summer packet - prospective students

Western University – CPM Summer Reading Packet

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Summer Packet


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Term Definition Example

Proximal Closer to the center, core or trunk The knee is more proximal than the ankle.

Distal Further from the center, core or trunk The ankle is distal to the knee.

Superficial Closer to the outside, near the surface A superficial scratch involves the epidermis.

Deep Further from the surface Muscles are deep to the subcutaneous fat

Superior Upper, situated above something else The superior surface of the calcaneus* supports the talus.

Inferior Lower, situated below something else The inferior medial calcaneal* tubercle is located on the bottom of the bone.

Medial Closer to the center of the body The big toe is medial to the pinky toe.

Lateral Further away from the center of the body The fibula is lateral to the tibia.

Median At the center of the body The median separates the body into right and left halves

Dorsal Of, relating to, or occurring on the back or spinal part of the body. In the foot, pertaining to the upper surface.

The toenails are located on the dorsal surface of the toes.

Plantar Of, relating to, or occurring on the sole of the foot. The plantar surface of the foot comes in contact with the ground.

Volar Of, relating to, or occurring on the palm of the hand (or the sole of the foot)

The volar surface of the hand contains our fingerprints.

Caudal Of, at or near the tail or hind parts, posterior. The tailbone is on the caudal portion of our body.

Cephalad Towards the head or the anterior part. The carotid arteries run cephalad toward the brain.

Median

Medial

Lateral

Plantar

Dorsal

Volar

Caudal Cephalad

Proximal

Distal

Superficial

Deep

Medical Terminology

*See page 9 to orient the bones of the foot.


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The meaning of medical jargon can be deduced by familiarizing yourself with various prefixes and suffixes. Below is a collection of commonly encountered prefixes and suffixes. Take a look at the terms in the example section to see the prefixes and suffixes in action as part of complex medical terms.

CONTRASTING PREFIXES

Meaning Example

a- Without or no “atraumatic” – without injury ab- ad-

Away from Toward

“abduction” – move away from midline “adduction” – move toward midline

anti- Against “antiemetic” – against vomiting (emetic = vomiting) dys- eu-

Difficult, painful or bad Good, easy or normal

“dystonia” – abnormal tone or motion “eutopic” – arising from normal tissue

endo- ex- ecto-

Within or inside Without, out of, outside or away from Outside

“endoscopic” – view inside “extrinsic” – structure originating outside the part where it acts (e.g. muscle) “ectopic” – located outside of normal place

hyper- hypo-

Elevated or more than normal Depressed or less than normal

“hyperhydrotic” – “hypodermic” – of or relating to the layer beneath the epidermis

inter- intra-

Between Within

“intervertebral” – between the vertebrae “intravenous” – within the vein as in (IV)

poly- oligo-

Many Scant or little

“polyarticular” – many joints “oligoamnios” – deficiency in amniotic fluid

pre- post-

Before After

“preprandial” – before meals “postprandial” – after meals

sub- super-

Below, under or less Above, beyond or excessive

“subcutaneous” – located or placed just under the skin “superinfection” – an infection following a previous infection

Suffixes Meaning Example Surgical

-tomy -stomy -ectomy -plasty

Cutting into or incision Surgically created opening Surgical removal Surgical repair

“arthrotomy” – cut into a joint “colostomy” – surgically created opening into colon “neurectomy” – surgical removal of a nerve “arthroplasty” – surgical reconstruction or repair of a joint

Procedure -centesis -gram -graph -graphy -lysis -scope -scopy -therapy

Puncture or removal of fluid or gas Record of Instrument that records Procedure that records Separation or breakdown Instrument to visually examine Procedure to visually examine Treatment

“arthrocentesis” – removal of joint fluid “arhtrogram” – examination of joint using radiograph “radiograph” – image produced by xrays “angiography” – image of arteries produced by xrays “neurolysis” – separation of nerves “arthroscope” – instrument to examine inside joints “laparoscopy” – procedure to examine the abdominal cavity “radiotherapy” – treatment of disease with radiation

Conditional -algia -itis -malacia -megaly -osis -pathy -sclerosis

Pain Inflammation Abnormal softening Enlargement Abnormal condition Disease Abnormal hardening

“metatarsalgia” – pain under the metatarsal heads “osteitis” – inflammation of the bone “cardiomalacia” – softening of heart tissue “organomegaly” – enlargement of the organs “dermatosis” – abnormal condition of the skin “retinopathy” – disease of the retina “arteriosclerosis” – hardening of arterial walls

Medical Terminology


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Cardinal planes

These provide a point of reference for when you discuss structures with others. They will help you to orient motion and normal anatomy alike. These planes are also used in advanced imaging such as CT scans or MRI (magnetic resonance imaging).

Three cardinal planes include:

Frontal plane – this plane divides the body into and front and back portion. Abduction and adduction of the leg at the hip joint occurs in the frontal plane.

Sagittal plane – this plane divides the body into left and right portions. Dorsiflexion, plantarflexion of the ankle joint occurs in the sagittal plane.

Transverse plane– this plane divides the body into top and bottom portions. Internal and external rotation of the foot occurs in the transverse plane.

Frontal Plane view of the skull Sagittal plane view of the skull

Transverse Plane view of the skull

Anatomical Terminology


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Movement and Biomechanics Important Terminology Concepts: When describing movement occurring at a point in time, any of the following suffixes may be used:

-tion (ex. pronation) -xion (ex. dorsiflexion) -sion (ex. inversion) -ing (ex.inverting).

When describing the position of a structure at a given point in time the “-ed” suffix is used.

E.g., the arm at the elbow joint: “flexed” = position of the joint “flexion” = motion to bring the elbow to the flexed position

If a structure is fixed in a particular position then the “-us” suffix is used.

E.g. If the foot is turning toward the median sagittal plane The foot is “adducting” = describes the motion as it is happening The foot is going through “adduction motion” = another way to describe the motion The foot is in an “adductus position” = final fixed position of the foot

Movement Descriptions:

Translation: Movement from one position to another in the transverse plane.

Biomechanical Terminology


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Flexion: Movement in the sagittal plane in which two bones of a joint become closer together.

Extension: Movement in the sagittal plane in which two bones of a joint become further apart.

Abduction: Movement away from the sagittal plane.

Adduction: Movement toward the sagittal plane.

Inversion: Movement of the sole of the foot toward the median sagittal plane.

Eversion: Movement of the sole of the foot away from the median sagittal plane.


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Circumduction: Combined movements of flexion, extension, abduction, adduction, and medial and lateral rotation. Protraction: Moving forward along a surface. Retraction: Moving backward along a surface.

Plantarflexion: Movement occurring in the sagittal plane in which the top of the foot moves away from the leg.

Dorsiflexion: Movement occurring in the sagittal plane in which the top of the foot moves toward the leg.

Elevation: Raising a structure away from the ground.

Depression: Lowering a structure toward the ground.

Opposition: Bringing two objects together. Example: bringing the thumb and index finger together.


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Other Important Terms: Hypermobility: Any motion occurring at a joint when the motion at that joint should not be occurring. Compensation: A change in structure, position, or function of one body part in an attempt to adjust for the abnormal structure, position, or function of another body part. Axis of motion: A straight line around which an object moves. For example, a door hinge lies on the vertical axis and the door rotates around that axis. Axes of motion may be on the sagittal, frontal, or transverse planes or somewhere in between those planes. Planar motion: A plane is the direction of movement of an object. This may occur in the sagittal, frontal, or transverse plane (“uniplanar” or one plane motion).

For example, walking occurs primarily in the sagittal plane.

More commonly, movement occurs in more than one plane at the same time.

For example, when inserting a screw into a wall, the screw has sagittal plane movement as it advances into the wall but ALSO has frontal plane motion as it twists.

When two planes of movement are involved the term “biplane” is used, while when three planes are involved this is termed “triplane.”

Supination: In the foot this is a complex three plane (triplane) motion consisting of inversion, plantarflexion, and adduction. In the hand this is seen as placing the palm backward while in the anatomical position.

Pronation: In the foot this is a complex three plane (triplane) motion consisting of eversion, dorsiflexion, and abduction. In the hand this is seen as placing the palm forward while in the anatomical position.


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BONES OF THE FOOT Be able to identify the names of the bones in the foot. Be familiar with how the bones relate to each other.

Rearfoot Calcaneus Talus

1 1

Midfoot Navicular Cuboid Cuneiforms (x3) – Medial, intermediate and lateral

1 1 3

Forefoot Metatarsals (x5) Phalanges (x14) – 2 for the big toe + 3 for digits 2-5 Sesamoids (x2) – tibial/medial and fibular/lateral

5 14 2

TOTAL 28 1 - CALCANEUS Heel bone 2 - TALUS Used to be referred to as the “astragalus” Sits on top of the calcaneus Connects the foot to the leg via the “ankle joint” 3 - NAVICULAR Sandwiched in between the talus and all three cuneiforms 4 - CUBOID Distal to the calcaneus, lateral to the navicular 5 - CUNEIFORMS 51Medial cuneiform – also referred to as the first cuneiform 52Intermediate cuneiform – also referred to as the second cuneiform 53Lateral cuneiform – also referred to as the third cuneiform 6 - METATARSALS Five bones, each with unique shapes on the different surfaces. Numbered from medial to lateral or from big toe to little toe 7 - PHALANGES (plural term, singular = “phalanx”) Proximal – attached to the metatarsal at the “knuckle”, there are 5 Middle – sandwiched between the proximal and distal phalanx, there are 4 Distal – the furthest tip of the toe under the nail, there are 5 8 – SESAMOIDS (see dashed structures) 2 bones that occur plantar to the first metatarsal

1

52 51

6

7

3

2

4

53

8 8

Osseous (Bony) Terminology


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Navicular Navicular Cuboid

Cuboid

Talus

Talus

Calcaneus

Proximal phalanx

DP

DP

DP

DP DP

DP

DP

DP DP

Dorsal View Plantar View

MP

MP

MP

MP

MP

MP

MP


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Joints

PIVOT joint = Atlantoaxial joint The uniaxial rotating motion occurs around a round process of bone. BALL AND SOCKET joint = Hip joint Multiaxial motion occurs as the round head of the femur (yellow) fits into its acetabulum or socket (blue) allowing a wide range of motion. CONDYLOID joint = Metacarophalangeal joint (“the knuckles”) Biaxial motion permits flexion/extension and abduction/adduction and combined circumduction motion. SADDLE joint = Carpometacarpal joint Biaxial motion where the saddle shaped head allows for movement in two directions HINGE joint = elbow joint Uniaxial motion permits flexion and extension only. PLANE joint = acromioclavicular joint Typically uniaxial and permits small gliding or sliding motion. The joint surfaces are usually flat or near flat.

Anatomical Terminology


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Muscles Type of muscles:

Skeletal muscle Moves bones and other structures – responsible for foot motion. Voluntary muscles, but there are things that occur beyond your control! Contraction occurs by shortening the fibers. Smooth muscle Forms walls of vessels and hollow organs – responsible for moving substances through the vessels and organs. Cardiac muscle Forms most of the walls of the hearts and nearby structures such as the aorta.

Muscle parts:

Muscle belly – fleshy part Tendon – transition from muscle belly to attachment in bone Aponeuroses – flat sheets made up by fusion of tendon tissue to anchor one muscle to another

Muscle shape Description Example Flat Parallel fibers, usually with aponeurosis External oblique muscle Pennate Feather-like shape that can be uni-, bi- or

multi-pennate Dorsal interosseous muscle in the foot

Fusiform Spindle shaped, larger centrally with thin ends in either direction

Biceps brachii muscle

Quadrate Four equal sides Quadratus plantae Circular or sphincteral Surrounds a body opening and functions to

constrict it Orbicularis oculi

Flat = Obliques Pennate = Dorsal interosseous

Fusiform = Biceps brachii

Quadrate = Quadratus plantae

Circular = Orbicularis oculi


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Muscles of the leg – Extrinsic These muscle bellies are found in the leg but exert their forces on the foot through tendons. There are 3 major muscle groups that we think about as “units” to function together. Each of the major units works to stabilize the foot and ankle against the opposing group. Each muscle has a different more specific function or role through the gait cycle and in other movements that will be discussed in your courses. The characteristics about each muscle such as origin, insertion, innervation and vascular supply will also be introduced in detail in your courses. Think about the muscles and tendons like a pulley system. Their specific course and insertion will help you to see how they function alone and then in relation to other structures.

The “fascia” helps to distinguish the different muscle compartments in the leg. Notice how the posterior muscle group is divided into superficial and deep.

Anterior muscle group

Tibialis anterior Extensor hallucis longus (EHL) Extensor digitorum longus (EDL) Peroneus tertius

Together these muscles help to dorsiflex the foot. The EHL and EDL muscles work at the level of the digits to extend them.


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Superficial Posterior muscle group Gastrocnemius Soleus The gastrocnemius and soleus muscles come together to form the Calcaneal tendon, also referred to as the Tendo-Achilles or Achilles tendon. They offer major plantarflexory motion of the foot.

Deep Posterior muscle group

Tibialis posterior Flexor Digitorum longus (FDL) Flexor Hallucis Longus (FHL)

The two posterior muscle groups work together to plantarflex and invert the foot.

The FDL and FHL work at the level of the digits to flex them.


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Lateral muscle group

Peroneus brevis (PB) Peroneus longus (PL)

These muscles help to stabilize and support the lateral ankle to prevent sprains and evert the foot.

INTRINSIC MUSCLES OF THE FOOT These muscles originate and insert within the foot. There is one intrinsic muscle on the dorsum of the foot. There are four layers of muscles on the plantar surface of the foot, they will be discussed from superficial to deep. They have various functions and patterns of innervation that will be covered in detain in your anatomy course.

Dorsum of the foot

Extensor digitorum brevis (EDB) (C – tendons of EDB) Dorsal interosseous (there are 4 muscles, only the first is easily visible here)

*The first tendon slip of the extensor digitorum brevis is referred to as the extensor hallucis brevis. This image also shows the extrinsic tendons from the leg. A – Extensor hallucis longus (EHL) B – Extensor digitorum longus (EDL)

Plantar muscles and tendons

Images for lower leg musculature obtained from: Netter, 4th ed.


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First plantar layer of the foot.

Abductor hallucis Flexor digitorum brevis Abductor digiti minimi

Second plantar layer of the foot.

Quadratus plantae Lumbricals (there are 4)

Extrinsic tendons for FHL and FDL also pass through this layer.

Third plantar layer of the foot.

Flexor hallucis brevis Adductor hallucis (2 heads) Flexor digiti minimi brevis

Fourth plantar layer of the foot.

Plantar interossei (there are 3) Notice the extrinsic tendons for tibialis posterior and peroneus longus pass through this layer.


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INTRO TERMINOLOGY

Primary Lesion First or predominant lesion

Secondary Lesion(s)

A feature that affects the primary lesion or may evolve from it. May be from an outside force like scratching, bug bites, cuts, infections, trauma, or even the healing process

Secondary effect = dry, scaly skin that develops around the primary lesion

Tertiary Lesion(s) Groupings and/or pattern of lesions

If the primary lesion was observed in a linear pattern, this would be referred to as a tertiary distribution.

NOMENCLATURE OF PRIMARY SKIN LESIONS

Term Definition Characteristic Image

Macule A flat lesion represented only by a color change on the skin

Usually < 1 cm You cannot feel a border if you run your finger over the edge

Papule A solid raised lesion with distinct borders

Usually < 1 cm in diameter Can have scales or crusts May be domed, flat-topped, umbilicated (with a stalk) or round

Nodule A raised solid lesion > 1 cm in diameter Can be in any layer of skin

Tumor A solid mass of skin or subcutaneous tissue

Larger than a nodule ***The term “tumor” does not imply malignancy

Dermatologic Terminology


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NOMENCLATURE OF PRIMARY SKIN LESIONS (cont.)


Plaque A solid, raised, flat-topped lesion Usually > 1 cm in diameter

Vesicle A raised lesion < 1 cm in diameter Often filled with clear fluid

Bullae Circumscribed (outline is obvious), fluid-filled lesions Usually > 1 cm in diameter

Pustule Circumscribed, elevated

Often containing pus, can be infected but may also be sterile. If sterile, the pus is made up of white blood cell materials.

Wheal Edema or swelling Isolated to upper epidermis or outer skin.

Burrow Linear lesion that is produced by infestation of skin

Formation of tunnels often created by scabies (almost microscopic bug) or cutaneous larva migrans (creeping worms)

Telangiectasia

Known as a “spider vein.” Permanent dilatation of superficial blood vessels in the skin

Can be just one or multiples


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NOMENCLATURE OF SECONDARY SKIN LESIONS


Scale Flakes or plates consisting of desquamated layers of stratum corneum

These desquamate (peel away) after injury to the skin

Crust Dried plasma or exudate Commonly seen in impetigo

Atrophy Thinning of or absence of the subcutaneous fat and epidermis

Example here is as a result of graft vs. host disease

Lichenification Thickening of the epidermis Skin lines become prominent

Due to exuberant scratching of a dry area An example of pruritic scabies is shown here

Erosion

Slightly depressed area Epidermis has been lost in part or in total

This is an example of a self-inflicted chemical burn causing erosion

Excoriation Broken area of skin due to scratching Swimmers’ itch was the cause of this boy’s excoriations

Fissure Linear fold of skin Can be prone to crack open on weight bearing surface and bleed


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NOMENCLATURE OF SECONDARY SKIN LESIONS (cont.)


Ulceration Necrosis (death) of tissue that is removed by friction or pressure.

Can involve any level of skin, fat, fascia, muscle, tendon and bone

Scar Permanent change following damage to skin.

Can occur after closure of skin in surgery if there is motion at the suture line.

Eschar

Hard plaque covering an ulcer or a wound. May look like charcoal.

Implies extensive tissue necrosis (death)

Keloids Hypertrophic, exaggerated response to skin injury resulting in a raised, exaggerated scar.

Connective tissue response Extends beyond original margins.

Petechiae Small, hemorrhagic (bleeding) lesions that do not blanch with pressure

Occur as result of minor conditions – allergic reaction, viruses – or life threatening ones

Purpura

Large hemorrhagic areas of bleeding Non-blanchable (stays red)

Image shows an example of a disease

Ecchymosis

Escape of blood from ruptured vessels into the skin Medical term for bruising

This child’s ecchymosis was secondary to leukemia and not to child abuse as some might think originally

Tertiary lesions will be discussed in detail in your dermatology course.

***Dermatology terminology information is presented compliments of Gary Williams, MD, of the University of Wisconsin, Madison, Department of Pediatrics, who originally prepared it with funding and support from the Wisconsin Area Health Education Center (AHEC) System

Additional images were obtained from personal patient photographs and SpringerImages.


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General Medical Literature Terminologies: Term Definition Example

Etiology The study of causes and origins of disease and conditions.

Natural history The origins, evolution, manifestations, and interrelationships of an organism with the patient or host animal.

The natural history of chicken pox involves the multiplication of the virus causing chicken pox in the patient’s body before manifesting as small red itchy spots on the skin.

Pathophysiology The study of functional changes associated with or resulting from disease or injury.

Pathogenesis The origins of a disease or condition and how that develops.

The pathogenesis of the common cold is infection by a rhinovirus that invades the immune system of the person it infects.

Risk factor A variable associated with an increased likelihood of a disease or condition. Smoking is a risk factor for heart failure.

Determinant AKA risk factors

Symptoms A constellation of subjective experiences as related by the patient to the medical examiner. A patient stating: “I feel feverish”.

Physical exam findings

Facts regarding a patient’s condition obtained through direct observation, touching and listening, of the patient by the medical examiner. This is distinguished from symptoms in that the examiner is directly involved in witnessing the patient’s condition (i.e. objective) rather than the patient reporting their experience (i.e. subjective).

Palpating (touching) a toe. Auscultating (listening) for heart sounds. The patient’s oral temperature measures 101.1°F.

Diagnostic Terminologies in the Literature (non-radiological): Term Definition Example

Serum A fluid like medium that is part of human blood. Diagnostic blood tests, where serum is separated from whole human blood to isolate particular components for testing, is called a serologic test.

Titers The quantity of antibody (Ab) present in an organism.

Varicella (chicken pox) titers must be reported for all health employees working in acute care hospitals to determine if they are adequately immunized against chicken pox.

Seroconversion The development of antibodies in blood serum as a result of exposure to an infection or immunization.

Titers for Varicella can reflect whether seroconversion has taken place.

Gram stain A special stain that distinguishes groups of micro-organisms on a slide that is viewed under a microscope.

Culture Growth of bacteria, fungus, yeast or viruses in a special medium.

E.coli was isolated from a culture that was obtained from a patient who recently had food poisoning.

Biopsy A sample of biological tissue taken from a patient for diagnostic purposes.

Pathology The study determining causes, processes, development, and consequences of disease.

Histology The study of microscopic structures in animal and plant tissues.

Medical Literature Terminology


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Medical Research Terminologies: Term Definition Example Inoculation The act of introducing an antigenic substance or

vaccine into the body to produce immunity to a specific disease.

Patients can be inoculated with flu vaccines during flu season by injection through the skin or by nasal spray.

Attenuated To weaken. Often used in reference to a weakened anatomical part or purposefully weakening the virulence of a micro-organism to be used as a vaccine.

The Achilles tendon is attenuated from repetitive past injuries.

Virulence A term used to describe HOW infectious, malignant, or poisonous a micro-organism can be.

The virulence of E.coli is determined by a surface protein on its outer membrane.

Distribution A characteristic of something spread over space or time.

If you spill coffee, the spread of your spill would have a certain distribution over the surface that it contacts. The number of times you drink coffee spread out over time would give you a distribution of your coffee drinking pattern.

Occurrence WHEN a specific event happens. Someone developing a cold would be an occurrence.

Epidemiology The study of the occurrence and distribution of diseases and other health-related conditions in populations. When doing research in epidemiology, one collects, summarizes and analyzes data collected from observation of a population.

Clinical epidemiology is the science of making predictions about individual patients by counting clinical events in groups of similar patients and using strong scientific methods to ensure that the predictions are accurate.

Biostatistics The application of statistical math in biology. This area of statistics is an important part of epidemiological research. It provides additional means of ensuring strong scientific methods and accurate predictions.

Methodologies The WAY something is done in a discipline, usually governed by a body of practices, procedures, and rules used by that discipline.

Research articles in the biological sciences contain a description of the procedures in sections called “Methods”.

Case Each individual (human or animal) identified with a disease or condition of interest.

The Center for Disease Control tracks the distribution of flu cases each year to help predict the amount of vaccines needed for next flu season.

Host In epidemiology, this refers to an organism that carries inside itself an invading organism that may or may not cause harm to the carrying organism.

Birds are hosts for the West Nile Virus and act as a disease carrier across state lines.

Epidemic When the number of new cases of a disease or condition, in a given human population, during a given time period, exceeds the number of normally expected cases for that same time period.

If a rare disease occurs at a rate of 0.5 cases per 10 years in a certain human population, then a rate of 8 cases per 10 years would be considered an epidemic.

Outbreak AKA epidemic.

Pandemic An epidemic that occurs in more than one geographic location.

Childhood obesity is considered a worldwide pandemic, affecting patients on multiple continents.

Medical Research Terminology


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Evidence based medicine

The combined use of a medical provider’s knowledge, personal experiences and judicious use of the medical literature to make an informed clinical decision.

Cohort A group of individuals with similar characteristics or behaviors.

A 9th grade class is considered a cohort based on their age and level of education.

Control In research: a constant factor from which a comparison can be made.

A control group of students enrolled in a regular gym class is compared to another group of students enrolled in an accelerated aerobics class to see if there is a difference in the rate at which students develop obesity.

Variable In research: a changing factor that you compare against a control to observe a result.

A control group of students enrolled in a regular gym class is compared to another group of students enrolled in an accelerated aerobics class (the variable) to see if there is a difference in the rate at which students develop obesity.

Placebo A substance that has no therapeutic effect, used as a control in testing new therapies.

Random Chance An unknown and unpredictable element during a period of observation that seems to have no assignable cause.

A causal relationship observed between two independent factors may be due to random chance.

Bias In epidemiological research: a process that interferes with discovering the true value of a relationship between two factors that is pervasive throughout the entire research process.

Confounder A factor that distorts the true relationship between your control and variable – making you think there is a causal relationship when there truly is none or vice versa.

Sample size The number of individuals selected from a representative population of interest. In biostatistics, referred to as “N”.

Mortality In epidemiological research, this almost always refers to death.

The mortality rate of patients from smoking related complications is something tobacco companies do not want consumers to know.

Morbidity In epidemiological research, this refers to a disease condition or state.

The morbidity from heart disease can severely impair a patient’s quality of life.

Co-morbidities Disease conditions or states that tend to be associated with one another.

Kidney failure is a co-morbidity of diabetes.

Survival In epidemiological research: the number of individuals that are still alive and/or healthy AFTER exposure to a disease/condition, at a specific point in time.

Prospective study

A study that starts with the present condition of a cohort and follows them into the future.

Retrospective study

A study that starts with the present condition of a cohort and collects data about their past history to explain their present condition.


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Case-control study

A study that compares cases to controls to postulate a relationship.

A control group of students enrolled in a regular gym class is compared to case group of students enrolled in an accelerated aerobics class to see if there is a difference in the rate at which students develop obesity.

Double-blinded A method in epidemiological research that prevents the data collector AND the study subject from knowing any factors that could influence the way they perceive information, collect information, and/or react during the study to increase quality.

Observer variation

Failure by the observer in a study or test to measure accurately, resulting in error.

Inter-observer variation

The amount of variation between results obtained by TWO or MORE observers examining the same material.

Intra-observer variation

The amount of variation ONE observer experiences when observing the same material more than once.

Reliability The extent to which repeated measurements of a stable phenomenon by different people and instruments at different times and places get similar results.

Validity The degree to which the data measures what they were intended to measure.

Exposure In epidemiological research: an individual that has been in contact with a particular disease or factors leading to a disease.

Exposure to the Varicella virus will cause someone to have Chicken Pox. Exposure to sunlight may increase the risk of developing skin cancer.

Outcome The result of some process or factor. The outcome of eating a fiber diet is a lower risk for colon cancer.

Distribution In research: the way a set of data is spread out over an area. This typically produces difference shapes ranging from a bell-shaped curve (i.e. normally distributed) or spiked at one end with a long tail at the other (i.e. skewed)

Frequency In research: the specific number of events occurring in a given period of time.

The frequency of an average adult’s heart beat is 60-100 beats per minute.

Nominal data Data that occurs in categories without any inherent order.

Deaths, births, gender, etc.

Dichotomous data

A subset of nominal data that pertains to things that easily divide into two categories

Present/absent Yes/no

Ordinal data Data that has some inherent order or rank, but the size of the intervals between categories is NOT specified.

Yelp, a social media site that rates businesses using a scale of 1 to 5 stars with 1 star meaning poor review, and 5 stars meaning a good review.

Interval data Data that has some inherent order or rank AND the interval between categories is equal no matter where on the scale. Interval data can be further divided into continuous data and discrete data.

Continuous data: blood pressure, birth weight, etc. Discrete data: age, number of times you eat in a day, etc.


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Term Definition Examples/Etc. Electromagnetic energy Electromagnetic energy

Electromagnetic radiation

Oscillating electric and magnetic fields that travel in a vacuum with the velocity of light. Includes x-rays, gamma rays, and some non-ionizing radiation.

Ultraviolet, visible, infrared, and radio waves

Electromagnetic spectrum

The broad range of wavelengths of radiation extending from very short wavelength cosmic rays to the very long wavelength radio waves that travel in straight lines and are characterized by a wave motion, and travel through a vacuum at the speed of light. The continuum of electromagnetic energy.

Nonionizing radiation Radiation for which the mechanism of action in tissue does not directly ionize atomic or molecular systems through a single interaction.

Ionizing radiation Radiation capable of ionization. High-energy electromagnetic radiation that produces ions as it passes through matter.

X-rays, gamma rays, and some energies of ultraviolet radiation

Natural environmental radiation

Naturally occurring ionizing radiation, including cosmic rays, terrestrial radiation, and internally deposited radionuclides.

Photon Electromagnetic radiation that has neither mass nor electric charge but interacts with matter as though it is a particle.

X-rays and gamma rays.

X-ray Penetrating, ionizing electromagnetic radiation having a wavelength much shorter than that of visible light.

Soft x-ray An X-ray that has low penetrability and therefore is of low quality.

Hard x-ray An X-ray that has high penetrability and therefore is of high quality.

X-ray quality The penetrability of an X-ray beam.

Quality A term referring to the penetrability or average energy of the X-ray beam.

X-ray quantity The output intensity of an X-ray imaging system, measured in roentgens (R).

Quantity A term referring to the number of protons in the X-ray beam. #

Occupational dose

The dose received by an individual in a restricted area during the course of employment in which the individual's assigned duties involve exposure to radiation.

Anode The positively charged electrode of an X-ray tube that contains the target and from which X-rays are emitted. Anodes may be either stationary or rotating.

Radiographic Terminology


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Cathode

The negatively charged electrode of an X-ray tube carrying the filament and focusing cup and from which electrons are discharged towards the target contained in the anode electrode.

Target The region of an X-ray tube anode struck by electrons emitted by the filament.

Primary radiation The radiation emitted from the X-ray tube; also,

unscattered radiation.

Scatter radiation

Radiation that enters a patient and is deflected from its initial course but may still contact and expose the X-ray film. Scatter radiation contributes to the patient radiation dose and degrades the radiographic image.

Radiographic intensifying screen

A device that converts the energy of the X-ray beam into visible light to increase the brightness of an X-ray image.

Radiographic contrast

The differences in optical densities between different portions of the radiograph that enable image details to be visualized. The final radiographic contrast visualized on the film is dependent on two independent factors, subject contrast and film contrast.

Radiographic mottle The nonuniform density of a uniformly exposed film due to quantum mottle, structure mottle, and film graininess.

Radiographic noise The undesirable fluctuation in the optical density of the image.

Radiographic technique

The combination of settings selected on the control panel of the X-ray imaging system to produce a quality image on the radiograph.

Radiographic technique chart

A guide that describes standard methods for consistently producing high-quality images.

mA Abbreviation for milliampere. The measure of X-ray tube current.

Kilovoltage The potential difference in thousands of volts applied across an X-ray tube that accelerates the electrons emitted by the cathode towards the anode.

Radiosensitivity The relative susceptibility of cells, tissues, and organs

to the harmful action of ionizing radiation.

Radiography An imaging modality that uses X-ray film and an X-ray tube that allows the tube to be moved in any direction and provides fixed images.

Underexposed Referring to a radiograph that is too light because too

little x-radiation reached the image receptor.

Resolution A measure of the ability of a system to image two separate objects and visually distinguish one from the other.

Image detail The sharpness of small structures on the radiograph.


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Subject contrast

The part of radiographic contrast determined by the size, shape, and X-ray attenuating characteristics of the subject being examined and the energy of the X-ray beam.

Cassette A light-tight container for holding a radiographic film during exposure, a rigid holder that contains the film and the screens.

Intensifying screen A sensitive phosphor that converts X-rays to light to shorten exposure time and reduce patient dose.

Computed radiography (CR)

Radiographic technique that uses a photostimulable phosphor as the image receptor and an area beam.

Contrast agent

Also referred to as contrast or contrast medium. Foreign substances (iodine, barium, air, gadolinium) introduced in tissue to increase the inherent subject contrast. Any internally administered substance that has a different opacity from soft tissue on radiography or computed tomography. Includes: • Iodine in water, used for arthrography. • Water soluble iodine, used to make blood vessels opaque; to demonstrate the inner structures of the urinary tract (kidneys, ureters and bladder); and to outline joints (the spaces between two bones). • May refer to air occurring naturally or introduced into the body.

Computed tomography (CT)

Sometimes referred to as CAT scan (computerized axial tomography). Imaging anatomical information from a cross-sectional plane of the body, each image generated by a computer synthesis of X-ray transmission data obtained in many different directions in a given plane.

Radiolucent

Materials offering little resistance to passage of X-radiation; those that have insufficient physical density to cast an appreciable image on film when exposed to kilovoltages used in radiography of the body.

Radiopaque Referring to a tissue or material that absorbs X-rays and appears bright on a radiograph.

Optical density The degree of blackening of a radiograph.

Endosteal Of or pertaining to endosteum, vascular tissue lining medullary cavity of bones (or, the inner surface of the cortex of a tubular bone).

Periosteum A fibrous connective tissue covering the outer surface

of bone.


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Epiphysis

The end segment of a long bone, separated from the diaphysis early in life by an epiphyseal plate but later becoming part of the larger bone once the plate ossifies.

Physis (aka epiphyseal plate)

A hyaline cartilaginous layer located between the epiphysis and diaphysis of a long bone. It functions as a longitudinal growing region.

AKA growth plate

Stochastic effects

The probability or frequency of the biologic response to radiation as a function of radiation dose. Disease incidence increases proportionally with dose, and there is no dose threshold.

FOOT AND ANKLE RADIOLOGY:

Objectives:

• Identify and name each radiographic view of the foot and ankle. • Identify the components of the diaphysis in a radiograph (periosteum, endosteum, medullary canal). • Identify the components of a long bone (epiphysis, physis, zone of provisional calcification, metaphysis, and diaphysis) in

the pediatric patient.

Patient Encounter H & P

Initial Impression

Justification for Radiographic Study

View Selection: Radiographic Views

Radiographic Anatomy

Image Formation: Exposure Technique Factors

Positioning Techniques Radiation Protection & Safety

Processing of Image Image Quality

Radiographic Interpretation: Systematic Evaluation

Cardinal Findings Prepare Report of Findings

Diagnosis of Radiographic Pathology: Positional, Congenital, Trauma, Arthritis, Infection,

Tumor, Miscellaneous

Special Imaging Studies: Indications, Interpretation


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Standard foot studies • Dorsoplantar (DP) • Lateral • Medial oblique • Lateral oblique • Sesamoid axial • Calcaneal axial

DP View/Projection Lateral View/Projection

Medial Oblique View/Projection Lateral Oblique View/Projection

Compare the two views. Notice the difference in how well you can see the metatarsal

bones.

Calcaneal Axial View/Projection Sesamoid Axial View/Projection


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Standard Ankle Studies • Anteroposterior (AP) • Mortise • Lateral • Medial (internal) oblique • Lateral (external) oblique

AP View/Projection

Mortise View/Projection

Lateral View/Projection


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Internal oblique View/Projection

External oblique View/Projection

THE END


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Self Assessment Quiz:

Medical Terminology: (fill in the blank)

1. In the image to the left, the arrow points to a structure that is _ _ _ _ _ _ _ _ to the knee joint.

2. The orange arrow is _ _ _ _ _ _ _ _ in comparison to the green arrow that is considered _ _ _ _ _ _ .

3. The blue line reflects the _ _ _ _ _ _. 4. The red arrow is _ _ _ _ _ _ to the green circle.

5. The yellow arrow is pointing to the _ _ _ _ _ _ surface of the foot.

6. The palm of the hand is also referred to as the _ _ _ _ _ _ surface.


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Matching:

7. a. Endo- ____ -uria: painful urination b. Oligo- ____ -inflammatory: against inflammation c. Super- ____ -neural: inside the nerve d. Anti- ____ -articular: affecting a few joints e. Dys- ____ -numerary: more numerous

8. a. -centesis ____ Hydro___: Water treatment b. -plasty ____ Tendin___: Abnormal condition of tendon c. -therapy ____ Angio___: Repair of arteries d. -megaly ____ Amnio___: Removal of amniotic fluid e. -osis ____ Spleno___: Enlarged spleen

9.

The brain is cut into a right and left half, therefore this is a

_______________ plane cut of the brain.

10.

The body is cut into proximal and distal parts, therefore this is a ______________ plane cut of the trunk of the body.

11. The term best describing a fixed position is: a. Dorsiflexed b. Dorsiflexing c. Dorsiflexion d. Dorsiflexory motion

12. The term used to describe movement at a point in time is: (choose two)

a. Inverted b. Inversion c. Inverting d. Inverted motion


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13. During surgery a piece of bone is moved from one position to another in the transverse plane. This is referred to as:

a. Rotation b. Flexion c. Translation d. Pronation

14. The x-ray to the right shows a hand with the thumb and index fingers in: a. Protraction b. Circumduction c. Depression d. Opposition

15. Toes are able to dorsiflex/plantarflex and abduct/adduct. This is an example of

________ motion. a. Uniplanar b. Biplanar c. Triplanar d. Imaginary

16. In order to ascend stairs, we must _________ our foot high enough to avoid tripping on the next step.

a. Elevate b. Plantarflex c. Rotate d. Translate

17. There are two of these bones in each foot:

a. Calcaneus b. Metatarsals c. Phalanges d. Sesamoids

18. Of the cuneiform bones, the first cuneiform is:

a. Most medial b. Most lateral c. Central

19. Which of the following statements is TRUE?

a. The talus is superior to the calcaneus b. The navicular is proximal to the talus c. The metatarsal is distal to the phalanx d. The cuboid is medial to the calcaneus

20. All of the following allow uniaxial motion, EXCEPT:

a. Hinge joint b. Plane joint c. Condyloid joint d. Pivot joint


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21. A muscle that is feather-like in shape is best referred to as: a. Circular b. Flat c. Fusiform d. Pennate

22. All of the following are considered part of the anterior muscle group, EXCEPT:

a. Tibialis anterior b. Peroneus longus c. Extensor hallucis longus d. Extensor digitorum longus

23. The deep posterior muscle group includes all of the following muscles, EXCEPT:

a. Soleus b. Tibialis posterior c. Flexor digitorum longus d. Flexor hallucis longus

24. Extrinsic tendons to the plantar surface of the foot can be observed in the: (choose 2 answers)

a. First plantar layer b. Second plantar layer c. Third plantar layer d. Fourth plantar layer

25. All of the following are found on the dorsum of the foot, EXCEPT:

a. Extensor hallucis brevis muscle b. Extensor hallucis longus muscle c. Extensor digitorum longus tendon d. Extensor digitorum brevis tendon

26. There are three:

a. Lumbricals b. Dorsal interosseous c. Plantar interosseous d. Adductor hallucis

27. An 84 year old female patient returns to your office with an increase in the number of lesions. What

started out as a singular lesion has increased to more than ten on her right foot and ankle. This is best referred to as a:

a. Primary lesion b. Secondary lesion c. Tertiary lesion d. Quaternary lesion

28. All of the following are true regarding a papule, EXCEPT:

a. May have scales or crusts b. Usually >1 cm in diameter c. Raised lesion with distinct borders d. Can be umbilicated


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29. A large nodule is called a: a. Macule b. Plaque c. Bullae d. Tumor

30. A elevated, well circumscribed lesion filled with pus is called a:

a. Bullae b. Vesicle c. Pustule d. Wheal

31. Telangiectasia is colloquially referred to as:

a. Spider vein b. Snake line c. Monster artery d. Migrans Larva

32. After developing a sunburn, the skin begins to peel away. This can be described as:

a. Atrophy b. Scale c. Crust d. Erosion

33. At the end of the summer, women often complain or painful bleeding cracks to their feet, usually their

heels. Another name for this is: a. Crust b. Atrophy c. Fissure d. Excoriation

34. A scar that develops more scar tissue than would be expected normally is referred to as a(n):

a. Eschar b. Scale c. Purpura d. Keloid

35. The medical term for a bruise is:

a. Ecchymosis b. Petechiae c. Scar d. Bullae

36. A variable associated with an increased likelihood of a disease or condition is best described as a(n):

a. Etiology b. Symptom c. Risk factor d. Natural History


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37. Before beginning work in a hospital, there are requirements to show ______ for hepatitis B, by obtaining ______.

a. Titers, Biopsy b. Seroconversion, Titers c. Culture, Biopsy d. Titers, Seroconversion

38. The study of microscopic structures in animal and plant tissues is called:

a. Microbiology b. Histology c. Pathology d. Biology

39. A cold vaccine is not likely to result in a recipient developing a cold because the virus has been:

a. Inoculated b. Distributed c. Attenuated

40. Incidence of diabetes has increased worldwide, this can be described as a(an):

a. Outbreak b. Pandemic c. Epidemic

41. In a research project, a sugar pill is administered to the subjects to provide a comparison for the active

drug. The sugar pill in this case is the: a. Variable b. Control c. Cohort d. Confounder

42. A study that starts with the present condition and follows patients into the future is called a:

a. Case-controlled study b. Double blinded study c. Prospective study d. Retrospective study

43. A photon is:

a. Positive b. Negative c. Neutral

44. The negatively charged electrode of an x-ray tube where the filament and focusing cup are located is

called the: a. Cathode b. Anode c. Target


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45. The radiation that contributes to the patient dose and degrades the radiographic image is called: a. Ionizing radiation b. Primary radiation c. Scatter radiation

46. The measure of x-ray tube current is referred to as:

a. Kilovolt b. Mottle c. Quality d. Milliampere

47. Underexposing an x-ray results in an image that is:

a. Too dark b. Too light c. Too small d. Too clear

48. All of the following are considered contrast agents, EXCEPT:

a. Natural air b. Iodine in water c. Water soluble iodine d. Normal saline

49. Bone can be visualized on x-ray, because it is:

a. Radiolucent b. Radiopaque c. Radioscreen d. Radiocontrast

50. Which view/projection is the image on the right an example?

a. Dorsal-plantar b. Lateral c. Medial oblique d. Lateral oblique

51. The oblique image that shows more of the metatarsal bones clearly is referred to as:

a. Dorsal oblique b. Plantar oblique c. Medial oblique d. Lateral oblique

52. The foot image showing the plantar metatarsal heads is called the:

a. Calcaneal axial view/projection b. Dorsal-plantar view/projection c. Sesamoid axial view/projection


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ANSWER KEY:

1. Proximal 2. Cephalad, Caudal 3. Median 4. Medial 5. Dorsal 6. Palmar 7. E, D, A, B, C 8. C, E, B, A, D 9. Sagittal 10. Transverse 11. A 12. B, C 13. C 14. D 15. B 16. A 17. D 18. A 19. A 20. C 21. D 22. B 23. A 24. B,D 25. B 26. C 27. C 28. B 29. D 30. C 31. A 32. B 33. C 34. D 35. A 36. C 37. B 38. B 39. C 40. B 41. B 42. C 43. C 44. A 45. C 46. D 47. B

48. A 49. B 50. A 51. C 52. C

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