Final Flashcards
3 types of osteoporosis
Generalized - hyperparathyroidism, Osteogenesis Imperfecta
Regional - immobilization, Reflex Sympathetic Dystrophy
Local - infection, arthritis, neoplasm
Rickets (children) and osteomalacia (adults)
Vit D Deficiency
Malabsorption, kidney dz
Widened growth plates, rachitic costal rosary
Osteopenia, trabecular
Scurvy
Vit C deficiency
Osteoporosis
White Line of Frankel, Wimberger’s sign (ring), Pelkin’s spurs, Trummerfeld Zone, subperiosteal hemorrhages
Hyperparathyroidism in spine, skull, hand
Spine - rugger jersey spine
Skull - salt and pepper resorption
Hand - acroosteolysis of distal phalanges, subperiosteal resorption
Acromegaly face, skull, foot
Face - widened mandibular angle
Skull - enlarged sella turcica
Foot - heel pad >20 mm
Long-term corticosteroids
osteoporosis of Cushing’s
osteonecrosis of femoral/humeral heads, distal femora and talus
Ischemic necrosis - intravertebral vacuum cleft sign
H-shaped vertebra
sickle cell anemia
Complications of sickle cell anemia
Osteomyelitis and AVN
Vertebral body collapse
Posterior mediastinal extramedullary hematopoiesis
Honeycomb trabecular patterns
Thalassemia
Hemophilic arthropathy in which 3 joints
ankle, knee, elbow (bilateral)
DDx for hemophilic arthropathy
Juvenile RA
Avascular necrosis/osteonecrosis sites
Femoral/humeral head, epiphyses, knees, neck of talus, waist of scaphoid
5 typical causes of avascular necrosis
Post trauma Corticosteroids Radiation Alcoholism Gout Caisson's disease Pancreatitis Post surgery Collagen disease
DJD (arthritic) characteristics
non-uniform joint space narrowing
osteophytes
subchondral sclerosis
subchondral cysts
Triangular sclerosis at iliac
Osteitis condensans ilii
bilateral
Females
Osteitis pubis medical procedure
Surgery near pubic symphysis
Marginal vs. non-marginal syndesmophytes
Marginal - symmetrical
Non-marginal - discontinuous
Marginal syndesmophyte spinal arthritis
AS
Non-marginal syndesphophyte spinal arthritis
Reiter’s, psoriatic arthritis, DDD, DISH
Systemic condition of DISH (diffuse idiopathic skeletal hyperostosis)
OPLL (ossification of posterior longitudinal ligament)
Dysphagia in which arthritis
DISH dt ossification of anterior longitudinal ligament
6 findings in neurotrophic arthropathy
distended joint dislocation disorganization density increase destruction debris
Conditions resulting from neurotrophic arthropathy
DM Alcoholism paralysis Syringomyelia Tabes dorsalis
Synoviochondrometaplasia
Metaplasia in synovium producing loose cartilaginous bodies, may calcify or be free within joint capsule
RA in hand and wrist sites
Bilateral PIP and MCP joints (digits 2 + 3)
Ulnar styloid
Triquetrum
NO DIP involvement
Marginal (sides of joints) erosion
RA
Gout (AS with marginal syndesmophytes)
Widening atlas-dens interspace
Destroy transverse ligament and dens
Laxity of transverse ligaments Dzs
RA
Marfans
Downs
RA vs. Psoriatic arthritis
RA - wrist involvement
PA - DIP involvement
AS
#1 site: SI #2 site: thoracolumbar Bilateral Young males 15-35 yo Square vertebral bodies - Romanus lesion and Shiny corner sign Carrot stick fx
DDx for SI and vertebral findings similar to AS
Enteropathic arthropathy (GI)
2 seronegative spondyloarthropathies with non-marginal syndesmophytes and peripheral arthritis
Psoriatic arthritis
Reiter’s disease
Reversible hand deformities
SLE
Acro-osteolysis
SLE
Scleroderma
Hyperparathyroidism
Terminal bony erosions dt resorption of distal phalanges
Overhanging sclerotic margin sign
Punched-out erosions in gout
Calcium pyrophosphate deposition (CPPD) sites
Pubic symphysis
Wrist
Knee
Hydroxyapatite deposition dz (HADD) sites
Hip
Shoulder
Osteoblastic METs carcinoma in adult females
Breast CA
3 causes of solitary sclerotic vertebral body/ivory vertebra
Osteoblastic METs
Paget’s dz
Hodgkin’s lymphoma
Multiple myeloma
Commonly vertebral body
Most densely opaque on X-rays
Primary osteosarcoma
10-25 yo
metaphysis
Codman’s triangle dt periostitis from aggressive bone lesions
Sunburst vs. onion skin appearance
Onion skin - Ewing’s sarcoma
Sunburst - osteosarcoma, more malignant
Ewing’s sarcoma
Diaphysis of long bone, where marrow is
Lytic appearance of neoplasms
Geographic - destructive lytic bone lesion, benign
Motheaten/permeative
Blowout
Osteochondroma
Solitary exostosis (cortex continuous with host bone) points away from joint, benign
Corduroy vertebra
Vertical lines in vertebral bodies in Paget’s dz
Spinal hemangioma
Solitary
Most common benign spinal tumor
Bone island
Asxs
Benign tumor with pn worse at night, relieved by aspirin
Osteoid Osteoma
Cortical bone involvement
Enchondroma
Calcification in 50%
Geographic lytic tumor matrix, thin cortex, most central
Hands, feet, then femur, tibia, humerus, ribs
Metaphyseal-diaphyseal
Multiple enchondromatosis
Ollier’s dz/Maffucci’s sign dt multiple tumors in enchondroma
Most common region of fibrous cortical defect
Lower extremity
Simple bone cyst
“Fallen Fragment” sign with cortex fx, fall into cyst fluid
Geographic lytic
meta-diaphyseal
Aneurysmal bone cyst
Named according to its appearance rather than histolog
Only benign tumor that crosses growth plate (metaphyseal, may extend to epiphysis)
Periostitis common
Giant cell tumor
Benign
Painful
Paget’s Dz in a long bone
Polyostotic >55 yo Ivory vertebrae Blade of grass/candle flame appearance; V lesion R side > L side Thick cortex Pseudofx Saber shin deformity
