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Chapman Aids to differentials flashcards > Bones > Flashcards

Bones Flashcards

1
Q

Generalised increased bone density

A

Myeloproliferative - myelosclerosis

Metabolic - renal osteodystrophy

Poising - Fluorosis

Malignant - Osteblastic mets, lymphoma, mastocytosis

Idiopathic
- Pagets

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2
Q

Solitary sclerotic bone lesion

A

Developmental - enostosis, FD

Neoplastic - mets, lymphoma, osteoma, healed bone lesion, primary bone sarcoma

Vascular - bone infarct

Traumatic. - callus

Infective - osteomyelitis of Garre

Idiopathic - pagets

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3
Q

Multiple scloertotic bone lesions

A

Developmental - FD, Osteopoikilosis, osteopathia striata, TS

Neoplastic - mets, lympomha, mastocytosis, healed lesions, MM, osteoma, multifocal osteosarcoma

Idiopathic - pagets

Vascular - bone infarcts

Traumatic - callus

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4
Q

Bone sclerosis with a periosteal reaction

A

Trauma - healing

Neoplastic - mets, lympoma, OO/Ob, osteosarcoma, Ewings, chondrosarcoma

Infective - OM, syphilis

Idiopathic - Cafffeys, meloheostosis

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5
Q

Solitary sclerotic lesion with LUCENT centre

A

Neoplastic - OO/Ob.

Infective - brodies abscess, syphilis,yaws, TB

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6
Q

Conditions involving skin AND bone

  • osteolytic bone lysions
A

Congenital
- NF, Basal cell naevus syndrome, angiodysplasias

Acquired
- Scleroderma, RA, Gout, Leprosy, Syphilis, Actinomycosis, LCH, Sarcoidosis, Mastocytosis, Pancreatitits with osteonecrosis.

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7
Q

Conditions involving skin AND bone

OsteoSCLEROTIC bone lesions

A

Congenital
- Osteopoikilosis
- osteopathia striata
-melorheostosis
gardners syndrome

Acquired
- Reiter syndrome
SAPHO
Kymphoma
sarcoid
haemangiomatosis
lipoatrophic diabetes mellitus

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8
Q

What is SAPHO

A

Synovitis, acne, pustulosis , hyperostosis, osteitis

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9
Q

Conditions involving skin AND bone

  • mixed Osteolytic and osteosclerotic
A

Gauchers
Psoritatic artheitis
SAPHO
Reiters Sarcoid
Pnacreatic bone lesions

Tumnours
- Maffuci
FD
Haemangioma

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10
Q

Coarse trabecular pattern

A

Pagets
Osteoporosis
Osteomalacia
Haemoglobinopathies
haemangioma
gauchers

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11
Q

Skeletal mets appearance of

Lung

A

Carcinoma - lytic
carcinoid - sclerotic

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12
Q

Skeletal mets appearance of

Breast

A

Lytic or mixed

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13
Q

Skeletal mets appearance of

Genitourinary

A

RCC - lytic

Wilms - lytic

Bladder 0 lytic (sometimes sclerotic)

Prostate - sclerotic

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14
Q

Skeletal mets appearance of

Reproductive

A

Cervix - lytic/mixed
Uterus - lytic
ovary - lytic
Testic - lytic, sometimes sclerotic

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15
Q

Skeletal mets appearance of

Thyroid

A

lytic - expansile

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16
Q

Skeletal mets appearance of

GI

A

Stomach - sclerotic or mixed

colon - lytic, rarely sclerotic

rectum - lytic

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17
Q

Skeletal mets appearance of

adrenal

A

phaeo - lytic and expansile

carcinoma - lytic

Neuroblastoma. - lytic, sometimes sclerotic

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18
Q

Skeletal mets appearance of

Skin

A

SCC - lytic

Melanoma - lytic, expansile

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19
Q

Sites of origin for different tumours

Diaphysis

A

adamantionoma
Osteoid osteoma
Chondromyxoid fibroma
Fibrous dysplasia

Ewings
Lymphoma
Lyeloma
Central
Chondrosarcoma

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20
Q

Metaphyis cancer

A

Peripheral chondrosarcoma
osteosarcoma

osteoblastoma
simple bone cyst

Enchondroma
chondrosarcoma

Giant cell tumour

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21
Q

epiphysis cancer

A

Chondroblastoma

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22
Q

DDx for

Lucent bone lesions
- medulla
- well defined
- marginal sclerosis
- no expansion

A

Geode (arthirits)
Healing lesion
brodies abscess
benign - simple bone cyst, enchondroma, chondroblastoma

Fibrous dysplasia

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23
Q

DDx for

Lucent bone lesions
- medulla
- well defined
- NO marginal sclerosis
- no expansion

A

absence of reactive bone formation suggests fast growth rate

mets
MM
EG
Brown tumour

Enchondroma
Chondroblastoma

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24
Q

Lucent lesion in medulla - ILL defined

A

aggressive pattern

mets
MM
OM
Lymphoma
Sarcomas (Osteo, Ewings, Central chondro, Fibro)

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25
Q

Lucent lesion in medulla

well defined

eccentric expansion

A

Giant cell tumour
ABC
Enchondroma
NOF
Chondromyxoid fibroma

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26
Q

Lucent lesion - grossly expansile

A

Malignant - mets, plasmacytoma, central chdonrosarcoma/lymphoma/fibrosarcoma or telangioectatic osteosarcoma

Benign
- ABC, Giant cell tumour, enchondroma

NON NEOPLASTIC
- FD, haemophiliac pseudotumour
brown tumour
hydatid

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27
Q

subarticular lucent bone lesion

A

Arthritides
- Osteoarthritis
- RA
- CPPD
- Gout
- Haemophilia

Neoplastic
Mets / MM
ABC
Giant Cell Tumour
Chondrobasltoma
Pigmented villonodular synovitis

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28
Q

lucent bone lesion
- containing calcium or bone

NEOPLASTIC

A

neoplastic
- mets (breast)

cartilage neoplasms
- benign, enchondroma, chondroblastoma, chondromyxoid fibroma

bone neoplasms
- bengin - OO/ob
- malignantn - osteosarcoma.

fibrous tissue neoplasms
- malignant, fibrosarcoma and malignant fibrous hisitiocytoma

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29
Q

lucent bone lesion
- containing calcium or bone

Non neoplastic causes

A

FD
Pagets (osteoporosis circumscripta)
AVN and bone infarction
OM with sequestrum
EG
Introsseous lipoma !

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30
Q

Moth eaten bone in an adult

A

Neoplastic
- Mets, MM, leukaemia, Long bone sarcoma, LCH

Infective - OM,

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31
Q

Regional Osteopenia

A

Disuse

Sudecks atrophy - complex regional pain syndrome.

Tranient osteoporosis of the hip

Regional migratory

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32
Q

generlaised osteopenia

A

Osteoporosis
osteomalaicia
hyperparathyroidims
diffuse infiltrative bone disease (MM / leukaemia)

33
Q

Osteoporosis features

A

low bone density
cortical thinning
accentuation of trabecular stress lines
brittle bones

34
Q

osteoporosis causes

endocrine

A

Hypogonadism - menopausal, eunuchoidism, tunrners
Cushings
DM
Acromegaly
Addisons
HyperPTH
mastocytosis (mast cells produce heparin)

35
Q

Osteoporosis

casues

disuse

A

Iatrogenic - steroids, heparin,

Deficiency - vit c, protein

36
Q

Congenital causes of osteoporosis

A

Osteogenesis imperfecta
turners
Homocystinuria
Neurmuscular disease
Mucoplysacharidoses
Trisomy 13 and 18
Pseudo and pseduo pseuo hyperparathyroidism
Glycogen storage diseases
Progeria

37
Q

Causes of osteomalacia / rickets

A

Vit D - diet/malabsorption

Renal disease
- GLomerular disease
- tubular diease, renal tubular acidosis, fanconi, familial hypophosphataemia

Hepatic
Parenchymal failure, obstructive jaundie

Anticonvulants
- phenytoin, phenobarbitol

tumour
- soft tissues, haemangiopericytoma
- bone - NOF< Giatn cell tumour, osteoblasotma. osteosarcoma

38
Q

mimicks of rickets / osteomalacia

A

hypophasphatasia - low alp
metaphyseal chondrodysplasiaic

39
Q

mimicks of rickets in under 6 months

A

Biliary atresia
Metabilic bone odisease of prematurity
hypophosphatemia
vitamin D tickets

40
Q

Paralell spiculated hair on end appearnce

A

Ewings
syphilis
Caffeys

41
Q

Sunray periosteum

A

Osteosarcoma
mets
ewings
haemangioma
meningioma
TB
Tropical ulcer

42
Q

Codman triangle angle

A

aggressive tissue extending into soft tissue

malignant or infeciton

43
Q

isolated and solitary periosteal reaction

A

Trauma
inflammatory
neoplasm

44
Q

Periosteal reaction - bilaterally symmetrical in adult

A

Hypertrophic osteoathropathy
Pachydemoperiostosis
Vascular insufficency
Thyroid acropachy
FLuorosis
DISH (Anterior x4 vert)

45
Q

what is DISH

A

diffuse idiopathic skeletal hyperostosis

46
Q

Periosteal reaction
- bilateral asymmetrical

A

mets
OM
Arthritides
Osteoporosis
Osteomalacia
NAI
Bleeding diathesis
Hand foot syndrome.

47
Q

Hypertrophic osteoarthropathy

Puomonary causes

A

Carcinoma of bornchus
lymphoma
abscess
bronchiectasis
mets

48
Q

Hypertrophic osteoarthropathy

Pleural

A

PLeural fibroma
mesothelioma

49
Q

Hypertrophic osteoarthropathy

cardiovascualr casues

A

Cyanotic congenital heart disease
- clubbing, rarely perisoteal reaction

50
Q

Hypertrophic osteoarthropathy
GI causes

A

UC
Crohns
Dysentry
Lymphoma
Whipples disease
Coeliac
Cirrhosis
Nasopharyngeal carcinomas - schminckes tumour
Juvenile polyposis

51
Q

causes of excessive callus formation

A

Steroid athropathy / cushings
Neuropathic artheropathy
ostegenesis imperfeta
NAI
paralytic states
renal osteodystropy
MM

52
Q

causes of AVN

A

Toxic
- steroids, EtoH, immunosupressants, anti inflams (indometacin).

Trauma
- idiopathic, fractures, radiotherapy, heat, fat embolism.

Inflammatory
- RA, SLE, scleroderma, infeciton, pancreatitis

Metabolic
- pregnancy, Diabetes, cushings, hyperlipidaemias, Gout

Haemopoietic
- Haemaglobinopathies
Polycathaemia rubra vera
Gauchers
haemophilia

Thrombotic and embolic
- Dysbaric osteonecrosis
arteritis

53
Q

Erosions of the medial metaphysis of the proximal humerus

A

normal variant
leukameia
mets neuroblastoma
gauchers
hurlers
glyocgen storate disease
Niemann-Pick
Hyperparathyroidism
RA

54
Q

erosion or absence of the outer end of the clavicle

A

RA
Post traumatic osteolysis
MM
Mets
Hyperparathyrodism
Cleidocranial dysplasia
Pyknodystostosis

55
Q

focal rib lesion

solitary or multiple

Neoplastic causes

A

commonest. Malignant –> primary –> benign

Mets - f, breast. m, bronchus, kidney, prostate

Primary malignant - MM, plasmacytoma, chonsdrosarcoma, askin.

benign - osteochondroma, enchondroma, LCH

56
Q

focal rib lesion

solitary or multiple

non neoplastic causes

A

Healed fracture
FD
Pagets
Brown tumour
Osteomyeltisi

57
Q

rib
inferior surface notching

A

Arterial - Coarc, aortic thrombosis, sublcavian obstruction, pulmonary oligaemia

Venous - superior vena caval obstruction

Arterioenous - pulmonary avm, chest wall avm

Neurogenic - NF. ribbon ribs,

58
Q

rib
superor surface notching

A

Connective tissue
- TA
SLE
Scleroderma
Sjogrens

metabolic
- hyperparathyroidism

Misc.
- NF, restrictive lung disease, poliomyeltis, marfans, osteogenesis imperfecta, progeria

59
Q

wide / thick ribs

A

Chronic anaemias
FD
Pagers
Healed fracture
Achondroplasia
Mucopolysacharidoses

60
Q

What is Madelung deformity

A

short distal radius with ulnar curve.
Triangular radius epiphyisis
dorsal subluxation of the distal ulna.
enalrged ulnar head

61
Q

types of madelung deformity

A
  1. isolated - bilatearl, asymmetrical, adolescent and young women
  2. dyschondrosteosis - LERI WEIL disease.
    - bilateral with mesomelic limb shortnening. AD. Males.
  3. Diaphyseal aclasis
  4. Turners
  5. Post traumatic
  6. Post infective
61
Q

Carpal fusion - isolated

causes

A

Triquetral lunate

Capitate hamate

Trapezium - trapezoid

62
Q

carpal fusion

syndrome related

A

Massive carpal fusion.

APerts syndrome
Arthrogryposis multiplex congenita
Ellis Van Crevald Syndrome
Holt Oram Syndrome
Turners
Symphalangism

63
Q

carpal fusion

acquired

A

inflammatory arthritides (juvenile and RA)

Pyogenic arthritis

Chronic TB arthritis

Post trauma

post surgery

64
Q

Short metacarpal or mettarsal

A

Idiopathic
Post trauma
Post infarction - sickle cell
Turners
Pseudohypoparathyroidism.

65
Q

Causes of arachnodactyly

A

Marfans
Homocystinuria - lens dislocats down, also they are dumb.

66
Q

distal phalangeal destruction

tuft

A

scleroderma
Raunauds
Psoriatic arthropathy
neuopathic disease, DM, leprosy.
Thermal injuries
Trauma
Hyperparathryrodism,
Epidermolysis bullosa
porphyria
phenytoin toxicity
snake venom

67
Q

distal phalangeal destruction

mid portion

A

Polyvinyl chloride tank cleaners
Acro-osteolysis of Hajdu and Cheney
Hyperparathyroidism

68
Q

distal phalangeal destruction

Periarticular

A

psoriatic arthropathy
erosive osteoarthritis
hyperparathyroidism
thermal injuries
scleroderma
multicentric reticulohistiocystosis

69
Q

distal phalangeal destruction

poorly defined lytic lesions

A

OM

mets - bronchus. Temrinal tuft can be solitary mets.
MM
ABC
Giant cell tumour
leprosy

70
Q

distal phalangeal destruction

well defined lytic lesions

A

Epidermoid cuyst
enchondroma
sacoid - lace like destruciton
GLomus tumour
Osteoid osteoma
fibrous dysplasia

71
Q

fluid filled levels on CT/ MRI

Benign

A

ABC
Chondroblastoma
Giant cell tumour
Simple bone cyst
fbirous dysplasia

72
Q

fluid filled levels on CT/ MRI

malignant

A

Telangiectactic osteosarcoma
malignant fibrous histiocytoma
necrotic bone tumours

73
Q

increased uptake on bone scans

A

mets - axial

joint disease - cervical, hips, hands,

traumatic - aligned rib fractures.

post surgery.

pagets

superscan - absent kidneys

metabolic bone disease

dental diease, extraction or inflammation

infection. vascular and blood pool phases.

74
Q

increased uptake in bone scan

NOT RELATED TO BONE DISEASE

A

artefacts

patient - urine, sweat, injeciton site, scars, breast shadow.

edge effect.

Physiological variants
- epiphyses in kids
inferior angle of scapula
calc of cartilage
bladder diverticulum
nipples
reanl pelvis

75
Q

increased uptake in bone scan

soft tissue uptake

ddx

A

Calc related
- Myositis ossificans
soft tissue osseous metaplasia
soft tissue tmours with calc
vascular calc
calcific tendonitis
abscess

other
- acute infarction
malignant pleural effusion
inflammatory carcinoma of the breast
hepatic necrosis
hepatic mets
tumour uptake

76
Q

bone scans

visualisation of normal organs with

Free pertechnetate

A

Thyorid
stomach
salivary glands

77
Q

bone scans

visualisation of normal organs with

Colloid formation

A

Liver
spleen
sometimes lung

78
Q

photopenic areas on bone scans

A

Artefacts

Avascular lesions - cyst
MM - could be rasied
Mets - lytic
Leukameia - could be raised
Haemangioma of spinke, sometimes increased

Chapman Aids to differentials flashcards (5 decks)

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