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MSK Diffuse Bone Dz Flashcards

1
Q

osteoporosis –> Tscore?

A

< -2.5

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2
Q

what is Zscore?

A

SD from age-matched F

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3
Q

osteoporosis –> vit/nutrient def etiology? (4)

A
  • osteomalacia
  • alcohol
  • hypoPh
  • scurvy
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4
Q

osteoporosis –> endocrine etiology? (2)

A
  • hyperPTH

- Cushing dz

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5
Q

focal osteoporosis –> etiology? (3)

A
  • disuse
  • reflex sympathetic dystrophy
  • transient regional osteoporosis of hip
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6
Q

what is Pelkin’s fx?

A

metaphyseal corner fx

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7
Q

osteoporosis –> genetic etiology? (3)

A
  • OI
  • Gaucher dz
  • anemia
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8
Q

scurvy –> signs? (2)

A
  • Wimberger ring sign

- Pelkin’s fx

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9
Q

what is Pelkin’s fx?

A

metaphyseal corner fx

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10
Q

what is osteomalacia?

A

vitD def –> faulty mineralization of bone matrix

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11
Q

what is Looser zone? highly specific for what condition?

A

osteomalacia –> cortical stress fx –> fill w abnormal, poorly mineralized osteoid –> radiolucent line thru cortex

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12
Q

Looser zone –> MC location? (3)

A
  • prox femur –> media
  • distal scapula
  • pubic bone
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13
Q

acromegaly –> foot –> charact finding? measuremt?

A

heel-pad thick >24mm

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14
Q

what is 1ary hyperPTH?

  • Ca level?
  • Ph?
A

PTH adenoma –> high PTH

  • high Ca
  • low Ph
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15
Q

what is 2ary hyperPTH?

  • Ca level?
A

renal fail –> low Ca –> inc PTH

  • Ca level normal
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16
Q

what is 3ary hyperPTH?

A

chronic 2ary hyperPTH –> PTH gland lose ctrl –>

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17
Q

hyperPTH –> hands –> subperiosteal resorb –> MC location?

A

2nd & 3rd middle phalanx –> radial aspect

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18
Q

hyperPTH –> clavicle –> subperiosteal resorb –> MC location?

A

acromial aspect

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19
Q

hyperPTH –> knee –> subperiosteal resorb –> MC location?

A

prox tib –> metaphysis –> medial

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20
Q

hyperPTH –> teeth –> subperiosteal resorb –> MC location?

A

lamina dura surrounding tooth socket

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21
Q

hyperPTH –> what other condition may occur? MC with 1ary/2ary/3ary hyperPTH?

A

1ary hyperPTH –> CPPD

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22
Q

hyperPTH –> ST calc, periosteal rxn, sclerosis –> MC with 1ary/2ary/3ary hyperPTH?

A

2ary

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23
Q

hyperPTH –> comp? (2)

A
  • insuff fx

- lig/tendon rupture

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24
Q

what is renal osteodystrophy?

A

chronic renal fail:

  • abn vit D metab –> osteomalacia
  • 2ary hyperPTH
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25
renal failure --> risk for what bone disorders? (4)
- renal osteodystrophy - osteomyelitis - avascular necrosis (if on steroid) - amyloidosis (chronic dialysis)
26
differentiate: osteomalacia vs renal osteodystrophy --> Looser zone
osteomalacia --> Looser zone renal osteodystrophy --> Looser zone uncommon
27
peds --> hypothyroid --> imaging features? (2)
- "bullet shape" vertebral body | - Wormian bones
28
peds --> hypothyroid --> RF for what condition?
SCFE
29
hypoPTH --> metastatic deposit of Ca --> MC locaiton? (2)
- subQ tissue | - basal ganglia
30
what is pseudo-hypoPTH?
PTH receptor defect
31
what is pseudo pseudo-hypoPTH?
normal PTH, normal PTH receptor --> pseudo-hypoPTH phenotype
32
pseudo-hypoPTH / pseudo pseudo-hypoPTH --> synd? (4)
- obese - round facies - short stature - brachydactyly
33
pseudo-hypoPTH / pseudo pseudo-hypoPTH --> classic XR finding?
1st/4th/5th --> short metacarpal
34
short 4th metacarpal --> ddx? (2)
- pseudo-hypoPTH / pseudo pseudo-hypoPTH | - Turner synd
35
peds --> hyperthyroid --> MSK manifestation?
accel bone mature
36
what is thyroid acropachy? clinical presentation? (3)
rare presentation of autoimmune thyroid disease (hyperthyroid, euthyroid, hypothyroid, or even post-treatment): - ST swell - finger clubbing - extremity --> diaphysis --> metacarpal/metatarsal/phalanx --> periosteal rxn
37
Paget dz --> epidemiology?
old adult --> >80yo
38
what is Paget dz?
unknown cause --> maybe paramyxovirus --> disturb osteoclastic & blastic regulation --> progressive
39
Paget dz --> ssx? (4)
- bone pain - osseous enlrg/bow - compress CN - high output heart fail
40
Paget dz --> RF for what condition?
weak subchondral bone --> OA
41
Paget dz --> MC locations? (3)
- skull - spine - pelvis
42
Paget dz --> 3 phases?
- phase I: osteolytic - II: mixed lytic & sclerotic - III: sclerotic
43
chronic Paget dz --> imaging appearance?
"caricature" of normal bone: - thick cortex - coarse irreg trabeculae - bone expand
44
Paget --> phase I --> skull --> typical appearance?
"osteoporosis circumscripta" --> geographic lytic region --> sharp margin
45
Paget --> phase II --> skull --> typical appearance?
"cotton wool"
46
Paget --> phase II --> spine --> typical appearance? (2)
- "picture frame" vertebra | - "ivory" vertebra
47
Paget --> pelvis --> typical appearance?
- asymm coarse thick trabecula | - thick iliopectineal/ilioischial line
48
Paget --> pelvis --> potential comp?
acetabular protrusio
49
Paget dz --> phase I --> long bone --> typical appearance?
osteolysis --> prox articular end --> to diaphysis --> sharp border --> "blade of grass", "flame-shaped margin"
50
Paget dz --> potential comp? (4)
- path fx - malig degen --> osteosarcoma - 2ary giant cell tumor - 2ary OA
51
what is hereditary hyperphosphatasia? (juvenile Paget)
AR --> infant-young child --> all bones --> cortex/trabecula thick, osteopenia, bowing --> severe deformity
52
differentiate: hereditary hyperphosphatasia? (juvenile Paget) vs Paget dz --> imaging findings?
hereditary hyperphosphatasia? (juvenile Paget): - diffuse - spare articular ends Paget: - can be multifocal, but not diffuse - involve articular ends
53
what is osteopetrosis?
osteoclast --> carbonic anhydrase def --> unable to resorb bone
54
osteopetrosis --> general imaging appearance?
entire skeleton --> diffuse marked sclerosis
55
osteopetrosis --> potential comp?
extremely brittle bones --> mult fx
56
osteopetrosis --> spine --> typical imaging appearance?
"sandwich"/"rugger jersey" vertebra
57
what is Gaucher dz?
AR --> glucocerebrosidase def --> cerebroside deposit --> macrophage (Gaucher cell) --> bone infarct, medulla expand, hepatosplenomeg
58
Gaucher dz --> long bone --> typical imaging appearance?
"Erlenmeyer flask" deformity
59
Gaucher dz --> spine --> typical imaging appearance?
vertebra --> endplate avascular necrosis --> "H-shape"
60
"H-shape"/"Lincoln log" vertebra --> ddx? (2) how to differentiate?
- Gaucher dz --> splenomeg | - sickle cell --> spleen auto-infarct
61
sickle cell --> osseous manifestations (3)
- bone infarct - osteomyelitis - marrow expand/hyperplasia
62
sickle cell --> bone infarct --> MC location? (2)
- femoral head | - long bone --> meta/dia-physis
63
what is sickle cell dactylitis (hand-foot synd)?
very young child --> hand/feet --> digits --> persistent hematopoietic marrow --> cold temp --> microvasc occlusion
64
sickle cell dactylitis (hand-foot synd) --> imaging appearance?
- ST swell | - periosteal rxn
65
marrow expansion --> ddx? (2)
- thalassemia | - sickle cell
66
red marrow reconversion --> MRI appearance?
T1 low signal
67
sickle cell --> marrow expansion --> long bone --> natural progression?
red cell production --> chronic stim --> medulla wide, trabecula coarse --> osteopenia --> insuff fx
68
red marrow reconversion --> skull --> imaging appearance?
- "hair on end" striation | - wide medulla
69
differentiate --> sickle cell vs thalassemia --> red marrow reconversion --> location?
thalassemia --> more common...: - facial bone - extramedullary hematopoiesis
70
differentiate --> sickle cell vs thalassemia --> degree of red marrow reconversion?
thalassemia --> more severe
71
thalassemia --> osseous hallmarks? (3)
- bone infarct - marrow expansion - osteomyelitis
72
thalassemia --> marrow expansion --> hand --> imaging appearance?
metacarpal & phalanx --> wide & square
73
thalassemia --> marrow expansion --> face --> imaging appearance?
marrow expansion --> obliterate paranasal sinuses --> "rodent" facies
74
long bone --> Erlenmeyer flask deformity --> ddx? (3)
- Gaucher - thalassemia - sickle cell
75
what is myelofibrosis?
progressive fibrosis of BM --> anemia --> splenomeg
76
myelofibrosis --> epidemiology?
older
77
myelofibrosis --> osseous appearance?
BM fibrosis --> diffuse sclerosis of bones
78
what is mastocytosis?
mast cells --> abn prolif
79
mastocytosis --> osseous appearance?
mast cells --> infiltrate BM: - diffuse osteopenia - diffuse sclerosis
80
bones --> diffuse sclerosis --> ddx? (9)
- renal osteodystrophy - sickle cell - myelofibrosis - diffuse osteoblastic mets - osteopetrosis - pyknodysostosis - mastocytosis - fluorosis - athlete (normal variant)
81
what is pyknodysostosis (osteopetrosis acro-osteolytica, Toulouse-Lautrec syndrome)?
AR --> bone dysplasia --> osteosclerosis & short stature
82
ivory vertebral body --> ddx? (3)
- osteoblastic mets - Paget dz - lymphoma
83
reflex sympathetic dystrophy --> bone scan findings?
inc uptake in all 3 phases --> inc. intra-articular
84
shoulder XR --> look like unilat RA, but preserved jt space --> ddx? (1)
reflex sympathetic dystrophy
85
marrow conversion --> order?
Extremities --> axial skeleton 1) epiphysis/apophysis 2) diaphysis 3) distal metaphysis 4) prox metaphysis
86
marrow re-conversion --> order?
1) spine 2) flat bones 3) metaphysis 4) diaphysis 5) epiphysis

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