Hematopoietic, Endocrine, Metabolic, and Nutritional Disorders I & II Flashcards
In a patient with eosinophilic granuloma, what does a radiodense focus within a lytic cranial lesion represent?
a. target lesion
b. button sequestrum
c. rain-drop skull
d. geographic skull
b. button sequestrum
Periosteal new bone formation in thyroid acropachy is most commonly seen in which bones?
a. radius and ulna
b. tibia and fibula
c. metacarpals and metatarsals
d. femur and humerus
c. metacarpals and metatarsals
A middle-aged man on long-term hemodialysis complains of moderate low-back pain, which began insidiously several months ago. Lumbar spine radiographs taken four weeks ago were essentially unremarkable, but a new set of radiographs demonstrates loss of the L2/3 and L3/4 disc spaces, with endplate destruction, reactive subchrondral sclerosis, and bony spurring and fragmentation. The patient’s white blood cell count and erythocyte sedimentation rate are within normal limits. These findings are consistent with?
a. infectious spondylitis due to hemodialysis
b. destructive spondyloarthropathy of hemodialysis
c. amyloidosis
d. Metastatic disease from an unknown primary tumor
b. destructive spondyloarthropathy of hemodialysis
Although a certain degree of subperiosteal resorption may be seen with disease causing high bone turnover, when extensive, it is pathognomonic for which disorder?
a. osteoporosis
b. osteopenia
c. osteomalacia
d. osteoclastoma
b. osteopenia
Which of the following disorders has a pathogensis similar to Osgood-Schlatter’s disease and may coexist with it?
a. Blount’s disease
b. osteoochodritis dissecans
c. Sinding-Larsen-Johnansson disease
d. spontaneous osteone of the knee (SONK)
c. Sinding-Larsen-Johnansson disease
The radiographic finding of increased radiolucency of bone is best termed?
a. osteoporosis
b. osteopenia
c. osteomalacia
d. osteoclastoma
b. osteopenia
Although a certain degree of subperiosteal resorption may be seen with disease causing high bone turnover, when extensive, it is pathognomonic for which disorder?
a. osteoporosis
b. hyperparathyroidism
c. reflex sympathetic dystrophy syndrome
d. osteogenesis imperfecta
b. hyperparathyroidism
Which of the following best describes the distribution in individual bones of periosetal new bone formation in thyroid acropachy?
a. generally symmetric
b. diaphyses are most involved
c. more prominent on the ulnar aspect
d. the distribution is completely unpredictable
b. diaphyses are most involved
Which of the following is a common finding in the spine in patients with acromegaly?
a. posterior osteophyte formation
b. disc calcification
c. marginal syndesmophytes, similar to those seen in ankylosing sponylitis
d. posterior scalloping
d. posterior scalloping
The most common causes of generalized osteoporosis are senescent osteoporosis and…
a. hyperparathryoidism
b. osteogenesis imperfecta
c. postmenopausal osteoporosis
d. multiple myeloma
c. postmenopausal osteoporosis
In osteomalacia, radiolucent areas oriented at right angles to the cortex, which incompletely span the diameter of the bone, represent what?
a. Fatigue fractures
b. Losers lines
c. Greenstick injuries
d. Harris lines
b. Losers lines
In which location within bone is conversion of bone marrow from fatty to red marrow considered unusual, at any age after the first few months of life?
a. femoral neck
b. base of the skull
c. apophyses or epiphyses
d. vertebral bodies
c. apophyses or epiphyses
Where is Thiemann’s osteochondrosis found?
a. fifth metatarsal base
b. ischiopubic sychondrosis
c. tarsal navicular
d. phalangeal bases
d. phalangeal bases
In magnetic resonance imaging of osteonecrosis of the femoral head, which of the following is a specific indicator of ischemic necrosis of the femoral head?
a. double-line sign
b. snowcap appearance
c. cresent sign
d. sagging-rope sign
a. double-line sign
Flattening and sclerosis of the 3rd metatasal head, with enlargement and irregularity of the base of the proximal phalanx, is an osteonecrosis most commonly seen in?
a. adolescent males
b. adult males
c. adolescent females
d. adult females
c. adolescent females
What is the fundamental morphologic abnormality that leads to arthritic compliants in patients with acromegaly?
a. increased tendency of the subchondral bone to fracture
b. capsular laxity leading to joint instability
c. overgrowth of cartilage with a more fragile ground substance matrix
d. a marked tendency to calcuim pyrophosphate dihydrate crystal deposition (CPPD)
c. overgrowth of cartilage with a more fragile ground substance matrix
In addition to vertebra plana, how may eosinophilic granuloma present in the spine?
a. ivory vertebra
b. band-like radiolucencies
c. soap-bubbly
d. diffuse osteopenia
c. soap-bubbly
Which of the following neoplasms is most frequently found to lead to oncogenic osteomalacia, as determined by histological analysis?
a. non-ossifying fibroma
b. hemangiopericytoma
c. giant cell tumor
d. hemangioendothelioma
b. hemangiopericytoma
Although any area of the skelton can be used when evaluating cortical bone loss in metabolic bone disease, which bones are usually investigated?
a. the proximal femur
b. the tubular bones of the hand
c. the lumbar spine
d. the calcaneus
b. the tubular bones of the hand
What is the cause of Legg-Calve-Perthes disease?
a. osteonecrosis
b. epiphysis
c. dysplasia
d. physeal osteochondritis
a. osteonecrosis
The ______ is a thin layer of connective tissue that lines the inside of the cortex and the surface of the medullary cavity.
a. Periosteum
b. Endosteum
c. Parenchyma
d. Mesenchyme
b. Endosteum
Which type of thalassemia affects the fetus?
a. alpha-thalassemia
b. beta-thalassemia
c. thalassemia minor
d. thalassemia intermedia
a. alpha-thalassemia
Which of the following findings hypervitaminosis D is characteristic of adults rather than children?
a. alternating dense and lucent metaphyseal bands
b. cortical thickening due to periosteal apposition
c. widespread osteosclerosis
d. massive soft tissue calcification
d. massive soft tissue calcification
The radiographic finding of transverse radiolucent metaphyseal line (“scurvy line”) seen in scurvy corresponds to which of the following pathologic/structural abnormalities of the affected bone:
a. thickened zone of provisional calcification
b. Trummerfield zone
c. a fracture through the metaphyseal area
d. a region of osteoclast proliferation
b. Trummerfield zone
Which of the following nuclear machine findings serves to rule out, or at least decrease the profitability of, post-traumatic osteonecrosis of the scapnoid?
a. decreased radiotracker uptake at the distal scaphoid pole
b. increased radiotracker uptake at the distal scaphoid pole
c. decreased radiotracker uptake at the proximal scaphoid pole
d. increased radiotracker uptake at the proximal scaphoid pole
d. increased radiotracker uptake at the proximal scaphoid pole
What is the pathologic basis for secondary hyperparathyroidism?
a. parathyroid adenoma
b. long-standing hypocalcemia leading to parathyroid hyperplasia
c. autonomously hyperfunctioning parathyroid glands
d. parathyroid carcinoma
b. long-standing hypocalcemia leading to parathyroid hyperplasia
What is the name of the radiographic sign given to the appearance created by enlargement and elongation of the mandible in acromegaly?
a. rodent facies
b. overbite
c. leonine facies
d. lantern jaw
d. lantern jaw
When a child presents with unexplained diffuse osteopenia and bilateral metaphyseal radiolucent bands, your primary diagnosis should be ________ until proven otherwise?
a. Osteoporosis
b. Multiple myeloma
c. Leukemia
d. Lymphoma
c. Leukemia
Which of the following allows differientiation between reflex sympathetic dystrophy and a primary articular disorder such as rheumatoid arthritis?
a. absence of periarticular osteopenia in RSD
b. the bilateral and symmetric nature in RSD
c. absence of intra-articular erosions in rheumatoid arthritis
d. preservation of joint space in RSD
d. preservation of joint space in RSD
What is the eponym for post-traumatic osteonecrosis of the vertebral bodies, leading to delayed collaspe and a painful kyposis?
a. Scheuermann’s disease
b. Schmorl’s disease
c. Junghann’s disease
d. Kummel’s disease
d. Kummel’s disease
In addition to many other complications, patients with small bowel malabsorptive states such as sprue or regional enteritis, are at risk for which of the following deficiencies?
a. scurvy
b. hypovitaminosis D
c. hypovitaminosis A
d. iron deficiency anemia
b. hypovitaminosis D
In rickets, there is deficient mineralization of the zone of provisional calcification, which eventually becomes radiolucent and irregular with progression of the disease. This leads to which of the following radiographic findings?
a. widening of the growth plate
b. fraying of the metaphysis
c. cupping of the metaphysis
d. increased radiodensity of the metaphysis
b. fraying of the metaphysis
Subperiosteal resorption of cortical bone at the medial aspect of the proximal may be seen in hyperparathyroidism, as well as in another disease process, in which it is known as what sign?
a. Frostberg’s sign
b. Waldenstrom’s sign
c. Wimberger’s sign
d. Hawken’s sign
c. Wimberger’s sign
Which of the following radiographic findings is suggestive ischemic necrosis of the vertebral body?
a. patchy osteosclerosis
b. a central depression at the vertebral linear endplates
c. an irregular intravertebral linear radiolucency
d. a completely flat compression of the vertebral body (vertebra plana)
c. an irregular intravertebral linear radiolucency
After what age does the gender difference in the frequency of osteoporosis disappear?
a. after the female menopause
b. after the male mid-life crisis
c. after 50 years of age
d. after 80 years of age
d. after 80 years of age
What distinguishes stress fractures seen with overuse of normal bone from pseudofractures of osteomalacia?
a. bilateral and symmetric distribution
b. presence of callus formation
c. location within bone (perpendicular to cortex)
d. parallel margins showing mild to moderate sclerosis
b. presence of callus formation
Which of the following is commonly associated with negative ulnar variance?
a. Preiser’s disease
b. Panner’s disease
c. Keinbock’s disease
d. Iselin’s disease
c. Keinbock’s disease
The cortical thickening seen in hypervitaminosis A occur in which region of tubular bones?
a. epiphysis
b. metaphysis
c. diaphysis
d. apophyses
c. diaphysis
Which of the following classes of drugs are particularly known to lead to osteomalacia?
a. non-steroidal anti-inflammatories
b. hormone-replacement therapy
c. anticonvulsants
d. intravenous contrast agents
c. anticonvulsants
Which of the following disorders was first noted in women during the first trimester of pregnancy is now known to occur in either gender and all ages groups causes spontaneous and sometimes severe hip pain without history of trauma or inflection and generally resolves within 3 months to one year?
a. regional migatory osteoporosis
b. reflex sympathetic dystrophy
c. transient osteoporosis of the hip
d. partial transient osteoporosis
c. transient osteoporosis of the hip
What is the name of the radiographic sign in scurvy, created by an epiphyseal shell of increased density with a central lucency?
a. Pelken’s sign
b. Waldenstrom’s sign
c. Wimberger’s ring epiphysis
d. Trummerfeld sign
c. Wimberger’s ring epiphysis
In quantitative bone material analysis, why is trabecular (cancellous) bone preferred to cortical (compact) bone for accurate analysis?
a. trabecular bone is more easily accessible for analysis
b. the high rate of metabolic turnover trabecular bone makes it more responsive to metabolic stimuli
c. the skeleton is mainly composed of tracecular bone which makes analysis more accurate
d. quantitative bone mineral analysis is performed on cortical bone, not trabecular bone
b. the high rate of metabolic turnover trabecular bone makes it more responsive to metabolic stimuli
In which physeal layer does the cartilaginous column became calcified?
a. zone of undifferentiated cartilage cells
b. zone of proliferating cartilage
c. zone of hypertrophic cells (maturation zone)
d. zone of provisional calcification
d. zone of provisional calcification
How is the alignment alteration seen in Blout’s disease best described?
a. acute varus angulation of the femur with respect to the tibia
b. acute inward angulation of the tabia just below
c. acute valgus angulation of the tabia respect to the femur
d. acute posterior angulation of the tabia just below the knee
b. acute inward angulation of the tabia just below
Which of the following terms best describes the condition that occurs when a decrease in bone mass is greater than that expected for a person of a given age, sex, and race, and which results in structural bone failure manifested by fractures?
a. osteoporosis
b. osteopenia
c. osteomalacia
d. osteoclastoma
a. osteoporosis
Where is the most frequent site of bone infarction in sickle cell anemia?
a. proximal humerus
b. distal femur
c. proximal femur
d. proximal tibia
c. proximal femur
Which of the following is the most common cause of endogenous Cushing’s disease?
a. adrenal adenoma
b. anterior pituitary neoplasm
c. adrenal hyperplasia
d. ectopic adrenal tissue
c. adrenal hyperplasia
Name the best radiographic projection to identify scaphoid fractures.
a. PA Wrist
b. PA Hand
c. Medial Oblique Wrist
d. PA Wrist with ulnar deviation
d. PA Wrist with ulnar deviation
The squared configuration of the skull due to accumulation of osteoid in the frontal and parietal regions of the skull in rickets is known as…
a. triphyllocephaly
b. craniostenosis
c. caput succedaneum
d. craniotabes
d. craniotabes
Which of the following is a typical feature of Gaucher’s disease?
a. Arachnodactyly
b. Scoliosis
c. Aortic dissection
d. Erlenmeyer flask deformity
d. Erlenmeyer flask deformity
The osteoporosis seen in Cushing’s disease resembles which other form of osteoporosis?
a. osteoporosis of immobilization
b. postmenopausal or senile osteoporosis
c. regional migratory osteoporosis
d. reflex sympathetic distrophy
b. postmenopausal or senile osteoporosis
The “rachitic rosary” is most commonly seen at the costochondrial junctions of which ribs?
a. the upper ribs
b. the middle ribs
c. the lower ribs
d. at all costochondrial junctions
b. the middle ribs
Osteonecrosis due to pancreatitis most commonly involves the femoral head and which other area?
a. small bones of the hands and feet
b. humeral head
c. talus
d. vertebral bodies
b. humeral head
Wrist radiographs of a 20 year old male patient with hyperparathyroidism reveal a large lucent lesion with well-defined margins and internal septations, eccentrically located near the subarticular region of the distal radius. The most likely diagnosis is?
a. giant cell tumor
b. aneurysmal bone cyst
c. osteoclastoma
d. fibrous cortical defect
c. osteoclastoma
Patients with sickle cell anemia demonstrate an unusual propensity which of the following infections?
a. Meningococcemia
b. Brucella
c. Klebsiella
d. Salmonella
d. Salmonella
Which of the following findings is less commonly seen in Thalassemia?
a. “hair-on-end” skull
b. rodent facies
c. H-vertebrae
d. Erlenmeyer flask deformity
c. H-vertebrae
Which of the following radiographic manifestations is particularly helpful in the diagnosis of lead poisoning in children?
a. multiple dense metaphyseal lines in a single bone
b. vertical striations within the metaphysis
c. overtubulation of the femora (long, gracile-appearing bones)
d. dense metaphyseal lines at the proximal fibula
d. dense metaphyseal lines at the proximal fibula
What is a common feature of skull lesions in eosinophilic granuloma due to non-uniform growth of the lesion?
a. surrounding sclerosis
b. soft tissue mass
c. beveled edges
d. extension across sutures
c. beveled edges
Of the following articulations, which one is most frequently involved in hemophilia?
a. knee
b. cervical spine
c. hip
d. wrist
a. knee
Which of the following are common associated imaging findings in transient osteoporosis of the hip?
a. loss of joint space
b. joint effusions
c. abnormal signal intensity in the acetabulum
d. abnormal signal intensity in the ipsilateral knew
b. joint effusions
How is the general osseous pathology of thalassemia represented on radiographs?
a. widespread osteosclerosis and obliteration of the marrow spaces
b. osteoporosis, widened medullary spaces and coarsened trabecular pattern
c. severe osteopenia and multiple fractures in various stages of healing
d. short, bowed tubulkar bones and multiple vetrebral abnormalities
b. osteoporosis, widened medullary spaces and coarsened trabecular pattern
On magnetic resonance imaging, what is the appearance of post-traumatic osteonecrosis of the scaphoid?
a. decreased signal intensity on T1, proton, and T2-weighted imaging sequences
b. increased signal intensity on T1 and proton-density weighted sequences, decreased signal intensity on T2
c. increased signal intensity on T1 , proton, and T2-weighted imaging sequences
d. decreased signal intensity on T1 and proton-density weighted sequences, decreased signal intensity on T2
d. decreased signal intensity on T1 and proton-density weighted sequences, decreased signal intensity on T2
Which of the following radiographic abnormalities is not an integral part but rather an associated finding in Scheuermann’s disease?
a. anterior vetrebral body wedging leading to kyphosis
b. cartilaginous node formation
c. loss of intervertebral disc height
d. scoliotic curvature at the same level as the kyphosis
d. scoliotic curvature at the same level as the kyphosis
At which of the following joints is subchondral bone resorption seen most commonly with hyperparathyroidism?
a. sacroiliac
b. sternoclavicular
c. acromioclavicular
d. symphysis pubis
a. sacroiliac
What percentage of Langerhans Cell Histiocytosis is made up eosinophilic granuloma?
a. 5%
b. 20%
c. 50%
d. 70%
d. 70%
Step-like central depression of the vertebral endplates is a characteristic finding of Sickle cell anemia and
A. Gaucher’s disease
B. Osteogenesis Imperfecta
C. Schuermann’s disease
D. Thalassemia minor
E. Osteoporosis
(Resnick, pg. 1818 Vol.3)
D. Thalassemia minor
Osteonecrosis following renal transplantation commonly involves what anatomical structure?
A. Metacarpal head
B. Metatarsal head
C. Femoral epiphysis
D. Humeral epiphysis
E. Lunate
(Resnick, pg. 2096 Vol. 3)
C. Femoral epiphysis
The mother of a pediatric patient is concerned that her toddler has had an allergic reaction due to his hands swelling up a week ago. She does not understand how this could have occurred because he has not been outside due to the freezing temperatures. Radiographs revealed circumferential periosteal elevation, subperiosteal new bone formation, and multiple patchy radiolucent foci distributed throughout the shafts of the metacarpals. This combination of findings is highly suggestive of which diagnosis?
A. Tuberculosis
B. Hand-foot syndrome
C. Yaws
D. Small pox E. Leukemia
(Resnick, pg. 2151 Vol 3)
B. Hand-foot syndrome
The mother of a pediatric patient is concerned that her toddler has had an allergic reaction due to his hands swelling up a week ago. She does not understand how this could have occurred because he has not been outside due to the freezing temperatures. Radiographs revealed circumferential periosteal elevation, subperiosteal new bone formation, and multiple patchy radiolucent foci distributed throughout the shafts of the metacarpals. What clinical information is relevant in determining the patient may most likely have sickle cell anemia?
A. The patient is of Mediterranean heritage.
B. The patient is of Jewish heritage.
C. The patient is of African heritage.
D. The patient is of Chinese heritage
E. The patient is of Irish heritage.
(Resnick, pg. 2151 Vol 3)
C. The patient is of African heritage.
According to Resnick, a serious and common complication of sickle cell anemia patients is
A. prostration
B. soft tissue swelling
C. acute chest syndrome
D. dactylitis
E. fever
(Resnick, pg. 2149 Vol 3)
C. acute chest syndrome
The only facial bone involved in sickle cell anemia is
A. the ethmoid.
B. the temporal bone.
C. the inferior nasal concha.
D. the sphenoid.
E. the mandible.
(Resnick, pg. 2150 Vol 3)
E. the mandible.
The snow-capped appearance in long tubular bones is most commonly seen in the
A. the radius.
B. the distal tibia.
C. the distal humerus
D. the proximal humerus.
E. the distal ulna.
(Resnick, pg. 2154 Vol 3)
D. the proximal humerus.
Extensive thickening of the cranial vault associated with marked diploic expansion and hair-on-end appearance is most commonly seen in
A. hemoglobin-C disease.
B. hemolytic Anemia
C. spherocytosis
D. thalassemia
E. acromegaly
(Resnick, pg. 2180 Vol 3)
D. thalassemia
A 4 year old male patient presents with diabetes insipidus and bilateral exophthalmos. Conventional radiographs of the skull reveal multiple lytic calvarial defects. What is the most likely diagnosis?
A. Lymphoma
B. Leukemia
C. Letterer-Siwe Disease
D. Eosinophilic Granuloma
E. Han-Schuller-Christian Disease
(Resnick, pg. 2264 Vol 3)
E. Han-Schuller-Christian Disease
A 3 year old male patient presents lymphadenopathy, fever, hepatosplenomegaly and purpuric skin lesions. Conventional radiographs of the skull reveal prominent lytic calvarial defects at the base of the skull and the mandible. What is the most likely diagnosis?
A. Lymphoma
B. Leukemia
C. Letterer-Siwe Disease
D. Eosinophilic Granuloma
E. Hand-Schuller-Christian Disease
(Resnick, pg. 2264 Vol 3)
C. Letterer-Siwe Disease
The hallmark finding commonly associated with spontaneous healing of patients with extraskeletal manifestations associated with Langerhan Histiocytosis is
A. vertebral body remodeling
B. sclerosis
C. bony resorption
D. density decrease
E. undertubulation
(Resnick, pg. 2264 Vol 3)
B. sclerosis
A conventional radiographic study of the bilateral hands of a 42 year old male demonstrates generalized osteopenia, digital clubbing and lytic destruction of the 2nd and 3rd metacarpals. He recently has been experiencing bouts of sternal pain and increasing tenderness. These findings are commonly seen in patients diagnosed with chronic leukemia. What is a well-known associated complication in such cases according to Resnick?
A. Gouty arthritis
B. Secondary gout
C. CPPD
D. SCM
E. PVNS
(Resnick, pg. 2294)
B. Secondary gout
The most common form of childhood malignancy is
A. Hairy cell leukemia
B. Osteosarcoma
C. Lymphoma
D. Acute Leukemia
E. Cytomegalic inclusion disease
(Resnick, pg. 2291 Vol 3)
D. Acute Leukemia
A 25 year old male presents with knee pain of 6 weeks duration. Radiographs demonstrated increased spacing of the intercondylar notch, bulbous enlargement of medial femoral condyle, periarticular osteopenia, and narrowing of the bilateral femorotibial joint spaces. This constellation of findings is concerning for which genetically linked pathology?
A. Juvenile Idiopathic Arthritis
B. Septic Arthritis
C. Hemophilia Arthropathy
D. Pigmented Nodular Villa Synov1itis
E. Tuberculous Arthritis
(Resnick, pg. 2351 Vol 3)
C. Hemophilia Arthropathy
Lunate malacia has an increased association with a shore ulna, which is also known as
A. positive ulnar variance
B. negative ulnar variance
C. VISI
D. DISI
E. Tuberculous Arthritis
(Resnick, pg. 3707 Volume 3)
B. negative ulnar variance
Which of the following conditions appears to share pathologic, clinical and radiologic features with Hand-Schuller-Christian disease, although it is uncommon disease process and the average patient is much older?
A. Rosai-Dorfman disease
B. Erdheim-Chester disaease
C. Burkitt’s lymphoma
D. Malignant histiocytosis
B. Erdheim-Chester disease
Flattening and sclerosis of the 3rd metatarsal head, with enlargement and irregularity of the base of the phalanx, is an osteonecrosis most commonly seen in?
A. Adolescent males
B. Adult males
C. Adolescent females
D. Adult females
C. Adolescent females
Which of the following is common finding in children with thalassemia major?
A. H-vertebrae
B. Irregular vertical striations near the ends of the the long bones
C. Multiple rib fractures
D. Premature fusion of the epiphyses
D. Premature fusion of the epiphyses
What is the most common skeletal abnormality of hypoparathyroidism?
A. Dense metaphyseal bands
B. Osteoporosis
C. Subcutaneous calcification
D. Osteosclerosis
D. Osteosclerosis
Which bones are most commonly affected by osteomyelitis in sickle cell anemia?
A. Facial bones
B. Skull
C. Long bones
D. Vertebrae
C. Long bones
In addition to periostitis, what other radiographic findings are most often seen with chronic venous insufficiency?
A. Soft tissue edema and ossification
B. Lymphedema
C. Osteoncrosis
D. Osteomyelitis
A. Soft tissue edema and ossification
In acromegaly, what radiographic appearance may be created by the formation and approximation of osseous excrescences and enlargement of distal tufts and bases of the distal phalanges?
A. Spade-like distal tufts
B. Pseudoforamina
C. Turret exostoses
D. Bizarre parosteal osteochondromatous proliferation
B. Pseudoforamina
In myelofibrosis, fibrotic replacement of bone marrow is demonstrated by which of the following changes in signal intensity on standard spin echo magnetic resonance sequences?
A. Increased T1 and decreased T2-weighted signal
B. Decreased T1 and increased T2-weighted signal
C. Increased T1 and T2-weighted signal
D. Decreased T1 and T2-weighted signal
D. Decreased T1 and T2-weighted signal
Which of the following complications is surprisingly uncommon in Cushing’s disease?
A. Vertebral compression fractures
B. Renal calculi
C. Osteonecrosis
D. Excessive callus formation
C. Osteonecrosis
Parathyroid hormone may have a direct effect on collagen or promote its enzymatic degradation, thus predisposing patients to capsular laxity and ligamentous instability. Which of the joints below are particularly vulnerable to this?
A. PIP and DIP joints
B. Glenohumeral joint
C. Subtalar joint
D. Acromioclavicular and sacroiliac joints
D. Acromioclavicular and sacroiliac joints
The “Salt and pepper skull” of hyperparathyroidsm is due to what pathologic process?
A. Intracotical bone resorption
B. Diploic bone resorption
C. Bone marrow hyperplasia
D. Trabecular bone resorption
D. Trabecular bone resorption
What is the pathologic basis of pseudohypoparathyroidism?
A. Deficient secretion of parathyroid hormone
B. Surgical removal of the parathyroid glands
C. The presence of biologically ineffective parathyroid hormone
D. Inability of end organs to respond to parathyroid hormone
D. Inability of end organs to respond to parathyroid hormone
Which disorder is described by the following paragraph: “osteolysis of the terminal phalanges of the hands with band-like radiolucencies across the waist of one or more terminal phalanges and tuftal resorption; affecting the thumb more frequently than other digits”.
A. post-traumatic acro-osteolysis
B. Leprosy
C. Multicentric reticulohistiocytosis
D. Acro-osteolysis due to polyvinyl chloride toxicity
D. Acro-osteolysis due to polyvinyl chloride toxicity
Which facial bone is commonly involved in marrow hyperplasia in sickle cell anemia?
A. Maxilla
B. Mandible
C. Occiput
D. Zygoma
B. Mandible
The Erlenmeyer-flask deformity may be seen, among others, in Gaucher’s disease, Pyle’s disease, osteopetrosis, and which of the following:
A. Hypophosphatasia
B. Plumism
C. Vitamin E toxicity
D. Bismuth toxicity
B. Plumbism
Which of the following describes a hemolytic anemia with onset in late childhood or adolescence, featuring anemia, jaundice, and splenomegaly; with normal hemoglobin, but abnormal (inflexible) erythrocytes which get stuck in and are destroyed by the spleen?
A. Aplastic anemia
B. Fanconi’s anemia
C. Sickle cell anemia
D. Hereditary spherocytosis
D. Hereditary spherocytosis
Which of the following skeletal manifestations may be seen in hypovitaminosis A occurring in infancy?
A. Early closure of cranial sutures
B. Widening of tubular bones
C. Epiphyseal overgrowth
D. Widening of cranial sutures due to increased intracranial pressure
D. Widening of cranial sustures due to increased intracranial pressure
Of the following articulations, which one is most frequently involved in hemophilia?
A. Knee
B. Cervical spine
C. Hip
D. Wrist
A. Knee
If adequately performed, hemodialysis generally leads to resolution of the bone changes seen in renal osteodystrophy. If,instead, these bone changes progress, what is now believed to be the primary cause?
A. Excessive removal of phosphate during dialysis
B. Osteomalacia due to aluminum intoxication
C. Phosphate retention during dialysis
D. Excessive removal of calcium during dialysis
B. Osteomalacia due to aluminum intoxication
In which of the following occupations would would the occurrence of band-like acro-osteolysis be most accurately be considered a form of stress fracture?
A. Snake handler
B. Polyvinyl chloride worker
C. Guitar player
D. Electrician
C. Guitar player
In a patient with eosinophilic granuloma, what does a radiodense focus within a lytic cranial lesion represent?
A. Target lesion
B. Button sequestrum
C. Rain-drop skull
D. Geographic skull
B. Button sequestrum
Which of the following processes results in thickening of the long bones in osteomalacia?
A. Cortical remodeling
B. Subperiosteal deposition of osteoid
C. Endosteal thickening
D. Appositional bone growth
B. Subperiosteal deposition of osteoid
At what age is sickle cell dactylitis or “hand-foot syndrome” most common?
A. Adulthood
B. Adolescence
C. 2 to 10 years
D. 6 months to 2 years
D. 6 months to 2 years
What skull abnormalities are commonly found in hypophosphatasia?
A. Widened diploe
B. Sclerotic skull base
C. Craniosynostosis
D. Basilar impression
C. Craniosynostosis
Bismuth toxicity in adults may demonstrate which of the following radiographic abnormalities?
A. Dense transverse metaphyseal bands
B. Erlenmeyer flask deformity
C. Osteonecrosis
D. Cortical hyperostosis
C. OSteonecrosis
Magnetic resonance imaging of the lumbar spine of a 15-year old female with sickle-cell anemia demonstrate a widespread decrease in signal intensity of vertebral bone marrow, on both T1, T2 and fat-suppressed sequences. This raises the concern for?
A. Bone marrow ischemia/infarction
B. Iron overload
C. Osteomyelities
D. Normal reconversion of bone marrow
B. Iron overload
In which location within bone is conversion of bone marrow from fatty to red marrow considered unusual, at any age after the first few months of life?
A. Femoral neck
B. Base of the skull
C. Apophyses or epiphyses
D. Vertebral bodies
C. Apophyses or epiphyses
Which of the following arthritic conditions may be seen in 18-40% of patients with primary hyperparathyroidism?
A. Calcium pyrophosphate crystal deposition disease
B. Oseoarthritis
C. Ochronosis
D. Gout
A. Calcium Pyrophosphate crystal deposition disease
Which of the following is a frequent extra-osseous complication of hemodialysis, which may be severe, and, according to a study quoted in Resnick, may affect up to 80% of patients?
A. Carpal tunnel syndrome
B. Septicemia
C. Osteonecrosis
D. Soft tissue and vascular calcification
D. Soft tissue and vascular calcification
The radiographic finding of increased radiolucency of bone is best termed?
A. Osteoporosis
B. Osteopenia
C. Osteomalacia
D. Osteoclastoma
B. Osteopenia
Subchondral bone loss may be seen within joints in osteoporosis. Which disease is mimicked by magical subchondral bone resorption?
A. Septic arthritis
B. Tuberculous arthritis
C. Rheumatoid arthritis
D. Psoriatic arthritis
C. Rheumatoid arthritis
Which of the following disorders represents a high-turnover osteoporosis characterized by urinary loss of calcium and phosphorus without a compensatory increase in intestinal calcium absorption?
A. Hyperparathyroidism
B. Osteoporosis of immobilization or disuse
C. Paget’s disease
D. Idiopathic juvenile osteoporosis
B. Osteoporosis of immobilization or disuse
Which of the following compression neuropathies is particularly characteristic in acromegaly, occurring in 30% of patients, frequently bilaterally?
A. Carpal tunnel syndrome
B. Compartment syndrome
C. Raynaud’s syndrome
D. Neural foraminal encroachment
A. Carpal tunnel syndrome
A radiodense or chalky appearance of bones throughout the thorax, vertebral column, and pelvis with relative sparing of the skull and appendicular skeleton suggest which of the following:
A. Osteopetrosis
B. Fluorosis
C. Hypervitaminosis D
D. Hypervitaminosis A
B. Fluorosis
Which of the following must be included in the differential diagnosis of gas within a vertebral body?
A. Dissected air from pneumothorax
B. Spinal infection
C. Chemical fixer artifact
D. Degenerative disc disease
B. Spinal infection
Which of the following spinal syndromes may represent a form of reflex sympathetic dystrophy?
A. Kummel’s disease
B. Scheuermann’s disease
C. Idiopathic juvenile osteoporosis
D. Idiopathic juvenile kyphosis
A. Kummel’s disease
Ward’s triangle in the neck of the femur is an area of comparative radiolucency bordered by four anatomic groups of trabeculae. With early trabecular resorption due to osteoporosis, which anatomic group of trabeculae becomes more accentuated?
A. The principal compressive group
B. The principal tensile group
C. Both principal compressive and principal tensile groups
D. The principal ad secondary compressive groups
C. Both principal compressive and principal tensile groups
Gradually developing biconcave deformities of the vertebral bodies are characteristic of disorders with diffuse weakening of bone, such as osteoporosis, osteomalacia, Paget’s disease and hyperparathyroidism. These deformities are known as…
A. H-vertebrae
B. FIsh vertebrae
C. Cartilaginous nodes
D. Cupid’s bow contour
B. Fish vertebrae
What is the most common radiographic finding in the skull in hypoparathyroidism?
A. Calvarial thickening
B. Enlargement of the frontal sinuses
C. Osteosclerosis of the skull base
D. Enlargement of the sella turcica
A. Calvarial thickening
What does the Hawkins sign represent?
A. Osteosclerosis of the entire talus, signifying talar osteonecrosis
B. Osteopenia of the entire talus, representing adequate blood supply to the talus after injury
C. A subchondral radiolucency in the talar dome, representing adequate vascularity in the area
D. Patchy radiolucency of the talar dome, signifying osteonecrosis
C. A subchondral radiolucency in the talar dome, representing adequate vascularity in the area
A frontal pelvis radiograph of an 18-year-old black male who complains of hip pain and limping demonstrates bilateral osteosclerosis and early subchondral collapse of the femoral epiphyses. A reasonable differential diagnosis includes which of the following?
A. Legg-Calve-Perthes disease
B. steroid-induced osteonecrosis
C. Gaucher’s disease
D. sickle-cell anemia
D. Sickle-cell anemia
What is the term for the appearance of the skull in Hand-Schuller-Christian disease, where confluent areas of destruction may isolate islands of bone?
A. Floating skull
B. Osteoporosis eosinophilica
C. Geographic skull
D. Beveled skull
C. Geographic skull
Which of the following is a complication of osteonecrosis which may occur many years after, and may possibly be a result of the repair process?
A. Pathologic fracture
B. Sarcomatous degeneration
C. Repeat infarction
D. Septic arthritis
B. Sarcomatous degeneration
What percentage of Langerhans Cell Histiocytosis is made up by eosinophilic granuloma?
A. 5%
B. 20%
C. 50 %
D. 70%
D. 70%
Where is the most frequent site of bone infarction in sickle cell anemia?
A. proximal humerus
B. distal femur
C. proximal femur
D. proximal tibia
C. proximal femur
Of the following magnetic resonance imaging methods used in the diagnosis of transient osteoporosis of the hip, which is incompatible with the effective use of gadolinium-based contrast agent?
A. chemical shift
B. fat suppression
C. STIR
D. spin-echo
C. STIR
Which bone in the skull remains unaffected by the changes due to marrow hyperplasia in thalassemia?
A. Frontal
B. Parietal
C. Temporal
D. Occipital
D. Occipital
The development of osteoporosis eventually occurs due to an imbalance between bone resorption and bone formation. In which of the following conditions is there an increase in both bone resorption and bone formation, leading to osteoporosis?
A. Hyperparathyroidism
B. Osteoporosis due to steroid administration
C. Osteoporosis due to alcoholism
D. Osteoporosis due to heparin administration
A. Hyperparathyroidism
Which of the following conditions most resembles chronic hypervitaminosis A?
A. Diffuse idiopathic skeletal hyperostosis
B. Infantile cortical hyperostosis
C. Diaphyseal dysplasia
D. Metaphyseal chondrodysplasia
B. Infantile cortical hyperostosis
Which condition may be noted in manufacturers of illicit alcohol (“moonshine”), in which renal tubular injury leads to uric acid retention?
A. Hemarthrosis, most prominently in the knees
B. Blindness
C. Saturnine gout
D. Renal tubular acidosis
C. Saturnine gout
Which feature of thalassemia may also be seen in hereditary spherocytosis, although milder and much more rarely?
A. Hair-on-end skull
B. Rodent facies
C. Diaphyseal infarction
D. H-vertebrae
A. Hair-on-end skull
In the radiologic staging of osteonecrosis of the femoral head, which stage demonstrates the crescent sign?
A. Stage 1
B. Stage II
C. Stage III
D. Stage IV
C. Stage III
Which of the following allows differentiation between reflex sympathetic dystrophy and a primary articular disorder such as rheumatoid arthritis?
A. Absence of periarticular osteopenia in RSD
B. The bilateral and symmetric nature of RSD
C. Absence of intra-articular erosions in rheumatoid arthritis
D. Preservation of joint space in RSD
D. Preservation of joint space in RSD
What is a common feature of skull lesions in eosinophilic granuloma, due to non-uniform growth of the lesion?
A. Surrounding sclerosis
B. Soft tissue mass
C. Beveled edges
D. Extension across sutures
C. Beveled edges
In a patient with hemolytic anemia, a paraspinal mass of low signal intensity on T1-weighted images, with a rim of higher signal intensity similar to fat, is consistent with?
A. A paraspinal abscess due to Salmonella infection
B. Superimposed diffuse idiopathic skeletal hyperostosis
C. Extramedullary hematopoiesis
D. Paraspinal hematoma due to pathologic vertebral fracture
C. Extramedullary hematopoiesis
What causes the coarsened trabecular pattern in osteomalacia?
A. Loss of secondary trabeculae in spongy bone, leading to greater prominence of the remaining trabeculae
B. The deposition of unmineralized osteoid which coats the trabeculae and lines haversian canals
C. An overabundance of osteoid seams in the cortex
D. This pattern is created by radiographic summation of multiple Looser’s lines
A. Loss of secondary trabeculae in spongy bone, leading to greater prominence of the remaining trabeculae
On magnetic resonance imaging of osteochondritis dissecans, which of the following is an indicator of instability of the osteochondral fragment?
A. High signal intensity on T2-weighted images, surrounding the fragment
B. On T2-weighted images, low signal intensity interface between the fragment and parent bone
C. With gadolinium, lack of enhancement of the interface between the fragment and the parent bone
D. High signal intensity on T1-weighted images, surrounding the fragment
A. High signal intensity on T2-weighted images, surrounding the fragment
Which of the following crystal deposition diseases might be expected to occur in a patient with severe thalassemia?
A. Hemochromatosis
B. Wilson’s disease
C. Calcium hydroxyapatite crystal deposition disease
D. Multicentric reticulohistiocytosis
A. Hemochromatosis
What substance is found in abnormal amounts in the blood and urine of patients with hypophosphatasia?
A. Phosphoethanolamine
B. Mike’s Hard Lemonade
C. Glucose
D. Urinary hydroxyproline
A. Phosphoethanolamine
Which of the following is a synonym for familial idiopathic hyperphosphatasia, a rare disorder of bone occurring in children, which shares some of its skeletal characteristics with a common disorder of bone affecting older individuals?
A. Juvenile rheumatoid arthritis
B. Juvenile Paget’s disease
C. Hyperostosis frontalis interna
D. Familial expansile osteolysis
B. Juvenile Paget’s disease
In the metaphyses of growing long bones, bismuth toxicity may share which of the following radiographic manifestations with lead toxicity?
A. Dense transverse metaphyseal bands
B. Erlenmeyer flask deformity
C. Osteonecrosis
D. Cortical hyperostosis
A. Dense transverse metaphyseal bands
The major skeletal abnormality in hyperthyroidism is ?
A. Osteomalacia
B. Generalized osteoporosis
C. Subperiosteal resorption
D. Hypertrophic osteoarthropathy
B. Generalized osteoporosis
Vascular occlusion in sickle cell anemia may lead to extensive osteosclerosis and coarsening of the trabecular pattern in the pelvis, spine and long bones. Which of the following processes could safely be excluded in the differential diagnosis of this appearance?
A. Paget’s disease
B. Gaucher’s disease
C. Myelofibrosis
D. Blastic metastasis
B. Gaucher’s disease
You are asked to evaluate radiographs of a child with a known autosomal-recessive congenital disorder. The history includes multiple fractures with resulting deformities and shortening of the extremities. There are significant blood enzyme abnormalities. The radiographs demonstrate general deossification with a coarsened trabecular pattern, bowing deformities and old fractures. The most striking radiographic abnormalities are noted at the growth plates, which exhibit rickets-like changes, but there are also irregular, quite prominent radiolucencies which extend deeply into the metaphysis. These findings suggest…
A. Fanconi’s syndrome
B. Hypophosphatasia
C. Hereditary vitamin D-dependent rickets
D. Familial vitamin D-resistant rickets
B. Hypophosphatasia
Which of the following is commonly associated with polyvinyl chloride toxicity acro-osteolysis?
A. Multiple sclerosis
B. Chronic fatigue syndrome
C. A disorder similar to Raynaud’s phenomenon
D. Aplastic anemia
C. A disorder similar to Raynaud’s phenomenon
