Term
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Definition
| A tissue covering the bone that brings blood and lymph vessels, as well as nerves, to it |
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Term
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Definition
| Prior to puberty, this disk of cartilage produces more cartilage which then is converted into more bone. In this way, the bone grows lengthwise. It is stimulated by growth hormone and inhibited by estrogens & progesterone. |
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Term
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Definition
| (also known as trabecular or cancellous bone). The mineral deposits are arranged as a system of struts. Bone marrow fill the spaces between. |
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Term
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Definition
| (also known as cortical bone). Dense deposits of minerals - chiefly calcium phosphate - and collagen. |
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Term
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Definition
| Some bones, such as the femur, also contain a central cavity filled with bone marrow. Bone marrow contains the stem cells that gives rise to all the types of blood cells. |
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Term
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Definition
CLEAN-UP CELLS
DISSOLVE OLD BONE & REMOVE IT |
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Term
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Definition
BUILD-UP CELLS
MAKE NEW BONE
RESPOND TO STRESS (FORCES) IN BONE |
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Term
| Cortex is thicker according to applied _________ |
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Definition
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Term
| what are the three phases of a triple phase nuclear medicine bone scan? |
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Definition
1. arterial (angiographic)
2. tissue (static)
3. whole body |
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Term
| what is another name for osteopetrosis? what is it? |
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Definition
marble bone dz
defect in osteoclastic bone activity (new bone is formed- osteoblastic activity- old bone is not cleared away; calcified matrix does not progress to remodeled haversian systems and bone remains weak |
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Term
| in the ppt, an ivory vertebrae is associated with what? |
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Definition
| metastases from carcinoma of the breast- radiodense vertebrae |
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Term
| what is the 1st and 2nd change in avascular necrosis of the hip? |
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Definition
1st: separation of cartilage and cortical bone
2nd: bone undergoes necrosis and fragmentation |
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Term
| AVN of the hip is particularly common in what population? |
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Definition
| overweight, pubertal males |
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Term
| in the ppt, the crescent sign is associated with what pathology? |
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Definition
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Term
| AVN is common with what chronic dz, why? |
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Definition
| sickle cell dz- multiple repeated microemboli infarct the growing plates of bones |
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Term
| what is "snow capping" associated with? |
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Definition
| AVN- on the picture of the humerus |
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Term
| what is diagnostic of a medullary bone infarct? |
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Definition
| the geographic calcific membrane |
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Term
| what is the DDX for a medullary bone infarct? |
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Definition
| bone infarct, bone cyst, and enchondroma |
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Term
an enchondroma:
-solitary or multiple?
-where?
-slow or fast growing?
-describe the cartilage
-thin or thick cortex? |
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Definition
-both
-diaphyseal
-in the medullary canal
-slow growing
-stippled, arc or ring of calcification of cartilage
-thin cortex |
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Term
| 4 characteristic of a simple bone cyst |
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Definition
-fluid filled
-usually oval
-extends axially
-may fx |
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Term
| simple bone cysts often present as ________ |
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Definition
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Term
| what is paget's disease thought to be caused by? |
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Definition
| chronic paromyxovirus infection |
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Term
| in paget's disease the what happens: what is wrong with the osteoblastic activity? describe the osteoid. what happens to the overall bone? |
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Definition
-osteoblastic activity is more rapid than normal
-osteoid remains calcified w.out bone formation
-bones enlarge, are more dense, and are weak |
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Term
| a lucent bone with thinned cortex and loss of trabecular pattern is characteristic of what |
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Definition
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Term
| in osteoporosis are ca and phosphorous normal? |
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Definition
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Term
| osteoporosis is based off the T score of DEXA scans, what are the classifications for osteopenia and osteoporosis? |
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Definition
-osteopenia: 1-2.5 SD units below normal young adult mineralization
-osteoporosis: >2.5 SD below |
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Term
| whats a common sx of hyperparathyroidism? |
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Definition
| resorption (erosion) of distal end clavicle- not more frequently present than hand changes, but more frequently found because of chest xrays |
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Term
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Definition
| bone is resorbed locally and replaced with fibrous matrix and blood |
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Term
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Definition
-cartilaginous matrix laid down at growth plate
-calcification does not occur normally
-ossification does not occur
-end plats continue to lay down cartilage producing the flared bone end appearances |
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Term
| who is rickets most common in? when is the usual onset? what are 4 causes? |
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Definition
-premature babies
-6 mos-1 year
-causes: malnutrition, lack of vitamin D, lack of sunlight exposure, hereditary (PO4 losing renal disease- fanconi's, inability to absorb fat- Vit d deficiency) |
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Term
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Definition
| hallmark of osteolmalacia in adults, short wide lucent bands, perpendicular to the cortex, surrounded by sclerotic margins |
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Term
| what are 4 common osteoblastic metastases? |
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Definition
| prostate, breast, lymphoma, carcinoid |
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Term
| what are 4 common osteolytic metastases ? |
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Definition
lung (MC males)
breast (MC females)
renal cell
thyroid |
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Term
| what does solitary palsmacytoma look like? how is it distinguishable from multiple myeloma? |
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Definition
-soap bubble appearance
-confined to 1 focus
-same cell type as myeloma (monocloncal B cell antibody) so may progress to multiple myeloma |
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Term
| multiple punched out lesions is characteristic of.... |
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Definition
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Term
| in addition to liver and lung, what other carcinoma has a predilection for long bones |
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Definition
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Term
| a nutrient canal is very hard to distinguish from a fx, what is usually required to differentiate? |
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Definition
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Term
| what is an angulated fx? distracted fx? |
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Definition
-deformity of axis distal to proximal fragments
-longitudinal separation without angulation |
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Term
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Definition
| any fracture that made a communication with extracorporeal location |
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Term
| starting with the most proximal portion of a long bone, name the portions of the bone |
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Definition
-epiphysis
-metaphysis
-diaphysis
-metaphysis
-epiphysis |
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Term
| what is the name of the classifications system used to predict the complication pathways of epiphyseal fx's? |
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Definition
salter harris
severity increases with number
type 2 is the most common |
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Term
| what are 2 incomplete fractures that are very common in peds? |
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Definition
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Term
| how can you distinguish a fx from an epiphyseal plate? |
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Definition
| fracture is blacker and the margins are more irregular |
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Term
| what is a dislocation? subluxation? |
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Definition
-dislocation: complete lack of joint integrity
-subluxation: maintains some joint contact |
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Term
| what is a clay shovelers avulsion? |
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Definition
| fracture C7 spinous processes |
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Term
| runners commonly get stress fractures where? |
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Definition
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Term
| what fx is associated with a fall on an oustretched hand (FOOSH)? |
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Definition
colles' fx
-dorsal angulation of the distal radius, or ventral angulation of the fx apex |
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Term
| what is the name for a reverse colle's fx? |
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Definition
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Term
| what fx is the same mechanism as a colles' fx but a younger pt? |
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Definition
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Term
| what is extremely useful in elbow fx's/dislocations before complete organization and calcification of epiphyses? |
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Definition
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Term
| hill sachs fx occurs with what? |
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Definition
| anterior dislocation of the shoulder |
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Term
| what is a more common fracture site of the hip- surgical neck or intertrochanteric? |
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Definition
| intertrochanteric is more common |
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Term
| how should an xray be performed to visualize hip fx? |
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Definition
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Term
| fractures at different stages of ________ are highly suggestive of what chronic child abuse./ |
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Definition
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Term
| how many weeks does a fx usually take to heal? |
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Definition
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Term
| healing of a fx starts within how many weeks? what are the three types of healing? |
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Definition
2-3 weeks
1. delayed union: monthly xray shows progress (none in 3-5 months warrants intervention)
2. non-union: healing of bone ends without bony connectivity (may have fibrous connection, fx ends are usually calcified or ossified, may develop synovial pseudoarthrosis)
3. malunion: healed with poor anatomical results, will likely result in proximal and distal destructive joint arthritis |
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Term
| arthritis usually occurs with joint narrowing or widening? |
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Definition
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Term
| what are the two classifications of arthritis? explain each |
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Definition
-hypertrophic: bone formation at joint site, subchondral sclerosis, osteophytic
-infectious: joint swelling and destruction of segments of cortical bone adjacent, erosive marginal irregular lytic lesions on or around joint surface |
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Term
| osteoarthritis (DJD) is usually degeneration of articular cartilage secondary to stress- what are 4 signs on film? |
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Definition
-osteophyte formation (hallmark)
-subchondral sclerosis
-subchondral cysts
-narrowing of joint space |
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Term
| erosive arthritis may lead to what, which is uncommon in DJD? |
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Definition
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Term
| what is charcot's arthropathy- what is the 2 step etiology? who is it commin in? |
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Definition
-diabetics now (formerly syphillitics)
-2 steps:
1. propioception loss : increased traumatic placement of insensate lower extremities while weight bearing
2. neuropathy causes the extremity to receive an increase in blood flow- the increased blood flow leads to osteopenia due to a mismatch in bone destruction and synthesis |
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Term
| what are 2 ways to get septic arthritis? what is the pathology? |
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Definition
-hematogenous seeding or joint invasion
-rapid destruction of bone from digestion by proteolytic enzymes released from WBCs and synovium-- usually monoarticular |
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Term
| is rheumatoid arthritis uni/bilaterial? symmetrical/nonsymmetrical? |
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Definition
| bilateral and symmetrical |
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Term
| in RA you see periarticular __________ and periarticular ___________ |
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Definition
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Term
| what do rheumatoid lung nodules look like? |
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Definition
| round granulomatous lesions which break down centrally and may cavitate |
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Term
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Definition
| presence of uric acid crystals incites inflammatory synovial response, clumps of urate crystals (tophi) form along articular margins and erode bone |
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Term
| what are 3 rheumatoid variants? |
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Definition
ankylosing spondylitis
reiter's syndrome
psoriatic arthritis |
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Term
| what is ankylosing spondylitis? what are 2 characteristics? |
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Definition
-disorder of the muscular or tendinous attachment to bone
-calcification and ossification of areas of tenon insertion, cartilage, CT
-bilateral, symmetric ossification of SI joints is diagnostic |
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Term
| what is the term for what the spine looks like in ankylosing spondylitis? where does it start and where does it proceed? what is is associated with? what is the ddx? |
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Definition
-bamboo spine
-starts at L5/S1 and proceeds cephalad
-eventually solidifies the entire spine to the base of the skull
-may be associated with ulcerative colitis
-DISH is the ddx |
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Term
| what is DISH (diffuse idiopathic skeletal hyperostosis)? what is a common feature? what are required characteristics? |
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Definition
-when spinal ligaments turn into bone- affects the ligaments of the spine, esp the anterior longitudinal ligament
-can cause syndesmophytes (bony outgrowth attached to a ligament) and tendonitis at sties other than the spine (knee, ankle, elbow)
-must involve at least 4 contiguous vertebrae of the thoracic spine, preservation of the intervertebral disc space, and absence of apophyseal joints or sacroiliac inflammatory changes |
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Term
| Psoriatic arthritis affects distal or proximal IP joints? is it symmetrical or asymmetrical? what are 3 characteristic findings? |
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Definition
-distal IP joints
-asymmetric joint destruction
-no periarticular osteoporosis
-3 findings
1. bony ankylosis of IP joints hands and feet
2. like reiter's--> erosions at ligament insertions
3. hallmark!: erosions of metatarslas and phalanges--> cupping and penciling of joints |
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Term
| what joints does rheumatoid arthritis affect first? |
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Definition
| MP and proximal IP joints |
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Term
| reiters syndrome: what are the 3 complaints? usually secondary to what? what joints does it affect? |
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Definition
-arthritis, uveitis, urethritis
-gonorrhea
-SI joints asymmetrically, heels (calcaneous at achilles tendon) , toes |
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Term
| the erosions of reiters arthritis, like rheumatoid, are periarticular. what differentiates the two? |
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Definition
-reiters does NOT deform the joints like rheumatoid
-reiters is Asymmetric
-involves feet>hands |
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Term
| Patient comes to your clinic following a fall on her outstretched hand. What is the best exam to order? What should you do next? |
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Definition
xray of wrist first
then cast and repeat xray wrist in 10-14 days or MRI wrist without contrast |
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Term
| 22 yo M w/ Sickle Cell Disease presents with acute L hip pain |
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Definition
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Term
| what are 4 causes of avascular necrosis? |
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Definition
sickle cell dz
steroids
vasculitis
trauma |
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Term
| 35 yo M comes into clinic after rolling his ankle. Pt meets Ottawa Rules. |
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Definition
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