Endomet

Question 1

normal bone quality, decreased bone quantity

Answer 1

Osteoporosis (compare to osteomalacia where there is abnormal bone quality, decreased or normal bone quantity)

Question 2

MC cause of osteopenia?

Answer 2

Senile and post-menopausal
loss of bone mass 0.5-1% a year after 25, 2-4+% per year post-menopause

Question 3

Causes of osteopenia other than age?

Answer 3

metastasis, multiple myeloma, alcoholism, Cushing’s, steroids, endocrine disorders, drugs, anemia, pregnancy, and diet

Question 4

After what age do men and women suffer osteopenia similarly?

Answer 4

80, before that 4x more common in women

Question 5

Radiographic features of osteopenia?

Answer 5

Loss of 2° stress trabeculae, accentuation of 1° trabeculae
“Pencil thin” cortices
Fractures-Compression fractures & Insufficiency fractures
Wide and indistinct Ward triangle
Fish vertebra – biconcave vertebral endplates

Question 6

biconcave vertebral endplates

Answer 6

Fish vertebrae of osteopenia

Question 7

Osteoporotic hyperkyphosis

Answer 7

Dowager’s hump

Question 8

On a DEXA scan, what best predicts the risk for fracture?

Answer 8

T-score (total bone density)
(z score is how you’re doing for your age/sex, but not used for fx risk prediction)

Question 9

“Osteoporosis” is diagnosed when a t score is…

Answer 9

Below -2.5

Question 10

“Osteopenia” is diagnosed when a t score is…

Answer 10

-1 to -2.5

Question 11

Causes of regional osteopenia?

Answer 11

Disuse
CRPS
TROH

Question 12

Causes of osteomalacia?

Answer 12

deficiency in calcium, phosphorus, vitamin D
abnormal vit D metabolism/resistance
malabsorption syndromes
renal lesions/failure
uncommon causes: dysplasia/tumor/drug reaction

Question 13

Imaging findings of osteomalacia?

Answer 13

generalized osteopenia
trabecular coarsening and indistinctness
fracture deformities
fish vertebrae
basilar invagination
Tri-radiate pelvis (protrusio acetabuli)
bell-shaped thorax
bowing deformities of the lower limbs
kyphoscoliosis

Question 14

Classic radiographic findings of rickets?

Answer 14

“paint brush” metaphyses (Little to no mineralization of the PZOC)

bowing deformities

Question 15

Chest finding in Rickets?

Answer 15

rachitic rosary - enlarged costochondral junctions

Question 16

Radiographic finding of heavy metal poisoning in children?

Answer 16

Dense metaphyeal band(s)
wide cranial sutures from brain swelling

Question 17

Clinical findings of lead poisoning?

Answer 17

abdominal pain, encephalopathy, and paralysis

Question 18

2 most common clinically significant hypervitiminoses?

Answer 18

Vit A, Vit D, vit E (fat soluable vitamins)

Question 19

Radiographic finding of Hypervitaminosis A
in children?

Answer 19

extensive periosteal reactions

Question 20

clinical findings of Hypervitaminosis A?

Answer 20

severe anemia and thrombocytopenia, bulging fissures and fontanelles, Delirium

Question 21

Radiographic finding of Hypervitaminosis D?

Answer 21

Soft tissue calcifications (Periarticular tumoral calcinosis, Renal Ca++, Vascular Ca++)

Question 22

excessive growth hormone secretion results in…

Answer 22

Acromegaly, or gigantism if before skeletal maturity

Question 23

Clinical findings of Acromegaly?

Answer 23

broad, large hands and feet
prominent forehead
nerve compression syndromes
arthritis

Question 24

Skull findings in acromegaly?

Answer 24

Enlarged sella turcica (classic, but not always present)
Max normal size: 16mm AP, 12mm deep
Enlarged frontal sinuses
Prognathic mandible (lantern jaw)

Question 25

Possible spine findings in acromegaly?

Answer 25

Imaging findings - spine
Enlarged discs, premature DJD
Increased diameter of vertebral bodies
Canal stenosis

Question 26

Hand/feet findings in acromegaly?

Answer 26

spade-like terminal tufts
widened diaphysis
Enlarged sesamoids
enlarged joints with osteophytes (later narrow due to poor quality cartilage)
enthesophytes
increased S.T. width
enlarged heel pad thickness (>20-26mm)

Question 27

Hyperparathyroidism demographics?

Answer 27

females affected 3:1 over males
peak age = 30-50 years

Question 28

MC cause of hyperparathyroidism?

Answer 28

Renal failure

Question 29

What is primary hyperparathyroidism?

Answer 29

overproduction of parathormone from a parathyroid adenoma

Question 30

What is secondary hyperparathyroidism?

Answer 30

overproduction of parathormone secondary calcium loss from chronic renal disease

Question 31

Labs for primary vs secondary hyperparathyroidism?

Answer 31

Primary: hypercalcemia, hypophosphatemia
Secondary: Normal or low blood calcium, hyperphosphatemia

Question 32

Radiographic findings of hyperparathyroidism?

Answer 32

-osteopenia
-Subperiosteal resorption
-salt and pepper skull (granular appearance)
-“rugger jersey” spine
-resorption of lamina dura around teeth
-widened sacroiliac joints and pubic symphysis
-Brown tumors

Question 33

target sites of subperiosteal resorption in HPT?

Answer 33

Radial side of phalanges, distal clavicle, medial aspect of proximal tibial and humeral metaphysis

Question 34

Things to look for in diabetes?

Answer 34

osteomyelitis and septic arthritis
neuropathic arthropathies
osteopenia
arteriosclerosis

Question 35

3 features of hypertrophic osteoarthropathy?

Answer 35

Clubbing of the fingers
Periostosis of tubular bones
Synovial effusions

Question 36

Most common cause of hypertrophic osteoarthropathy?

Answer 36

Lung cancer

Question 37

List possible causes of hypertrophic osteoarthropathy.

Answer 37

Lung cancer
Other lung and pleural pathologies
Liver diseases
GI diseases
Variety of other causes, including vascular (especially in kids)