You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is 76 year old man presents with lytic lesion in the vebrae. X-Ray skull showed multiple punched out lesions. The diagnosis is and explain in detail?
B i.e. Multiple Myeloma Old age, male sex & veebral involvement (lytic lesion) indicate towards diagnosis of Metastasis & Multiple myeloma. But Absence of primary and characterestic multiple punched out lesions on X-Ray skull is diagnostic of Multiple myelomaQ. Osteomalacia: - Looser's zoned or PseudofractureQ (Hallmark) Mnemonic - "Losse Pencilin Fish" - Pencilling-in- of veebral bodies - Cod - fish (marked biconvex) veebraeQ Hyper parathyroidism : - Brown tumorQ Mnemonic - - Sub periosteal ErosionQ "Brown Erosed Salt Basket" - Salt & Pepper or Pepper - Pot skullQ - Basket work appearanceQ of coex Renal Osteodystrophy(d/t CRF): - It combines findings of ostemalacia, hyperparathyroidism and bone sclerosis - Osteomalacia lit Looser's zone - Hyper PTH 1/t Subperiosteal Erosion of bone - Osteosclerosis Vt Rugger Jersey spineQ (End plate sclerosis with alternating bands of radiolucency) In children with CRF, the combination of rickets & hyperparathyroidism leads to Rotting Fence Post appearance.Q Multiple Myeloma: Two cardinal features are: Generalized reduction of bone density (Osteopenia) Localized areas of radiolucency (Punched outQ/Rain drop lesionsQ) in red marrow areas i.e. axial skeletal - spine & skull. In multiple Myeloma lytic lesions of spine are usually associated with some collapse & soft tissue extension i.e. paraveebral soft tissue shadows (differentiation from Metastasis). Differentiation from inflamatory lesions can be made as the interveebral disc space & aicular surfaces are not affected.