Week 3: Skeletal System Pt 2

Question 1

The pineal gland and pituitary gland are controlled by the

Answer 1

Hypothalamus

Question 2

Hypothyroidism

Answer 2

Under activity of them thyroid gland

Question 3

Hyperthyroidism

Answer 3

Over activity of the thyroid gland

Question 4

Bone Densitometry/DXA

Answer 4

An important modality in the evaluation of osteoporosis. DXA units readily show bone density by evaluating the bone mass of the distal radius, femoral neck, and lumbar spine. The results of bone densitometry are used in combination with routine laboratory tests of blood and urine to determine loss of bone mass. Bone mineral densitometry reports indicate the amount of bone mass present and compare the density of an individual to norms used during evaluation

Question 5

Osteopenia

Answer 5

A radiographically visible decrease in bone density

Question 6

Osteoporosis

Answer 6

a commonly known metabolic bone disorder in which the structural integrity of the trabecular pattern of bone is destroyed and is identified as a bone mass less than 648 mg/cm2

Question 7

Primary Osteoporosis vs Secondary Osteoporosis

Answer 7

•Primary osteoporosis: most common, may be further classified as postmenopausal or senile(old age)
•Secondary osteoporosis: most often associated with an existing disease of the endocrine system or is the result of a medication

Question 8

Cause of Osteoporosis and the effect on the bone structure:

Answer 8

• Thinning cortical bone & enlargement of the medullary canal; without diameter changes
• Bones become “porous”
• Subject to compression fractures
• Bones cave from weakened structure

Question 9

Osteoporosis etiology: Is it genetic, congenital, hormonal, metabolic, or chromosomal?

Answer 9

Metabolic (and hormonal)

Question 10

Is osteoporosis additive or destructive? Do we increase of decrease technique?

Answer 10

Destructive, decrease the technique

Question 11

Best modality for Osteoporosis

Answer 11

Bone mineral densitometry, radiography

Question 12

Osteomalacia

Answer 12

a condition caused by lack of calcium in tissues and failure of bone tissue to calcify

*also known as Rickets if it occurs before growth plate closure

Question 13

If osteomalacia occurs before growth plate closure, it is known as ______
•What causes this?

Answer 13

•Rickets
•Caused by a lack of vitamin D and calcium in a child’s diet. However, rickets can also be caused by a genetic defect or other underlying health conditions

Question 14

Etiology of Paget’s disease?

Answer 14

Unknown

Question 15

Two stages of Paget’s Disease are

Answer 15

► Osteolytic: breakdown of bone
► Osteoblastic: replaced by soft and poorly mineralized bone

Question 16

Paget’s radiographic appearance

Answer 16

Cotton wool

Question 17

Modality to help detect Paget’s

Answer 17

Nuclear medicine

Question 18

Is Paget’s disease additive or destructive?

Answer 18

can be considered both an additive condition because of the increased bone growth and a destructive condition because the added bony matrix is much less dense

Question 19

What is Acromegaly?

Answer 19

an endocrine disorder caused by a disturbance in the function of the pituitary gland; this disorder primarily affects the skeletal system

Question 20

Acromegaly etiology

Answer 20

caused by excessive secretion of GH in adults

Question 21

Acromegaly Radiographic appearance

Answer 21

Radiography demonstrates enlarged sella turcica & changes in skull bones

Question 22

Acromegaly modality choice

Answer 22

MRI is modality of choice to evaluate the pituitary gland

Question 23

Acromegaly physical characteristics

Answer 23

prominent forehead and jaw, widened teeth, and abnormally large, spade-like hands, and a coarsening of facial features

Question 24

Fracture

Answer 24

a discontinuity of bone caused by mechanical forces either applied to the bone or transmitted directly along the line of a bone

Question 25

Epistaxis

Answer 25

Nosebleed usually present with a nose fracture

Question 26

Dislocation (luxation)

Answer 26

joint dislocation, or luxation, results when a bone is out of its joint and not in contact with its normal articulation

Question 27

Subluxation

Answer 27

a partial dislocation, often occurring with fracture

Question 28

Benefits of digital imaging in fracture evaluation

Answer 28

helpful in evaluating soft tissue structures surrounding a skeletal fracture because images can be manipulated to demonstrate details of both soft tissue and bone

Question 29

T or F: Radiography is important for skeletal trauma evaluation

Answer 29

True

Question 30

T or F: Wet fiberglass or plaster cast requires routine exposure factors

Answer 30

False, exposure factors must be increased

Question 31

T or F: One projection is enough for evaluating trauma

Answer 31

False, at least 2

Question 32

T or F: Long bone trauma requires joints above and below to be radiographed

Answer 32

True

Question 33

Identify the responsibilities of the radiographer while imaging patients suspected of fracture

Answer 33

• Set appropriate technique to optimize visualization of bony and soft tissue structures • Cast, no cast • Assess the patient • Inquire how injury occurred • Communicate with radiologist • Note points of tenderness, pain • Provide detailed patient history

Question 34

Delayed union vs Malunion vs Nonunion

Answer 34

•Delayed union: fracture that does not heal within the usual time •Malunion: a fracture that heals in a faulty position •Nonunion: a fracture in which healing does not occur and the fragments do not join

Question 35

Open (Compound) Fracture

Answer 35

•Bone has penetrated the skin •Potential to lead to Osteomyelitis

Question 36

Closed (Simple) Fracture

Answer 36

the skin is not penetrated which reduces the chance of infection

Question 37

Impacted Fracture

Answer 37

Fractured bone end is jammed into the cancellous tissue of another fragment

Question 38

Comminuted Fracture

Answer 38

Sometimes, one or more fragments separate along the edges of the major fragment in addition to the major line of the fracture.

Question 39

Complete, Noncomminuted Fracture

Answer 39

one in which the bone has separated into two fragments. The fracture may be recognized according to the direction of the fracture line. A **spiral, transverse, or oblique** fracture is an example of this type

Question 40

Avulsion Fracture

Answer 40

Fragment of bone is pulled away from the shaft

Question 41

Incomplete Fracture

Answer 41

Those in which only part of the bony structure gives way, with little or no displacement. A common example is the **greenstick fracture.**

Question 42

Greenstick Fracture

Answer 42

Incomplete fracture, cortex breaks on one side without separation or breaking of the opposing cortex

Question 43

Growth Plate Fracture

Answer 43

Involve the end of a long bone of a child. The fracture may be limited to growth plate cartilage and is thus not directly visible unless displacement occurs, or it may extend into the metaphysis, epiphysis, or both

Question 44

Stress Fracture

Answer 44

Usually occur as a result of an abnormal degree of repetitive trauma. They are generally found at the point of muscular attachments, as in the tibia or fibula of a runner.

Question 45

Fatigue Fracture

Answer 45

Occur at sites of maximal strain on a bone, usually in connection with unaccustomed activity. Most frequently, fatigue fractures are found in the metatarsals, particularly the second metatarsal

Question 46

Occult Fracture

Answer 46

In an occult fracture, clinical signs are manifested without radiologic evidence. Follow-up examination within 10 days reveals bone reabsorption or displacement at the fracture site. The most common sites for occult fractures are the carpal scaphoid and the ribs

Question 47

Differentiate between: •Closed reduction: •Open reduction:

Answer 47

•Closed reduction: The most common treatment is splinting, casting, or both. Requires that a local or general anesthetic be given to the patient for pain management. •Open reduction: Required when orthopedic hardware is needed to maintain fracture reduction or when an open fracture needs to be irrigated (flushed out)

Question 48

What is the Salter-Harris system and briefly describe the “grading”

Answer 48

Fractures are numbered I through VI, with I being least severe and VI being most severe. Comparison projections are often used with such fra­ctures to compare growth plate appearances, and MRI may be used to further evaluate epiphyseal separations. Healed injuries of this type may result in an alteration of the length of the involved bone. Because of possible length discrepancies, frequent radiographic examinations may be required, often up to years after the injury.

Question 49

Colles Fracture

Answer 49

Fracture through the distal inch of radius. The fragment is angled backward on the shaft.

Question 50

Smith Fracture

Answer 50

Displacement of the distal fragment toward the palmer aspect of the hand

Question 51

Boxer’s Fracture

Answer 51

occurs on the fifth metacarpal (occasionally fourth) as a result of a blow to or with the hand

Question 52

Bennett Fracture

Answer 52

Fracture and dislocation of the first carpometacarpal joint. An Avulsion fracture.

Question 53

Monteggia Fracture

Answer 53

Fracture of the proximal third of the ulnar shaft, with anterior dislocation of the radial head

Question 54

Pott Fracture

Answer 54

Dislocation of the ankle joint and fracture of both malleoli in the ankle

Question 55

Trimaleolar Fracture

Answer 55

Involves the medial and posterior malleoli of the tibia and lateral malleolus of the tibia

Question 56

The most common wrist fracture is ________ and when present, it externally resembles a(n) ________

Answer 56

Colles fracture; dinner fork

Question 57

The most common metacarpal fracture is the ________

Answer 57

Boxer’s fracture

Question 58

Discuss the significance of the “fat pad sign” Radiographically, how might the following indicate the presence of a fracture? •Posterior fat pad: •Anterior fat pad:

Answer 58

The elbow “fat pad sign” may be an indicator of a nonvisualized underlying fracture of the bones of the elbow. •Posterior fat pad: Visualization of a posterior fat pad is considered a sign of a possible underlying fracture or dislocation. If the joint capsule is distended by fluid as a result of a fracture, the posterior fat pad becomes displaced from bone and is visible on the lateral projection of the elbow •Anterior fat pad: In the elbow, normally a small accumulation of fat is present adjacent to the anterior surface of the distal humerus and the anterior surface of the proximal radius. **The anterior fat pad may also be displaced, giving a sail-shaped appearance.**

Question 59

Differentiate between the following and identify the bones affected in each injury. •Tripod fracture: •Blowout fracture:

Answer 59

•Tripod fracture: The zygoma is fractured at all three sutures: frontal, temporal, and maxillary. •Blowout fracture: A direct blow to the front of the orbit that transfers the force to the orbital walls and floor.

Question 60

Which bone has the slowest healing time following a traumatic injury?

Answer 60

Mandible

Question 61

The most frequently fractured facial bone is the

Answer 61

Nasal bone

Question 62

Describe the Hills-Sachs deformity:

Answer 62

A compression fracture of the humeral head. It occurs on the superior and posterior head of the humerus because of impaction of the humeral head against the glenoid labrum during dislocation

Question 63

Another term (and acronym) for Battered child syndrome is:

Answer 63

Nonaccidental trauma (NAT)

Question 64

Describe Shaken Baby Syndrome or Abusive head trauma: •How does it occur? •What modalities are useful in diagnosing this condition?

Answer 64

•Abusive head trauma, a severe type of physical abuse that affects the child’s head and neck. **•How does it occur?** Shaking of the child causes whiplash injury to the neck and brain trauma such as a subdural or subarachnoid hematoma, with no evidence of trauma to the external cranium. High morbidity & mortality rate: 25% **•What modalities are useful in diagnosing this condition?** CT & MRI

Question 65

Describe Avascular necrosis: •What anatomical structures are most likely to be affected? •Which modality can best demonstrate this condition in the early stages?

Answer 65

Bone death resulting from inadequate blood supply. **•What anatomical structures are most likely to be affected?** hip, knee, shoulder, or carpal scaphoid **•Which modality can best demonstrate this condition in the early stages?** MRI

Question 66

Giant Cell Tumor (GCT)

Answer 66

•Aggressive neoplasms characterized by a **"soap bubble"** appearance •Lucent lesion in the metaphysis, usually at the distal femur (Merrills) •Decrease exposure factors (Osteoclastic disease)