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CORE > MSK Diffuse Bone Dz > Flashcards

MSK Diffuse Bone Dz Flashcards

1
Q

osteoporosis –> Tscore?

A

< -2.5

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2
Q

what is Zscore?

A

SD from age-matched F

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3
Q

osteoporosis –> vit/nutrient def etiology? (4)

A
  • osteomalacia
  • alcohol
  • hypoPh
  • scurvy
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4
Q

osteoporosis –> endocrine etiology? (2)

A
  • hyperPTH

- Cushing dz

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5
Q

focal osteoporosis –> etiology? (3)

A
  • disuse
  • reflex sympathetic dystrophy
  • transient regional osteoporosis of hip
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6
Q

what is Pelkin’s fx?

A

metaphyseal corner fx

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7
Q

osteoporosis –> genetic etiology? (3)

A
  • OI
  • Gaucher dz
  • anemia
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8
Q

scurvy –> signs? (2)

A
  • Wimberger ring sign

- Pelkin’s fx

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9
Q

what is Pelkin’s fx?

A

metaphyseal corner fx

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10
Q

what is osteomalacia?

A

vitD def –> faulty mineralization of bone matrix

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11
Q

what is Looser zone? highly specific for what condition?

A

osteomalacia –> cortical stress fx –> fill w abnormal, poorly mineralized osteoid –> radiolucent line thru cortex

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12
Q

Looser zone –> MC location? (3)

A
  • prox femur –> media
  • distal scapula
  • pubic bone
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13
Q

acromegaly –> foot –> charact finding? measuremt?

A

heel-pad thick >24mm

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14
Q

what is 1ary hyperPTH?

  • Ca level?
  • Ph?
A

PTH adenoma –> high PTH

  • high Ca
  • low Ph
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15
Q

what is 2ary hyperPTH?

  • Ca level?
A

renal fail –> low Ca –> inc PTH

  • Ca level normal
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16
Q

what is 3ary hyperPTH?

A

chronic 2ary hyperPTH –> PTH gland lose ctrl –>

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17
Q

hyperPTH –> hands –> subperiosteal resorb –> MC location?

A

2nd & 3rd middle phalanx –> radial aspect

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18
Q

hyperPTH –> clavicle –> subperiosteal resorb –> MC location?

A

acromial aspect

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19
Q

hyperPTH –> knee –> subperiosteal resorb –> MC location?

A

prox tib –> metaphysis –> medial

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20
Q

hyperPTH –> teeth –> subperiosteal resorb –> MC location?

A

lamina dura surrounding tooth socket

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21
Q

hyperPTH –> what other condition may occur? MC with 1ary/2ary/3ary hyperPTH?

A

1ary hyperPTH –> CPPD

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22
Q

hyperPTH –> ST calc, periosteal rxn, sclerosis –> MC with 1ary/2ary/3ary hyperPTH?

A

2ary

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23
Q

hyperPTH –> comp? (2)

A
  • insuff fx

- lig/tendon rupture

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24
Q

what is renal osteodystrophy?

A

chronic renal fail:

  • abn vit D metab –> osteomalacia
  • 2ary hyperPTH
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25
Q

renal failure –> risk for what bone disorders? (4)

A
  • renal osteodystrophy
  • osteomyelitis
  • avascular necrosis (if on steroid)
  • amyloidosis (chronic dialysis)
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26
Q

differentiate: osteomalacia vs renal osteodystrophy –> Looser zone

A

osteomalacia –> Looser zone

renal osteodystrophy –> Looser zone uncommon

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27
Q

peds –> hypothyroid –> imaging features? (2)

A
  • “bullet shape” vertebral body

- Wormian bones

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28
Q

peds –> hypothyroid –> RF for what condition?

A

SCFE

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29
Q

hypoPTH –> metastatic deposit of Ca –> MC locaiton? (2)

A
  • subQ tissue

- basal ganglia

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30
Q

what is pseudo-hypoPTH?

A

PTH receptor defect

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31
Q

what is pseudo pseudo-hypoPTH?

A

normal PTH, normal PTH receptor –> pseudo-hypoPTH phenotype

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32
Q

pseudo-hypoPTH / pseudo pseudo-hypoPTH –> synd? (4)

A
  • obese
  • round facies
  • short stature
  • brachydactyly
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33
Q

pseudo-hypoPTH / pseudo pseudo-hypoPTH –> classic XR finding?

A

1st/4th/5th –> short metacarpal

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34
Q

short 4th metacarpal –> ddx? (2)

A
  • pseudo-hypoPTH / pseudo pseudo-hypoPTH

- Turner synd

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35
Q

peds –> hyperthyroid –> MSK manifestation?

A

accel bone mature

36
Q

what is thyroid acropachy? clinical presentation? (3)

A

rare presentation of autoimmune thyroid disease (hyperthyroid, euthyroid, hypothyroid, or even post-treatment):

  • ST swell
  • finger clubbing
  • extremity –> diaphysis –> metacarpal/metatarsal/phalanx –> periosteal rxn
37
Q

Paget dz –> epidemiology?

A

old adult –> >80yo

38
Q

what is Paget dz?

A

unknown cause –> maybe paramyxovirus –> disturb osteoclastic & blastic regulation –> progressive

39
Q

Paget dz –> ssx? (4)

A
  • bone pain
  • osseous enlrg/bow
  • compress CN
  • high output heart fail
40
Q

Paget dz –> RF for what condition?

A

weak subchondral bone –> OA

41
Q

Paget dz –> MC locations? (3)

A
  • skull
  • spine
  • pelvis
42
Q

Paget dz –> 3 phases?

A
  • phase I: osteolytic
  • II: mixed lytic & sclerotic
  • III: sclerotic
43
Q

chronic Paget dz –> imaging appearance?

A

“caricature” of normal bone:

  • thick cortex
  • coarse irreg trabeculae
  • bone expand
44
Q

Paget –> phase I –> skull –> typical appearance?

A

“osteoporosis circumscripta” –> geographic lytic region –> sharp margin

45
Q

Paget –> phase II –> skull –> typical appearance?

A

“cotton wool”

46
Q

Paget –> phase II –> spine –> typical appearance? (2)

A
  • “picture frame” vertebra

- “ivory” vertebra

47
Q

Paget –> pelvis –> typical appearance?

A
  • asymm coarse thick trabecula

- thick iliopectineal/ilioischial line

48
Q

Paget –> pelvis –> potential comp?

A

acetabular protrusio

49
Q

Paget dz –> phase I –> long bone –> typical appearance?

A

osteolysis –> prox articular end –> to diaphysis –> sharp border –> “blade of grass”, “flame-shaped margin”

50
Q

Paget dz –> potential comp? (4)

A
  • path fx
  • malig degen –> osteosarcoma
  • 2ary giant cell tumor
  • 2ary OA
51
Q

what is hereditary hyperphosphatasia? (juvenile Paget)

A

AR –> infant-young child –> all bones –> cortex/trabecula thick, osteopenia, bowing –> severe deformity

52
Q

differentiate: hereditary hyperphosphatasia? (juvenile Paget) vs Paget dz –> imaging findings?

A

hereditary hyperphosphatasia? (juvenile Paget):

  • diffuse
  • spare articular ends

Paget:

  • can be multifocal, but not diffuse
  • involve articular ends
53
Q

what is osteopetrosis?

A

osteoclast –> carbonic anhydrase def –> unable to resorb bone

54
Q

osteopetrosis –> general imaging appearance?

A

entire skeleton –> diffuse marked sclerosis

55
Q

osteopetrosis –> potential comp?

A

extremely brittle bones –> mult fx

56
Q

osteopetrosis –> spine –> typical imaging appearance?

A

“sandwich”/”rugger jersey” vertebra

57
Q

what is Gaucher dz?

A

AR –> glucocerebrosidase def –> cerebroside deposit –> macrophage (Gaucher cell) –> bone infarct, medulla expand, hepatosplenomeg

58
Q

Gaucher dz –> long bone –> typical imaging appearance?

A

“Erlenmeyer flask” deformity

59
Q

Gaucher dz –> spine –> typical imaging appearance?

A

vertebra –> endplate avascular necrosis –> “H-shape”

60
Q

“H-shape”/”Lincoln log” vertebra –> ddx? (2) how to differentiate?

A
  • Gaucher dz –> splenomeg

- sickle cell –> spleen auto-infarct

61
Q

sickle cell –> osseous manifestations (3)

A
  • bone infarct
  • osteomyelitis
  • marrow expand/hyperplasia
62
Q

sickle cell –> bone infarct –> MC location? (2)

A
  • femoral head

- long bone –> meta/dia-physis

63
Q

what is sickle cell dactylitis (hand-foot synd)?

A

very young child –> hand/feet –> digits –> persistent hematopoietic marrow –> cold temp –> microvasc occlusion

64
Q

sickle cell dactylitis (hand-foot synd) –> imaging appearance?

A
  • ST swell

- periosteal rxn

65
Q

marrow expansion –> ddx? (2)

A
  • thalassemia

- sickle cell

66
Q

red marrow reconversion –> MRI appearance?

A

T1 low signal

67
Q

sickle cell –> marrow expansion –> long bone –> natural progression?

A

red cell production –> chronic stim –> medulla wide, trabecula coarse –> osteopenia –> insuff fx

68
Q

red marrow reconversion –> skull –> imaging appearance?

A
  • “hair on end” striation

- wide medulla

69
Q

differentiate –> sickle cell vs thalassemia –> red marrow reconversion –> location?

A

thalassemia –> more common…:

  • facial bone
  • extramedullary hematopoiesis
70
Q

differentiate –> sickle cell vs thalassemia –> degree of red marrow reconversion?

A

thalassemia –> more severe

71
Q

thalassemia –> osseous hallmarks? (3)

A
  • bone infarct
  • marrow expansion
  • osteomyelitis
72
Q

thalassemia –> marrow expansion –> hand –> imaging appearance?

A

metacarpal & phalanx –> wide & square

73
Q

thalassemia –> marrow expansion –> face –> imaging appearance?

A

marrow expansion –> obliterate paranasal sinuses –> “rodent” facies

74
Q

long bone –> Erlenmeyer flask deformity –> ddx? (3)

A
  • Gaucher
  • thalassemia
  • sickle cell
75
Q

what is myelofibrosis?

A

progressive fibrosis of BM –> anemia –> splenomeg

76
Q

myelofibrosis –> epidemiology?

A

older

77
Q

myelofibrosis –> osseous appearance?

A

BM fibrosis –> diffuse sclerosis of bones

78
Q

what is mastocytosis?

A

mast cells –> abn prolif

79
Q

mastocytosis –> osseous appearance?

A

mast cells –> infiltrate BM:

  • diffuse osteopenia
  • diffuse sclerosis
80
Q

bones –> diffuse sclerosis –> ddx? (9)

A
  • renal osteodystrophy
  • sickle cell
  • myelofibrosis
  • diffuse osteoblastic mets
  • osteopetrosis
  • pyknodysostosis
  • mastocytosis
  • fluorosis
  • athlete (normal variant)
81
Q

what is pyknodysostosis (osteopetrosis acro-osteolytica, Toulouse-Lautrec syndrome)?

A

AR –> bone dysplasia –> osteosclerosis & short stature

82
Q

ivory vertebral body –> ddx? (3)

A
  • osteoblastic mets
  • Paget dz
  • lymphoma
83
Q

reflex sympathetic dystrophy –> bone scan findings?

A

inc uptake in all 3 phases –> inc. intra-articular

84
Q

shoulder XR –> look like unilat RA, but preserved jt space –> ddx? (1)

A

reflex sympathetic dystrophy

85
Q

marrow conversion –> order?

A

Extremities –> axial skeleton

1) epiphysis/apophysis
2) diaphysis
3) distal metaphysis
4) prox metaphysis

86
Q

marrow re-conversion –> order?

A

1) spine
2) flat bones
3) metaphysis
4) diaphysis
5) epiphysis

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