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MSK > Endo/Met > Flashcards

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
Q

What is the classic triad associated with Hans-Schuller-Christian disease?

A

i) exophthalmos
ii) diabetes insipidus
iii) lytic skull lesions

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25
Q

What are the classic radiological signs seen with Hans-Schuller-Christian disease?

A

Skull & Long bones:

  • geographic lesions (multiple lytic lesions coalesce)
  • hole within a hole appearance (beveled edge)
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26
Q

At what age does Hans-Schuller-Christian present?

A

early childhood to middle age

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27
Q

Are solitary lesions or multiple lesions M/C in EG?

A

Solitary (but 20% will progress to polyostotic)

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28
Q

What are the 3 M/C locations affected in EG?

A

1) skull (>50%)
2) mandible (25%)
3) pelvis (20%)

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29
Q

When found in the spine, which area does it M/C involve?

A

Thoracic (>50%)

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30
Q

What is the prognosis of a silver dollar VB in EG?

A

> 90% experience 48-95% restoration of body height within 1 yr

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31
Q

Where within the long bone does EG M/C involve?

A

Diaphysis (60%)

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32
Q

What are the specific pathological granulomas proliferated in EG?

A

Birbeck granules

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33
Q

What is main underlying condition of primary HPT?

A

Parathyroid adenoma (90%)

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34
Q

What is the underlying cause of secondary HPT?

A

Persistent Ca++ and P loss – by chronic renal disease

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35
Q

What is the underlying cause of tertiary HPT?

A

Parathyroid acting independently of serum calcium levels – seen in DIALYSIS patients.

36
Q

What is the laboratory findings seen with primary HPT?

A

i) Hyperparathormone –> causes release of Ca++ into bloodstream
ii) Hypercalcemia –> osteoclastic resorption d/t elevated serum parathormone
iii) Hypophosphatemia –> excreted readily (unlike Ca++)

37
Q

What is Recklinghausen’s disease of bone?

A

Osteoclastic and osteocytic resorption lead to replacement by fibrous tissue (i.e. osteitis fibrosa cystica)

38
Q

What is the pathological hallmark sign of HPT?

A

Subperiosteal bone resorption at ligament and tendon insertions.

39
Q

What are brown tumors?

A

Cyst-like fibrous accumulations with osteoclastic giant cells.

40
Q

Where are the M/C locations for subperiosteal bone resorption in HPT?

A
  • radial aspect of proximal & middle phalanx (2nd & 3rd digit)
  • medial metaphyses humerus & tibia
41
Q

What findings are seen with tertiary HPT?

A

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
Q

What are the soft tissue changes seen with HPT?

A
  • subcutaneous calcification
  • vascular calcification
  • nephrocalcinosis (75%)
  • chondrocalcinosis
  • periarticular (ligaments/tendons) calcification
  • salivary gland, pancreas calcification
43
Q

What is a characteristic facial involvement of HPT?

A

Floating tooth sign –> lamina dura resorbed around tooth socket

44
Q

What are the clinical features seen with acromegaly?

A
  • prognathic jaw
  • prominent forehead
  • large hands and feet
  • thickened & darkened skin
  • deepened, husky voice
  • bilateral carpal tunnel syndrome
45
Q

What are the spinal findings seen with acromegaly?

A
  • early widened disc heights
  • premature DJD w/ exuberant osteophytes
  • posterior body scalloping (dural ectasia)
  • widened ADI and facet joints
46
Q

What is primary Cushing’s disease vs. secondary vs. iatrogenic?

A 
Primary = adrenal cortical malfunction (excessive glucocorticoids released)
Secondary = anterior pituitary neoplasm
Iatrogenic = administration of corticosteroids
47
Q

What are the clinical features of Cushing’s disease?

A
  • moon facies
  • buffalo hump (fat accumulation upper T/S)
  • purple striae on abdomen
  • osteoporosis
48
Q

What are the radiographic features of Cushing’s disease?

A
  • osteoporosis
  • osteonecrosis (ONLY with corticosteroid therapy) –> bilateral femoral heads (30-50%)
  • compression fx of the spine
49
Q

What is the ddx of intravertebral vacuum cleft sign?

A

i) osteoporosis
ii) MM
iii) mets
iv) Kummel’s disease
v) radiation therapy

50
Q

What is hypothyroidism in a newborn?

A

Cretinism

51
Q

Who develops thyroid acropachy and what are the clinical manifestations?

A

Patients successfully treated for hyperthyroidism.

Painless, progressive digital swelling.

52
Q

What is an aka for hyperthyroidism?

A

Graves’ disease

53
Q

What are the radiographic features of hyperthyroidism?

A

Generalized osteopenia

54
Q

What are the radiographic features of hypothyroidism?

A
  • delayed closure and fragmentation of epiphysis
  • sail vertebra (cretinism)
  • Wormian bones
55
Q

What are the radiographic features of thyroid acropachy?

A

Dense periostitis at:

  • radial aspect metacarpals & phalanges
  • tibial aspect metatarsals & phalanges
56
Q

Which endo/met condition gives you basal ganglion calcification?

A

pseudohypoparathyroid & pseudopseudo

57
Q

Which endo/met condition is the juvenile version of Paget’s disease?

A

Hyperphosphatasia

58
Q

Pseudofractures in osteomalacia present on which side of the curve (concave or convex)?

A

Concave

59
Q

What are the radiographic features of rickets?

A
  • paint brush
  • widening/cupping metaphyses
  • rachitic rosary
  • harrison’s grooves
60
Q

What is the M/C tumor to result in oncogenic osteomalacia?

A

Hemangiopericytoma

61
Q

What facial appearance is seen with Paget’s?

A

Mouse face

62
Q

What hormones are released from the posterior pituitary?

A

Vasopressin & oxytocin

63
Q

What hormones are released from the anterior pituitary?

A 
Growth hormone
Prolactin
ACTH
TSH
FS
LH
64
Q

What osseous finding do you see at the articular surface of joints in acromegaly?

A

beak-like osteophytes

65
Q

What is the M/C/C of growth hormone hypersecretion?

A

Benign pituitary tumor

66
Q

What common finding is seen with acromegaly and rickets?

A

prominent costochondral junction (acromegalic rosary & rickitic rosary)

67
Q

What hip finding has an increased incidence in hypopituitarism?

A

SCFE

68
Q

What is the major radiographic finding seen with hypopituitarism?

A

Delayed skeletal maturation (delayed appearance of growth ossification centers & delayed fusion)

69
Q

What is the M/C/C of hyperthyroidism?

A

Thyroid adenoma

70
Q

What is the M/C clinical finding seen with hyperthyroidism?

A

exophthalmos

71
Q

What are the calcium, phosphorus & alkaline phosphatase levels?

A

All 3 are elevated.

72
Q

What are the clinical features of thyroid acropachy?

A
  • exophthalmos
  • pre-tibial myxedma
  • finger clubbing
73
Q

What is the M/C radiological sign seen in hypothyroidism?

A
  • slow skeletal maturation (like hypopituitarism)

- ephyseal dysgenesis

74
Q

What is the hip finding seen in hypothyroidism?

A

SCFE (like hypopituitarism)

75
Q

What is the hip finding seen in renal ostedystrophy in 10% of cases?

A

SCFE

76
Q

List the 7 locations of bone resorption in HPT?

A 
TIESSSS:
Trabecular
Intracortical
Endosteal
Subligamentous
Subperiosteal
Subphyseal
Subchondral
77
Q

List 2 aka for brown tumor in HPT.

A

i) Osteoclastoma

ii) Osteitis fibrous cystica

78
Q

What % of diabetic patients have DISH?

A

21%

79
Q

What skull findings are seen in hypervitaminosis A?

A
  • bulging of fontanelles
  • widened sutures
  • acute hydrocephalus
80
Q

What radiographic findings are seen in hypervitaminosis A?

A
  • cortical hyperostosis
  • metaphyseal cupping
  • premature physeal closure
81
Q

What’s the M/C/C for hypervitaminosis D in a child? In an adult?

A

Child –> treatment of rickets

Adult –> treatment of Paget’s and RA

82
Q

What are the radiographic findings associated with hypervitaminosis D?

A

Children:

  • alternating metaphyseal dense and lucent bands
  • cortical thickening
  • metastatic calcification (in viscera, blood vessels, falx etc.)

Adults:

  • osteoporosis
  • massive soft tissue calcification!!
83
Q

What is the cause for the dense metaphyseal lines in lead poisoning?

A

Deposition of calcium (chondrosclerosis)

84
Q

What are the 2 main causes for lead poisoning in adults?

A

i) bullets, shrapnel etc. (lead arthropathy)

ii) Saturine gout

85
Q

What are 2 causes for bismuth poisoning?

A

i) pepto bismol

ii) pregnant women with syphils

86
Q

What is Menke’s syndrome (kinky hair)?

A

Defect in copper absorption from gut –> obliterates arteries in brain & soft tissues.

87
Q

Fluorosis occurs when the fluorine content in water is greater than how much?

A

> 4ppm

88
Q

What is the radiological triad associated with fluorosis?

A

i) sclerosis
ii) osteophytosis
iii) enthesophytosis

Other:
- periostitis

MSK (5 decks)

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