Nutritional, Metabolic and Endocrine Disorders

Question 1

What is the most common metabolic bone disorder described as a skeletal disease, characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture?

Answer 1

Osteoporosis

Question 2

After the age of 35, how much cortical bone is lost per year? Trabecular bone?

Answer 2

Cortical bone: 1% per year

Trabecular bone: 2% per year

Question 3

At menopause, how much does this loss accelerate? Lumbar spine?

Answer 3

10 fold
20 fold (6% per year)

Question 4

At what age does sex ratio or bone loss equalize between male:female?

Answer 4

80 years old

Question 5

How likely is someone to get a mid femur stress fracture for patients taking Bisphosphonates compared to untreated women?

Answer 5

50x

Question 6

What may Progressive angular kyphotic deformity within 1 year of spinal compression fracture result in?

Answer 6

Spinal Stenosis

Question 7

What is an effective and minimally invasive procedure in which acrylic bone cement is injected to stabilize and strengthen a collapsing vertebral body?

Answer 7

Vertebroplasty

Question 8

What percent of patients with osteoporotic compression fracture will experience another fracture within 1 year?

Answer 8

20%

Question 9

What uses a balloon dilatation of vertebral body, with subsequent instillation of polymethylmethacrylate?

Answer 9

Kyphoblasty

Question 10

What DEXA score is a comparison of a person’s bone density with that of a healthy 30-year-old of the same sex?

Answer 10

T-score

Question 11

What DEXA score is a comparison of a person’s bone density with that of an average person of the same age and sex?

Answer 11

Z-score

Question 12

What is a normal T-score?

Answer 12

> -1

Question 13

What T-score indicates osteoporosis?

Question 14

What is most commonly used to assess the strength of vertebrae in assessment of fracture risk?

Answer 14

Quantitative CT

Question 15

How much percent loss of bone mass is needed to indicate osteoporosis?

Answer 15

30-50%

Question 16

What are 2 Roentgen signs of osteoporosis?

Answer 16

cortical thinning

altered trabecular pattern

Question 17

What is the Vertebral body shape of osteoporosis?

Answer 17

Vertebra Plana (compression of anterior and posterior portions of vertebral body)

Question 18

What is a Loss of anterior vertebral body height called?

Answer 18

Wedge vertebra

Question 19

Where are wedge vertebra most commonly seen?

Answer 19

mid thoracic and TL junction

Question 20

What is a Hour-glass or fish vertebrae and is Due to pressure of nucleus pulposus upon weakened endplates?

Answer 20

Biconcave vertebra

Question 21

What do vertebra plana’s have inside the vertebral body?

Answer 21

GAS

Question 22

What presents with marked sacral tenderness on physical examination, and rami fractures present with pain in the low back, groin, or hip?

Answer 22

Sacral Insufficiency Fractures

Question 23

What is the characteristic sign of a Sacral Insufficiency Fracture?

Answer 23

H-pattern/Honda sign

Question 24

What 2 parts of the body does Reflex Sympathetic Dystrophy Syndrome (RSDS) (rapid progressive osteoporosis) usually affect?

Answer 24

hand and shoulder

Question 25

Who does Reflex Sympathetic Dystrophy Syndrome (RSDS) usually affect?

Answer 25

>50yo

Question 26

Which hip of females does Transient Osteoporosis of Hip typically affect?

Answer 26

Left hip

Question 27

What may Transient Osteoporosis of Hip be associated with?

Answer 27

pregnancy

Question 28

What age group does Transient Osteoporosis of Hip affect?

Answer 28

20-40 year olds

Question 29

When would you expect a full recovery from Transient Osteoporosis of Hip?

Answer 29

3-12 months

Question 30

What does Transient Osteoporosis of Hip affect?

Answer 30

Bone marrow edema in the femoral head and neck

Question 31

In regards to Immobilization Osteoporosis, what does immobilization do to osteoblastic activity?

Answer 31

inhibit

Question 32

In regards to Immobilization Osteoporosis, what does immobilization do to osteoclastic activity?

Answer 32

accelerate

Question 33

There are 4 patterns to Disuse Osteoporosis, which one has all bones involved have similar degree of bone loss and is the most common form?

Answer 33

Uniform

Question 34

There are 4 patterns to Disuse Osteoporosis, which one is localized circular lucencies predominate, especially in the epiphyseal regions?

Answer 34

Spotty

Question 35

There are 4 patterns to Disuse Osteoporosis, which one is linear transverse subchondral or metaphyseal Lucent zones?

Answer 35

Bands

Question 36

There are 4 patterns to Disuse Osteoporosis, which one is lamination or scalloping loss of definition in the outer and inner cortical margins?

Answer 36

Cortical

Question 37

What means soft bones and is also known as adult rickets and has a Lack of calcium deposited in osteoid?

Answer 37

Osteomalacia

Question 38

What are characteristic features of pseudofractures (looser lines) of Osteomalacia?

Answer 38

Fractures at right angles to cortex Uncalcified osteoid Bilateral and Symmetrical

Question 39

What minerals are deficient in rickets?

Answer 39

Vitamin D, calcium, or phosphate

Question 40

What kind of drugs can cause rickets?

Answer 40

anticonvulsant drugs (Dilantin)

Question 41

What age does rickets usually develop?

Answer 41

6-12 months old

Question 42

What are unmineralized osteoid along anterior rib cage for rickets known as?

Answer 42

Rachitic Rosary

Question 43

Do growth plates widen or narrow with rickets?

Answer 43

Widen

Question 44

How many months of vitamin C need to be administered before symptoms and skeletal changes occur with scurvy?

Answer 44

4 months

Question 45

What is a clinical hallmark of scurvy?

Answer 45

spontaneous hemorrhages from capillary fragility

Question 46

What are all the radiographic features of scurvy?

Answer 46

``` osteopenia white line of Frankel Wimberger's Ring Corner Sign Pelken's Spurs Trummerfield Zone Subperiosteal hemorrhage ```

Question 47

What is an accumulation of fibrous tissue produces localized cyst like destructive bone lesions that are brown in color?

Answer 47

Brown Tumors

Question 48

What is a brown tumor associated with?

Answer 48

Hyperparathyroidism

Question 49

What is the Pathologic Hallmark of Hyperparathyroidism?

Answer 49

Subperiosteal Bone Resorption

Question 50

What is a radiographic feature involving the skull with hyperparathyroidism?

Answer 50

Salt and Pepper Skull

Question 51

What is a radiographic feature involving the spine with hyperparathyroidism?

Answer 51

Rugger Jersey Spine

Question 52

What kind of arteries do Monckeberg medial calcific sclerosis affect?

Answer 52

medium-sized muscular arteries

Question 53

Is there vascular narrowing with Monckeberg medial calcific sclerosis?

Answer 53

No

Question 54

``` What is your diagnosis? These are the clinical findings: --Hepatosplenomegaly – Yellowing of skin – Dermatitis – Pruritis – Alopecia ```

Answer 54

Hypervitaminosis A

Question 55

What is a secretory Eosinophilic Adenoma of anterior pituitary gland produces intramembranous bone tissue growth, and subcutaneous tissue hypertrophy?

Answer 55

Acromegaly

Question 56

If the above occurs prior to closure of the growth plates, what is it called?

Answer 56

Gigantism

Question 57

What does the heel pad thickness have to be in order for it to be labeled as acromegaly?

Answer 57

>20mm

Question 58

What part of the bone does lead primarily affect?

Answer 58

Metaphysis

Question 59

Why does lead mostly affect the distal femur, both ends of the tibia, and distal radii in children?

Answer 59

they're the most rapidly growing bones

Question 60

What is the radiographic feature of lead poisoning?

Answer 60

dense metaphyseal bands