Midterm Flashcards
(361 cards)
1
Q
3 types of osteoporosis
A
Generalized
Regional
Localized
2
Q
CATBITES for generalized osteoporosis
A
Congenital: OI
Acquired: no
Trauma: for whole body? Na, haha
Blood: sickle cell anemia and thalassemia
Infection: nope
Tumor: MM (in which sometimes osteoporosis is first finding), lyric mets,
Endocrine: Hyperparathyroidism
Surgery: steroids
Nutritional: vitamin d deficiencies (rickets in kids, osteomalacia in adults)
3
Q
Generalized osteoporosis causes (12)
A
Age Post menopause Steroids Heparin MM Mets HyperPTH Scurvy Osteomalacia Rickets Sickle cell anemia OI
4
Q
Regional osteoporosis causes (2)
A
Disuse/immobilization, RSD/CRPS
5
Q
Localized osteoporosis causes (3)
A
Infection
Inflammatory arthritis
Neoplasm
6
Q
Definition of osteoporosis
A
Low bone mass
Microarchitectural deterioration of bone tissue
=> enhanced bone fragility => increase in fracture risk
7
Q
Senile/post menopausal osteoporosis age range
A
5th-6th decades
8
Q
Senile/post menopausal osteoporosis gender preference and ratio
A
F>M 4:1
9
Q
Does senile/post-menopausal osteoporosis cause pain?
A
Only when complicated by fracture and deformity
10
Q
Useful lab findings in senile/post menopausal osteoporosis
A
None
11
Q
MC osteoporotic-related fracture states
A
Spine
Hip
Wrist
12
Q
Up to 30% of seniors wit hip fracture die within how many months of injury
A
6 months
13
Q
Pathology of senile/postmenopausal osteoporosis?
A
Unknown
14
Q
Discuss bone quality and amount in senile/post-menopausal osteoporosis
A
Normal bone quality, but deficient in amount
15
Q
What factors of senile/post-menopausal osteoporosis result in thinned cortex and trabecular accentuation?
A
Resportion of cortical and medullary bone
16
Q
What will you find on an x-ray of an individual with senile/post-menopausal osteoporosis? (10)
A
Cortical thinning
Altered trabecular patterns
PSEUDOHEMANGIOMATOUS
PENCIL THIN CORTICES and endplates
General radio lucency
PANCAKE PLANA (must ddx from serious pathology: mets and MM)
WEDGED TRAPEZOIDAL SHAPE (ddx: compression fractures)
BICONCAVE end plates (fish/codfish/hourglass at multiple contiguous levels)
ISOLATED END PLATE INFRACTION
SCHMORL’s nodes (MC tx and upper LX)
17
Q
Additional features of senile/postmenopausal osteoporosis
A
Colles, numeral neck, ankle malleoli fx’s
Insufficiency fx’s : sacrum (H/I/arc), pubis, medial femoral necks, tib/fib, calcaneus, metatarsals
18
Q
Proximal femora stress lines. Which one lasts the longest?
A
#1 principal compressive group lasts the longest #2 principal tensile group #3 secondary compressive group WARDS TRIANGLE
19
Q
Ddx for 24 year old with decreased bone mass
A
Thalassemia
OI
20
Q
Reflex sympathetic dystrophy syndrome (RSD)/Complex regional pain syndrome (CRPS) definition
A
Regional osteoporosis
Post-trauma bone disorder
ACUTE PAINFUL OSTEOPOROSIS
21
Q
What is the difference between RSDS and disuse osteoporosis?
A
PAIN!
22
Q
Age range for RSDS regional osteoporosis
A
> 50
23
Q
History for RSDS regional osteoporosis
A
History of recent trauma which may have been trivial
24
Q
RSDS progression
A
Progressive P, swelling and atrophy DISTAL TO TRAUMA SITE
25
Marrow fat that goes into a joint space ddx
Fx
26
Pathological feature of RSDS regional osteoporosis
Neurovascular imbalance, promoting osseous hyperemia
27
What will you see on an x-ray of RSDS regional osteoporosis
PATCHY, MOTTLED OSTEOPOROSIS
Later: uniform osteoporosis
NO JOINT DISEASE
28
Three forms of regional osteoporosis
RSDS
Disuse
Transient regional osteoporosis
29
When would changes appear on an x-ray from disuse & immobilzation osteoporosis
7-10 days, extreme by 2-3 months
30
4 radiological patterns of disuse atrophy
1. Uniform
2. Spotty
3. Bands (linear transverse subchondral/metaphysical lucent zones)
4. Cortical lamination or scalloping: loss of def in outer/inner cortical margins
31
If function is restored to the involved body part, what will happen in disuse and immobilization osteoporosis?
Normal appearance and complete resititution is anticipated
32
Transient regional osteoporosis cause
No associated etiology
33
Transient regional osteoporosis prognosis
Reversible and sudden
34
Transient regional osteoporosis has two entities:
1. Transient osteoporosis of the hip
| 2. Regional migratory osteoporosis
35
Transient regional osteoporosis of the hip affects what age group and what gender more?
20-40 years
| M>F
36
Transient osteoporosis of the hip is associated with what feminine condition and what side?
Haha pregnancy and left hip
37
Where would you see marked osteoporosis in transient osteoporosis of the hip?
Femoral head, less severe in femoral neck and acetabulum
38
Regional migratory osteoporosis affects what gender most?
M>F
39
Regional migratory osteoporosis prefers UE or LE?
LE (foot, ankle)
40
What describes regional migratory osteoporosis?
Localized, regressing, migratory osteoporosis
41
3 causes of localized osteoporosis
Inflammatory arthritis (RA)
Infection
Neoplasm
42
Define osteomalacia
Lack of OSTEOID MINERALIZATION leading to GENERALIZED BONE SOFTENING
43
Clinical features of osteomalacia (3)
Muscle weakness
Bone pain
Deformities
44
What 3 measures will be elevated in osteomalacia?
Parathormone, alkaline phosphatase, urinary hydroxyproline
45
Normal to decreased __ and __ will be seen in osteomalacia
Calcium and phosphorous
46
What condition would have osteoid seams?
Osteomalacia
47
What is an osteoid seam, and what condition would you see it in?
Increased amount of uncalcifed osteoid tissue seen in osteomalacia
48
What condition would have pseudofractures? What are pseudo fractureS?
Osteomalacia
| Probably insufficiency fractures healing with uncalcifed osteoid (osteoid seam)
49
What are 4 alternate terms used for pseudofractures? What condition are they associated with?
```
Osteomalacia
Increment fractures
Milkman' syndrome
Looser' lines
Umbau zonen
```
50
Radiological features associated with osteomalacia (4)
Decreased bone density
Coarse trabecular pattern
Loss of cortical definition
Pseudofractures (ddx pagers, fibrous dysplasia, rickets)
51
What is rickets?
Deficiency in vitamin D
52
What are the 3 forms of rickets?
1. Vitamin D deficiency
2. Renal osteodystrophy (renal rickets).
3. Renal tubular defect
53
Renal osteodystrophy is chronic or acute renal disease
Chronic
54
Renal tubular defect definition and what condition is it associated with?
Failure to resort phosphate in urine interferes with osseous mineralization due to lake of phosphate
Associated with rickets
55
Age group for rickets
6months to 1 year
56
Clinical features of rickets (7)
```
Growth plate swelling
Irritability
Deformities
Tetany
Delayed maturity
Weakness
Elevated alkaline phsophatase levels
```
57
Pathological feature of rickets
Growth plate cartilage hypertrophied
| Failure to mineralized or degenerate
58
Radiologic features of rickets (6)
```
Generalized osteopenia
Coarse trabecular changes
Widened growth plates
Architects (costal) rosary
Absent zone of provisional calcification
Frayed "paintbrush" and cupped metaphyses
```
59
What are the two defining features of rickets?
Widened growth plate and paint brush appearance
60
Scurvy is aka
Barlow disease
61
Scurvy is a deficiency fo what vitamin
C
62
How long does it take for scurvy to develop?
4-10 months
63
In what condition will you find capillary fragility?
Scurvy
64
What age will yo find scurvy?
4-14 months?
65
Where would you find spontaneous hemorrhages?
Scurvy
66
In what condition would you find costal rosary (scorbutic rosary)?q
Scurvy
67
What radiological features would you find in scurvy?
```
Abnormal growing ends of long bonds
Osteoporosis
DENSE ZONE OF PROVISIONAL CALCIFICATION (white line of franker)
RING EPIPHYSIS (wimberger's sign)
Pelken's spurs
Scorbutic zone (trummerfeld zone)
Subperiosteal hemorrhages
```
68
Insuffiency fractures and bowing is associated with what condition?
Rickets
69
Subperiosteal hemorrhages are due to what and promote what in what condition
Due to deficiency of intracellular cement which in turn promotes vascular fragility
70
Names associated with scurvy
- Barlow' disease
- white line of frankel (dense zone of provisional calcification)
- wimberger's sign (ring epiphysis)
- pelken's spurs
- trummerfeld zone (scorbutic zone)
71
Describe pathogenesis behind hyperparathyroidism
Increased PTH activity => osteoclasts effect on skeleton
72
Three forms of hyperparathyroidism
Primary (Parathyroid tumor)
Secondary (renal disease)
Tertiary (renal dialysis)
73
Gender greatest affected by hyperparathyroidism
F>M, 3:1
74
Age group of hyperparathyroidism
30-50 years
75
Clinical features of hyperparathyroidism (5)
```
Weakness
Lethargy
Poly dips is
Polyuria
Elevated ALPase and parathormone levels
```
76
What levels are elevated in hyperparathyroidism? (2)
Elevated alkaline phosphatase and parathormone levels
77
Soft tissue calcification ddx list
Hyperparathyroidism
Scleroderma
SLE
78
tumor of ribs ddx
Malignant: Mets
Benign: fibrous displasia
If also Mandible: browns tumor
79
Pathological features of hyperpTH
Osteoclasts and osteolytic resorption with fibrous tissue displacement (osteitis fibrosis cystica)
80
Define osteitis fibrosis cystica and what condition it is associated with
Hyper PTH
| Osteoclastic and osteolytic resorption with fibrous tissue replacement
81
Define Brown's tumors and are pathological feature of which condition?
HyperPTH
| D/t hemorrhagic giant cell proliferation
82
Hallmark pathological feature of HyperPTH
Subperiosteal bone resorption, specifically of radial side of 2-3rd phalanges
83
5 radiological features associated with hyperpTH
```
Osteopenia
Accentuated trabecular patterns
Subperiosteal resorption
Loss of cortical definition
BROWN TUMORS
```
84
Target sites of hyperPTH
Hand!
Skull!
Spine!
85
What is seen in the hand of an individual with HyperPTH
Subperiosteal resorption of the radial margins of proximal and middle phalanges of 2nd and 3rd digits with acroosteolysis
86
What is seen in the skull of an individual with hyperPTH
Salt and pepper, resorption of lamina dura (teeth!)
87
What is seen in the spine of an individual with hyperPTH
Osteopenia, trabecular accentuation, end plate concavities
RUGGER JERSEY SPINE
WIDENED SI JINOTS
88
Ddx for sclerotic pubic rami in x-ray (3)
1. Osteitis pubis
2. Infection
3. HPT
89
Ddx for widened SI joint
1. AS
2. Reiters
3. Psoriatic
90
Radiological features of HPT (ST changeS) (4)
Nephorcalcinosis
Renal calculus
Chondrocalcinosis
Calcification in various periarticular tissues and viseral organs
91
Causes of acromegaly? (2)
Pituitary eosinophilia ademona = excess growth hormone AFTER growth plates have fused
Excessive growth hormone production before growth centers close = GIGANTISM!
92
5 clinical features of acromegaly
Prominent forehead
Thickened tongue
Broad and large hands
Predisposition to degenerative arthritis (esp. spine and weight bearing joints)predisposition to CTS probs
93
Pathological features of acromegaly (3)
Activation of periosteum appositional new bone, articular cartilage proliferation and subcutaneous hyperplasia
94
Radiologic features of the foot specifically in acromegaly?
Heel pad >20mm (1 inch)
95
Why would sella turcica be enlarged? And this is seen most predominantly in what condition?
D/t pituitary neoplasm
| Acromegaly
96
What is prognathism? And what condition is it associated with?
Widened mandibular angle
| Acromegaly
97
Radiological features in the skull in someone with acromegaly (4)
Sella turcica enlargement, sinus overgrowth, malocclusion, prognathism
98
Radiological features of the hand in someone with acromegaly (4)
Widened shafts, bony protuberances, enlarged distal tufts (spade-like), widened joint spaces
99
Spade-like tufts are associated with what condition?
Acromegaly
100
Why will you see widened joint spaces in acromegaly?
Cartilage overgrowth! Duh haha
101
What is going to happen in an individuals joints who has acromegaly?
Wear out at earlier age in odd spots = DJD
102
Compression fractures at every level. What MUST be on your ddx? What else?
Corticosteroid use.
| Cushing's disease
103
Excessive glucocorticoid steroids form adrenal cortex = what condition
Cushing's
104
A neoplasm in which area can produce similar clinical features as cushings?
Anterior pituitary
105
Where does a patient store fat in cushings? What is it called?
Upper thorax (buffalo hump) and face (moon face)
106
Clinical features of cushings (3)
Accelerated hair growth and HTN
Moon face and buffalo hump
Purple stria on abdomen and axillae
107
Air in the bone vs. air in the disc. Name it!
Bone: cushings! Collapsed vertebra d/t osteonecrosis!
Disc: vacuum phenomenon found in DJD
108
Osteoporosis of cushing's disease radiological findings (2)
Thinned vortices, density diminished
| BICONCAVE END PLATE CONFIGURATIONS
109
Osteonecrosis of cushing's/steroid induced osteonecrosis radiological finding
Vertebral body collapse - after steroid meds - d/t ischemic necrosis (called intervertebral vacuum cleft sign)
110
Where is osteonecrosis d.t cushings/steroid-induced osteonecrosis found? (3)
Femoral and numeral heads
Distal femora
Talus
111
Skeletal dysplasias (4) + sclerosis bone dysplasias (3)
```
Achondroplasia
OI
Marfan's
Cleidocranial dysplasia
+
Osteopetrosis
Osteopoikilosis
Melorheostosis
```
112
Achondroplasia aka (3)
Chondrodystrophia fetalis
Chondrodystrophic dwarfism
Micromelia
113
What is achondroplasia?
Hereditary, autosomal dominant disturbance in epiphyseal-chondroblastic growth and maturation
114
What causes achondroplasia?
Unknown
Parents are normal in 90% of cases
Two achondroplastics = may manifest severe form which is usually lethal within the first weeks of life
115
Average height of achondroplasia?
50 inches!
116
What is rhizomelia and what condition is it associated with?
Long bones shorted especially proximal ones
| Achondroplasia
117
Is UE or LE more affected in achondroplasia?
UE
118
Explain the head of an individual with achondroplasia
Large cranium, prominent forehead and depressed nasal bridge
119
What is the spinal column like in an individual with achondroplasia?
Length = normal, thus dwarfism is due to limb shortening yo!
120
Thoracolumbar kyphosis develops in which skeletal dysplasia condition?
Achondroplasia
121
Rolling gait is caused by the posterior tilt of the pelvis and posterior angulation of the hip joints is charactersistc of which skeletal dysplasia?
Achondroplasia
122
MC cause of ivory vertebra:
Osteoblastic mets
| Hodgkin lympha
123
Posterior body scalloping is noted in ___ anterior body scalloping noted in ___
Achondroplasia; hodgkins lymphoma
124
Trident hand is associated with what skeletal dysplasia
Achondroplasia
125
What is trident hand
Separation of 3rd and 4th digits and inability to approximate them in extension
126
May die at birth due to a difficult delivery, small foramen magnum or constricted thorax are clinical features of which condition
Achondroplasia
127
Small foremen magnum is seen in which condition
Achondroplasia
128
Hydrocephalus and small foramen magnum can lead to cord compression are neurological complications of which skeletal displasia
Achondroplasia
129
Most significant complication in adulthood of achondroplasia
Congenital spinal stenosis = often leading to paraplegia!!!
130
Four clinical syndromes caused by spinal stenosis... which is most commonly seen in which condition?
ACHONDROPLASIA
1. NR compression d/t disc herniation/osteophyte formation
2. Transverse myelopathy over several years d/t severe kyphosis
3. Acute transverse myelopathy with sudden paraplegia following trauma
4. Intermittent claudication of cauda equine d/t ischemia
131
Define brachycephaly
Large cranium though short in ant-post dimension seen in achondroplasia
132
Prominent frontal bones and small nasal bones
Achondroplasia
133
Metaphysical cupping
Splayed bone ends seen in achondroplasia
134
Champagne glass pelvis
Achondroplasia
135
Tell me about the discs of individuals with achondroplasia
Increased, height of discs = vertebral bodies
136
Interpedicular spaces of achondroplasia
Decreased in lumbar region = narrowing of spinal canal
137
Bullet nose vertebra
Achondroplasia
| Angular kyphosis develops at TL = resulting in this
138
Pedicles of achondroplasia
Short and thick
139
Spatulatled or paddled shaped pelvis is d/t
Tilting of the pelvis
| Achondroplasia
140
Key features of achondroplasia (10)
```
Champagne glass pelvis
Stenosis foramen magnum
Basilar impression is frequent
Brachycephaly
Small interpedicular spaces in lumbar spine
Bullet-nosed vertebra
Spatulated or paddle shaped pelvis
Trident hand
Rhizomelia
Big booty big booty big booty on x-ray
```
141
Ddx of achondroplasia (3)
Mucopolysaccharidoses, trisomy, spondyloepiphyseal dysplasia
142
Most serious involvement in osteogenesis imperfecta
Skeleton but can see changes in ligaments, skin, sclera, inner ear and dentition
143
Synonyms of OI (4)
Osteopsathyrosis idiopathica, jollities Ossian, fragilitas Ossian, lobstein's disease
144
3 major clinical criteria for diagnosis of OI
Only 2 need to be present:
1. Osteoporosis with abnormal fragility of skeleton
2. Blue sclera
3. Abnormal dentition (dentinogenesis imperfecta)
145
Hearing loss, generalized ligamentous laxity, episodic sweating and abnormal temperature regulation, easy bruising, hyperlastic scars and premature vascular calcification are other findings of which skeletal dysplasia?
OI
146
What are the forms of OI?
1. Congenita = lots of stillborn and infant mortality
| 2. Tarda (normal life expectancy)
147
What are the 2 main subdivisions of OI tarda?
Type 1: acquired bowing
| Type 2 no bowing deformities
148
What is your ddx of type 1 OI Tarda?
Rickets!!! D/t acquired bowing
149
Trivial trauma fractures, blue sclera, brown choroid, "Saturn's ring" around cornea, blue-ish gray to yellowish-brown opalescent teeth, otosclerosis, abnormal temperature regulation, crappy platelet aggregation, growth retardation, LE more affected than others clinical features of what condition
OI
150
Enzyme deficiency of ATPase may be cause of what condition?
OI
151
Cardinal features of OI (3)
Decreased bone density
Pencil-thin vortices
Multiple fractures
152
3 subgroups of OI based on radiographic findings:
Thin and gracile bones
Short thick bones
Cystic bones
153
Ddx of pseudotumors found in OI?
Osteosarcoma
154
What is a pseudotumor and what is it found in?
Excessive callus formation
155
5 radiological features of OI
```
Wormian bones
Playtbasia (w/basilar impression)
Kyphoscoliosis
Biconcave lens vertebra
Premature DJD and protrusio acetabuli
```
156
Midline defects (SBO)
Cleidocranial dysplasia
157
Accessory ossification center in metacarpal is indicative of what skeletal dysplasia?
Cleidocranial dysplasia
158
Brachycephaly, wormian bones, small faces d/t underdeveloped sinus are indicative of what skeletal dysplasia
Cleidocranial dysplasia
159
Cases without clavicular or cranial findings are called
Mutational dysostosis
| Cleidocranial dysplasia
160
Narrow or cone shaped chest indicative of which condition
Cleidocranial dysplasia
161
MC complaints of cleidocranial dysplasia patients
Abnormal dentition with severe caries and periodontitis
162
Widening of principal sutures (sagittal and coronal) giving a hot cross-bun appearance is indicative of which skeletal dysplasia
Cleidocranial dysplasaia
163
Enlarged foramen magnum indicative of which skeletal dysplasia? Which features a stenotic foramen magnum?
Cleidocranial dysplasia; achondroplasia
164
What percent of cases of cleidocranial dysplasia has a completely missing clavicle?
10%
165
Small and underdeveloped pelvic bones = small pelvic bone seen in which skeletal dysplasia
Cleidocranial dysplasai
166
Shortening of radius with abnormal wrist articulation is occasionally seen in which skeletal dysplasia
Cleidocranial dysplasia
167
3 complications of cleidocranial dysplasia
Hearing loss
Dental problems
Dislocations of shoulders and hips with scoliosis
168
Scoliosis is common in which skeletal dysplasia
Marfan's
169
key features of marfan's (4)
Scoliosis, C1-2 instability, dissecting aortic arch aneurysms, arachnodactyly
170
Hyperkyphosis seen in which skeletal dysplasia
Marfan's
171
These individuals are generally >6 feet. Not gigantism
Marfan's
172
Ehlers danlos causes the same joint laxity as this condition
Marfan's
173
Hip dislocations, genu recurvatum, patellar dislocations and pes plants are clinical features of which condition
Marfan's
174
Myopia and contracted pupils (2' to absent dilator m of pupil) encountered in which condition
Marfan's
175
Floppy valve syndrome. Define and indicate which condition
Dilation of ascending aorta with valve abnormalities => L sided insufficiency
Marfan's
176
Elongation of extremities without increase in width classic finding of which condition
Marfan's
177
Osteoporosis Is a feature of marfan's. T/F
False
| However, vortices are thinned and trabeculae are delicate
178
Widened spinal canal, posterior body scalloping of vertebral bodies present in which condition
Marfan's.
| Note: posterior body scalloping is best finding in achondroplasia
179
Pectus excavatum deformity with elongated ribs seen in which condition
Marfan's
180
Homocystinuria seen in which condition
Marfans
181
What 4 features would you use to differentiate marfan's from others
Look for osteoporosis
Vertebral body flattening
Mental retardation
Homocystinuria
182
3 sclerosis bone dysplasias
Osteopetrosis
Osteopoikilosis
Melorheostosis
183
Sclerosis bone dysplasias MC feature
Increase in bone density!
184
Sclerosing bone dysplasias feature a disturbance of bone...
remodeling and formation
185
Osteopetrosis defining features (2)
Rare hereditary and familial bone abnormality
| Lack of resorption of normal primitive osteochondroid tissue
186
Two forms of osteopetrosis
1. Benign autosomal dominant
| 2. Severe malignant autosomal recessive (consanguinity! Hah)
187
Synonyms of osteopetrosis (6)
Albert-schonberg's disease
Osteosclerosis
Osteopetrosis generalisata, osteosclerosis generalisata, marble bones, chalk bones
188
CHALK BONES is a synonym for which condition
Osteopetrosis
189
Severe malignant autosomal recessive osteopetrosis is found when? And what happens next?
Infancy
| They die within second year of life
190
Severe anemia, thrombocytopenia, hepatosplenomegaly, lymphadenopathy, failure to thrive, osteomyelitis are features of
Severe malignant autosomal recessive osteopetrosis
191
FAILURE TO THRIVE
Osteopetrosis - severe malignant autosomal recessive
192
Possible optic nerve atrophy is seen in which condition
Due to cranium involvement
| Osteopetrosis
193
What are two known sequela of osteopetrosis
Leukemia and sarcoma
194
Most frequent cause of death is (2)
Massive hemorrhage and recurrent infection
195
How are 50% of osteopetrosis causes discovered?
By accident! As they're asymptomatic
196
Ddx of osteopetrosis (2)
Idiopathic hypercalcemia and heavy metal poisoning
197
Is CMT contraindicated in osteopetrosis?
Yes! Bones are brittle
198
Lab findings in osteopetrosis (3)
Anemia
Thrombocytopenia
Serum ca2+ elevated
199
Osteoclasts unresponsive to PTH and unable to resorb bone and cartilage are pathological features of which condition
Osteopetrosis
200
BONE WITHIN A BONE APPERANCE
ERLENMEYER FLASK DEFORMITY
SANDWICH VERTEBRA
Are classic features of which condition
Osteopetrosis
201
Bone within a bone appearance
Striations seen in osteopetrosis
202
Can't remodel bone thus producing flared metaphysis. Name this and the associated condition
Erlenmeyer flask deformity of osteopetrosis
203
Long bones are flared and elongated metaphysis are radiological features associated with which condition
Osteopetrosis
204
Uniformly dense vertebra, dense bands adjacent to END plates with normal appearing midbody. Name it and the associated condition
Sandwich vertebra and osteopetrosis
205
Pathological fractures are associated with which condition
Osteopetrosis
206
Small round or ovoid radiopacities appearing in juxtaarticular regions of bone is characteristic of which condition
Osteopoikilosis!!
207
Synonyms of osteopoikilosis (2)
Osteopathic condensates disseminate
| Spotted bones
208
25% of these cases have cutaneous abnormalities including dermatofibrosis lenticularis disseminata, predisposition to keloid formation and sclerodeerma like lesions
Osteopoikilosis
209
Normal lab findings are seen in which conditions
Marfan's
Osteopoikilosis
Melorheostosis
210
Spongy bone remodeling related to mechanical stress is characteristic of which condition
Osteopoikilosis
211
This condition may be a anifestation of a metabolic disorder of connective tissue
Osteopoikilosis
212
The histology of this condition resemble a solitary bone island
Osteopoikilosis
213
Symmetric lesions with predilection for long tubular bones, carpals and tarsals in jUXTA-ARTICULAR POSITION are radiologic features of which condition
Osteopoikilosis
214
Which condition is associated with osteopathic striata and melorheostosis
Osteopoikilosis
215
Ddx for osteopoikilosis (3)
Blastic mets
Tuberous sclerosis
Mastocytosis
216
Rare, sclerosis bone dysplasia
Melorheostosis
217
Wax flowing down a lighted candle
Melorheostosis
218
Leri type of osteopetrosis, osteosarcoma eberneizzante monomelica
Flowing hyperostosis are synonyms for which condition
MELORHEOSTOSIS
219
What is the most common presenting symptom of melorheostosis?
PAIN!!!!
220
What is seen more in adults than in children in helorheostosis? (2)
Joint swelling and limitation of motion
221
Genu varus, foot valgus and dislocation of patella are common in which condtion?
MELORHEOSTOSIS
222
An amorous pigmentation, scleroderma like atrophy of skin and muscle wasting are soft tissue changes seen in which condition
Melorheostosis
223
These conditions most commonly affect lower limbs (4)
Regional migratory osteoporosis
OI
Marfan's - LE exhibits greater overgrowth than upper
Melorheostosis
224
What begins more proximal and progresses dismally?
Melorheostosis
225
Ddx for melorheostosis (3)
Osteoblasts mets
Mastocytosis
Tuberous sclerosis
226
Most marked roentgen feature
Cortical thickening in a streaked or wavy pattern
227
Hyperostotic bone protruding under periosteum and usually follows along one side of long bone are characteristic of which condition
Melorheostosis
228
Hematologist conditions (5)
```
Sickle cell anemia
Thalassemia
Hemophilia
Aneurysms
Osteonecrosis conditions
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229
Chronic congenital hereditary hemolytic anemia characterized by abnormal Hb structure
Sickle cell anemia
230
Splenomegaly and sometimes gallstones are associated with this condition
Sickle cell anemia
231
H shaped vertebra, bioconcave, sclerotic are characteristic of which condition
Sickle cell anemia
232
Abdominal crises, jaundice, bone pain, DACTYLITIS, infections, gallstones, cardiac and renal failure, hepatosplenomegaly and marrow displasia are seen in which condition
Sickle cell anemia
233
Which form is most symptomatic in sickle cell anemia
HbS-S
234
Bone changes due to marrow hyperplasia, ischemia and necrosis are characteristic of which condition
Sickle cell anemia
235
Major signs of sickle cell anemia (9)
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Generalized osteoporosis (marrow hyperplasia)
Thin cortices (increased radiolucency)
Coarse trabeculae
Large vascular channels
Widened medullary cavity
Growth deformities
Epiphyseal ischemic necrosis
Medullary infarcts (metaphysis or diaphysis)
Secondary salmonella osteomyelitis
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236
What are some characteristics found in the spine of a sickle cell anemia patient
Vertebral bodies are osteoporotic
| Deformed end plates with central depression (hyperplasia of central portion of vertebra)
237
step off, fish, H vertebra are deformities found in which hematologic condition
Sickle cell anemia
238
Vertebral body collapse seen in which hematologist condition
SICKLE CELL ANEMIA
239
Osteomyelitis d/t staph aureus and salmonella are seen in which hematologist condition
Sickle cell anemia
240
Hereditary disorder of hemoglobin synthesis producing anemia is what hemotoligic condition
Thalassemia
241
Synonyms of thalassemia
Cooley' anemia and mediterranean anemia
242
Pallor, underdevelopment, organometallic, altered fancies, abnormal blood exam are characteristic of which condition
Thalassemia
243
Marrow hyperplasia! (Hair on end appearance in skull!) characteristic of which condition
Thalassemia!
| Marrow hyperplasia is also seen in sickle cell anemia
244
Marrow hyperplasia, cortical thinning, widened medullary cavity, loss of tubulation, coarse trabecular (honeycomb), growth disturbances, fractures, chondrocalcinosis and hemochromatosis, granular osteoporosis and fish vertebrae are characteristic of which condition
Thalassemia
245
HONEY COMB
Hair on end appearance in skull
Rodent fancies
Are characteristic of which condition
Thalassemia!
246
Describe the spine seen in thalassemia (3)
Coarse trabeculae
Thin vortices
End plates normal
247
Describe the skull of thalassemia (2)
Frontal bone shows earliest and most prominent changes:
| Hair on end: granular, widened dipole, vertical radiating spicules
248
Sinuses of thalassemia
Obliterated, rodent fancies
249
Chest of thalassemia (5)
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Cardiomegaly
Posterior mediastinal masses
Opaque liver and lymph nodes
Rib expansion
Coarsened trabeculae
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250
Long bones in thalassemia
Osteoporotic and lack normal metaphysis/diaphysis concave constriction, sometimes erlenmeyer flask deformity
251
Deficiency of various clotting factors
Hemophilia
252
Hemophilia' gender preference
Male
253
Hemorrhage within joints, especially knee, ankle and elbow (BI/symmetrical)
Hemophilia
254
Lack of factor VIII is classic __
Hemophilia A;
| Factor IX is hemophilia B
255
Repeated hemarthrosis precipitates synovial proliferation similar to what 2 conditions
Pan us, similar to gout and CPPD
256
Fibrosis, bone erosion, osteoporosis, growth disturbances, late cartilage degeneration (cysts and sclerosis) are characteristic of what conditions
Hemophilia
257
Dx for hemophilia (1)
Juvenile RA
258
Mc joints affected in hemophilia (3)
Knee
Ankle
Elbow
259
Enlarged ephiphyses, widened intercondylar nothced and squared inferior patella are characteristic of which condition
Hemophilia
260
Could see fluid in lung fields - consolidation seen in which condition
Hemophilia
261
Atherosclerosis is MC cause of which condition. List others
Aneurysms
| Infection, stenosis, syphilis, arteritis
262
Abdominal aortic aneurysm is seen at which lumbar levels
L2-4 ST mass
Peripheral rim calcifcation
Vertebral erosions (oppenheimer)
263
How big does an aneurysm have to be to be AAA in plain film
3.8 cm
264
Diagnostic modality of choice for AAA
US or CT
265
Chance of rupture
<5 cm = < 5%
>6cm = 15%
>7cm = 75%
266
General features of aortic arch aneurysm (4)
Atherslcoris, syphilis, trauma, marfan's
267
2nd MC abdominal aneurysm site
Common iliac arteries
268
3rd MC abdominal site
Splenic artery aneurysm
269
Osteonecrosis aka
AVN, ischemic necrosis, aseptic necrosis
270
Two types of osteopetrosis
1. Epiphyseal necrosis
| 2. Metaphysical/diaphyseal infarcts
271
Epiphyseal necrosis may remain clinically silent until
Articular collapse occurs
272
Metaphysical/diaphyseal infarct ddx - these are asymptomatic
Enchondroma
273
Epiphyseal infarcts are self limiting over 2-8 years, progressing through 4 phases
Avascular
Revascularization
Repair
Deformity
274
7 features of avascular phase
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Loss of blood supply
Bone death
Cartilage growth
Low grade synovitis
Disuse, hypermedia
No clinical findings
Normal x-ray
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275
5 features of revascularization phase of osteonecrosis
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Neovascularization periphery center
Subchondral fx
Fibrosis and granulation tissue (bone resorption)
Woven bone
Altered biomechanical stress
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276
2 features of repair phase of osteonecrosis
Bone deposition
| Regression of osteoclasis
277
2 features of deformity phase of osteonecrosis
Normal bone
| Femoral head flattening
278
Epiphyseal osteonecrosis. Describe it. (6)
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Collapse of articular cortex
Fragmentation
Sclerosis
Mottled trabecular pattern
Subchondral cysts
Subchondral fx
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279
Cortical infarcts are what seen where
Periostitis and patch loss of density seen in distal femur, proximal tibia and proximal humerus
280
Ddx for osteonecrosis
| 3
Bone infarct
Enchondroma
Chondrosarcoma
281
Spontaneous osteopetrosis of femoral head in adults cause:
Avascular necrosis of femoral head from unknown cause
282
Synonym of spontaneous osteonecrosis of femoral head in adults
Chandler's disease
283
Male:female ratio and age of spontaneous osteopetrosis of femoral head in adults
4:1, 30-70 years old
| 50% bilateral
284
Necrotic wedge at anterosuperior aspect of head separated by fibrous tissue and sclerotic margin of abnormal bone
Spontaneous osteopetrosis of femoral head in adults
285
Need AP and frog leg views to diagnosis what condition
Spontaneous osteonecrosis of femoral head in adults
286
Signs of spontaneous osteopetrosis of femoral head in adults (6)
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Anterosuperior aspect
Cortical collapse
Cystic radiolucencies
Sclerosis
Fragmentation
Degenerative joint changes, medial periosteal bone apposition, subchondral fracture, trabecular alteration and wedged or semilunar configuration
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287
Subchondral fracture seen in what condition
Spontaneous osteonecrosis of femoral head in adults
288
Spontaneous osteonecrosis of the knee cause and affects what area
Unknown; medial console of distal femur in adults
289
Epidemiology of spontaneous osteopetrosis of the knee
Females 40-60 years old
290
Ddx spontaneous osteonecrosis of the knee (1)
OD
291
Legg-calve-perthes disease occurs in what age group and what gender
3-12
5:1 male predominance
10% bilateral
292
Legg-calves-perthes disease lateral develops into waht
Secondary DJD
293
Four stages of LCP disease
Avascular
Revascularization
Repair
Deformity
294
Is cartilage affected in LCP disease?
No
295
How long does LCP disease work?
2-8 years
296
What is best for diagnosising LCP disease in early stages?
MRI
297
Soft tissue swelling, small obturator foramen, increased medial joint space, small femoral head, wide teardrop, epiphyseal fragmentation, sclerosis
Leg-Calve-Perthes disease
298
Short, wide metaphysis, with cysts; enlarged greater trochanter, head deformities
LCP disease
299
Lateral displacement treated with correctional osteotomy to promote remodeling of cartilage and femoral neck in which condition
LCP disease
300
Keinboch's disease definition
Avascular necrosis of carpal lunate
301
LCP disease clinical features (4)
Painful limp
Reduced mobility
Muscle atrophy
Trendelenburg test positive
302
Gender preference of keinboch's disease
Males 9:1
303
Age group for keinboch's disease
20-40 years of age
304
Classic findings of keinboch's disease
Severe pain with wrist or middle finger extension
305
Clinical features of keinboch's disease (2)
History of acute or chronic trauma
| Worsening pain and disability
306
Keinboch's disease pathological features (4)
AVN d/t cut off blood supply
Resorption
Deposition of calcium appears as chalky white on x-ray
Fragmentation and collapse
307
Radiological features of keinboch's disease (3)
Increased density (patchy sclerosis)
Lucent areas
Articular collapse
Decreased size of lunate
308
Osgood schlatter's disease clinical features (4)
M>F
11-15 years of age
History of single violent injury or repetitive flex-ext movements
Pain/swelling and tenderness over tibial tubercle
309
BI lateral views with slight medial rotation using high and low kV to diagnosis this condition
Osgood-schlatter
310
5 radiological features of osgood-schlatter's disease
Displaced skin contour
Thickened and indistinct patellar ligament
Blurred and opacified infrapatellar fat
Isolated irregular ossicles
Anterior surface irregularities in tuberosity
311
Scheuermann's disease is classically of what part of the spine
Thoracic
312
Scheuermann's affects what age group
Adolescents
313
Synonyms of scheuermann's disease (3)
Juvenile kyphosis, traumatic epiphysitis, vertebral epiphysitis
314
Gender preference of scheuermann's disease and age range
M>F, 13-17 years old
315
Pain, fatigue and defective posture most notable findings of which disease
Scheuermann's
316
SCHMORL'S NODES, multiple at 3 contiguous levels sign of what in thoracic spine, decreased disc height and increased kyphosis, elongation of vertebral bodies in AP dimension
Scheuermann's
317
Disorder of adolescence where small segment of subchondral bone undergoes ischemic necrosis secondary to trauma or primary vascular occlusion and may form loose body
OCD
318
OCD common age and gender preference and are of body
11-20 years
M>F
Knee and ankle
319
Other common spots of OCD (8)
Talus, elbow, patella, hip, foot, shoulder, wrist, TMJ
320
AVN of metatarsal head MC second, sometimes seen in third
Freiberg's disease
321
Gender preference of freiberg's disease and age group
F>M 3:1
| 13-18
322
High heels and young ballerinas sometimes a cause of this disease
Freiberg's disease
323
AVN secondary to trauma or increased stress in 2nd metatarsal
Freiberg's disease
324
Radiological features of freiberg's disease (4)
Articular cortex flattened and collapsed
Sclerosis: stress reaction seen in shaft of metatarsal
Lucency with cyst formation
Widened joint space
325
Ddx of widened joint space (4)
Acromegaly d/t cartilage proliferation
HPT due to subchondral resorption
Thickened metatarsal cortex
"Morton's foot"
326
What is morton's foot and what condition is it associated with?
Elongated second metatarsal seen in freiberg's disease
327
Kohler's disease
NAVICULAR AVN
328
Gender preference and age of kohnler's
M>f
| 5 years old
329
Normal calcaneal apophysis radiologic features
Fragmented, irregular sclerotic calcaneal apophysis is normal presentation AND NOT RELATED TO SEVER'S DISEASE! This is a normal finding!
330
SCFE is what type of salter harris dislocation?
One!!!
331
What is type 1 S altar harris dislocation?
Fracture through growth plate, goes through cartilaginous growth plate, separates epiphysis and metaphysis
332
SCFE age range
10-15 years old
333
What happens in SCFE?
Femoral neck slips off femoral head
334
Usually unilateral but what percent occurs bilaterally
40%
335
More common in what gender
Males, but bilateral is mc in females
336
SCFE associated with (3)
Renal osteodystrophy
Rickets
Radiotherapy
337
BI AP frog leg views are essential to diagnosis what condition
SCFE
338
Slippage in what direction for SCFE
Posteromedial
339
Features of SCFE (4)
Abnormal Klein's line
+ trendelenburg
Capener's sign
Tear drop distance increased
340
CIA
BI AVN
| D/t corticosteroids, idiopathic, alcoholism
341
SIT
Unilateral AVN
| D/t surgery, idiopathic, trauma
342
What imaging modality shows AVN changes before any other?
MRI
343
What percent of the time is leg calves bilateral?
10%
344
T2 shows what as darker?
Bone, fluid is lighter
345
T1 weighted, what is darker?
Fluid, bone is lighter
346
What's STIR?
Like T2 but suppressed fat
347
Crescent sign is seen where with what condition and what is it
Patchy sclerosis above articular bone = lucency under the bone = crescent sign
Subchondral fracture under articular bone that falls a way
DEIFNITELY AVN
348
MC in african american
Sickle cell anemia
349
MC in mediterranean and asian
Thalassemia
350
Hemophilia MC in M/F?
Males
351
Old white smoking males
AAA
352
Cushings disease can cause AVN?
Yes, all over the place
353
Hand and foot disease/dactilytis associated with which condition
Sickle cell anemia
354
Dactylitis mimics what
An infection. Seen in sickle cell anemia
355
What is a complication of sickle cell anemia?
Osteomyelitis
356
What is thalassemia?
Genetic blood disorder that causes body to have less hemoglobin thus less healthy red blood cells, = anemia
357
RODENT FACES
THALASSEMIA
358
Hair on end
Thalassemia
359
Marrow hyperplasia
Thalassemia
360
Honeycomb appearance
Thalassemia
361
H shaped vertebrae
Sickle cell anemia
