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Skeletal Rad II > Test #1 > Flashcards

Test #1 Flashcards

1
Q

Osteomas have a predilection for what site in the body?

A

Skull

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2
Q

Enchondromas have a predilection for what part of the body?

A

Hand

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3
Q

Hemangiomas have a predilection for what site in the body?

A

Vertebra

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4
Q

Where is the M/C location for a Ewing’s Sarcoma?

A

Shaft of the femur in younger people

Can show up in pelvis if pt is older

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5
Q

Examples of tumors that predominate in areas of red or hematopoietic marrow

A

Ewings
Lymphoma
Myeloma

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6
Q

Majority of bone tumors & infections arise in which part of the bone?

A

Metaphysis

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7
Q

Bone tumors typically arise in locations where the homologous normal cells are _________

A

Most active

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8
Q

This is caused by a puncture wound that forces epithelial cells into the bone where it grows & develops into a cyst

A

Epidermoid cyst

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9
Q

If a lesion involves the vertebral body is it more likely to be malignant or benign?

A

Malignant

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10
Q

If a lesion is more likely to involve the pos. vertebra is it more likely to be malignant or benign?

A

Benign

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11
Q

A “cleavage line” usually indicates what type of lesion location?

A

Parosteal location

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12
Q

Malignant or aggressive lesions tend to be small or large at time of discovery?

A

Large except for:
Fibrous dysplasia
Simple Bone Cyst
ABC

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13
Q

If a lesion is longitudinal in shape then it tends to be malignant or benign?

A

Benign

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14
Q

If a lesion is pleomorphic (round-shape) then it tends to be malignant or benign?

A

Malignant

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15
Q

An imperceptible zone of transition of a lesion indicates what?

A

It’s malignant

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16
Q

If the zone of transition of a lesion is sharp, it indicates what?

A

It’s benign

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17
Q

What are the 3 types of lesion margins?

A

A margin w/ sharp demarcation by sclerosis
A margin w/ sharp demarcation & no sclerosis
A margin w/ an ill-defined region

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18
Q

What are 2 types of lesions that typically have a sharp margination?

A

Fibrous dysplasia

SBC

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19
Q

What are 2 examples of lesions w/ an imperceptible margination?

A

Metastasis

Infections

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20
Q

What % of cancellous bone must be destroyed before evidence is noted on conventional films?

A

30%-50%

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21
Q

What are the 3 patterns of bone destruction?

A

Geographic pattern
Moth-eaten pattern
Permeative pattern

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22
Q

Which 2 patterns of bone destruction indicate malignancy or infection?

A

Moth-eaten pattern

Permeative pattern

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23
Q

What are the characteristics of the Geographic pattern of bone destruction?

A 
Least aggressive pattern
Circumscribed & uniformly lytic
Tend to be sharply marginated
May be trabeculated
M/C indicative of a slow-growing lesion
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24
Q

What are characteristics of the Moth-eaten pattern of bone destruction?

A

Multiple small or moderate sized lucenies (2-5mm)
Margins are frequently ill-defined
Longer zone of transition
Indicative of aggressive lesions

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25
Q

What are characteristics of the Permeative pattern of bone destruction?

A

Multiple holes <1mm in size
Poorly demarcated, not easily separated from normal bone
Areas of destruction may coalesce
Indicative of a very aggressive lesion

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26
Q

What is the dominate internal extracellular substance of a lesion called?

A

Matrix

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27
Q

Most tumors have what type of matrix?

A

Radiolucent matrix

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28
Q

This type of calcification occurs in devitalized (dead) tissue

A

Dystrophic calcification

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29
Q

This type of calcification results from abnormal calcium metabolism

A

Metastatic calcification

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30
Q

This type of matrix has a diffuse to hazy, fluffy, cotton, or cloud-like appearance

A

Osseous matrix

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31
Q

This type of matrix has a stippled, flocculent, arc or ring-like, popcorn-like, comma shaped appearance

A

Cartilage matrix

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32
Q

This type of matrix has a smoky, hazy, or ground glass appearance

A

Fibrous matrix

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33
Q

This type of matrix is hard to identify on plain film if it is intraosseous

A

Fat matrix

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34
Q

What are the two types of osseous matrix?

A

Tumor new bone (confined to bone)

Reactive new bone (seen in soft tissue)

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35
Q

What are the characteristics of Tumor New Bone?

A

New bone produced by osteogenic tumors
Fluffy, cloud-like in appearance
May appear homogenous or inhomogenous

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36
Q

What lesion is an example of Tumor New Bone?

A

Osteosarcoma

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37
Q

This type of osseous matrix lays down new bone in response to a stimulus

A

Reactive New Bone

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38
Q

What two lesions are examples of reactive new bone type of osseous matrix?

A

Degenerative sclerosis

Metastasis

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39
Q

What are the characteristics of cartilage matrix?

A

Many cartilage tumors produce matrix calcification
Extent & frequency of pathologically evident calcification is usually greater than seen on xray
Stipple, flocculent, pop-corn, ring-like appearance

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40
Q

What are examples of lesions assoc. w/ cartilage matrix?

A

Chrondrosarcoma
Enchondromas
Chondroblastomas

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41
Q

What are characteristics of a fibrous matrix?

A

Uniform increase in radiodensity
Smokey or hazy, ground glass appearance
Often difficult to identify

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42
Q

What is an example of a lesion assoc. w/ fibrous matrix?

A

Fibrous dysplasia

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43
Q

What is the trabeculation pattern assoc. w/ a giant cell tumor?

A

Delicate or thin

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44
Q

What is the trabeculation pattern assoc. w/ an ABC?

A

Delicate, horizontal possibly extending into the soft tissue

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45
Q

What is the trabeculation pattern assoc. w/ a hemangioma?

A

Honeycombed, striated, radiating

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46
Q

What is the trabeculation pattern assoc. w/ a NOF?

A

Lobulated

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47
Q

This is a key factor is assessing the growth rate of a lesion

A

Cortical integrity

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48
Q

What are the 3 types of appearances assoc. w/ cortical integrity?

A

Cortical erosion
Cortical Penetration
Cortical Expansion

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49
Q

Which of the 3 types of cortical integrity appearances implies malignancy or infection?

A

Cortical Penetration

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50
Q

This type of cortical integrity appearance is caused by slow growing medullary tumors that erode the inner cortex producing a lobulated or scalloped appearance

A

Cortical Erosion

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51
Q

This is a frequent feature of cartilaginous & fibrous tumors

A

Endosteal scalloping

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52
Q

This type of cortical integrity appearance is the result of progressive endosteal erosion together w/ periosteal bone formation. It is generally a sign of a benign, medullary tumor, however may be the result of a slow-growing malignancy

A

Cortical expansion

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53
Q

This is a fundamental response of bone to disease in which the Haversian system allows spread of the bone forming irritant causing the periosteum to lift

A

Periosteal response

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54
Q

What layer is the new bone formed by in a periosteal response?

A

Cambium layer

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55
Q

What is the latent period seen in a periosteal response?

A

10-21 day latent period

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56
Q

What age group if a periosteal response more often seen?

A

Children b/c the periosteum is more easily lifted in children

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57
Q

What are examples of bone forming irritants that can cause a periosteal response?

A 
Blood
Pus
Neoplasm
Edema
Granulation Tissue
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58
Q

This is a type of periosteal response that is solid or simple & most often benign

A

Uniterrupted responses

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59
Q

This type of periosteal response is AKA a laminated or layered (onion-skin) periosteal response, Spiculated periosteal response, or Codman’s triangle & also indicates malignancy or infection

A

Interrupted Response

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60
Q

This periosteal response causes a continuous layer of new bone that attaches to the outer cortical surface. It may be undulating, smooth, elliptical & is related to a slow form of irritation

A

Solid Periosteal Response

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61
Q

What lesions are assoc. w/ a solid periosteal response?

A

Osteoid osteoma
Stress Fx
Venous stasis
HPO (hypertrophic pulmonary osteoarthropathy)

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62
Q

What is the M/C cause of hypertrophic pulmonary osteoarthropathy (HPO)?

A

Bronchogenic carcinoma

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63
Q

This type of periosteal response has alternating layers of opaque & lucent densities & can be seen w/ slow growing & aggressive tumors & infections

A

Laminated Periosteal Response AKA layered, onion-skin, lamellated

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64
Q

What lesion is assoc w/ a laminated periosteal response?

A

Ewings Sarcoma

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65
Q

This type of periosteal response has fine lines of new bone oriented perpendicular to the cortex or radiating from a point source. Usually indicative of very aggressive bone tumors

A

Spiculated periosteal response AKA Perpendicular, brushed whiskers, hair-on-end, sunburst

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66
Q

What lesions is assoc. w/ Spiculated Periosteal Responses?

A

Osteosarcoma

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67
Q

This results from the subperiosteal extension of the lesion & may accompany malignant, benign tumors or infections

A

Codman’s triangle AKA Codman’s angle, periosteal cuff

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68
Q

When you see an aggressive bone lesion in a child, you should think of what 3 things?

A

Osteosarcoma
Ewings Sarcoma
Infection

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69
Q

Benign tumors & tumor-like conditions typically do not exhibit soft tissue extensions except for?

A

Giant-cell
ABC
Osteoblastomas

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70
Q

What non-neoplastic conditions may exhibit a soft tissue component?

A

Osteomyelitis

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71
Q

What do soft tissue changes include?

A

Displaced overlying skin lines
Altered myofascial planes
Density changes (opacity vs lucency)

72
Q

What do tumors do to myofascial plane lines?

A

Displace them

73
Q

What do infections do to myofascial plane lines?

A

Obliterates them

74
Q

How do infections & tumors differ when it comes to joint spaces?

A

Infections may cross joint spaces & the open physis, whereas tumors generally do not. Exceptions: ABCs will cross growth plates, chordromas

75
Q

Osseous dissemination of cells originating from a primary malignant neoplasm

A

Metastatic bone tumor

76
Q

What is the M/C osseous malignancy?

A

Metastasis

77
Q

What are the M/C primary sites of metastatic bone tumors?

A 
Breast
Prostate
Lung
Kidney
Thyroid
Bowel
78
Q

What are the least common sites of metastatic bone tumors?

A

CNS tumors

basal cell carcinoma of the skin

79
Q

Primary malignant tumors arise in what type of bone?

A

Normal bone

80
Q

Secondary malignant tumors arise in what type of bone?

A

diseased bone

81
Q

Bone tumors usually metastasize through the _______ whereas other tumors usually go through the ______

A

Blood;Lymph

82
Q

What are the M/C primary tumors that lead to metastasis in females?

A

Breast
Thyroid
Kidney
Cervix

83
Q

What are the M/C primary tumors that lead to metastasis in males?

A

Prostate
Lung
Bladder

84
Q

What are the M/C primary tumors that lead to metastasis in children?

A

<5 yoa - neuroblastoma

10-20 yoa - Ewings & osteosarcoma

85
Q

What is the leading primary tumor that causes osteolytic metastasis in females?

A

Breast

86
Q

What is the leading primary tumor that causes osteolytic metastasis in males?

A

Lung

87
Q

What is the leading primary tumor that causes osteolytic metastasis in children?

A

Neuroblastoma

88
Q

What is the leading primary tumor that causes osteoblastic metastasis in females?

A

Breast

89
Q

What is the leading primary tumor that causes osteoblastic metastasis in males?

A

Prostate

90
Q

What is the leading primary tumor that causes osteoblastic metastasis in children?

A

Hodgkins

91
Q

What age group is metastasis M/C in?

A

after the 4th decade

92
Q

What is the M/C presentation of metastasis?

A

Bone pain at the site, insidious in onset & progressive

93
Q

What is the M/C complication of metastasis?

A

Pathologic fx

94
Q

What are some clinical manifestations of metastasis?

A

may be asymptomatic; bouts of excerbation/remission
May see a soft tissue mass
Weight loss, cachetic (state of ill health), anemia, fever

95
Q

Where do a majority of metastatic lesions occur?

A

In the spine

96
Q

What are some lab values that would show an altered value?

A 
ESR
Calcium
Alkaline Phosphatase
Acid Phosphatase & PSA
Proteins
97
Q

What lab value could help distinguish b/w metastatic & myeloma?

A

Proteins

98
Q

What is the M/C pathway for metastatic dissemination?

A

Hematologic frequently via Batson’s plexus

99
Q

What is the imaging procedure of choice for metastasis screening?

A

Bone scintigraphy

100
Q

What are the M/C (H-to-L) skeletal locations for metastasis?

A 
Vertebrae
Ribs & Sternum
Pelvis
Skull
Prox. long bones
101
Q

Are metastatic tumors more often osteolytic or osteoblastic?

A

Osteolytic

102
Q

What are radiographic features of osteolytic metastasis?

A

Cortical & trabecular destruction
Moth-eaten or permeative pattern
Wide zone of transition
May be expansile

103
Q

What are radiographic features of osteoblastic metastasis?

A 
Localized or diffuse increased radiopacity
Scattered pattern (Snow-ball)
Poorly defined margins
104
Q

What are some radiographic features that differentiate metastasis from a primary tumor?

A

Usually multiple sites
Usually no periosteal response
Rarely a soft tissue mass
Rarely expands bone

105
Q

What are the M/C primaries assoc. w/ a blow-out metastasis?

A

Thyroid & kidney

106
Q

What are some characteristics of a blow-out metastasis?

A

Often highly expansile & bubbly
May be solitary
Often mimics a primary malignancy

107
Q

FOGMACHINES is the mnemonic for expansive lesions of bone. What do the letters stand for?

A 
Fibrous dysplasia
Osteoblastoma
Giant Cell
Metastatic disease/myeloma
ABC - Aneurysmal bone cyst
Cartilaginous tumors
Hyperparathyroid cyst (Brown tumor)/Hemangioma
Infection
NOF - Non ossifying fibroma
Enchondroma/Eocinophilic granuloma
Simple bone cyst
108
Q

What areas of the spine are the M/C sites for metastasis?

A

Lumbar & thoracic (Body & pedicle)

109
Q

Metastasis is the M/C cause of destruction of what part of the vertebra?

A

Pedicle

110
Q

What sign is assoc. w/ pedicle destruction caused by metastasis?

A

Winking Owl Sign or One-eyed pedicle

111
Q

What are the 3 M/C causes of ivory vertebrae?

A

Osteoblastic metastasis (Normal size)
Pagets (Enlarged)
Hodgkins (Scalloping)

112
Q

What sign does osteolytic metastasis cause in the ribs?

A

Extrapleural sign (M/C cause)

113
Q

Where is the M/C location for metastasis in the distal extremities?

A

The foot

114
Q

What is the M/C primary to metastasize into the distal extremities?

A

Lung

115
Q

What type of metastasis is M/C’ly seen in the skull?

A

Osteolytic

116
Q

This is AKA Kahler’s disease. M/C primary osseous malignancy

A

Multiple myeloma

117
Q

Multiple myeloma is a malignant proliferation of what type of cells?

A

Plasma cells

118
Q

What is the M/C cause of death from multiple myeloma?

A

Pneumonia/respiratory failure

119
Q

What is the 2nd M/C cause of death from multiple myeloma?

A

Renal disease

120
Q

What age group is most affected by multiple myeloma?

A

50-70 years of age

121
Q

Who is affected by multiple myeloma more, males or females?

A

Males 2:1

122
Q

What are some typical symptoms of multiple myeloma?

A

fever & fatigue related to anemia

Progressive pain, M/C low back, aggravated by exercise & weight bearing

123
Q

What are hematology lab features of multiple myeloma?

A

Normochromic normocytic anemia
Thrombocytopenia
Marked rouleax formation
Increased ESR

124
Q

What are the biochemical lab features of multiple myeloma?

A 
Increased serum Ca
Increased serum uric acid
Hyperglobulinemia w/ reverse A/G ratio
M spike on serum protein electrophoresis
Bence Jones proteinuria
125
Q

What are the M/C skeletal locations for multiple myeloma?

A

Lower T-spine & L-spine
Skull
Pelvis
Ribs

126
Q

What is the best imaging method for identifying multiple myeloma?

A

X-rays

127
Q

What is the earliest manifestation of multiple myeloma on an xray?

A

Loss of bone density

128
Q

What is a pathological collapse of a vertebra assoc. w/ multiple myeloma called?

A

Wrinkled vertebra

129
Q

What is a pedicle sign?

A

multiple myeloma spares the pedicles early in the disease

130
Q

What is the radiographic hallmark of multiple myeloma?

A

sharply circumscribed, purely osteolytic, punch-out lesions

131
Q

multiple myeloma in the skull is known as?

A

Rain drop skull

132
Q

Severe & diffuse bone destruction assoc. w/ multiple myeloma M/C’ly occurs where?

A

Pelvis

Sacrum

133
Q

Where is expansion of bone assoc w/ multiple myeloma M/C?

A

Ribs
Long bones
Pelvis

134
Q

This is a highly expansile, geographic lesion typically a soap bubble appearance. Localized form of multiple myeloma.

A

Solitary plasmacytoma

135
Q

What are the M/C sites of a solitary plasmacytoma?

A

Mandible
Pelvis
Vertebrae
Ribs

136
Q

What is the ddx for multiple myeloma?

A

Osteolytic metastasis
Osteoporosis
Possibly NHL

137
Q

What is the ddx for solitary plasmacytoma?

A

Blow-out metastasis
Brown tumor
Fibrous dysplasia
Giant-cell

138
Q

What % of solitary lesions develop into multiple myeloma?

A

70%

139
Q

4th M/C primary osseous malignancy. Distinctive small, round cell primary sarcoma, probably arising from the connective tissue of bone marrow

A

Ewings Sarcoma

140
Q

Types of round cell tumors?

A

Ewings Sarcoma
non-Hodkins lymphoma
Multiple Myeloma

141
Q

What are the 2 M/C osseous malignancies under 25yrs of age?

A

Osteosarcoma

Ewings Sarcoma

142
Q

What age group/gender is most affected by ewings sarcoma?

A

5-25yoa, male 2:1

143
Q

What are symptoms assoc. w/ ewings sarcoma?

A

Increasing local pain (several months duration)
Soft tissue mass, tender but not warm
Malaise & moderate fever

144
Q

What’s the difference b/w osteomyelitis & ewings sarcoma?

A

Timing - osteomyelitis takes days/weeks, ewings sarcoma progresses over months

145
Q

What are lab findings assoc. w/ ewings sarcoma?

A

Leukocytosis
Anemia
Elevated ESR

146
Q

What is the classic appearance of a ewings sarcoma on a xray?

A

Permeative pattern of destruction involving diaphysis
Laminated periosteal response
Saucerization

147
Q

Does ewings sarcoma have a narrow or wide zone of transition?

A

Wide

148
Q

Extrinsic pressure from the soft tissue mass assoc. w/ ewings sarcoma causes what?

A

Saucerization

149
Q

What imaging method is best for demonstrating soft-tissue & bone marrow involvement of ewings sarcoma?

A

MRI

150
Q

What is the M/C complication of ewings sarcoma?

A

Metastasis to bone & lung (M/C primary osseous malignancy to metastasis to bone)

151
Q

What is the ddx for ewings sarcoma?

A

Osteomyelitis
Metastatic neuroblastoma
NHL
Osteosarcoma

152
Q

2nd M/C primary malignancy. Neoplastic osteoid & bone matrix formed by malignant cells of connective tissue

A

Osteosarcoma

153
Q

Secondary osteosarcoma’s are assoc. w/ what diseases?

A

Paget’s disease

Fibrous dysplasia

154
Q

What age group & gender is most affected by osteosarcomas?

A

10-25 yoa; Males 2:1

155
Q

What lab value may be elevated w/ an osteosarcoma?

A

Alkaline phosphatase

156
Q

Where is the M/C location for an osteosarcoma?

A

Distal femur (50-75% involve the knee)

157
Q

Where is osteosarcoma most often seen in older pts?

A

Flat bones

158
Q

Where do osteosarcomas typically originate?

A

Metaphysis

159
Q

What are the periosteal responses seen w/ osteosarcoma?

A

Sunburst (classic)
Hair-on-end
Codman’s triangle
Occasionally laminated response

160
Q

What are typical xray findings assoc. w/ osteosarcoma?

A

Soft tissue mass is common
Tumor new bone w/i the destructive lesion or at its periphery
Cumulus cloud appearance

161
Q

What are complications assoc. w/ osteosarcoma?

A

Metastasis: Pulmonary (pneumothorax) & osseous
“Cannon-ball metastasis”
Pathologic fx

162
Q

What is the 5 year survival rate for osteosarcoma?

A

Exceeds 50% (averages 20%)

163
Q

Type of osteosarcoma seen in pts 25-40?

A

Parosteal Osteosarcoma

164
Q

What are the M/C locations for a parosteal osteosarcoma?

A

Femoral metaphysis (M/C)
Prox. tibia
Prox. humerus

165
Q

What are the radiographic features of a parosteal osteosarcoma?

A

Dense oval or spherical shaped mass
Attached to the cortical surface
May see a radiolucent cleft separating a portion of the mass form the bone
Most likely seen on pos. aspect of femur

166
Q

What is NHL AKA?

A

Primary bone lymphoma
Reticulum cell sarcoma
Lymphosarcoma
Histiocytic lymphoma

167
Q

What type of tumor is a NHL?

A

Round cell tumor (rare)

168
Q

What is the criteria for primary NHL?

A

Initial involvement of a single bone w/ at least 6 months before distal metastasis w/o generalized NHL

169
Q

What age group, gender are most affected by NHL?

A

25-40; 2:1 Males

170
Q

What are typical symptoms assoc. w/ NHL?

A

Dull, aching pain & swelling of long duration at site
Minor symptoms possible present a year or more
General well-being of pt usually good
Fever & weight loss may be present

171
Q

NHL is the M/C primary malignancy to give rise to what?

A

Pathologic fx

172
Q

M/C sites for NHL?

A

Femur
Tibia
Humerus

173
Q

What are the M/C locations of NHL in the bone?

A

Diaphyseal

Metaphyseal adjacent to the diaphysis

174
Q

What are radiographic findings assoc w/ NHL?

A

permeative pattern of bone destruction
Minimal to no periosteal response
Cortex often distrupted (expansions or thickening)
Sclerotic lesions possible in vertebrae & flat bones

175
Q

What type of pts are less likely to have a periosteal response?

A

Older pt’s

176
Q

What is the ddx assoc. w/ NHL?

A

Systemic lymphoma
Ewing’s sarcoma
Paget’s disease
Myeloma

Skeletal Rad II (5 decks)

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