Final Review Flashcards by Lindsay Kirkpatrick

What clinical examination confirms that a scoliosis is structural rather than functional?

Adam test

How well did you know this?

Not at all

Perfectly

You note an anteater sign. What pattern of tarsal coalition does this represent?

Calcaneonavicular

How well did you know this?

Not at all

Perfectly

Your patient has 2/5 strength of the wrist flexors. Which intervertebral foramen contains the nerve that is involved?

(C7 nerve root)
C6/C7 IVF

How well did you know this?

Not at all

Perfectly

What imaging modality is the gold standard for the evaluation of bone density?

DEXA

How well did you know this?

Not at all

Perfectly

The distal femurs demonstrate an Erlenmeyer flask deformity. The patient’s T-score is +2.0. What is the first item on your differential?

Osteopetrosis

How well did you know this?

Not at all

Perfectly

Rickets and hyperparathyroidism coexist in what condition?

Renal osteodystrophy

How well did you know this?

Not at all

Perfectly

What is the name of the system for grading skeletal maturation based on the iliac apophysis?

Riser

How well did you know this?

Not at all

Perfectly

A new mom presents with SI pain. There are triangular foci of sclerosis in a bilateral asymmetric distribution. What is the diagnosis?

Osteitis Condensans ilii

How well did you know this?

Not at all

Perfectly

A 35 year old underwater welder presents with a stippled lesion in the medullary cavity of the proximal humeral metaphysis. The lesion has a serpiginous contour. Which should be the first item on your differential?

Medullary Infarct

How well did you know this?

Not at all

Perfectly

Which condition should you suspect when a PA chest radiograph reveals a pectus excavatum and a 4-5cm thoracic aorta?

Marfan syndrome

How well did you know this?

Not at all

Perfectly

You suspect your patient has a non-emergent abdominal aortic aneurysm. What is the most appropriate imaging follow-up?

Doppler with ultrasound

How well did you know this?

Not at all

Perfectly

Which arthritis, when untreated, has the greatest association with Osteonecrosis?

SLE

How well did you know this?

Not at all

Perfectly

What imaging tool is the definitive diagnostic test for complex regional pain syndrome?

3 phase bone scan

How well did you know this?

Not at all

Perfectly

What is the minimum Meyerding grade for bilateral facet dislocation?

How well did you know this?

Not at all

Perfectly

Which injuries are associated with child abuse? SELECT ALL THAT APPLY

a. Skull fractures
b. Rib fractures
c. Metaphyseal corner fractures
d. Multiple fractures in various stages of healing
e. None of the above

a. Skull fractures
b. Rib fractures
c. Metaphyseal corner fractures
d. Multiple fractures in various stages of healing

How well did you know this?

Not at all

Perfectly

Which MRI pulse sequence is most sensitive for edema?

STIR

How well did you know this?

Not at all

Perfectly

A geographic lytic expansile lesion is present in the distal femoral metaphysis of a 32yo patient. There is a short zone of transition, no periosteal reaction, no matrix pattern and no soft tissue mass. The lesion grows directly to the Trochlear groove. What is the diagnosis?

GCT

How well did you know this?

Not at all

Perfectly

Intoxication with which mineral is associated with gout?

Lead

How well did you know this?

Not at all

Perfectly

An 8 year old presents with 5 weeks of ankle pain. Radiographs reveal a geographic lytic lesion in the medullary cavity of the distal tibial metaphysis. There is no periosteal reaction, no matrix calcification, and no soft tissue mass. Past medical history is remarkable for pneumonia 8 weeks ago. What is the diagnosis?

Brodie abscess

How well did you know this?

Not at all

Perfectly

What condition is a well established cause of Osteonecrosis?
a. Marram syndrome
b. Cleidocranial dysplasia
c. Anabolic steroid treatment
d. Caisson disease

Caisson disease

How well did you know this?

Not at all

Perfectly

You patient has torticollis. Radiographs reveal globular calcification immediately inferior to the anterior arch of C1. What is the diagnosis?

Hydroxyapatite deposition disease (HADD)

How well did you know this?

Not at all

Perfectly

What is the biggest clinical concern in a patient with a degenerative spondylolisthesis?

Central stenosis

How well did you know this?

Not at all

Perfectly

Which condition is hall marked by bony horns growing off the posterior aspect of the ilia?

Osteoonychodystrophy

How well did you know this?

Not at all

Perfectly

Which portion of the SI joints best demonstrates the erosive changes of ankylosing spondylitis?

Lower/iliac

How well did you know this?

Not at all

Perfectly

What is the radiographic latent period for osteomyelitis of the distal radius?

7-10 days ## Footnote 14-17 days in spine.

Which feature helps distinguish hemophilia from JCA? a. Ballooning of the epiphysis b. Increased intercondylar notch c. Osteopenia d. Uniform joint space loss

Increased intercondylar notch

What is the MRI findings for a hemangioma?

High T1, High T2

Why does a cervical spine burst fracture have a higher rate of neurologic compromise than a lumbar spine burst fracture?

The presence of the spinal cord

Which of these bone diseases is x-ray sensitive for? a. Osteoporosis b. Fracture c. Malignancy d. Infection e. None of the above

None of the above

Which findings are more common in thalassemia than in sickle cell anemia? MARK ALL THAT APPLY 1-4. a. Hair on end skull b. Osteonecrosis c. Erlenmeyer flask deformity d. H-shaped vertebra

Hair on end skull Erlenmeyer flask deformity

Which organism is the most common to cause osteomyelitis in a user of IV heroin?

S. aureus

A 53 year old underwater welder presents with a stippled medullary lesion in the proximal humeral metaphysis. What should be the first item on the differential diagnosis list?

Chondrosarcoma

Which is the primary diagnostic criteria for Scheuermann disease?

3 segments with 5 degrees of wedging (anterior)

What is the most common organism to cause osteomyelitis?

S. Aureus

Which cervical spine manifestation of rheumatoid arthritis is the most clinically significant?

Increased ADI

Your patient has positive Ottawa criteria for the knee. Radiographs reveal an obliquely oriented radiolucent line in the patella, with corticated margins. What is the diagnosis?

Vertical patellar Fx

Which of these conditions represents an absolute contraindication to HVLA manipulation of the spine and extremities? a. Ehlers Danlos b. Achondroplasia c. Rheumatoid arthritis d. Cervical ribs

Ehlers Danlos

Which condition does NOT have generalized osteopenia as a radiographic finding? a. Osteopetrosis b. Osteogenesis imperfecta c. Hyperparathyroidism d. Osteomalacia

Osteopetrosis

Multiple geographic lytic lesions with hazy internal calcification is present in the proximal femurs, with an accompanying bilateral shepherds crook deformity in a 52yo. What is the diagnosis?

Polyostotic fibrous dysplasia

Which finding in the hands and feet is strongly suggestive of acromegaly?

Spade tufts

AP and lateral bilateral knee views on a 20yo demonstrate excessive bowing of the femurs and tibiae. Mild generalized osteopenia is noted. In the distal tibiae, there are radiolucent lines extending approximately 1/3 of the way through the bone. What is the diagnosis?

Osteomalacia

Which type of Modic change is characterized by high T1 and low T2 signal on MRI?

On a 12yo patient, the AP ankle demonstrates a fracture through the tibial epiphysis, running into the growth plate. On the lateral view there is a metaphyseal fracture of the tibia, also running into the growth plate. What type of salter Harris fracture is described?

A bone is noted extending from the Lamina of C5 to the greater angle of the scapula. This is seen in frequent association with which condition?

Klippel Feil syndrome

Which of the 5 cervical lines is the most reliable to determine the presence of a spondylolisthesis?

Posterior body line (Georges Line)

Which feature aids in distinguishing Myositis Ossificans from osteosarcoma?

Zonal phenomenon

Soft tissue infection with clostridium perfringens will demonstrate which of the 4 radiographic densities?

Air

Your patient has decreased sensation along the lateral aspect of the leg, running anterior to the lateral malleolus, and extending along the dorsum of the foot. Which disc herniation(s) would be consistent with the finding? MARK ALL THAT APPLY 1-6 ANSWERS a. L4/L5 foraminal b. L4/L5 subarticular c. L5/S1 foraminal d. L3/L4 subarticular e. L5/S1 subarticular f. L3/L4 subarticular g. None of the above

L4/L5 subarticular L5/S1 foraminal

What is the most likely location in the musculoskeletal system for tuberculosis to disseminate?

Spine

A football player presents with severe neck pain after tackling an opponent while leading with his helmet. Radiographs reveal anterior wedging of C6, as well as convex posterior body margin. What is the diagnosis?

Compression fracture

Your patient has a 23 degree right convexity from T1-T6 and a 34 degree left convexity from T6-T11. What term would be applied to this finding?

Double primary

There is a fracture fragment at the anterior inferior body margin of C6. What is the mechanism of injury?

Flexion

Your patient presents with back pain 2 weeks after abdominal surgery, with normal radiographs. What is the best follow up imaging?

MRI with contrast

The idea behind imaging decision making is to decrease population radiation dose as much as possible. What is the term applied to this concept?

ALARA

In what paragraph of the radiology report would the following statement go: A rib is noted arising from C7 on the left

A (Anatomy)

Which condition has Wormian bones and osteopenia as the primary findings?

Osteogenesis imperfecta

Frontal radiographs demonstrate a short segment, high angles scoliosis. What would you expect to find in the apical region? a. Lateral hemivertebra b. Posterior scalloping c. Tall vertebra d. Twisted ribbon ribs

Lateral hemivertebra

What is the threshold for translational instability in the lumbar spine?

4.5 mm

A 14 year old patient has a left lumbar scoliosis. Radiographs reveal a sclerotic right pedicle of L2. What is the etiology of the scoliosis?

Tumor-related

Which radiographic appearance is most suggestive of chronic osteomyelitis?

Wavy solid periosteal Rxn

Select all conditions with posterior vertebral body scalloping as a feature. a. Achondroplasia b. AAA c. Hodgkin lymphoma d. No correct answer listed

Achondroplasia (also NF-I, Marfans, and Acromegaly)

According to the most up to date evidence based information, what is the best imaging to determine the presence of an active fatigue fracture of the pars interarticularis?

SPECT

What is the term applied to pain associated with a lumbosacral transitional segment?

Bertolotti syndrome

What condition has an epiphyseal osteochondroma as a feature?

Trevor disease

Numerous hyperpigmented cutaneous macules with a smooth outer border are consistent with what condition?

Neurofibromatosis (Coast of California)

What is the term applied to the bone destruction of permeative osteolytic in osteomyelitis?

Involucrum

Select 2 conditions which both have generalized osteoporosis and osteonecrosis as features. a. Marfans b. Cushings c. Acromegaly d. Sickle cell anemia

b. Cushings d. Sickle cell anemia

What imaging follow up should be performed on patients with neck pain and a congenital fusion?

Flexion/extension radiographs

What would you include on the differential for a clavicle in 2 separate pieces, both ends having smooth well rounded corticated margins? a. No correct answer listed b. HPT c. Non-union fracture d. PTOC e. Cleidocranial dysplasia

Cleidocranial dysplasia

Avascular necrosis of the lunate is associated with which of the following? a. Lunate dislocation b. Scapholunate dissociation c. Negative ulnar variance d. Fischer fracture e. No correct answer listed

Negative ulnar variance

Which metabolic arthritis is associated with 'crowned dens syndrome'?

CPPD

A 14 year old track athlete presents with complaints of 'patellar tendinitis'. Radiographs demonstrate fragmentation of the apex of the patella. What is the diagnosis?

Sinding Larsen Johansson

When involving the cervical spine, which condition is frequently associated with dysphasia?

DISH (Also stylohyoid ligament ossification/ Eagle Syndrome)

Which of these would be a cause of a functional scoliosis? a. Neurofibromatosis type 1 b. Leg length inequality c. Cerebral palsy d. Moderate DJD

Leg length inequality

When looking for rib fractures on a rib x-ray series, which cortex is the most sensitive for displaying fracture?

Superior

Following a FOOSH injury, your patient has numbness of the thumb, index and middle fingers. What injury do you suspect?

Lunate dislocation

A 13 year old running athlete presents complaining of progressively worsening leg pain. Radiographs reveal cortical thickening in the tibial diaphysis. There are no other abnormalities. Which do you suspect?

Fatigue fracture

The L2 vertebral body is wedged anteriorly. The posterior body margin is concave. The posterior elements are intact. There is a step defect in the anterior body cortex. What is the diagnosis, and is this acute or old?

Compression fracture Acute

Which conditions should be included in a widened medial hip joint space in a pediatric patient? a. SCFE b. Septic arthritis c. LCP d. Osteoid osteoma e. No correct answer listed

SCFE LCP

You suspect acromegaly. What imaging should be ordered?

MRI with pituitary protocol

Your patient has unilateral sacroiliac irregularity and sclerosis, and also complains of hand pain and stiffness. What is the most likely diagnosis?

Psoriatic arthritis

What is the most common geographic lytic lesion in the foot?

Enchondroma

An AP and frog leg hip radiograph on an 8 year old reveals sclerosis, flattening and fragmentation of the femoral head. What is the diagnosis?

Legg Calve Perthes

The technetium 99-MDP used in bone scintigraphy is taken up by which type of bone cell?

Osteoblasts

You note conduit wall calcification in the 3 view hand radiograph of your patient. What is the underlying cause?

Atherosclerosis

A pediatric patient has bulbous costochondral junctions. Which condition do you suspect? a. Chondrodysplasia punctata b. Hemophilia c. Rickets d. Osteogenesis imperfecta

Hemophilia

A skier's thumb is a disruption of which ligament?

Ulnar collateral ligament at the MCP

A 7 year old patient has an eccentric, geographic lytic lesion in the distal tibial metaphysis. There is a narrow zone of transition, ground glass matrix, no soft tissue mass. The x-ray was taken because the child has twisted their ankle. What is the diagnosis?

Fibrous cortical defect

Which imaging modality does not utilize ionizing radiation? a. Bone scan b. Ultrasound c. Radiographs d. Computed tomography

Ultrasound

A 54 year old patient has a 3cm blastic lesion in the sacrum. The lesion is found to be warm on bone scan. What is the diagnosis? a. Blastic Mets b. Chondrosarcoma c. Enostoma d. Osteoma

Enostoma

Which condition is associated with shoulder impingement syndrome? a. Bankart fracture b. Humeral pseudotumor c. Cleidocranial dysplasia d. Os acromiale

Os acromiale

Knee radiographs in a 32 year old reveal intracapsular effusion and destruction of the subarticular cortex at the trochlear groove. What is the diagnosis? a. PVNS b. Septic arthritis c. Primary SCM d. GCT

Septic A

What is the most common wrist fracture in a 65 year old patient with a FOOSH injury?

Colle's

A subarticular lucent cleft is noted in the top of the femoral head. What stage of AVN does this indicate?

Revascularization

There is an anterior translation of C1 with an ADI measuring 7mm. What conditions should be included in the differential diagnosis? SELECT ALL THAT APPLY a. Down syndrome b. Jefferson fracture c. Os odontoideum d. Odontoid agenesis e. Rheumatoid arthritis f. No correct answer included

All are included

You detect an ivory vertebra in a 61 year old. There is no anterior scalloping or vertebral enlargement. What is the first item on your differential?

Metastatic disease

Lumbar radiographs reveal generalized osteopenia, widened bilateral SI joints, and several soft tissue calcifications. A rheumatoid panel is negative. What is the diagnosis? a. Acromegaly b. Scleroderma c. Enteropathic arthritis d. Hyperparathyroidism

Hyperparathyroidism

Lumbar radiographs in a 38 year old reveal a missing pedicle at L2 on the right. The contralateral pedicle is mildly enlarged. What should be the first diagnosis on the differential list?

Agenesis

There is motheaten osteolysis with a wide zone of transition in the right ilium of a 57 year old female. There is no periosteal reaction, matrix pattern, or soft tissue mass. What is the correct differential? a. Metastatic disease, multiple myeloma, lymphoma b. Metastatic disease, lymphoma, multiple myeloma c. Multiple myeloma, lymphoma, metastatic disease d. Multiple myeloma, metastatic disease, lymphoma

Metastatic disease, multiple myeloma, lymphoma

AP and frogleg radiographs on a 5 year old patient showing a small femoral head, a steeply inclined shallow acetabulum and superolateral femoral displacement. What is the diagnosis.

DDH