Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6 SKEL B > MIDTERM > Flashcards

MIDTERM Flashcards

1
Q

Bilateral symmetry is in what % of RA patients?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is juxta-articular osteopenia due to?

A

Hyperemia, disuse, and steroid therapy may lead to generalized form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Uniform loss of joint space is associated with what?

A

Collagenase/chemical destruction RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bare area bone destruction is what?

A

Marginal (rat bite) erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Pannus?

A

granulation tissue made up of new capillary growth and fibroblasts that grows into the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can be infrequent, solid, or laminated in RA?

A

Juxta articular periostitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can deformity of RA be due to?

A

joint destruction, ligament laxity, and stenosing tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is stenosing tenosynovitis?

A

Tendon sheaths scar, shrink, and pull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the areas of foot and hand affected by RA?

A

forefoot, MTP joints, PIP joints possible, dorsal dislocation on MTP, fibular dislocation on digits (Lanois deformity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Primary DJD does not care about ____ but likes ______ ?

A

MCP, but does like DIP and PIP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RA likes ____ and does not involve ____ ?

A

Likes MCPs, and does not involve DIP joints (besides thumb) and entire wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What tendon does RA like?

A

the extensor carpi ulnaris tendon that runs right along side the ulnar styloid process, common for patients to complain of this before they get soft tissue swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Does RA create radial or ulnar deviation?

A

ulnar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the Boutonniere hand deformity:

A

“BEFE”

boutonniere, extend DIP, flex PIP, extend MCP

Fingers are STUCK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the “swan neck” hand deformity:

A

“FEF”

(Flex DIP, extend PIP, flex MCP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the Mallet finger RA:

A

DIP joint hyperflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the sign of RA that combines different hand deformities?

A

Arthritis Mutilans

  • boutonniere
  • swan neck
  • mallet finger
  • zig zag, ulnar deviation

(looks like your hand is in a blender)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the zig zag look associated with RA?

A

Radial carpal deviation with ulnar deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the exceptions of the hand deformities in RA?

A

Doesn’t like 2-5th DIP joints, but every other joint in upper extremity is fair game

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is rheumatoid’s primary focus?

A

Synovial Membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a deposition of immune complexes involving multiple systems?

A

Systemic Lupus Erythematous (SLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When does System Lupus Erythematous (SLE) occur?

A

Female childbearing years

48/100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What areas does SLE affect?

A

Skin and joints very common, kidney is severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The butterfly rash is prevelant in how many percent of patients, and what disease is it involved with?

A

SLE and 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the symptoms of SLE?

A

90% joint symptoms, pain, swelling, and stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is the joint ivolvment in SLE?

A

Mile with little destruction, that’s why a lot of SLE deformities are reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What would you radiographically see on SLE?

A

Osteopenia, tuft resorption, and calcinosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the corticosteroid changes that occur within SLE?

A

It is called, Corticosteroid Osteopothay, and one would see osteopenia, fractures, and AVN. Bone changes occur because of the steroid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the early symptoms of SLE?

A

Chronic, episodic pain, stiffness, and soft tissue swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is PSS?

A

Progressive _S_ystemic _S_clerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is PSS main target?

A

(Scleroderma) Subcutaneous connective tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the main age group and gender of PSS?

A

Females 30-50 y.o.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What systems are affected by PSS?

A

systemic inflammatory then scarring disorder, skin, lungs, GI tract, heart, kidneys, MSK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

90% of scleroderma patients have ______ ?

A

Raynaud’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does “CREST” stand for? What disease is it associated with?

A

Progressive Systemic Sclerosis

  • Calcinosis
  • Raynauds
  • Esophagus
  • Scleroderma
  • Teleangiectasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Describe the Calcinosis portion of CREST in PSS:

A

Calcinosis Cutis, Circumscripta, and Universalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Calcinosis Circumscripta pic:

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Calcinosis Universalis pic

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the components associated with the Esophagus in CREST (PSS)?

A

GERD is common, and there is difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

scleroderma x ray pic

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Describe “Teleangiectasia” (CREST) associated with PSS:

A

Localized areas of redness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What’s the most common area of damage for PSS?

A

Hands, feet, and face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What happens to the skin during PSS?

A

It begins to tighten due to scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What type of arthritis is associated with PSS?

A

“Non-erosive arthritis”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Selective destruction of _____ is common in PSS?

A

1st MCC (base of thumb-trapezium) is distinctive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Tuft Resorption is associated with what?

A

(PSS) scleroderma is the default condition that causes this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the origin of Dermatomyositis/Polymyositis?

A

It is unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is more common, Dermatomyositis or Polymyositis?

A

Dermatomyositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is dermatomyositis?

A

Dermatomyositis is an uncommon inflammatory disease marked by muscle weakness and a distinctive skin rash. Likely autoimmune

  • Muscle fascial inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Dermatomyositis may occur _____ ?

A

secondary to neoplasm of lung, prostate, female pelvic organs, breast, and GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the key features of Dermatomyositis?

A
  • Non - suppurative inflammation of skeletal muscle with
    • Weakness
    • Erythematous skin rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What does the inflammation of Dermatomyositis lead to?

A

Eventual scarring of fascia and subsequent calcinosis universalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Is there tuft resorption with Dermatomyositis?

A

YES, there is “non destructive small joint inflammation with tuft resorption”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

The articular of Dermatomyositis resembles what?

A

PSS and SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is Mixed Connective Tissue Disorder described as?

A

MCTD is characterized by overlapping clinical features of PSS, SLE, DM and possibly RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is common with Mixed Connective Tissue Disorder?

A

Arthropathy consisting of arthralgia and arthritis is common in the small joints of the hand, foot, and wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is Jaccoud’s Arthropathy?

A

1867, Infrequent, deforming, non-erosive hand and foot arthropathy

  • Originally subsequent to rheumatic fever (from systemic strept)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the deformities of Jaccoud’s Arthropathy?

A
  • Ulnar deviation with flexion
  • Boutonniere and swan neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

KNOW THIS PIC :

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the history of Sjogren’s Syndrome?

A

1930, A Swedish Opthalmomologist described a patient with low secretions from lacrimal and parotid glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is Sjogren’s syndrome due to?

A

Lymphocytic accumulation in and obstructing exocrine glands

  • Can be primary or secondary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Sjogren’s Syndrome is most common in _____

A

Females 40-50 year old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What does Sjogren’s Syndrome cause?

A
  • Keratoconjunctivitis sicca (dry eyes), xerostomia (dry mouth), as well as other areas of dryness (nose, skin, and vaginal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the 3rd most common rheumatic autoimmune disorder next to RA and SLE?

A

Sjorgren’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the clinical triad of Sjogren’s syndrome?

A
  1. Keratoconjunctivitis sicca
  2. Xerostomaia
  3. Autoimmune rheumatoid type disorder usually RA but can be SLE or PSS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Describe Juvenile chronic Arthritis:

A

Juvenile onset adult type RA (Rh factor +)

  • Rheumatoid in a child under the age 16
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are the radiologic signs in Juvenile Chronic Arthritis, (Juvenile onset adult type RA) Rh factor + ?

A
  • Bilateral symmetry
  • Starts in hands and moves toward axial skeleton
  • Longer term = Worse it gets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the 3 Juvenile chronic Arthritis subcategories?

A
  1. Juvenile Onset Adult type RA (Rh factor + )
  2. Still’s Disease (Rh factor - )
  3. Juvenile Onset Rheumatoid variant disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the main characteristics of Still’s Disease?

A
  • Classic systemic form
  • Polyarticular form
  • Pauci - or monoarticular form - only have it in one joint or 2/3 but WON’T have a widespread form
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Still’s disease is Rh +

t/f ?

A

FALSE (negatron)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Describe Juvenile onset Rheumatoid variant disease:

A

HLA-27 spondyloarthropathies, and Rheumatoid variants can Uncommonly happen in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Juvenile onset adult type RA (Rh factor +), Still’s Disease (Rh factor - ), and Juvenile onset Rheumatoid variant disease are all _____ ?

A

Inflammatory arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is a bone infarct?

A

Ischemic death of the cellular elements of the bone and marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What does a bone infarct refer to?

A

Lesions occurring in the metaphysis and diaphysis of bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Lesions in the epiphysis are called what?

A

Avascular Necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What are the 3 classifications of Osteonecrosis?

A
  1. Bone ends children
  2. Bone ends adults
  3. Metaphysis and Diaphysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

In osteonecrosis, bone ends in children are called what?

A

Epiphyseal ischemic necrosis, femoral head is the most common location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is adult osteonecrosis?

A

Chandler’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is osteonecrosis in children?

A

Legg-Calves - Perthes disease, femoral head is the most common location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is it called when osteonecrosis is found in the metaphysis and diaphysis?

A

Medullary infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the normal cause of osteonecrosis in the metaphysis and diaphysis?

A

It can be idiopathic or secondary to a number of conditions that reduce blood supply to the bone such as an intraluminal abnormality, extrinsic compression or combo of both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Osteonecrosis can be ____ or _____

A

Idiopathic or Secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Osteonecrosis can be idiopathic or secondary to a number of conditions that reduce blood supply to bone, what are they?

A
  • Intraluminal abnormality
  • An extrinsic compression
  • Combo of both
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What does therapeutic radiation do in regards to Osteonecrosis?

A

Inflames the walls of arteries, narrows the lumen, and causes obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Children usually develop ostenecrosis through ____

A

TRAUMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the “gold standard” for detection of Osteonecrosis?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What plays a major role in diagnosing osteonecrosis at a young age?

A

CT scans, MRI, and bone scans, but if we see it on plain film, this means it is far along in its stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

AVN shows up how on a bone scan?

A

COLD AREA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is the most common hematological condition of the skeleton?

A

AVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is AVN predisposed to?

A

Areas of tenuous blood supply with poor collateral circulation, that’s why the femoral head is the most common area - it gets most of its blood from one blood vessel (lateral peripheral artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Under the category of external vessel compression in osteonecrosis, what are the 3 subcategories?

A

infection, gaucher’s disease, hyperlipidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is Gaucher’s disease?

A

Lipid storage disease, genetic disorder, accumulation of abnormal fatty material that accumulates in macrophages.

  • Cells accumulate in marrow – creates pressure — squishes vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What could cause external vessel compression?

A

Hyperlipidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Vessel wall disorders in the etiology of AVN is due to what?

A

Therapeutic levels of radiation used to treat cancers, it inflames blood vessels and narrows lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Under etiologies of AVN, Thrombo-embolic disorders are classified as:

A
  1. Alcoholism
  2. Sickle-cell
  3. Caisson’s disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Why would alcoholism cause a thrombo-embolic disorder?

A

Causes pancreatitis, fatty embolism in the blood, and is one of the MORE COMMON causes of AVN

  • typically BILATERAL (long term alcoholics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

How would sickle cell cause a thrombo embolism?

A

Widespread AVN in femoral heads, humeral heads, etc. You can get an embolism in the kidneys or lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is Caisson’s disease?

A
  • This could cause a nitrogen gas embolism
  • “Diver’s disease”
  • Rapid decompression in aircraft can cause it
  • Tends to involve in HUMERAL HEADS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Describe what corticosteroid use can do:

A

Prednisone for a period of time to treat rheumatoid type arthritis can cause AVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

_______ with prednisone leads to AVN?

A

LUPUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the pneumonic for etiology list?

A

PLASTIC RAGS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Etiology of AVN - Pancreatitis:

A

Pregnancy, late stage pregnancy - particularly develop AVN in left hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Patient with Cushing’s syndrome may develop AVN, t/f?

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is the “I” in PLASTIC RAGS pneumonic?

A

_IDIOPATHIC****_

  • One of the more common ones, aka “SPONTANEOUS AVN”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is the “C” in PLASTIC RAGS?

A

Caisson’s, rapid decompression, nitrogen embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is the “A” in PLASTIC RAGS?

A

Amyloidosis:

  • Metabolic Arthritic disorders (lumpy bumpy)
  • Amyloid - abnormal protein material
  • Amyloid accumulating in bone marrow causes compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is the “G” in PLASTIC RAGS?

A

Gaucher’s

“Hematological disorder”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What would you see in the epiphyseal findings of osteonecrosis?

A
  • Deep dull joint pain, exacerbated by activity
  • Limp waddling gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What would you notice with the medullary portion of bone in Osteonecrosis?

A

Medullary infarct typically asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is a _bolded**_ finding of ostenecrosis?

A

_Osteochondritis Dissecans**_ may cause joint locking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are common locations of Osteochondritis Dissecans?

A

Knee and ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What are the main points of Osteochondritis Dissecans?

A
  • Specific, focal subchondral AVN
  • Does not involve entire epiphyseal area – right up at articular surface
  • Usually due to trauma
  • Late teens, early adults
  • Subchondral piece of cartilage that falls into joint (joint mouse)
  • Get secondary DJD from it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What are the 4 stages of Osteonecrosis?

A
  1. Avascular
  2. Revascularization
  3. Repair - Reossification
  4. Deformity - Healed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

During the Avascular stage of AVN, what would you see?

A
  • Joint effusion – especially at the hip
    • Push the femur slightly lateral - increase medial joint space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

How does the bone look during the Avascular stage of Osteonecrosis?

A

Normal, no radiographic changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What can be a precursor to AVN?

A

TOH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What would describe, Avascular event has occured but has not started to heal yet?

A

Avascular stage of Osteonecrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What are the 3 stages to the principles of Infarction?

A

• Stage 1: cessation of intracellular metabolic activity at a

chemical level.

• Stage 2: alteration or interruption of intracellular enzyme

systems

• Stage 3: disruption or dissolution of intracellular nuclear

and cytoplasmic ultrastructure. Irreversible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Adults rarely get beyond what stage of AVN?

A

Revascularization (2)

  • Deformity happens in this stage, once you deform the bone and the adult secondary DJD happens faster than they can get through being healed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What happens to the bone during the Revascularization stage of AVN

A

(2)

  • New osteoblasts/clasts
    • Clasts take away the dead bone
  • New vascular vessels/capillaries growing in the area - happens SLOWLY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What are the radiographic findings during Revascularization?

A
  • Look more radiolucent because clasts take away dead bone
  • Areas of increased bone density where blasts are building on dead trabeculae
  • Intermixed pattern of density in the femoral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What are the signs you’d see during Revascularization stage of AVN?

A
  • Crescent sign - arc right under bone
  • Snow cap - osteosclerosis of femoral head
  • Fragmentation - well into second stage
    • can become extremely fragmented in CHILDREN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is the overall quantity/quality of bone during Revascularization stage of AVN?

A

Net reduction in bone –> subchondral fracture

  • Femoral head collapses
  • FLATTEN FEMORAL HEAD - disrupt biomechanical integrity of articular cartilage –> DJD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What happens during the Repair - Reossification stage of AVN?

A
  • NEW BONE formation
  • More bone seen on the previous x-ray

** Fast is 2 years, and has been known to take 8 years **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Children need to be radiographed every _____ during Repair stage of AVN?

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is the last stage of AVN?

A

Deformity - Healed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What are the major findings in the last stage of AVN?

A
  • Normal bone density but shape change
  • Cox magna
  • Cox Plana
  • Reduced femoral neck angle
  • Large greater trochanter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What will happen to children during the Deformity stage of AVN?

A

They will heal but they may get secondary DJD years later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What will the signal look like taking an MRI for AVN?

A

Loss of signal in the marrow on a T1 weighted scan

  • T1 water is dark
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Describe the epiphyseal on an MRI in AVN:

A

MRI are most sensitive, and it is often seen bilateral

  • May demonstrate joint effusion
  • GOLD STANDARD for early MRI imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What are the 4 main signs of AVN?

A
  1. SNOW CAP SIGN
  2. CRESCENT/RIM SIGN
  3. MUSHROOM Deformity
  4. HANGING ROPE SIGN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What can you also get from AVN (appears on X ray)?

A

Geodes - once you fracture articular surface, synovial fluid can leak down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Once the femoral head flattens in AVN it _____

A

PERMANENTLY Deformed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What would you think if you saw a bilateral case of AVN?

A

If it’s bilateral it’s probably not idiopathic - most likely alcohol or corticosteroids **

  • Sickle cell classically does it bilateral at multiple places
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Adults typically don’t make it past what stage of AVN?

A

REVASCULARIZATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Healed AVN has what signs?

A
  • Articular deformity
    • Early OA
  • Acetabular dysplasia, hanging rope
  • Trochanteric overgrowth
  • Mushroom cap deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Altered signal from fat and edema - ring of dark signal around the area of necrosis describes:

A

MRI findings of Osteonecrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is a group of disorders that share certain features?

A

Osteochondroses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Osteochondroses has a predilection for what?

A

Immature skeleton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What does osteochondroses involve?

A

Involvement of the epiphysis, apophysis, oor epiphyseal equivalent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What are the radiographic pictures dominated by in Osteochondroses?

A
  • Fragmentation
  • Collapse
  • Sclerosis
  • Frequently, reossification with reconstruction of the osseous contour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Osteochondroses is more common in boys or girls?

A

BOYS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Legg Calves - Perthes discovered in 1910 affects patients from ______

A

4-8 years old, and is more common in boys (5:1)

  • Bilateral in 10-20%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What are the clinical signs of Legg-Calve Perthes Disease?

A
  • Limping
  • Pain
  • limiting movement (abduction and internal rotation) - or could be salter harris fracture

TRAUMA in 25% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

If parents smoke during pregnancy, it increase the risk of this disease in the child?

A

Legg Calve Perthe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What are the radiographic findings in Legg Calve Perthes disease?

A
  • Soft tissue swelling
  • Small epiphysis
  • Lateral displacement of ossification center
  • Flattening, fissuring, and fracture of the ossification center
  • Intraepiphyseal gas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What is Waldenstrong’s Radiographic Staging Initial stage?

A
  • Increased head-socket distance (medial joint space widens)
  • Subchondral plate thinning
  • Dense epiphysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What are the 5 stages of Waldenstrom’s Radiographic Staging?

A
  1. Initial
  2. Fragmentation
  3. Reparative
  4. Growth
  5. Definitive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What happens during the Fragmentation stage of Waldenstrom’s?

A
  • Subchondral fracture
  • An inhomogenous dense epiphysis
  • Porous appearance with metaphyseal cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What happens during the Reparative Stage of Waldenstrom’s?

A
  • Normal bone in areas of resorption and removal of sclerotic bone
  • epiphysis has more homogenous appearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What happens during the Growth stage of Waldenstrom’s?

A
  • Re-ossification
  • Normal femoral shape approached
  • Some degree of flattening does occur - earlier detection –> less deformity
    • Greater the deformity - higher chance of DJD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What happens during the Definitive stage during Waldenstrom’s?

A

Final shape is determined with joint congruency or incongruency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Waldenstrom’s Radiographic staging is under what category?

A

Legg-Calve Perthes Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What happens to the Metaphysis during Legg-Calves Perthes Disease?

A
  • Metaphyseal cysts - frayed looking areas
  • Widening and shortening of the femoral neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Secondary OA is a problem in what?

A

Legg-Calve Perthe’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What is the basic problem of Legg-Calve Perthes

A

basic problem is osteonecrosis with
structural failure of bone, fragility of blood
supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What is Legg Calve Perthe’s Disease different from?

A 
diff. from hypothyroidism and other
avascular necrosis (ie, sickle cell)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

How long does healing for Legg Calve Perthe’s Disease last?

A

18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What are the main history components of Freidberg’s Infarction?

A
  • Affects children and adults
  • Usually unilateral
  • Woman 3 or 4:1
  • Ages 13-18
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What are the clinical findings of Freiberg’s Infarction?

A
  • Local pain and swelling
  • Complain about MTP joint hurting
  • Increased density, flattened
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What does Freiberg’s Infarction lead to?

A

DJD - Forefoot MTP joint most common place

  • DJD is secondary in Freiberg’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What is the pathogenesis of Freiberg’s Infarction?

A

pathogenesis is AVN secondary to
single or repeated trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Healed osteonecrosis pic

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What is AVN in the scaphoid?

A

Preiser’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What are the main points of Preiser’s Disease?

A
  • Scaphoid is most common carpal bone to fracture
  • Sclerosis analagous to snowcap appearance in femoral head
  • Eventually collapses like femoral head collapses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What usually happens secondary to fracture of scaphoid?

A

Preiser’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Radial carpal DJD – Secondary DJD describes what?

A

Preiser’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

What suggests AVN of tarsal navicular navicular?

A

Kohler’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What are the main attributes of Kohler’s disease?

A
  • Boys 4 or 6:1
  • 3-6 years old
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What are the radiographic findings of Kohler’s Disease?

A
  • Radiographs reveal patchy increased density and fragmentation
  • Local Pain, tenderness, and swelling
  • Look a little osteosclerotic, maybe radiolucent in areas, flattened
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What is AVN of the lunate?

A

Kienbock’s Disease

172
Q

What happens during “Advanced Collapse” of Kienbock’s disease?

A
  • Very negative ulnar deviation
  • Very flattened lunate - almost looks like a crescent sign
173
Q

Describe the “ulnar variance” associated with Kienbock’s disease:

A
  • Patients that have negative ulnar variance have an increased risk of lunate AVN – causes excessive stress load on proximal carpal load
    • Patients should be followed
174
Q

What leads to DJD and decreased wrist function?

A

Kienbock’s Disease

175
Q

What are the main attributes of Vertebral body AVN?

A
  • May occur with corticosteroids, compression fracture, or osteoporosis
  • “Intravertebral Vacuum
176
Q

What are the radiograhic findings of Vertebral body AVN?

A
  • Radiolucency in vertebral body (almost looks like gas)
  • FLATTENING
177
Q

Aka for vertebral body AVN?

A

Kummel - Verneuli’s Disease

178
Q

What represents a focal subchondral infarction of sub-articular bone?

A

Osteochondritis Dissecans

179
Q

Describe what happens during Osteochondritis Dissecans:

A

The necrotic bone may become a free floating fragment separated from the parent bone

  • JOINT MOUSE: Damages hyaline cartilage and causes secondary DJD
180
Q

What case attributes are associated with Osteochondritis Dissecans?

A
  • Often associated with trauma
  • Seen in young individuals
  • Complain about joint pain
181
Q

What is the most common place for Osteochondritis Dissecans?

A

Knee is a common place, more common is lateral portion of medial femoral condyle

182
Q

Medullary Necrosis affects, ?

A

Large Tubular Bones

  • Tibia, Fibula, humerus, femur
183
Q

What are the main characteristics of Medullary Necrosis?

A
  • Medullary infarcts
    • Faint rim of calcification outlining area
  • Usually found by accident – traumatic determinism (x-ray after trauma and find this)
  • Can disappear overtime (go through all the stages to heal)
  • NO SYMPTOMS
184
Q

What classification is Medullary Necrosis in?

A

3rd in classification

  • Bone-ends children
  • Bone - ends adults
  • Everywhere else (diaphysis & metaphysis)
185
Q

What are the radiographic signs of medullary necrosis?

A
  • Snake like appearance in medullary cavity (twisted appearance)
  • One of the benign cartilage tumors (enchondroma) is in the differential with this – looks familiar
186
Q

What are the first few main points of Osteomyelitis?

A
  • Early diagnosis is intrinsic to appropriate therapy (antibiotics) being instituted
  • Often a high index of clinical suspicion is required rather than reliance on radiographic changes
  • Relatively short time frame for symptomatology
187
Q

most of the time, the infections of osteomyelitis are ______

A

secondary

188
Q

What is Cellulitis?

A

Infection of skin, subcutaneous fat, or connective tissue (tendons/ligaments/muscle)

189
Q

What is Osteomyelitis?

A

Infection of Bone (marrow spaces)

190
Q

What is Septic Arthritis?

A

Infection of joint (synovial tissue, articular surfaces)

191
Q

What is osteotitis?

A

Inflammatory condition usually confined to cortex

192
Q

What type of bacteria destroys joints very quickly?

A

Staph Aureus

193
Q

What are the “at risk groups” of osteomyelitis?

A
  • Immunosuppressed
  • Diabetics
  • Post surgical
  • Vascular insufficiency
  • Sickle Cell anemia
  • IV drug Users (pseudomonas aeruginosa)
194
Q

Explain Intravenous drug users in regards to Osteomyelitis:

A

“Mainliners Syndrome”

  • S JOINTS
    • ​spine - discovertebral
    • sacroiliacs
    • symphysis pubis
    • sternoclavicular
  • ALL ARE AXIAL JOINTS ****
195
Q

What are the categories under Osteonecrosis?

A
  • Osteochondroses
  • Legg-Calve Perthes Disease
  • Freiberg’s Infarction
  • Preiser’s Disease
  • Kohler’s Disease
  • Kienbock’s Disease
  • Vertebral Body AVN
  • Osteochondritis Dissecans
  • Medullary Necrosis
196
Q

What are the categories of Osteomyelitis?

A
  • Acute
  • Subacute
  • Chronic
197
Q

What are the clinical features of acute osteomyelitis?

A
  • Edema
  • Lymphadenopathy
  • Warm Skin
  • Cellulitis
  • Joint Pain
  • Happens within 2 weeks of disease onset
198
Q

Subacute Osteomyelitis develops _____

A

Within one to several months

199
Q

Chronic Osteomyelitis develops _____

A

After several months

200
Q

What are the classifications of Osteomyelitis?

A
  • Suppurative
  • Non-Suppurative
  • Syphilitic (lues) - Teponema Pallidum
201
Q

What are the aerobes associated with Osteomyelitis?

A
  • Myobacterium Tuberculosis****
  • Neisseria Gonorrhea
  • Pseudomonas
  • Fungus
202
Q

What are the anaerobic or faculative anaerobes associated with Osteomyelitis?

A

_****Staphylococcus Aureus**** (MOST COMMON)_

  • Streptococcus Pyogens
  • Treponema Palladium
203
Q

What is under the suppurative classification of Osteomyelitis?

A
  • Bone marrow infection by (pyogenic) non-tubercular organism (anything but TB)
  • Staylococcus aureus 90%
  • Haemophilus Influenza
  • Streptococcus Pneumonia
  • E. Coli
  • Pseudomonas
    • IV drug abuse
    • Mainliners Syndrome
    • Axial Joints
    • S joints
204
Q

What’s under the Non-suppurative category of Osteomyelitis?

A
  • Mycobacterium tuberculosis
  • Granulomatous
  • Fungal Infections
  • Blastomycosis - regional fungal infection
205
Q

What’s under the Syphilitic (lues) teponema pallidum?

A
  • Congenital
  • Acquired
206
Q

What is the Route of Contamination in Osteomyelitis?

A

Osseous and articular contamination by 4 principle mechanisms

207
Q

What are the 4 principle mechanisms of contamination in osteomyelitis?

A
  1. Hematogenous spread of infection - via bloodstream
  2. Spread from a contiguous source - cutaneous, sinus, and dental infections
  3. Direct Implantation - Penetrating injuries, particularly in the feet
  4. Postoperative Infection - contamination of surgical sites
208
Q

What are the clinical characteristics of Osteomyelitis?

A
  • Most often between 2-12
  • 3:1 male dominance
    • Boys have greater tendency to do things that make them vulnerable
  • Large tubular bones of extremities (metaphysis and richly vascularized)
    • Femur
    • Tibia
    • Humerus
    • Radius
209
Q

What are the Radiographic Findings associated with Osteomyelitis?

A
  1. Moth eaten ostelysis
  2. Periosteal reaction (involucrum - very substantial, mature, solid layer of bone around host bone)
  3. Cloaca
  4. Sequestra
  5. Marjolin’s Ulcer
210
Q

What is the “Cloaca” associated with the Radiographic finding of Osteomyelitis?

A
  • Hole through cortex and periosteal bone
  • Allows exudate out into the soft tissue
211
Q

What is “sequestra” associated with radiographic findings of Osteomyelitis?

A

Segments of necrotic bone separated from living bone by granulation tissue

212
Q

What is Marjolin’s Ulcer associated with Osteomyelitis radiographic findings?

A

Epidermoid carcinoma occuring at a sinus tract

  • Rare finding after 20-30 years with chronic disease
213
Q

How long does it take to see Radiographic evidence of Osteomyelitis?

A

10-14 days

214
Q

What is Brodie’s Abscess?

A

Low grade infection usually seen in children, may MIMIC osteoid osteoma

215
Q

What are the main points of Septic Arthritis?

A
  • May occur secondary to subarticular osteomyelitis or direct inoculation
  • Usually monoarticular
  • Spinal Involvement with TB frequently multi-disc level
  • Only 10% of skeletal infectious disease will be spinal
216
Q

What is Tom Smith Arthritis?

A
  • Spread of metaphyseal osteomyelitis to the adjacent joint when the metaphysis is intrascapular
  • Proximal and Distal femur and humerus as well as tibia
217
Q

What are the modes of infection occuring in Osteomyelitis?

A
  • Trauma/post - surgical
  • UTI - particularly bad for getting it into the spine
  • Pneumonia
  • Skin (open wound or cellulitis)
218
Q

What are the most common locations of Osteomyelitis?

A
  • Knee
  • Hip
  • Ankle
  • Shoulder
  • Spine
  • Venous Stasis and Gravity
219
Q

What are the 4 Radiographic Stages?

A
  1. Latent (Hidden) stage 1-10 days
    1. No radiographic findings
  2. Early Stage days 10-21 days
    1. Decreased bone density and soft tissue
    2. Periarticular Osteopenia - characteristic of RA
  3. Middle Stages - weeks
    1. ​Moth eaten destruction and periosteal reaction (solid)
    2. Lytic moth eaten destruction may cross anatomical barriers
  4. Late Stage - months
    1. ​Involucrum, sequestrum, cloaca
    2. Solid Periosteal Reaction - parallel to periosteal layer of bone
220
Q

What stage of osteomyelitis would you see moth eaten destruction and periosteal reaction?

A

Middle stage

221
Q

What is sequestrum?

A

Chalk, white area representing dead bone

222
Q

What is the vocabulary associated with Involucrum of Osteomyelitis?

A
  • Bony collar
  • Continuation of periosteal response
  • will eventually represent the new periosteum
  • Cloaca: Drainging sinus, more common with chronic disease
223
Q

What are the characteristics of arthritides?

A
  • Degenerative and Inflammatory
  • INFLAMMATORY:
    • Soft tissue swelling
    • osteoporosis
    • erosions
    • Septic arthritis
224
Q

What are common themese within Septic Arthritis?

A
  • Joint infection
  • MC in joints in which the capsules covers metaphysis
  • Joint capsule infected first
  • Completely eliminates both sides of the joint
225
Q

What are the radiographic features of Septic Arthritis?

A
  • Joint effusion
  • Juxtaarticular Osteoporosis
  • Erosions
  • Joint space loss
  • Lytic destruction that crosses the joint space

​

Tumors respect joints, INFECTIONS DONT!

226
Q

Describe Infectious Spondylodiscitis:

A

Infection that gets into the disc and starts at the end plates

  • Both suppurative and non-suppurative can do this
227
Q

Pediatric patient with disc space loss =

A

INFECTION

228
Q

What would give you the idea that you’re seeing infection vs. DJD?

A

Destruction on both sides of disc level with disc narrowing and prevertebral swelling - think infectious

229
Q

What “favors” TB?

A

Gibbus - hyperkyphosis with an angle

230
Q

DJD is the most common reason for having joint space narrowing but it does not _______

A

DESTROY end plates,

INFECTION DESTROYS END PLATES

231
Q

Metastasis can completely destroy the vertebral bodies, but _____

A

NOT touch the discs

232
Q

What does TB destroy?

A

More of the front of the vertebral body - segment begins to flex forward

233
Q

How much bone loss do you need for it to be detected on plain film?

A

30-70%

234
Q

What imaging is more detailed, and more sensitive?

A

Computed Tomography

235
Q

Tuberculosis is simply ______

A

Non suppurative Osteomyelitis

236
Q

What is the most common cause of infection related death world wide?

A

Tuberculosis with 15 million people infected in the USA

237
Q

What are the clinical features of Tuberculosis?

A
  • Respiratory symptoms
    • _Pulmonary infection first (PRIMARY TB)**_
    • In an immunocompetent person, TB is asymptomatic 98% of the time
238
Q

What happens with the pulmonary infection in Tuberculosis?

A

Spreads through lymphatics and vascular system - _lymphohemotogenous dissemination - secondary TB***_

  • Can embed organisms in bone marrow and spine
239
Q

What is gohn’s tubercle?

A

Localized embedded areas of tubercular bascillus organisms that are walled off and contained

240
Q

What are the symptoms of Tuberculosis?

A
  • Respiratory symptoms
  • Weight loss
  • night sweats
  • vague joint/back pain
  • persistently elevated ESR
241
Q

What does TB really like?

A

The spine and joints - more so than suppurative

242
Q

What is spinal tuberculosis?

A

POTTS DISEASE

243
Q

What’s the most common place for TB?

A

SPINE

244
Q

What are the radiographic features of TB?

A
  • similar to osteomyelitis in the spine, but:
    • Multiple levels
    • Paraspinal cold abscesses with Ca2+
    • Subligamentous spread to multiple vertebrla bodies
      • Spreads under ALL
245
Q

Explain the “Paraspinal cold abscesses with Ca2+” in the Radiographic features of TB:

A
  • New capillary growth with fibroblasts oozing from infectious site - granulation tissue can occur around the vertebra
  • Below diaphragm in lumbar area - granulation runs down psoas muscle - psoas abscesses
  • Calcifies because it scars
246
Q

What are the most common places for TB?

A

Spine, hips, and knees

247
Q

What is TB joint infection

A

Tuberculosis septic arthritis

248
Q

What will you see with Tuberculosis septic arthritis - TB joint infection?

A
  • PHEMISTER’S TRIAD
    • Juxtaarticular osteoporosis (osteopenia)
    • Marginal erosions
    • Slow joint space loss (uniform)
  • SCROFULA - associated with TB - cervical lymphadenitis
    • Cervical lymph nodes enlarged
249
Q

Osteitis Deformans =

A

Paget’s Disease

250
Q

What is Paget’s Disease?

A

Very common bone softening disease - many asymptomatic early in disease; progress with pain, bowing and enlargement with possible neurological complications (especially if it involves the spine)

251
Q

Where is Paget’s most common?

A

Great Britain and descendants

  • About 5% of the world (1 in 20)
  • Uncommon in Asia and Africa
  • In US slightly higher incidence the further north you go
252
Q

What is the etiology of Paget’s?

A

Undetermined, current thought is the latent Virus

253
Q

Describe the bone in Paget’s:

A

Bone is extrememly vascular - tremendously high increase in blood flow

  • This can overload the heart - high cardiac output –> lead to heart failure
254
Q

What does the lab report of Paget’s Disease look like?

A
  • Serum alkaline phosphatase - indication of liver activity and osteoblastic activity
  • Urinary and serum hydroxyproline - from collagen breakdown
255
Q

Describe the simple definition in early stage of Paget’s:

A

Bone/osteoclastic resorption - where you will find hydroxyproline

256
Q

Describe what simply happens in 2nd stage of Paget’s in regards to the lab findings:

A

Bone productive - high osteoblastic activity - significant elevation of alkaline phosphatase (20 x’s normal level)

257
Q

Patient with Paget’s disease frequently have ______

A

both stages going on at the same time - may see increase in both labs

258
Q

Where is Paget’s most common?

A

Big Tubular bones, pelvis, spine, and cranial vault

259
Q

What is a distinguishing characteristic of Paget’s?

A

Can jump over joints and involve the bones on the other side of the joint - typically subarticular (goes right up to the bone end)

  • Can also cause deformity of the subarticular bone - impact the integrity of the cartilage of the joint - secondary DJD
260
Q

Is there periosteal involvment in Paget’s?

A

NO

261
Q

What is the age group of Paget’s ?

A

> 40 years old

262
Q

What are the stages of Paget’s?

A

4 stages

  1. Stage 1 - Osteoclastic Resorpiton
  2. Stage 2 - Bone Productive - mixed stage, biphastic stage
  3. Stage 3 - Osteosclerotic stage
  4. Stage 4 - Malignant Degeneration
263
Q

What happens during the 1st stage of Paget’s?

A
  • Seen with areas of radiolucency
  • Lytic Phase - radiographic findings depend on if it is a long bone or flat bone
264
Q

Describe the tubular component of Paget’s in regards to the 1st stage:

A

Tubular - progresses proximal to distal, or distal to proximal

  • Will have an area of radiolucency in a V shape (“blade of grass” or “candle flame”) or oblique line
265
Q

What happens to the skull in paget’s?

A

*1st stage***

  • Skull/flat bone - large well-defined geographic area of radiolucency “osteoporosis circumscripta”
    • IN SKULL ONLY
266
Q

What are some features of Stage 2 Paget’s?

A
  • Repair stage that comes behind
  • Osteoid is poor quality (lot of fibrous tissue)
  • Accentuate the bone cortex and thicken the trabeculae - increase bone density and increase size
267
Q

What stage do most patient’s stay in Paget’s?

A

STAGE 2

268
Q

What will happen to the bone during Paget’s?

A
  • Sclerosis and lucency
  • Trabecular and cortical thickening
  • Bone enlargment - bone may lose vertical height (due to softening) but gain horizontal size
269
Q

What appearance will the Paget’s skull present with during stage 2?

A
  • Skull is cotton wool appearance - fluffy, non homogenous look
    • will cause enlargment of head
    • often spares facial bones
270
Q

What will the spine present with during Paget’s in the 2nd stage?

A

Vertebral body “picture frame” - name for cortical thickening - best illustrated in the lumbar layer

  • May see ivory vertebral body
  • Can extend posterior
271
Q

What is your differential diagnosis for ivory vertebra?

A

Pagets, blastic mets, lymphoma (Hodgkins)

272
Q

What is a “sign” in stage 2 of Paget’s?

A

“Brim/rim” sign - cortical thickening along the inside bony pelvic margin

* Bony enlargment in the spine can cause the neurological symptoms

273
Q

Describe Stage 3 of Paget’s:

A
  • Bone becomes homogenously osteosclerotic looking
  • Cannot distinguish trabeculae from cortex
274
Q

Describe stage 4 of Paget’s:

A

Most people do not get to this stage, and bone becomes very painful

275
Q

What can you use to diagnose Paget’s?

A
  • Radiographs
  • Bone scan can find areas of involvment
  • CT/MRI can asses for complications
276
Q

What are the complications of Paget’s?

A
  • Osseous Deformity
  • Fractures
  • Neurologic Symptoms
  • Arthropathy (secondary DJD)
  • Neoplasm (4th stage)***

KNOW THIS ****

277
Q

What are the “Osseous deformities associated with Paget’s?”

A
  • Due to bone softening
  • Bowing common
  • Acetabular protrusion with positive Kohler’s line
  • Basilar Invagination
  • Saber - shin deformity - bowing of tibia
278
Q

What type of fractures do you see in Paget’s?

A

Pseudofractures: Thin lines of radiolucency from unmineralized osteoid associated from softening

279
Q

Describe pseudofractures in Paget’s:

A
  • Can become true fractures
  • typical in femur, humerus, and pelvis
  • AKA: osteoid seam, Milkman’s syndrome, increment fracture, Looser’s lines, umbazone
280
Q

What is a Banan fracture in Paget’s?

A

Usually through a pseudofracture in big tubular bones, horizontal/transverse fracture

  • SPINE CAN HAVE COMPRESSION FRACTURES
281
Q

Describe Neoplasm symptoms in Paget’s:

A
  • Sacromatous transformation that are most often lytic (only about 1% of patients)
  • Occur in OLDER patients (55-80 y.o.)
  • May have soft tissue mass develop around it
282
Q

What are common sites of neoplasms?

A

FEMUR, pelvis, humerus

(UNCOMMON in spine)

283
Q

Osteosarcom neoplasm %

A

50-55%

284
Q

Fibrosarcoma neoplasm %

A

20-25%

285
Q

Chondrosarcoma neoplasm %

A

10%

286
Q

What is a neoplasm?

A

Abnormal cellular growth that can be benign or malignant

  • Malignant: Ability to metastasize/spread
  • Benign: Does not metastasize, but this does not mean insignificant
287
Q

Any cell found in bone can produce ______

A

a tumor

* Subdivided by what type of cell it comes from

288
Q

If a tumor originates in bone it is called a _____

A

primary bone tumor

289
Q

What is a secondary bone tumor basic definition?

A

Starts somewhere else and metastasizes to bone

290
Q

What is a tumor like lesion?

A

Lesions that radiographically appear as tumors but are not histo-pathologically classified as a tumor - usually produce geographic radiolucency

291
Q

Primary bone tumors, benign category:

A
  1. Osteoma - MOST COMMON, intramembranous bone tumor, dont hurt
  2. Osteoid Osteoma - not as common, HURT
  3. Osteoblastoma - RARE, but half occur in spine
292
Q

Malignant bone tumr =

A

Osteosarcoma

293
Q

Describe conventional osteosarcomas:

A

Most of these are central sclerotic (about 75%) originate from inside the bone and loves the distal femoral metaphysis

  • 72% (over 2/3 of all osteosarcomas)
294
Q

What is multifocal Osteosarcomatosis?

A

Most often in children in first decade, nearly always fatal

295
Q

Osteosarcoma can be from post therapeutic radiation, t/f

A

true

296
Q

What type of malignant bone tumor is extremely vascular?

A

Telangiectatic

297
Q

What type of tumor can become an ostoesarcoma?

A

Dedifferentiated chondrosarcoma

298
Q

What osteosarcoma originates in the soft tissue attached to the bone?

A

Extraskeletal Osteosarcoma

299
Q

What are 2 of the most common benign bone tumors?

A

Chondroma and Solitary Osteochondroma - asymptomatic

300
Q

What is a tumor of the cortical bone?

A

Chondroma, and it is a common benign

301
Q

What is a benign bone tumor that is inside the bone?

A

Enchondroma

302
Q

Is osteochondroma benign or malignant?

A

Benign

303
Q

What is a fibromyxoid chondroma?

A

Tumor made of fibrous mucus cartilage

  • Dominant content is cartilage
  • Loves the TIBIA - rare to be anywhere else

BENIGN

304
Q

What is a chondroblastoma?

A

High concentration found in the epiphysis - where chondroblasts are located - may spread into rest of bone

BENIGN**

305
Q

What are the 3 Malignant cartilage Tumors?

A
  • Primary Chondrosarcoma
  • Secondary Chondrosarcoma
  • Clear cell chondrosarcoma
306
Q

What is primary chondrosarcoma?

A

Didn’t require anything else for it to be there, it originates by itself

307
Q

What is secondary chondrosarcoma?

A

From a preexisting benign tumor that malignantly degenerate - can be multiple

  • Central secondary chondrosarcoma - From ENCHONDROMA, central is inside the bone in medullary cavity or cortex
  • Peripheral - OSTEOCHONDROMA - located external to the bone, looks like a trunk/stalk of broccoli coming off
308
Q

Central secondary chondrosarcoma comes from _____

A

Enchondroma

309
Q

Peripheral secondary chondrosarcoma comes from _____ ?

A

Osteochondroma

310
Q

What is clear cell chondrosarcoma?

A

Usually near a joint, mistaken for chondroblastoma

311
Q

What is one of the more common bone tumors?

A

Giant cell tumor of bone/osteoclastoma

312
Q

What are the characteristics of Giant cell tumor?

A
  • Classically expansile soap bubble lesion
  • about 1 in 5 are malignant
  • “Quasi - malignant” can go either way - 80% malignant
313
Q

Where do giant cell tumors most likey occur?

A

At the knee (HURT)

314
Q

Marrow tumors, aka:

A

round cell tumors

315
Q

What is the common theme with marrow tumors (round cell tumors)?

A

_Occur in diaphysis and are all MALGINANT AND DESTRUCTIVE ******_

316
Q

Ewings Sarcoma is in what category?

A

Marrow tumor (round cell tumor)

  • Classically gives laminated periosteal reaction
  • moth eaten appearance
  • big tubular bone in young children
317
Q

What is the most common primary bone malignancy in first decade (peak in teenagers)?

A

EWINGS SARCOMA

  • dont confuse Leukemia, which is the most common malignancy in the first decade
318
Q

What category is Non-Hodgkin Lymphoma under? (NHL)

A

Marrow tumor (round cell tumor: malignant)

319
Q

What is the most common primary bone malignancy?

A

_Multiple Myeloma**** TEST_

320
Q

Where would you see true punched out lesions?

A

Multiple Myeloma

321
Q

Explain Myelomatosis:

A

Form of multiple myeloma:

  • Produces osteopenia, looks like osteoporosis - will also have weakness and fatigue due to anemia - radiographically will look the same
322
Q

What will plasmacytoma have?

A

Geographic soap bubble lesion

323
Q

What is “extra osseous” ?

A

Branch of multiple myeloma

  • Mass in nasal pharynx (difficulty breathing), very uncommon
324
Q

What is under the Benign Vascular and Connective Tissue tumor?

A

Hemangioma - produces localized coarsening of the trabecular pattern

325
Q

What is the “Malignant vascular tumor?’

A

Fibrosarcoma

326
Q

What is the notochord remnant tumor?

A

Chordoma - most often found in Clivus, C2, sacro-coccygeal, will cross the joint

327
Q

What are secondary tumors?

A

Metastatic tumors in bone

328
Q

Vast majority of secondary tumors are _____

A

Hematogenous

329
Q

Osteolytic mets is a _____

A

secondary tumor

330
Q

What has 75% occurence %, osteolytic mets or osteoblastic mets?

A

Osteolytic

331
Q

What are the key points of osteolytic mets?

A
  • Destroys by physical bulk and restricting osteoblasts
  • 80% of metastasis found in spine, ribs and pelvis with another 10% found in cranium
  • Rarely go beyond the elbow and knee
332
Q

What accelerates osteoblasts?

A

Osteoblastic mets

333
Q

Pic of mixed mets

A
334
Q

What is in the “Tumor Like” category?

A
  • Not exhaustive list
  • Fibrous dysplasia - as common as Paget’s
335
Q

How can tumors be classified?

A
  • They can be classified by location of where they originate - most often from the metaphysis
336
Q

If a tumor is most likely benign, what will it’s characteristics be?

A
  • Almost always originate before age of 30 (with exception of giant cell tumor 20-40 years old)

KNOW THIS***

337
Q

What are the top “Malignant Tumors” ?

A

MOCEF - top 5 primary malignant

  1. Multiple Myeloma: Over 40
  2. Osteosarcoma: under 30
  3. Chondrosarcoma: 40 - 60
  4. Ewing’s: Under 40
  5. Fibrosarcoma: 30 - 60
338
Q

Primary Bone Tumors:

A
  • Bone Forming Tumors
  • Cartilage Forming Tumors
  • Giant Cell Tumor of Bone/Osteoclastoma
  • Marrow Tumors (Round Cell Tumors)
  • Vascular and Connective Tissue Tumors
  • Notochord Remnant Tumor
339
Q

What are the Bone forming primary bone tumors?

A
  • Benign
    • Osteoma
    • Osteoid Osteoma
    • Osteoblastoma
  • Malignant - Osteosarcomas
    • Conventional Osteosarcoma
      • 72% central
      • 75% sclerotic
      • 25% lytic
    • Parosteal Os 4%
    • Periosteal Os 1%
    • Multifocal Os/osteosarcomatosis 1%
    • Osteosarcoma of Jaw - 6%
    • Post Radiation Os - 4%
    • Os in Paget’s disease - 3%
    • Os Degeneration from benign condition - 1%
    • Telangiectatic Os - 3%
    • Dedifferentiated Chondrosarcoma - 3%
    • Extraskeletal Os. < 1%
340
Q

What are the Benign Cartilage Forming Tumors?

A
  • Benign
    • Chodnroma/Enchondroma
    • Solitary Osteochondroma
    • Chondromyxoid Fibroma/Fibromyxoid Chondroma
    • Chondroblastoma
341
Q

What are the malignant Cartilage forming tumors?

A

Malignant

  • Primary Chondrosarcoma - arise de novo
  • Secondary Chondrosarcoma - from preexisting benign tumor
    • Central - From enchondroma
    • Peripheral - From Osteochondroma
  • Clear cell chondrosarcoma - mistaken form chondroblastoma, low grade
  • Extra Skeletal - Rare
342
Q

What are the marrow tumors (round cell tumors?)

A
  • Ewing’s Sarcoma
  • NHL (non hodgkin lymphoma) of bone/reticulum cell sarcoma
  • Multiple Myeloma
343
Q

What are the branches of multiple myeloma?

A
  • Classical MM
  • Myelomatosis
  • Plasmacytoma
  • Extra Osseous MM
344
Q

Vascular and Connective Tissue tumors are in what category, what are their subcategories?

A

It is in the category of “primary bone tumor”

  • Benign - Hemangioma
  • Malignant - Fibrosarcoma
345
Q

Metastatic Tumors in bone - most common skeletal malginancy

A
  • Osteolytic Mets
  • Osteoblastic Mets
  • Mixed Mets
346
Q

Tumor Like Conditions:

A

PRIMARY BONE TUMORS

  • Solitary bone cyst/Unicameral bone cyst
  • Aneurysmal bone cyst
  • Fibrous Cortical defect and nonossifying fibroma
  • Fibrous Dysplasia
  • Brown Tumor of hyperparathyroidism
  • Pseudotumors of Hemophilia
  • Large Arthritic Cysts/Geode
347
Q

If it’s a benign tumor they overwhelmingly originate when?

A

Before the Age of 30

348
Q

If a tumor is asymptomatic and benign, it may not show till ____

A

age 50

349
Q

When does Giant cell tumor usually occur?

A

20-40 this is an exception

350
Q

Metastisis happens how?

A

Through Vascular system

351
Q

Big 6 strongest potential to spread?

A
  1. Breast - females 70%
  2. Lung - 25%
  3. Prostate - Males 60%
  4. Kidney
  5. Ewing’s
  6. Neuroblastoma

*** Breast, lung, prostate, and kidney account for 80%

352
Q

Where does lytic Mets come from?

A

Physical bulk - pressure from the tumor taking up space which impedes the osteoblasts

  • More common (75% of metastasis destroys)
353
Q

Approximately 80% of all osseous metastases will be found _____

A

In the axial skeleton

  • 28% ribs
  • 39% vertebra
  • 13% bony pelvis

10 % of skeletal metastasis will be found in the cranium

10% extremities

354
Q

Is Enostosis primary or secondary bone tumor?

A

Primary

AKA BONE ISLAND

355
Q

What is enostosis classified as?

A

Tumorlike, usually an incidental finding, and is asymptomatic

356
Q

What are the characteristics of Enostosis?

A
  • Rare in children
  • Osteosclerotic bone lesion
  • Can be considered a hamartoma (benign tumor that is multicellular and has all the cells of the host tissue)
357
Q

Where is the location of Enostosis?

A

Intramedullary Location - usually up against inner surface of cortex

  • Composed of normal appearing compact lamellar bone with haversian canals
  • Blends with surround trabecular bone creating irregular margin
358
Q

What is the radiological appearance of Enostosis

A
  • Round to oval (.2 - 2 cm) osteoblastic area
  • Epiphyseal or metaphyseal
  • Bone scan NORMAL

95 % no need for further radiologic evaluation

359
Q

WHat is the differential diagnosis for Enostosis?

A

Osteoblastic Mets, osteoma, osteoid osteoma, low grade osteosarcoma

360
Q

Osteoblastic mets ____

A

HURTS

361
Q

low grade osteosarcoma is ____

A

PAINFUL

362
Q

When would you take a biopsy of Enostosis?

A

Increase in size of 25% in 6 months

363
Q

Bony pelivs is a common site to see ____

A

enostosis

364
Q

Giant bone island is a _____

A

Enostosis that is > 2-3 cm in size

More likely to have increased activity on bone scan

365
Q

What are the possible diseases related to Enostosis?

A
  • Osteopoikilosis
  • Osteopathia Striata
  • Melorheostosis
366
Q

Osteopoikilosis =

A

Periarticular bone islands

367
Q

Osteopathia Striata =

A

Lesions are more elongated in periarticular pattern, Vooerheve disease, fan-like bands in flat bones

368
Q

What are the 3 common characteristics of Melorheostosis?

A
  • Osteosclerotic bone disorder
  • Often symptomatic (pain, decreased ROM, contractures, limb swelling, bowing)
  • Scleroderma - like skin lesions over osseous changes
369
Q

What is the radiology of Melorheostosis?

A

o Osseous excrescences often exuberant and lobulated along bone surface

o Single limb—more common lower extremity

o Also endosteal involvement may extend into marrow space

o Intense activity on bone scan

o Long drippy bone island

​

370
Q

Benign Bone forming:

A

OSTEOMA

OSTEOID OSTEOMA

OSTEOBLASTOMA

371
Q

Osteoma aka:

A

Ivory Exostosis

372
Q

What is a benign, slow growing hamartomatous lesion composed of well differentiated mature bone?

A

Osteoma

373
Q

What is the defect in Osteoma?

A

One resorption or formation during skeletal maturation

374
Q

What does osteoma arises beneath?

A

Endosteum from inner surface of cortex

375
Q

What causes surrounding reactive bone formation in Osteomas?

A

Elevation of periosteum from underlying bone

376
Q

Osteoma is a bone of _____

A

Intramembranous origin

377
Q

Extracranial Osteoms -

A

.03% of bone biopsied primary bone lesions

378
Q

Paranasal sinus osteomas -

A

.4%

Most have a osteosclerotic lesion in a frontal or ethmoid lesion

379
Q

What are the associated abnormailities with Osteoma?

A
  • Gardner’s Syndrome
  • Mutation of Adenmatous Polyposis Coli Gene (5q21)
  • Multiple osteomas, intestinal polypsos, soft tissue desmoid tumors
  • Bone lesions may precede intestinal polyposis
380
Q

Describe Gardner’s Syndrome in Osteoma:

A
  • Autosomal Dominant
    • Syndrome of hamartomatous tumors in different locations
    • One of the key findings - osteomas
    • Will develop color cancer (precursor to colon cancer)
381
Q

In osteoma, most just have ____

A

single solitary osteoma

382
Q

What are the clinical issues associated with Osteoma?

A
  • Small lesions usually asymptomatic
  • Project away from cortical surface
  • Palpable enlarging osseous mass
383
Q

What is the nasal issue with Osteoma?

A
  • Large oseomain paranasal sinus may obstruct nasal ducts
    • Can erode wall of cranial fossa and dura
    • Can cause mucocele, sinusitis, headache, pain
384
Q

What can osteoma tumors near orbit cause?

A

Cause exopthalmosis, double vision, vision loss

385
Q

What about the Hx of Osteoma:

A
  • Found before 30 but can be seen anytime
  • EQUAL GENDER
  • No malginant potential
386
Q

What looks identical to bone island but has different location?

A

Osteoma

387
Q

What does Osteoma look like radiographically?

(first 3)

A
  • Well defined round dense sclerotic lesion attach to underlying bone
  • Vast majority in frontal and ethmoid sinus
  • DENSE ivory like sclerotic mass
388
Q

What does Osteoma look like radiographically?

(last 3)

A
  • No satellite lesions
  • Low signal on MRI
  • Plain film is good to see them
389
Q

OSTEOID OSTEOMA: main characteristics

A
  • Painful!
  • Produce dense periosteal reaction
  • Can regress spontaneously - infarction
  • Local swelling and point tenderness
390
Q

What is Osteoid Osteoma characterized by?

A

Nidus less than 1 cm of osteoid/woven bone is vascular tissue surrounded by zone of reactive sclerosis

391
Q

What is elevated in Osteoid Osteoma?

A

Prostaglandin E2 elevated 100-1000 times within Nidus (pain and vasodilation)

392
Q

Describe the nidus in Osteoid osteoma:

A

Radiolucent and is the actual tumor

393
Q

Pain is worse at night with what tumor?

A

Osteoid Osteoma

394
Q

Whats the origin of Osteoid Osteoma?

A

Unknown, inflammatory, traumatic, vascular, viral

395
Q

What is a distinguishing characteristic of Osteoid Osteoma?

A

These can produce a painful scoliosis, and they happen in the spine (lean into a legion)

396
Q

Osteoid Osteoma is more common in ______

A

males 2-3:1

397
Q

What are the first 4 radiological features of Osteoid Osteoma?

A
  • Long bones are common
  • Metaphysis/Diaphysis
  • Phalanges of hands and feet
  • Spine (10%)
    • Posterior Elements 90% - posterior arch lamina
    • Vertebral body 10%
398
Q

What are the last 5-6 radiological features of osteoid osteoma?

A
  • Cortical: 70-80%
    • Radiolucent Nidus < 1.5 cm with surrounding dense sclerosis
    • Periosteal reaction may be present
  • Medullary: 25%
  • CT - well defined, round oval nidus surrounded by sclerosis
  • MRI - T1 WI nidus isointense to muscle
399
Q

What does osteoid osteoma look like on bone scan?

A

lights up

(will have a solid dense periosteal reaction)

400
Q

OSTEOBLASTOMA aka:

A

Giant osteoid osteoma, osteogenic fibroma

401
Q

What is Osteoblastoma characterized by?

A
  • Production of osteoid and woven bone
  • Lesion > 1.5 cm
  • Histology similar to osteoid osteoma
402
Q

What are the %’s associated with Osteoblastoma?

A

< 1% of primary bone tumors

3% benign bone tumor

403
Q

Describe Osteoblastoma:

A
  • Circumscribed mass, often surrounded by shell of cortical bone or periosteum
  • Sharp interphase between lesion and cancellous bone
404
Q

What does the nidus look like in Osteoblastoma?

A
  • 2-10 cm, friable, deep red (highly vascular)
  • Very vascular connective tissue stroma with interconnecting trabecular bone
405
Q

What are the symptoms of osteoblastoma?

A
  • Dull, localized pain of insidious onset
  • Pain rarely interferes with sleep
  • Localized swelling, tenderness, and decreased ROM
  • Doesnt respond well to aspirin
406
Q

Osteoblastoma originates ____

A

under 30

407
Q

Osteoblastoma gender pref.

A

2-3:1 in males

408
Q

WHat can Ostoeblastoma have?

A

Foci of aggressive stage 3 lesion (prone to aneurysmal bone cysts formation)

RECURRENCE AFTER resection = 10-25%

409
Q

In aggressive osteoblastoma, the recurrence is ____ %

A

50

410
Q

First 4 things of Osteoblastoma (radiology):

A
  • 30-50% SPINAL
    • Posterior elements –> 60% spinous, transverse process, pedicle
    • Posterior elements with extension into vertebral body 25%
    • Vertebral body 15%
  • Long bones, 30% originate in metaphysis
411
Q

What are the 5-8 radiographic features of Osteoblastoma?

A
  • Hands and feet 15%
  • Skull and Jaw 15%
  • Pelvis 5%
  • Expansile, lytic circumscribed lesion
  • Reactive sclerosis 60%
412
Q

Last radiologic features of Osteoblastoma:

A
  • CAN rapidly increase in size
  • Secondary aneurysmal bone cyst (ABC): 16% can look exactly the same
  • NECT: Expansile, lytic lesion with or without matrix mineralization
    • Can be purely radiolucent inside, speckled (inside matrix), or sclerotic looking

KEY IS EXPANSION

413
Q

MALIGNANT PRIMARY BONE TUMORS:

A

Osteosarcoma, aka Osteogenic Osteosarcoma

414
Q

What is the main definition of Osteosarcoma?

A

Malignant tumor with ability to produce osteoid directly from neoplastic cells

415
Q

Talk about the growth rate of Osteosarcoma:

A

Frequency of tumor occurence corresponds to greatest growth rate during adolescence

416
Q

What is chemically happening in osteosarcoma?

A

Overexpression of P-glycogen in OGS cells with propensity for metastasis and rx failure

alteration in Rb genes in OGS

417
Q

Think of osteosarcoma as ____

A

osteoblastic malignant tumor

418
Q

Periosteal reaction of osteosarcoma =

A

Spiculated

419
Q

2nd primary bone tumor is ____

A

Osteosarcoma (MOCEF)

420
Q

When does osteosarcoma peak?

A

teens

421
Q

Where is the most common location for osteosarcoma?

A

Distal femoral metaphysis

422
Q

Osteosarcomatosis survival:

A

Change low

423
Q

Where will osteosarcoma metastasize to?

A

LUNG

424
Q

Osteosarcoma has a majority of unknown origin, primary, but secondary to predisposing factors are:

A
  • Paget’s Disease (4th stage)
  • Bone infarction
  • Radiation
425
Q

What is the most common malignant primary bone tumor in young adults and children?

A

Osteosarcoma

426
Q
A

6 SKEL B (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions