Radiology

Question 1

key characteristics of xray- osteoporosis

Answer 1

-dec cortical thickening

Question 2

key characteristics of xray- osteopetrosis

Answer 2

-diffuse, dense bone

Question 3

key characteristics of xray- paget’s

Answer 3

-thickening of calvarium

Question 4

key characteristics of xray- osteonecrosis

Answer 4

• xray- irregular lucencies w adj sclerosis

- MRI- dark serpiginous necrotic bone

Question 5

key characteristics of xray- ankylosing spondylitis

Answer 5

-bamboo spine

Question 6

key characteristics of xray- giant cell tumor

Answer 6

-soap bubble appearance

Question 7

key characteristics of xray- osteochondroma

Answer 7

exostosis of bone

Question 8

key characteristics of xray- osteosarcoma

Answer 8

• sunburst pattern

- codman triangle around metaphysis of long bones

Question 9

key characteristics of xray- ewing sarcoma

Answer 9

-onion skin around diaphysis of long bone

Question 10

diaphysis lesions

Answer 10

• ewing sarcoma
• myeloma
• osteoid osteoma

Question 11

metaphysis lesions

Answer 11

• osteosarcoma

- osteochondroma

Question 12

epiphysis lesions

Answer 12

-giant cell tumor

Question 13

Rheumatoid arthritis

Answer 13

• pannus- MCP and PIP
• subcutaneous nodules
• radial deviation of wrist, ulnar dev of fingers
• boutenaries, swan neck
• autoimmune- symmetrical
• morning stiffness, improves w use

Question 14

Osteoarthritis

Answer 14

• mechanical- unilateral
• subchondral cysts, oteophytes- Heberden nodes (DIP), bouchard nodes (PIP)
• pain in weight bearing joints and after use

Question 15

osteoporosis- radiology

Answer 15

• kyphosis
• osteopenia
• compression fractures
• anterior wedging (codfish deformity)

Question 16

osteopetrosis- pathology

Answer 16

osteoclast dysfxn- thickened bone, prone to fractures

• bone fills marrow spaces- pancytopenia, extramedullary hematopoiessis
• carbonic anhydrase mutations

Question 17

Paget dz- pathology

Answer 17

• inc bone resorption; new bone formation- abnormal, woven
• bone enlargement and deformity
• risk of osteosarcoma!!

Question 18

Paget dz- clinical manifestations

Answer 18

• > 50 yo

- asx usually- inc hat size, inc output HF, osteosarcoma, bowed tibia and deafness

Question 19

Paget dz- markers, radiology

Answer 19

• inc serum alk phos
• skull- diploic thickening of inner and outer calvarium, cotton wool appearance (mixed lytic and sclerotic lesions), frontal bone enlargment
• long bones- bowing of femur, ant curve of tibia, mosaic pattern of woven and lamellar bone

Question 20

Osteonecrosis- pathology

Answer 20

• infarction of bone and marrow
• fractures or corticosteroid admin
• most common site- femoral head (medial circumflex femoral a)

Question 21

osteonecrosis- radiography, MRI

Answer 21

• micro fractures accum in dead bone- crescent sign
• MRI- dbl line sign; osteochondral fragmentation; dark serpiginous necrotic bone
• rim sign- fluid b/w sclerotic borders

Question 22

Ankylosing spondylitis- is what

Answer 22

• HLA-27

- chronic infl dz of spine and sacroiliac joints

Question 23

Ankylosing spondylitis- radiology

Answer 23

• vertebral fusion

- bamboo spine

Question 24

giant cell tumor (osteoclastoma)- who, what is it

Answer 24

• 20-40 yo
• distal femur, proximal tibia
• non-neoplastic osteoclasts
• arise in epiphysis
• arthritis-like dx’s, fractures

Question 25

giant cell tumor- radiograph

Answer 25

• soap-bubble appearance
• multinucleated giant cells
• narrow zone of transition

Question 26

osteochondroma- who, is what

Answer 26

• exostosis of bone
• rarely transforms into chondrosarcoma
• males < 25 yo
• endochrondral origin only- metaphysis near growth plate- esp knee!
• slow growing tumors

Question 27

osteochondroma- radiology

Answer 27

• cartilage-capped tumor attached to skeleton by bny stalk
• metaphyseal region
• pic is when malignant transformation

Question 28

osteosarcoma

Answer 28

• bimodal- 10-20 yo- metaphyseal areas of long bones

- >65 yo

Question 29

osteosarcoma- radiology

Answer 29

• large destructive, mixed lytic and blastic mass
• Codman triangle- triangular shadow b/w cortex and raised areas of periosteum
• Sunburst appearance- lesion grows too fast- Sharpey’s fibers!!

Question 30

Ewing sarcoma- is what

Answer 30

• malignant- primitive round cells
• t(11;22- fusion protein EWS-FLI1
• white boys < 15 yo
• diaphysis of long bones
• painful enlarging mass, warm, tender swollen

Question 31

Ewing sarcoma- radiograph

Answer 31

• destructive lytic tumor

- onion-skin!!