Misshapen or Broken Bones
Second most common bone disease after osteoporosis, also called Osteitis Deformans
Paget's Disease of bone
First… what's the difference?
Rickets - open growth plates
Osteomalacia - closed growth plates…
Both defined as an inability to mineralize osteoid… but why??
Grossly bloody fluid; WBC <200; PMN <10%
Traumatic injury (hemarthrosis)
Traumatic tap
Hematalogic disease (hemophilia)
Cotton-wool appearance to the skull and combination lytic/blastic lesions of the pelvis and long bones. DEXA shows multitude of "hot spots" showing high bone turnover
Paget's Disease of bone
(+) Rheumatoid Factor
Trick question: suggestive of autoimmune disease, but not sensitive or specific enough for diagnosis... keep testing
58 year old with T2DM, HTN, CHF, and on dialysis. Serum Ca WNL, PTH elevated. (diagnosis and treatment)
Secondary hyperparathyroidism
Treat with: Vit D supplementation ± Ca supplement
67 year old computer programmer from MI, spends most of his time indoors and rarely exercises. Diet mostly consisting of delivery from fast-food restaurants. Complaint of low back pain, rib pain, and muscle weakness
Vitamin D deficient Osteomalacia
Knee aspirate, turbid/cloudy fluid; WBC 14000; PMN 67%; positively birefringent
Pseudogout
Elderly person with complaints of chronic finger pain. On plain films you notice radial deviation at the MCP joints with radiographic intra-articular erosions at the edge of the articular cartilage
Rheumatoid Arthritis
High clinical suspicion for avascular necrosis of the femoral head. What is the best diagnostic tool?
MRI
9 year old, short stature, showing early signs of hearing loss, history of multiple fractures during non-contact sports
Osteogenesis Imperfecta (COL1A1, or COL1A2 genes)
45 year old female with a low-impact fracture of her humerus while playing pickup basketball. History significant for HTN, seizure disorder as a kid. No previous fracture history.
Long-term anticonvulsant use (phenytoin) causing osteomalacia
Clear, pale yellow fluid; WBC <200, PMN <10%
Normal Finding
30 year old female with non-specific, episodic hand and knee pain. Radiographs of the hands and kenes are negative for pathology. Previous appointments over the last 3 years made for photosensitivity, facial skin rash, and chronic GI upset
Systemic Lupus Erythematosus (SLE)
43 year old male with chronic iritable bowel. Plain film of his abdomen showes diffuse osteophyte formation across all vertebrae
Ankylosing Spondylitis
45 year old male, born-again Christian, previous medical history of heavy alcohol abuse and ESLD, s/p liver transplant 8 months prior
Tansplantation Osteodystrophy; chronic immunosupressant use (glucocorticoids, cyclosporine, tacrolimus)
53 year old male with incidental abnormal laboratory findings of serum calcium at 14.6, and PTH of 180 (normal 20-70). Further questioning reveals muscle weakness, sensitivity to touch over the cheeks, and chronic increasing low back/pelvic pain and a nodule on the anterolateral neck
Parathyroid adenoma/carcinoma, leading to hyperparathyroidism, leading to clinical osteomalacia
Very cloudy fluid; WBC 79,000; PMN 90%; with pelvic/abdominal pain
Septic arthritis, ddx gonorrhea
45 year old male, thinks he was diagnosed with eczema as a kid, no recent follow up. Primary complaint of insidious finger pain. Radiographs showing significant joint erosion with "telescoping" of the proximal bone into the distal bone
Psoriatic Arthritis
63 year old female with new onset blurry vision, jaw and tongue pain while chewing, tinnitus, and stiffness in her neck, shoulders, and hips
Giant Cell Arteritis/Temporal Arteritis
7 year old child of parents living in a commune, born at home with minimal medical care since birth. Complaints of low-grade stomach and body aches, with pain in the knee. Physical exam shows hepatosplenomegaly. Labs significant for pancytopenia. Hip radiograph shows Erlenmyer flask deformity of the distal femur. Bone marrow biopsy shows lipid-laden macrophages
Gaucher Disease - non-fatal subtype
48 year old male with complaints of worsening bone pain. Previous workup largely inconclusive, but included chronic low-grade metabolic acidosis, and high urinary pH with calcium phosphate crystals
Type I RTA induced osteomalacia
Hip aspirate, cloudy fluid; WBC 20,000; PMN 55%; new onset cough with radiographs showing hilar lymphadenopathy and perihilar infiltrates
Poncet Disease/Skeletal TB
Chronic bone pain and abnormal lab results. Radiographs showing "salt-and-pepper" appearance to the skull, and finger radiographs showing subperiosteal bone resorption. Histologic analysis of finger lesion shows benign giant cell tumor. Following appropriate treatment, repeat radiographs show normal appearing bone
Hyperparathyroidism
Painful joint with enlarging mass at the joint line. Biopsy of the mass shows crystalline uric acid
Gout