Exam 2 - DI Past Paper PDF

EXAM 2 - DI Vascular Anatomy & Infections (by age) Infant (40 older 40 degrees Kummel Decreased VB height (Vertebral Body)...

EXAM 2 - DI Vascular Anatomy & Infections (by age) Infant (40 older 40 degrees Kummel Decreased VB height (Vertebral Body) Air in VB SIFK Elderly Fx (femoral condyle) Osteoporosis AKA old: SONK MC location: (subchondral Weight bearing osteonecrosis of the portion of medial knee) femoral condyle VAN Neck Normal Anatomy (ischiopubic synchondrosis) Blount Beak-like projection medial femoral (medial tibial condyle) condyle - Flattening - Depression Sever Pain at posterior heal, increased FU: (calcaneal apophysis) with: - MRI to see apophysis - Activity - Walking - Running - Jumping - Etc. Kohler Flat. (navicular – children) Frag. Scler. Meuler-Weiss (navicular – adults) Diaz Black line (hawking sign) (talus) - Good prognostic sign - Indicated revascularization - NOT crescent sign = bad Panner (capitellum) Preiser (scaphoid) HASS (humeral head) Vascular Demographics Clinical Information Disorders Monckeberg Secondary to DM Sclerosis / calcification of the tunica media Medial Sclerosis Hyperparathyroidism Systemic Lupus Erythematosus Atherosclerosis Aorta MC degenerative arterial disease Iliac Subclavian Atheromatous plaques involve the intimal and subintimal layers Carotid Coronary Thumbnail Sign  EXAM 2 - DI Femoral Abdominal Aortic 50+ Diameter of the aorta: *** Aneurysm M - >3cm is considered aneurysmal - Referral for doppler ultrasound is recommended for 3.5 to Seen in 7-9% of males 3.8cm age 80 - Contraindication for HVLA chiropractic manipulation - 5.5cm prophylactic surgery Risk factors: - 7cm, 75% will rupture in 5 years - High BP - Smoking 50% are clinically silent - High cholesterol - May present with back pain - Obesity - Emphysema Dissection or rupture can increase symptoms suddenly - Genetics - Diaphoresis - Rigid abdomen, pulsations - Back or groin pain - Shock, rapid HR, anxiety, or clammy skin Radiographs are not sensitive for AAA detection! - 75% will demonstrate calcific atherosclerosis Use a Doppler Ultrasound (first choice) CT angiography (surgical planning)  EXAM 2 - DI Spondylolisthesis Degree Direction Level Due to Wiltse Classification: 1) Dysplastic - Congenital anomaly of posterior arch - More common in Cervical Spine - Cervical – absent articular pillars - Lumbar – elongated post. element 2) Isthmic - pars involvement * - mostly L5 (MC) - Type A – fatigue fx of pars (MC in people under 50) - Type B – elongation but intact pars (micro trauma and remodeling) - Type C – acute traumatic pars fx (major trauma like car accident) 3) Degenerative* - mostly L4 4) Traumatic - region other than pars is involvement 5) Pathological - 6) Iatrogenic - Extra info (general): Spondylosis is just OA of Spine Spondylolysis is pars break Spondylolisthesis is a slippage (any cause) Spondylolytic spondylolisthesis is slippage from a pars break Defect = chronic Fracture = acute 50+ is L4, degeneration (degenerative) -50 is L5, Pars break (isthmic) Difference in incidence is believed to be due to the thickness of the pars interarticularis. Hx that points to pars defect: Adolescent patient (10-15y) Repetitive hyperextension loading Fatigue fracture of the pars interarticularis (continuation of activity resulting in non-union healing) Gymnasts, high diver, cheerleader, weightlifter, pole-vaulters Unilateral spondylolysis - less common than bilateral - frequently overlooked - may heal of progress into bilateral defect - no spondylolisthesis should be visualized - Wilkinson Syndrome (dense unilateral sclerotic pedicle) - DDx: Osteoid osteoma Instability: - F&D views - Compression-traction - Don’t help patient in flexion extension could kill them Yochum Value for lumbar instability: - 4mm of translation - >11mm of excessive angular motion - AMA is different (>4.5mm) (the better one Dr. Bodalia likes)  EXAM 2 - DI Spondylolistheses (Cervical): Congenital - C6 is MC - Anterolisthesis usually seen - SB Occulta - Hypoplastic pedicles & articular process Traumatic - facet dislocations, hangman’s - Degenerative - Can see anterolisthesis or retrolisthesis - Usually mid-cervical Definition: - Cycle to fatigue fx → healing → fatigue fx - Leading to elongation Management: Stable (inactive) - Chiro - Biomechanical eval of pelvis and lower extremity Unstable - Boston anti-lordotic brace (acute) - Surgical arthrodesis (chronic) Wiltse Classification Type 2A Information Suspected: 2A - 1st do AP & Lateral - 2nd do oblique (most definitive), Ferguson (tilt-up) for L5 - MRI for bone marrow edema (acute fatigue) Positive for active defect: 2A - Stop activity - Boston brace (typically done via orthopedist) - Allow fatigue fx to heal (6-8 weeks) - Healed non-unions, majority asymptomatic Physical Exam Findings: 2A - Accentuated lordosis - Stork test (sn) - Spinous process with palpable step defect - Isthmic – SP above move anterior - Degenerative – SP of affected segment moves anterior In an adult: 2A - Major concern for instability (>4.5mm total) - Would result in widening or opening of spinal canal; but narrow the IVF. Risk of progression: 2A - 2-3% will show progression - Occurs between 5-15y - Most likely within the first 2 year after fx - 4.5mm total  EXAM 2 - DI Type 2C Information Secondary to acute hyperextension Major acute injuries Type 3 Information MC type in patients older than 50y Slippage from degeneration Facet orientation changes Neural arch intact MC is L4 Central canal stenosis & neurogenic claudication Typically, not more than grade 1 Hyper Sclerosis & Facet DJD Type 4 Information Acute fx of posterior arch (not involving the pars) Hangman fx (C2 pedicle region) Facet dislocation Type 5 Information Weaking of the osseous structure making the pars susceptible to fx. Osteoporosis, Metastasis, Paget, Osteopetrosis Type 6 Information Not common, not on original Wiltse classification, only on boards** Typically, in segments adjacent to surgical fusion F&D views Pain in area of previous surgical fusion Scottie Dog: - Nose → TVP - Ear → S.A.F. (superior articular facet) - Front Leg → I.A.F. (inferior articular facet) - Neck → Pars - Eye → Pedicle - Body → Lamina MC 1st MC Major Pathway of spread Hematogenous - UTI or URTI 1st MC cause of Acute Suppurative Osteomyelitis Staphylococcus Aureus 1st MC pathway of spread for Acute Suppurative Osteomyelitis Hematogenous from UTI or URI 1st MC location for Acute Suppurative Osteomyelitis Femur 1st MC location of infection Metaphysis 1st MC location for Septic Arthritis Knees & Hips  EXAM 2 - DI Buzzwords Spina Ventosa TB dactylitis (finger) Potts Puffy Tumor TB of the skull (frontal bone) w/ scalp abscess Weaver Bottom Sub-gluteal infective bursitis with direct extension of the ischium F E G N O M A S H I (brodies) C Geographic Lytic AGE? + LOC? Upper resp. infe. Pneumonia Cough Increase WBC Night pain relieved by aspirin  EXAM 2 - DI Buzzwords / Specific Radiographic Features (examples)  EXAM 2 - DI Pathologies Acute suppurative osteomyelitis Brodie’s abscess EXAM 2 - DI  EXAM 2 - DI Septic arthritis Chronic osteomyelitis Diabetic osteomyelitis Septic arthritis Non-Suppurative osteomyelitis Tuberculosis Syphilis