systemic bone diseases

Question 1

What does CATBITES stand for?

Answer 1

Congenital
Arthritis
Trauma
Blood
Infection
Tumor
Endocrine, nutritional, metabolic
Soft tissue

Question 2

what are the 2 hormones that inhibit bone production?

Answer 2

PTH

cortisol

Question 3

what hormones and nutrients stimulate bone production?

Answer 3

GH
T3, T4
Calcitonin
D 
C

Question 4

what is an all encompassing definition for increased radiolucency or decreased bone density?

Answer 4

osteopenia

Question 5

what is the MC osteopenia?

Answer 5

osteoporosis

Question 6

what are some other causes of osteopenia?

Answer 6

osteomalacia
hyperparathyroidism
rickets/osteomalacia
scurvy
neoplasm

Question 7

which osteopenia has linear radiolucencies/ looser lines on imaging?

Answer 7

osteomalacia

Question 8

which osteopenia produces subchondral and subperiosteal resorption?

Answer 8

HPT

Question 9

which osteopenia produces focal lesions?

Answer 9

neoplasms- plasma cell myeloma

Question 10

what percent of bone mass loss is needed to be seen on film?

Answer 10

30-50%

Question 11

which condition has qualitatively normal but quantitatively deficient bone?

Answer 11

osteoporosis

Question 12

which type of fracture in women doubles every 5 years after 60?

Answer 12

hip fracture

vertebral fractures are also high at 64%

Question 13

senile, postmenopausal and transient or regional are all what classification of osteoporosis?

Answer 13

primary

Question 14

what are some causes of secondary osteoporosis?

Answer 14

corticosteroids
malignancy
infection
arthritides
disuse 
RSD

Question 15

osteoporosis radiographic features seen in the spine

Answer 15

cortical thinning- pencil thin
resorption of non-stress bearing trabeculae
accentuated vertical struts
altered vertebral shape- wedge shaped, compressed, fish vertebra, codfish deformity
schmorl’s nodes
end plate infarctions

Question 16

with severe fractures, if the compression exceeds 30% of original body height or retropulsion is present or if neurologically compromised, what additional imaging is needed?

Answer 16

CT- evaluation of canal, bone marrow and hemorrhage in canal

Question 17

what are some radiographic signs for osteoporosis in an extremity?

Answer 17

pencil thin cortices
endosteal scalloping
loss of secondary trabeculae
fracture risk

Question 18

what are the trabecular patterns of the hip?

Answer 18

1 primary compressive- medial
2 secondary compressive- lateral
3 primary tensile

Question 19

confluence of the 3 trabecular groups forms a triangle of radiolucency known as?

Answer 19

Ward’s triangle

Question 20

in osteoporosis, which trabecular pattern is last to be involved?

Answer 20

primary compressive

Question 21

radiolucency of ward’s triangle is more prominent in?

Answer 21

osteoporosis

Question 22

with increasing severity, tensile group compression regresses ___ to _______ opening Ward’s triangle laterally

Answer 22

medial to lateral

Question 23

with significant osteopenia how do you differentiate osteoporosis from MM?

Answer 23

with MM patient is too young for osteoporosis and will have multiple punched out lesions

Question 24

what are T-scores used to measure?

Answer 24

fracture risk associated with osteoporosis

Question 25

What are the WHO t-scores?

Answer 25

T-1 or higher= normal T -2.5 to -1= osteopenia T below -2.5= osteoporosis T below -2.5 + fragility fracture= severe osteoporosis

Question 26

disuse inhibits ______ activity

Answer 26

osteoblastic

Question 27

what is a regional osteoporosis following a trivial trauma with acute pain in those under 50 and especially affects the hands?

Answer 27

reflex sympathetic dystrophy

Question 28

what are some clinical signs of RSD?

Answer 28

reflex hyperactivity of SNS pain, swelling, vasomotor disturbances, trophic skin changes (skin atrophy, pigmentation abnormal)

Question 29

who is most affected by transient osteoporosis of the hip?

Answer 29

30-50 year olds 3:1 males 3rd tri pregnancy females- usually left hip bilateral in men onset of sudden pain, antalgia and limp, self limiting over 3-12 months

Question 30

which condition has an abnormally high osteoid to mineralized bone ratio- inadequately mineralized bone matrix?

Answer 30

osteomalacia

Question 31

what are the 2 main causes of osteomalacia?

Answer 31

Vit D metabolism | renal tubular phosphate loss

Question 32

what is fanconi's syndrome?

Answer 32

renal tubular phosphate loss, associated with osteomalacia

Question 33

what are linear regions of unmineralized osteoid usually bilateral and symmetrical at right angles to the bone?

Answer 33

looser lines

Question 34

what condition do you see looser lines/ pseudofractures?

Answer 34

osteomalacia

Question 35

what condition presents with muscle tetany, irritability, weakness, delayed development, small stature, bone deformities and pain

Answer 35

rickets- also soft tissue swelling around growth plates due to hypertrophied cartilage

Question 36

what is elevated in rickets?

Answer 36

alkaline phosphatase

Question 37

where are the most prominent radiographic features of rickets usually seen?

Answer 37

costochondral jx of middle ribs distal femur, proximal humerus both ends of tibia distal ulna and radius

Question 38

what is fraying and what condition do you see it in?

Answer 38

widened, bulky growth plates and irregularity- rickets

Question 39

splaying, fraying, bowing deformities and rachitic rosary of the chest are all seen in?

Answer 39

rickets

Question 40

what is the term for expansion of the anterior rib ends at the costochondral junctions?

Answer 40

rachitic rosary

Question 41

splaying of weakened bone at jx of metaphysis and physis predisposes to?

Answer 41

slipped epiphysis- epiphysiolysis

Question 42

paintbrush metaphysis is seen in?

Answer 42

rickets

Question 43

what is Barlow's disease?

Answer 43

scurvy

Question 44

what are some clinical findings of scurvy?

Answer 44

``` osteopenic bone spontaneous hemorrhage cutaneous petechiae, bleeding gums, hematuria joint swelling irritability frog-leg position malaise and lethargy ```

Question 45

what is a dense sclerotic zone of provisional calcification due to delayed conversion of bone?

Answer 45

white line of Frankel

Question 46

what are beak like metaphyseal outgrowths extended at right angles to shaft?

Answer 46

Pelken's spurs

Question 47

what sign shows radiodense sclerosis around epiphysis and radiolucency centrally?

Answer 47

wimberger's sign

Question 48

what is corner sign?

Answer 48

irregularity of metaphyseal margins

Question 49

what is it called when there is a radiolucent band visible directly beneath zone of provisional calcification?

Answer 49

Trummerfeld's zone/ scorbutic zone

Question 50

subperiosteal hemorrhage, Trummerfeld's zone, white line of frankel, wimberger's ring and pelken's spurs are all radiographic features seen in?

Answer 50

scurvy

Question 51

primary HPT is the MC and 90% caused by?

Answer 51

parathyroid gland adenoma

Question 52

what is the MC cause of hypercalcemia?

Answer 52

primary HPT

Question 53

what are 3 causes of secondary HPT?

Answer 53

chronic renal disease hemodialysis renal osteodystrophy

Question 54

what type of HPT is seen in dialysis patients, parathyroid gland acts independent of serum calcium?

Answer 54

tertiary HPT

Question 55

renal stones, peptic ulcers, pancreatitis, confusion, lethargy, weakness, bone pain, polyuria and polydypsia are all signs of?

Answer 55

HPT

Question 56

what are brown tumors?

Answer 56

cystic accumulations of fibrous tissue

Question 57

what are some radiographic signs seen in HPT?

Answer 57

``` osteopenia subperiosteal resorption distal tuft resorption brown tumors soft tissue calcification cortical definition loss ```

Question 58

what is the most radiographic definitive sign of HPT?

Answer 58

subperiosteal resorption- esp at radial margins of middle and proximal phalanges of 2-3 digits

Question 59

widened joint spaces and osteolysis is seen MC where in HPT?

Answer 59

AC and SI joints

Question 60

what happens to the teeth with HPT?

Answer 60

loss of lamina dura of teeth

Question 61

rugger jersey sign and salt and pepper skull are classic signs of?

Answer 61

HPT

Question 62

what are lytic lesions containing osteoclasts and mononuclear cell and fibroblasts with focal hemorrhages?

Answer 62

brown tumors

Question 63

what produces the brown color in a brown tumor?

Answer 63

hemosiderin from hemorrhage

Question 64

brown tumor aka

Answer 64

osteoclastoma

Question 65

what accounts for 10% of all neoplasms within the cranium?

Answer 65

pituitary tumors

Question 66

headaches, visual disturbances and generalized discomfort in the extremities are all signs of?

Answer 66

pituitary tumor

Question 67

what is a classic radiographic sign seen in pituitary tumors?

Answer 67

enlarged sella turcica

Question 68

an oversecretion of GH from pituitary adenoma occuring AFTER open growth plate closure resulting in excessive growth and proliferation of CT?

Answer 68

acromegaly

Question 69

excessive GH before growth plates close

Answer 69

gigantism

Question 70

"spade like" distal tufts and hooking osteophytes with widened shaft and increased joint spaces of extremities is seen with?

Answer 70

acromegaly

Question 71

frontal bossing is seen with?

Answer 71

acromegaly and gigantism

Question 72

macroglossia and heel pad thickening are seen with?

Answer 72

acromegaly

Question 73

what is cushings aka

Answer 73

hypercortisolism

Question 74

what are radiographic features seen in cushings?

Answer 74

``` generalized osteopenia compression fractures avascular necrosis- high atherosclerotic plaquing healing with excessive callus ```