7.1: Nontraumatic highlights

Question 1

Bones are continuously undergoing _____________

Answer 1

remodeling

Question 2

How do you remember the bone metastatic diseases (2 groups)

Answer 2

1) “BLT with Pickles and Ketchup”
Breast, Lung, Thyroid, Prostate, Kidneys

2) “Lead kettle” (Pb – KTL)
Osteoblastic: Prostate
Mixed: Breast
Osteolytic: Kidney, Thyroid, Lungs

Question 3

Prostate carcinoma has a significant likelihood of ______________ metastatic disease

(important)

Answer 3

osteoblastic

Question 4

When Osteoblastic Metastatic Disease affects the bone cortex, this leads to a ______________ reaction

Answer 4

periosteal

Question 5

What is the Study of choice for detecting skeletal metastases?

Answer 5

Bone scan

Question 6

Bone scan: Recall that ____________ denotes diffuse increased uptake with decreased renal uptake

Answer 6

superscan

Question 7

List the conditions of increased bone density

Answer 7

1) Osteoblastic Metastatic Disease
2) Avascular necrosis

Question 8

Crescent sign may indicate?

Answer 8

Linear subchondral fractures, potentially due to AVN (get MRI)

Question 9

When __________________ occurs in epiphysis, it is called “avascular necrosis”

Answer 9

osteonecrosis

Question 10

1) What may cause “net formation”?
2) What are 2 other signs?

Answer 10

1) Paget’s Disease
2) Thickened cortex
Coarse, trabecular pattern

Question 11

Most accurate way of measuring bone density is what?

Answer 11

DEXA

Question 12

Differentiate a T score and Z score (important)

Answer 12

1) T score: bone density of young healthy patient
2) Z score: bone density of age matched normal patient

Question 13

What are the different T scores? (important)

Answer 13

Normal: -1 or higher
Low: Between -1 and -2.5
Osteoporosis: 2.5 or lower

Question 14

Subperiosteal bone resorption (esp in fingers) and Acroosteolysis may be seen with?

Answer 14

Hyperparathyroidism

Question 15

What are some causes of decreased bone density?

Answer 15

1) Osteoporosis
2) Osteolytic Metastatic Disease
3) Hyperparathyroidism
4) Myeloma
5) Osteomyelitis

Question 16

“Expansile/ soap bubbly lytic lesion with internal trabeculations without periosteal rxn”
and
“Pedicle sign / winking owl sign” indicates?

Answer 16

Osteolytic Metastatic Disease

Question 17

Most common primary bone malignancy in adults is?

Answer 17

Myeloma

Question 18

What is a surgical emergency that can take 10 days to show XR signs?

Answer 18

Osteomyelitis

Question 19

What are the 3 main categories of arthritis?

Answer 19

1) Hypertrophic
2) Erosive
3) Infectious

Question 20

Hypertrophic Arthritis: What is it characterized by? Give examples of this category

Answer 20

1) Characterized by bone formation (e.g. subchondral sclerosis, osteophytes)
2) Primary OA
Secondary OA
Charcot arthropathy
CPPD

Question 21

What is the most common type of arthritis?

Answer 21

Primary osteoarthritis
AKA DJD

Question 22

Subchondral cysts, osteophytes, Sclerosis, and joint space narrowing all indicate?

Answer 22

Primary osteoarthritis

Question 23

Secondary Osteoarthritis:
1) What is it?
2) What does it look like?

Answer 23

1) Joint degeneration secondary to another cause
Usually trauma
Infection, AVN, CPPD, RA
Age-inappropriate osteoarthritis
2) More asymmetric; unusual location (e.g. elbow)

Question 24

Most dramatic joint destruction of any arthritis is?

Answer 24

Charcot Arthropathy

Question 25

Differentiate CPPD and pseudogout

Answer 25

1) CPP + asymptomatic = CPPD 2) CPP + redness, pain, swelling = pseudogout

Question 26

Minimal sclerosis relative to degree of joint space narrowing indicates?

Answer 26

RA

Question 27

What is the #1 cause of infectious arthritis?

Answer 27

IV drug use

Question 28

Differentiate bulging and herniated discs

Answer 28

1) Bulging disc: Annulus bulging, nucleus intact 2) Herniated disc: Nucleus extrudes through annular tear

Question 29

What does the ligamentum flavum connect? What is it significance?

Answer 29

Laminae of adjacent vertebral bodies; lies in posterior portion of spinal canal. If enlarged, can contribute to nerve being pinched

Question 30

__________ is ideally the study of choice for spinal pathology

Answer 30

MRI

Question 31

___________ is the study of choice for evaluating disc herniation

Answer 31

MRI

Question 32

What is the study of choice for spinal stenosis?

Answer 32

MRI

Question 33

DISH: 1) What does it stand for? 2) What defines it? 3) What differentiates it from ankylosing spondylitis?

Answer 33

1) Diffuse idiopathic skeletal hyperostosis 2) Bridging ossification of at least 4 contiguous vertebral bodies 3) SI joints are normal

Question 34

Ankylosing Spondylitis: What are 2 key findings?

Answer 34

Almost always positive for HLA-B27 & can see Sacroiliitis on PE

Question 35

Discitis / Osteomyelitis: 1) Main cause? 2) What is the most sensitive test?

Answer 35

1) S. aureus 2) MRI

Question 36

Pathologic compression fractures especially in posterior aspect can help differentiate osteoporotic fractures from what?

Answer 36

Spinal malignancy

Question 37

Spinal Malignancy: What is the study of choice?

Answer 37

Bone scan