Metabolic Bone Disease

Question 1

defined as diminished bone quantity in which the bone is otherwise normal

Answer 1

osteoporosis

Question 2

bone quantity is normal but the quality of the bone is abnormal in that it is not normally mineralized

Answer 2

osteomalacia

Question 3

results in excess nonmineralized osteoid

Answer 3

osteomalacia

Question 4

most common cause of osteoporosis

Answer 4

aging

Question 5

Main radiographic finding in osteoporosis is

Answer 5

Thinning of cortex

Question 6

Osteoporosis is most reliably demonstrated in what bone

Answer 6

Second metacarpal at the middiaphysis

Question 7

Normal metacarpal cortical thickening should be approximately

Answer 7

1/4 to 1/3 the thickness of the metacarpal

Question 8

Measurement of bone mineral content for the purposes of predicting fracture risk and monitoring response to therapy is usually done by means of _______ which compares a patient’s bone mineral density of the spine and hip wirh that of a healthy 30 year old adult

Answer 8

Dual-energy x-ray absorptiometry (DXA)

Question 9

True or false: calcium additives have not been shown to reverse the process of primary osteoporosis

Answer 9

True

Question 10

Can alleviate postmenopausal osteoporosis

Answer 10

Estrogen

Question 11

Drugs that inhibit osteoclastic acitvity and thus slow bone loss and are commobky prescribed to treat osteoporosis and to prevent bony complications related to osseous metastatic disease as they reduce fracture risk

Answer 11

Biphosphonate drugs

Question 12

A type of osteoporosis that can be seen in a patient of any age is

Answer 12

Disuse osteoporosis

Question 13

Radiographic appearance of disuse osteoporosis that is due to osteoclastic resorption in the cortex causing intracortical holes

Answer 13

Patchy appearance of bone

Question 14

Form of osteoporosis that can mimic a permeative lesion because of multiple cortical holes that project over the medullary space, thus resembling a medullary permeative process

Answer 14

Aggressive osteoporosis

Question 15

2 Other causes of pseudopermeative process aside from disuse osteoporosis

Answer 15

Hemangioma and radiation

Question 16

Hemangioma can cause cortical holes in 2 ways, namely

Answer 16

From focal hyperemia causing focal osteoporosis or by the blood vessels themselves tunneling through the cortex

Question 17

Radiation can cayse cortical holes in bone and mimic a permeative process because of

Answer 17

Death of cortical osteocytes, which can enlarge lacunae in the cortex

Question 18

3 Differential diagnosis of permeative lesion in young people (<30 yo)

Answer 18

Ewing sarcoma, infection, eosinophilic granuloma

Question 19

3 Differential diagnosis of permeative lesion in older patients

Answer 19

Multiple myeloma, metastatic carcinomatosis, primary lymphoma of bone

MML

Question 20

Result of too much nonmineralized osteoid

Answer 20

Osteomalacia

Question 21

Most common cause of osteomalacia

Answer 21

Renal osteodystrophy

Question 22

Only finding that is pathognomonic for osteomalacia is a

Answer 22

Looser fracture

Question 23

Fracture through large osteoid seams

Answer 23

Looser fracture

Question 24

Looser fracture tend to occur in what body parts (3)

Answer 24

Femur, pelvis, scapula

FPS

Question 25

Osteomalacia in children is called

Answer 25

Rickets

Question 26

Causes epiphyseal playes to become flared and irregular and the long bones to undergo bending from bone softening

Answer 26

Rickets

Question 27

Occurs from excess parathyroid hormone

Answer 27

Hyperparathyroidism

Question 28

Hormone that causes osteoclastic resorption in bone, which leads to osteoporosis and osteomalacia

Answer 28

Parathyroid hormone

Question 29

Primary HPT are caused by

Answer 29

Parathyroid adenomas and hyperplasia

Question 30

Most common cause of HPT is from

Answer 30

Renal disease

Question 31

Radiographic sign that is Pathognomonic for HPT is

Answer 31

Subperiosteal bone resorption

Question 32

Subperiosteal bone resorption in HPT is seen most commonly on the (3)

Answer 32

MRS - Radial aspect of middle phalanges of the hand, - medial aspect of proximal tibia and - subchondral bone resorption at sacroiliac joints

Question 33

Rugger jersey spine is seen in

Answer 33

Hyperparathyroidism

Question 34

Cystic lesions in hyperparathyroidism that are often expansile and aggressive in apearance

Answer 34

Brown tumors

Question 35

2 Few skeletal changes seen in hypoparathyroidism

Answer 35

Calvarial thickening and calcification in the basal ganglia

Question 36

Caused by congenital failure of tissues to respond to PTH. Parathyroid glands are normal in these cases

Answer 36

Pseudohypoparathyroidism

Question 37

4 Characteristic appearance of patients with pseudohypoparathyroidism

Answer 37

Obesity, round facies, short stature and brachydactyly

Question 38

Hypothyroidism is a ______ problem, pseudohypoparathyroidism is a ______ problem, and pseudopseudohypoparathyroidism is a ____

Answer 38

Hypothyroidism- parathyroid gland problem Pseudohypoparathyroidism- end organ problem Pseudopseudohypoparathyroidism is a mimicker of pseudohypoparathyroidism morphologically

Question 39

A secreting adenoma or hyperplasia of the anterior lobe of the pituitary gland will result in

Answer 39

Accelerated bone growth

Question 40

3 Skull findings in acromegaly

Answer 40

Calvarial thickening, enlarged sinuses, enlarged sella turcica

Question 41

Appearance of jaw in acromegaly

Answer 41

Prognathic

Question 42

Terminal tufts of distal phalanges in acromegaly appears as

Answer 42

Spade appearance/shovel

Question 43

Has been used as a sign of acromegaly

Answer 43

Thickening of heel pad adjacent to calcaneus

Question 44

Rare manifestation of hyperthyroidism that occurs only after prior thyroidectomy

Answer 44

Thyroid acropachy

Question 45

Useful differential point that can be used to tell thyroid acropachy from other causes of diffuse periostitis

Answer 45

Periostitis involving the ulnar aspect of fifth metacarpal

Question 46

Decreased thyroid secretion

Answer 46

Cretinism

Question 47

Epiphyses appears stippled in this metabolic disease

Answer 47

Thyroid gland hypofunction or cretinism

Question 48

Diffuse increase in bone density

Answer 48

Osteosclerosis

Question 49

By far most common disease in which osteosclerosis is seen

Answer 49

Renal osteodystrophy

Question 50

The sine qua non of renal osteodystrophy is

Answer 50

Subperiosteal bone resorption

Question 51

Subperiosteal bone resorption in renal osteodystrophy is reliably seen at the

Answer 51

Radial aspect of middle phalanges of hands

Question 52

Fish vertebrae is seen in

Answer 52

Sicke cell disease

Question 53

Bone infarcts and step-off deformities of vertebral body endplates, avascular necrosis of the hip are seen in

Answer 53

Sickle cell disease

Question 54

Also called angogenic myeloid dysplasia, it is caused by progressive fibrosis of the marrow in patients older than 50 years of age

Answer 54

Myelofibrosis

Question 55

Myelofibrosis leads to

Answer 55

Anemia with marked splenomegalynand extramedullary hematopoiesis

Question 56

Hereditary abnormality that results in extremely dense bones throughout the skeleton

Answer 56

Osteopetrosis

Question 57

2 forms of osteopetrosis

Answer 57

Congenita and tarda

Question 58

Form of osteopetrosis that can be lethat

Answer 58

Congenita

Question 59

Form of osteopetrosis that is milder

Answer 59

Tarda

Question 60

Characteristic finding is bone-in-bone appearance often seen in the vertebral bodies in which vertebrae have a small replics of the vertebral body inside the normal one

Answer 60

Osteopetrosis

Question 61

Sandwich vertebrae is seen in

Answer 61

Osteopetrosis

Question 62

Sandwich vertebrae in osteopetrosis can be differentiated from rugger jersey spine in rickets by noting that

Answer 62

The bands of sclerosis in sandwich vertebrae are denser

Question 63

Other congenital abnormality with dense bomes that shoild be considered in the differential diagnosis of osteosclerosis. These patients are typically short and have hypoplastic mandibles

Answer 63

Pyknodysostosis

Question 64

Distinguishing radiographic finding of pyknodysostosis

Answer 64

Acroosteolysis with sclerosis acro = point; osteo = bone; lysis = dissolve

Question 65

In this condition, the distal phalanges often have the appearance of chalk that has bern put into a pencil sharpener

Answer 65

Pyknodysostosis

Question 66

Pyknodysostosis is aka

Answer 66

Toulouse-Lautrev syndrome

Question 67

Can cause uniformly increased bone density, thickened small bowel folds with nodules and urticaria pigmentosa

Answer 67

Mastocytosis

Question 68

Paget’s disease classically causes

Answer 68

Bony enlargement

Question 69

Paget’s disease commonly occur in

Answer 69

Pelvis, with thickened iliopectineal line on pelvic brim

Question 70

3 Distinct radiographic phases of Paget’s disease

Answer 70

Lytic, sclerotic and mixed lytic and sclerotic phase

Question 71

Lytic phase of Paget disease usually present as

Answer 71

Sharp leading edge called flame-shaped or blade-of-grass leading edge

Question 72

In a long bone, with sole exception of the tibia, Paget disease always starts at the

Answer 72

End of bone

Question 73

Radiographic finding that patients with fluorosis often have is

Answer 73

Ligamentous calcification

Question 74

Calcification of sacrotuberous ligament is said to be characteristic of

Answer 74

Fluorosis