Bone Density

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  1. What doe DXA stand for?
    dual x-ray absorptiometry
  2. the skeleton is the store house for:
    essential minerals
  3. literal term for porous bone
    osteoporosis
  4. what protein maintains the skeletons flexibility?
    collagen
  5. What happens to excess calcium that is not absorbed into the bone?
    excreted through the kidneys
  6. what are the 3 cells of the bone?
    • 1.) osteocytes
    • 2.) osteoblasts
    • 3.) osteoclasts
  7. what are Osteoblasts?
    bone-producing cells
  8. What cell is responsible for bone remodeling?
    osteoclasts
  9. What bone cell has multi-nucleated cells that contain and secrete calcium-dissolving acids?
    osteoclasts
  10. What are the 2 major types of bone?
    • cortical 
    • trabecular
  11. what is cortical bone
    • dense, tightly aligned
    • compresses in a limited number of directions (ex. skull and femur shaft)
  12. where is trabecular bone found?
    locations that receive either low mechanical stresses or multi-directional stresses (femoral head, calcaneus)
  13. what are 3 ways to characterize bone for DXA?
    • 1 weight bearing/ non weight bearing
    • 2 axial/ appendicular
    • 3 central/ peripheral
  14. Which bones are weight bearing?
    spine and lower extremities (including calcanious)
  15. which bones are part of the axial skeleton?
    skull, ribs, sternum and spine
  16. which bones are part of the appendicular skeleton?
    all extremeties
  17. What part of the skeleton is a central site?
    • thoracic and lumbar spines
    • proximal femure
  18. what is included in the peripheral skeleton sites?
    calaneus, tibia and forearm
  19. at what age range is peak bone mass reached?
    30-35 yr
  20. peak bone mass is generally ___% higher in men than women
    30%
  21. age related bone loss in men happens ___-___ years later in life than in women
    10-15
  22. in a mature adult about ___% of trabecular bone is renewed on an annual basis
    25
  23. in a mature adult about ___% of cortical bone is renewed on annual basis
    3
  24. about ___% of bone surface is resting at any given time
    90
  25. what happens when osteoclasts become active?
    they create small cavities in the bone surface
  26. most of the adult skeleton is ___ every 10 years
    replaced
  27. what are the 3 calcium-regulating hormones?
    • Parathyroid hormone (PTH)
    • Calcitrol (active vitamin D)
    • Calcitonin
  28. which systemic hormones regulate bone growth?
    • growth hormone/ insulin-like hormone
    • growth factor
    • thyroid hormone
    • cortisol
  29. which hormone increases intestinal absorption of calcium?
    calcitriol
  30. What hormone in small amounts is necessary for normal bone development but in large amounts blocks growth?
    cortisol
  31. what is a synthetic form of cortisol?
    glucocorticoids
  32. highest stress impacts occur to the ______ due to compression loading
    vertebral spine
  33. what are the 2 alternate imaging modalities for 3-D evaluation of trabecular bone
    • micro-computed tomography (mCT)
    • MRI
  34. what is microdamage?
    fatigue to bone that occurs from daily physiologic loading to the skeleton
  35. how many bones are in the axial skeleton?
    80
  36. how many bones are in the adult appendicular skeleton
    126
  37. what are the shape classifications of bones?
    • long
    • short
    • flat
    • irregular
  38. what is Arthrology
    study of joints or articulations
  39. what are the common functional classifications of joints?
    • synarthosis
    • amphiarthrosis
    • diarthrosis
  40. synarthrosis-
    immovable joint
  41. amphiarthrosis-
    limited movement joint
  42. diarthrosis-
    freely movable joint
  43. what is the definition of a structural classification
    based on the type of tissue that separates the ends of the bone
  44. what are the 3 structural joint categories
    • fibrous
    • cartilaginous
    • synovial
  45. Fibrous joint-
    lacks a joint cavity and adjoining bones are held together by fibrous connective tissue
  46. Cartilaginous joints-
    lack a joint cavity and are only slightly movable.
  47. Synovial joints-
    freely movable with a fibrous capsule containing synovial fluid
  48. The development of critical thinking skills allows imaging professionals to:
    A) interpret and analyse ethical theories
    B) evaluate the application of ethical theories to a given situation
    C) plan an appropriate course of action
    D) all of the above
    D) all of the above
  49. Today, in the US ___ million people already have osteoporosis.
    a) 2
    b) 4
    c) 6
    d) 10
    • D) 10
    • and almost 34 million more have low bone mass
  50. Nearly 1 in 5 hip fracture patients end up in a nursing home.
    a) True
    b) false
    a) true
  51. Experts predict that by 2025, the direct care expenditure costs in the US will rise to approximately ___ billion
    A)5
    B)10
    C)25
    D)30
    C)25
    (this multiple choice question has been scrambled)
  52. All of the following are calcium regulating hormones except:
    A) parathyroid
    B) calcitriol
    C) calcitonin
    D) insulin
    D) insulin
    (this multiple choice question has been scrambled)
  53. Insulin-Like growth factor (IGF-1) is produced in large amounts int the:
    a) liver
    b) pancreas
    c) gallbladder
    d) thyroid
    • a) liver
    • IGF-1 is produced in large amounts in the liver and locally produced in other tissues, particularly in bone
  54. In the mature adult, approximately ___% of trabecular bone and about ___% of cortical bone is renewed on an annual basis.
    A. 35, 5
    B. 25, 3
    C. 18,2
    D. 12, 1
    B. 25, 3
    (this multiple choice question has been scrambled)
  55. Even when there is no fracture many people with ___ & ___ may suffer from bone pain.
    • Osteomalacia
    • Rickets
  56. How long does the rapid phase last?
    4-8 years
  57. Women have ___ phase of age related bone loss
    2
  58. Gonadatropin-releasing hormone agonists are used in men and women to treat what?
    • Prostate cancer
    • endometriosis
  59. ___% of patients with Paget's disease are men
    60
  60. Which IO has frequent fracture and short stature?
    type III
  61. What is the adult equivalent of Rickets?
    Osteomalacia
  62. What are the 7 clinical risk factors for FRAX?
    • prior low trauma fracture
    • rheumatoid
    • high alcohol intake
    • systemic steroid use
    • parental history of hip fracture
    • secondary osteoporosis
    • current smoker
  63. What is also known as Type II Osteoporosis
    Secondary
  64. What medications can cause bone loss?
    • corticosteroid
    • thyroid drugs
    • heparin
    • antiseizure
  65. What is a result of cumulative impact of bone loss and deterioration of bone structure that occurs as people age?

    A) Osteomalacia
    B) Secondary Osteoporosis
    C) type III
    D) Primary Osteoporosis
    D) Primary Osteoporosis
    (this multiple choice question has been scrambled)
  66. What is also referred to as age related Osteoporosis?

    A) Primary Osteoporosis
    B) Secondary Osteoporosis
    C) cylindrical cavities
    D) osteoclasts
    A) Primary Osteoporosis
    (this multiple choice question has been scrambled)
  67. Women are ___-___ times more likely to develop osteoporosis than men
    2-3
  68. What phase of bone loss begins at menopause?
    Rapid Phase
  69. __-__% of cortical bone is lost during rapid phase
    5-10
  70. __-__% of trabecular bone is lost during rapid phase.

    A) 10-15
    B) 5-10
    C) 2-3
    D) 20-30
    D) 20-30
    (this multiple choice question has been scrambled)
  71. the slow phase of bone loss results ___% of cortical and trabecular loss.

    A) 20-25
    B) 10-15
    C) 5-10
    D) 2-3
    A) 20-25
    (this multiple choice question has been scrambled)
  72. What is thought to be the main cause of both rapid and slow phase loss?

    A) Estrogen Deficiency
    B) collagen
    C) parathyroid
    D) Primary Osteoporosis
    A) Estrogen Deficiency
    (this multiple choice question has been scrambled)
  73. ___% of elderly men are deficient in biologically active sex steroids.
    30-50
  74. What is also referred to as senile osteoporosis?
    a.) Secondary
    b.) Primary
    a.) Secondary
  75. Which type of bone loss occurs particularly in the 7th decade of life?

    A) C) Secondary Osteoporosis
    B) type III
    C) Osteopenia
    D) Rapid Phase
    A) Secondary Osteoporosis
    (this multiple choice question has been scrambled)
  76. Secondary Osteoporosis is caused from decreased absorption of calcium from the ___.
    intestine
  77. Which eating disorder is associated with Secondary Osteoporosis?
    Anorexia
  78. Most of the loss occurs ___ in the course of glucocorticoid use.

    A) Early
    B) 4-8 years
    C) Late
    D) 2-4 years
    A) Early
    (this multiple choice question has been scrambled)
  79. What skeletal deformity is caused by Rickets?

    A) limited movement joint
    B) all extremeties
    C) Bowed Legs
    D) type III
    C) Bowed Legs
    (this multiple choice question has been scrambled)
  80. Rickets-
    childhood disease that results from a delya in depositing calcium phosphate mineral in growing bones
  81. Why is there no bone deformity in Osteomalacia?
    longitudinal growth has stopped
  82. Can Rickets/Osteomalacia be genetic?
    A.) Yes
    B.) No
    A.) Yes
  83. Define Paget's Disease
    bone grows abnormally large in some areas but not in others due to over active osteoclast
  84. What is the 2nd most common bone disease?

    A) Secondary Osteoporosis
    B) Osteopenia
    C) Paget's Disease
    D) Secondary Osteoporosis
    C) Paget's Disease
    (this multiple choice question has been scrambled)
  85. Most Prostate metastasis are ___

    A) haversian systems
    B) osteolytic
    C) Osteoblasic
    D) osteolytic
    C) Osteoblasic
    (this multiple choice question has been scrambled)
  86. Most breast metastasis are ___.

    A) Osteoblasic
    B) haversian systems
    C) osteoclasts
    D) Osteolytic
    D) Osteolytic
    (this multiple choice question has been scrambled)
  87. what T Score indicates osteoporosis?
    -2.5
  88. What qualifies as "established" osteoporosis?
    -2.5 T-score and 1 or more fractures
  89. What T-score is considered osteopenia?
    -1 to -2.5
  90. What is the most common benign bone tumor?
    Osteochondroma
  91. is the most common malignant bone tumor
    Ewing's Sarcoma
  92. How many Clinical risk factors are used in FRAX?

    A) 10
    B) 7
    C) 5
    D) 8
    B) 7
    (this multiple choice question has been scrambled)
  93. What is considered high alcohol intake for FRAX?
    3 or more drinks per day
  94. All of the following are true regarding causes of bone loss and fractures in osteoporosis except:

    A) failure to replace lost bone due to impaired formation
    B) abnormal bone composition due to genetics
    C) increased sex hormone production
    D) increased tendency to fall
    C) increased sex hormone production
    (this multiple choice question has been scrambled)
  95. Primary Osteoporosis is mainly a disease of :
    A. pregnant females
    B. the elderly
    C. young adults
    D. adolescents
    B. the elderly
    (this multiple choice question has been scrambled)
  96. Approximately ___% of patients with inflammatory bowel disease are diagnosed with osteopenia as children.

    A) 2-3
    B) 50
    C) 25
    D) 75
    C) 25
    (this multiple choice question has been scrambled)
  97. The rapid phase of bone loss in postmenopausal women and the slow phase of bone loss in aging women and men appeared to be largely a result of ___ deficiency.

    A) Thyroxin
    B) testosterone
    C) estrogen
    D) pitosin
    C) estrogen
    (this multiple choice question has been scrambled)
  98. All of the following are contributing factors and causes of secondary osteoporosis except:
    A.) alcohol and tobacco use
    B.) dietary deficiencies
    C.) rheumatoid arthritis
    D.) active lifestyle
    D.) active lifestyle
    (this multiple choice question has been scrambled)
  99. Most individual with osteogenesis imperfecta suffer from:
    a.) osteopenia
    b.) recurrent fractures
    c.) skeletal deformities
    d.) all of the above
    d.) all of the above
  100. All of the following are factors associated with lower risk of women developing osteoporosis except:
    A.) women who are over weight
    B.) women who eat large amounts of dairy products and vegatables
    C.) white or Asian ethnicity
    D.) women who exercise regularly
    C.) white or Asian ethnicity
    (this multiple choice question has been scrambled)
  101. FRAX algorithms give a ___ year probability of hip fracture and a ___ year probability of a major osteoporotic fracture.
    A.)2, 5
    B.)5,10
    C.) 10,10
    D.) 10,15
    C.) 10, 10
    (this multiple choice question has been scrambled)
  102. According to the NOF, a T-score between ___&___ at the femoral neck or lumbar spine is ostopenia
    A. -1.0 - 2.5
    B. .5 - -1.0
    C. 1.0- 1.5
    D. 2.0- 2.5
    A. -1.0 and -2.5
    (this multiple choice question has been scrambled)
  103. The cells within bones responsible for bone remodeling are:
    A. osteocytes
    B. osteophytes
    C. osteoclasts
    D. osteoblasts
    D. osteoblasts
    (this multiple choice question has been scrambled)
  104. Which of the following contains predominantly trabecular bone?
    A. skull
    B. phalanges
    C. spine
    D. femur shaft
    C. spine
    (this multiple choice question has been scrambled)
  105. Peak bone mass is achieved between ___-___ years of age

    A) 10-15
    B) 20-25
    C) 30-35
    D) 5-10
    C) 30-35
    (this multiple choice question has been scrambled)
  106. A geometric property that describes the distribution of mass around the neutral bending axis of and object is called:
    A. compression loading
    B. area moment of inertia
    C. microarchitecture
    D. Wolff's theory
    B. area moment of inertia
    (this multiple choice question has been scrambled)
  107. a term used to describe a rounded projection on bone is known as:
    A. crest
    B. process
    C. ala
    D. condyle
    D. condyle
    (this multiple choice question has been scrambled)
  108. the spinal column consists of:
    a. 5 lumbar vertebrae
    b. 7 cervical and 12 thoracic vertebrea
    c. 5 fused vertebrae that make up the sacrum and coccyx
    d. all the above
    d. all the above
  109. What is the upper flat curved part of the main portion of the ilium?
    ala or wing
  110. what is a rounded prominence on the outer/ lateral border of a bone?

    A) crest
    B) condyle
    C) ala
    D) trochanter
    D) trochanter
    (this multiple choice question has been scrambled)
  111. refers to a rounded outward or elevated surface.
    a. convex
    b. concave
    a. convex
  112. which parts of the spine are lordotic?
    a. cervical
    b. thoracic
    c. lumbar
    d. sacral
    • a. cervical
    • c. lumbar
  113. What is the first primary compensatory curve?
    cervical lordosis (concave)
  114. what is the secondary compensatory curve?
    lumbar lordosis (concave)
  115. ___ is used to describe the normal anterior concavity of the cervical and lumbar spine, but can also refer to an abnormally increased curvature.
    A. scoliosis
    B. lordosis
    C. kyphosis
    B. lordosis
    (this multiple choice question has been scrambled)
  116. What 4 things can cause kyphosis?
    • metabolic and neuromuscular conditions
    • osteogenesis imperfecta
    • spina bifida
    • scheuermann's disease
  117. What is the most common spinal curvature disorder?
    A. kyphosis
    B. lordosis
    C. scoliosis
    C. scoliosis
    (this multiple choice question has been scrambled)
  118. the body of C2 fuses with the odontoid process between __ and __ years of age
    3-6
  119. Persistent lateral curvature of the vertebral spine of more than 10 degrees in the upright standing position is known as:

    A) area moment of inertia
    B) kyphosis
    C) Osteochondroma
    D) scoliosis
    D) scoliosis
    (this multiple choice question has been scrambled)
  120. Schuermann's disease is characterized by the presence of at least ___% anterior wedging in at least ___ adjacent thoracic vertebrae.
    A. 10,12
    B. 14, 16
    C. 5, 3
    D. 3, 6
    C. 5, 3
    (this multiple choice question has been scrambled)
  121. there are ___ pairs of spinal nerves.
    A. 20
    B. 16 
    C. 32
    D. 28
    C. 32
    (this multiple choice question has been scrambled)
  122. the type of vertebral deformity caused by vascular insufficiency during fetal development and may affect more than one vertebrae is:
    A.  block vertebra
    B. hypoplasia
    C. asomia
    D. coronal cleft
    B. hypoplasia
    (this multiple choice question has been scrambled)
  123. the final carpal bone to ossify by 9 yr old is:
    a. pisiform
    b. trapezoid
    c. lunate
    d. hamate
    • a. pisiform
    • is a large sesamoid bone and is the last to ossify
  124. When imaging the proximal femur, in an effort to bring the femoral neck parallel to the plane of the scan table, the technologist should internally rotate the femur __ degrees
    A. 10-20
    B. 15-20
    C. 3-15
    D. 5-10
    B. 15-20
    (this multiple choice question has been scrambled)
  125. if the BMD measurement by central DXA of the lumbar spine or the femoral neck cannot be obtained, the NOF recommends BMD measurement by DXA at the on third (33%):
    A. ulnar site
    B. distal humeral site
    C. radius site
    D. proximal humeral site
    C. radius site
    (this multiple choice question has been scrambled)
  126. the NOF recommends BMD testing of:
    A. all premenopausal women
    B. postmenopausal women age 65 and older and me age 70 and older
    C. postmenopausal women and men age 50 and older
    D. children and adolescents
    B. postmenopausal women age 65 and older and me age 70 and older
    (this multiple choice question has been scrambled)
  127. Recommended frequency of BMD testing states that at least ___ months must have passed since the month of the last measurement except in specific situations
    A. 6
    B. 15
    C. 23
    D. 12
    C. 23
    (this multiple choice question has been scrambled)
  128. Based on the ACR Appropriateness Criteria for DXA scanning, variant ___ is for suspected fracture of a vertebral body in a patient with suspected osteoporosis and a negative initial radiograph.
    A. 5
    B. 8
    C. 2
    D. 4
    B. 8

    suspected fracture of a vertebral body based on clinical history, height loss, or steroid therapy, DXA and VFA is given a 9 rating and radiography of the T&L spine is given and 8 rating.
    (this multiple choice question has been scrambled)
  129. Osteoporosis is diagnosed when BMD is:
    A. 2.5 SD or more below that of a young-normal adult
    B. withing 1 SD of a young-normal adult
    C. 2.0 SD or more below that of a young-normal adult
    D. between 1.0 and 2.5 SD below that of a young normal adult
    A. 2.5 SD or more below that of a young-normal adult
    (this multiple choice question has been scrambled)
  130. The first established unit of x-ray dose which quantifies amount of radiation exposure in air is called:
    A. Roentgen
    B. rad
    C. rem
    D. Curie
    A. Roentgen
    (this multiple choice question has been scrambled)
  131. An acute dose of radiation of ___rads to the ovaries or testicles can result in permanent sterilization.
    A. 200
    B. 125
    C. 300
    D. 600
    D. 600 rad
    (this multiple choice question has been scrambled)
  132. The usual effective radiation dose received during CT of the pelvis is ___mrem
    A. 1000
    B. 700
    C. 460-1580
    D. 70
    A. 1000
    (this multiple choice question has been scrambled)
  133. The distance the technologist should stand or sit from the x-ray tube when preforming DXA scans is ___ft
    3 ft
  134. The risk for vertebral and non vertebral fractures has been proven to be reduced by ___ after one year of treatment.
    A. Calcitonin
    B. Parathyroid hormone
    C. Bisphosphaonate
    D. Estrogen
    C. Bisphosphaonate
    (this multiple choice question has been scrambled)
  135. recent findings have linked ___ therapy to increased incidence of heart attack and stroke and physicians frequently reconsider its use in the treatment of osteoporosis
    A. glucocorticoid
    B. calcitonin
    C. estrogen
    D. bisphosphanoate
    C. estrogen
    (this multiple choice question has been scrambled)
  136. gastrointestinal disturbances with some severe reactions have been reported in patients taking ___ for the treatment of osteoporosis.
    A. bisphosphonates
    B. estrogen 
    C. raloxifene
    D. calcitonin
    A. bisphosphonates
    (this multiple choice question has been scrambled)
  137. controllable lifestyle factors that are responsible for 10-15% of bone mass structure include:
    A. genetic factors
    B. diet and exercise
    C. ethnic origin
    D. poverty and lack of access to healthcare
    B. diet and exercise
    (this multiple choice question has been scrambled)
  138. The most critical period for bone health is during ___
    A. fetal development
    B. adolescence
    C. adult life
    D. childhood
    B. adolescence
    (this multiple choice question has been scrambled)
  139. The recommend calcium dose for individuals age 19-50 is ___mg/day
    A. 1300
    B. 610
    C. 1000
    D. 1200
    C. 1000
    (this multiple choice question has been scrambled)
  140. diets with an increase of ___-rich foods may reduce the need for calcium to be withdrawn from the skeleton
    A. copper
    B. vitamin k
    C. potassium
    D. magnesium
    C. potassium
    (this multiple choice question has been scrambled)
  141. The US Surgeon General recommends a minimum of ___ min of moderate intensity physical activity most, if not all, days of the week.
    A. 40
    B. 60
    C. 30
    D. 50
    C. 30
    (this multiple choice question has been scrambled)
  142. Weight loss of ___% or more in older women increases risk for hip fracture.
    A. 3
    B. 5
    C. 10
    D. 15
    C. 10
    (this multiple choice question has been scrambled)
  143. extended lactation and multiple pregnancies are strongly associated with subsequent osteoporosis related to hormones that affect calcium absorption.
    a. true
    b. false
    b. false
  144. doses of 7.5 mg/day of ___ can completely shut off formation of new bone, while the loss of older bone continues at a faster rate than normal.
    A. penicillin
    B. prednisone
    C. taoxifen
    D. coumadin
    B. prednisone
    (this multiple choice question has been scrambled)
  145. the most common causes of secondary osteoporosis in men is related to all of the following except:
    A. glucocorticoids
    B. hypogonadism
    C. alchoholism
    D. hypocalciuria
    D. hypocalciuria
    (this multiple choice question has been scrambled)
  146. a disorder causing too much calcium to be lost through the urine, making calcium unavailable for bone building is known as:
    A. hypercalciuria
    B. hypocalciuria
    C. homocystinuria
    D. hypogonadism
    A. hypercalciuria
    (this multiple choice question has been scrambled)
  147. hormone deprivation thearapy in men which has been found to have a strong link with osteoporosis is typically a treatment of:
    A. rheumatoid arthritis
    B. prostate cancer
    C. systemic mastocytosis
    D. hyperparathyroidism
    B. prostate cancer
    (this multiple choice question has been scrambled)
  148. men who sustain a hip fracture are more likely than women to die from complications.
    true/false
    true
  149. in men the diagnosis of osteoporosis is often not made until a fracture occurs
    true/false
    true
  150. reasons to consider bone density testing in men include___
    a. a fracture after the age of 50
    b. to monitor the effect of treatment on bone loss
    c. not receiving treatment for bone loss although treatment is indicated
    d. all the above
    d. all the above
  151. men age 50 and over require ___mg of calcium daily
    A. 500
    B. 1500
    C. 1200
    D. 1000
    C. 1200
    (this multiple choice question has been scrambled)
  152. the drug used for treatment of men with primary or hypogonadal osteoporosis who are at high risk for fracture is:
    A. teripartide (forteo)
    B. zoledronic acid (reclast)
    C. alendronate (fosamax)
    D. risedronate (actonel)
    A. teripartide (forteo)
    (this multiple choice question has been scrambled)
  153. osteoporosis in a child is characterized as ___ when there is no identifiable cause
    A. secondary
    B. tertiary
    C. primary
    D. idiopathic
    D. idiopathic
    (this multiple choice question has been scrambled)
  154. at birth an infant has as many as ___ separate skeletal bones in the body.
    A. 240
    B. 270
    C. 280
    D. 206
    B. 270
    (this multiple choice question has been scrambled)
  155. the intra-membranous ossification process occurs during the formation of all of the following except:
    A. ulna and radius
    B. flat bones of the skull
    C. mandible and maxilla
    D. clavicle
    A. ulna and radius
    (this multiple choice question has been scrambled)
  156. it is believed by bone health experts that 75% of an individual's final bone mass is influenced by ___
    A. genetics
    B. healthy lifestyle
    C. calcium rich diet
    D. behavioral factors
    A. genetics
    (this multiple choice question has been scrambled)
  157. the AAP recommendation for upper level calcium intake in children ages 4-8 yr is ___mg
    A. 2500
    B. 1000
    C. 1300
    D. 1500
    A. 2500
    (this multiple choice question has been scrambled)
  158. The recommended level of vitamin D intake for infants, children and adolescents including breastfed infants is ___IU per day
    A. 800
    B. 500
    C. 200
    D. 400
    D. 400
    (this multiple choice question has been scrambled)
  159. persons with anorexia nervosa have increased bone formation and decreased bone resorption
    True/False
    false
  160. improvement of BMD is often seen in sufferers of anorexia nervosa when ___ occurs
    a. healthy nutritional status
    b. weight gain
    c. return of regular menstrual periods
    d. all of the above
    d. all of the above
  161. "fish vertebra deformity" is a manifestation of ___ disease
    A. cystic fibrosis
    B. diabetes
    C. sickle cell
    D. rheumatic
    C. sickle cell
    (this multiple choice question has been scrambled)
  162. The diagnosis of osteoporosis in children should be based on___.
    presence of low BMD and significant fracture history.
  163. The most common site of fracture in children in the ___
    a. fingers
    b. clavicle
    c. humerus
    d. forearm
    • d. forearm at 45%
    • vs fingers 13%, clavicle 5%, humerus 3%
  164. define epiphyseal plates
    cartilaginous plates found between the diaphysis and  each epiphysis until skeletal growth is complete

  165. What do the dark areas show?
    A. central sites
    B. axial skeleton
    C. apendicular skeleton
    D. peripheral sites
    A. central sites
    (this multiple choice question has been scrambled)
  166. What is this an image of?
    A. single photon absorptiometry of hand
    B. radiogrammetry
    C. radiographic photodensitometry
    D. radiographic absorptiometry
    C. radiographic photodensitometry
    (this multiple choice question has been scrambled)
  167. What does the arrow indicate?
    A. L1 fracture
    B. aortic calcification
    C. osteophytes
    D. facet sclerosis
    A. L1 fracture
    (this multiple choice question has been scrambled)

  168. What does the arrow indicate?
    A. osteophytes
    B. fracture
    C. cortical shell
    D. end plate sclerosis
    D. end plate sclerosis
    (this multiple choice question has been scrambled)

  169. What does the arrow indicate?
    A. osteophytes
    B. cortical shell
    C. fracture
    D. end plate sclerosis
    A. osteophytes
    (this multiple choice question has been scrambled)
  170. What does the arrow indicate?

    A. L1 rib facet
    B. laminectomy
    C. fracture
    D. aortic calcification
    D. aortic calcification

    ch 2. indicates the faint outline of the calcified aorta
    (this multiple choice question has been scrambled)

  171. What is this an image of?
    A. Lateral L-spine x-ray
    B. Lateral L-spine DXA
    C. Lateral T-spine DXA
    B. Lateral L-spine DXA
    (this multiple choice question has been scrambled)
  172. this is an image of :

    A. AP proximal femur
    B. PA proximal femur
    C. PA proximal humerus
    D. AP proximal humerus
    B. PA proximal femur
    (this multiple choice question has been scrambled)

  173. this is an image of:
    A. Right femur
    B. Right humerus
    C. Left humerus
    D. Left femur
    D. left femur
    (this multiple choice question has been scrambled)

  174. Which DXA is properly positioned?
    A. B
    B. A
    C. Both
    D. Neither
    B. A
    (this multiple choice question has been scrambled)
  175. What is wrong with this DXA positioning?

    A. nothing
    B. not enough internal rotation
    C. old fracture in Ward's area
    D. too much internal rotation
    A. nothing
    (this multiple choice question has been scrambled)
  176. What is wrong with this DXA positioning?

    A. not enough internal rotation
    B. nothing
    C. old fracture in Ward's area
    D. too much internal rotation
    A. not enough internal rotation
    (this multiple choice question has been scrambled)
  177. define %CV
    • percent coefficient variation.
    • is given by manufacturers to express the precision of the equipment
  178. name the weight bearing sites of the skeleton:
    • total spine
    • lower extremitys
    • portions of the pelvis
  179. what is the most sensitive weight bearing bone?
    calcaneus
  180. name the appendicular sites:
    • extremitys
    • girdles (includes scapula and pelvis)
  181. name the central sites for DXA:
    • T-spine
    • L-spine
    • proximal femur
  182. do central densotometers measure peripheral sites along with central sites?
    a. true
    b. false
    • a. true
    • ch 1 densotometers that measure central sites are called Central Densotometers, though some have the ability to measure peripheral sites too.
  183. name the peripheral sites for DXA:
    • calcaneus
    • tibia
    • metacarpals
    • phalanges
    • forearm
  184. Which DXA ROI have predominantly trabecular bone?
    • L-spine
    • Ward's Area
    • Calcaneus
    • portions of the forearm
  185. define trabecular bone:
    spongy, has a higher metabolic rate
  186. What ROIs are predominantly cortical bone?
    • femoral neck
    • phalanges
    • portions of the forearm
  187. how is BMC quantified for DXA?
  188. how is BMC quantified for QCT?
  189. how is BMD reported for the L-spine?
    a. each individual vertebra
    b. total BMC for each vertebra divided by total area for each vertebra
    c. average for all vertebra
    d. individual cortical and trabecular for all spines
    • b. total BMC for each vertebra divided by total area for each vertebra
  190. What is QUS?
    quatitative ultra sound
  191. how does QUS measure bone?
    • speed of sound (SOS)
    • Broadband Ultrasound Attenuation (BUA)
    • Stiffness index
  192. explain Speed of Sound (SOS).
    speed that sound wave passes through the bone. expressed as meters/sec
  193. explain Boadband Ultrasound Attenuation (BUA).
    amount of energy lost from sound wave as it passes through bone. expressed as decibels/mgz
  194. What is the T-score compairing?
    the patient's BMC with the peak value for an average healthy young adult of the same sex
  195. How is a Z-score compared?
    the patient's BMC compared to the average values for a healthy person of the same sex, age, and race.
  196. explain Standard Deviation (SD).
    the plus/minus scale from the average
  197. Why is the Z-score used?
    to suggest if bone-loss may/may not be caused by something other than normal age related bone loss if the patient's BMC is lower than the average of their age, sex, and race.
  198. What is an Age-regression Graph?
    • the top line is a young adult peak.
    • the bottem line is the expected change of BMD as the patient ages if nothing changes
  199. How much bone demineralization has to occur before it can be seen on diagnostic x-rays?
    at least 40%
  200. What is Qualitative Spinalmorphemetry (QSM)?
    uses a lateral spine x-ray to look at the cortical shell thickness and trabecular patterns.
  201. What is the Singh Index?
    uses an AP hip x-ray to look at the cortical shell thickness and trabecular patterns
  202. Describe radiogrammetry.
    • radiograph of the hand is measured with fine calipers across the metacarpals.
    • Can be used with digital radiographs and use a computer analysis.
    • Correlates well with BMD.
  203. what is the Radiologic Osteoporosis Score?
    uses radiogrammetry of the femur and the bio-concavity of the L-spine to determine BMD
  204. what is Radiographic Photodensitometry?
    • was the starter technology for SPA, DPA, and current DXA
    • is a radiograph of the bone alongside a step wedge which is then measured with a photodensity scanner and compared to known BMD correlations with the step wedge densitys
  205. describe Radiographic Absorptiometry (RA).
    • 2 x-rays of the left hand are taken on non screen film at 2 different KVp techniques
    • it is then sent to a lab and digitized for computer analysis of the ring and middle finger
    • is good  for long term reproducible results
  206. what is Single Photon Absorptiometry (SPA)?
    • uses a single radioactive material that produces 1 level of radiation as a radiation source
    • scanned forearms and heels because it needs a water bath to insure uniformity.
  207. why was SPA and DPA considered un precise?
    because of the radioactive decay over time followed by sudden increase in radioactivity when old source was repalced
  208. what is Dual Photon Absorptiometry (DPA)?
    • works the same as SPA, but uses a radioactive material that produces 2 different KV intensity's.
    • doesn't need a water bath, so it could scan central sites.
  209. How is DXA different from DPA?
    • DXA uses x-ray generators rather than a radioactive isotope.
    • faster scan times
  210. what is a K-Edge filter for?
    for DXA equipment that filters the beam into two different KVp ranges.
  211. What is a pulse power KV source for?
    the same as a K-edge filter
  212. what is a highly collimatied beam that follows the detector pattern (zig-zags)?
    pencil beam
  213. Which beam is wide and scans a whole detector row at at time
    fan beam
  214. what does a Morphometric x-ray absorptiometry look for?
    looks for spinal fx in the lateral spine
  215. What is the difference between SXA and DXA?
    SXA is the counter part to single photon absorptiometry, but is now obsolete since DXA is more avalible
  216. What is Quantiative CT (QCT)?
    BMC given via CT scan of the L-spine
  217. How does QCT work?
    • patient is scanned in the CT scanner with a phantom.
    • 8-10mm slices through 2 or more vertebral body (T12-L3).
    • only looks at trabecular portion of the vertebral body.
    • t.
  218. marrow fat decreases with age
    true/false
    false
  219. what is Dual Energy QCT used for?
    to eliminate error from marrow fat
  220. What does a pereferal QCT look at?
    the forearm. best for patients who's bones are still growing
  221. what are the 6 parts of an individual vertebra?
    • Body
    • pedicles
    • lamina
    • spinus process
    • transvers process
    • articulating surface
  222. what shape is L1-L3 vertebra in?
    A. Bat
    B. Dog Bone
    C. U or Y
    D. H or X
    C. U or Y
    (this multiple choice question has been scrambled)
  223. what is unique about L3's shape?
    it has the largest transverse processes.
  224. What shape is L4 vertebra in?
    A. Bat
    B. U or Y
    C. H or X
    D. Doge Bone
    C. H or X
    (this multiple choice question has been scrambled)
  225. what shape is L5's vertebra?
    A. Bat
    B. U or Y
    C. Dog Bone
    D. H or X
    C. Dog Bone
    (this multiple choice question has been scrambled)
  226. Why is L5 not to be included in a PA DXA scan?
    it has too much interference with the pelvis
  227. Why do you count the lumbar spine from L5-L1 instead of L1-L5 for a DXA scan?
    so that you don't accidentally factor in a T-spine vertebra as it will lower total BMC and possibly create a false positive result
  228. Should a vertebra with a previous fracture (new or old) be included in a PA L-spine DXA?
    no. because it can inacuratly increase the BMD for that vertebra
  229. What spinal artifacts can inaccurately increase BMD of the spine?
    • osteophytes
    • facet sclerosis (grade 2 or 3 only)
    • aortic calcification
    • vertebral fx
  230. is there a way to overcome most spinal artifacts?
    yes. Lateral Spine DXA
  231. which lumbar vertebra in the lateral position is least affected by ribs or pelvis?
    A. L2
    B. L4
    C. L3
    D. L1
    C. L3
    (this multiple choice question has been scrambled)
  232. why should a Lat L-spine DXA be paired with another scan site measurment?
    for better accuracy since L3 may be the only vertebra measured and it is mainly a trabecular measurment
  233. what forms the Ward's area?
    anatomic region in the neck of the femur that is formed by the intersection of 3 trabecular bundles
  234. what are the DXA ROIs of the proximal femur?
    • femoral neck
    • Ward's Area
    • trochanteric region
    • shaft
  235. how far should you rotate the leg and which direction to bring the femoral neck parallel to the table?
    internally 15-20 degrees
  236. what does the lesser trochanter look like on a DXA image if it is not rotated enough?
    pointy
  237. How do you reposition if you can not see the lesser trochanter?
    A. internally rotate
    B. nothing this is normal
    C. externally rotate
    D. bend the knees
    C. externally rotate
    (this multiple choice question has been scrambled)
  238. does leg domination have any effect on the BMC of the femurs?
    no
  239. in cases of scoliosis lower BMD is shown on which hip?
    the side of convexity
  240. does previous femur fracture (with out surgery) have any affect on a proximal femur DXA?
    yes, it will be in accurate and should not be scanned
  241. What are the forearm measurment sites?
    • 33% or 1/3 site
    • 50%
    • 10%
    • 5-8mm
    • ultradistal
  242. name the proximal forearm sites
    • 33% or 1/3
    • 50%
  243. name the distal forearm sites:
    • 5-8mm
    • 10%
    • ultra distal
  244. Which arm should be scanned?
    A. non dominate arm
    B. dominate arm
    C. always right (if no fracture history)
    D. always left (if no fracture history)
    A. non dominate arm
    (this multiple choice question has been scrambled)
  245. What is the importance of least significant change (LSC)?
    it determines the minimum interval between follow up measurements before a change in BMC can be seen
  246. how long does a short term precision study last?
    2-4 weeks
  247. how long does a long term precision study last?
    usually 1yr
  248. What is the recommended follow up time between DXAs for a normal patient?
    • L-spine is recommended once per year
    • Proximal Femur is recommended every 2 years
  249. What is the recommened follow up time between DXAs for a patient taking steroids?
    every 6 months
  250. what is an anthropormorphic phantom?
    replicates skeletal region to detect a shift in BMD values over time
  251. what is an anthroporomrphic phantom made of?
    hyoroxaptite or aluminum
  252. what is a European Spine Phantom?
    was developed independently from DXA equipment manufactures and is generally used in research
  253. What is the WHOs deffinition of osteoporosis?
    a BMD that is 2.5 SD or more below average peak BMD of the young adult
  254. What is the WHOs deffinition of established osteoporsis?
    A BMD of 2.5SD or more below the average of a young adult and a history of fracture
  255. Define a clinical spine fracture
    a spinal fracture that causes symptoms
  256. what is a morphometric spinal fracture?
    a fracture that can be seen on a radiograph but has little to no symptoms
  257. What can cause a failure to attain peak BMD?
    • genetics
    • dietary calcium deficiency
    • lack of exercise
  258. What are the non prescription interventions?
    life style modifications and OTC meds
  259. Most DXA images are approved by the FDA for use in making structural diagnoses
    True/False
    False
  260. how many contiuous vertebrae is preffered for PA spine DXA
    A. 1 or 2
    B. 3-4
    C. 4-5
    D. they don't have to be contiguous
    B. 3-4
    (this multiple choice question has been scrambled)
  261. the anticipated rate of change in the total hip ROI is ___ than the femoral neck ROI

    faster or slower
    slower
  262. what special imaging should be done for some one with hyperparathyroidism?
    a. 33% forearm
    b. lateral l-spine
    c. 5-8mm forearm
    d. total body
    • a. 33% forearm
    • because hyperparathyroidism tends to have more effect on cortical bone and the 33% forearm is mostly cortical bone
  263. why is the forearm typically not used to monitory osteoporosis thearpy?
    the rate of change is slower than the L-spine or hips
  264. what type of bone is measured in a total body scan?
    cortical
  265. the risk of fracture ___ for each SD decline in BMD.
    a. double
    b. tripples
    d. sees very little increase
    c. decreases
    a. double
  266. Name the bisphosphonate anti resorptive medications:
    • alendronate (fosamax)
    • risedronate (actonel)
    • ibandronate (boniva)
    • zoledronic acid (reclast
  267. name the non bisphosphonate anti resorptive meds
    • etrogen thearapys
    • raloxifene (evista
    • denosumabb (prolial)
  268. name the anabolic osteoporosis meds
    teripartide (forteo)
  269. for pediatric DXA a cancer survivor is recommended to have imaging done at what point?
    either 2yr after chemo or by the age of 18 which ever comes first
  270. when is DXA recommened for children?
    • recurrent fractures
    • bone pain
    • bone deformitys
    • osteopenia seen on x-ray
    • cancer survivors
    • females with eating disorders/excessive exercis
    • females after 6+ months without menstrul cycle
  271. what are the prefered sites for children 3yr old and up?
    PA L-spine and total body
  272. When should a T-score be used for comparison on children?
    never before age 20

Card Set Information

Author:
adavis
ID:
332302
Filename:
Bone Density
Updated:
2017-07-17 14:05:12
Tags:
BD bone density registry review
Folders:
CH3 Review of skeletal anatomy for bone densiometry technologists
Description:
skelatal anatomy for bone densetometry registry review
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