systemic bone diseases

Question 1

hormones and nutrients that stimulate bone production

Answer 1

GH, T3 & T4, calcitonin, vit D, vit C

Question 2

hormones inhibiting bone production

Answer 2

PTH, cortisol

Question 3

all encompassing definition for increased radiolucency of bone

Answer 3

osteopenia

Question 4

most common etiology for osteopenia

Answer 4

osteoporosis

Question 5

other common etiologies for osteopenia besides osteoporosis

Answer 5

osteomalacia (vit D deficiency), hyperparathyroidism, rickets (vit D deficiency in a child), scurvy (vit C deficiency), neoplasm

Question 6

if there is a radiolucency in bone does that automatically mean that it is osteoporosis

Answer 6

no, could be other factors

Question 7

TRUE or FALSE: osteopososis is qualitatively normal but quantitatively deficient in bone

Answer 7

TRUE

Question 8

looser’s lines indicate what

Answer 8

osteomalacia

Question 9

primary osteoporosis

Answer 9

senile osteoporosis, postmenopausal osteoporosis, transient or regional osteoporosis

Question 10

secondary osteoporosis

Answer 10

corticosteroids, malignancy, infection, arthritides, disuse, RSD

Question 11

endocrinopathy of osteopenia

Answer 11

acromegaly, hyperparathyroidism, hyperthyroidism, Cushing’s disease, pregnancy, heparin, alcoholism

Question 12

what does a step deformity indicate

Answer 12

new compression fracture

Question 13

on an MRI what is the difference between old and new compression fractures

Answer 13

old compression fractures have normal marrow signal intensity, new fractures have abnormal signal intensity

Question 14

what color would a vertebral body be with a new compression fracture on a T1 weighted MRI

Answer 14

black

Question 15

the gradual loss of skeletal mass that is seen with advancing age

Answer 15

senile/postmenopausal osteoporosis

Question 16

risk factors for osteoporosis

Answer 16

female, older than 70, caucasian & asian, early onset of menopause, longer mostmenopausal interval, inactivity, especially lack of weight bearing activity

Question 17

modifiable risk factors for osteoporosis

Answer 17

smoking, alcohol abuse, excessive caffeine consumption, excessive dietary protein consumption, lack of dietary calcium, lack of sunlight exposure (to generate endogenous vit D)

Question 18

cod fish deformity is indicative of

Answer 18

osteoporosis

Question 19

in cases of severe fractures, a CT is needed is compression exceeds what percentage of the original body height

Answer 19

30% (or retropulsion is present or neurologically compromised)

Question 20

what can be assumed if the interpedicular distance is widened

Answer 20

trauma

Question 21

cases of pathologic compression fracture

Answer 21

osteoporosis (MC), lytic mets, multiple myeloma

Question 22

fractures in what part of the vertebra do not compromise the mechanical stability

Answer 22

anterior 1/3 of the vertebral body and everything posterior to the body

Question 23

fractures in what part of the vertebra do compromise the mechanical stability

Answer 23

posterior 2/3 of the vertebral body or any other two regions

Question 24

what is assumed when the thoracic aorta has more density than the bones surrounding it

Answer 24

decreased bone density, not necessarily increased density of the aorta because of calcification

Question 25

indications of osteoporosis in an extremity

Answer 25

thinned cortices, endosteal scalloping, loss of the secondary trabeculae, risks of fractures

Question 26

different groups of trabeculae

Answer 26

greater trochanter group, secondary compressive group, principle tensile group, principle compressive group

Question 27

wards triangle is formed by

Answer 27

trabecular groups

Question 28

specifically which trabecular groups make up wards triangle

Answer 28

laterally - secondary compressive group, medially - principle compressive group, superiorly - principle tensile group

Question 29

look at trabecular groups on page 240

Answer 29

page 240

Question 30

TRUE or FALSE: osteopososis is qualitatively normal but quantitatively deficient in bone

Answer 30

FALSE; it is made visible in patients with osteoporosis

Question 31

diffuse, significant osteopenia (especially in a patient too young for osteoporosis) could indicate

Answer 31

multiple myeloma

Question 32

rain drop skull is indicative of

Answer 32

multiple myeloma

Question 33

myltiple lytic calvarial lesions and punched out lesions are indicative of

Answer 33

multiple myeloma

Question 34

DEXA scan

Answer 34

dual energy x-ray absorptiometry

Question 35

a bone density measurement will determine the bone mineral density for the area measured and compares that result with the average bone mineral density of the norm. this is the use of which machine

Answer 35

DEXA

Question 36

how does the WHO define osteoporosis

Answer 36

T-scores

Question 37

T-scores

Answer 37

(-1) or higher = normal, (-2.5) to (-1) = osteopenia, below (-2.5) = osteoporosis, below (-2.5) with fragility fracture = servere osteoporosis

Question 38

a person with 90% of normal bone density will tend to have what T-score

Answer 38

1 (goes down 1 for every 10% of bone lost)

Question 39

altered bone quality, lack of calcium salts deposited, and abnormally high ratio of osteoid to mineralized bone (inadequately mineralized bone matrix)

Answer 39

osteomalacia

Question 40

two main causes for osteomalacia

Answer 40

vit D metabolism, renal tubular phosphate loss

Question 41

franconi's syndrome

Answer 41

osteomalacia

Question 42

looser lines/zones are assocaited with

Answer 42

osteomalacia

Question 43

best diagnostic procedure for osteomalacia

Answer 43

bone biopsy

Question 44

radiographic findings of osteomalacia

Answer 44

osteopenia, coarsened trabeculation, looser lines, bone softening deformities, basilar invagination, acetabular protrusion

Question 45

linear regions of unmineralized osteoid usually bilateral and symmetrical at right angles to the bone. what does it signify

Answer 45

looser lines; osteomalacia

Question 46

radiographic findings for rickets

Answer 46

widened, bulky epiphyseal plates and irregularity (fraying), splaying (cupping) of the weakened bone at the junction of the metaphysis and physis

Question 47

rachitic rosary

Answer 47

rickets

Question 48

paintbrush metaphysis

Answer 48

rickets

Question 49

patient with joint swelling, irritability, pain and tendency to lie supine and motionless with thighs abducted probably has

Answer 49

scurvy

Question 50

manifested by spontaneous hemorrhage due to capillary fragility

Answer 50

scurvy

Question 51

white line of frankel

Answer 51

scurvy

Question 52

pelken's spurs

Answer 52

scurvy

Question 53

wimberger's sign

Answer 53

scurvy

Question 54

trummerfeld's zone

Answer 54

scurvy

Question 55

dense sclerotic zone of provisional calcification due to delayed conversion to bone

Answer 55

white line of frankel

Question 56

beak-like metaphyseal outgrowths

Answer 56

pelken's spurs

Question 57

radiodense sclerosis around epiphysis, radiolucent centrally

Answer 57

wimberger's sign

Question 58

scorbutic zone, a radiolucent band may be visible directly beneath zone of provisional calcification

Answer 58

trummerfeld's zone

Question 59

strong osteoclastic hormone

Answer 59

PTH

Question 60

primary hyperparathyroidism

Answer 60

parathyroid gland adenoma

Question 61

secondary hyperparathyroidism

Answer 61

hemodialysis (endstage renal glomerular disease) aka... renal osteodystrophy

Question 62

renal osteodystrophy (synonym)

Answer 62

secondary hyperparathyroidism

Question 63

most common type of hypercalcemia

Answer 63

primary HPT

Question 64

elevated PTH levels, hypercalcemia, hypophosphatemia

Answer 64

primary HPT

Question 65

loss of calcium and phosphorus and stimulates PTH release

Answer 65

secondary HPT

Question 66

maintains the circulating level of calcium ions

Answer 66

PTH

Question 67

stimulates osteoclasts

Answer 67

PTH

Question 68

calcium loss and abnormal vit D formatino leading to hypocalcemia and the release of PTH

Answer 68

secondary HPT

Question 69

radiographic findings for HPT

Answer 69

osteopenia, subperiosteal resorption, distal tuft resorption, accentuated trabeculation, brown tumors, loss of cortical definition, soft tissue calcification

Question 70

most definitive radiographic sign of HPT

Answer 70

subperiosteal resorption

Question 71

ungal tufts

Answer 71

distal tufts; HPT

Question 72

salt and pepper skull

Answer 72

HPT

Question 73

rugger jersey spine

Answer 73

HPT

Question 74

sub-endplate sclerosis

Answer 74

rugger jersey spine

Question 75

geographic lytic lesion containing osteoclasts and mononuclear cells and fibroblasts with focal hemorrhages

Answer 75

brown tumor

Question 76

bone disorder occurring when the kidneys fail to maintain proper levels of calcium and phosphorus in the blood

Answer 76

renal osteodystrophy

Question 77

symptoms of pituitary tumor

Answer 77

HEADACHES!!!, visual disturbances, generalized discomfort in extremities

Question 78

significance of an enlarged sella

Answer 78

empty sella, tumor, normal, aneurysm

Question 79

what are the normal measurements of the sella turcica across and deep

Answer 79

16mm across and 12 mm deep

Question 80

what causes acromegaly

Answer 80

pituitary tumor secreting GH

Question 81

which type of ossification is responsible for the subcutaneous hypertrophy of the bone tissue; most common in the hands and feet

Answer 81

intramembranous

Question 82

specifically what causes gigantism in patients with a pituitary tumor

Answer 82

a pituitary tumor secreting excessive GH before the growth centers close

Question 83

acromegaly predisposes patients to what disorder

Answer 83

DJD

Question 84

TRUE or FALSE: patients with acromegaly have normal life spans

Answer 84

FALSE; shortened lifespan

Question 85

tissues affected by acromegaly

Answer 85

bone, cartilage, skin, organs

Question 86

TRUE or FALSE: patients with acromegaly have enlarged jaw, hands, feet, and head with no increase in height

Answer 86

TRUE

Question 87

macroglossia is associated with

Answer 87

acromegaly

Question 88

protruding frontal sinuses, prominent forehead is associated with

Answer 88

acromegaly

Question 89

TRUE or FALSE: an enlarged sella turcica could indicate acromegaly

Answer 89

TRUE

Question 90

radiographic findings of acromegaly

Answer 90

spade like distal tufts, hooking osteophytes, increased joint spaces (initially), widened shaft, increased tissue thickness

Question 91

a heel pad thickness greater than ___ indicates acromegaly

Answer 91

23mm

Question 92

what is the indication if the patient has a heel pad is greater than 23mm

Answer 92

acromegaly

Question 93

most common form of hypercortisolism

Answer 93

exogenous corticosteroid administration

Question 94

types of patients at risk for hypercortisolism

Answer 94

patients requiring immunosuppression (autoimmune disorders, organ transplants)

Question 95

endogenous oversecretion of ACTH by the pituitary and adrenal cortex adenoma, or ectopic ACTH secretion

Answer 95

hypercortisolism

Question 96

excessive glucocorticoid steroids, released by the adrenal cortex

Answer 96

cushing's syndrome

Question 97

patient is obese, especially in the upper thorax and face (moon face)

Answer 97

cushing's syndrome

Question 98

accelerated hair growth

Answer 98

cushing's syndrome

Question 99

deposition of fat over the upper thoracic spine

Answer 99

buffalo hump

Question 100

buffalo hump is indicative of

Answer 100

cushing's syndrome

Question 101

abdominal striae are indicative of

Answer 101

cushing's syndrome

Question 102

radiographic findings for cushing's syndrome

Answer 102

osteopenia, compression fractures, AVN, atherosclerotic plaquing

Question 103

most common congenital dwarfing skeletal dysplasia

Answer 103

achondroplasia

Question 104

shortened proximal long bones are indicative of

Answer 104

achondroplasia

Question 105

trident hands

Answer 105

achondroplasia

Question 106

narrowing of the spinal canal

Answer 106

achondroplasia

Question 107

metaphyseal cupping is indicative of

Answer 107

achondroplasia

Question 108

champagne glass pelvis

Answer 108

achondroplasia

Question 109

exaggerated posterior body convexity (posterior body scalloping)

Answer 109

achondroplasia

Question 110

horizontal sarcum

Answer 110

achondroplasia

Question 111

what to look for on film of spine when achondroplasia is suspected

Answer 111

scalloping of the posterior vertebral bodies, canal stenosis, no spinous/lamina (due to laminectomy), horizontal sacrum, champagne glass pelvis

Question 112

what to look for on film of skull when achondroplasia is suspected

Answer 112

macrocephaly, frontal bossing, foramen magnum stenosis (associated with arnold-chiari malformation)

Question 113

cleidocranial dysplasia is defect in which type of ossification

Answer 113

intramembranous

Question 114

radiographic features of cleidocranial dysplasia

Answer 114

inverted "pare shaped" fontanelle, wormian bones, hypoplasia or aplasia of clavicles, wide pubic symphysis (pubic diastasis)

Question 115

failure of collagen to be produced normally

Answer 115

marfan's syndrome

Question 116

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

Answer 116

marfan's syndrome

Question 117

inherited disorder marked by abnormal type I collagen formation

Answer 117

osteogenesis imperfecta

Question 118

common clinical findings for osteogenesis imprefecta

Answer 118

skeletal, blue sclera, abnormal detition, premature otosclerosis

Question 119

brittle bones

Answer 119

osteopetrosis

Question 120

bone within a bone

Answer 120

endobone

Question 121

endobones or bone within a bone indicate what

Answer 121

osteopetrosis

Question 122

sandwich vertebrae are indicative of

Answer 122

osteopetrosis

Question 123

erlenmeyer flask deformity is indicative of

Answer 123

osteopetrosis

Question 124

difference between rugger jersey spine and osteopetrosis findings on film

Answer 124

osteopetrosis has well defined endplates