31 - housemaids knee is inflammation of which bursa?
a- subpatellar
b- suprapatellar
c- infrapatellar
d- pre patellar
answer is d. pre- patellar bursitis .
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32 - bone growth is influenced maximally by ?
a- estrogen
b- thyroxine
c- growth hormone
d- testesterone
answer is c.
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33 - albert schonberg disease is also called as ?
a - osteoporosis
b- osteodystrophy
c- osteopetrosis
d- osteitis punctata
answer is c . OSTEOPETROSIS .
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34 - trident hand is seen in
a- achondroplasia
b- scurvy
c- mucopolysaccaridosis
d- none
answer is a .
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35 - rocker bottom foot is seen in?
a- congenital vertical talus
b- CTEV over correction
c- grice procedure
both a and b are right .
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36 - ganglion is most commonly seen over ?
a- dorsal aspect of wrist
b- volar aspect of wrist
c- over forehead
d- dorsum of the tongue
answer is a.
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37 - calcitonin is secreted by ?
a- thyroid gland
b- parathyroid gland
c- adrenal gland
d- ovaries
answer is a . the thyroid gland . and this is the reason calcitonin is useful as tumor marker in the medullary carcinoma of the thyroid.
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38 - all of the following can cause osteoporosis except
a- hyperparathyroidism
b- steroids use
c- fluorosis
d- thyrotoxicosis
answer is c . fluorosis does not cause osteoporosis .
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39 - rugger jersey spine is seen in ?
a- fluorosis
b- achondroplasia
c- renal osteodystrophy
d- marfan's syndrome
answer is c .
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40 - spina ventosa is seen in ?
a- tuberculosis dactylitis
b- meningo myelocele
c- malignant melanoma
answer is a .
Showing posts with label renal osteodystrophy. Show all posts
Showing posts with label renal osteodystrophy. Show all posts
Thursday, January 3, 2008
26 - rugger jersey spine
Renal Osteodystrophy
· Constellation of musculoskeletal abnormalities occurring with chronic renal failure featuring some combination of
o Osteomalacia (adults)
o Rickets (children)
o 2° hyperparathyroidism
o Soft-tissue calcifications
o Osteosclerosis
o Soft-tissue + vascular calcifications
· Low calcium levels lead to osteomalacia
o Additional factors responsible for osteomalacia are
§ Inhibitors to calcification produced in the uremic state
§ Aluminum toxicity
§ Dysfunction of hepatic enzyme system A
§ Renal insufficiency with diminished filtration results in phosphate retention
· Maintenance of Ca x P product lowers serum calcium directly, which in turn increases parathyroid hormone production (2°hyperparathyroidism)
· Osteopenia
o Combined effect of
§ Osteomalacia (reduced bone mineralization due to acquired insensitivity to vitamin D / antivitamin D factor)
§ Osteitis fibrosa cystica (bone resorption)
§ Osteoporosis (decrease in bone quantity)
o Complications
§ Fracture predisposition (lessened structural strength) with minor trauma
· Spontaneously
§ Fracture prevalence increases with duration of hemodialysis + remains unchanged after renal transplantation
· Sites of fractures
o Vertebral body (3-25%)
o Pubic ramus, rib (5-25%)
o Milkman fracture / Looser zones (in 1%)
o Metaphyseal fractures
o Prognosis
§ Osteopenia may remain unchanged / worsen after renal transplantation + during hemodialysis
· Secondary hyperparathyroidism
o Cause
§ Inability of kidneys to adequately excrete phosphate leads to hyperplasia of parathyroid chief cells (2° hyperparathyroidism)
§ Excess parathyroid hormone affects the development of osteoclasts, osteoblasts, osteocytes
o Hyperphosphatemia
o Hypocalcemia
o Increased PTH levels
o Subperiosteal, cortical, subchondral, trabecular, endosteal, subligamentous bone resorption
o Osteoclastoma = brown tumor = osteitis fibrosa cystica (due to parathyroid hormone -stimulated osteoclastic activity
§ More common in 1° hyperparathyroidism
o Periosteal new-bone formation (8-25%)
o Chondrocalcinosis
§ More common in 1° hyperparathyroidism)
· Osteosclerosis (9-34%)
o One of the most common radiologic manifestations
§ Most common with chronic glomerulonephritis
o May be the sole manifestation of renal osteodystrophy
o Diffuse chalky density
o Thoracolumbar spine in 60% with dense end-plates produce appearance of rugger-jersey (rugger jersey spine)
Rugger-jersey spine in
Renal osteodystrophy
o Also in pelvis, ribs, long bones, facial bones, base of skull (children)
o Prognosis
§ May increase/regress after renal transplantation
· Soft-tissue calcifications
o Metastatic secondary to hyperphosphatemia (solubility product for calcium + phosphate exceeds 60-75 mg/dL in extracellular fluid)
§ Hypercalcemia
§ Alkalosis with precipitation of calcium salts
o Dystrophic secondary to local tissue injury
§ Location
· Arterial (27-83%)
o In medial + intimal elastic tissue
§ Dorsalis pedis a., forearm, hand, wrist, leg
o Pipestem appearance without prominent luminal involvement
· Periarticular (0-52%)
o Multifocal
o Frequently symmetric
o May extend into adjacent joint
o Chalky fluid / pastelike material
o Inflammatory response in surrounding tenosynovial tissue
o Discrete cloudlike dense areas
§ Fluid-fluid level in tumoral calcinosis
o Prognosis
§ Often regresses with treatment
· Treatment
o Decrease of phosphorus absorption in bowel
o Vitamin D3 administration (if vitamin D resistance predominates)
o Parathyroidectomy for 3° hyperparathyroidism (= autonomous hyperparathyroidism)
the picture below shows how a rugger jersey looks like-- with alternating bands .
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