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OSTEO Flashcards

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1
Q

What is hyperparathyroidism?

A

PTH strong osteo clastic hormone

Overactive PTGland

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2
Q

Primary hyperparathyroidism

A

Parathyroid gland adenoma

Increase Ca

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3
Q

Secondary hyperparathyroidism

A

Chronic renal/kidney disease
Hemodialysis
Renal osteodystrophy
Decreased Ca

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4
Q

Tertiary HPT

A

Dialysis patients
Parathyroid gland acts independent of serum calcium levels
Increased or normal Ca

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5
Q

HPT is most common in who?

A

Females

30-50

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6
Q

What is seen in patients with HPT?

A

Pain, fractures, weakness, lethargy, polydispia/uria
Hypercalcemia leads to muscle weakness, hypotonia
Renal stones, pancreatitis
Hypercalcemia more common in primary, normal to low in sec and tert
elevated alkaline phosphatase and PTH

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7
Q

Radiology of HPT

A 
Osteopenia
Subperiosteal resorption
Accentuated trabeculation 
Brown tumors (cystic accumulations of fibrous tissue)
Loss of cortical definition
Soft tissue calcification
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8
Q

Subperiosteal resorption

A

Most definitive radiographic sign of HPT

Especially at the radial margins, middle and proximal phalanges of the 2nd and 3rd digits

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9
Q

Subperiosteal resorption appearance

A

Outer cortical erosion looks frayed or lace like

Widened joint space and osteo lysis in AC and SI joints

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10
Q

What does HPT look like in the axial skeleton?

A

Osteosclerosis (rugged jersey spine)
Subperiosteum resorption at AC or SI joints
Salt and pepper skull

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11
Q

Subchondral resorption in HPT in SI joints does what?

A

Makes the joint wider. Most likely AS if that’s all you see, but if sero neg…consider others like HPT.

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12
Q

What is a brown tumor?

A

Feature of HPT
Lyric lesion containing osteoclasts and mononuclear cells and fibroblasts with focal hemorrhages.
Hemosiderin from hemorrhage causes browning
Central and expansive
AKA osteoclastoma

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13
Q

If you have a hole with a salt and pepper skull, what is it Most likely?

A

A brown tumor in HPT

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14
Q

What is Renal osteodystrophy?

A

None disorder occurring when kidneys fail to maintain proper Ca and phosphorus levels in blood.
Affects patients on dialysis.
HPT (secondary or tertiary)

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15
Q

What should you assume with a patient that has a history of kidney disease?

A

Secondary or tertiary HPT

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16
Q

Secondary may appear similar to what?

A

Osteoporosis

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17
Q

Patient on dialysis…

A

Assume secondary or tertiary HPT

Renal osteodystrophy

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18
Q

HPT absorbs what in the teeth?

A

Lamina dura

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19
Q

Vessel calcification in the ankle is most likely diabetes, but may also be_______________.

A

HPT(secondary or PRIMARY, most likely secondary)

Hx for kidney problems or treatments (dialysis)

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20
Q

Vascular calcification in hands with subperiosteal resorption?

A

HPT

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21
Q

Anterior Pituitary function

A 
GH
ACTH
TSH
follicle stim hormone/ LH
Prolactin
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22
Q

Posterior pituitary function

A

ADH

Oxytocin

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23
Q

Pituitary tumors account for what?

A

10% of all neoplasms within the cranium.

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24
Q

What types of systemic bone diseases are there?

A

Metabolic
Nutritional
Endocrine

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25
People with systemic bone diseases will have what finding that other imaging pathologies have?
Cat bites
26
How does bone metabolism work?
``` Hormones and nutrients stimulate bone production like: GH TH Calcitonin Vit D Vit C ```
27
What hormones inhibit bone production/metabolism?
Parathyroid Hormone | Cortisol
28
What is Osteopenia?
All encompassing definition for increase Radiolucency of bone. Vague.
29
What is the most common etiology for seeing osteopenia?
Osteoporosis.
30
What are other causes of osteopenia?
Osteomalacia/rickets- Vit D deficiency HPT Scurvy- Vit C deficiency Neoplasms
31
What should you do when you find osteopenia on an image?
Search for additional and more specific abnormalities: Osteomalacia-linear radiolucencies (looser's lines) HPT - subperiosteal and subchondral resorption Neoplasms- plasma cell myeloma producing focal lesions
32
What is osteoporosis?
Qualitatively normal but quantitatively deficient bone. Generalized Regional Localized Osteopenia + typical clinical and histological features=osteoporosis
33
What type of patients will you see with osteoporosis?
35 yrs and older Females progress more rapidly from hormonal deprivation leading to osteoclastic activity. Reduction of skeletal muscle. 5th/6th decade for females, 6th/7th decade for men
34
What thoracic spine characteristics will you see in patients with osteoporosis?
Compression fractures, leading to thoracic kyphosis.
35
What other fractures might you see with osteoporosis?
Proximal femur (hip), ribs, humerus and radius
36
What is the rate of hip fractures for females with osteoporosis?
Chances double every 5 years after 60.
37
Are vertebral fractures common in osteoporosis?
Yes, 64% or 700,000/year in USA.
38
How many total fractures due to osteoporosis?
More than 1 million every year
39
What types of osteoporosis are there?
Primary and Secondary
40
What is primary osteoporosis?
Senile Postmenopausal Transient or regional
41
What is secondary osteoporosis?
``` Corticosteroids Malignancy Infection Arthritics Disuse RSD ```
42
What is generalized osteopenia?
Age-related, senile/postmenopausal | Endocrinopathy, acromegaly, HPT, Hypothyroidism, cushiness, pregnancy, heparin, alcoholism
43
What is the significance/prevalence of osteoporosis?
55% of population over 50 1 of 2 females experience insufficiency fx post-menopausal 10-20% mortality 2/3 will not return to pre-fracture state
44
How should you work with imaging and osteoporosis?
Get old films and compare MRI Bone scan Lab work
45
Osteoporosis and modic types.
Old compression fractures show normal marrow signal intensity (white) increased T1 signal New fractures or marrow replacement is dark...or decreased T1 signal.
46
Skeletal muscle reduction in females and males Vs Skeletal mass reduction in females and males
muscle reduction in females 5th/6th decades, men 6th/7th Skeletal mass reduction in females 4th decade, 5th/6th in men.
47
Senile/post menopausal patients will experience what symptoms?
Pain from microfractures Loss of height from compression fractures Accentuated kyphosis
48
Risks for Osteoporosis
``` Female Older than 70 Caucasian or Asian Early onset of menopause Long postmenopausal interval Inactivity ```
49
MODIFIABLE RISKS of osteoporosis
Smoking, alcohol, caffeine Excessive protein consumption Lack of calcium Lack of sun, Vit D synth
50
Radiographic features of osteoporosis
``` Osteopenia Cortical thinning Resorption of nonstress-bearing trabecular Accentuated vertical struts Altered vertebral shape ```
51
Radiographic manifestations of osteoporosis
Increased Radiolucency, or washed out appearance Altered trabecular pattern Mal shaped vertebrae
52
What are some examples of vertebral deformities in osteoporosis?
``` Codfish deformity (biconcave) Schmorl's nodes Endplate infractions Washed out Radiolucency Cortical thinning ```
53
How should you handle severe fractures of the spine?
CT if the compression exceeds 30% of the original body height or retropulsion is present or if neurologically compromised
54
If you see posterior body convexity, what is that indicative of?
Bursting fracture, with possible fragments in foramen. | If there is no posterior body convexity, then compression fracture is likely
55
What is a widened interpedicular distance indicative of?
Fracture of neural arch or posterior body
56
Using the 3 1/3's rule, what constitutes an unstable fracture?
Anything involving the middle columns.
57
If you see demineralization, it is likely what?
Osteopenia or osteoporosis
58
A pathological compression fracture is identified by what?
Decreased body height anteriorly and posteriorly
59
What is a pathological fracture indicative of?
Osteoporosis Lytic Mets Multiple myeloma Eosinophilia granule a (KIDS)
60
What might you see in the thoracic cavity of someone with osteoporosis?
Washed out appearance of vertebrae, and a calcification of the AORTA. Increased kyphosis
61
What does osteoporosis look like in an extremity?
Thinned vortices (pencil thin) Endosperm scalloping (from inside to out) Loss of the secondary trabecular Risks of fractures
62
What is wards triangle?
Primary compressive band (medial) Secondary compressive band (lateral) Primary tensile band Form a triangle at the neck of femur
63
Radiolucency of wards triangle is more prominent in what?
Osteoporosis
64
In advanced osteoporosis, what part of the triangle is last to be involved?
The principle compressive component
65
What will you see in the lab work of osteoporosis patients?
Normal, besides high hydroxyproline and urinary total pyridinoline
66
How should you manage osteoporosis?
Diet and exercise | Sunlight and Vit D
67
Holes are most likely due to what?
Lyric mets or multiple myeloma
68
What will you see in pathological generalized osteoporosis/osteopenia?
``` Plasma cell myeloma (multiple myeloma) Metastisis Anemia Nutritional def. Diabetes mellitus Immunodeficiency Chronic liver disease ```
69
What is a multiple myeloma?
Proliferation of plasma cells producing IgG/IgA antibodies MC in osteopenia Patients too young for osteoporosis Compression fractures/pathological fractures Multiple lyric calvarial lesions (punched out lesions) "Rain drop skull"
70
What is a DEXA scan?
Dual Energy X-Ray Absorptiometry Evaluates osteoporosis Measures bone mineral density (BMD) and compares it to average BMD of young adults at peak BMD
71
What to recommend to osteoporosis patients?
Stay active Supplemental calcium, protein, Vit C No smoking/drinking Strongly consider taking estrogen supplements after menopause
72
What are the different types of regional osteoporosis?
Immobilization and disuse Reflex sympathetic dystrophy syndrome Transient regional osteoporosis
73
What are the two kinds of transient regional osteoporosis?
Transient regional osteoporosis of the hip And Regional migratory osteoporosis (difficult to diagnose)
74
What is disuse osteoporosis?
inhibits osteoclastic activity Immobilized, paralysis, inflammatory joint disease Extremity injury
75
How can you identify disuse osteoporosis?
Diffuse osteopenia throughout disused body part Lucent bands of osteopenia just proximal to physeal line Subchondral lucency Uniform or spotty demineralization
76
What is reflex sympathetic dystrophy syndrome?
``` Acute pain, regional osteoporosis following trivial trauma Older than 50 Hands Reflex hyperactive SNS Skin atrophy/ pigmentation abnormalities AKA complex regional pain syndrome ```
77
How to identify RSDS?
``` Soft tissue swelling Regional Early mottle appearance Aggressive/severe Juxtaarticular Spread and become bilateral/ patchy ```
78
What may be different about RSD images?
Severe demineralization, but the joints are OKAY
79
What is transient osteoporosis of the hip?
``` 20-40, may be associated with pregnancy MC men Bilateral in women Periarticular osteoporosis Decreased T1, increased T2 SELF LIMITING 3-12 months ```
80
What is Osteomalacia?
Altered bone quality Decreased calcium High ratio of osteoid to mineralized bone
81
What causes osteomalacia?
Vitamin D metabolism | Renal tubular phosphate loss (X-linked hypophosphatemia familial vitamin D resistant rickets)
82
What is rickets?
Childhood osteomalacia
83
Vit D in osteomalacia?
Vit D hydroxylated by liver Forms 25 OH Hydroxylated by kidney Forms 1,25 OH 2D Malnutrition, malabsorption, renal disease may alter this process
84
Imaging of osteomalacia
Non specific Osteopenia Coarseness trabeculation Looser zones
85
What are looser lines?
Pseudo fractures in the femur that are commonly bilateral | Unmineralized osteoid
86
Looser lines and shepherds deformity are seen in what pathology?
Osteomalacia
87
What kind of disease is rickets?
Systemic disease of infants and children Childhood osteomalacia Rare in western world Deficient Vit D or calcium phosphate
88
What causes rickets?
Inadequate dietary Vit D, exposure to UV, malabsorption, chronic acidosis, renal tubular defects
89
How do you treat rickets?
Vit D supplements and sunlight
90
Symptoms of rickets?
Tetany, irritability, weakness, small stature, bone deformity, pain Soft tissue swelling around growth plates (hypertrophied cartilage) Calcium levels may be normal to low, elevated alkaline phosphatase
91
How would you describe rickets?
Osteopenia Widened, frayed metaphysis-epiphyseal plate junction Lack of provisional zone of calcification Return of the zone is a sign of healing (PAINTBRUSH METAPHYSIS)
92
What is scurvy?
AKA Barlow's disease long term Vit C def. Rare in western world Infants 8-14 months with pasteurized or boiled milk. Elderly affected when diets are compromised Avitaminosis of at least 4 months
93
What will you see in a patient with scurvy?
spontaneous hemorrhage of capillaries Bleeding gums, hematuria Joint swellings, irritability, pain, lie in FROG LEG POSITION
94
Vit C and scurvy
Vit C is essential to form collagen, osteoid, and endothelial linings.
95
Imaging of scurvy
Osteopenia (thin cortex, loss of trabeculation) Widened METAPHYSIS Dense zone of provisional calcification Beak like metaphyseal outgrowths (Perkins Spurs) Trimmer fields zone-Radiolucency band directly under zone of provisional calcification Radio dense sclerosis around epiphysis (WIMBERGER's Sign)
96
What is acromegaly and gigantism?
Pituitary adenoma secreting growth hormone Prominent hands and feet Excessive GH before growth centers close is gigantism...after growth centers close is acromegaly
97
What is acromegaly?
Over secretion of GH from pituitary adenoma after Growth centers close. Results in proliferation of connective tissues: Bone, cartilage, skin, organs.
98
What features are prominent in acromegaly?
Thickening of palms and soles Enlarged jaw, hands, feet, head Spreading teeth Loss of menstrual function
99
Radiographic features of acromegaly
spade-like distal tufts Hooking osteophytes Increased joint spaces Widened shaft
100
What is CATBITES?
``` Congenital Arthritis Trauma Blood Infection Time or Endocrine, nutritional, metabolic Soft tissue ```
101
What is Cleidocranial dysplasia?
A defect of intramembranous bone growth Defects in skull, clavicle and mid line Pubic diastasis Generalized dysplasia, below avg height, large head, drooping shoulders
102
What does the skull look like in Cleidocranial dysplasia?
Inverted pear Wormian (intrasuture) bones Hypo or aplasia of the clavicle
103
What are mid line defects in Cleidocranial dysplasia?
Spinal bifida type
104
What is pubic diastasis in Cleidocranial dysplasia?
Wide pubic symphysis, due to lack of ossification
105
What is the diagnosis is for a patient with no clavicles or hypoplasia of clavicles?
Cleidocranial dysplasia | May have Wormian bones, pear shaped skull
106
What is Marfan's syndrome?
Collagen disorder that fails to produce normal collagen | Connective tissue disorder
107
What will you find on Marfan's syndrome radiographs?
Scoliosis, acetabular protrusion, pectus excavating
108
What are clinical features of Marfan's syndrome?
Tall stature, arachnodactyly, heart valve defects, aortic aneurysm, lens dislocation
109
What simple tests can be done to confirm Marfan's syndrome?
Thumb test | Wrist test
110
What is a vascular condition Marfan's syndrome patients are at risk of?
Aortic aneurysm
111
What is pectus excavatum?
Seen in Marfan's syndrome Funnel chest Posterior displaced/curved sternum..pushes heart to the left
112
What is osteogenesis imperfecta?
Inherited disorder marked by abnormal type I collagen formation. Ranges from mild osteopenia to dwarfism to multiple fractures.
113
What are the 4 major clinical criteria of osteogenesis imperfecta?
Skeletal fragility Blue sclera Abnormal dentition Premature otosclerosis
114
What can osteogenesis imperfect often be confused with?
Child abuse...look for 4 major criteria
115
What does osteogenesis imperfecta look like on film?
Osteopenia, bowed long bones, thin corticies, multiple fractures with healing deformities, kyphoscoliosis
116
Clinical features of osteogenesis imperfecta?
Lethal at birth Confused with child abuse Treatment is directed at limiting deformity and injury. Zebra stripes on bone due to bisphosphonate therapy
117
What is Osteopetrosis?
Group of entities, representing a type of sclerosing bone disease Hereditary and familial Abnormality of decreased osteoclastic activity
118
What does Osteopetrosis look like on film?
``` Loss of medullary space Pathological fractures Dense, fragile, thin cortices BONE WITHIN A BONE* or ends one SANDWICH VERTEBRAE*(vertebrae inside a vertebrae)****** Erlenmeyer flask deformity* ```
119
What is osteopetrosis sometimes called?
Marble bone | Brittle bone disease

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