contribute to diagnosing and managing patients with bone tumors - **F** • Nuclear Medicine may be performed to identify possible metastatic involvement and post-treatment follow-up - **T** • The most common benign neoplasm/bone tumor is Osteoma - **F it’s osteochondroma** • Osteoid osteomas are less than 2 cm in dimension - **T** • Enchondroma arises in the metaphysis - **F it’s the marrow space** • Enchondroma is a result of incomplete endochondral ossification - **T** • Osteochondromas are often asymptomatic unless the affected long bone is traumatized, which results in a pathological fracture - **T** • Enchondromas appear as small radiolucent lesions containing small, strippled calcifications with sharply defined margins - **T**

Question 39

Is Osteoclastoma/Giant Cell Tumor (GCTs) malignant or benign?

Answer 39

Can be either

Question 40

Osteoclastoma/Giant Cell Tumor (GCTs) •Characterization of the disease •Affects which part(s) of the body? •Radiographic appearance •Radiographic modifications •What modalities are useful?

Answer 40

**•Characterization of the disease:** Locally aggressive neoplasms characterized by the presence of numerous, multi­nucleated osteoclastic giant cells. May be benign or malignant. Symptoms: pain, tenderness, and occasionally a palpable mass and pathologic fracture. **•Affects which part(s) of the body?** Affects epiphyseal-metaphyseal region of long bones: Lower femur, upper tibia and lower radius. **•Radiographic appearance:** “Soap bubble” appearance **•Radiographic modifications:** It’s a destructive disease so we need to reduce technique **•Useful modalities:** CT & MRI

Question 41

Clubfoot is also known as

Answer 41

talipes equinovarus

Question 42

T or F: Osteosarcoma/Osteogenic is the most common malignant neoplasm

Answer 42

True

Question 43

Osteosarcoma/Osteogenicsarcoma •Etiology? •Commonly found where on the body? •Radiographic appearance? •Preferred modality?

Answer 43

**•Etiology?** linked genetically to deletion of genetic material on chromosome 13 and the oncogene src **•Commonly found where on the body?** metaphyses of long bones: Distal femur, proximal tibia **•Radiographic appearance?** sunray or sunburst **•Preferred modality?** MRI & CT & NM

Question 44

Ewing Sarcoma •Etiology? •Commonly found where on the body? •Radiographic appearance? •Preferred modality?

Answer 44

**•Etiology?** Arises from the medullary cavity and involves bone more diffusely, giving rise to uniform thickening of bone **•Commonly found where on the body?** tend to affect the extremities and the pelvis **•Radiographic appearance?** classic onion skin or laminated appearance **•Preferred modality?** Radiography, CT, and MRI

Question 45

Chondrosarcoma •Etiology? •Commonly found where on the body? •Radiographic appearance? •Preferred modality?

Answer 45

**•Etiology?** malignant tumor of cartilaginous origin and is composed of atypical cartilage **•Commonly found where on the body?** Most lesions arise in the metaphysis, but extension into the epiphysis may occur after epiphyseal plate closure **•Radiographic appearance?** irregular or circular radiolucencies in combination with granular areas of calcification **•Preferred modality?** Radiography, MRI

Question 46

Multiple Myeloma •Etiology? •Commonly found where on the body? •Radiographic appearance? •Preferred modality?

Answer 46

**•Etiology?** neoplastic disease of B-cells in plasma, results in cell proliferation as a result of an abnormally large amount of immunoglobulin, most commonly IgG. Hematopoietic disease (blood), but 90% of individuals have bone involvement **•Commonly found where on the body?Confined to the bone marrow**, but forms osteolytic tumors that weaken the bone. Common bone sites: pelvis, ribs, spine, skull **•Radiographic appearance?** multiple “punched-out” round, lytic lesions **•Preferred modality?** Radiography (skeletal survey is used for diagnosis)

Question 47

Metastic Diseases •Signs and symptoms of bone tumors? •What bones are commonly affected by metastatic disease and why? •Which modality(ies) supports the diagnosis of metastatic disease? •Description and radiographic technique for: -Additive/Sclerotic Pathology: -Destructive/Lytic/Subtractive Pathology:

Answer 47

**•Signs and symptoms of bone tumors?** pain, impaired mobility, and pathological fracture **•What bones are commonly affected by metastatic disease and why?** The bones of the skeletal system that contain red bone marrow. These include flat bones (such as the ribs, sternum, pelvis, and skull), the vertebrae, and the upper ends of the femora (Fig. 2.47) and humeri. **The spine is the most common site for metastasis to occur** **•Which modality(ies) supports the diagnosis of metastatic disease?** Radionuclide bone scans **•Description and radiographic technique for:** **-Additive/Sclerotic Pathology:** Increase technique **-Destructive/Lytic/Subtractive Pathology:** Decrease technique