1
Q
How many bones in the appendicular skeleton? Axial skeleton?
A
Appendicular = 126 Axial = 80
2
Q
Last bone to ossify?
A
Clavicle
3
Q
Name the 3
A
Ectoderm
Mesoderm
Endoderm
4
Q
T or F
Bone is derived from Ectoderm
A
False
Mesoderm
5
Q
Where is the primary centre of ossification on a long bone?
A
Diaphysis
6
Q
Name the site of secondary ossification on a long bone
A
Epiphysis
7
Q
Name the 3 parts of a long bone
A
Epiphysis
Metaphysis
Diaphysis
8
Q
What is the strongest thickest part of a long bone?
A
Diaphysis
9
Q
What are the 2 types of bone formation processes?
A
Intramembranous
Endochondral
10
Q
What type of bone formation do Flat bones fall under?
A
Intramembranous
11
Q
Name the bones ossified in a membrane
A
Parietal Temporal Upper occipital Frontal ....
12
Q
T or F
Primary ossification of long bones helps widen the bone
A
False
Lengthen
13
Q
T or F
Secondary ossification occurs within epiphysis and apophyses
A
True
14
Q
Endochondral ossification is associated with what bones?
A
Tubular bones
Vertebrae
Ethmoids
Inferior conchae
15
Q
What is an apophysis?
A
A protuberance
Functions as the attachment site for ligaments & tendons
16
Q
What is known as the site of attachment of tendons and ligaments, is highly vascularized with high metabolic activity?
A
Enthesis
17
Q
T or F
Periosteum is visible on films
A
False!
You don’t see it unless it gets irritated from infection or malignancy
18
Q
List the 4 functions of the periosteum
A
- Attaches the cortex via outer fibrous extensions called Sharpey’s Fibers
- Maintains caliber of bone by appositional bone growth
- Provides a transitional zone of attachment for muscles, ligaments, and tendons
- Serves as a source of vascular profusion for the outer third of the cortex.
19
Q
Aka’s for Physis
A
Physeal plate
Growth plate
20
Q
T or F
The blood supply to the metaphysics and distal end of a bone in a child is continuous
A
False
This is describing and adult.
In children vascular supply DOES NOT cross growth plate.
21
Q
In an infant do any of the metaphyseal blood vessels penetrate the cartilaginous growth plate to supply the epiphysis?
A
Yes
22
Q
name the zones of the of the growth plate from the epiphysis to the metaphysics
A
- Resting Zone
- Zone of Proliferation
- Zone of Hypertrophy
- Zone of Degeneration
23
Q
T or F
If the resting zone is injured growth will stop
A
True
24
Q
What zone attaches the growth plate to the epiphysis
A
Resting Zone
25
What zone is where bone lengthens due to active growth of chondrocyte?
Zone of Proliferation
26
What is the weakest portion of the growth plate?
Zone of hypertrophy
27
In what zone will Salter-Harris fractures occur?
Zone of hypertrophy
28
What is a function of the zone of degeneration?
Attaches growth plate to metaphysis
29
T or F
| Cancellous bone makes up 80% of total bone mass
False
| Compact!
30
On what bone is the coracoid process found?
Scapula
31
Where is the conoid process found?
Clavicle
32
What bone is the coronoid process on?
Ulna
33
Name the categories used to classify bone diseases
```
Congenital
Arthritis
Trauma
Blood (hematological)
Infection
Tumor
Endocrine, nutritional, metabolic
Soft tissue
```
34
Name the 3 categories of Behaviour of Lesions
1. Osteolytic
2. Osteoblastic
3. Mixed Lesion
35
What colour on a film will Osteolytic lesions appear? Osteoblastic
```
lytic = black colour
blastic = bright white
```
36
We can further classify Osteolytic Lesions into what 3 categories?
Geographic
Motheathen
Permeative
37
Permeative lesions will appear how on films?
Very tiny pin holes. They appear as the tinniest of holes compared to Motheaten and Geographic
38
T or F
Geographic lesions are malignant
False
39
What type of lesions can be classified as both benign and malignant?
Motheaten
40
Is a geographic lesion fast or slow growing?
Slow
41
T or F
| Geographic lesions typically have ill defined borders
False
Sharp well defined borders
42
T or F
Geographic lesions have a narrow zone of transition
True
43
Describe the borders of a moth-eaten lytic lesion
Ragged borders
| 2-5 mm
44
punched out lesions = ?
Multiple Myeloma
45
T or F
Permeative lytic lesions have a narrow zone of transition
False
Wide!!
46
Osteoblastic aka _________
Osteogenic
47
eccentric means?
off centre
48
T or F
Sharp margins = malignancy
False
Benign
49
Poorly defined or long zone of transition will generally signify malignancy or benign?
Malignancy
50
What is the most frequent imaging modality to evaluate skeletal system? Why
Plain Film Radiography
| -Cheap and available
51
What % of bone loss needs to happen in order to see it on a plain film?
30-50%
52
How big does a lesion need to be to see it on a plain radiograph?
1-%cm
53
T or F
Plain film radiographs are specific and sensitive
False
Specific but insensitive
54
Advantages of Plain Film Radiography?
Readily available
Relatively inexpensive
Non-invasive
55
Disadvantages of Plain Film Radiography?
Lack of soft tissue discrimination
Decreased sensitivity in detecting osseous lesion
Technical artifacts
Ionizing radiation
56
What does DEXA stand for?
Dual Energy E-ray Absorptiometry
57
Why is a DEXA used?
To evaluate bone density
58
What is a T-Score in regards to DEXA scans?
The patients age vs. avg 30 yo
59
What is a Z-score
The patients score vs. avg female the same age
60
T or F
In Dexa scans....
> -1 = osteopenia
False
This is normal
61
What score would classify a patient as osteopenia with a DEXA
-1 to -2.5
62
What is a contrast study?
This is when injectable dye is inserted into the blood
63
What the disadvantages of Contrast Examinations
Invasive
Operator and interpreter dependent
Only see structural surface
May miss small lesions
64
What is Myelography
Exam of spine and spinal cord with an injection of contrast into the subarachnoid space.
65
What pathologies can be dx with Myelography?
Spinal Stenosis
Nerve Root Disease
Disc Disease
66
Disadvantages of Myelography?
Risk of infection
Nerve root damage and dural tears
Headaches
67
What does a bone scan look for?
Increased metabolic activity - infection or tumour
68
T or F
Bone scans are very sensitive and not very specific
True
69
Dark spots on a bone scan are called?
Hot Spots
70
T or F
For a CT scan and bone is white.
True
71
In regards to an MRI T1 is used to see fat or water?
Fat
72
What MRI is used to see fluid?
T2
73
In a T1 MRI do the disks look black or do they look white?
Black
74
What does osteopenia mean?
Osteopenia is a term used to describe general radiolucent bone. Osteopenia is loss of bone density.
75
Name the three types of osteoporosis.
1. Generalized
2. Regionalized
3. Localized
76
List some conditions associated with generalized osteoporosis.
Malignant bone disease, senile and postmenopausal, acromegaly, alcohol, hemolytic anemia, heparin therapy, hyperparathyroidism, steroids
77
What loss of bone density must be present in order to see osteoporosis on x-ray?
30–50%
78
Typically osteoporosis is seen in females and males in what decade of life?
Emails: 5-6th decade of life.
Males: 6–7th decade of life.
79
What are some complications associated with osteoporosis?
Fractures – spinal compression fractures [most under diagnosed]
Increased thoracic kyphosis [spinal stenosis]
Other fractures – proximal femur humorus and radius
80
What is the name of the triangle in the pelvis associated with bone loss and osteoporosis?
Wards Triangle
81
What are the radiographica findings/features of Osteoporosis
Increased radiolucency - osteopenia
Cortical thinning - pencil thing
Altered trabecular patterns
82
What specific changes can be seen in the spine radiographically with osteoporosis?
```
Curve changes
decreased bone density
trabecular changes
cortical thinning
changes in vertebral shape
```
83
What is the major weight-bearing trabeculae?
Principle compressive group
84
From where does the principal compressive group run?
From the medial metaphyseal cortex to superior femoral head
85
What trabecular pattern runs from the lateral cortex inferior to the greater trochanter?
Principle tensile group
86
T or F the secondary compressive group extend in an arch-like pattern medially
False
This is describing the principle tensile group
87
What is it called when a bone is not strong enough to withstand normal physiological stress?
Insufficiency fracture
88
Where is regional migratory osteoporosis most commonly seen?
In lower extremities
89
What are some conditions associated with localized osteoporosis
Infection
Inflammatory arthritis
Neoplasm
90
What is Sudeck's Atrophy
overactive sympathetic nervous system -> leads to immobilization = decreased osteoblastic activity and increased osteoclastic activity.
91
A lack of Ca++ deposited in osteoid tissue is associated with what condition?
Osteomalacia
92
T or F
Osteomalacia has normal bone quality and decreased bone quantity
False
This is osteopenia.
Malacia has normal quantity and decreased quality
93
What are some causes of Osteomalacia
Deficiency in Vit D, Calcium, Phosphorus or dietary chelators
Absorption problems - gastric abnormalities, biliary disease or enteric malabsorption.
Neoplasm
Fibrous Dysplasia
94
Clinical findings for Osteomalacia include...
General muscle weakness
Bone pain on palpation
Deformitites - usually weight bearing bones
95
Describe the Radiographic findings of osteomalacia
```
Decreased bone density (low bone mineral content)
Mottled trabecular pattern
Loss of cortical definition - thinner
Pseudo fractures
Deformities.
```
96
Name some of the aka's for Pseudo-fractures
Looser lines
Milkman's Syndrome
Umbau Zone
97
Where are the most common sites for pseudo fractures?
Femoral necks
Pubic and ischial rami
Ribs
Axillary border of scapulae
98
What are rachitic rosary?
Costochondral bumps on the anterior rib cage that are associated with Rickets.
99
T or F
With Rickets it is uncommon for soft tissue to swell around the growth plates.
False
100
T or F
A more narrow growth plate is seen with children with Ricket's
False - widened growth plate of long bones
101
Describe what a "paintbrush metaphysis" looks like
Irregular, frayed and cupped metaphyseal margin
Skel Rad A
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