#foarad

A malignant bone process is more likely to be 1 or more metastasis than a primary bone cancer, and more bone mets are (osteo)lytic than osteoblastic (or sclerotic). Lytic bone lesions arise when tumor cells from a primary tumor in a different part of the body are deposited in the vascular beds of the bone matrix and grow with the help of parathyroid hormone-related peptide (PTHrP) stimulating osteoclasts to chew up existing bone. Sclerotic bone mets lead to more bone deposition through an uncertain mechanism. Both are seen better on CT or MRI than on plain xrays; sclerotic lesions are seen better than lytic ones on nuclear medicine scans (bone scintigraphy or PET-CT).

Pro-Tip: A single primary malignancy can lead to mixed lytic and sclerotic lesions.

Lytic lesion: Puyó Vera D, Renal cell carcinoma with metastases to the bony pelvis. Case study, Radiopaedia.org (Accessed on 20 Oct 2025) https://doi.org/10.53347/rID-29355

Q. When should you order a follow-up chest x-ray after a child is treated for pneumonia? A. 4-8 weeks after completing antibiotics B. Only if the child has recurrent pneumonia C. Only if the child has empyema D. B and C. .

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A. The answer is D, order a follow-up CXR after 4-8 weeks only if a child has recurrent or complicated PNA. You want to make sure any radiographic findings have resolved and, if not, investigate a congenital abnormality such as pulmonary sequestration."

Tools to calculate osteoporosis risk: FRAX (Fracture Risk Assessment Tool)

SCORE (Simple Calculated Osteoporosis Risk Estimation)

OSIRIS (Osteoporosis Index of Risk)

ORAI (Osteoporosis Risk Assessment Instrument)

The simplest is the OST (Osteoporosis Self-Assessment Tool), which uses weight and age and is available for both women and men.

Q. What is the difference between a transient ischemic attack (TIA) and a cerebrovascular accident (CVA)?

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A. A transient ischemic attack--sometimes called "a baby stroke"--is when a clot forms in or travels to a small artery in the brain, temporarily blocking blood flow. A patient may or may not have symptoms such as slurred speech or loss of coordination. However, the body is able to clear the blockage and restore blood flow without the surrounding neurological tissue sustaining lasting damage that can be seen on a brain CT or MRI. 

A cerebrovascular accident occurs when the body cannot remove the blockage, causing permanent brain damage that can be seen on imaging. Sometimes with time and therapy a patient may recover some or all of the skills they lost, other times the damage is too severe. For instance, a stroke in the motor cortex that causes flaccid paralysis can, after 6 months, lead to spastic paralysis as the lower motor neurons degenerate from the lack of stimulation from the now-dead upper motor neurons.

Pro-Tip--We *used* to define a TIA as an incident in which symptoms resolved within 24 hours and didn't leave damage on CT or MRI imaging of the brain, but up to 50% of these did cause scarring. Now any event that causes scarring is defined as a stroke, no matter whether the patient had symptoms or how long they lasted.

Q. What pastry-themed finding in the pons can be seen on brain imaging in neurodegenerative disorders? .

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VA clinical researchers recently published a large, prospective, observational cohort study that confirms 6 best practices for reducing odds of both 90-day and one-year mortality after a TIA or CVA. 

All patients should have carotid artery Dopplers within 14 days to measure stenosis that might require intervention via carotid endarterectomy (for symptomatic stenosis >70%, or asymptomatic stenosis >80%). Carotid artery imaging was associated with an adjusted odds ratio of 0.49 (95% CI, 0.38-0.63) for 90-day mortality and 0.61 (95% CI, 0.52-0.72) for 1-year mortality. 

The study results were confounded by the finding that patients with prior endarterectomy had better 90-day outcomes than those without. The authors speculated that surgeons had operated on patients who were healthier ("better surgical candidates"), thus the procedure itself may not have been not responsible for their survival but rather merely an indicator of their general well-being.