Systemic Bone Disease Flashcards
<p>What are the three catagorys of systemic bone disease?</p>
<p>Metabolic, Nutritional, Endocrine</p>
<p>What does CATBITES stand for?</p>
<p>Congenital ARthritis Trauma Blood Infection Tumor Endocrine Soft Tissue</p>
<p>What Homrones and nutrients stimulate bone production?</p>
<p>Growth Hormone Thyroid hormone (T3, T4) Calcitonin Vit. D Vit. C</p>
<p>What hormones inhibit bone production?</p>
<p>Parathyroid hormone
| Cortisol</p>
<p>What is the termfor an all encompassing definition for increased radiolucency of bone?</p>
<p>Osteopenia</p>
<p>What is the most common etiology of osteopenia?</p>
<p>osteoporosis</p>
<p>What are some other etiologies that can cause osteopenia?</p>
<p>osteomalacia hyperparathyroidism Rickets Scurvy Neoplasm</p>
<p>T/F the finding of radiolucent on a bone on an x-ray is an automatic diagnosis of osteoporisis?</p>
<p>False</p>
<p>When bone resorption exceeds bone formation it is known as what? </p>
<p>osteopenia</p>
<p>What is done once osteopenia is discovered?</p>
<p> a search is done for more specific abnormalities </p>
<p>osteomalacia reveals linear radiolucenies called?</p>
<p>Looser's lines</p>
<p>HPT can produce subperiosteal and subchondral resorption and is normally found by what health care professional?</p>
<p>Dentsits</p>
<p>neoplasms such as plasma cell myeloma produce \_\_\_\_\_\_\_\_\_</p>
<p>focal lesions</p>
<p>If there are reasons for decreased bone density other than osteoporosis then we use the term \_\_\_\_\_\_\_\_\_\_\_\_\_</p>
<p>osteopenia</p>
<p>plain film is \_\_\_\_\_\_\_\_\_\_\_\_ to changes in bone mineral?</p>
<p>insensitive</p>
<p>What percentage of bone mass loss is needed before osteopenia can be diagnosed on a plain film?</p>
<p>30-50%</p>
<p>T/F Radiographic technique can widely alter the perception of whether or not osteopenia is present</p>
<p>True</p>
<p>In osteoporosis, bone is qualitatively \_\_\_\_\_\_\_\_,nad quantitatively \_\_\_\_\_\_\_\_\_ bone
a. normal; deficient
b. deficient; normal</p>
<p>a. </p>
<p>diagnosis of osteoporosis is made by the radiographic find of \_\_\_\_\_\_\_\_\_\_ </p>
<p>osteopenia</p>
<p>At what age does bone mass begin to decrease?</p>
<p>35</p>
<p>bone mass decreases due to reduced \_\_\_\_\_\_\_\_\_\_\_ differentiation, activity and life span</p>
<p>osteoblastic </p>
<p>What is more active in osteoporosis?
a. osteoblasts
b. osteoclast</p>
<p>b</p>
<p>What are the two reasons that women get osteoporosis faster than men?</p>
<p>hormonal deprivation
| increased osteoclast activity</p>
<p>what is the most common type of bone fracture in osteoporosis?</p>
<p>compression bone fractures in the vertebrea </p>
<p>Chance of hip fracture for women increase at what rate?</p>
<p>double every five year after 60</p>
<p>What are the two classification systems of osteoporosis?</p>
<p>primary and secondary</p>
<p>What are the example of primary osteoporosis?</p>
<p>Senile osteoporosis
Postemenopausal osteoporosis
transient or regional osteoporosis</p>
<p>What are some examples of secondary osteoporosis?</p>
<p>Corticosteroids Malignancy Infection Arthritides Disuse RSD</p>
<p>Cushing's disease is an example of \_\_\_\_\_\_\_\_\_ osteopenia</p>
<p>Endocrine</p>
<p>What percentage of the population will have osteoporosis after the age of 50?</p>
<p>55%</p>
<p>What is the mortality rate per year of osteoporosis?</p>
<p>10-20%</p>
<p>what percentage of patients will require long term nursing home care after a hip fracture?</p>
<p>25%</p>
<p>What is the best the way to diagnose for osteoporosis?</p>
<p>prior films of the patients </p>
<p>What color should the vertebrae be on a T1 MRI?
| If the patient has dark vertebrae?</p>
<p>White
it will be dark and an indicator of marrow replacement or possibly a tumor</p>
<p>the gradual loss of skeletal mass</p>
<p>Senile Osteoporosis</p>
<p>the increased bone loss seen in women following menopause </p>
<p>postmenopausal osteoporsis</p>
<p>the gradual loss of skeletal mass begins in women in the \_\_\_\_\_\_\_ decade</p>
<p>fourth</p>
<p>the gradual loss of skeletal mass begins in men in the \_\_\_\_\_\_\_\_\_\_\_decade</p>
<p>fifth or sixth</p>
<p>What three things occur with senile/postmenopausal osteoporosis?</p>
<p>pain (due to microfractures)
loss of height/compression fracture
accentuated kyphosis (thoracics). </p>
<p>what are some risk factors for osteoporosis?
| </p>
<p>Female >70 years Caucasian or Asian Early onset of menopause longer menopausal interval Inactivity, lack of weight bearing activities</p>
<p>cortical thinning "pencil thin" is an indicator of what condition?</p>
<p>osteoporosis</p>
<p>resorption of nonstress bearing trabeculae is a sign of what condition?</p>
<p>osteoporosis</p>
<p>vertical lines an x ray is an indicator of what condition?</p>
<p>osteoporosis</p>
a codfist deformity might be seen in a patient with _________
osteoporosis
prominent trabeculation and thin cortex
are signs of what condition?
osteoporosis
What are some spine findings of osteoporosis?
changes in vertebral contour
uniform decrease in
radiodensity is noted
Endplate fractures/infarctions
Compression fractures
Pathologic fracturesWhat is the order of pathology in vertebrae shape?
step defect -> wedge deformity -> Biconcave vertebra -> pancake vertebra
if the compression exceeds 30% of the original body height or retropulsion is present or if neurologically compromised in the veretbra what is the suggested action?
take a CT scan
What are some reasons for doing a CT/MRI scan?
canal and neuroforaminbone marrow for differentiation between osteoporosis and pathologyal effacement
bone marrow for differentiation between osteoporosis and pathology
A loss of whiteness on an x ray is an indicator of what condition?
osteopenia
What are some radiographic manifestations of osteoporosis?
radiolucency
altered trabecular pattern
cortical thinning
Wedge shaped vertebrae
fish vertebrae, codfish deformity
Schmorl's nodes
End plate infractionsWhat are some reasons for a pathological compression fracture?
Osteoporosis
Lytic metastasis
Multiple myeloma
What makes a pathological compression fracture (why is it pathologic?)
decrease in height of the entire body
A pathological compression fracture can be attributed to what reason in a child?
Eosinophilic granuloma
What is the three column method criteria for mechanical stability of the vertebra?
Fracture of column A or C is stable.
Column B is unstable.
What are some features of osteoporosis in an extremity?
thinned cortices (pencil thin)
endosteal scalloping
loss of the secondary trabeculae
risks of fractures
What makes up Ward’s triangle?
primary compressive band (1)
secondary compressive band (2)
primary tensile band (3)
an accentuated wieght bearing trabeculation is also known as what?
pseudo hemangioma
Radiolucency of Ward’s trangle is more prominent in what condition?
osteoporosis
What is the last compressive component to be involved in osteoporosis?
advanced osteoporosis
In what direction does tensile group regress from?
medial to lateral this opens Ward’s trangle laterally
What is a possible outcome of adjusting someone with with a thoracic adjustment who has osteoporosis?
rib fractures
What are some reasons for pathological generalized osteoporosis/osteopenia?
plasma cell (multiple) myeloma metastasis anemia nutritional deficiencies diabetes mellitus immunodeficiency states chronic liver disease.
What test is performed to evaluate for osteoporosis?
DEXA scan
What does a DEXA scan measure for?
calcium content in the bones, this measure the bone mineral density
What is the term for the number of standard deviation from a young adult normals?
T-score
What does a T score predict?
predicts fracture risk
for every 1 standard deviation of a T score what is the increase in the chances of a fracture?
the risk doubles
What are some recommendations for the prevention of osteoporosis?
Stay active and get plenty of exercise supplement calcium protein and Vat C Don't smoke Don't drink excessively estrogen supplementation following menopause
What are some causes regional osteoporosis?
Immobilization and disuse
Reflex sympathetic dystrophy syndrome
Transient regional osteoporosis
Disuse osteoporosis inhibits _________ activity
a. osteoclast
b. osteoblast
b
What are some causes for disuse osteoporosis?
immobilized, paralysis, inflammatory joint ds
extremity injury
What is seen throughout the disused body part in a disuse osteoporotic patient?
diffuse osteopenia
What will be seen on an x-ray of a patient that suffered an extremity injury due to disuse osteoporosis?
- diffuse osteopenia seen throughout the disused body part
- lucent bands of osteopenia may be seen just proximal to the physeal line
- subchondral lucency
- uniform or spotty demineralization
What condition has clinical features of intense, burning pain, tactile stimulaion is painful, swelling, vasomotor disturbances, trophic skin changes including skin strophy and pigmentation abnormalities?
Reflex sympathetic dystrophy syndrome
What condition is characterized by acute pain, regional osteoporosis following trivial trauma?
Reflex sympathetic dystrophy syndrome
where does Reflex sympathetic dystrophy syndrome normally occur?
Hand
RSD has reflex hyperactivity of the _______
SNS
T/F imaging for reflex sympathetic dystrophy syndrome is specific enough to diagnose for it?
False, need clinical information
What is the age group for those with TOH?
middle aged adults 20-40
TOH is more common in what gender?
men
TOH in men is generally…
a. unilateral
b. bilateral
b
TOH in women most likely involves what hip?
left
Diffused bone marrow edema on MRI is
a. decreased on T1, increased T2
b. increased on T1, decreased T2
a
Osteomalacia is altered bone ________
a. quality
b. quantity
a
There is abnorall high ratio of __________ to mineralized bone in osteomalacia
osteoid
What are the two major causes of osteomalacia?
- vitamin D metabolis
2, renal tubular phosphate loss- X- linken hypophosphatemia rickets
- Fanconi’s syndrome
where is Vit. D metabolized?
It is then hydroxylated in the kidney to form what?
Hydroxylated in the liver to form 25 OH
1,25 OH2 D
Radiography of osteomalacia is _______
a. specific
b. nonspecific
b
RAdiograph of osteomalacia will see _________ trabeculation
Coarsened
What is the best diagnostic procedure for osteomalacia?
bone biopsy
Looser’s lines are present with ostemalacia. These linear regions of unmineralized osteoid are usually _________ and ________ at right angles to the bone.
a. Unilateral; symmetric
b. Unilateral; Asymmetric
c. Bilateral; symmetric
d. Bilateral; asymetric
c
What are three vitamins/minerals that are deficient in rickets?
Vit D, calcium, or phosphate
Soft tissue swelling around growth plates due to hypertrophied cartilage is known as what?
Rickets
There is ___________ alkaline phosphatase in Rickets
a. elevated
b. diminished
a
What are some causes of Rickets?
inadequate vit D intake, Inadequate UV radiation, malabsorption, chronic acidosis, renal tubular defects, anticonvulsants
What is the treatment for rickets?
Vit D supplements and sunlight
Findings for rickets is most prominently in _________ growing bones in the body?
What bones?
fastest
costochondral junctions of the middle ribs, distal femur, the proximal humerus, both ends of the tibia, distal ulna and radius
Cupping of the weakneded bone at the junction of the metaphysis and physis is seen in what condition?
Rickets
What is the feature and condition that is characterized by cartilage overgrowth and metaphysealsplaying at the costochondral junction of the ribs
Rachitic rosary
rickets
wide, frayed, irregular metaphysis, lack of zone of provisional calcification and coarsened trabeculation is a sign of what condition?
Rickets
A Paintbrush metaphysis is most commonly seen in what condition?
Rickets
Scurvy is also known as what?
Barlow’s disease
What population is most commonly affected by scurvy?
How long does it take to occur?
8-14 month infants fed on pasteurized or boiled milk
4 months of avitaminosis
Cutaneous petechiae, bleeding gums, hematuria, joint swelling, and laying in the frog leg position is most common of what condition?
Scurvy
What condition is often mistaken for child abuse?
Scuvy
What condition has low serum ascorbic acid levels?
Scurvy
Vitamin C is essential for the formation of what substances?
Collagen, osteoid, endothelial linings
What condition has beak-like metaphyseal outgrowths that extend at right angles to the shaft of the vertebra?
Pelken’s spurs
Radiodense sclerosis around epiphysis, and radiolucent centrally is an indicator of what condition?
What is it known as?
Scurvy
Wimberger’s sign
A rediolucent band tha tmay be visible directly beneath zone of provisional calcification (disorganized osteoid) is known as what?
It is most likely seen in what condition?
Trummerfeld’s zone
Scurvy
PTH is a strong ___________ hormone
a. osteoblastic
b. osteoclastic
osteoclastic
What is the cause of primary HPT?
Parathyroid gland adenoma 90% of the time
What is the cause of secondary HPT?
Chronic renal disease
What is the cause of tertiary HPT?
It is also known as?
Hemodialysis
Renal osteodystrophy
What is the most common type of HPT?
a. primary
b. secondary
c. tertiary
a
What is the most common cause of hypercalcemia?
Primary HPT
A persistent loss of calcium and phosphorus will stimulation what type of HPT?
a. primary
b. secondary
c. tertiary
b
What HPT is seen in dialysis patients, parathryoid gland acts __________ of serum calcium levels
a. dependent
b. independent
b
T/F Radiographic DDx of types of PTH is difficult
True
What age group and gender most commonly have HPT?
30-50
women
Hypercalcemia leads to what other condition?
What is a condition that HYpercalcemia cancome from?
muscle weakness, hypotonia
HPT
Hypercalcemia in __________ PTH, normal to low calcium levels in __________
a. primary
b. secondary
c. tertiary
* two answers
A, B
HPT will have elevated levels of what enzyme and hormone?
alkaline phosphatase and PTH
stones, bones, abdominal groans and psychiatric moans has to do with what condition?
what does each of them mean?
HPT
renal stones, peptic ulcers, pancreatitis, confusion, lethargy, weakness
What is the main function of parathormone physiology?
maintain circulating levels of calcium ion
Parathyroid hormone stimulates…
a. osteoclasts
b. osteoblasts
a
Parathormone increase calcium absorption through _________________
intestines
The presence of a brown tumor on an x-ray is most likely a manifestation of what disease?
HPT, it is the accumulation of fibrous tissue
What is the most definitive radiographic sign of HPT?
Subperiosteal resorption
Where does subperiosteal resorption normally occur?
radial margins, middle and proximal phalanges of the 2nd and 3rd digits
widened joint spaces adnn osteolysis esp at the AC and SI joint is a sign of what condition?
Subperiosteal resorption which is a radiographic sign for HPT
outer cortical erosion that appears frayed or lace like is a radiographic sign of what?
Subperiosteal resorption which is a radiographic sign for HPT
Ungal tuft resorption is a radiographic feature of what condition?
HPT
Resorption of the distal clavicale is a sign of what condition?
HPT
Rugger jersey spine would be seen in what condition?
HPT
What is another name for osteosclerosis and what condition is it normally seen in?
Rugger jersey spine
HPT
How would sub-endplate sclerosis be seen on an x-ray?
rugger jersey spine
Wide SI joints is consistent with what condition?
Subchondral resorption/HPT
The_________from the hemorrhage produces the grossly brown color found in a brown tumor
hemosiderine
Geographic lytic lesion containing osteoclasts and mononuclear cells and fibroblasts with focal hemorrhages.
Brown tumor
What is another name for a brown tumor?
osteoclastoma
A radiographic sign of a salt and pepper skull would be indicative of what condition/
HPT
Waht is a bone disorder occurring when the kidneys fail to maintain proper lavels of calcium and phosphorus in the blood?
Renal osteodystrophy
What population is affected by renal osteodystrophy?
patients on dialysis
What are some causes of renal osteodytrophy?
HPT
Amyloid
Aluminum arthropathy
Secondary HPT may be similar to what other condition?
osteopetrosis
Pituitary tumors account for _____% of all neoplasms within the cranium
10%
What percentage of the US population have small pituitary adenomas?
25%
What are some symptoms of pituitary tumors?
Headaches
Visual disturbances
Generalized discomfort in the extremities
symptoms may vary depending on the type of tumor that is present
An enlarged sella Turcica could be a sign of what?
Pituitary tumor
The secretion of growth hormone by a pituitary adenoma in the adult produces what condition?
What two things does it produce?
Acromegaly
intramembranous bone tissue and subcutaneous hypertrophy
Excessive growth hormone before growth centers close is manifest in what condition?
Gigantism
A person with acromegaly or gigantism has a predisposition to _____________
DJD
What conditoin has a radiographic feature of spade-like distal tufts of the extremities?
Acromegaly
A prominent frontal sinus of ht eforehead might be a sign of what condition?
Acromegaly
A progmatic jaw might be a radiographic feature of what condition?
Acromegaly
Hypercortisolism is a condition that is caused by an increase in the production of ________ or by excessive use of it and other ____________
cortisol; steroid hormones
Hypercortisolism can be caused byeither exogenous mean or __________
endogenous
What condition is result of excessive glucocorticoid steroid release?
Glucocorticod steroids are released from what?
Cushing’s syndrome
adrenal cortex
A patient that is obese, especially in the upper thorax and face “moon face” has what conditon?
Cushing’s syndrome
The round face that comes with Cushing’s syndrome is known as what?
moon face
The deposition of fat over the upper thoracic spine is known as what and is characteristic of what disease?
buffalo hump
Cushing’s Syndrome
Purple striae on the abdomen, with vertebra and rib fractures are symptoms of what disease?
Cushin’s syndrome
What kind of fracture is most likely to be seen in a patient with
Cushing’s syndrome?
compression fracture
A compression fracture with excessive callus is a radiographic feature of what condition?
Cushing’s Syndrome
Avascular necrosis and atherosclerotic plaquing would be seen in what condition?
Cushing’s Syndrome
Wha tis the most common condition of congnital dwarfing skeletal dysplasia?
Achondroplasia
Achondroplasia is marked by …
A. Hypochondroplasia
B Hyperchondroplasia
A
T/F normal life expectancy and metal status is seen in people with achondroplasia?
True
A patient with achondroplasia will have normal or near normal trunk length with marked ___________
Rhizomelic micromelia
A champagne glass radiographic feature is characteristic of what condition?
Achondroplasia
Fingers that are of approximately equal length and diverge from one another in two pairs plus the thumb is known as what and seen in what condition?’
Trident Hands
Achondroplasia
Posterior body scalloping and short pedicles with narrowed interpediculate distance leading to a narrow, trefoil spinal canal is seen in what condition?
Achondroplasia
A rounded “bullet” vertebrae will be seen in what condition?
Achondroplasia
A flat vertebra that is seen in a patient with achondroplasia is known as what?
Platyspondyly
A horizontal sacrum on an x-ray would be an indicator of what condition?
Achondroplasia
What abnormality would be seen in a patient with achondroplasia in the thoracolumbar area of the spine?
Kyphosis
A patient with Achondroplasia will have macrocephaly, fontal bossing, foramen magnum stenosis , and is assocated with __________ malformation?
Arnold-Chiari
What kind of gait will be seen in a person with Achondroplasia?
Waddling gait
Cleidocranial dysplasia would show a defect of _____________ bone growth
intramembranous
What condition would you expect to see Pubic diastasis in?
Cleidocranial dysplasia
an inverted “pear shape” of a skull with wormian bones would be characteristic of someone with what condition?
Cleidocranial dysplasia
What would you expect to see with the clavicles of a patient with Cleidocranial dysplasia?
Hypoplasia or aplasia
What would be your clinical diagnosis of a patient with generalized syplasia, below average height, large head, and drooping shoulders?
Cleidocranial dysplasia
What condition would be characterized by a collagen disorder that fails to produce normal collagen, it is also a connective tissue disorder?
Marfan’s syndrome
Scoliosis, acetabular protrusion, and pectus excavatum would be seen in what condition?
Marfan’s syndrome
What condition of the fingers would lead you to a diagnosis of Marfan’s syndrome?
Archnodactyly
Osteogenesis imperfecta is an inherited disorder marked by abnormal type _____ collagen formation
I
How many subtypes exist for Osteogenesis imperfecta
4
What are four major clinical criteria for Osteogenesis imperfecta?
skeletal fragility
Blue sclera
Abnormal dentition
premature otosclerosis
Osteopenia, bowed long bones, thin cortices, multiple fractures, and syphscoiosis would be indicators of what condition?
osteogenesis imperfecta
What is the treatment for Osteogenesis imperfecta?
limiting deformity and injury
T/F Osteogenesis imperfecta can be confused with child abuse
True
Zebra stripes on an x-ray is associated with _____________ therapy, which is a therapy for Osteogenesis imperfecta
Bisphosphate therapy
What condition is known as brittle bone disease?
Osteopetrosis
What is a group of entities, representing a type of sclerosing bone disease?
Osteopetrosis
How is osteopetrosis normally acquired?
hereditary and familial
Osteopetrosis is an abnormality of decreased ___________ activity
osteoclastic
What are some radiographic images that may be seen in someone with osteopetrosis?
Loss of medullary space Pathological fractures dense bones, thick cortices hypoplasia of frontal sinuses bone within a bone or endobone sandwich vertebrae Undertubulation of extremities resuling in an "Erlenmeyer flask" deformity
Excessive white bone on an x-ray would be a sign of what condition?
osteopetrosis
