PAC555 Clinical Applications Quiz 2

Two views at __________ degree angles to each other (orthogonal) are typically the best approach to x-ray

90

When imaging a joint, image the bone __________ and __________

Above; Below

The perimeter of normal bone forms a __________, __________ line

Smooth; White

The bone __________ is thicker in some areas than in others

Cortex

The inner portion of the bone is spongy, or __________, and appears in darker grayscale than the __________

Cancellous; Cortex

The cancellous of the bone has a __________-like appearance

Net

The __________ between the cortex and medullary cavity is readily visualized

Junction

The __________ is the shaft of the bone

Diaphysis

The __________ is the cap on either end of the bone

Epiphysis

The __________ is where the diaphysis and epiphysis meet. It is the site of epiphyseal growth plate in children (adds length to bone)

Metaphysis

The __________ is the growth center that allows growth of a bony prominent for insertion of tendons or ligaments

Apophysis

The __________ is the closest bony surface to the joint space, seen well on x-ray

Articular cortex

The __________ lies just below the articular cortex

Subchondral bone

The __________ and __________ are not seen on an x-ray but occupy joint space. These are seen better on MRI

Articular Cartilage; Synovial fluid

True or False: Synovial membranes and joint capsules can be seen on x-ray

False

Bone __________ and __________ can change in response to disease or pathologic stress. This is due to bone being a living organ that undergoes ongoing turnover

Density; Composition

__________ reabsorb, or break down, old bone and reduce bone density

Osteoclasts

__________ produce new bone matrix

Osteoblasts

Diseases that increase bone density produce lesions referred to as __________ or __________ lesions

Blastic; Sclerotic

Diseases that decrease bone density produce lesions referred to as __________ lesions

Osteolytic

What are the two main types of diseases that increase bone density?

-Diffuse

-Focal

What is the main diffuse disease that increases bone density?

Osteoblastic metastases

What are the 3 main focal diseases that decrease bone density?

-Osteoblastic metastases

-Avascular necrosis of bone

-Paget disease of the bone

In osteoblastic metastatic disease, bony metastases are common from carcinomas of the __________ or __________

Prostate; Breast

Osteoblastic metastatic disease produces __________ that can be focal or diffuse

Sclerosis (increased whiteness)

In osteoblastic metastatic disease, there is a loss of the __________ boundary

Corticomedullary

Avascular necrosis of bones occurs when bone loses __________ supply

Blood

Avascular necrosis of bone has necrotic bony tissues that collapses and becomes __________, in turn appearing whited on x-ray

Denser

Avascular necrosis of bone usually is a __________ rather than __________ lesion

Focal; Diffuse

Paget disease of bone occurs mostly in older __________ and is due to chronic __________ infection

Men; Paramyxoviral

Paget disease of bone forms __________ bone though it is more brittle and susceptible to fracture

Denser

Paget disease of bone is often __________ lesions in one or a few bones

Focal

On x-ray, paget disease of bone appears as thickening of the bony cortex, thicken of trabecular pattern in __________ bone, and a gradual increase in size of affected bones

Cancellous

What are the 2 main diffuse diseases that decrease bone density?

-Osteoporosis

-Hyperparathyroidism

What are the 3 main focal diseases that decrease bone density?

-Localized osteolytic metastases

-Multiple myeloma

-Osteomyelitis

What are the 7 main risk factors for osteoporosis?

-Postmenopausal state

-Advanced age

-Steroid medications

-Cushing disease

-Estrogen deficiency

-Inadequate physical activity

-Alcoholism

X-ray has poor sensitivity to diagnose osteoporosis, so individuals must have __________ loss of bone mass before it is recognizable

50%

Osteoporosis is best diagnosed by __________

DEXA scans

In osteoporosis, there is decreased bone density, thinning of __________, decreased visible trabecular, and increased contrast between cortex and __________

Cortex; Medullary cavity

The increased contrast between the cortex and medullary cavity in osteoporosis is due to __________ density of medullary cavity, not __________ density of cortex

Decreased; Increased

In hyperparathyroidism, the parathyroid hormone stimulates __________ activity that removes calcium from bone to deposit into the __________

Osteoclastic; Bloodstream

In hyperparathyroidism, there is an overall __________ in bone density

Decrease

In hyperparathyroidism, there is __________ bone resorption most common on the radial side of middle phalanges of index and middle fingers

Subperiosteal

In hyperparathyroidism, there is erosion of distal __________ and lytic lesions in __________ bones

Clavicle; Long

In hyperparathyroidism, lytic lesions are often called __________

Brown tumors

Brown tumors are named for the high content of __________ pigment which gives the tumors a brown color

Hemosiderin

For lytic lesions of hyperparathyroidism to occur, cortical bone is replaced with __________ and blood

Fibrous tissue

In osteolytic metastatic disease, the __________ is almost always involved

Medullary cavity

In osteolytic metastatic disease, lesions are __________ and __________ shaped

Lucent; Irregularly

What are the 4 commonly involved malignancies in osteolytic metastatic disease?

-Some lung cancers

-Ewing’s sarcoma

-Myeloma

-Leukemia

In myeloma, there is malignancy of __________ cells affects calcium metabolism and bone density

Plasma

X-ray is more sensitive than __________ for detecting myeloma lesions

Radionuclide bone scan

What are the 2 characteristic radiographic findings of myeloma?

-Diffuse and severe osteoporosis

-Multiple, small, “punched out” lesions

In osteomyelitis there is focal destruction of bone due to infection, usually by __________

Staphylococcus aureus

What are the 3 main radiographic findings of osteomyelitis?

-Focal cortical bone destruction

-Soft-tissue swelling

-Focal osteoporosis

Osteomyelitis is detected up to 10 days earlier by __________ or nuclear medicine than by x-ray

MRI

What are the 3 broad categories of radiographic findings in arthritis?

-Hypertrophic arthritis

-Erosive arthritis

-Infectious arthritis

Hypertrophic arthritis is characterized by bone __________ at the affected site

Formation

Hypertrophic arthritic bone formation may either be __________ or __________

Subchondral sclerosis; Osteophyte formation

__________ refers to new bone formation within the parent bone. It is common in hypertrophic arthritis

Subchondral sclerosis

__________ refers to new bone formation that protrudes from the parent bone. It is common in hypertrophic arthritis

Osteophyte formation

What are the 4 main radiographic features of hypertrophic arthritis; osteoarthritis?

-Subchondral sclerosis

-Subchondral cysts

-Osteophyte formation at joint margin

-Narrowed joint space

__________ results from chronic impaction and bone necrosis

Subchondral cysts

Erosive arthritis is characterized by small, irregularly shaped __________ lesions around the joint space

Lytic

The prototype disease of hypertrophic arthritis is __________

Osteoarthritis

The prototype disease of erosive arthritis is __________

Gout

In erosive arthritis, __________ occurs due to deposition of urate crystals in the joint

Arthropathy

What are the 3 radiographic features erosive arthritis?

-Sharp erosions adjacent to joints

-Soft tissue nodules (top) containing irate crystals may be seen in severe cases

-Joint space narrowing usually not seen until late in course of disease

Sharp erosions adjacent to the joints in erosive arthritis is said to resemble __________

Rat bites

Soft tissue nodules of erosive arthritis that contain urate crystal are called __________

Tophi

Infectious arthritis is characterized by joint swelling, __________, and destruction of the __________

Osteopenia; Articular cortex

Infectious arthritis is classified as either __________ or __________

Pyogenic; Nonpyogenic

Pyogenic infectious arthritis is caused by __________ and __________ organisms

Staphylococcal; Gonococcal

Nonpyogenic infectious arthritis is caused by __________

Mycobacterium tuberculosis

X-ray has low-sensitivity for septic arthritis and osteomyelitis. A diagnosis is usually made with a combination of __________ and joint __________

MRI; aspiration

What are the 2 radiographic features of acute fractures?

-Fracture lines

-Abrupt discontinuity of bony cortex

__________ are areas of increased lucency (appear blacker) compared to normal bone

Fracture lines

Naturally occurring lines in bone tend to follow an irregular, meandering course when they change __________

Direction

Fracture lines are generally __________, but when they change direction, they do so abruptly

Straight

__________ are naturally occurring anatomic variants that can mimic a fracture, but are not pathological

Fracture imposters

What are the 3 fracture imposters?

-Sesamoid bones

-Accessory ossicles

-Apophyses

__________ are bony inclusions that form in tendon as it passes over a joint. These are usually bilateral

Sesamoid bones

The most common sesamoid bone is the __________. Others include the thumb, great toe, and posterolateral knee

Patella

__________ are epiphyseal or apophyseal ossification centers that do not fuse with parent bone

Accessory ossicles

Accessory ossicles are most common in the __________ and are usually bilaterally symmetric

Foot

__________ are growth centers that add prominences to a bone where tendons or ligaments insert. These are usually bilaterally symmetric

Apophyses

Dislocations and subluxations occur only at __________

Joints

__________ occur when bones that form the joint are no longer in apposition

Dislocation

__________ occur when bones that form the joint are still in partial contact with each other

Subluxation

What are the 4 things fractures are usually described according to?

-Degree of fracture (complete vs incomplete)

-Number of bony fragments

-Fracture line direction

-Relationship of fragments

__________ fractures fully break the bony cortex, separating the fracture bone into two pieces

Complete

__________ fractures only break a part of the bony cortex

Incomplete

Incomplete fractures usually occur in incompletely __________ bone or in bone that is weaker due to disease

Calcified

Incomplete fractures are more common in __________

Children

What are the 2 types of incomplete fractures?

-Greenstick fracture

-Torus (or buckle) fracture

Greenstick fractures occur most commonly in __________

Children

__________ fractures appear as a bulge that disrupts the smooth outer contour of the bony cortex. This occurs due to __________ of the bony cortex

Torus (buckle); Compression

__________ fractures divide a bone into only two fragments

Simple

__________ fractures divide a single bone in 3 or more fragments

Comminuted

What are the two types of comminuted fractures?

-Segmental fracture

-Butterfly fragment