Osseous

Question 1

Generalized increased bone density (Non-peds)

Answer 1

Myelosclerosis, renal osteodystrophy, fluorosis, blastic mets, lymphoma, mastocytosis, Paget

Question 2

Solitary sclerotic bone lesion

Answer 2

Dev - bone island or FD
Neo - Mets, lymphoma, osteoma, osteoid osteoma, healed malignant lesion, promary bone sarcoma, Paget
Vas - bone infarct
Traumatic callus formation
Inf - Sclerosing OM of Garre

Question 3

Multiple sclerotic bone lesion

Answer 3

Dev - FD, osteopoikilosis/striata, tuberous sclerosis

Neo - mets, lymphoma, mastocytosis, MM, Gardener syndrome, multifocal osteosarcoma, Paget

Question 4

Bone sclerosis with periosteal reaction

Answer 4

Healing fracture with callus
Neo - Mets, lymphoma, osteoid osteoma, osteosarcoma, Ewing sarcoma, chondrosarcoma
Inf - OM, syphilis
Idio - Infantile cortical hyperostosis, Melorheosotosis

Question 5

Solitary sclerotic lesion with central lucency

Answer 5

Neo - Osteoid osteoma, osteoblastoma

Inf - Brodie abscess, spyhilis, Yaw, TB

Question 6

Osteolytic lesion with Skin involvement

Answer 6

Cong - NF, basal cell naevus syndrome, angiodysplasia

Acq - Scleroderma, RA, Gout, leprosy, syphylis, LCH, sarcoidosis, Mastocytosis, Pancreatitis with osteonecrosis

Question 7

Osteoblastic lesions with skin involvement

Answer 7

Cong - Osteopoikilosis, gardner syndrome

Acq - Reactive arthritis, SAPHO, lymphoma, sarcoidosis

Question 8

Mixed blastic/lytic with skin lesions

Answer 8

Gaucher disease, psoriatic arthritis, SAPHO, Reactive arthritis, Sarcoidosis

Question 9

Coarse trabecular pattern

Answer 9

Paget, osteoporosis/malacia, hemoglobinopathies (Thalassemia, Gaucher), hemangioma

Question 10

Lytic skeletal mets (Origin sites)

Answer 10

Lung carcinoma, breast, renal cell carcinoma, Wilm tumor, bladder transitional cell, reproductive, thyroid, rectocolon, adrenal, skin

Question 11

Blastic skeletal mets (Origin sites)

Answer 11

Lung carcinoid, breast, testis, prostate, bladder (TCC), stomach, colon, neuroblastoma

Question 12

Medullary based, well-defined, corticated lucent lesion

Answer 12

Geode, Healing lesion, Brodie abscess, SBC, enchondroma, chondroblastoma, FD

Question 13

Medullary based, well-defined, NON-corticated lucent lesion

Answer 13

Mets, MM, EG, brown tumor, Enchondroma, chondroblastoma

Question 14

Medullary based, ill-defined lesion

Answer 14

Mets, MM, OM, Lymphoma, osteosarcoma, Ewing sarcoma, central chondrosarcoma, Fibrosarcoma

Question 15

Medullary based, well-defined, eccentric lytic lesion

Answer 15

GCT, ABC, enchondroma, NOF, chondromyxoid fibroma

Question 16

Lucent expansive lesion

Answer 16

Benign - ABC, GCT, enchondroma
Malignant - Mets, plasmacytoma, lymphoma, fibrosarcoma, telangiectatic osteosarcoma
Other - FD, hemophilic pseudotumor, browns tumor, hydatid

Question 17

Subarticular lucent bone lesion

Answer 17

Arth - OA, RA, CPPD, gout, hemophilia
Neo - Mets/MM, ABC, GCT, Chondroblastoma, PVNS
other - Post-traumatic, osteonecrosis, TB

Question 18

Lucent bone lesion with calcium/bone

Answer 18

Neo - Mets (breast), cartilage tumors (enchondroma, chondroblastoma, CMF, chondrosarcoma), bone tumor (osteoid osteoma, osteosarcoma), fibrous tumor (MFH)
Other - FD, Paget, AVN, OM, EG, intraosseous lipoma

Question 19

Moth-eaten/permeative in adults

Answer 19

Neo - Mets, MM, Leukemia, Ewing, lymphoms, osteosarcoma, chondrosarcoma,MFH, LCH
Inf - Acute OM

Question 20

Regional osteopenia

Answer 20

Disuse, Sudeck atrophy, TOH, regional migratory osteoporosis

Question 21

Generalize osteopenia

Answer 21

Osteoporosis, osteomalacia, HPT, Diffuse infiltrative bone disease (MM or leukemia)

Question 22

Osteomalacia/Rickets

Answer 22

Vitamin D deficiency, renal disease (renal osteodystrophy, Fanconi), hepatic disease, anticonvulsants, Mimicors ( hypophosphotasia, metaphyseal chondrodysplasia)

Question 23

Hair on end periosteal reaction

Answer 23

Ewing, syphilis, infantile cortical hyperostosis

Question 24

Sunburst periosteal reaction

Answer 24

Osteosarcoma, Mets, Ewing, Hemangioma, meningioma, TB, tropical ulcer

Question 25

Codman triangle periosteal reaction

Answer 25

Aggressive malignant lesion or infection

Question 26

Bilateral symmetrical periosteal reaction in adults

Answer 26

HOA, pachydermoperiostitis, vascular insufficiency, thyroid acropathy, fluorosis, DISH

Question 27

Bilateral Asymmetrical periosteal reaction in adults

Answer 27

Mets, OM, reactive/Ps. A, Non-accidental injuries, bleeding diatheses, Hand-foot syndrome

Question 28

Cause of HOA

Answer 28

Pulmonary - Carcinoma, lymphoma, abscess, cystic fibrosis, mets Pleural - fibroma, mesothelioma Cyanotic congenital heart disease GI - ulcerative collitis, Crohn disease, dysentry, lymphoma, Celiac, juvenile polyposis

Question 29

Exuberant callus formation

Answer 29

Steroid/cushing syndrome, neuropathic arthropathy, OI, NAI, renal osteodystrophy, MM

Question 30

Erosion of the medial metaphysis of the proximal humerus

Answer 30

Normal variant, leukemia, Gaucher disease, Hurler, Glycogen storage disease, HPT, RA, Neimann-Pick disease

Question 31

Erosion of the distal clavicle

Answer 31

RA, Post-trauma, MM, mets, HPT, CCD, pyknodysostosis

Question 32

Focal rib lesion (solitary or multiple)

Answer 32

Neo - Mets, MM, Chondrosarcoma, Askin tumor, benign (osteochondroma, enchondroma, LCH) Non-neo - Healed rib fracture, FD, paget disease, brown tumor, OM

Question 33

Rib notching - inferior surface

Answer 33

``` Coarctation of the aorta (4-8th rib) Aortic thrombosis (lower ribs) Subclavian obstruction (upper unilateral) Pulmonary oligemia SVC obstruction Pulmonary and chest wall AVM NF ```

Question 34

Rib notching - superior surface

Answer 34

Connective tissue - RA, SLE, scleroderma, Sjogren HPT Misc - NF, poliomyelitis, Marfan, OI, progeria

Question 35

Wide or thick ribs

Answer 35

Chronic anemia, FD, Paget, healed fracture, achondroplasia, MPS

Question 36

Madelung deformity

Answer 36

Idiopathic, dyschondrosteosis, diaphyseal aclasis, Turner syndrome, post-infective

Question 37

Common carpal coalition

Answer 37

1. Triquetral-lunate 2. Capitate-Hamate 3. Trapezium-trapezoid

Question 38

Massive carpal coalition (proximal-distal row)

Answer 38

Acrocephalosyndactyly (Apert), Ellis-Van Creveld, Holt-Oram, Turner, symphalangism, acquired (RA, pyogenic, chronic TB, post-trauma/surgery)

Question 39

Short metacarpal/tarsal

Answer 39

Idiopathic, post-traumatic, post-AVN, Turner's, Pseudohypoparathyroidism, Pseudo-pseudoHPT

Question 40

Arachnodactyly

Answer 40

Marfan, Homocystinuria

Question 41

Acro-osteolysis (tuft)

Answer 41

Scleroderma, Raynaud disease, Ps. A, thermal, trauma, Hperparathyroidism, Phenytoin toxicity

Question 42

Acro-osteolysis (mid-portion)

Answer 42

PVC, Hajdu Cheney, hyperparathyroidism

Question 43

Periarticular osteolysis

Answer 43

Ps. A, Erosive OA, hyperparathyroidism, Scleroderma, MCRH

Question 44

Poorly defined lytic lesion in the distal phalanges

Answer 44

OM, mets, MM, ABC, GCT, leprosy

Question 45

Well defined lytic lesion in the distal phalanges

Answer 45

Enchondroma, sarcoidosis, glomus tumor, FD, osteoid osteoma

Question 46

Fluid-fluid level in bone lesion

Answer 46

Benign - ABC, chondroblastoma, GCT, SBC, FD | Mal - Telangiectatic osteosarcoma, MFH, necrotic bone tumor

Question 47

Increased uptake on bone scan

Answer 47

Blastic mets, joint disease, Trauma, post-surgery, paget disease, Superscan, metabolic bone disease, infection

Question 48

Photopenia on bone scan

Answer 48

AVN, MM, lytic mets, leukemia, Spina hemangioma