1
Q
most common arthropathy
A
osteoarthritis
2
Q
essential findings in oa
A
OJ Simpson is OA
- osteophytes (spurs)
- sclerosis (increased whiteness or calcification)
- joint space narrowing (always)
3
Q
most common weight bearing parts
A
- medial compartment of knee
- superolateral aspect of the hip
- spine (diffuse)
all must be present!
4
Q
occasional findings in oa
A
- subchondral cyst/geode
- marked degenerative joint disease
- primary osteoarthritis
- erosions
5
Q
classic findings in primary osteoarthritis
A
- dip, pip, base of thumb
- bilateral
- symmetric
- younger patients (female)
6
Q
differential for oa
A
diffuse idiopathic skeletal hyperostosis
- osteophytes without sclerosis or joint space narrowing
- spurs on spine
- idiopathic
7
Q
clinical and radiologic hallmarks of rheumatoid arthritis
A
RA! OJ is SOFT, BI, and MARGINALized by the PD
- soft tissue swelling
- osteoporosis
- joint space narrowing
- marginal erosions
- proximal distribution
- bilateral and symmetric
8
Q
typical presentation of ra
A
- hand: proximal bilateral symmetrical
- knee: all compartments
- hip: axial migration
9
Q
subgroup of hla b27 spondyloarthropathies
A
- negative for ra factor
- involvement of axial skeleton (vertebral bodies)
- ankylosing spondylitis
- ibd
- psoriatic arthritis
- reactive arthritis (reiter’s)
10
Q
characteristics of hla b27 spondy
A
- bony ankylosis
- proliferative new bone formation
- predominant axial spinal involvement
11
Q
what is syndesmophyte
A
- mostly spine
- paravertebral ossification
- as and ibd = syndesmophytes are marginal and symmetric
- reiter’s and psoriatic arthritis = non-marginal and asymmetric
12
Q
sacroiliac joint involvement in spondyloarthropathies
A
as and ibd = bilateral and symmetric
pa and rs = bilateral asymmetric or unilateral
13
Q
bony abnormalities in gout take ___ years to manifest
A
4-6 years
14
Q
hallmarks of gout
A
- well defined erosions
- soft tissue nodules
- random distribution
- no osteoporosis
15
Q
what is podagra
A
specific term for finding in 1st metatarsopahangeal joints
16
Q
gout vs pseudogout
A
gout: monosodium urate
pseudogout: calcium pyrophosphate dihydrate crystals
17
Q
classic triad of pseudogout
A
- pain
- cartilage calcification (chondrocalcinosis) !!! @ knee, symphysis pubis, triangular fibrocartilage
- joint destruction
- severe mimics carcot joint
18
Q
pseudogout is associated with
A
- hyperparathyroidism
- gout
- hemochromatosis
19
Q
classic findings in charcot’s joint
A
- severe joint destruction and fragmentation
- dislocation
- heterotopic new bone/osteophyte formation
- diabetic foot!!
20
Q
most common etiology of septic arthritis
A
s aureus via hematogenous spread, local direct extension, or trauma
21
Q
radiologic findings in septic arthritis
A
- soft tissue swelling and distention of joint capsule with fluid (early)
- joint space narrowing (late)
- absence of osteoporosis
- bone destruction and ankylosis
22
Q
radiologic findings in tb arthritis
A
- earliest sign: joint effusion
- cartilage preservation at sites of weight bearing
phemister triad of classical signs:
- periarticular osteoporosis
- gradual joint space narrowing
- peripheral bone erosion
23
Q
bone infection in adults vs children
A
read
24
Q
how to diagnose acute osteomyelitis
A
- 10-12 day lag of symptoms and radio findings
- earliest sign: soft tissue swelling
- bone scan very sensitive
25
radio sign for bone abscess
sharply outlined area of rarefaction or lucency in metaphysis surrounded by irregular dense sclerosis
26
subacute vs chronic osteomyelitis
subacute >2 w
| chronic >1 mo
27
sequestrum and involcrum in osteomyelitis
- sequestra: necrotic avascular area
| - involucrum: shell of bone that cloaks sequestrum
28
what is infectious spondylitis
- osteomyelitis in vertebra
- hematogenous
- vertebral body > disc > endplate
29
radiologic findings in infectious spondylitis
- earliest: decreased disc height
- narrowing of disc space
- erosion and destruction of vertebral end plates
- paravertebral soft tissue mass
30
t/f tuberculous spondylitis has a greater tendency to spread in spine compared to infectious spondylitis
true
31
most severe form of tuberculous spndylitis
bony ankylosis
- sticking of bones
- contiguous vertebrae
32
what is a gibbus deformity
sharp angulation of the vertical spine
33
most common metabolic bone disease
osteoporosis (primary senile osteoporosis most common)
34
how to diagnose osteoporosis
sum the cortex of the second metacarpal and sum of the cortex should be more than 1/3 of the entire diaphysis
<1/3 = osteoporosis
35
osteomalacia vs osteoporosis
malacia: failure of deposition of calcium salts
porosis: deficiency of organic matrix of bone
both have finding of decreased radiographic density
36
uses of bone dositometry
- diagnose osteoporosis
- determine susceptibility to fractures
- monitor treatment
- postmenopausal with hormones
37
causes of osteomalacia in adults
- renal osteodystrophy !! (chronic renal insufficiency)
- biliary disease
- dietary insufficiency
- vitamin d deficiency
38
radiologic finding for osteomalacia
- less defined cortical outline
- diffuse osteopenia
- looser fracture/ looser zone/ pseudofracture
- bone softening: inward bending of pelvic sidewalls and protrusio acetabuli
39
radio findings in hyperparathyroidism
- subperiosteal resorption
- earliest: resorption of distal phalanx
- generalized osteopenia
- brown tumors
- chondrocalcinosis
- osteosclerosis
- rugger jersey sign (spine)
40
findings in pseudohypoparathyroidism
brachydactyly
41
findings in acromegaly
- enlarged joint spaces
- flaring up of bones
- enlarged terminal tufts of distal phalanges
- squared proximal phalanges
- frontal bossing
42
findings in scurvy
- wimberger's ring
- white line of scurvy
- scurvy zone
- corner sign
43
vitamin d deficient rickets is common in ___
4-18 mos old
44
findings in vit d deficient rickets
- craniotabes (early)
- most common in knee
- rachitic rosary sign
- loss of zone of metaphyseal provisional calcification
- metaphysis is irregularly coarse, frayed, widened
- indistinct epiphyseal margins
45
osteosarcoma
- most common malignant primary tumor
- destructive or lyric changes with sclerosis
- malignant periosteal reaction
- soft tissue extension
46
findings in ewing's sarcoma
- permeative malignancy
- partially sclerotic appearance
- onion peel periostitis
47
what is chrondrosarcoma
- from degeneration of osteochondroma/ enchondroma
| - lytic destructive lesion with amorphous calcification
48
multiple myeloma
- >40 yo
- diffuse with wide margins
- not hot on bone scan
- well defined punched out lesions (swiss cheese)
49
what is enchondroma
- !! benign cystic lesion of phalanges
| - calcified chondroid matrix except in pahalnges
50
criteria for giant cell tumor
- epiphyseal and abuts articular surface
- at close epiphyses
- eccentric
- well defined border that is not sclerotic
51
soap bubble appearance
aneurysmal bone cyst (seen in mri, multiple fluid levels)
52
sites for solitary bone cyst
central, metaphyseal
| calcaneus, proximal humerus, proximal femur
53
hallmark of avascular necrosis
- icarats
- increased bone density at an otherwise normal joint
- early: joint effusion
- patchy or mottled density
- subchondral lucency
- mr most sensitive
18 ORR
flashcards
Decks in class (21)
# Cards
-
Orthopedic Emergencies57
-
Fractures UE41
-
Fractures LE47
-
Sports Injuries35
-
Orthopedic Infections45
-
Degenerative and Inflammatory Joint Disease46
-
Spine47
-
Osteoporosis36
-
Pedia Ortho0
-
Foot24
-
Hand32
-
Intro to Physical Medicine24
-
Physical Modalities of Rehab Med29
-
Therapeutic Exercises38
-
Immobilization Syndrome37
-
Pedia Rehab21
-
Radio 131
-
Radio 253
-
CT Diseases53
-
Rheumatoid Arthritis35
-
Gout32
