Canadian Boards Part B (Radiology)

MC level of C-Spine Disc herniation

C5/6 -->flx/ext inj

Spondyloarthropathies

AS/Enteropathic

Reiter's / Psoriatic

Oblique Radiograph Rules

L.AO / R.PO = Left IVF

(ASS / POO Rules)

Spondy___ definitions

Spondy- litis = Inflammation

Spondy- losis = Degeneration

Spondy- lithesis = pars break + slippage

Spondy- lysis = Break in pars

Disc degeneration X-Ray sign

Vacuum sign

Anode Heel Effect

Uneven distribution of radiation intensity in the x-ray beam.

Higher intensity @ cathode

>> place thicker part of body

Greater anode angle = bigger difference (the goal is to have a smaller anode angle)

Most noticeable when using large cassette from short distance

Kerley Lines

Thin linear lines seen with pulmonary edema

A Lines - pneumoconiosis (long & hilum)

MC B Lines - Congestive heart failure (short & peripheral)

Looser lines

Osteromalacia (mid D deficiency)

Pseudofractures in poorly mineralized bones

Stress Fracture

Radiolucent clefts in bone w/ thickening of surrounding cortex

Sella Turcica Size

Vertical = 5-16

A-P = 4-12

Skinner's Line

1 Landmarks: a line is drawn through and parallel to the femoral shaft, a perpendicular line is drawn tangential to the tip of the greater trochanter.

2 The fovea capitus should lie above or at the level of the trochanter line.

If the fovea capitus falls below this line it indicates fracture or coxa vara.

Klein's Line

1 Landmarks: a line is drawn along the outer margin of the femoral neck.

2 The femoral head should intersect the line.

Failure to intersect the line indicates a slipped capital femoral epiphysis.

This is the best line of mensuration for SCFE.

Iliofemoral Line

1 Landmarks: a smooth curvilinear line is drawn along the outer ilium, across the joint and onto the femoral neck.

2 Bilateral asymmetry indicates a slipped femoral capital epiphysis, dislocation, fracture, or dysplasia.

Shenton's Line

1 Landmarks: a smooth curvilinear line is drawn along the inferior femoral neck to the superior aspect of the obturator foramen.

2 An interrupted, discontinuous line indicates a dislocation, neck fracture, or slipped capital femoral epiphysis

Kohler's Line

1 Landmarks: a line is drawn along the pelvic inlet to the outer aspect of the obturator foramen.

2 If the acetabular floor crosses the line, this indicates protrusio acetabuli.

Hip radiograph lines

Skinner - Femoral Neck & Shaft lines // Possible fracture

Klein - Top outer margin of femoral neck // SCFE

Iliofemoral - Outersurface of ileum & femoral neck // SCFE, dislocation, fracture

Shenton - Underside of femoral neck to inferior pubic ramus // SCFE, dislocation, fracture

Kohler - Vertical line, pelvic inlet to obturator foramen // Protrusio Acetabuli --> RA Pagets

Femoral Angle

120-130 degrees

<120=coxa vera

>130=coxa valga

Which vitamin doesnt affect BP

Phosphorus

-All of Ca, Na, K are involved

Quebec Task Force Classification

Acute - 0-7days

Subacute - 7 days - 7weeks

Chronic - >3 months

MERCY guidelines

3-5x/ week for 10-14 days should see resolution of LBP

Schilling Test

A diagnostic analysis for pernicious anemia

Malabsorption of radioactive B12 w/ or w/o intrinsic factor

Pernicious Anemia = w/o IF

Lichtheim's disease

Subacute combined degeneration of spinal cord

Degeneration of the posterior and lateral columns of the spinal cord due to vitB12 deficiency

ALS

Autoimmune Dz

Onset >50

Degeneration of UMN&LMN

S/Sx - Weakness starting distally, muscle fasiculations, Hyperreflexia

MS

Inflammatory Dz that creates damage to myelin sheaths of CNS

MS S/Sx

1st sign is vision changes

Mild: Numbness, spasticity, fatigue

Severe: Paralysis, pain, vision loss, ataxia, cognitive impairment

Syringomyelia

Cyst of the spinal cord

Loss of pain & temp & cape/shawl like distribution over shoulders and neck

Associated w/ Chiari

Headaches in Kids

MC Cause is dehydration

4 Types: Dehydration, tension, rebound, migraine

Child v Adult Migraine

Short --> 1-4 hours not 4-72

Pulsating & retro-orbital

Laterally --> Unilateral or Bilateral while Adult is unilateral

Abdominal Pain --> adults have none

Aura --> Infrequent in kids

Sciatic N Innervation

L4-S2

Osteosarcoma

MC = Knee (distal femur / prox tib)

MC 10-25

2nd MC malignant bone tumor

MC malignant bone tumor in kids

Likes mataphysis

Unstable compression fracture

MC @ T12/L1 / 2= L5/S1

- Step defect

- Wedge deformity

- Linear zone of condensation

- End plate displacement

- Paraspinal swelling

- Unusual bowel gas

Charcot Joint (Neurotrophic Joints) 6 Ds

1. Distension

2. Density INCR

3. Debris

4. Dislocation

5. Disorganization

6. Destruction

Charcot Joint (Neurotrophic Joints) Causes

Spina Bifida, Alcoholism DM, MS, Syrinomyelia, Charcot-Marie Tooth, Syphilis

Charcot Joint (Neurotrophic Joints)

Painless instability

Absent DTR

Radiograph Sx - Licked candy stick apprearance, Bag of bones

Antifreeze Antidote

Ethanol (Alcohol)

Pagets

M >55y/o

"Increasing Hat" Sign

Osteitis Deformans - Bone becomes hyperactive, normal matrix fortened w/ enlargement

MC Target - Pelvis, VB, Clavicle, Humerus, Ribs

Complications:

Path Fx - Transverse banana-like

Stenosis

Anemia

Pagets Dx

Labs:

-INCR Alk phos (normal Ca+ & P)

-hot on bone scan

-INCR urine pyridinoline cross-links

X-Ray:

-Osteoporosis circumscripta (Cotton-wool skull)

-Picture-frame vert / Ivory Vert (IHOP)

-Sheppards Crook Deformity

Disc Herniation Levels & NR Exits

Cervical- Affects BELOW / NR Exits ABOVE disc

Lumbar - Affects BELOW / NR Exits BELOW disc

Polyarteritis Nodosa

Vasculitis of small and medium vessels

RENAL AND VISCERAL ARTERIES / not pulmonary arteries

Type 3 Hypersensitivity

Polyarthritis

Inflammation of 5+ joints

MC from systemic autoimmune dz

SLE S/Sx

Characterized by ANA (autoantibodies)

W (often african-american)

-Malar Rash

-Pain w/o deformity in 1+ peripheral joint

-Plueritis

-Photosensitivity

Callus Formation

~14 days after fx

Hip Pattern

IR < Abd < ER

MSk Pain Ddx

O'Donahue's

Muscle / Tendon = Pain w/ Active & Resisted

Ligament = Pain w/ Passive

Temporal Arteritis

Inflammation of Large blood vessels

MC in Elderly men

Associated with Polymyalgia Rheumatica

Headache

Tenderness over temporal artery (hurts to wear sunglasses)

Rachitic Rosary

Prominent knobs @ costochaondral joints

Due to Rickets/Osteomalacia or HPT

DECR Ca+ >> lack of cartilage mineralization >> overgrowth of joint

Abdominal quadrants

RUQ - Liver / Gall bladder

LUQ - Stomach / Spleen

RLQ - Appendix / Intestines

LLQ - Intestines

DISH

Ligament Calcification & Ossification

50-60 y/o Men w/ Diabetes

S/Sx - Morning stiffness, joint/tendon pain. dysphagia, hoarseness

MC @ T/L, OPLL @ C/T

Flowing hyperostosis for >4 segments

Spondylolesthesis

Type 1 - Congenital

Type 2 - Isthmic --> MC @ L5

Type 3 - Degenerative --> MC @ L4

Type 4 - Traumatic

Type 5 - Pathological

Type 6 - Iatrogenic

Odontoid Fractures

Type 1 - Fracture through dens - Stable --> MC cause is avulsion of annular ligament

Type 2 - Base of odontoid Most Unstable

Type 3 - Through VB below dens

Knee Tunnel View

Used to visualize tibial plateau

Sunrise View

Patella

Stenosis Measurements

C1 <16

C2 <14

C3 <13

C4-7 - <12

Sjorgens/Sicca Synd

Antibodies attack exocrine glands

Dry mucosal surfaces

Osteomalacia/Rickets

Generalized muscle weakness

Accetuated trabecular patterns

Paintbrush metaphysis (widening of medullary zones

Thinned cortex

Pseudofractures

Osteopetrosis

Increased density of atypically soft bone

Thin medullary bone w/ thick cortex

Hypoparathyroidism

MC after thyroidectomy

Decr Blood Ca+ (Remember, PTH causes incr blood Ca)

S/Sx Tetany

+ Chvostek's sign (Eye contraction on tap)

+ Trousseau's sign (BP cuff creates carpometacarpal spasm)

Hyperreflexia

Hyperparathyroidism

50 y/o W MC

causes resorption of calcium >> hypercalcemia, renal stones, bone resorption

S/Sx = Bones, stones, groan, moans

Osteoporosis - distal radius / mid femur

Rugger jersey spine

Salt & pepper skull

Cauda Equina Synd

Cause: SOL L3-S1

S/Sx : LBP w/ radiation

Saddle numbness

bowel/bladder distubances

Scoliosis

3 Types: Idiopathic MC / Moderate = 20-40 deg.

Functional - reversible

Structural - Irreversible w/ fixed vertebral rotation / Adams Test

- Rib humping on side of convexity

Scoliosis Progression

Double curves mc than single curves

Lower Risser Sign = incr probability of progression

F>M

Scoliosis Management (Cobb Angles)

<20 = Watch and wait ~<6mths

20-40 = Brace

>40 = Surgical intervention

Malignant Melanoma

Sun-Exposed Skin

Hard dark plaque w/ ulceration

Squamous Cell Carcinoma

2nd MC

Red Scaly papule - most dangerous

Basal Cell Carcinoma

MC

Least likely to metastasize

Looks like cherry danish - rolled translucent pearly border

Vertical calcification seen in lower C-Spine

Thyroid Cartilage

Abdominal Aorta

bifurcates into left and right common iliac arteries @ L3/4

Common Iliac bifurcates into internal/external @ L5/S1

Pelligrini steida

Calcification of the medial collateral ligament in the knee

DJD or Trauma

Spider Angioma

A form of telangiectasis characterized by a central elevated red dot the size of a pinhead from which small blood vessels radiate

MC Tumor Questions

MC Primary Malignancy in kids - Osteosarc

MC Primary Malignancy in bones - Multiple myeloma

MC Malignancy to bones - Mets (lung/breast/prostate)

Oseopetrosis

Dense brittle bones

Osteoclast failure

Hx of recurrent fractures

Unexplained anemia --> decr bone marrow

Spleno & hepatomegaly --> throm bocytopenia due to decr RBCs

Osteopetrosis Radiograph

Bone within Bone

Sandwich ver

No medullary cavity in long bones

Erlenmeyer Flask deformity

Fixation Hypotheseis

Gillet end play of a fixated joint = abrupt & hard

Watkins chiropractic philosophy

Chiropractic should be more scientific

Korr

Segmental facilitation theory

Established the concept of subluxation creating a hyperactive nervous system, rather than a decrease in nerve impulses, muscle is central to his theory

Carver Philosophy

School emphasized science

Structural approach which stresses changes in chiropractic principles and perspectives

Whiplash

Should almost always have radiographs minimum cervical

Only do a davis series once you have ruled out gross instability or fracture

Whiplash Rating

WAD 1 - No physical signs

2 - MSk signs

3 - Neuro signs

4 - Fracture / Dislocation

Elbow Articulations

Capitulum --> Radius

Trochlea --> Ulna

Tumors that cross growth plates

Chondroblastoma --> 2-25 y/o

Giant cell tumor --> 20-40 y/o

Otto's Pelvis

Bilateral protrustion acetabuli

X Ray screens have what material in them

Phosphorus Crystals

What is used to process radiographs

Silver nitrate

-fluorescent lights will damage x rays

Scheurmanns disease

aka idiopathic spondylodystrophy

Increased kyphosis

>3 vertebra

Wedging of at least 5 degrees or more

Peak age at 10-16

Ewing's Sarcoma

10-25

Diaphysis of long bones

Osteosarcoma v Ewing's Sarcoma

Ewings = Diaphysis

Osteosarc = Metaphysis

Simple bone cyst (unicameral)

Benign

Straw coloured fluid

Metaphysis of prox humerus / femus

Radiograph: Fallen fragment sign

Aneurysmal Bone Cyst (ABC)

Benign, Painful

5-20 y/o

Metaphysis of long bones

Eccentric expansile lytic lesion

Only benign tumour to cross growth plate

CPPD (calcium pyrophosphate deposition disease // pseudogout)

MC in knees - also wrist, hands, ankles, elbow

>60 y/o

Chondrocalcinosis

HADD (hydroxyapatite Deposition Disease // Dystrophic calcification

MC Supraspinatus

Tendon Calcification

Tuberculosis Spondylitis // Potts Dz

MC in t-spine

Crosses VB into IVD

Gibbus deformity

Will self-resolve

Osteomyelitis

MC Staph aureus

Marjorin Ulcer --> Osteomyelitis turns into squamous cell carcinoma

Osteology Changes RA v OA

OA = osteosclerosis

RA = osteoporosis

MC Tumor in hand

Enchondroma

MC Location for lumbar injuries

Compression: L5-S1

Shearing: L4-L5

Abdominal Calcifications

MC in RLQ

Least Common in LUQ

Types:

Concertions

Conduit Wall

Cyst Wall

Mass-like

Normal Growth Patterns

Age 0-2: Genu Varum

Age 3-4: Valgus

Age 5-7: Straight

Adult: Slight Valgus (Q Angle ~15 deg)

- If medial malleoli touch, there is >10cm between condyles (varus)

- If condyles, there is >10cm between medial malleoli (valgus)

Osteitis Condensens Illi

MC in Multiparous Females

Insidious Onset of LBP

Bilateral Symmertical Triangles of sclerosis on ILIAC SIDE of SI J

Marfans Synd

Failure to produce normal collagen

Radiographic: Tall vert w/ Posterior scalloping

Possible scoliosis

Congenital Hip Dysplasia

PUTTI'S TRIAD:

1. Hypolastic femoral head

2. Shallow acetabular shelf

3. Femoral head outside acetabulum

Ortolani's - Going Up (Hip ER, Flx, Abd)

Barlow - Coming Down (Add, ext)