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Radiology Tumors > Nutritional Metabolic and Endocrine > Flashcards

Nutritional Metabolic and Endocrine Flashcards

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1
Q

what is the most common metabolic bone disorder

A

osteoporosis

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2
Q

what is defined as skeletal disease characterized by low bone mass and micoarchitectural deterioration of bone tissue with increase in bone fragility and susceptibility to fracture

A

osteoporosis

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3
Q

what is osteoporosis

what bones are affected

A

reduction in bone quantity - decreased bone density -
normal bone just not enough of it

axial skeleton and long bones

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4
Q

what is osteopenia

A

poverty of bone causes increased radiolucency of bone

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5
Q

what is regional osteoporosis

what is this due to

A

decrease bone density in region or segment of body - limb or portion of limb

immobilization after fracture

complex regional pain syndrome - reflex sympathetic dystrophy

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6
Q

transient osteoporosis of the hip is seen on what imaging

A

bone scan - hot

T1 - diffuse zone of low signal intensity - edema

T2- high signal - edema

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7
Q

what is localized osteoporosis

causes

A

focal loss of bone density affecting a small area of bone

inflammatory arthropathy
neoplasm
infection

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8
Q

what is senescent osteoporosis

A

senile or old age osteoporosis

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9
Q

what does bone mass start decreases

what percent is lost per year? cortical and trabecular

what percent is lost by age 65

at menopause, bone loss accelerates to what fold? what percent per year

A

> 35 years old

1% of bone mass lost per year of cortical bone

2% of bone mass lost per year of trabecular bone

20-40% of bone mass lost by age 65

menopause - 10 fold increase - 20 fold increase in lumbar spine - 6% lost per year

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10
Q

reduction in skeletal mass is gradual and is clinically evident in the __ decades of females life and __ decades of males

A

females - 5th and 6th decade

males - 6th and 7th decade

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11
Q

are men or women more affected by osteoporosis

at what age is the ratio equal

A

women MC 4:1

age 80 M=F

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12
Q

what are the risk factors and things than prevent osteoporosis

A 
stay active and get exercise 
eat protein, calcium, vitamin c
dont drink excessively 
take estrogen after menopause 
vitamin d
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13
Q

what are complications of osteoporosis

A

spinal cord compression fractures
increase thoracic kyphosis
fractures - femur, ribs, humerus, radius

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14
Q

incidence of __ fracture __ every __ years after the age of __ with osteoporosis

A

hip fracture
doubles
5 years
age 60

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15
Q

what are complications of bisphosphonates

example of drug

A

subtrochanteric femoral fracture - atypical stress fractures in femur diaphysis

alendronate
fosamax
actonel

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16
Q

what is the swedish study

A

2009 swedish study

study performed by Aspberger

incidence of mid femur stress fracture is 50x higher for patients on bisphosphonates

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17
Q

if osteoporotic patient presents with pain on coughing sneezing and straining what should you consider

A

acute compression fracture

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18
Q

progressive angular kyphotic deformity within a year of spinal compression fracture results in what

A

spinal stenosis

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19
Q

neurological abnormalities are __ with spinal compression fractures

A

infrequent

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20
Q

what is (percutaneous) vertebroplasty

results

complications

A

polymethylmethacrylate PMMA (acrylic bone cement) is injected into vertebral body to stabilize and strengthen collapsed vertebrae - outpatient

immediate and substantial results in perception of pain and function - strengthen and stabilize vertebrae

may have nerve root pain from leakage of injected material

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21
Q

20% of patients with osteoporosis compression fracture will experience what within 1 year

A

another fracture

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22
Q

what uses a balloon dilatation of vertebral body with subsequent instillation of polymethylmethacrylate

A

kyphoplasty

emphasis on balloon

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23
Q

what is a kyphoplasty procedure like

A

surgeon inserts catheter into vertebrae and then inserts and inflates a small balloon - this creates a cavity as it inflates - balloon is deflated and withdrawn from vertebrae - surgeon inserts needle into catheter to deliver cement into cavity - cement hardens and provides immediate stability

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24
Q

in weight bearing joints, preferential resorption of non essential supporting trabeculae occurs during bone loss with sparing of the most important trabeculae that are oriented ___

A

vertically - most important - they are spared in osteoporosis

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25
what are some features of single photon absorptiometry
- high false negative rates - unreliable - 2-5 mRad - single photon emitted that is attentuated through bone - calcaneus or radius - equal degree of association with vertebral osteoporosis
26
what are some features of dual photon absorptiometry
- photons emitted at 2 different levels - applied to spine and proximal femur - influenced by osteophytes, scoliosis, vascular calcifications, sclerosis - 5-15 mRad - low radiation dose to the patient - high resolution images have been useful for evaluating vertebral fractures ALSO CALLED DEXA! dual energy xray absorptiometry
27
DEXA scores are reported as what and what do these scores mean
T score and Z score T score - comparison of bone density with that of a 30 year old of the same sex Z score - comparison of bone density with that of an average person of same age and sex
28
what do the T scores of a DEXA scan indicate
T score > -1 = normal -1 to -2.5 = osteopenia < -2.5 = osteoporosis
29
what do the Z scores of a DEXA scan indicate
< -2 = may indicate something other than the aging process is causing abnormal bone loss
30
what is a quantitative CT scan
MC used to assess the strength of vertebrae in assessment of fracture measurements correlate with prevalence of fracture 200-250 mRAD!! alot of radiation calibration with standard, dual photon beam passes through vertebral body, then compared to patient density with phantom density
31
what is used to assess bone mineral density as a diagnostic tool for osteoporosis and other related fractures
due to lower radiation dose and cost, DEXA scan remains the dominant screening tool quantitative CT has increased with advent of new developments in CT technique
32
what are the advantages of quantitative CT over DEXA scan
1. ability to separate cortical and trabecular bone 2. provides true volumetric density in units of mg/cc 3. no errions due to spinal degeneration cahanges or aortic calcification 4. information on bone morphometry
33
what are the roentgen signs of osteoporosis
decrease bone density and mass - bone density approaches that of soft tissues cortical thinning - pencil thin cortices, endosteal scalloping altered trabecular pattern - trabecular resorption with accentuation of remaining trabeculae weigh bearing regions of bones, washed out appearance in severe stages
34
what is the generic term for bone loss
osteopenia
35
what percent of bone mass needs to occur before you see it on xray? appendicular skeleton? axial skeleton?
30-50% of bone mass needed to see on xray in appendicular skeleton 50-70% of bone mass loss needed to see on xray in axial skeleton
36
what are the features of osteoporosis in the spine
``` decreased bone density cortical thinning - end plates trabecular changes altered vertebral body shape increased kyphosis scoliosis due to compression fractures resorption of trabeculae ```
37
resorption of trabeculae due to osteoporosis will occur in what trabeculae first what appearance does this give to the vertebral body
transverse vertebral body trabeculae resorbed first pseudohemangioma appearance
38
osteoporosis can result in compression fractures of anterior and posterior portion of the vertebral body giving it the name of
``` vertebral plana or pancake vertebrae or crush ```
39
when you see pancake vertebrae or vertebral plana you must rule out what other conditions how do we rule out
lymphoma multiple myeloma metastatic disease lab studies
40
what is it called when there is loss of anterior vertebral body height what is this due to
wedge vertebrae may be due to trauma with normal bone mineralization or no trauma and poor bone mineralization
41
wedge vertebraes are most common where
mid thoracic and TL region
42
what shaped vertebrae is due to pressure of nucleus pulposus and weakened vertebral endplates compare disc height to normal
``` biconcave vertebrae or hourglass vertebrae or fish vertebrae ``` normal disc height
43
what are schmorls nodes characteristics
small but can be large painful can trigger premature DDD process due to loss of nuclear pressure
44
there is strong evidence that pain carrying nerve fibers can grow inward, deep into the __ and __ this can cause pain known as __
middle annulus and nucleus pulposus discogenic pain
45
what is our ddx if we see a vertebral body with GAS inside the body
``` metastatic disease myeloma radiation amyloidosis corticosteroid induced AVN ```
46
gas in a vertebral body will have what signal intensity on MRI
low signal
47
what are fractures that are oriented VERTICALLY seen as areas of osteolysis and adjacent areas of sclerosis
stress fractures | - sacrum and symphysis
48
insufficiency fractures are confirmed with what
MRI ? bone scan CT
49
what do sacral insufficiency fractures present as what do rami fractures present as
sacral tenderness pain in the low back, groin, and hip some patients may be asymptomatic with both
50
sacral stress fracture has a characteristic ___ pattern that indicates insufficiency fracture
H pattern or Honda Sign
51
what do stress fractures look like in appendicular skeleton how do they appear on MRI
cortical disruption along with a fine line of increased density - sclerotic bone forms after stress fracture low signal intensity on T1
52
longitudinal stress fractures that are parallel with the bone appear how on MRI and CT
periosteal edema marrow edema transverse CT cuts are needed
53
in a running athlete with lower leg pain, the primary differential diagnosis includes whats in your ddx if they are no distant runners
muscle and tendon injury chronic compartment syndrome shin splints stress fracture intermittent claudication osteomyelitis neoplasm
54
what is reflex sympathetic dystrophy syndrome what is another term
complex regional pain syndrome usually due to trauma patient > 50 acute onset of painful regional osteoporosis progressive pain, stiffness, swelling, atrophy, contracture
55
reflex sympathetic dystrophy syndrome or complex regional pain syndrome affects what areas MC
hand and shoulder
56
what causes the osteoporosis in complex regional pain syndrome
hyperemia of bone augments osteoclastic resorption of bone resulting in rapid progressive osteoporosis
57
what is the recover like for reflex sympathetic dystrophy syndrome
slow recovery may never recover fully residual dystrophy, contracture, joint stiffness
58
what are the joints and margins like in complex regional pain syndrome
joint spaces and margins are normal
59
what are the characteristics of transient osteoporosis of the hip
- left hip exclusively in females - severe osteoprosis of femoral head - may have joint effusion - unknown etiology - 20-40 years old - may be associated with pregnancy - sudden onset of pain, antalgia, and limp - full recovery in 3-12 months
60
what is another name for transient osteoporosis of the hip why
transient bone marrow edema presents with bone marrow edema in the femoral head and neck
61
what conditions cause transient bone marrow edema
``` transient osteoporosis of the hip AVN epiphyseal fractures arthropathies osteoid osteoma infection ```
62
what does transient osteoporosis of the hip look like on MRI
decreased signal on T1 increased signal on t2 (edema)
63
how does disuse and immobilization osteoporosis occur
immobilization inhibits osteoblastic activity in bone and accelerates osteoclastic activity of bone
64
when do xray changes occur in disuse and immobilization osteoporosis does this process last forever
7-10 days pronounced after 2-3 months no, complete resolution of normal bone density after therapy
65
what are the 4 patterns of disuse osteoporosis what is the most common pattern or form
uniform - all bone involved have similar degree of bone loss - MC form spotty - localized circular lesions predominate especially in epiphyseal regions bands - linear transverse subchondral or metaphyseal lucent zones cortical - lamination or scalloping loss of definition in the outer and inner cortical margins
66
while steroids do decrease inflammation, they can also lead to steroid induced osteoporosis. how does this occur
steroids have the following affects: decrease formation of new bone increase breakdown of old bone decrease absorption of calcium from food by the body
67
what is osteomalacia what does it mean what is it due to
altered quality of bone means soft bone lack of calcium deposited in osteoid due to altered calcium, phosphorous, or vitamin D metabolism
68
what are some conditions that can lead to osteomalacia
malabsorption syndrome hypovitaminosis D renal osteodystrophy sprue - celiac disease
69
osteomalacia deformities of weight bearing bones are due to what
uncalcified osteoid located on surfaces of trabeculae and linings of haverians canals
70
what are the radiographic findings of osteomalacia
pseudofractures - also called looser or milkman lines osteopenia bone defomities
71
what do the pseudofractures appear like in osteomalacia on xray
fractures at right angles to the cortex uncalcified osteoid bilateral and symmetrical
72
after you see radiographic findings of osteomalacia, what is the next step
confirm with lab dx
73
what is rickets due to
due to deficiency of vitamin D, calcium, or phosphate malabsorption renal disorders anticonvulsant drugs - dilantin lack of sunshine
74
what is a systemic disease of young children and infants what is the adult version
rickets osteomalacia
75
when does rickets usually occur in children
6-12 months of age
76
what are the soft tissue abnormalities that occur in rickets what are the gross general abnormalities that occur
soft tissue swelling around growth plates due to hypertrophied cartilage rachitic rosary - unmineralized osteoid along anterior rib cage
77
what are characteristics of rickets
physis cartilage grow normally but fail to calcify absent zone of provisional calcification widening of growth plates due to accumulation of osteoid irregular, frayed, cupped, metaphyseal margins "paint brush" frayed zones of provisional calcification bowing deformities, fractures, osteopenia, scoliosis, pseudofractures, abnormal bone length
78
what does scurvy do to bone
supresses osteoblastic activity decreased production of collagen and osteoid
79
what people get scurvy
infants 8-14 months fed only boiled or pasteurized milk or long term deficieny of vitamin C
80
in scurvy, you need at least __ (amount of time) of avitaminosis C before symptoms and skeletal changes occur
4 months
81
what is the clinical hallmark of scurvy
spontaneous hemorrhages due to capillary fragility
82
what are the signs and radiographic findings of scurvy
generalized osteopenia due to inhibition of cell activity white line of frankel - dense zone of provisional calcification wimbergers rings - dense peripheral ring epiphysis corner sign - infarction of epiphyseal/metaphyseal margins in irregularity affecting lateral and medial margins of zopc/white line of frankel pelken spurs - spurs at metaphyseal margins extending perpendicular to cortex scorburitc zone or trumerfeld zone - poor osteoid located along metaphyseal side of zopc which appears as radiolucent band subperiosteal hemmorhage - blood elevates periosteum which may calcify when healing occurs
83
what area may collapse in scurvy
corner sign - may collapse or fracture with impaction
84
what is hyperparathyroidism due to what does excessive PTH due
overactive parathyroid gland initiates osteoclasts to resorption with fibrous tissue replacement causing osteitis fibrosa cystica (soft fragile bone)
85
what is tertiary hyperparathyroidism
state of excessive secretion of PTH after a long period of secondary PTH and resulting in high blood calcium levels unregulated PTH
86
what are characteristics of hyperparathyroidism
brown tumors - accumulation of fibrous tissue produces cyst like destructive brown bone lesions subperiosteal resorption - pathological - occurs along outer cortex at insertional points of ligaments and tendons
87
what are predictable locations for subperiosteal resorption in hyperparathyroidism
radial margins of middle and proximal phalanges - 2 and 3 digits medial metaphysis of humerus and tibia distal clavicles trochanters and tuberosities lacelike appearance of external bone SI erosion widening of pubic symphysis and AC joint
88
salt and pepper skull is characteristic of what diseases
hyperparathyroidism | salt and pepper - granular appearance of osteopenia
89
what do browns tumors look like in hyperparathyroidism
expansile septated mimics destructive lesion fluid levels seen on MRI
90
rugger jersey sign is seen in what condition
hyperparathyroidism seen in vertebrae
91
since blood calcium is increased in hyperparathyroidism, what can occur
calcification with tissues and organs nephrocalcinosis - renal caliculi chondrocalcinosis sclerosis of monckenberg
92
monckenberg medial calcific sclerosis is a disease of what
medium sized muscular arteries
93
what are characteristics of monkenberg medial calcific sclerosis
- people over 50 - calcium deposits in tunica MEDIA of artery - no intima involvment - no vascular narrowing - calcium may undergo calcificaiton - seen on xray
94
what radiographic feature is pathognomonic for scurvy
trummerfeld zones
95
what are the clinical features of hypervitaminosis A
``` hepatosplenomegaly jaundice - yellow skin dermatitis pruritis alopecia osteopenia ```
96
what kind of periosteal reactions are noted on xray in hypervitaminosis A
solid periosteal reactions on shafts of long bones femur, tibia, fibula, metatarsal, humerus, ulna, radius, metacarapals
97
what is the etiology of acromegaly what does the etiology cause
secretory eosinophilic adenoma of anterior pituitary gland produces intramembranous bone tissue growth and subcutaneous hypertrophy
98
what does secretory eosinophilic adenoma of anterior pituitary gland cause before the closure of growth plates? and after closure of growth plates?
before - gigantism after - acromegaly
99
what are relevant features of acromegaly
``` heel pad thickness enlarged sella turcica widened mandible angle sinus enlargement prominent ungal tufts spade like ungal tufts premature DJD increase ADI due to cartilage overgrowth ```
100
why is heel pad thickness and ADI increased in acromegaly what is the heel pad thicknesss in acromegaly
cartilage thickening > 20 mm
101
what is lead poisoning also called
plumbism
102
what does plumbism cause
dense metaphyseal bands aka lead lines
103
why is lead put into bone during lead poisoning
lead has higher affinity for bone than calcium so it replaces calcium
104
lead poisoning deposits lead into what part of the bone
during growing bone, lead is primarily deposited into the metaphysis
105
in children, lead poisoning affects what bones why
metaphysis of distal femur, both ends of tibia, and distal radii most rapidly growing bones in the body
106
what are clinical features of lead poisoning
pica - weird cravings of dirt and clay

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