RT54C Spring 2012 Midterm Study Guide Midterm questions are from: Ch.

1 (15 questions), 3 (20 questions) and 4 (40 questions) 75 points totalmultiple choice, matching and true/false. Bring scantron.
1. Sign vs. symptom, know examples of each Sign: Measurable or objective manifestations Examples: Rash, fever, blood pressure Symptom: Subjective manifestations, feelings the patient describes Example: Nausea 2. Definition of: Morbidity Rate: Incident of sickness/illness sufficient to interfere with an individuals normal daily routine Mortality Rate: Death in a population Asymptomatic: Does not show symptoms 3. Define nosocomial infection & understand how to prevent them Nosocomial Infection: Hospital Acquired Disease Example: Pneumonia How to prevent: Wash your hands! 4. Know the difference between ischemia and infarct Ischemia: Deficiency of blood supply to an organ or part thereof, may result in tissue necrosis I.e. Some blood getting through but not enough Infarct: Localized area of ischemic necrosis due to occluded blood supply Example: Blood supply cut off (Stroke or heart attack) 5. Know the differences between general disease categories: Congenital: Present at birth - May result from trauma, drugs, radiation - Example: Downs Syndrome

Inflammatory: Inflammation is defined as the initial response of body tissue to local injury - Local and systemic effects - Capillary dilation - Increased capillary permeability - Cellular necrosis - Phaygocytosis o Caused by: Trauma, chemical substances, or infectious organisms - Redness = Rubor - Heat = Calor - Swelling = Tumor - Pain = Dalor - Loss of function Hereditary: DNA irregularity/genetic - Example: Hemophilia Metabolic: Disease caused by the disturbance of the normal physiologic function of the body - Endocrine Disorders (Hormone Imbalance) o Hypersecretion o Insufficient Secretion - Fluid Imbalance o Dehydration - Homeostasis - Examples: Diabetes & Hyperparathyroidism (usually affect more than one area) 6. Define Debridement: Tissue Regeneration: - Variability of tissue regeneration dependent on tissue/cell type - Scar tissue (destroyed tissue replaced with grained tissue) Debridement: The medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining tissue. - Repair Process - Remodeling KNOW: Not all tissues regenerate (if at all) & that scar tissue is replaced with granulated tissue 7. Know which of the following diseases are due to aging: Osteoarthritis: (Degeneratvie Joint Disease & part of the Aging process) Osteomyelitis: (Caused by a broad spectrum of infectiousoften gram positive

organisms that reach bone by hematogenous spread, by extension from an adjacent site of infection, or by direct introduction of organisms (after trauma/surgery) Osteogenesis imperfecta: (inherited generalized disorder) Osteoporosis: (Aging and postmenopausal hormonal changes) 8. Know the TNM system (T, N, and M stand for and what the numbers associated with them indicate.) Grading/Staging of Cancer Grading = Assesses aggressiveness or degree of malignancy Staging = Extensiveness of primary tumor & presence/absence of metastases T-Tumor Size {T1-T4} N-Node (lymph node involvement) {N0-N3) M-Metastases (spread) {M0-M1} Assists with: Treatment planning & prognosis 9. Know the time frame cancer patients must be cancer free in order to be considered cured Defined as Curative Curative: - Tx allows for 5+ years disease free 10.Understand the three ways cancer spreads Neoplastic-Malignant - Collectively tumors referred to as cancers - Invasive * Growth continues, spreads, invades other cells * Poorly defined borders Metastasize = Spread to distant sites 1) Hematogenous spread 2) Lymphatic Spread 3) Direct Spread 11.Understand the inflammatory reactionwhat is happening? Define hyperemia, what part of the inflammatory reaction is hyperemia associated with? (See page 6 in syllabus notes for details)
Chemical injury, physical injury, microbial injury lead to >>> Cell death >>>

Product of Cell Necrosis Capillary Dilation > Increased blood flow and slowing of flow

Increased Capillary permeability > extravasation of fluid Attraction of leukocytes > Migration of white cells to site of necrosis Systemic Respone > Fever & leukocytosis (Increase in WBCs) Heat > Redness > Tenderness > Swelling > Pain (These go through each area from top to bottom) Hyperemia: An excess of blood in part of the body, caused by increased blood flow, as in the inflammatory response, local relaxation of arterioles, or obstruction of the outflow of blood from an area. Skin overlying a hyperemic area usually becomes reddened and warm. * In the Inflammatory Response Reaction Process, Hyperemia is associated with Capillary Dilation which leads to >>> Increased blood flow >>> Slowing of flow >>> Heat and Redness associated with Hyperemia as well. 12.Define Edema Edema: Swelling due to abnormally large amounts of fluid in intercellular tissue i.e. Elephantitis - May be Localized (one area) - May be General (entire body affected) i.e. Ascites, kankles 13.Understand the difference between: Ecchymosis: Subcutanous purpura larger than 1 centimeter or a hematoma, commonly called a bruise. (Blood escaped into the tissues from ruptured blood vessels) Purpura: The appearance of red or purple discolorations on the skin that do not blanch on applying pressure. Caused by bleeding underneath the skin and measure 0.3-1cm (3-10 mm) Ptechiae: Red or purple spot on the body caused by a minor hemmorhage. Smallest of the three classes of purpric skin eruptions. Measure less than 3mm 14.Understand grading vs. staging (Part of TNM process, see above also) Grading = Assesses aggressiveness or degree of malignancy Staging = Extensiveness of primary tumor & presence/absence of metastases

15.Discuss positioning for pleural effusion and TB that will better visualize the disease process. Some pleural effusions are best seen on a routine lateral projection posteriorly. - The diagnosis of a small pleural effusion is best made using a horizontal

beam and the patient in a lateral decubitus position with the affected side down. - With placement of the patient in a slight lateral trendelenburg position, where pleural fluid may be seen as a layer of linear opacification along the dependent chest wall. - Tuberculosis = Apical Lordotic View (Move clavicles out of the apices of the lung, this is an oxygen rich area) 16.Be able to tell the difference between the four types of pneumonia (causation and radiographic appearance) See other study guide 17.What is the cause of Hyaline Membrane Disease? (What is missing?) Hyaline Membrane Disease: Also known as Idiopathic Respiratory Distress Syndrome (IRDS) is one of the most common causes of respiratory distress in the newborn. - Occurs primarily in premature infants, especially those who have diabetic mothers or who have been delivered by cesarean section. Hypoxia and increasing respiratory distress may not be immediately evident at birth but almost always appear within 6 hours of delivery - Results from a lack of surfactant and immature lungs. - Surfactant: A mixture of lipids, proteins, and carbohydrates that creates a high surface tension, requiring less force to inflate and maintain the alveoli. - The disease process results from surfactant deficiency caused by cell immaturity or birth trauma. 18.Define Bronchiectasis Bronchiectasis: Refers to permanent abnormal dilation of one or more large bronchi as a result of destruction of the elastic and muscular components of the bronchial wall. (Bronchitis is a common complication of Bronchiectasis and is nearly always the result of a bacterial infection) 19.List the diseases under Pneumoconioses. Be able to tell the difference between them. (What caused them?) 1) Silicosis: Most common and best-known work-related lung disease. Inhalation of high concentrations of silicon dioxide (crystalline silica) primarily affects workers engaged in mining, foundry work, and sandblasting. Quartz dust, the most frequent cause of inhalation silicosis, is the second most common element in the earths crust. 2) Asbestosis: May develop in improperly protected workers engaged in manufacturing asbestos products, in handling building materials, or in

working with insulation composed of asbestos. 3) Anthracosis (Coal Workers Pneumoconiosis) Coals miners, especially those working with anthracite (hard coal) have increased susceptibility to development of pneumoconiosis from inhalation of high concentrations of coal dust. Has led to the name black lung 20.What is Coccidioidomycosis caused by? - Coccidioidomycosis is caused by a fungus, Coccidioides immitis, which is found in the desert soil of the southwestern United States. Transmitted through fungal spores in the air (Immunosuppressed patients are more susceptible and the disease may progress quickly in those with a compromised immune system)

21.What diseases are examples of pulmonary mycosis? The term pulmonary mycosis means fungal infection of the lung. The two most common systemic fungal infections found in North America are: *Histoplasmosis (endemic of the Mississippi and Ohio River Valleys) *Coccidioidomycosis (seen in the southwestern United States) 22.Explain how endotracheal tube placement could cause Atelectasis - An important Iatrogenic cause of Atelectasis is the improper placement of an endotracheal tube below the level of the tracheal bifurcation. Because of geometric factors, the endotracheal tube tends to enter the right mainstem bronchus, effectively blocking the left bronchial tree and causing collapse of part or all of the left lung. 23.Define: Cystic fibrosis (mucoviscidosis) is a hereditary disease characterized by the secretion of excessively viscous mucus by all of the exocrine glands; it is caused by a defective gene in the middle of chromosome 7. Most common clinically important genetic disorder among white children. 90% of the morbidity and mortality related to cystic fibrosis occurs as a result of respiratory involvement. Croup: Primarily a viral infection of young children that produces inflammatory obstructive swelling localized to the subglottic portion of the trachea. The edema causes inspiratory stridor or a barking cough, depending on the degree of laryngeal obstruction. RSV: (Respiratory syncytial virus) Estimated to affect almost all children by

age 2 years. Fewer than 2% require hospitalization. The virus attacks the lower respiratory tract and causes necrosis of the respiratory epithelium of the bronchi and bronchioles, which leads to bronchiolitis. The necrotic material and edema from the infection cause bronchial obstruction. Asthma: A very common disease in which widespread narrowing of the airways develops because of an increased responsiveness of the tracheobronchial tree to various stimuli (allergens) Common allergens are house dust, pollen, molds, animal dander, certain fabrics, and various foods.

24.Describe the procedure used to remove fluid from the pleural cavity Associated with Pleural Effusion: Treatment involves Thoracentesis (surgical puncture of the chest wall) 25.Name the #1 risk factor for COPD (Check this one???) Cigarette smoking 26.Define pulmonary embolus. What causes it? What does it look like on CT? What population is at the greatest risk for developing PE? Pulmonary Embolus: Vascular condition & blood clot in pulmonary artery or one of its branches, usually in lower lobes because of flow to these areas - May lead to area of infarct - More than 95% from DVT (Deep Vein Thrombosis) * Population at risk for PE? - Those who have DVT (blood clot in leg) or history of DVT - Those who have had a pulmonary embolism before - Pregnant women at higher risk - Those with varicose veins - Sitting for long periods of time on airplane, in car etc - Inherited conditions * Filling defect on a CT Scan 27.Describe COPD - Includes several conditions in which chronic obstruction of the airways leads to an ineffective exchange of respiratory gases and makes breathing difficult. In many cases, two disease processes coexist to cause the obstructive process. Factors that predispose to COPD include cigarette smoking, infection, air pollution, and occupational exposure to harmful substances, such as asbestos.

28.Know how to adjust technical factors for: Emphysema: Reduce Technical Factors (-) Cystic Fibrosis: Reduce Technical Factors (-) Osteoporosis: Reduce Technical Factors (-) Osteopetrosis: Increase Technical Factors (+) to compensate for the increase in bone formation (increased attenuation factor) Osteogenesis imperfecta: Decrease Technical Factors (-) Bone cyst: ? 29.Define lung abscess. What does it look like radiographically? - Collection of pus in a cavity formed by necrotic tissue. Most commonly due to aspiration, microorganisms invade the lung via the right bronchus (since it is wider) Radiographic Appearance: Areas of consolidation, or capsule with air/fluid level if there is communication with the bronchial trees * Early Abscess may result in cavitation * May become filled with fluid or pus May need to increase or decrease your technique depending on severity 30.Know the most common primary sites for Bone Metastasis: The most common primary tumors are carcinomas of the breast, lung, prostate, kidney, and thyroid. 31. Define: Osteopetrosis: Osteopetrosis (marble bones) is a rare hereditary bone dysplasia in which failure of the resorptive mechanism of calcified cartilage interferes with the normal replacement by mature bone. - Prevents the bone marrow from forming, so that the bones become very brittle and stress fractures occur often. - Patient may become anemic as a result of the lack of blood-producing bone marrow. Osteogenesis imperfecta: (Brittle bones) is an inherited generalized disorder of connective tissue characterized by multiple fractures and an unusual blue color of the normally white sclera of the eye. Achondroplasia: Most common form of dwarfism; it results from diminished proliferation of cartilage in the growth plate (decreased echondral bone formation). - Autosomal dominant condition does not affect membranous bone formation. This means that the person has short limbs which contrast with with the

nearly normal length of the trunk (axial skeleton). Gout: Disorder of the metabolism of purine (a component of nucleic acids) in which an increase in the blood level of uric acid leads to the deposition of uric acid crystals in the joints, cartilage, and kidney. 32.Define osteomyelitis. When can this disease be visualized radiographically? What modality can visualize it sooner (discussed in class)? - Bacterial osteomyelitis is an inflammation of the bone (osteitis) and bone marrow (myelitis) caused by a broad spectrum of infectious (most often gram positive) organisms that reach bone by hematogenous spread, by extension from an adjacent site of infection, or by direct introduction of organisms (after trauma or surgery). - Because the earliest changes of osteomyelitis are usually not evident on plain radiographic images until about 10 days after the onset of symptoms, radionuclide (technetium Tc-99m) bone scanning is the most valuable imaging modality for the early diagnosis of osteomyelitis. 33.Know the difference between Osteoarthritis vs. Rheumatoid arthritis Osteoarthritis: (Degenerative Joint Disease) An extremely common generalized disorder characterized pathologically by loss of joint cartilage and reactive new bone formation. Part of the wear and tear of the ageing process, degenerative joint disease tends to affect predominantly the weightbearing joints (spine, hip, knee, ankle) and the interphalangeal joints of the fingers. Rheumatoid Arthritis: Chronic systemic disease of unknown cause that appears primarily as a nonsupportive (noninfectious) inflammatory arthritis of the small joints of the hands and feet. - Women are affected about three times more frequently than men, and the average age of onset is ~40. - Usually has an insidious origin and may either run a protracted and progressive course, leading to a crippling deformity of affected joints, OR undergo spontaneous remissions of variable length. - Usually symmetric involvement of multiple joints, and the disease often progresses proximally toward the trunk until practically every joint in the body is involved. 34.Understand Osteomalacia vs. Rickets Osteomalacia: Refers to insufficient mineralization of the adult skeleton. The lack of a balance between osteoid formation and mineralization influencing bone quality results in either excessive osteoid formation or, more

frequently, insufficient mineralization. <Proper calcification of osteoid requires that adequate amounts of calcium and phosphorus be available at the mineralization sites> - In osteomalacia, failure of calcium and phosphorus deposition in bone matrix may be attributed to an inadequate intake of, or failure of absorption of, calcium, phosphorus, or Vitamin D. Rickets: Rickets is a systemic disease of infancy and childhood that is the equivalent of osteomalacia in the mature skeleton. In this condition, calcification, of growing skeletal elements is defective because of a deficiency of vitamin D in the diet or a lack of exposure to ultraviolet radiation (sunshine), which converts sterols in the skin into Vitamin D. Most common in premature infants, rickets usually develops between ages 6 months and 1 year. 35.Know what positioning best displays osteoarthritis of the lower extremity - Usually affects weight bearing joints - Standing Position 36.Describe where Pagets is found first in the body. Understand the phases of this disease and the difference between the two. > The pelvis is the most common and often the initial site of Pagets disease. A distinctive early sign is coarsening of the trabeculae along the iliac margins, which causes thickening of the pelvic brim. > 2 Phases: Destruction & Repair - Destruction of bone, followed by a reparative process, results in weakened, deformed, and thickened bony structures that tend to fracture easily. - The destructive phase often predominates initially; there is more frequently a combination of destruction and repair in the pelvis and weight-bearing bones of the lower extremities. For example: In long bonesthe destructive phase usually begins at one end of the bone and extends along the shaft for a variable distance before ending in a typical, sharply demarcated, V-shaped configuration (blade of grass appearance). In the reparative stage, the bone is enlarged with an irregularly widened cortex and coarse, thickened trabeculae. 37.Describe what multiple myeloma looks like radiographically - The classic radiographic appearance of multiple myeloma is multiple punched out osteolytic lesions scattered throughout the skeletal system and best seen on lateral views of the skull. - In the spine, it is usually limited to showing affects in the vertebral bodies.

38.What is the name for a fracture that occurs due to tumor or infection? Pathologic Fracture: This type of fracture is in the area of diseased bone and may show vertebral collapse or bone destruction (radiolucency due to an underlying cause)

39.Know the difference between: 1) Boxers Fracture: Transverse fracture of the neck of the fifth metacarpal with volar (palmer) angulation of the distal fragment. This injury is typically the result of a blow struck with a fist. 2) Smith Fracture: Opposite of a Colles fracture 3) Colles Fracture: Transverse fracture through the distal radius with dorsal (posterior) angulation and often overriding of the distal fracture fragment. Usually caused by a fall on the outstretched hand and is the most common fracture of the wrist. 4) Monteggia Fracture: Isolated fracture of the shaft of the ulna associated with anterior dislocation of the radius at the elbow. 5) Gallezzis Fracture: The combination of a fracture of the shaft of the radius and a dorsal (posterior) dislocation of the ulna at the wrist 40. Know the difference between: Clay Shovelers, Jeffersons and Hangmans fx. (What is happening with the bony anatomy, what is the primary cause, is it stable or unstable) 1) Clay Shovelers Fracture: Avulsion fracture of a spinous process in the lower cervical or upper thoracic spine. The diagnosis can be made from the frontal view by noting the double shadow of the spinous processes caused by the caudal displacement of the avulsed fragment. - STABLE Fracture 2) Jeffersons Fracture: Comminuted fracture of the ring of the atlas, involves both the anterior and posterior arches and causes displacement of the fragments. - The characteristic appearance on frontal radiographs or tomograms is a bilateral offset or spreading of the lateral articular masses of C1 in relation to the opposing articular surfaces of C2. - Fractures of the odontoid process are usually and located at the base of the dens at its junction with the body.

- UNSTABLE Fracture 3) Hangmans Fracture: Result of acute hyperextension of the head on the neck. Appears as a fracture of the arch of C2 anterior to the inferior facet and is usually associated with anterior subluxation of C2 on C3. (Usually a result of motor vehicle collisions) - UNSTABLE Fracture 41.Define ischemic necrosis Ischemic Necrosis of bone is caused by loss of the blood supply, which in turn can result from such varied conditions as thrombosis, vasculitis, disease of surrounding bone, and single or repeated episodes of trauma. - Among the many conditions associated with ischemic necrosis are acute trauma (fracture or dislocation), steroid therapy and Cushings disease, hemolytic anemia (especially sickle cell disease), chronic alcoholism and chronic pancreatitis, Gauchers disease, radiation therapy, and caisson disease (complication of underwater diving, the so-called bends).

42.Know the difference between: Chondrosarcoma: Malignant tumor of cartilaginous origin that may originate anew or within a preexisting cartilaginous lesion (i.e. osteochondroma and enchondroma). Tumor grading of this neoplasm depends on the maturity and differentiation of the cells. Commonly occur in long bones, but often originate in a rib, scapula, or vertebra. - On a radiograph or CT, Chondrosarcomas demonstrate endosteal scalloping and cortical destruction. Ewings sarcoma: Primary malignant tumor arising in the bone marrow of long bones. A tumor of children and young adults, Ewings sarcoma has a peak incidence in the midteens and is rare in persons over 30 years of age. - Major complaint is local pain, of several months duration which persistently increases in severity and may be associated with a soft tissue mass. Osteochondroma: (Exostosis) Benign projection of bone with a cartilaginous cap that arises in childhood or the teen years, especially about the knee. - The exostosis occurs in the Epiphyseal plate (the ring of Ranvier) and grows laterally from the epiphysis. Osteogenic Sarcoma: Generally occurs in the end of a long bone in the metaphysis (especially about the knee) This tumor consists of osteoblasts, which produce osteoid and spicules of calcified bone. - Most arise in people between 10-25 years of age.

43.Define the following: Comminuted Fracture: Composed of more than two fragments. Subluxation: Incomplete or partial dislocation. Transverse Fracture: Runs at a right angle to the long axis of a bone and most commonly results from a direct blow or is a fracture within pathologic bone. Avulsion Fracture: Generally small fragments torn from bony prominences; they are usually the result of indirectly applied tension forces within attached ligaments and tendons rather than direct blow. 44.Understand osteoclastic vs. osteoblastic cells Osteoclastic Cells: Enlarge the diameter of the medullary cavity by removing bone from the diaphysis walls. Osteoblastic Cells: Osteoblasts from the periosteum produce new bone around the outer circumference. (Both continuously resorb old bone and produe new bone until the bone assumes its adult size and shape) 45.Understand spina bifida occulta vs. spina bifida cystica > Spina Bifida refers to a posterior defect of the spinal canal, resulting from failure of the posterior elements to fuse properly. A congenital disorder. Spina Bifida Occulta: A mild, insignificant form in which there is a splitting of the bony neural canal at the L5 or S1 level. - No abnormality of spinal cord or meninges. Spina Bifida Cystica: Larger defect (There are 3 types) 1) Meningocele = herniation of meninges 2) Myelocele = herniation of spinal cord 3) Myelomeningocele = spinal cord + spinal cord/nerve roots, neurologic deficits, hydrocephalus (this one is the worst of the three) - Treatment for Spina Bifida Occulta = None - Treatment for Spina Bifida Cystica = Surgery, shunt

46.Define Malunion: The healing of fracture fragments in a faulty position. It leads to impairment of normal function or a cosmetic appearance that may require surgical correction.

47.Define SNAT. What is another name for SNAT?

Suspected Nonaccidental Trauma (SNAT) Another name for SNAT = Battered Child Syndrome 48.Understand positioning for DEXA. Understand Z and T-scores. Know what different T-scores mean. DEXA = Dual-energy x-ray absorptiometry bone densitometry used to image the hip and spine, assisting in the determination of bone quality. - Usually an AP Lumbar Spine & AP Lumbar Hip are taken. Z score compares the patient with an average individual of the same age and sex T score compares the patient with an average young, healthy individual with PEAK bone mass - The image data are compared with those of other individuals of the same race, age, and weight to determine a bone-quality value. This value indicates whether the patient has: Normal bone (T-score greater than -1.0 standard deviation) Osteopenia (T-score between -1.0 and -2.5 standard deviation) or Osteoporosis (T-score less than -2.5 standard deviation) 49.Understand spondylolysis vs. spondylolisthesis Spondylolysis: Cleft in the part interarticularis situated between the superior and inferior articular process of the vertebra without displacement Spondylolisthesis: Spondylolysis with displacement of vertebral alignment 50.How much bone density loss is required before osteoporosis is visualized radiographically? 50-70% of the bone density must be lost before it can be demonstrated as a lucent area on routine radiographs. - Essential to use the lowest practical kVp - CT Scan and DEXA Scans provide data that measure bone mineral content