Bone Path I Final

Front 1

Wimbergs sign dz and location
BONUS****5pts

Back 1

cengenital syphilis, medial surfaces of proximal tibia

Front 2

m/c loc. for osteoid osteoma

Back 2

50-60% in femus and tibia.
diaphysis w/ ext. into metaphysis.
pain releved by asparin*

Front 3

osteoid osteoma give away

Back 3

night pain relieved by aspairn

Front 4

m/c loc. for Osteoblastoma

Back 4

posterior elements of the spine(lumbar)
can also be in longbones of lower extrem w/ diaphyseal and metaphyseal ext.

Front 5

this is the 2nd m/c primary malingancy of bone.

Back 5

Osteosarcoma

Front 6

m/c primary malignancy of bone

Back 6

multiple myeloma

Front 7

what is the 3rd M/C primary malignancy of bone?

Back 7

Chondrosarcoma

Front 8

what is the 4th m/c primary malignancy of bone?

Back 8

Ewing's sarcoma

Front 9

what is the m/c malignancy of bone?

Back 9

metastasis

Front 10

what is the m/c benign tumor of bone?

Back 10

osteochondroma

Front 11

HME

Back 11

multiple osteochondromas

Front 12

HME has a 25% chance of turning into this malignancy

Back 12

chondrosarcoma

Front 13

the maximum allowance for the cartilage cap in an adult with an osteochondroma is?

Back 13

2cm, observed on MRI

Front 14

m/c benign tumor of the hand;

Back 14

Enchondroma

Front 15

what is Maffucci"s Dz?

Back 15

multiple enchondromas and soft tissue hemangiomas

Front 16

what is Olliers Dz?

Back 16

multiple enchondromas(w/ no soft tissue masses)

Front 17

what are the differences b/w GCT and Chondroblastomas?

Back 17

GCT is in older pt(closed growth plate)

Chondroblastoma is in younger pt.

Front 18

what do GCTs and chondroblastomas have in common?

Back 18

both are epiphyseal tumors. they are both m/c tumors of patella (GCT#1, Chondroblastoma #2)

Front 19

what is the rarest of all tumors? what is the location and what is the rad sign?

Back 19

chondromxoid fibroma;
loc=tibial apophysis
rad sign= bite sign

Front 20

what are the 2 lzns considered "normal variants" and are "dont touch" lzns?

Back 20

90% found in lower ext.
1)Fibrous Cortical defect"FCD"- pt 4-8yo loc@ distal posterior medial femur

2)Non-Ossifying Fibroma "NOF"- pt 8-20yo loc @ tibia

Front 21

M/C tumor of the ribs

Back 21

Fibrous Dysplasia

Front 22

M/C tumor of sacrum

Back 22

GCT- causes lytic lzn in other areas of the spine

Front 23

name the 2 lytic, expansile tumors of the spine

Back 23

ABC-loc=neural arch
Osteoblastoma-loc=post elements of lumbar spine

Front 24

M/C benign tumor of the clavicle

Back 24

ABC

Front 25

what imaging modalty will diff dx an ABC from other tumors?

Back 25

T2 MRI fluid levels b/c blood element

Front 26

what are the 2 types of SBC's? what are the differences?

Back 26

Active vs. Latent SBC's

Active is loc by the growth plate, can potentially continue growing

Latent are away from growth plate and will not grow any larger

Front 27

Location of Active SBC

Back 27

Active is loc by the growth plate, can potentially continue growing

Front 28

Location of Latent SBC

Back 28

Latent are away from growth plate and will not grow any larger

Front 29

what is classic Rad feature of a SBC?

Back 29

falling fragment sign-free floating osseous fragment

Front 30

what is the 4th m/c primary malignancy of bone?

Back 30

Ewings
-also the m/c malig in a childs pelvis

Front 31

what is the M/C malignancy of the pelvis in a child?

Back 31

Ewing's sarcoma

Front 32

what is the M/C benign tumor of the spine? what is its Sign?

Back 32

Hemangioma, cordurory cloth

Front 33

what is the signal characteristic of a hemangioma on MRI?

Back 33

high on T1 AND T2.

Front 34

lzn in central calcaneous that is lytic with central calcification. what are the signal characteristics?

Back 34

Lipoma w/ and MRI that has high t1 and low t2

Front 35

Multiple Myeloma has what lab and radiographic signs?

Back 35

punched out lzns, rain drop skull, colapse of vert bodies.

Lab=bence jones bodies, inverted A/G ratio, hypercalcemia, hyperuricemia, anemia.

Front 36

radiographic finding of Eosinophillic Granuloma of the skull, mandible, spine?

Back 36

skull= beveled edge, hole in a hole, button sequestrum

Mandible=floating teeth sign

spine= vertebra plana(silver dollar sign aka coin on coin vert.) thoracics m/c site of involvement.

Front 37

what is MC extra skeletal manifestation of pt w/ fibrous dysplasia?

Back 37

cafe-au-lait spots

Front 38

cafe-au-lait spots are associated with which two conditions?

Back 38

fibrous dysplasia, Neurofibromatosis

Front 39

"coast of maine" cafe-au-lait spots are asociated with?

Back 39

Fibrous Dysplasia

Front 40

"coast of california" cafe-au-lait spots are associated with?

Back 40

neurofibromatosis

Front 41

What are the 4 stages of Pagets Dz?

Back 41

1-osteolytic-no symptoms
2-Mixed-most pts are dx'ed
3-osteoblastic-
4-Neoplastic degeneration 10%(malignant)

Front 42

MC microbe associated with Osteomyelitis

Back 42

Staph Aureus

Front 43

what are radiograpic findings with Osteomyelitis?

Back 43

sequesterum(necroic bone low T1 and T2) and invelucrum(new periosteal shell walling off infection)

Front 44

what is Marjolin's ulcer?

Back 44

Chronic osteomyelitis with decades of no treatment(20 – 30 years) often demonstrates sinus tracts which function to decompress the infected region. This can lead to the development of squamous cell carcinoma within the sinus

Front 45

what is MCisotope used to dx Ostoemyelitis?

Back 45

Gallium

Front 46

what is the expansile, lytic, lace like lzn associated with short tubular bones in conjunction with tuberculosis

Back 46

Spina Ventosa???????

Front 47

what is a unique feature of multiple melanoma?

Back 47

T1 images are hyperintense, this is atypical of of skeletal mets

Front 48

Metastasis is what?

Back 48

spread of Dz from one location to another remote location with no direct contact to origionl site.

Front 49

what are the three forms of METs?

Back 49

1) osteoblastic- (lung, prostate, GI)
2) mixed
3) osteolytic-(breast*)

Front 50

Osteoblastic METs are asociated with?

Back 50

lung, GI, prostate. will have elevated Alk. phos.

Front 51

osteolytic METs are associated wiht cancer from what organs?

Back 51

breast cancer.

Front 52

what is the cause of primart Hyperparathyroidism(HPT)?

Back 52

Adenoma of the Parathyroid(good prognosis w removal of adenoma)

Front 53

What is the cause of secondary and tertiary Hyperparathyroidism(HPT)?

Back 53

Chronic renal Dz, renal failure (poor prognosis)

Front 54

what are the classic lab findings of primary HPT?

Back 54

hyperclacemia,

Front 55

what are calcium levels with secondary or tertiary HPT?

Back 55

low due to renal failure.

Front 56

What are the causes and radiographic signs associated with Rickets?

Back 56

-Vitamin D deficiency in kids
-Cupped metaphysic or paintbrush metaphysic
(NOTE: Osteomalacia is Vitamin D deficiency in adults)

Front 57

What is the hallmark of hyperparathyroidism and common locations?

Back 57

-Sub-periostial re-absorption of bone
-2nd and 3rd digits of hand on radial side, distal clavicle, symphysis pubis, and sacral iliac joint

Front 58

Where are the common names and locations for Osteonecrosis(AKA Avascular necrosis)?

Back 58

-AVN of scaphoid is Preiser’s disease
-AVN of lunate is Kienbock’s disease
-AVN of proximal femoral epiphysis is Legg-Calve-Perthes disease
-AVN of the 2nd and 3rd metatarsal head is Freiberg’s disease(high heels)
(NOTE: The lunate is the most common carpal bone to dislocate while the scaphoid is the most common carpal bone to fracture)

Front 59

What is the cause and radiographic findings of Scurvy?

Back 59

-Vitamin C deficiency
-Wimberger’s Ring epiphysis(wimbergers sign is seen is the medial surface of the proximal tibia with congenital syphilis)

Front 60

What is Osteochondritis Dessicans and the two most common locations affected?

Back 60

-Chondral or osteochondral defects caused by a traumatic event resulting in the sheering off of a portion of the articular cartilage over the surface of the bone, or as it sheers off the articular cartilage it also fragments and pulls a portion of the underlying bone with it causing this small little defect in the parent bone as well as giving you this fragment of cartilage and bone within this joint space.
-Most common locations are the lateral aspect of the medial femoral condyle and the medial aspect of the talor dome

Front 61

What are the essential amino acids of collagen and which one do we see at high levels when there is significant bone turnover?

Back 61

-Glycine, proline, and hydroxyproline
-Hydroxyproline is an important indicator of bone turn over

Front 62

what is the isotope used for bone scan?

Back 62

Technetium 99

Front 63

what is the isotope used for infection?

Back 63

Gallium 67

Front 64

bone marrow conversion timeline..***

Back 64

in long bones of appendicular skeleton
1)epiphyses, apophyses, and mid-diaphysis
2)distal metaphysis, proximal metapysis.

Front 65

Gardners syndrome

Back 65

multiple osteomas, colonic polyps, soft tissue tumors

Front 66

classical manifestation of of Osteoid osteoma

Back 66

night pain relieved by aspirin

Front 67

age for Osteoid osteoma

Back 67

skeletally immature, kids

Front 68

Osteoid osteoma is related to what condition?

Back 68

osteoblastoma has sclerosis. dif dx by size of nidus. (o.o. is <1cm )

Front 69

DDX for osteoid Osteoma

Back 69

•Brodie’s abscess (much larger abcess) and stress fractures are major DDX. Painful, relieved by NSAIDs. M/C region = lumbar spine (neural arch).

Front 70

DDX for Lystic Expansile LZN of spine

Back 70

-ABC=(thoracolumbar, neural arch, 5-20 yoa)

-GCT (Vertebral body, Females 3-4th decade)

-Osteoblastoma (m/c lumbar spine, posterior elements - neural arch with possible extension into vertebral body, 10-30 yoa)

Front 71

•Classic appearance of osteochondroma:

Back 71

benign, bony outgrowth (sessile = broad and flat base, pedunculated is long and narrow stalk), with cartilage cap. • Metaphysis (adj to joint facing away from joint).

Front 72

•Solitary osteochondroma has what chance of turning malignant?

Back 72

1% conversion to malignancy. M/C transformation is chondrosarcoma around 30 YOA.

Front 73

how do you DDX malignant vs. benign osteochondroma

Back 73

evaluate size and thickness of cap thru MRI if malignant. Well defined cap with regular, stippled calcification = benign. Extensive, incomplete, poorly defined calcification = malignant. Cap for kid can be upwards to 3 cm b/c growth plates. Adult, be concernd when over 2 cm.

Front 74

sequestrum appears how on MRI

Back 74

low on T1 and T2

Front 75

What are other complications involved with benign osteochondroma?

Back 75

nerve entrapment, bursa formation, fracture, osseous deformity, vascular injury (“Bowstrung” over tumor resulting in pseudoaneurysm), malignant transformation.

Front 76

what is the MC benign tumor of bone?

Back 76

Osteochondroma

Front 77

what are the MC locations to find Osteochondroma?

Back 77

M/C in Femur, humerus, tibia. seen in metaphysis pointing away from jt.

Front 78

what is the MC benign tumor of the hand?

Back 78

Enchondroma

Front 79

Mult enchondromas is what dz?

Back 79

Ollier’s Dx aka Enchondromatosis.

Front 80

•Maffucci’s Syn

Back 80

similar to olliers(enchondromatosis) but with mult soft tissue masses in hands and feet.

Front 81

what is Codman’s Tumor with pain radiating to adjacent joint.

Back 81

Chondroblastoma

Front 82

where is the typical lnxfound with chondroblastoma?

Back 82

epiphysial region next to articular surface.

Front 83

what is the second MC turmor of the patella?

Back 83

Chondroblastoma first MC is GCT

Front 84

what age group is MC with chondroblastoma?

Back 84

young

Front 85

describe the matrix of chondroblastoma

Back 85

matrix is made of cartilage, so it may calcify.

Front 86

describe a chondroblastoma on x-ray

Back 86

geographic, lytic, epiphyseal, may calcify.

Front 87

DDX chondroblastoma from GCT

Back 87

both are found in Epi.

-chondroblastoma is is younger pt, and may calcify.
-GCT is also found in the body of the lumbar spine

Front 88

where are the MC locations of NOF and FCD?

Back 88

long bones of lower ext.

Front 89

What are possible complications of NOF and FCD?

Back 89

Don’t normally become malignant but can cause pathological fracture. Not neoplastic, just poor bone being layed.

Front 90

what is location of GCT?

Back 90

Epiphyseal(DDX from chondroblastoma), spine, patella.

Front 91

what is the MC tumor of the patella?

Back 91

GCT

Front 92

what is the MC malignant tumor of the sacrum?

Back 92

GCT

Front 93

what is the MC age group for SBC?

Back 93

<14yo

Front 94

what is the classic sign for SBC?

Back 94

fallen fragment sign.

Front 95

describe the histology of SBC

Back 95

not a true neoplasm, fibrous lined, fluid filled cyst. (high on T2, low in T1)

Front 96

what is the MC location of SBC?

Back 96

•Proximal humerus and femur right up against growth plate

Front 97

describe x-ray appearance of SBC

Back 97

•Produce cortical thinning with no periosteal reaction
•Fallen Fragment Sign = classic sign. Fluid filled chamber with cortex weakened and piece falls in.

Front 98

describe histo appearance of ABC

Back 98

•Contain flowing blood within vascular channels

Front 99

what age pt. and what sx may present to your office with ABC.

Back 99

•Rare and found in ages 5-20
•Acute pain, pathological fractures. •

Front 100

what are MC locations for ABC

Back 100

M/C femur and tibia
•Spinal lesions involve neural arch of thoracolumbar region

Front 101

DDX for ABC are?

Back 101

DDX: GCT, osteoblastoma

Front 102

Ewings sarcoma is the ONLY neoplasm to do what?

Back 102

•simulates infection; only neoplasm to do so

Front 103

DDX for Ewings sarcoma are?

Back 103

osteosarcoma, lymphoma, infection***

Front 104

what is the MC tumor found in the pelvis of a child?

Back 104

Ewings sarcoma

Front 105

•what is the M/C benign tumor of spine (m/c thoracolumbar region)

Back 105

Hemangioma- Affect the vertebral body and may expand into neural arch.

Front 106

how will a Hemangioma look on x-ray?

Back 106

Skull-(frontal and parietal lobes). “Spoked-Wheel” appearance b/c of geographic, lytic defect with dense spicules radiating from center of lesion

-Spine; (mc thoracolumbar)Corduroy cloth appearance. Mimicked by Paget’s Disease

Front 107

who is MC pt with Hemangioma?

Back 107

•Women, skeletally mature > 40 YOA.

Front 108

hemangioma on MRI will be:***

Back 108

high on T1 and T2***

Front 109

DDX for Hemangioma

Back 109

•DDX: Osteoporosis, Paget’s Disease, Renal Osteodystrophy

Front 110

what are classic signs for lipomas?

Back 110

•Target sign = classic feature on X-Ray. Central portion necrotic with calcium deposits but outer area fatty so lucent.

•Classic MRI feature = high T1 and low T2 and really low on fat suppressed.

Front 111

what is classic for a lipoma on MRI?

Back 111

•Classic MRI feature = high T1 and low T2 and really low on fat suppressed.

Front 112

this tumor is a remnant of the notochord.

Back 112

Chordoma

Front 113

Chordoma will only appear where in the skeleton?

Back 113

Only place it occurs is in the spine. M/C = Sphenooccipital (clival) or sacrococcygeal region.
• Only primary malignant tumor of bone that spreads to adjacent vertebral segments by crossing the IVD

Front 114

chordoma is the only primary malig tumor to do this...

Back 114

•Only primary malignant tumor of bone that spreads to adjacent vertebral segments by crossing the IVD

Front 115

kahlers dz is a aka for?

Back 115

Mult. Myeloma.

Front 116

what are the lab findings with Multiple Myeloma?

Back 116

oCBC: normocytic, normochromic anemia and thrombocytopenia. Slight leukocytosis. Elevated ESR.

oBlood Chem: Hypercalcemia, Amyloid Kidney, inverse A/G ratio***, IgG predominates, Bence Jones’ proteins***, hyperuricemia,

Front 117

a punched out lzn is the hallmark of what?

Back 117

•Hallmark lesion of sk. Multiple myeloma

Front 118

•when the Calvaria is involved with mult. meloma you will see.

Back 118

raindrop skull.

Front 119

what is expected to be seen on bone scan with Multiple myeloma?

Back 119

•Immunoglobulin accelerate osteoclasts without osteoblast increase. Bone scan will be cold (photopenia)

Front 120

what can be seen in the spine with Mult. Myeloma?

Back 120

•Vertebra plana = pathological collapse of the vertebral body as a whole. Different than wedge fracture in osteoporosis

Front 121

•Vertebra plana is seen in what?

Back 121

multiple myeloma, pathological collapse of the vertebral body as a whole. Different than wedge fracture in osteoporosis

Front 122

what is ivory vertebra and what conditions will you see this?

Back 122

•Ivory vertebra = purely osteoblastic lesions.

-metastatic disease, and Paget’s. Metastatic breast cancer

Front 123

DDX for Multiple Myeloma:

Back 123

metastasis and lymphoma. Favors red marrow in posterior elements. Affects vertebral bodies and spares the neural arch unlike metastasis. Raindrop skull will have uniform size unlike metastasis.

Front 124

what age group is MC for EG(eosinophilic granuloma)?

Back 124

•¾ of pts will be less than 20 years old (skeletally immature). 5-10 years = peak

Front 125

what are the image findings for: EOSINOPHILIC GRANULOMA

Back 125

•P 84 imaging findings:
Skull - Hole within a hole, beveled edge, button sequestrum.

Mandible - floating tooth sign,

Spine – thoracic most involved, silver dollar vertebra aka vertebra plana aka coin-on-edge vertebra

Front 126

DDX for : EOSINOPHILIC GRANULOMA

Back 126

Ewing’s sarcoma, osteosarcoma, osteomyelitis, leukemia, lymphoma, fibrous dysplasia.

Front 127

this is known as "the great imitator of bone DZ"

Back 127

Fibrous dysplasia

Front 128

•what is the Main extraskeletal manifestation with Fibrous dsplasia?

Back 128

•Main extraskeletal manifestation is café au lait spots (Coast of Maine).

Front 129

what bones are affected by FD?

Back 129

•Can affect any bone. M/C benign lesion of ribs may demonstrate extrapleural sign

Front 130

how will FD appear on x-ray?

Back 130

•Sometimes lucent, sometimes opague, sometimes looks like Paget’s Dx

Front 131

what is seen with FD?

Back 131

• Fibrous tissue where bone should be = weakened area. Bowing deformity aka Shepherd’s crook (femoral angle near 90 degrees creating coxa vara), sabre shin deformity, pseudofracture

Front 132

what is Shepherd’s crook?

Back 132

•Fibrous dysplasia; Bowing deformity aka Shepherd’s crook (femoral angle near 90 degrees creating coxa vara), sabre shin deformity, pseudofracture

Front 133

how do you DDX FD from rickets and osteomalacia?

Back 133

DDX by which side fracture is on. F.D. and Pagett’s on convex, Rickett’s and osteomalacia on concave side

Front 134

how will FD appear on bone scan?

Back 134

bright, shows increased uptake of isotope.

Front 135

what age is MC w pagets dz?

Back 135

over 40 yo

Front 136

at what stage are most cases of Pagets Dx'ed?

Back 136

stage 2

Front 137

at what stage is pagets cosidered malignant?

Back 137

stage 4

Front 138

how does pagets MC become malignant?

Back 138

• M/C neoplastic malignancy development is osteosarcoma then fibrosarcoma. Know picture frame vertebra in stage 2, the name in stage 1; ivory vertebra in stage 3

Front 139

DDX pagets

Back 139

osteoblastic mets, lymphoma, paget’s (All similar age groups > 40, only paget’s has bony enlargement).

Front 140

what lab findings are common for METS?

Back 140

Hypercalcemia, hydroxyprolinuria, hydroxyprolinemia, elevated alkaline phosphatase, myelophthisic anemia. Eleveated blood acid phosphatase with prostatic mets.

Front 141

what are the typiclas locations for METS?

Back 141

Prostate (blastic), Breast (mixed), Lung (mixed), RATS (Renal, Adrenal, Thyroid, Skin) blowout metastasis = lytic and expansile

Front 142

what mets are lytic and expansile?

Back 142

RATS (Renal, Adrenal, Thyroid, Skin) blowout metastasis = lytic and expansile

Front 143

what si MC cause for osteomyelitis?

Back 143

staph aureus and transmission is hematogenous

Front 144

what condition will have a heel pad to increase to >20cm?

Back 144

Acromagaly

Front 145

wimbergers ring is associated with?

Back 145

scurvy.

Front 146

MC benign tumor of the skeleton is

Back 146

osteochondroma