MSP Lab Midterm Review Flashcards
Which of the following does NOT occur during the inflammatory phase of fracture repair?
A) vessel rupture
B) bone necrosis in area of fracture
C) periosteal tearing
D) neovascularization between fractured bone ends
E) initial cartilage deposition at site of fracture
Neovascularization between fractured bone ends (occurs during reparative phase)
Which of the following levels of blood calcium would indicate hyperparathyroidism?
A) 12.6 mg/dL
B) 8.7 mg/dL
C) 10.4 mg/dL
D) 8.0 mg/dL
12.6 mg/dL
(normal = 8.6 - 10.6)
What lab findings would be elevated in hyperparathyroidism?
Calcium
PTH
What findings might you see on a radiograph of Rickets?
- paintbrush sign (widened metaphysis/growth plate)
- bowing of legs
- pathologic fractures/pseudofractures due to loss of inorganic component of bone
Which of the following is true of Osteomalacia?
A) increased organic component
B) increased inorganic component
C) decreased organic component
D) ratio of organic to inorganic components does not change
increased organic component (+ decreased inorganic)
A 55 year old patient has hypocalcemia. Name 2 conditions this could be caused by.
- secondary hyperparathyroidism
- hypoparathyroidism
- osteomalacia/rickets (vit D deficiency)
- pseudohypoparathyroidism
Which of the following is a potential sequela of osteopetrosis? (see pic)
A) anemia
B) primary hyperparathyroidism
C) osteomyelitis
D) pseudoparalysis of parrot
E) genu varum
anemia
Which of the following describes the pathogenesis of achondroplasia?
A) decreased chondrocyte proliferation
B) hypofunctioning osteoblasts
C) hyperfunctioning osteoclasts
D) vitamin D deficiency
E) pituitary adenoma
decreased chondrocyte proliferation and growth
Periosteal lifting creates a(n) ____ appearance on a radiograph
A) radiolucent
B) osteolytic
C) radiopaque
D) osteopenic
radiopaque
Metabolic ____ helps to retain bone density in both males and females
estrogen
Which of the following is characteristic of Scurvy on a radiograph?
A) subperiosteal bacterial infection
B) subperiosteal hemorrhage
C) vitamin D deficient bowing
D) inability to form marrow cavity
E) pathological fracture
subperiosteal hemorrhage
A patient presents with signs and symptoms of hypercalcemia. What is the term used to describe the relatively large, focal radiolucent lesion found on a radiograph?
brown tumor
What metabolic pathology causes bowing of bones?
Rickets (occurs before growth plates close)
What diagnostic lab findings would be elevated in a patient with hypervitaminosis D?
- Blood Calcium
- Urinary Calcium
Which symptom of Marfan’s syndrome can cause life-threatening complications?
A) vessel fragility
B) scoliosis
C) ocular lens detachment
D) joint dislocation
vessel fragility (increased risk of aneurysm)
Which of the following could cause acromegaly?
A) growth hormone supplementation
B) pineal adenoma
C) hyperparathyroidism
D) increased caffeine consumption
E) mutation of DBN1 gene
GH supplementation (or hypersecretion)
What is the treatment for osteopetrosis?
A) vitamin D supplementation
B) alkaline phosphatase supplementation
C) biophosphonates
D) vitamin C supplementation
vitamin D supplementation
(Active form Vit D increases expression of RANKL which binds RANK receptors on osteoclasts: ^osteoclastic activity which ^Ca2+ resorption from bone)
What radiographic finding creates the appearance of anterior bowing of the tibia due to reactive bone formation and thickening of the cortex?
sabre shin
What is the etiology of achondroplasia?
mutation of FGFR3 gene
What are the radiographic characteristic of achondroplasia? (see pic)
- wavy cortical lines
- champagne glass pelvis
- shortened bones
- spinal stenosis
- hyperlordosis
A soccer player fractures their clavicle and does not immobilize it properly during healing. After 6 months their clavicle is more mobile than usual. What term might describe this bony abnormality?
pseudoarthrosis
What cellular events are responsible for the “hazy cloud” appearance on a radiograph? (see pic)
osteoblasts lay down procallus
(conversion of procallus to bony callus appears as hazy cloud)
During the remodeling phase of fracture repair, the ____ around a fracture is being remodeled to conform to the bone’s use as stated in Wolf’s law.
callus
An open fracture is in the ____ stage of repair. (see pic)
inflammatory
The type of fracture that results in 2 or less bone fragments is called ____. (see pic)
non-comminuted
A patient reports tenderness in their wrist after falling on an outstretched hand. Immediate radiographic imaging reveals no obvious fractures.
What do you suspect? Where does this occur most commonly?
- occult fracture
- scaphoid, ribs
What happens to blood calcium levels in patients with vitamin D toxicity?
increase
What change in ESR would you expect to find with osteomyelitis?
increased ESR
What change in PTH would you expect to find with vitamin D toxicity?
decreased PTH
What is the cause of osteonecrosis?
ischemia
(swelling blocks BVs)
What is a Gibbous deformity? (see pic; name the deformity)
sharply angled kyphosis in t/s due to vertebral collapse
The reactive bone formation that forms around a sequestrum is called ____
involucrum
What part of the spine is destroyed by Tuberculosis?
vertebral bodies - IVDs are spared! (Favors TL region)
(collapse creates Gibbous deformity)
What term describes a radiolucent (lytic) lesion with a sclerotic border? (see pic)
Brodie abscess
What condition presents with sabre shin? (see pic)
congenital syphilis
Why does congenital syphilis have the appearance of anterior bowing of the legs?
periostitis & reactive bone formation
What is the range for normal phosphate levels?
2.5 - 4.5 mg/dL
What are the effects of PTH on the kidney?
- ^calcitriol
- conserve Ca2+
- ^excretion of phosphate
What radiographic feature differentiates congenital syphilis from rickets?
- bowing of limbs = rickets
- sabre shin (illusion of bowing) = syphilis
Are bone deformations that occur due to rickets reversible?
NO
Explain why vitamin D deficiency causes rickets. (see pic)
- vit D builds bone and maintains healthy Ca2+ levels through increase in calcitriol & calbindin
- low Ca2+ and phosphate levels = impaired bone mineralization (more osteoid)
Referring to an image of reddish/brown areas on an infant skull, what is indicated by this discoloration, and what condition could cause this? (see pic)
- Subperiosteal bleed/hemorrhage due to vessel fragility
- collagen synthesis disorder (eg. Scurvy, Marfans)
What would you expect phosphate levels to be in a patient with hypoparathyroidism?
normal
On their most recent visit to your office, you notice that a patient has calcific deposits in the soft tissue of their arm and hyporeflexia. They also report being lethargic and experiencing weight loss despite not changing their diet. You re-examine your patient’s chart and notice they reported a history of kidney stones. What pathology best fits this profile? (see pic)
primary hyperparathyroidism
what is the term for an elongated mandible (leading to an underbite) as a result of growth hormone supplementation?
Prognathism
A 30 year old patient presents with prognathism and increased soft tissue density, which could be caused by supplementation of ____
GH
What is the most significant finding for osteoporosis?
DEXA T-score of -2.5 or lower
(eg. T-score of -3.5 indicates osteoporosis)
What are the radiographic findings of Marfan syndrome?
- thin, long bones
- low soft tissue density
- scoliosis
What are the major concerns for Marfan syndrome? (see pic)
- vessel fragility
- mitral valve prolapse
What cells are not functioning in osteopetrosis?
osteoclasts
In what stage of fracture repair does Wolf’s law apply?
remodeling
Increased organic to inorganic ratio would create what property of bone?
plasticity
What term would describe a DEXA score of -1.5?
osteopenia
What are the diagnostic lab results of secondary hyperparathyroidism?
- hypocalcemia
- ^PTH
- ^phosphate
What is the biggest difference between secondary hyperparathyroidism and pseudohypoparathyroidism?
secondary HPT due to renal disease
Compressive forces during the remodeling stage of fracture repair results in increased ____ activity
osteoblastic
What are the diagnostic lab results of primary hyperparathyroidism?
- ^Ca2+
- ^PTH
- decreased phosphate
What happens to urinary calcium levels in patients with hypervitaminosis D?
very high
Why might a patient with tuberculosis in the spine have neurological symptoms?
spinal deformity/infection can block spinal nerves and/or compress spinal cord
In what stage of fracture repair would you see a “hazy cloud” appearance on a radiograph?
reparative
What 2 conditions would have hypercalcemia?
Hypervitaminosis D
Primary HPT
What 2 conditions would have decreased parathyroid hormone?
Hypervitaminosis D
Hypoparathyroidism
What 2 conditions have elevated phosphate?
Secondary HPT
Pseudohypoparathyroidism (high end of normal)
What 2 conditions have elevated urinary calcium?
Hypervitaminosis D
Primary HPT (late stage due to kidney damage)
