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Endo/Met Flashcards

0
Q

What are the classic radiographic signs seen with scurvy in an INFANT?

A
  • dense zone of provisional calcification (White line of Frankel)
  • ring epiphysis (Wimberger’s ring)
  • bony protuberances at metaphyseal margins (Pelken’s spur)
  • lucent metaphyseal band (scorbutic/Trummerfeld zone)
  • SUBPERIOSTEAL HEMORRHAGE
  • irregular metaphyseal margins (corner or angle sign)
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1
Q

What are the aka for scurvy?

A

a) Barlow’s disease

b) hypovitaminosis C

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2
Q

What are the anatomical sites and corresponding clinical/radiographic findings seen in hypervitaminosis A?

A

i) Shafts of long bones –> solid periosteal new bone
ii) Cranial sutures –> diastasis of cranial sutures
iii) Skin & hair –> dermatitis, jaundiced skin, alopecia
iv) Liver –> hepatomegaly

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3
Q

What are the classic radiographic signs seen with scurvy in an INFANT?

A
  • dense zone of provisional calcification (White line of Frankel)
  • ring epiphysis (Wimberger’s ring)
  • bony protuberances at metaphyseal margins (Pelken’s spur)
  • lucent metaphyseal band (scorbutic/Trummerfeld zone)
  • SUBPERIOSTEAL HEMORRHAGE
  • irregular metaphyseal margins (corner or angle sign)
  • metaphyseal cupping
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4
Q

What are the anatomical sites and corresponding clinical/radiographic findings seen in hypervitaminosis D?

A

i) Blood vessel walls –> extensive calcification in blood vessel walls
ii) Kidneys –> calcifications in kidney; polyuria
iii) Periarticular tissues –> periarticular calcifications

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5
Q

What are the radiographic features of fluorosis?

A
  • skeletal sclerosis
  • exuberant vertebral hyperostosis, spinal exostoses
  • sacrotuberous and sacroiliac ligament
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6
Q

What lab findings are present in rickets?

A
  • elevated serum alkaline phosphatase

- normal/low serum calcium & phosphorus

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7
Q

What is the differential diagnosis of “paintbrush metaphysis”?

A 
CHARMS
C = congenital infections (syphilis, rubella)
H = hypophosphatasia
A = achondroplasia
R = rickets
M = metaphyseal dysostosis
S = scurvy
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8
Q

What is the M/C metabolic bone disease?

A

Osteoporosis

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9
Q

How much bone loss is needed before its seen on plain film?

A

30-50%

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10
Q

What is the healing time and quality of bone in fracture deformities associated with osteoporosis?

A

Normal healing time and quality

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11
Q

Which is the last trabecular pattern to be obliterated in the hip with osteoporosis?

A

Principal compressive group (1st is secondary compressive group)

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12
Q

What is the relationship of hip DJD and spinal compression fractures?

A

Diminished incidence of spinal compression fx.

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13
Q

What is the relationship of hip DJD and incidence of osteoporosis?

A

<5% of osteoporosis cases have concurrent DJD

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14
Q

What is the M/C sacral insufficiency fracture?

A

Single vertical fracture through sacral ala (“I pattern”).

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15
Q

Insufficiency fractures fractures of the calcaneus is commonly seen in patients with which predisposing condition?

A

Diabetes

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16
Q

Transient osteoporosis of the hip in pregnant woman M/C occurs in which hip?

A

left

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17
Q

Gaucher’s disease predominately affects which pop’n?

A

Ashkenazic Jews

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18
Q

What is the fundamental problem with Gaucher’s disease?

A
  • lipid metabolism abnormality
  • deficient liposomal enzyme activity (acid beta glycosidase)
  • abnormal accumulation of glycosyl ceramide in reticulo-endothelial cells
  • Gaucher cells replace normal marrow elements
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19
Q

What are the radiographic features of Gaucher’s disease in the femur?

A
  • avascular necrosis of head
  • Erlenmeyer flask deformity
  • medullary expansion –> cortical thinning
  • osteoporosis
  • periostitis
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20
Q

What are the radiographic features of Gaucher’s disease in the spine?

A
  • diffuse osteopenia
  • vertebral body collapse
  • H-shaped vertebra/biconcave endplates (“fish vertebra”)
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21
Q

What are the clinical features of Gaucher’s disease?

A
  • splenomegaly
  • yellowish-brown skin
  • scleral pigmentation
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22
Q

List the different subtypes of Histiocytosis X from best to worst prognosis?

A

i) EG
ii) Hans-Schuller-Christian
iii) Letterer-Siwe

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23
Q

What is the M/C x-ray finding seen with Letterer-Siwe?

A

Calvarial lytic lesions

rarely, aggressive lysis in long bone diaphyses – surrounding onion skin periosteal rxn

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24
What is the classic triad associated with Hans-Schuller-Christian disease?
i) exophthalmos ii) diabetes insipidus iii) lytic skull lesions
25
What are the classic radiological signs seen with Hans-Schuller-Christian disease?
Skull & Long bones: - geographic lesions (multiple lytic lesions coalesce) - hole within a hole appearance (beveled edge)
26
At what age does Hans-Schuller-Christian present?
early childhood to middle age
27
Are solitary lesions or multiple lesions M/C in EG?
Solitary (but 20% will progress to polyostotic)
28
What are the 3 M/C locations affected in EG?
1) skull (>50%) 2) mandible (25%) 3) pelvis (20%)
29
When found in the spine, which area does it M/C involve?
Thoracic (>50%)
30
What is the prognosis of a silver dollar VB in EG?
>90% experience 48-95% restoration of body height within 1 yr
31
Where within the long bone does EG M/C involve?
Diaphysis (60%)
32
What are the specific pathological granulomas proliferated in EG?
Birbeck granules
33
What is main underlying condition of primary HPT?
Parathyroid adenoma (90%)
34
What is the underlying cause of secondary HPT?
Persistent Ca++ and P loss -- by chronic renal disease
35
What is the underlying cause of tertiary HPT?
Parathyroid acting independently of serum calcium levels -- seen in DIALYSIS patients.
36
What is the laboratory findings seen with primary HPT?
i) Hyperparathormone --> causes release of Ca++ into bloodstream ii) Hypercalcemia --> osteoclastic resorption d/t elevated serum parathormone iii) Hypophosphatemia --> excreted readily (unlike Ca++)
37
What is Recklinghausen's disease of bone?
Osteoclastic and osteocytic resorption lead to replacement by fibrous tissue (i.e. osteitis fibrosa cystica)
38
What is the pathological hallmark sign of HPT?
Subperiosteal bone resorption at ligament and tendon insertions.
39
What are brown tumors?
Cyst-like fibrous accumulations with osteoclastic giant cells.
40
Where are the M/C locations for subperiosteal bone resorption in HPT?
- radial aspect of proximal & middle phalanx (2nd & 3rd digit) - medial metaphyses humerus & tibia
41
What findings are seen with tertiary HPT?
Dialysis-related arthropathy - caused by amyloid deposits in articular tissues - symmetric destructive polyarthropathy (inflammatory-like) Dialysis-related spondyloarthropathy - cervical spine M/C - vertebral collapse and erosions
42
What are the soft tissue changes seen with HPT?
- subcutaneous calcification - vascular calcification - nephrocalcinosis (75%) - chondrocalcinosis - periarticular (ligaments/tendons) calcification - salivary gland, pancreas calcification
43
What is a characteristic facial involvement of HPT?
Floating tooth sign --> lamina dura resorbed around tooth socket
44
What are the clinical features seen with acromegaly?
- prognathic jaw - prominent forehead - large hands and feet - thickened & darkened skin - deepened, husky voice - bilateral carpal tunnel syndrome
45
What are the spinal findings seen with acromegaly?
- early widened disc heights - premature DJD w/ exuberant osteophytes - posterior body scalloping (dural ectasia) - widened ADI and facet joints
46
What is primary Cushing's disease vs. secondary vs. iatrogenic?
``` Primary = adrenal cortical malfunction (excessive glucocorticoids released) Secondary = anterior pituitary neoplasm Iatrogenic = administration of corticosteroids ```
47
What are the clinical features of Cushing's disease?
- moon facies - buffalo hump (fat accumulation upper T/S) - purple striae on abdomen - osteoporosis
48
What are the radiographic features of Cushing's disease?
- osteoporosis - osteonecrosis (ONLY with corticosteroid therapy) --> bilateral femoral heads (30-50%) - compression fx of the spine
49
What is the ddx of intravertebral vacuum cleft sign?
i) osteoporosis ii) MM iii) mets iv) Kummel's disease v) radiation therapy
50
What is hypothyroidism in a newborn?
Cretinism
51
Who develops thyroid acropachy and what are the clinical manifestations?
Patients successfully treated for hyperthyroidism. | Painless, progressive digital swelling.
52
What is an aka for hyperthyroidism?
Graves' disease
53
What are the radiographic features of hyperthyroidism?
Generalized osteopenia
54
What are the radiographic features of hypothyroidism?
- delayed closure and fragmentation of epiphysis - sail vertebra (cretinism) - Wormian bones
55
What are the radiographic features of thyroid acropachy?
Dense periostitis at: - radial aspect metacarpals & phalanges - tibial aspect metatarsals & phalanges
56
Which endo/met condition gives you basal ganglion calcification?
pseudohypoparathyroid & pseudopseudo
57
Which endo/met condition is the juvenile version of Paget's disease?
Hyperphosphatasia
58
Pseudofractures in osteomalacia present on which side of the curve (concave or convex)?
Concave
59
What are the radiographic features of rickets?
- paint brush - widening/cupping metaphyses - rachitic rosary - harrison's grooves
60
What is the M/C tumor to result in oncogenic osteomalacia?
Hemangiopericytoma
61
What facial appearance is seen with Paget's?
Mouse face
62
What hormones are released from the posterior pituitary?
Vasopressin & oxytocin
63
What hormones are released from the anterior pituitary?
``` Growth hormone Prolactin ACTH TSH FS LH ```
64
What osseous finding do you see at the articular surface of joints in acromegaly?
beak-like osteophytes
65
What is the M/C/C of growth hormone hypersecretion?
Benign pituitary tumor
66
What common finding is seen with acromegaly and rickets?
prominent costochondral junction (acromegalic rosary & rickitic rosary)
67
What hip finding has an increased incidence in hypopituitarism?
SCFE
68
What is the major radiographic finding seen with hypopituitarism?
Delayed skeletal maturation (delayed appearance of growth ossification centers & delayed fusion)
69
What is the M/C/C of hyperthyroidism?
Thyroid adenoma
70
What is the M/C clinical finding seen with hyperthyroidism?
exophthalmos
71
What are the calcium, phosphorus & alkaline phosphatase levels?
All 3 are elevated.
72
What are the clinical features of thyroid acropachy?
- exophthalmos - pre-tibial myxedma - finger clubbing
73
What is the M/C radiological sign seen in hypothyroidism?
- slow skeletal maturation (like hypopituitarism) | - ephyseal dysgenesis
74
What is the hip finding seen in hypothyroidism?
SCFE (like hypopituitarism)
75
What is the hip finding seen in renal ostedystrophy in 10% of cases?
SCFE
76
List the 7 locations of bone resorption in HPT?
``` TIESSSS: Trabecular Intracortical Endosteal Subligamentous Subperiosteal Subphyseal Subchondral ```
77
List 2 aka for brown tumor in HPT.
i) Osteoclastoma | ii) Osteitis fibrous cystica
78
What % of diabetic patients have DISH?
21%
79
What skull findings are seen in hypervitaminosis A?
- bulging of fontanelles - widened sutures - acute hydrocephalus
80
What radiographic findings are seen in hypervitaminosis A?
- cortical hyperostosis - metaphyseal cupping - premature physeal closure
81
What's the M/C/C for hypervitaminosis D in a child? In an adult?
Child --> treatment of rickets | Adult --> treatment of Paget's and RA
82
What are the radiographic findings associated with hypervitaminosis D?
Children: - alternating metaphyseal dense and lucent bands - cortical thickening - metastatic calcification (in viscera, blood vessels, falx etc.) Adults: - osteoporosis - massive soft tissue calcification!!
83
What is the cause for the dense metaphyseal lines in lead poisoning?
Deposition of calcium (chondrosclerosis)
84
What are the 2 main causes for lead poisoning in adults?
i) bullets, shrapnel etc. (lead arthropathy) | ii) Saturine gout
85
What are 2 causes for bismuth poisoning?
i) pepto bismol | ii) pregnant women with syphils
86
What is Menke's syndrome (kinky hair)?
Defect in copper absorption from gut --> obliterates arteries in brain & soft tissues.
87
Fluorosis occurs when the fluorine content in water is greater than how much?
>4ppm
88
What is the radiological triad associated with fluorosis?
i) sclerosis ii) osteophytosis iii) enthesophytosis Other: - periostitis

MSK (5 decks)

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