Term
| If the patient is over 50, what should we assume until proven otherwise? |
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Definition
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Term
| What 5 questions should you ask when looking at an X-ray? |
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Definition
| 1)How old is the pt? 2)Where is the lesion? 3)What is the lesion doing to the bone? 4)What is the bone doing to the lesion? 5)Is the lesion producing or destroying any bone or cartilage? |
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Term
| What is the unit of measurement used to determine the attenuating properties of tissues in CT? |
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Definition
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Term
| What form of imaging should be chosen for soft tissue lesions? |
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Definition
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Term
| What is the diff btwn T1 & T2 weighted MRIs and what is each best for visualizing? |
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Definition
| T1=fat is brightest, water/fluid darkest (fat deposition), T2=water/fluid brightest, fat darkest (edema) |
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Term
| What is a bone scan (radionucleide technique) used to detect & how? |
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Definition
| Areas of unusual bone re-building, the unstable nuclei are taken up by osteoblasts which are present in areas of bone growth |
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Term
| Why is a bone scan not used for metastases? |
|
Definition
| The absence of significant reactive changes in the bone. |
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Term
| Which imaging technique is used for 3D imaging? |
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Definition
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Term
| Which imaging technique is best for viewing metastases? |
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Definition
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Term
| Osteophytes, narrowing of joint space, bony sclerosis, & subchondral cysts are radiographic features assoc w which disease? |
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Definition
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Term
| Which body part should you always get X-rays of when diagnosing RA? |
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Definition
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Term
| Periarticular osteopenia, hypervascular cartilage & synovium, narrowing erosions, & pannus are radiographic features assoc w which disease? |
|
Definition
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Term
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Definition
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|
Term
| Eroded bone around joint & "punched out" periarticular erosions w sclerotic overhanging borders are radiographic features assoc w which disease? |
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Definition
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Term
| Calcification outlining the articular cartilage within the joint space & diffuse calcification of menisci are are radiographic features assoc w which disease? |
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Definition
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Term
| Bamboo spine, rosary bead appearance, enthesopathy, vertebral squaring, normal disk spaces, ligamentous calcification, & spinal/sacroiliac fusion are radiographic features assoc w which disease? |
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Definition
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Term
| "Pencil in Cup" deformity of DIP, ankylosed finges, arthritis mutilans, & plaque-like lesions are radiographic features assoc w which disease? |
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Definition
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Term
| Asymmetric spondylitis/sacroiliacitis & periostitis are radiographic features assoc w which disease? |
|
Definition
| Reiter's Syndrome (reactive arthritis) |
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Term
| Sacroiliitis & symptoms predominantly affecting the lower body are radiographic features assoc w which disease? |
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Definition
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Term
| PIP contractures & marked resorption of terminal tufts of bone are radiographic features assoc w which disease? |
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Definition
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Term
| First osteopenia, then abnormally placed sclerosis are radiographic features assoc w which disease? |
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Definition
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Term
| A crescent sign in bone is a radiographic feature assoc w which disease? |
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Definition
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Term
| Decreased disk space, osteophytes, facet hypertrophy, & ligament hypertrophy are radiographic features assoc w which disease? |
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Definition
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Term
| Annular tears & bulging nuclear pulposis are radiographic features assoc w which disease? |
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Definition
|
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Term
| What are the 4 types of fractures? |
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Definition
| Oblique, butterfly, spiral, & transverse |
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Term
| What is the most common cause of a Brodie's abscess? |
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Definition
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Term
| Osteopenia, osteitis fibrosa cystic, and "Brown tumors" containing giant cells are radiographic features assoc w which disease? |
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Definition
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Term
| Osteomalacia, "rugger jersey spine", soft tissue calcification, osteitis fibrosa, & amyloidosis are radiographic features assoc w which disease? |
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Definition
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Term
| Cortical thinning, bone bowing, & poor calcification of normal bone growth are radiographic features assoc w which disease? |
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Definition
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Term
| Compression fractures (esp in vertebrae), hip fractures, & normal mineralization are radiographic features assoc w which disease? |
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Definition
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Term
| A bump w a cartilagenous cap that grows @ right angle to an appendicular long bone is what type of tumor? |
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Definition
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Term
| A well circumscribed lytic lesion w chicken-wire calcifications seen in the Xray of a young male pt's knee epiphysis is likely what type of tumor? |
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Definition
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Term
| A X-ray showing a tumor invading the center of the bone to permeate trabeculae & "fill in the gaps" causing "entrapment" of bony trabeculae is likely what? |
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Definition
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Term
| A tumor showing spicules of bone w spindle-shaped chondroblasts is likely what? |
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Definition
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Term
| A tumor showing no periosteal destruction but cortical (--> joint) destruction due to tumor cells acting like osteoclasts is what? |
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Definition
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Term
| A lytic tumor w a sunburst or onion ring appearance & a diffuse infiltrate of small round cells is likely what? |
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Definition
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|
Term
| If you see multiple lesions, what is your first thought? |
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Definition
|
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Term
| What imaging technique must be used to view meniscus? |
|
Definition
| MRI (not visible on Xray) |
|
|
Term
| Where does calcification occur in cartilage tumors vs bone tumors? |
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Definition
| Cartilage tumors - in center; Bone tumors - around rim. |
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Term
| What is an infxn of the bone/marrow called? |
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Definition
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Term
| What is a piece of dead bone that has been separated from normal bone during necrosis called? |
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Definition
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Term
|
Definition
| New live bone deposited on a sequestrum. |
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Term
| If a Brodie's abscess doesn't spread, why is it still a risk? |
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Definition
| Even though the bone walls off infxn it still contains bacteria. If pt later has trauma or immunosuppressants, can reactivate. |
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|
Term
| How do you treat a Brodie's abscess? |
|
Definition
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Term
| Osteomyelitis in which the infxn arrives by blood stream is called what? Who does it usually affect? |
|
Definition
| Hematogenous; children, immunosuppresed, diabetic, vascularly insufficient adults. |
|
|
Term
| What is a Direct Osteomyelitis? |
|
Definition
| Bug introduced directly into bone from perforating wound, hospital procedure, contaminated prosthesis. |
|
|
Term
| What are the 2 types of osteomyelitis? |
|
Definition
|
|
Term
| What is the most common organism that gets into bone & causes osteomyelitis? |
|
Definition
|
|
Term
| Why is infxn of joints a medical emergency? |
|
Definition
| Pus directly digests cartilage. |
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|
Term
| What are the 1st & 2nd most common bones to be infected by hematogenous osteomyelitis & why? |
|
Definition
| 1-Knee, 2-Shoulder; large bones, rich in metaphyseal area w vascularity |
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|
Term
| What steps are necessary for bacteria to be able to get into bone marrow? |
|
Definition
| Enter bone circulation--> cause thrombosis in capillary loop near epiphyseal plate--> slows blood flow down enough for bacteria to create a stronghold & replicate--> exit through vessel fenestrae into marrow |
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|
Term
| How is an anoxic focus created in the marrow? |
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Definition
| As bacteria proliferate & cause pressure the vessels are 1st thing to go because softer than bone--> marrow is wiped out via anoxia |
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|
Term
| What process creates the holes in bone seen in infxn? |
|
Definition
| Marrow anoxic focus grows--> bone dies if not getting blood from marrow--> osteoclasts resorb bone to relieve pressure--> holes |
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|
Term
| What happens if bacteria spreads outward from marrow thru cortex enough to get into perforating arteries? |
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Definition
| Can pull periosteum off, vessels stretch creating thrombus, this kills more cortex. |
|
|
Term
| How does formation of a draining sinus ("cloaca") of pus affect skin epithelia? |
|
Definition
| Creates a neoplasm in skin epithelia (squamous cell carcinoma). |
|
|
Term
| What is the only way to cure chronic osteomyelitis once it has caused squamous cell carcinoma? |
|
Definition
|
|
Term
| How does bone wall off an abscess? |
|
Definition
| Sclerosis (bone deposition) |
|
|
Term
| What are the 3 benign tumors of bone origin? |
|
Definition
| Osteoma, Osteoid Osteoma, Osteoblastoma |
|
|
Term
| What is a "primary bone tumor"? |
|
Definition
| One which originate in bone or from bone-derived cells and tissues. |
|
|
Term
| What is the difference in the transition zone in benign vs malignant bone tumors? |
|
Definition
| Benign-Narrow & Sharp; Malignant-Indistinct |
|
|
Term
| What are the 3 benign bone tumors of cartilage origin? |
|
Definition
| Osteochondroma, Endochondroma, Chondroblastoma |
|
|
Term
| What are the 2 benign tumors of fibrous tissue origin? |
|
Definition
| Non-Ossifying Fibroma, Fibrous Dysplasia |
|
|
Term
| Is an Osteoid Osteoma benign or malignant? How big can it get? |
|
Definition
|
|
Term
| How does an Osteoid Osteoma usually present? |
|
Definition
| Extremely painful, especially @ night. Pain usually relieved by aspirin. |
|
|
Term
| Where do Osteoid Osteomas usually occur? |
|
Definition
| Cortices of long bones (appendicular skeleton), but can be anywhere. |
|
|
Term
| X-ray shows a single lytic lesion (radiolucency) surrounded by an area of dense reactive sclerosis - what is it? |
|
Definition
|
|
Term
| Who usually gets Osteoid Osteomas? |
|
Definition
|
|
Term
| Histiological appearance of an Osteoid Osteoma? |
|
Definition
| Interlacing trabeculae of woven bone, osteoblasts & osteoclasts |
|
|
Term
| Treatment of Osteoid Osteoma? |
|
Definition
|
|
Term
| X-ray looks like an Osteoid Osteoma but is >2cm - what is it? |
|
Definition
|
|
Term
| How does an Osteoblastoma present? |
|
Definition
| Low grade dull pain (not necessarily relieved by aspirin or worse at night) |
|
|
Term
| Where do Osteoblastomas usually occur? |
|
Definition
|
|
Term
| Why is sclerosis usually not seen on Xrays of Osteoblastomas? |
|
Definition
| Bone matrix is produced but there is little mineralization. |
|
|
Term
| What is the family of malignant mesenchymal neoplasms where tumor cells produce bony matrix called? |
|
Definition
|
|
Term
| Where are Osteosarcomas usually found? |
|
Definition
|
|
Term
| Xray shows indistinct transition zone & Codman's triangle on the distal femur of a 15yo boy - what is it? |
|
Definition
|
|
Term
| Without chemo, where are Osteosarcomas likely to metastasize to? |
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Definition
|
|
Term
| Which bone tumor shares a genetic risk w RB? |
|
Definition
|
|
Term
| Elevated serum alkaline phosphatase + a "hot" bone scan point to what? |
|
Definition
|
|
Term
| What is the determining diagnostic factor of Osteosarcoma? |
|
Definition
| Tumor cell production of woven bone. |
|
|
Term
| How do Osteosarcomas often present? |
|
Definition
| Pain, soft tissue swelling, pathologic fracture |
|
|
Term
| What is the most common primary bone malignancy? |
|
Definition
|
|
Term
| What causes Codman's Triangle? |
|
Definition
| Tumor raises periosteum away from bone causing a triangle of new, subperiosteal bone. |
|
|
Term
| What is an Osteochondroma caused by? |
|
Definition
| Defect in the growth plate |
|
|
Term
| What forms the major portion of an Osteochondroma? What actually grows? |
|
Definition
| Bony outgrowth (exostosis); cartilage cap |
|
|
Term
| An Osteochondroma may be secondary to what disease? |
|
Definition
| Osteochondromatosis (multiple hereditary exostoses) |
|
|
Term
| Which gender is more likely to get an Osteochondroma & why? |
|
Definition
| Boys, AD w incomplete penetrance in F |
|
|
Term
| Xray shows a paraosteal growth in the metaphysis of a teenage boys femur - what is it? |
|
Definition
|
|
Term
| Which benign tumor is caused by remnants of the cartilage growth plate that did not undergo involution to be replaced by bone? |
|
Definition
|
|
Term
| Which tumor is a benign intramedullary neoplasm of hyaline cartilage? |
|
Definition
|
|
Term
| A spontaneous mutation leading to multiple Endochondromas usually involving the hands & feet is called what? |
|
Definition
|
|
Term
| What is Mafucci's syndrome and what is it's relationship w Endochondromas? |
|
Definition
| Multiple soft tissue vascular tumors; Often malignant transformation of the lesions into chondrosarcoma |
|
|
Term
| Where are Endochondromas most likely to occur & why? |
|
Definition
| Hands & feet, a lot of growth plates |
|
|
Term
| A biopsy showing multiple lobules of hyaline cartilage & lamellar bone remains @ periphery is likely what? |
|
Definition
|
|
Term
| Xray shows a well-demarcated lytic lesion w a thin border of sclerosis @ the epiphysis of a 15 yo girl's knee - what is it? |
|
Definition
|
|
Term
| Biopsy shows round/ovoid cells w osteoclast-like giant cells, pink cartilage matrix, & "chicken wire" calcification - what is it? |
|
Definition
|
|
Term
| How does a Non-ossifying Fibroma usually present? |
|
Definition
| As an incidental finding on X-ray (could have caused fracture) |
|
|
Term
| Biopsy shows spindle cells in cartwheel arrangement w scattered multinucleated giant cells - what does your differential include? |
|
Definition
| Non-ossifying Fibroma, Giant Cell Tumor |
|
|
Term
| What age group is most likely to get a Non-ossifying Fibroma? |
|
Definition
|
|
Term
| Fibrous dyplasia is caused by chromosomal aberrations that lead to what? |
|
Definition
| Overproduction of disorganized & fibrotic bone matrix. |
|
|
Term
| What type of tumors cause Shepard's Crook deformity & what is it? |
|
Definition
| Fibrous dysplasia; Multiple fractures & repair in appendicular skeleton, ground-glass pattern of ossification |
|
|
Term
| What syndrome includes polyostotic Fibrous Dysplasia, precocious puberty, unilateral macular pigmented skin lesions, & fibromyxomatous soft tissue tumors? |
|
Definition
|
|
Term
| What precursor are Giant Cell tumors derived from? |
|
Definition
| Macrophage-monocyte precursor |
|
|
Term
| What makes Giant Cell tumors kinda not so benign? |
|
Definition
| Locally aggressive, 10% metastasize to lung |
|
|
Term
| Xray shows radiolucent lesion extending from metaphysis to articular surface w no periosteal rxn - what is it? |
|
Definition
|
|
Term
| Where is a Giant Cell tumor likely to occur? |
|
Definition
| Metaphysis, epiphysis of distal femur, proximal tibia |
|
|
Term
| What age grp/gender is most likely to get a Giant Cell tumor? |
|
Definition
|
|
Term
| When diagnosing a Giant Cell tumor, what is it important to r/o? |
|
Definition
| Other tumors w giant cells, esp brown cell tumor of hyperthyroidism |
|
|
Term
| What are the most common sites of cancers that metastasize to bone? |
|
Definition
|
|
Term
| How do Metastatic cancers to the bone usually present? |
|
Definition
|
|
Term
| Xray shows multiple combined lytic & blastic lesions in highly vascularized locations such as spine, pelvis, skull - what is it? |
|
Definition
|
|
Term
| Which malignant bone tumor is caused by a cancer of plasma cells? |
|
Definition
|
|
Term
| How does Multiple Myeloma lead to hypercalcemia? |
|
Definition
| Osteoclasts resorb bone causing lytic lesions, leads to release of calcium in blood --> hypercalcemia |
|
|
Term
| How does multiple myeloma appear in xray? |
|
Definition
| Lytic, moth-eaten pattern if lysis in skull & vertebra |
|
|
Term
| How is Multiple Myeloma diagnosed? |
|
Definition
| Bone scan, monoclonal gammopathy |
|
|
Term
| Name of a malignant tumor where the neoplastic cells form cartilage matrix? |
|
Definition
|
|
Term
| Xray shows "popcorn" appearance but invading the bone - what is it? |
|
Definition
|
|
Term
| What differentiates Chondrosarcomas from Chondromas, Osteochondromas, & Chondroblastomas? |
|
Definition
| The hyaline cartilage entraps lamellar bone |
|
|
Term
| Where do Chondrosarcomas usually occur & where do they usually metastasize to? |
|
Definition
| Pelvis, proximal femur --> lung |
|
|
Term
| What age group is most prone to Chondrosarcomas? |
|
Definition
|
|
Term
| Xray shows an "onion skin" appearance of periosteum - what is it? |
|
Definition
|
|
Term
| In what type of tumor would Membranous stain detect CD99 & PAS stain detect abundant cytoplasmic glycogen? |
|
Definition
|
|
Term
| Which age group is more susceptible to Ewing Sarcoma? |
|
Definition
|
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