Metabolic & Endocrine Disorders Flashcards
1
Q
Normal bone quality, decreased bone quantity =
A
Osteoporosis
2
Q
Females are affected by osteoporosis __:__ over males
A
4:1
(After 80, females = males)
3
Q
Secondary causes of ____ include metastasis, multiple meyloma, alcoholism, endocrine disorders, etc.
A
OSteoporosis
4
Q
Clinical presentation of ____ include:
- Clinically silent
- Increased kyphosis as disease progresses
- Symptoms become apparent when there are fractures
A
Osteoporosis
5
Q
Radiographs are ____ (good/not good) are grading osteoporosis
A
Not good
6
Q
Radiographic findings of ____ include:
- Osteopenia (on radiographs this is a descriptive term ie. less dense, DEXA scan it is diagnosis)
- Loss of 2° stress trabeculae, accentuation of 1° trabeculae
- Vertical striations in VBs (pseudohemangiomas)
- Pencil thin cortices
- Compression fractures (anterior wedge, fish vertebra)
A
Generalized Osteoporosis
7
Q
What are is the likely cause of these findings?
(Normal on left)
A
Generalized Osteoporosis - CT w/ Fish Verterbra
8
Q
What is the likely cause of these findings?
A
Generalized Osteoporosis - Accentuated Vertical Striations (pseudohamangiomas)
9
Q
What is the likely cause of these findings?
A
Generalized Osteoporosis - Accentuated Vertical Striations, anterior wedging, and gas bubble
10
Q
What is the likely cause of these findings?
A
Generalized Osteoporosis - Anterior compression fracture as a result of hyperkyphosis
11
Q
What is the likely cause of these findings?
A
Generalized Osteoporosis - Ward’s Triangle
12
Q
What is the likely cause of these findings?
A
Generalized Osteoporosis - Pencil thin cortices
13
Q
What is the likely cause of these findings?
A
Generalized Osteoporosis - Insufficiency Fracture
14
Q
____ is gold standard for osteoporosis diagnosis, ____ is most accurate but expensive
A
DEXA scan
Quantitative CT
15
Q
____ is the most common cause of regional osteoporosis
Other causes are ___ & ____
A
Disuse (common following immobilization)
Complex Regional Pain Syndrome (CRPS) & Transient osteoporosis of hip (TROH)
16
Q
Regional osteopenia can be seen within _____ in disuse regional osteoporosis, _____ following CRPS
A
7-10 days
3-4 months
17
Q
What is the most likely cause of these findings?
A
Regional Osteoporosis - Disuse
18
Q
- Relatively normal bone quantity, poor bone quality
- Results in soft bones
Imaging findings include:
- Generalized osteopenia
- Trabecular coarsening & indistinctness
- Fracture deformites (fish vertebrae, Triradiate pelvis, kyphoscoliosis, etc.)
- Pseudofractures (insufficiency fractures in unusual locations)
A
Osteomalacia
19
Q
What is the most likely cause of these findings?
A
Osteomalacia - but NOT associated specifically, can be seen in any condition with decreased bone density (quantity, quality or both)
20
Q
What is the most likely cause of these findings?
A
Osteomalacia - Pseudofractures
(Can also be seen in Padgets or Fibrous dysplasia)
21
Q
- Vitamin D related
- Primarily a disease of growth plates (seen w/ osteomalacia)
- Clinically, may see bowing deformities, overgrowth of cartilage near joints, “rachitic rosary”
A
Rickets
22
Q
Image findings of ____ include:
- “Paint brush” metaphysis
- Splayed/cupping of metaphysis
- Non-calcified zone of provisional calcification → widened growth plate
A
Rickets
23
Q
What is the most likely cause of these findings?
A
Rickets - Non-calcific zone of provisional calcification & cupped appearance
24
Q
What is the most likely cause of these findings?
A
Rickets - Paint brush metaphysis
25
What is the most likely cause of these findings?
Rickets - Rachitic Rosary
26
What is the most likely cause of these findings?
Rickets - Bowing Deformities
27
What is the most likely cause of these findings?
Scurvy
28
Dense zone of provisional calcification in scurvy =
White line of Frankel/scurvy
29
Well defined ring around epiphysis seen in scurvy =
Wimberger’s ring
30
- Arise from metaphyseal margins
- Due to collapse of the scorbutic zone
- Seen in Scurvy
Pelken’s spurs
31
Lucent region adjacent to the zone of provisional Ca++ seen in scurvy
Scorbutic/Trummerfeld zone of attrition
32
What is the most likely cause of these findings?
Scurvy
33
- Osseous changes seen following long term megadoses of Vitamin A
- Vitamin A regulates osteoclastic and osteoblastic activity
- Clinical findings include dermatitis, puritis, alopecia, and hepatosplenomegaly
Imaging findings include:
- Osteopenia
- Solid periosteal reaction
Hypervitaminosis A
34
What is the most likely cause of these findings?
Hypervitaminosis A (but there are many other differentials)
35
- Soft tissue changes seen following long term mega doses of Vitamin D
Imaging Findings include:
- Periarticular calcification (referred to as tumoral calcinosis bc large mass of calcification)
- Renal & vascular calcification
Hypervitaminosis D
36
What is the most likely cause of these findings?
Hypervitaminosis D - Tumoral Calcinosis
37
Clinically can see abdominal pain, encephalopathy & paralysis
Imagining findings include:
- Dense linear bands along the zone of provisional calcification
- Wide sutures from brain swelling
Lead poisoning
38
What is the most likely cause of these findings?
Lead poisoning - sclerotic metaphyseal bands
39
What is the most likely cause of these findings?
Lead poisoning - multiple sclerotic metaphyseal bands
40
- Secondary to excessive growth hormone secretion
- In **adults** results In predominate soft tissue & membranous bone overgowth
- In **adolescence** results in increased length of bone (gigantism)
Clinical findings include:
- Broad, large hands/feet
- Prominent forehead
- Nerve compression syndromes
- Arthritis
Acromegaly
41
What is the most likely cause of these findings?
Acromegaly - Enlarged Sella Turcica
42
What is the most likely cause of these findings?
Acromegaly - Enlarged frontal sinus
43
What is the most likely cause of these findings?
Acromegaly - Spade like distal tufts
44
What is the most likely cause of these findings?
Acromegaly - increased heel pad thickness
45
Imaging findings of ____ include:
- Generalized osteopenia is main finding
- May see increase incidence of fractures
- Physical findings include enlarged neck, rapid HR, weightloss, proptosis
Hyperthyroidism
46
Clinical findings include:
- Coarse dry skin & hair
- Farigue, lethargy
Imaging findings include:
- Delayed skeletal maturation (hallmark)
- Wormian bones
- Fragmented epiphyses
- Sail vertebra w/ gibbous deformity
Hypothyroidism
47
What is the most likely cause of these findings?
Hypothyroidism - Sail vertebra
48
What is the most likely cause of these findings?
Hypothyroidism - Delayed skeletal maturation
49
- Females affected 3:1 over males
- Peak age 30-50 years
- Increased osteoclastic activity w/ fibrous tissue replacement
- Hypercalcemia and hypophosphatemia
Hyperparathyroidism
50
\_\_\_\_\_ hyperparathyroidism = due to overproduction of parathormone 2º to parathyroid adenoma
Primary
51
\_\_\_\_\_ hyperparathyroidism = due to overproduction of parathormone 2º to chronic renal disease (most common)
Secondary
52
\_\_\_\_ hyperparathyroidism = seen in dialysis patients, long term renal disease; parathyroid gland acts independent of calcium levels
Tertiary
53
Imagining findings of ____ include:
- Osteopenia
- Salt & pepper skull (granular appearance)
- Rugger jersey spine
- Resorption of lamina dura of mandible
- Endplate irregularities
- Widened SI joints & symphysis
Hyperparathyroidism
54
What is the most likely cause of these findings?
Hyperparathyroidism - Salt & Pepper skull
55
What is the most likely cause of these findings?
Hyperparathyroidism - loss of lamina dura
56
What is the most likely cause of these findings?
Hyperparathyroidism - Rugger Jersey Spine
(Also small vessel calcification which = hyperparathyroidism or diabetes)
57
Which is rugger jersey vs. sandwich vertebra?
Left = sandwich, Right = Rugger jersey
58
What is the most likely cause of these findings?
Hyperparathyroidism - Subchondral bone resorption
59
Subperiosteal resoprtion on the radial aspect of 2nd & 3rd middle phalanges is diagnostic for \_\_\_\_
Hyperparathyroidism
60
Brown tumors (osteoclastoma)
- Soap bubbly & expansile
are associated with what condition?
Hyperparathyroidism
61
What is the most likely cause of these findings?
Hyperparathyroidism - Distal tuft resorption
62
What is the most likely cause of these findings?
Hyperparathyroidism - Subperiosteal resorption
63
What is the most likely cause of these findings?
Hyperparathyroidism
64
What is the most likely cause of these findings?
Hyperparathyroidism - Browns tumor
65
What is the most likely cause of these findings?
Hyperparathyroidsm - Small vessel calcification (differential = diabetes)
66
What is the most likely cause of these findings?
Hyperparathyroidism - Tumoral Calcinosis (w/ small vessel calcification)
67
What is the most likely cause of these findings?
Hyperparathyroidism - Chondrocalcinosis (depositional w/ secondary degenerative changes)
68
- Manifestations are due to decreased vascular integrity, particularly in lower extremitiy
Imagining findings:
- Cellulitis, osteomyelitis & septic arthritis
- Neuropathic arthropathies
- Osteopenia
- Vascular calcification (Monkeberg's arteriosclerosis)
- Vas deferens calcifcation
Diabetes
69
What is the most likely cause of these findings?
Diabetes - Neuropathic Arthropathy (Septic Arthritis is differential)
70
- Can take on the follow patterns:
- Hypertrophic
- Atrophic
- Mixed hypertrophic & antrophic pattern
Neuropathic anthropathy
71
What is the most likely cause of these findings?
Diabetes - Neuropathic Arthropathy
72
What is the most likely cause of these findings?
Diabetes - Smal vessel calcification (differential = hyperparathyroidism)
73
What is the most likely cause of these findings?
Diabetes - cellulitis
74
What is the most likely cause of these findings?
Diabetes - Vas Deferens calcification
75
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