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OSTEO Flashcards

1
Q

What is hyperparathyroidism?

A

PTH strong osteo clastic hormone

Overactive PTGland

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2
Q

Primary hyperparathyroidism

A

Parathyroid gland adenoma

Increase Ca

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3
Q

Secondary hyperparathyroidism

A

Chronic renal/kidney disease
Hemodialysis
Renal osteodystrophy
Decreased Ca

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4
Q

Tertiary HPT

A

Dialysis patients
Parathyroid gland acts independent of serum calcium levels
Increased or normal Ca

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5
Q

HPT is most common in who?

A

Females

30-50

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6
Q

What is seen in patients with HPT?

A

Pain, fractures, weakness, lethargy, polydispia/uria
Hypercalcemia leads to muscle weakness, hypotonia
Renal stones, pancreatitis
Hypercalcemia more common in primary, normal to low in sec and tert
elevated alkaline phosphatase and PTH

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7
Q

Radiology of HPT

A 
Osteopenia
Subperiosteal resorption
Accentuated trabeculation 
Brown tumors (cystic accumulations of fibrous tissue)
Loss of cortical definition
Soft tissue calcification
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8
Q

Subperiosteal resorption

A

Most definitive radiographic sign of HPT

Especially at the radial margins, middle and proximal phalanges of the 2nd and 3rd digits

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9
Q

Subperiosteal resorption appearance

A

Outer cortical erosion looks frayed or lace like

Widened joint space and osteo lysis in AC and SI joints

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10
Q

What does HPT look like in the axial skeleton?

A

Osteosclerosis (rugged jersey spine)
Subperiosteum resorption at AC or SI joints
Salt and pepper skull

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11
Q

Subchondral resorption in HPT in SI joints does what?

A

Makes the joint wider. Most likely AS if that’s all you see, but if sero neg…consider others like HPT.

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12
Q

What is a brown tumor?

A

Feature of HPT
Lyric lesion containing osteoclasts and mononuclear cells and fibroblasts with focal hemorrhages.
Hemosiderin from hemorrhage causes browning
Central and expansive
AKA osteoclastoma

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13
Q

If you have a hole with a salt and pepper skull, what is it Most likely?

A

A brown tumor in HPT

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14
Q

What is Renal osteodystrophy?

A

None disorder occurring when kidneys fail to maintain proper Ca and phosphorus levels in blood.
Affects patients on dialysis.
HPT (secondary or tertiary)

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15
Q

What should you assume with a patient that has a history of kidney disease?

A

Secondary or tertiary HPT

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16
Q

Secondary may appear similar to what?

A

Osteoporosis

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17
Q

Patient on dialysis…

A

Assume secondary or tertiary HPT

Renal osteodystrophy

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18
Q

HPT absorbs what in the teeth?

A

Lamina dura

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19
Q

Vessel calcification in the ankle is most likely diabetes, but may also be_______________.

A

HPT(secondary or PRIMARY, most likely secondary)

Hx for kidney problems or treatments (dialysis)

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20
Q

Vascular calcification in hands with subperiosteal resorption?

A

HPT

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21
Q

Anterior Pituitary function

A 
GH
ACTH
TSH
follicle stim hormone/ LH
Prolactin
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22
Q

Posterior pituitary function

A

ADH

Oxytocin

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23
Q

Pituitary tumors account for what?

A

10% of all neoplasms within the cranium.

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24
Q

What types of systemic bone diseases are there?

A

Metabolic
Nutritional
Endocrine

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25
Q

People with systemic bone diseases will have what finding that other imaging pathologies have?

A

Cat bites

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26
Q

How does bone metabolism work?

A 
Hormones and nutrients stimulate bone production like:
GH
TH
Calcitonin
Vit D
Vit C
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27
Q

What hormones inhibit bone production/metabolism?

A

Parathyroid Hormone

Cortisol

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28
Q

What is Osteopenia?

A

All encompassing definition for increase Radiolucency of bone.
Vague.

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29
Q

What is the most common etiology for seeing osteopenia?

A

Osteoporosis.

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30
Q

What are other causes of osteopenia?

A

Osteomalacia/rickets- Vit D deficiency
HPT
Scurvy- Vit C deficiency
Neoplasms

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31
Q

What should you do when you find osteopenia on an image?

A

Search for additional and more specific abnormalities:
Osteomalacia-linear radiolucencies (looser’s lines)
HPT - subperiosteal and subchondral resorption
Neoplasms- plasma cell myeloma producing focal lesions

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32
Q

What is osteoporosis?

A

Qualitatively normal but quantitatively deficient bone.
Generalized
Regional
Localized
Osteopenia + typical clinical and histological features=osteoporosis

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33
Q

What type of patients will you see with osteoporosis?

A

35 yrs and older
Females progress more rapidly from hormonal deprivation leading to osteoclastic activity.
Reduction of skeletal muscle. 5th/6th decade for females, 6th/7th decade for men

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34
Q

What thoracic spine characteristics will you see in patients with osteoporosis?

A

Compression fractures, leading to thoracic kyphosis.

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35
Q

What other fractures might you see with osteoporosis?

A

Proximal femur (hip), ribs, humerus and radius

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36
Q

What is the rate of hip fractures for females with osteoporosis?

A

Chances double every 5 years after 60.

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37
Q

Are vertebral fractures common in osteoporosis?

A

Yes, 64% or 700,000/year in USA.

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38
Q

How many total fractures due to osteoporosis?

A

More than 1 million every year

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39
Q

What types of osteoporosis are there?

A

Primary and Secondary

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40
Q

What is primary osteoporosis?

A

Senile
Postmenopausal
Transient or regional

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41
Q

What is secondary osteoporosis?

A 
Corticosteroids
Malignancy
Infection
Arthritics
Disuse
RSD
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42
Q

What is generalized osteopenia?

A

Age-related, senile/postmenopausal

Endocrinopathy, acromegaly, HPT, Hypothyroidism, cushiness, pregnancy, heparin, alcoholism

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43
Q

What is the significance/prevalence of osteoporosis?

A

55% of population over 50
1 of 2 females experience insufficiency fx post-menopausal
10-20% mortality
2/3 will not return to pre-fracture state

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44
Q

How should you work with imaging and osteoporosis?

A

Get old films and compare
MRI
Bone scan
Lab work

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45
Q

Osteoporosis and modic types.

A

Old compression fractures show normal marrow signal intensity (white) increased T1 signal
New fractures or marrow replacement is dark…or decreased T1 signal.

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46
Q

Skeletal muscle reduction in females and males
Vs
Skeletal mass reduction in females and males

A

muscle reduction in females 5th/6th decades, men 6th/7th

Skeletal mass reduction in females 4th decade, 5th/6th in men.

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47
Q

Senile/post menopausal patients will experience what symptoms?

A

Pain from microfractures
Loss of height from compression fractures
Accentuated kyphosis

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48
Q

Risks for Osteoporosis

A 
Female
Older than 70
Caucasian or Asian
Early onset of menopause
Long postmenopausal interval
Inactivity
49
Q

MODIFIABLE RISKS of osteoporosis

A

Smoking, alcohol, caffeine
Excessive protein consumption
Lack of calcium
Lack of sun, Vit D synth

50
Q

Radiographic features of osteoporosis

A 
Osteopenia
Cortical thinning
Resorption of nonstress-bearing trabecular
Accentuated vertical struts
Altered vertebral shape
51
Q

Radiographic manifestations of osteoporosis

A

Increased Radiolucency, or washed out appearance
Altered trabecular pattern
Mal shaped vertebrae

52
Q

What are some examples of vertebral deformities in osteoporosis?

A 
Codfish deformity (biconcave)
Schmorl's nodes
Endplate infractions
Washed out Radiolucency
Cortical thinning
53
Q

How should you handle severe fractures of the spine?

A

CT if the compression exceeds 30% of the original body height or retropulsion is present or if neurologically compromised

54
Q

If you see posterior body convexity, what is that indicative of?

A

Bursting fracture, with possible fragments in foramen.

If there is no posterior body convexity, then compression fracture is likely

55
Q

What is a widened interpedicular distance indicative of?

A

Fracture of neural arch or posterior body

56
Q

Using the 3 1/3’s rule, what constitutes an unstable fracture?

A

Anything involving the middle columns.

57
Q

If you see demineralization, it is likely what?

A

Osteopenia or osteoporosis

58
Q

A pathological compression fracture is identified by what?

A

Decreased body height anteriorly and posteriorly

59
Q

What is a pathological fracture indicative of?

A

Osteoporosis
Lytic Mets
Multiple myeloma
Eosinophilia granule a (KIDS)

60
Q

What might you see in the thoracic cavity of someone with osteoporosis?

A

Washed out appearance of vertebrae, and a calcification of the AORTA. Increased kyphosis

61
Q

What does osteoporosis look like in an extremity?

A

Thinned vortices (pencil thin)
Endosperm scalloping (from inside to out)
Loss of the secondary trabecular
Risks of fractures

62
Q

What is wards triangle?

A

Primary compressive band (medial)
Secondary compressive band (lateral)
Primary tensile band

Form a triangle at the neck of femur

63
Q

Radiolucency of wards triangle is more prominent in what?

A

Osteoporosis

64
Q

In advanced osteoporosis, what part of the triangle is last to be involved?

A

The principle compressive component

65
Q

What will you see in the lab work of osteoporosis patients?

A

Normal, besides high hydroxyproline and urinary total pyridinoline

66
Q

How should you manage osteoporosis?

A

Diet and exercise

Sunlight and Vit D

67
Q

Holes are most likely due to what?

A

Lyric mets or multiple myeloma

68
Q

What will you see in pathological generalized osteoporosis/osteopenia?

A 
Plasma cell myeloma (multiple myeloma)
Metastisis
Anemia
Nutritional def.
Diabetes mellitus
Immunodeficiency
Chronic liver disease
69
Q

What is a multiple myeloma?

A

Proliferation of plasma cells producing IgG/IgA antibodies
MC in osteopenia
Patients too young for osteoporosis
Compression fractures/pathological fractures
Multiple lyric calvarial lesions (punched out lesions)
“Rain drop skull”

70
Q

What is a DEXA scan?

A

Dual Energy X-Ray Absorptiometry
Evaluates osteoporosis
Measures bone mineral density (BMD) and compares it to average BMD of young adults at peak BMD

71
Q

What to recommend to osteoporosis patients?

A

Stay active
Supplemental calcium, protein, Vit C
No smoking/drinking
Strongly consider taking estrogen supplements after menopause

72
Q

What are the different types of regional osteoporosis?

A

Immobilization and disuse
Reflex sympathetic dystrophy syndrome
Transient regional osteoporosis

73
Q

What are the two kinds of transient regional osteoporosis?

A

Transient regional osteoporosis of the hip
And
Regional migratory osteoporosis (difficult to diagnose)

74
Q

What is disuse osteoporosis?

A

inhibits osteoclastic activity
Immobilized, paralysis, inflammatory joint disease
Extremity injury

75
Q

How can you identify disuse osteoporosis?

A

Diffuse osteopenia throughout disused body part
Lucent bands of osteopenia just proximal to physeal line
Subchondral lucency
Uniform or spotty demineralization

76
Q

What is reflex sympathetic dystrophy syndrome?

A 
Acute pain, regional osteoporosis following trivial trauma
Older than 50
Hands
Reflex hyperactive SNS 
Skin atrophy/ pigmentation abnormalities
AKA complex regional pain syndrome
77
Q

How to identify RSDS?

A 
Soft tissue swelling
Regional
Early mottle appearance
Aggressive/severe
Juxtaarticular
Spread and become bilateral/ patchy
78
Q

What may be different about RSD images?

A

Severe demineralization, but the joints are OKAY

79
Q

What is transient osteoporosis of the hip?

A 
20-40, may be associated with pregnancy
MC men
Bilateral in women
Periarticular osteoporosis
Decreased T1, increased T2
SELF LIMITING 3-12 months
80
Q

What is Osteomalacia?

A

Altered bone quality
Decreased calcium
High ratio of osteoid to mineralized bone

81
Q

What causes osteomalacia?

A

Vitamin D metabolism

Renal tubular phosphate loss (X-linked hypophosphatemia familial vitamin D resistant rickets)

82
Q

What is rickets?

A

Childhood osteomalacia

83
Q

Vit D in osteomalacia?

A

Vit D hydroxylated by liver
Forms 25 OH
Hydroxylated by kidney
Forms 1,25 OH 2D

Malnutrition, malabsorption, renal disease may alter this process

84
Q

Imaging of osteomalacia

A

Non specific
Osteopenia
Coarseness trabeculation
Looser zones

85
Q

What are looser lines?

A

Pseudo fractures in the femur that are commonly bilateral

Unmineralized osteoid

86
Q

Looser lines and shepherds deformity are seen in what pathology?

A

Osteomalacia

87
Q

What kind of disease is rickets?

A

Systemic disease of infants and children
Childhood osteomalacia
Rare in western world
Deficient Vit D or calcium phosphate

88
Q

What causes rickets?

A

Inadequate dietary Vit D, exposure to UV, malabsorption, chronic acidosis, renal tubular defects

89
Q

How do you treat rickets?

A

Vit D supplements and sunlight

90
Q

Symptoms of rickets?

A

Tetany, irritability, weakness, small stature, bone deformity, pain
Soft tissue swelling around growth plates (hypertrophied cartilage)
Calcium levels may be normal to low, elevated alkaline phosphatase

91
Q

How would you describe rickets?

A

Osteopenia
Widened, frayed metaphysis-epiphyseal plate junction
Lack of provisional zone of calcification
Return of the zone is a sign of healing (PAINTBRUSH METAPHYSIS)

92
Q

What is scurvy?

A

AKA Barlow’s disease
long term Vit C def.
Rare in western world
Infants 8-14 months with pasteurized or boiled milk.
Elderly affected when diets are compromised
Avitaminosis of at least 4 months

93
Q

What will you see in a patient with scurvy?

A

spontaneous hemorrhage of capillaries
Bleeding gums, hematuria
Joint swellings, irritability, pain, lie in FROG LEG POSITION

94
Q

Vit C and scurvy

A

Vit C is essential to form collagen, osteoid, and endothelial linings.

95
Q

Imaging of scurvy

A

Osteopenia (thin cortex, loss of trabeculation)
Widened METAPHYSIS
Dense zone of provisional calcification
Beak like metaphyseal outgrowths (Perkins Spurs)
Trimmer fields zone-Radiolucency band directly under zone of provisional calcification
Radio dense sclerosis around epiphysis (WIMBERGER’s Sign)

96
Q

What is acromegaly and gigantism?

A

Pituitary adenoma secreting growth hormone
Prominent hands and feet
Excessive GH before growth centers close is gigantism…after growth centers close is acromegaly

97
Q

What is acromegaly?

A

Over secretion of GH from pituitary adenoma after Growth centers close. Results in proliferation of connective tissues: Bone, cartilage, skin, organs.

98
Q

What features are prominent in acromegaly?

A

Thickening of palms and soles
Enlarged jaw, hands, feet, head
Spreading teeth
Loss of menstrual function

99
Q

Radiographic features of acromegaly

A

spade-like distal tufts
Hooking osteophytes
Increased joint spaces
Widened shaft

100
Q

What is CATBITES?

A 
Congenital
Arthritis
Trauma
Blood
Infection 
Time or
Endocrine, nutritional, metabolic
Soft tissue
101
Q

What is Cleidocranial dysplasia?

A

A defect of intramembranous bone growth
Defects in skull, clavicle and mid line
Pubic diastasis
Generalized dysplasia, below avg height, large head, drooping shoulders

102
Q

What does the skull look like in Cleidocranial dysplasia?

A

Inverted pear
Wormian (intrasuture) bones
Hypo or aplasia of the clavicle

103
Q

What are mid line defects in Cleidocranial dysplasia?

A

Spinal bifida type

104
Q

What is pubic diastasis in Cleidocranial dysplasia?

A

Wide pubic symphysis, due to lack of ossification

105
Q

What is the diagnosis is for a patient with no clavicles or hypoplasia of clavicles?

A

Cleidocranial dysplasia

May have Wormian bones, pear shaped skull

106
Q

What is Marfan’s syndrome?

A

Collagen disorder that fails to produce normal collagen

Connective tissue disorder

107
Q

What will you find on Marfan’s syndrome radiographs?

A

Scoliosis, acetabular protrusion, pectus excavating

108
Q

What are clinical features of Marfan’s syndrome?

A

Tall stature, arachnodactyly, heart valve defects, aortic aneurysm, lens dislocation

109
Q

What simple tests can be done to confirm Marfan’s syndrome?

A

Thumb test

Wrist test

110
Q

What is a vascular condition Marfan’s syndrome patients are at risk of?

A

Aortic aneurysm

111
Q

What is pectus excavatum?

A

Seen in Marfan’s syndrome
Funnel chest
Posterior displaced/curved sternum..pushes heart to the left

112
Q

What is osteogenesis imperfecta?

A

Inherited disorder marked by abnormal type I collagen formation.
Ranges from mild osteopenia to dwarfism to multiple fractures.

113
Q

What are the 4 major clinical criteria of osteogenesis imperfecta?

A

Skeletal fragility
Blue sclera
Abnormal dentition
Premature otosclerosis

114
Q

What can osteogenesis imperfect often be confused with?

A

Child abuse…look for 4 major criteria

115
Q

What does osteogenesis imperfecta look like on film?

A

Osteopenia, bowed long bones, thin corticies, multiple fractures with healing deformities, kyphoscoliosis

116
Q

Clinical features of osteogenesis imperfecta?

A

Lethal at birth
Confused with child abuse
Treatment is directed at limiting deformity and injury.
Zebra stripes on bone due to bisphosphonate therapy

117
Q

What is Osteopetrosis?

A

Group of entities, representing a type of sclerosing bone disease
Hereditary and familial
Abnormality of decreased osteoclastic activity

118
Q

What does Osteopetrosis look like on film?

A 
Loss of medullary space
Pathological fractures
Dense, fragile, thin cortices
BONE WITHIN A BONE* or ends one
SANDWICH VERTEBRAE*(vertebrae inside a vertebrae)******
Erlenmeyer flask deformity*
119
Q

What is osteopetrosis sometimes called?

A

Marble bone

Brittle bone disease

osteo (1 decks)

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