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Diagnostic Imaging I Final COPY (Goldfish) > Systemic and Nutritional Diseases > Flashcards

Systemic and Nutritional Diseases Flashcards

1
Q

What hormones and nutrients can STIMULATE bone production?

A
  • -Vitamins D and C,
  • -Growth Hormone,
  • -Thyroid hormone (T3, T4)
  • -Calcitonin
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2
Q

Which hormones can INHIBIT bone production?

A

Parathyroid hormone (PTH) and cortisol

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3
Q

What is the definition of increased radiolucency or decreased density of bone?

A

Osteopenia

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4
Q

What condition is the most common cause of osteopenia?

A

Osteoporosis

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5
Q

Does the finding of osteopenia (radiolucent bone) automatically indicate osteoporosis?

A

No; other conditions can also cause osteopenia

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6
Q

What percentage of bone mass loss is needed before it can be detected on a plain film?

A

30-50%

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7
Q

Is bone involved with osteoporosis deficiently quantitatively or qualitatively?

A

Quantitatively (density)

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8
Q

At what age does bone mass begin to decrease due to reduced osteoblastic differentiation, activity, and overall life span?

A

35

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9
Q

Why is osteoporosis uncommon in children?

A

Both osteoblasts and osteoclasts function at equal rates in kids

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10
Q

Why does osteoporosis start sooner in females?

A

Hormonal deprivation (then increased osteoclastic activity)

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11
Q

When does reduction in skeletal mass become clinical observable in both males and females?

A

Males: 50s-60s (6th or 7th decade)
Females: 40s-50s (5th or 6th decade)

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12
Q

What is the most visible sign that someone could be developing osteoporosis?

A

Fractures (vertebral, proximal femur, ribs, humerus, radius)

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13
Q

What is the rate of hip fractures seen among women as they age over 60 years?

A

Chance doubles every 5 years after 60

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14
Q

What is the most common fracture seen among the elderly?

A

Spinal compression fracture

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15
Q

What percentage of the population has osteoporosis after the age of 50?

A

55%

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16
Q

Is the “step defect” seen in the acute or chronic stage of a spinal compression fracture?

A

Acute

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17
Q

What kind of change to the thoracic stature is seen in individuals with senile or postmenopausal osteoporosis?

A

Accentuated kyphosis

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18
Q

What is the race bias for osteoporosis?

A

Asians or Caucasians

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19
Q

What is the gender bias for osteoporosis?

A

Females

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20
Q

What is the age risk factor for osteoporosis?

A

Being over 70

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21
Q

What are the risk factors for osteoporosis?

A

Female, Caucasian/Asian, >70 years old, early onset of menopause, longer postmenopausal interval, inactivity (lack of weight bearing exercise)

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22
Q

What are some modifiable risk factors for osteoporosis?

A

Smoking, alcohol abuse, excessive caffeine, excessive dietary protein, lack of calcium, lack of sunlight to get vitamin D

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23
Q

What radiographic sign and change is seen on the endplates of the vertebrae with osteoporosis?

A

Cortical thinning **

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24
Q

What is the term for the biconcave***, washed-out appearance of the vertebral bodies seen with osteoporosis?

A

Codfish deformity

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25
Q

What is the term for the accentuated primary trabeculae seen with osteoporosis?

A

Pseudo-hemangioma appearance

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26
Q

When must a CT be done following a spinal compression fracture?

A

If compression exceeds 30% of original body height or if neurological compromise is present from retropulsion

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27
Q

A spinal compression fracture can be stable when the damage occurs at what part of the vertebral body?

A

Anterior body margin

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28
Q

What is the name of the confluence of the 3 trabecular patterns at the hip that becomes more prominent in osteoporosis?

A

Ward’s triangle

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29
Q

In what order do we see changes in the trabecular patterns of the hip?

A

1 primary compressive (medial) 2 secondary compressive (lateral) 3 primary tensile

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30
Q

An increase in which lab value is associated with osteoporosis?

A

Hydroxyproline

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31
Q

What radiographic signs are seen with multiple myeloma?

A
  • -Punched out lesions,
  • -Multiple lytic calvarial lesions,
  • -Compression fractures,
  • -Raindrop skull
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32
Q

In a case of diffuse significant osteopenia in a patient too young for osteoporosis, what would be a condition to consider?

A

Multiple myeloma

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33
Q

What type of machine directly evaluates osteoporosis?

A

Dual Energy X-ray Absorptiometry (DEXA scan)

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34
Q

How does the WHO define osteoporosis in terms of T-scores from a DEXA scan?

A

-1 or higher = normal, -2.5 to -1 = osteopenia, below -2.5 = osteoporosis, below -2.5 plus fragility fracture = severe osteoporosis

35
Q

At what T-level is a patient considered osteoporotic?

A

Below -2.5

36
Q

What are good recommendations for our patients who may be at risk for osteoporosis?

A

Stay active, get calcium, protein, and vitamin C in the diet, don’t smoke or drink excessively, maybe take estrogen supplements

37
Q

What is the most common cause of regional osteoporosis?

A

Disuse (example = cast following injury)

38
Q

Why does disuse lead to osteoporosis of that area?

A

Inhibition of osteoblasts

39
Q

What is another name for reflex sympathetic dystrophy?

A

Sudeck’s atrophy

40
Q

If a patient came in complaining of pain in the hands or feet accompanied by regional osteoporosis following a trivial trauma like hitting his/her funny bone, what would the suspected condition be?

A

Reflex sympathetic dystrophy (Sudeck’s atrophy)

41
Q

What is the most common location for Sudeck’s atrophy?

A

Hands or feet

42
Q

What other visible signs can be seen on the hands and feet of someone with Sudeck’s atrophy?

A

Skin color changes, skin atrophy

43
Q

Is the location of osteoporosis seen distal or proximal to the site of minor trauma with reflex sympathetic dystrophy (RSD)?

A

Distal to (example = trauma on knee results in issues with foot)

44
Q

What is the age and gender bias for transient osteoporosis of the hip?

A

Males aged 30-50 (usually bilateral)

45
Q

In what population of females do we see transient osteoporosis of the hip more commonly and uniquely on which hip, most likely?

A

Pregnant females in 3rd trimester - usually left hip

46
Q

How is transient osteoporosis of the hip diagnosed?

A

MRI (diffuse bone marrow edema, decreased T1 and increased T2)

47
Q

How is transient osteoporosis of the hip treated?

A

Usually self-resolving over 3-12 months

48
Q

Which affects the QUALITY of bone: osteoporosis or osteomalacia?

A

Osteomalacia

49
Q

Which condition is caused by the lack of calcium salts deposited in bone resulting in inadequate mineralized bone matrix with an abnormally high ratio of osteoid to mineralized bone?

A

Osteomalacia

50
Q

What are the 2 main causes of osteomalacia?

A
  • -1 vitamin D metabolism

- -2 renal tubular phosphate loss

51
Q

What condition is equivalent to osteomalacia but in children?

A

Rickets

52
Q

In which organ is vitamin D converted into its physiologically active form?

A

Kidneys

53
Q

What other organ besides the kidneys participates in vitamin D metabolism?

A

Liver

54
Q

What other mineral is lost besides calcium due to decreased vitamin D intake?

A

Phosphate

55
Q

Looser lines are associated with what condition?

A

Osteomalacia

56
Q

What are looser lines?

A

Pseudo fractures seen as horizontal osteoid seams

57
Q

What is the best diagnostic procedure for osteomalacia?

A

Bone biopsy

58
Q

What is the condition meaning the presence of multiple pseudofracture lines that are commonly seen with osteomalacia (Looser lines)?

A

Milkman’s syndrome

59
Q

How does osteomalacia affect trabeculation?

A

Makes it more coarse

60
Q

In what direction do Looser lines lie?

A

Perpendicular to long axis of bone

61
Q

What is the term for the deformity of the femurs commonly seen in children with Rickets?

A

Shepherd’s Crook deformity

62
Q

What is the term for the deformity of the tibia seen in children with Rickets (and also other conditions)?

A

Saber shin

63
Q

What elevated lab value is present with rickets?

A

Alkaline phosphatase

64
Q

What are the causes of rickets?

A

Inadequate intake of vitamin D or lack of exposure to UV radiation, malabsorption, chronic acidosis, renal tubular defects, anticonvulsants

65
Q

How is rickets treated?

A

Sunlight and vitamins D supplementation (resolvable)

66
Q

What are the areas of most rapid growth in order?

A
  • -1 costochondral junctions of middle ribs
  • -2 distal femur
  • -3 both ends of tibia
67
Q

What is the second most rapidly growing area?

A

Proximal tibia

68
Q

What is the third more rapidly growing area?

A

Distal radius/ulna

69
Q

What is the term for the appearance at the ribs of a children with rickets where the chest has cartilage overgrowth and metaphysical splaying at the costochondral junction of the ribs?

A

Rachitic rosary

70
Q

What is the term for the frayed appearance seen at the epiphyseal plate junction of the bones with those who have rickets?

A

Paintbrush metaphysis

71
Q

What is the term for the central radiolucency seen near the bone fraying in those with rickets?

A

Cupping (splaying)

72
Q

Tibial bending is naturally occurring up to what age?

A

Up to 6 months

73
Q

What is another name for scurvy?

A

Barlow’s disease

74
Q

Scurvy is the long term deficiency of what vitamin?

A

C (low serum ascorbic acid levels)

75
Q

Scurvy primarily involves with population?

A

Infants 8-14 months fed pasteurized or boiled milk

76
Q

Why does a lack of vitamin C lead to the symptoms of scurvy?

A

Vitamin C is important for the formation of collagen, osteoid, and endothelial linings

77
Q

Why does spontaneous hemorrhage occur with scurvy?

A

Capillary fragility due to lack of vitamin C

78
Q

Scurvy is also mistaken for what?

A

Child abuse

79
Q

Those with scurvy tend to lie in what position?

A

Frog-leg: supine and motionless with thighs abducted

80
Q

What is the ring-shaped radiodense sclerosis around of the epiphysis called that is seen with scurvy?

A

Wimberger’s sign

81
Q

What is the dense (sclerotic) zone (WHITE) of provisional calcification seen with scurvy that is due to delayed conversion to bone?

A

White line of Frankel

82
Q

What is the term for the radiolucent (DARK) band that is sometimes visible directly beneath the zone of provision calcification (white line of Frankel) seen with scurvy?

A

Trummerfeld’s zone

83
Q

What is the term for the beak-like metaphyseal outgrowths that extend at right angles to the shaft with scurvy patients?

A

Pelken’s spurs

84
Q

What change to the periosteum is most commonly seen in kids with scurvy?

A

Subperiostial hemorrhage

Diagnostic Imaging I Final COPY (Goldfish) (9 decks)

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