Musculoskeletal II (metabolic bone disease)

Question 1

complete:
____ means increased bone density where ____ means decreased bone density

Answer 1

1. osteosclerosis
2. osteoporosis

Question 2

definition of Osteoporosis

Answer 2

Osteoporosis is a metabolic bone disease characterized by decreased bone mass and skeletal fragility

Question 3

Risk factors of Osteoporosis

Answer 3

Sex (females have higher risk)
Age (older adults have higher risk)
Body mass index (lower body mass carries higher risk)
Smoking
Alcohol consumption
Ever long term use of oral glucocorticoids
Rheumatoid arthritis

Question 4

causes of Osteoporosis

Answer 4

1. idiopathic
2. juvinile
3. senile
4. menopausal
5. cushing’s syndrome
6. steroid therapy

hint = idiopathic, 3 ages, 2 cortisole

Question 5

radiological finding of Osteoporosis

by plain X-ray [5]

Answer 5

1. Thinned cortex
2. less trabeculae
3. endosteal resorption
4. pencilling
5. osteoporotic biconcave fracture

the last two in vertebrae only

Question 6

how to measure the Osteoporosis

Answer 6

1. corticomedullary index (CMI) in the metacarbal
2. DXA scan (Dual energy X ray Absorptiometry)
3. Singh index (grade 6 normal to 1 severe) in the femur

normal CMI 25 - 33 %

Question 7

The diagnosis of osteoporosis/osteopaenia is made on the basis of:
1. plain x ray
OR
2. CT appearances

Answer 7

Neither X-rays nor CT scans.

if the bones appear to be low in density, then the diagnosis can be suspected.

Question 8

different between Rickets
and osteomalcia

Answer 8

in young –> Rickets
in adults –> osteomalcia

before or after epiphyseal closure

Question 9

causes of Rickets
and osteomalcia

Answer 9

Decreased production of endogenous vitamin D

Question 10

hmmm ..what are the causes of “Decreased production of endogenous vitamin D”

Answer 10

malnutrition
malabsorption
mal-reabsorption
mal-synthesis

*the last two are not scientific, i mean renal faliure and decrease sun exposure *

Question 11

special sign in Osteomalacia

Answer 11

pseudo fracture (weak zone)

Question 12

radiological signs of Rickets (in the wrist)

Answer 12

Fraying = Indistinct margins of the metaphysis
Splaying =Widening of metaphyseal ends.
Cupping = Concavity of metaphysis

Question 13

causes of osteosclerosis

Answer 13

1. hyperparathyroidism
2. paget disease
3. metastasis

Question 14

signs of osteosclerosis due to hyperparathyroidism

Answer 14

1. sub-peri-osteal bone resorption in the radial side (in the hand)
2. brown tumor (in the manduble & pelvis)
3. Rugger Jersy Spine

Question 15

whay it’s called Rugger Jersy Spine

Answer 15

https://i0.wp.com/radrounds.com/wp-content/uploads/2020/07/Picture1.jpg?w=710&ssl=1

نوع قمصان لرياضة
rugby 🏉

لو انا سميته لسميته zebra spine 😂 🦓

Question 16

signs of osteosclerosis due to paget disease

Answer 16

paget tride
1. bone expansion
2. cortical thickning
3. trabeculation bone thickning

Question 17

The radiologist can’t give the diagnosis by CT and X-ray only but at least can say benign or malignant, isn’t right?

Answer 17

no .. even that they can’t.

for most likely benign say (non agressive lesion)
and for most likely malignant say (agressive lesion)

Question 18

radiological signs of aggressive / nonaggressive bone lesion [4]

Answer 18

1. wide zone of transition
2. ballooning lesion
3. periosteal reaction (soild, lamillated, spiculated, codman’s/sunburst)
4. soft tissue swelling

Question 19

the most common tumor in the Phalanges

Answer 19

enchondroma

Question 20

differnt between ABC and GCT

Answer 20

ABC
- young
- upper tibia
- metaphysial
- expansile

GCT
- adult
- lower femur
- epiphysial

ABC = aneurysmal bone cyst, GCT = giant cell tumor

Question 21

differnt between OO and NOF

Answer 21

OO
- diaphysial
- small, round with sclerotic margin
- painful needs (NSAIDs)

NOF
- metaphysial
- bubbly lytic lesion with sclerotic rim
- asymptomatic and resolve spontaneously

OO = ostioid ostioma, NOF = non ostioid fibroma

Question 22

differnt between metastasis and TB

Answer 22

metastasis
- destruction of vertebral body and posterior element (pedical destruction)

TB
- abscess & calcification
- destruction of intervertebral disc and vertebral plate

Question 23

most common type of bone tumors (1ry or 2ry)

Answer 23

2ry (70%)
coms from:
1. mainly from prostate/ breast
2. lung
3. liver
4. kidney
5. thyroid

Question 24

types of secondary bone tumor

Answer 24

1. sclerotic
2. lytic

multiple (mainly) or solitary

Question 25

most common cause of mutiple lytic bone lesion

especially in skull

Answer 25

multiple myeloma