Wednesday, 30 November 2016

Fistula Test

How are the results of Fistula test interpreted?
1. In fistula over the dome of the lateral semicircular canal: Increase pressure causes conjugate horizontal deviation of the eyes towards the normal side. As pressure is maintained, jerk nystagmus develops with fast component towards the affected ear. As pressure is released, eyes return to normal

2. Fistula of the lateral semicircular canal (anterior to the ampulla) causes deviation of eyes, to the affected side

3. Vestibular erosion causes rotatory horizontal nystagmus towards the diseased ear

4. Fistula of the posterior semicircular canal causes vertical movement of eyes.

Tuesday, 29 November 2016

Peripheral signs of AR:

Peripheral signs of AR:
large-volume, 'collapsing' pulse also known as:
Watson's water hammer pulse
Corrigan's pulse (rapid upstroke and collapse of the carotid artery pulse)
low diastolic and increased pulse pressure
de Musset's sign (head nodding in time with the heart beat)
Quincke's sign (pulsation of the capillary bed in the nail; named for Heinrich Quincke)
Traube's sign (a 'pistol shot' systolic sound heard over the femoral)
Duroziez's sign (systolic and diastolic murmurs heard over the femoral artery when it is gradually compressed with the stethoscope)
Also, these are usually less detectable in acute cases.
Less used signs include:
Lighthouse sign (blanching & flushing of forehead)
Landolfi's sign (alternating constriction & dilatation of pupil)
Becker's sign (pulsations of retinal vessels)
Müller's sign (pulsations of uvula)
Mayen's sign (diastolic drop of BP>15 mm Hg with arm raised)
Rosenbach's sign (pulsatile liver)
Gerhardt's sign (enlarged spleen)
Hill's sign - a ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AI. Considered to be an artefact of sphygmomanometric lower limb pressure measurement.
Lincoln sign (pulsatile popliteal)
Sherman sign (dorsalis pedis pulse is Quickly located & unexpectedly prominent  age>75 yr)
Ashrafian sign (Pulsatile pseudo-proptosis)
Cor en sabot(boot shaped heart)- TOF
Cor bovinum- 3° syphilis. N chronic AR..

Saturday, 26 November 2016


1...ectyoma gangrenosa is dt??? pseudomonas
2...paracetamol causes ???photoTOXICITY
3...wavelength f uv-A???
   250- 280 nm
4..vit d produced max in???  stratum basale acne comadone lenoleic acid level??? decrease....
6...carpet track sign seen in??? DLE

Sunday, 20 November 2016


drugs used in hypertensive emergency-nitroprusside
(mostimp - nifedipine not used..)

Drugs causing disulfiram like action.

1. LEVODOPA ------------------- dopamine
2. ENALAPRIL ------------------- enalaprilat
3. SULINDAC --------------------- sulfide metabolite
4. BECAMPICILLIN –---------- ampicillin
5. SULFASALAZINE –---------- 5 – aminosalicyclic acid
6. PREDNISONE ----------------- prednisolone
7. ZIDOVUDINE ----------------- zidovudine triphosphate
8. CYCLOPHOSPHAMIDE --- aldophosphamide

1. spironolactone
2. ketoconazole
3. estrogens
4. testosterone
5. digitalis
6. clomiphene
7. phenytoin
8. griseofulvin
9. calcium channel antagonists
10. reserpine
11. isoniazid
12. methyldopa
13. ethionamide

Drugs causing Fatty liver
1. Antiarrythmics - Amiodarone
2. Antibiotic - Tetracycline ( high-dose, intravenous )
3. Anticonvulsant - Valproic acid
4. Antiviral - Dideoxynucleosides ( eg: Zidovudine ), protease inhibitors ( indinavir, ritonavir )
5. Oncotherapeutics - Asparginase, Methotrexate .

Friday, 18 November 2016

Drugs of choice in Psychiatric disorders

Drugs of choice in Psychiatric disorders
1. Body dysmorphic disorder - Fluoxetine
2. Obsessive Compulsive disorder - Fluoxetine/Clomipramine
3. Depression with cardiac disease - Fluoxetine, Mianserine.
4. Trichotillomania - Fluoxetine
5. Nocturnal enuresis - Imipramine
6. Panic disorder - Imipramine
7. Panic attack/disorder - Imipramine
8. Suicidal depression - ElectroConvulsive Therapy (ECT)
9. Catatonic Schizophrenia - ElectroConvulsive Therapy (ECT)
10. Manic depressive psychosis (Bipolar disorder) - Lithium carbonate
11. Pregnancy with Bipolar disorder - Carbamazepine
12. Rapid cycling Bipolar disorder - Sodium valproate
13. Gilles de la tourette syndrome - Haloperidol
14. Attention Deficit Hyperactivity Disorder (ADHD) -Methylphenidate
15. Narcolepsy - Methylphenidate (amphetamine)
16. Monosymptomatic hypochondriacal psychosis - pimozide.
17. Somatization disorder - amitriggtilline
18. Depression with acid peptic disease - doxepin
19. Generalized Anxiety Disorder (GAD) - Benzodiazepines,Buspirone
20. Borderline Personality Disorder - Antidepressants,Fluoxetine
21. Phobias - MAO inhibitors, Paroxetine
22. Delusional disorder - Antipsychotics

NM blocker

Longest acting NM blocker               ----------> PANCURONIUM
Shortest & fastest acting NM blocker ------------> Succinyl choline
Shortest acting competitive blocker -------------> Mivacurium
Fastest acting competitive blocker   -------------> Rocuronium
Maximal vagal block is seen in ------------------> Pancuronium
Max ganglionic blockade         -------------------> dTc
vagal and ganglionic stimulation -----------------> Succinyl choline
Mc muscle relaxant used for routine surgery ---> Vecuronium
Most potent skeletal muscle relaxant ------------> Doxacurium
least potent S.M.R                     ------------------>Sch
Least potent compititive blocker   -----------------> Rocuronium
only comp. blocker metabolized by plasma cholinesterase -->Mivacurium

Wednesday, 16 November 2016

New Juvenile Law

The bill allows for juveniles 16 years or older to be tried as adults for heinous offences like rape and murder. Heinous offences are those which are punishable with imprisonment of seven years or more.
  1. The bill mandates setting up Juvenile Justice Boards and Child Welfare Committees in every district. Both must have at least one woman member each.
  2. Once the bill becomes law, the decision to try a juvenile 16 years or older as an adult will be taken by the Juvenile Justice Board, which will have a judicial magistrate and two social workers as members. If the board decides against it, the juvenile will be sent for rehabilitation.
  3. The Child Welfare Committees will look at institutional care for children in their respective districts. Each committee will have a chairperson and four other members, all specialists in matters relating to children.
  4. The government says it listed the bill more than a dozen times in the monsoon session and the ongoing winter session but it could not be taken up due to disruptions. The opposition, led by the Congress, had assured support to pass the bill today.
  5. The bill aims to "consolidate and amend the law relating to children alleged and found to be in conflict with law and children in need of care and protection by catering to their basic needs through proper care, protection, development, treatment, social re-integration, by adopting a child-friendly approach."
  6. The proposed law also aims at adjudicating and disposing cases dealing with juveniles keeping in mind "the best interest of the children and their rehabilitation."
  7. India is a signatory to the UN Convention on the Rights of the Child which mandates that all children under the age of 18 years be treated equal.  The pending bill has been criticised for violation of the Convention.
  8. The bill also deals with adoption of children and lays down the eligibility criteria for adoptive parents. A central adoptive resource agency will frame the rules for adoption, which will be implemented by state and district level agencies.

Tuesday, 15 November 2016

Year Opium Act / Other Regulations

1843 Mc Naughten’s Rule
1857        Only the central govt can cultivate opium
1878        Import export of opium prohibited
1919 Import Export permitted
1919        Indian Medical Degrees Act
1923 Workmens Compensation act
1930        Dangerous Drugs
1933 Indian Medical Councils Act - Uniform Standard
1933        Dangerous Drugs
1938        Dangerous Drugs
1940        Drugs and Cosmetics
1948 Declaration of Geneva
1948 ESI
1948 Indian Factory Act 63
1950        Drug Control Act for Maximum Price
1951 Plantation Labour Act
1954 Durham
1954        Drugs and Magic Remedies not for Abortion, Contraception, Increased Sex, Menstruation, Venereal Diseases
1955 Medicinal and Toilet preparation Act
1956 Indian Medical Councils Act
1960 Court for Juvenile Offenders
1960 Geneva Convention Act - Red Cross Emblem
1962        Drugs and Cosmetics
1964 Durham
1971 Acccepted by West Bengal ( 9.2.1971)
1974 Bengal Medical Act
1986 COPRA

Drugs and Schedules
C Biological and Special Products
H Poisons
L Antibiotics, Antihistamines 

IPC related to Medical Entrance Exams

The Indian Penal Code of 1860, sub-divided into twenty three chapters, comprises five hundred and eleven sections. The Code starts with an introduction, provides explanations and exceptions used in it, and covers a wide range of offences.

81 - Act likely to cause harm, but done without criminal intent, and to prevent other harm
82 - Act of a child under seven years of age
83 - Act of a child above seven and under twelve of immature understanding
84 - Act of a person of unsound mind
85 - Act of a person incapable of judgment by reason of intoxication caused against his will
86 - Offence requiring a particular intent of knowledge committed by one who is intoxicated
87 - Act not intended and not known to be likely to cause death or grievous hurt, done by consent
88 - Act not intended to cause death, done by consent in good faith for person's benefit
89 - Act done in good faith for benefit of child or insane person, by or by consent of guardian
90 - Consent known to be given under fear or misconception. Consent of Insane person. Consent of child
91 - Exclusion of acts which are offences independently of harm caused
92 - Act done in faith for benefit of a person without consent
93 - Communication made in good faith
94 - Act to which a person is compelled by threats
95 - Act causing slight harm
96 - Things done in private defence
97 - Right of private defence of the body and of property
98 - Right of private defence against the act of a person of unsound mind, etc.
99 - Acts against which there is no right of private defence
100 - When the right of private defence of the body extends to causing death
101 - When such right extends to causing any harm other than death
102 - Commencement and continuance of the right of private defence of the body
103 - When the right of private defence of property extends to causing death
104 - When such right extends to causing any harm other than death
105 - Commencement and continuance of the right of private defence of property
106 - Right of private defence against deadly assault when there is risk of harm to innocent person

191 - Giving false evidence
192 - Fabricating false evidence
193 - Punishment for false evidence
194 - Giving or fabricating false evidence with intent to procure conviction of capital offense
195 - Giving or fabricating false evidence with intent to procure conviction of offense punishable with imprisonment for life or imprisonment, 195A - Threatening any person to give false evidence
196 - Using evidence known to be false
197 - Issuing or signing false certificate
198 - Using as true a certificate known to be false
199 - False statement made in declaration which is by law receivable as evidence
200 - Using as true such declaration knowing it to be false
201 - Causing disappearance of evidence of offense, or giving false information to screen offender
202 - Intentional omission to give information of offense by person bound to inform
203 - Giving false information respecting an offense committed
204 - Destruction of document or electronic record to prevent its production as evidence
205 - False impersonation for purpose of act or proceeding in suit or prosecution
206 - Fraudulent removal or concealment of property to prevent its seizure as forfeited or in execution
207 - Fraudulent claim to property to prevent its seizure as forfeited or in execution
208 - Fraudulently suffering decree for sum not due
209 - Dishonestly making false claim in Court
210 - Fraudulently obtaining decree for sum not due

228 - Intentional insult or interruption to public servant sitting in judicial proceeding, 228A - Disclosure of identity of the victim of certain offenses etc.
229 - Impersonation of a juror or assessor, 229A - Failure by person released on bail or bond to appear in Court

269 - Negligent act likely to spread infection of disease dangerous to life
270 - Malignant act likely to spread infection of disease dangerous to life
271 - Disobedience to quarantine rule
272 - Adulteration of food or drink intended for sale
273 - Sale of noxious food or drink
274 - Adulteration of drugs
275 - Sale of adulterated drugs
276 - Sale of drug as a different drug or preparation
277 - Fouling water of public spring or reservoir
278 - Making atmosphere noxious to health
279 - Rash driving or riding on a public way
280 - Rash navigation of vessel
281 - Exhibition of false light, mark or buoy

299 - Culpable homicide
300 - Murder
301 - Culpable homicide by causing death of person other than person whose death was intended
302 - Punishment for murder
303 - Punishment for murder by life convict
304 - Punishment for culpable homicide not amounting to murder, 304A - Causing death by negligence, 304B - Dowery death
305 - Abetment of suicide of child or insane person
306 - Abetment of suicide
307 - Attempt to murder
308 - Attempt to commit culpable homicide
309 - Not Applicable as per latest hearing
310 - Thug
311 - Punishment
312 - Causing miscarriage
313 - Causing miscarriage without woman's consent
314 - Death caused by act done with intent to cause miscarriage
315 - Act done with intent to prevent child being born alive or to cause it to die after birth
316 - Causing death of quick unborn child by act amounting to culpable homicide
317 - Exposure and abandonment of child under twelve years, by parent or person having care of it
318 - Concealment of birth by secret disposal of dead body
319 - Hurt
320 - Grievous hurt
321 - Voluntarily causing hurt
322 - Voluntarily causing grievous hurt
323 - Punishment for voluntarily causing hurt
324 - Voluntarily causing hurt by dangerous weapons or means
325 - Punishment for voluntarily causing grievous hurt
326 - Voluntarily causing grievous hurt by dangerous weapons or means 326A - Voluntarily causing hurt by use of acid,etc. 326B - Voluntarily throwing or attempting to throw acid
327 - Voluntarily causing hurt to extort property, or to constrain to an illegal act
328 - Causing hurt by means of poison, etc. with intent to commit an offence
329 - Voluntarily causing grievous hurt to extort property, or to constrain to an illegal act
330 - Voluntarily causing hurt to extort confession, or to compel restoration of property
331 - Voluntarily causing grievous hurt to extort confession, or to compel restoration of property
332 - Voluntarily causing hurt to deter public servant from his duty
333 - Voluntarily causing grievous hurt to deter public servant from his duty
334 - Voluntarily causing hurt on provocation
335 - Voluntarily causing grievous hurt on provocation
336 - Act endangering life or personal safety of others
337 - Causing hurt by act endangering life or personal safety of others
338 - Causing grievous hurt by act endangering life or personal safety of others

339 - Wrongful restraint
340 - Wrongful confinement
341 - Punishment for wrongful restraint
342 - Punishment for wrongful confinement
343 - Wrongful confinement for three or more days
344 - Wrongful confinement for ten or more days
345 - Wrongful confinement of person for whose liberation writ has been issued
346 - Wrongful confinement in secret
347 - Wrongful confinement to extort property, or constrain to illegal act
348 - Wrongful confinement to extort confession, or compel restoration of property
349 - Force
350 - Criminal force
351 - Assault
352 - Punishment for assault or criminal force otherwise than on grave provocation
353 - Assault or criminal force to deter public servant from discharge of his duty
354 - Assault or criminal force to woman with intent to outrage her modesty, 354A - Sexual Harassment and punishment for sexual harassment, 354B - Assault or use of Criminal force to woman with intent to disrobe, 354C - Voyeurism, 354D - Stalking
355 - Assault or criminal force with intent to dishonour person, otherwise than on grave provocation
356 - Assault or criminal force in attempt to commit theft of property carried by a person
357 - Assault or criminal force in attempt wrongfully to confine a person
358 - Assault or criminal force on grave provocation
359 - Kidnapping
360 - Kidnapping from India
361 - Kidnapping from lawful guardianship
362 - Abduction
363 - Punishment for kidnapping, 363A - Kidnapping or maiming a minor for purposes of begging
364 - Kidnapping or abducting in order to murder, 364A - Kidnapping for ransom, etc.
365 - Kidnapping or abducting with intent secretly and wrongfully to confine person
366 - Kidnapping, abducting or inducing woman to compel her marriage, etc., 366A - Procuration of minor girl, 366B - Importation of girl from foreign country
367 - Kidnapping or abducting in order to subject person to grievous hurt, slavery, etc.
368 - Wrongfully concealing or keeping in confinement, kidnapped or abducted person
369 - Kidnapping or abducting child under ten years with intent to steal from its person
370 - Trafficking in persons, 370A - Exploitation of a trafficked person
371 - Habitual dealing in slave
372 - Selling minor for purposes of prostitution, etc.
373 - Buying minor for purposes of prostitution, etc.
374 - Unlawful compulsory labour
375 - Rape
376 - Punishment for rape, 376A - Punishment for causing death or resulting in persistent vegetative state of victim, 376B - Sexual Intercourse by a man with his wife during separation, 376C - Sexual Intercourse by a person in authority, 376D - Gang Rape, Intercourse by any member of the management or staff of a hospital with any woman in that hospital, 376E - Punishment for repeat offenders
377 - Unnatural offences

493 - Cohabitation caused by a man deceitfully inducing a belief of lawful marriage
494 - Marrying again during lifetime of husband or wife
495 - Same offence with concealment of former marriage from person with whom subsequent marriage is contracted
496 - Marriage ceremony fraudulently gone through without lawful marriage
497 - Adultery
498 - Enticing or taking away or detaining with criminal intent a married woman

503 - Criminal intimidation
504 - Intentional insult with intent to provoke breach of the peace
505 - Statements conducing to public mischief
506 - Punishment for criminal intimidation
507 - Criminal intimidation by an anonymous communication
508 - Act caused by inducing person to believe that he will be rendered an object of the Divine displeasure
509 - Word, gesture or act intended to insult the modesty of a woman
510 - Misconduct in public by a drunken person

Properties of halothane

Properties of halothane
Mnemonic-Halothane CC
A-analgesic action absent
L-liver toxic
O-orthostatic hypotension
H-heart(decrease CO)
One more property of halothen is reduce portal blood flow...

Saturday, 5 November 2016

Important stains and their uses in pathology.

Important stains and their uses in pathology.
1. Lipid or fat - Sudan black or oil red O
2. Calcium - von kossa or alzarine red s
3. Haemosiderin or iron - Prussian blue or Perls stain
4. Collagen - Masson trichrome
5. Mucin - mucicarmine, alcian blue
6. Fungi - PAS, silver methanamine
7. Melanin - Masson Fontana
8. Mast cells - toluidine blue
9. Amyloid - Congo red
10. Basement membrane - PAS
11. Nucleic acid or DNA - feulgen, acridine orange
12. Routine histo pathology - hematoxylin and eosin ( H&E)
13. Routine peripheral smear - geimsa or leishman
14. Lymphoblast - PAS ( block positivity)
15. Myeloblasts - myeloperoxidase, non specific esterase, Sudan black B.

Thursday, 3 November 2016

Ortho High Yield

Infection - Will affect the disc/joint space and both endplates/sides equally and evenly. Usually will not involve multiple levels. AKA discitis, osteomyelitis or discogenic spondylitis.
Confirm infection on a lateral film 1-3 levels.
Commonly seen with cutaneous interruption - puncture wounds, or post strep/staph infections

Sequestrum - Fragment of a necrosed bone that has become separated from surrounding bone.

Involucrum - Covering of newly formed bone enveloping the sequestrum with infection of the bone.

Metastasis - Will not enlarge bone.

Blastic metastasis - An area of whitening that does not extend off the bone, disc spaces maintained, irregular borders, and trabecular bone mottled.

Prostate metastasis - Primarily blastic, likes the spine and pelvis. Midline calcification AP pelvis above pubic symphysis.

Lytic metastasis - Short zone of transition, extensive osteolysis. Look for missing pedicle w/o contralateral sclerosis. TS follow ribs to vertebral bodies looking for missing pedicles.

Multiple Myeloma - MC 1 malignant bone tumor. Bone scans are cold. MC sites spine, pelvis, skull, ribs and scapula. Punched out lesions, raindrop skull and vertebra plana.
Lab findings Bence Jones proteinuria and reversed AG ratio.

Osteosarcoma - Permeative or ivory medullary lesion in metaphysis of a long bone. Codman’s reactive triangle, sunburst response, cortical interruption with soft tissue mass formation - cumulus cloud appearance.

Chondrosarcoma - MC sites pelvis, proximal femur, and humerus.
Metaphyseal or diaphyseal lesions with ill defined margins, popcorn matrix calcification, laminated or spiculated periosteal response.

Ewings Sarcoma - MC sites long bones of the lower extremity and inominate.
Classic presentation is a permeative diaphyseal with an onion skin layering of the periosteum.
Cortical saucerization is a characteristic sign. MC 1 malignant bone tumor to metastasize to bone.

Fibrosarcoma - Highly destructive medullary lesion, lytic, and eccentrically placed in a long bone. Produces the largest soft tissue mass of all 1 malignant tumors, seldom has a periosteal response.

Giant Cell Tumor - Expansile destructive lesion, soap bubble appearance, at the end of long bones.
MC site metaphysis extending to a subarticular location, can affect the joints.

Osteochondroma - MC sites femur, humerus, tibia, pelvis ribs and scapula. Two types - sessile appear as asymmetric bumps lacking a stalk, and pedunculated appear as a lobulated cauliflower mass with a dense amorphous calcified cap.
Pedunculated also appear as coat hanger exostoses growing away from the joint space on the metaphysis. Often an asymptomatic, incidental finding

Hemangioma - Most common benign tumor of the spine, corduroy cloth vertebra. 1-2 vertebral levels.

Osteoid osteoma - Night pain relieved by aspirin. MC location in the cortex with a radiolucent nidus and surrounding reactive sclerosis. DDx: Brodie’s abscess.

Osteoblastoma -MC site neural arch of the spine, lesions radiolucent and expansile. Tubular bone lesions are metaphyseal or diaphyseal with a nidus 2cm and no reactive sclerosis.

Enchondroma - Most common benign tumor of the hand, geographic expansile lytic lesions of a phalanx.

Ollier’s disease = Multiple enchondromas.

Chondroblastoma - Most common seen in the epiphysis as an oval or round lytic lesion that can spread to metaphysis, fluffy cotton wool calcification of the matrix.

Simple bone cyst - AKA unicameral bone cyst. Expansile geographic lesion that is pseudoloculated. Metaphyseal end is larger than the diaphyseal end creating a truncated cone appearance.
Usually Dx by spontaneous fracture.
Fallen fragment sign. MC sites humerus and proximal femur.

Aneurysmal bone cyst - Expansile lesion in the long bones creating eccentric metaphyseal saccular
Cortical ballooning termed blown out appearance or finger in the balloon sign. Spinal lesions affect
the neural arch..

Non ossifying fibroma(NOF) and fibrous cortical defect(FCD) - Distal tibia
MC site for NOF, distal femur
MC site for FCD. Lesion is solitary, eccentric, radiolucent ovoid, and bubbly usually in metaphysis.
3cm = FCD, > 3cm = NOF.

Pedunculated Osteoma - Well circumscribed radiopaque lesion.
Common site - Paranasal sinuses.

Paget’s - AKA osteitis deformans. Ivory vertebra, blade of grass sign, cortical thickening, cotton wool skull, shepherd’s crook deformity, picture frame vertebra, saber shin deformity, protrusio acetabuli, bone expansion, increased hat size.
Lab Dx: Urinary hydroxyproline, alkaline phosphatase. Malignant degeneration to osteosarcoma.

Brim Sign - Thickening of the cortex at the pectineal line and the pelvic rim. Seen with Paget’s.

Fibrous dysplasia - Shepherd’s crook deformity, ground glass appearance, septations of bone giving cobweb appearance. Expansile lesions with cortical thinning. MC benign tumor of rib creating extrapleural sign. Rind of sclerosis around a geographic lesion. AKA polyostotic fibrous dysplasia.

Skin lesion café-au-lait spots - coast of Maine appearance.
Monostotic Fibrous dysplasia - Short zone of transition, sclerotic ring often found in the neck of the femur.

DISH - Diffuse Idiopathic Skeletal Hyperostosis. Ossification of ALL with non-marginal syndesmophytes.
Disc spaces and facets are spared. Dx on lateral film, difficulty swallowing, can be associated with diabetes.
Syndesmophyte - Bony outgrowth or ossification of a ligament that attaches to bone.

AS - Ankylosing Spondylitis. Initial  marginal pencil thin syndesmophytes, can cause sclerosing of posterior motor units. Syndesmophytes thicken with time, B/L SI joint obliteration, decreased chest expansion.

Anderson lesion - Fracture of pathologic calcification. Ex: Ankylosing spondylitis.
Osteopoikilosis - Widespread multiple circumscribed round or ovoid lesions of increased density.
AKA bone measles.

Osteopetrosis - Vertebra within a vertebra appearance, bone within a bone appearance.

Tuberculosis - Likes apices of the lungs, can have calcified density in the lung field or miliary type lesions.
Can also produce lesions in the spleen. Cold abscess formation in the psoas muscle.

Pott’s = TB of the spine Gibbus formation with angular kyphosis.

Histoplasmosis - Egg shell calcification, coin shaped lesion.

Hyperparathyroidism - Rugger jersey sign, salt and pepper skull, increased serum calcium. Sub-periosteal resorbtion on the radial side of the fingers with soft tissue calcification.

Pancreatic calcification - midline calcification frequently seen with alcoholics.

Sarcoidosis - Pulmonary signs include lymphadenopathy(1-2-3 sign, potato nodes), infiltrates and fibrosis.
Scleroderma - Acro-osteolysis, soft tissue retraction, calcification and tapered fingers.
CREST sign = Calcinosis, Raynauds phenomenon, Esophageal abnormalities, Scleroderma and

Parasites - Multiple calcific densities in muscle tissue.

Gout - Increased uric acid concentration leading to deposition of crystals and tophi formation.
Overhanging edge sign, avascular necrosis, juxta- articular erosions. Grossly inflammatory condition works from outside into the joint space. AKA lumpy bumpy arthritis.

Sickle cell anemia - Endplate biconcavity of all vertebral levels.

Osteitis condensans ilii - Primarily multiparous females, bilateral dense iliac subchondral sclerosis.
Joint spaces normal. AKA hyperostosis triangularis ilii. Will often see paraglenoid sulcus.

Osteitis condensans pubis - Usually males, bilateral subchondral sclerosis of the pubic rami.

Klippel Feil Syndrome - Classic triad = Short webbed neck, low hairline, and decreased C/S ROM. Multiple congenitally blocked vertebra,

Sprengle’s Deformity - elevated scapula, and omovertebral bone.

Congenital fusion/blocked vertebra - Wasp waist deformity, remnant disc, one spinous process for levels of fusion. Usually have more than one fusion/irregularity. If disc bulges beyond anterior vertebral body line acquired condition = surgical.

Ivory vertebra - Blastic lesion, DDx:
Paget’s, Blastic mets, Hodgkin’s lymphoma.

Butterfly vertebra - AKA double hemivertebra. Figure eight.Hemivertebra - Congenital absence or
failure to develop half of a vertebra.
Commonly associated with scoliosis.

Facet tropism - Sometimes visible on AP film, evaluate with CT transverse view.

Lumbarization - First sacral segment does not fuse with sacrum and forms a sixth lumbar vertebra.
Sacralization - Fusion of the fifth lumbar segment with sacrum.
Pedicle agenesis - Unilateral missing or small pedicle with sclerotic contralateral pedicle from increased loading.
Congenital hip dysplasia - Putti’s
Triad = small femoral head, shallow acetabulum, and superior/lateral dislocated femoral head.
Cleidocranial dysplasia - Skull = Wormian bones, hot cross bun sign, frontal bossing, and platybasia.
Thorax = anomalous clavicular development, scapula small, winged or elevated.
Knife clasp deformity - Elongated L5 spinous with spina bifuda occulta at S1 and pain with extension.
Fracture - Need to have pieces to diagnose.
Jefferson’s fracture - C1 compression fracture, unstable needs to be braced.

Hangman’s fracture - C2 decompression fracture, stable but needs bracing.

Odontoid fracture - Three types: apical, transverse at the base, and
transverse extending into the body of C2.
Chance fracture - Shear fracture of the vertebral body caused by automobile lap belt restraint.
Honda sign - Horizontal fracture through the sacrum that results in the appearance of the Honda shaped “H”.
Spondylolytic spondylolisthesis - Fracture of the pars interarticularis with anterior slippage of the
vertebral body.
Assess from posterior body line, CS with George’s line. LS Dx from oblique film with Scotty dog neck interruption.
Anterolisthesis - AKA spondylolisthes is. Anterior slippage of the vertebral body w/o fracture. Assessed with Meyerding grading scale: 0-25% = grade I, 25-50% = grade II, 50-75% = grade III, 75-99% = grade IV, 100% = spondyloptosis.
Napolean hat sign - AKA bowline of Brailsford, seen with advanced grade IV anterolisthesis or spondyloptosis.

Rib Fracture - Follow ribs two at a time checking for alteration in lines.
Primary location lateral aspect of film where ribs curve from posterior to anterior. Do not assess ribs on a lateral thoracic.
Compression fracture - Fracture of a vertebra by pressure along the long axis of the vertebral column. Can cause angular kyphosis in the thoracic spine. AP film look for hyper lateral flexion with height intact and increased width. Disc is relatively well maintained. AKA anterior wedging.
Avulsion fracture - Usually seen at anterior inferior aspect of vertebral body, not confined within outline of vertebral body.
Femur fracture - Subcapital, basocervical, intertrochanteric, or subtrochanteric. Pathological fractures usually subcapital or femoral neck.
Limbus vertebra - Located at the anterior superior vertebral margin.
Congenital anomaly containing cortical margins within confines of the vertebral body.
Anterior fat pad normally seen on an AP elbow, AKA sail sign. Posterior fat pad sign a more reliable indicator of fracture. In 90 % of adolescents posterior fat pad sign indicates fracture, MC site radial head.
Galeazzi fracture - Middle to distal 1/3 of the radius with dislocation of the distal radial/ulna joint.
Monteggia fracture - Proximal ulna with dislocation of the radius.
Colle’s fracture - Posterior distal radius.
Smith’s fracture - Anterior distal radius.
Boxer’s fracture - 2nd or 3rd metacarpal vs. Bar room fracture - 4th or 5th metacarpal.
Jones fracture - Fifth metatarsal.
March fracture - Stress fracture of metatarsal.
Diastatic fracture - Separation of a partially moveable joint. Ex: Fracture with separation of a suture.
Protrusio Acetabuli - Weakening/fracture of the acetabulum commonly seen with bone softening conditions like Paget’s, RA. BL protrusio acetabuli = Otto’s pelvis commonly seen with RA.

Terry Thomas sign - Separation of the scaphoid lunate articulation from lunate dislocation.
AKA David Letterman sign.

Pelligrini Stiedas Disease - Medial condyle injury of the knee with partial avulsion of the MCL with

Rheumatoid Arthritis - Lab: RA factor,
C-reactive protein, increased ESR.
Early radiographic signs MC seen in the hands and feet. Uniform loss of joint space. Hands all fingers affected starts in MCP joints = Haygarth’s nodes. Can also affect PIP = Bouchard’s nodes, but never DIPS.
BL and symmetrical distribution, periarticular soft tissue swelling, juxtaarticular osteoporosis,
periarticular erosions and cysts, with uniform loss of joint space. Ligament laxity predominantly in hands with ulnar deviation of the fingers. Rarely see subchondral sclerosis. Can affect SI unilaterally.
Pencil in cup deformity.
Whittled appearance to periarticular bone. DDx: SLE.

Osteoarthritis - AKA DJD. Progressive, non-inflammatory process.
Asymmetric distribution, non-uniform loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts, facet arthrosis, IVF stenosis, disc height and vacuum sign.
UV arthrosis/facet arthrosis - C/S oblique, hourglass IVF = IVF encroachment.
Erosive OA - Inflammatory variant of DJD involving DIP’s and PIP’s.
Erosion’s = gull wing deformity, sclerosis, osteophytes, periostitis, ankylosis, and non-uniform loss of joint space.

Psoriatic arthritis - MC involves DIP’s, also interphalangeal and PIP’s with widened joint spaces, ray pattern, sausage digit due to increased swelling, pencil in cup deformity and rat bite erosions.

Reiter’s - Triad of conjunctivitis, urethritis and polyarthritis usually following sexual exposure. Lateral foot heel spurs, SI erosion and sclerosis often unilateral, spine nonmarginal syndesmophytes
Calcium pyrophosphate deposition disease AKA CPPD - Crystals deposited within the articular cartilage leading to thin linear cartilage calcification parallel to and separate from adjacent subchondral bone.

Osteochondritis dessicans - MC site is lateral aspect of the medial femoral condyle. Joint mouse.
Hydroxyapatite deposition disease
AKA HADD, calcific bursitis -
Calcification within a tendon, bursa,or other periarticular soft tissue. MC sites include shoulder, hip, and the cervical spine. Shoulder = clock dial positions 3 & 9 calcific bursitis, between 1 & 2 and 10 & 11 calcific tendonitis.
Synoviochondrometaplasia - Synonyms include joint mice, synovial chondromatosis, steochondromatosis,
and osteochondral loose bodies. MC
sites include knee, hip, ankle and hip. Can lead to formation of a
Baker’s cyst.
Baker’s cyst - Enlargement of the gastrocnemius-semimembranosus bursa, commonly seen in RA and synoviochondrometaplasia.
Charcot’s joint - AKA neurotrophic joint. Six D’s: Distension -from effusion, Density -subchondral sclerosis,
Debris-bony intraarticular fragments,
Dislocation,, Disorganizaton-bag of bones, and Destruction of articular bone. Lack of subjective and objective pain. Commonly seen with diabetes and syphilitic tabes.

Scheuermann’s disease - AKA juvenile kyphosis, vertebral epiphysitis. Dx
from lateral film, at least three contiguous vertebra, irregular endplates, decreased disc height, increased kyphosis. MC middle to lower T/S, primarily teenagers.
Myositis ossificans - Post traumatic calcification of muscular tissue.

Risser’s Sign - Diffusion of iliac crest apophysis, used to determine skeletal maturity. Maturation lateral to medial.

Eisenstein Sign - Canal stenosis viewed from lateral film, posterior body line to spinolaminar line.
Normal should be ½ or more than the width of the vertebral body.
Pedicogenic stenosis.

Chamberlain’s Line - Hard palate to the opisthion, > 5mm = to basilar invagination.

McGregor’s Line - Hard palate to the base of the occiput, > 7mm = to basilar invagination.
Martin’s Basilar Angle - Root of the nasion/sella turcica to foramen magnum, 128-152. Check for
McNabb Line - Facet imbrication, parallel to inferior end plate draw line posterior. Should not cross the superior articulating facet of the inferior vertebra. Lateral lumbar oblique view. Rostrocaudal migration.
Jackson’s cervical stress line - Flexion at C5/6, extension and neutral at C4/5.
Ullmann’s Line - Draw line perpendicular to S1 endplate line, should not intersect L5 body.Indicates spondylolisthesis.
Klein’s Line - Used to Dx slipped femoral capital epiphysis.
C/S Gravity Line - Tip of odontoid to anterior C/7 vertebral body.
L/S Gravity Line - L3 body center vertical line to anterior 1/3 of sacral base. AKA Ferguson’s line.
Boehler’s angle of 35 degrees - Calcaneal compression fracture.
Eburnation - Laying down more bone.
Bony infarct - Leads to increased whitening of bone.
Aneurysm - Leads to decreased whitening of bone.
Staghorn calculi - Calcification in the renal calyces.
Silhouette Sign - Loss of the heart outline due to lung consolidation. Ex: Pneumonia with lobar consolidation.
Hahn’s venous fissure - Horizontal radiolucent cleft on lateral thoracic film.
Renal artery aneurysm - AP film lateral to the L2/3 vertebral bodies.
25% calcify a circular or ring-like pattern.
Pleural effusion - Best seen with the lateral decubitus view.
Lung Apices - Best seen on apical lordotic view.
Pneumothorax - PA chest, look at dark lung field first. Air in pleural cavity, no vascular markings on side of lesion.
Trachea pushed away from side of lesion
Atelectasis - Collapsed lung, trachea pulled toward side of lesion, no vascular markings on side of lesion.
Pneumoperitonium - Air in the abdomen, best seen with erect abdomen view.
Knee - Medial condyle extends distally past lateral condyle.
Y Epiphysis - Acetabulum.
Ischial pubic growth plate usually closes by age nine.
Isthmic spondyolisthesis - Greatest degree of slippage occurs during 2-10 years old.
Medial oblique - View taken to visualize the proximal talofibular joint.
AP Coccyx - Caudal tube tilt.
Dorsiplantar foot - 5 degree cephalad tube tilt.
L/S IVF - Seen on the lateral film.
ADI - Assess from lateral cervical
films. Adult up to 3mm, children up to 5mm.
Lateral flexion film - Tuck chin in and flex to chest.
Facet dislocation - AKA facet perching. Ligamentous instability of posterior motor unit.
Geographic lesion - Circumscribed and uniformly lytic lesion.
MRI - T1 weighted = fat weighted = whiter fatty structures. T2 weighted = water weighted = whiter water based structures. Cortical bone is black on MRI.
CT - Used to study bone, chest or abdomen.
LCP - Pseudo widening of the joint
space, flattening and fragmentation of the femoral head.
Legg Calve Perthes Slipped Femoral
Capital Epiphysis
3-12 YO, especially 5-7 10-15 YO
5:1 male Increased in males
Limp with vague pain especially Limp with hip pain to knee of obese with abduction and int rot.
adolescent. Femur displaces sup, ext rot,
AKA avascular necrosis of femoral head adduction of the neck on the head.
Subchondral fracture (crescent sign)
Dx with Klein’s line on AP view
1 cause obscure - hereditary, trauma, 50% have a Hx of significant trauma endocrine, inflammatory, nutritional. Also assoc with rickets & osteodistrophy
10% bilateral 20-30% bilateral
Fabella - Sesamoid bone found in the lateral head of the gastrocnemius tendon proximally.
Capitulum - Distal humerus ,articulates with the radial head.
Olecranon fossa - Posterior distal humerus, accepts olecranon process of the ulna.
Coronoid process - Located on the anterior ulna, articulates with the trochlea.
Coracoid process - Located on the scapula.
Supracondylar fossa - Located on the humerus.
Supraglenoid sulcus - Located on the humerus.
Paraglenoid sulcus - Female pelvis lateral to SI joints, usually postpartum.
Os trigonum - Accessory ossicle posterior to the tibia, superior to the calcaneus.
Os vesalianum - Sesamoid bone proximal to the fifth metatarsal.
Megenblase - Stomach gas magenblase syndrome excessive gas in the stomach, owing
to habitual taking in of air with the food.
Paraglenoid sulcus
Supraglenoid sulcus humerus
The fabella sign is displacement of the fabella that is seen in cases of synovial effusion and popliteal fossa masses. The fabella is a sesamoid bone located inside the gastrocnemius lateral head tendon on the posterior side of the knee, in about 25% of people.
Fabella sesamoid bone on lateral side of gastrocnemius joint locking is a symptom of pathology in a joint . Joint locking is a common symptom of:
Osteochondritis dissecans
Synovial osteochondromatosis
Causes of joint locking include "joint mice Myositis ossificans comprises two syndromes
characterized by heterotopic ossification (calcification) of muscle.
Fallen fragment sign - the presence of a bone fragment in the dependent portion of a lucent bone
lesion. It is said to be pathognomonic of a simple (unicameral) bone cyst finger in a balloon."sign

aneurism bone cyst ABC
distal femur reveals a wedge- or V-shaped area of radiolucency in the diaphysis (arrows);
this lucency represents the blade of grass sign and is indicative of active Paget disease gull-wing appearance Central erosion proximally with marginal proliferation distally at both the DIP and PIP joints
Gull-wing configuration is not specific for erosive osteoarthritis

Tuesday, 1 November 2016