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a Prometheus book FRCR Part 2A flashcards > Module 2: MSK > Flashcards

Module 2: MSK Flashcards

1
Q

stress fracture is

A

abnormal stress on normal bone

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2
Q

insufficiency fracture is ..

A

normal stress on abnormal bone

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3
Q

bones heal in how many weeks

A

6-8

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4
Q

Most often scaphoid fracture

A

waist 70%
thenproximal 20%
then distal 10%

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5
Q

first sign of AVN for scahpod fracutre

A

sclerosis

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6
Q

why does sclerosis signify AVN in scaphoid

A

dead bone can’t turnover

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7
Q

location of fracture most at risk of aVN in scaphoid

A

proximal

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8
Q

Scaphoid fracture on MRI look for what

A

Dark on T1

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9
Q

What is a SLAC wrist

A

complication of trauma

Scapho-lunate advanced collapse

injury to SL ligament

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10
Q

what is SNAC wrist

A

a potential complication of trauma as well

Scaphoid non-union advanced collapse

happens with injury to the scaphoid

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11
Q

which way does the scahpoid want to be rotating

what holds it back

A

flexion

SL ligament holds it back

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12
Q

if SL breaks what happens to the capitate?

A

the scaphoid radial distance narrows

the capitate moves proximally.

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13
Q

how can you treat a SLAC wrist?

A

wrist fusion - max strength loss of motion

proximal row carpectomy - max rom, lose strength

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14
Q

describe a perilunate dislocation

A

capitate moved off the back (sits perilunate)

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15
Q

describe a midcarpal dislocation

A

lunate is dislocated anteriorly and capitate posterily

(all moved from the mid)

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16
Q

describe a lunate dislocation

A

lunate rotate and dislocated anteriorly.

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17
Q

Normal Scaphlunate distance

A

3mm

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18
Q

the lunate wants to move in which direction ?

A

rock posteriorly

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19
Q

what does DISI stand for

A

dorsal intercalated segmental instability

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20
Q

VISI stands for

A

volar intercalated segmental instability

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21
Q

What happens in DISI ?

A

rocking dorsally of the lunate

happens due to an injury of the SL ligament. (therefore a radial sided injury)

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22
Q

What happens in VISI?

A

very rare

ulnar sided injury will damage the lunotriquetral ligament. Lunate is no longer pinned.

Lunate will tilt volar direcitons.

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23
Q

what is the normal scaphoid lunate angle?

A

30 - 60 degrees

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24
Q

DISI vs VISI angles ?

A

DISI - opens the angle- greater than 60

VISI - closes into a V - less than 30

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25
Q

Bennett and rolando fractures - whats the difference

A

Rolando is comminuted

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26
Q

in a bennet fracture, what tendon attachement causes the dorsolateral dislocation

A

abductor pollicis longus

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27
Q

What is gamekeepers thumb?

A

base of the proximal phalanx of the thumb

ulnar collateral ligament disruption

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28
Q

What is a stener lesion

A

in gamekeepers thumb.
adductor tendons get caught in the torn edges of the Ulnar collateral ligament (which has been broken off)

yo yo appearance on MRI

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29
Q

What is carpal tunnel syndrome.

hwo does it appear on US

A

Median nerve impingment.
thenar eminence wasting

enlargement of median nerve on US is the thing to look for

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30
Q

what treatment is assocaited with carpal tunnel syndrome

A

Ax with dialysis

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31
Q

Guyons canal syndrome can be caused by what ?

A

cycling

handle bar palsy

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32
Q

guyons canal is made by what bones

A

hamate hook
pisiform

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33
Q

fracture of the radial head with anterior dislocation of the DISTAL radial ulnar joint is called

A

Essex Lopresti

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34
Q

Ulnar fracture and radial head dislocation is called

A

Monteggia

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35
Q

Radial head fracture and ulnar dislocation at the Distal RU joint

A

Galeazii

Essex-Lopresti starts with E for elbow; indicating that it involves the radial head or neck

wheras Galeazzi involves the radial diaphysis.

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36
Q

cubital tunnel syndrome occurs due to

A

repetitive valgus stress

compression from tumour, haematoma et

accessory muscle compression
- anconeus epitrochlearis

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37
Q

Hill Sachs lesion is on the

A

Humerus

posterolateral

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38
Q

Bankart lesion is on the

A

glenoid

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39
Q

Hill sachs occurs where on the humers?

A

postero lateral

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40
Q

Hill Sachs best seen on which radiograph view

A

internal rotation

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41
Q

Bankart lesions are found where on the glenoid

A

anterior inferior labrum

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42
Q

Bankart and Hill sachs happen in hwihc type of dislocation

A

anterior

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43
Q

inferior dislocation causes what damage

A

to the axillary nerve

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44
Q

trough sign

A

happens in posterior dislocation

injury to the anterior humeral had impaction

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45
Q

shoulder prosthesis depends on what?

A

is the cuff intact

is the glenoid intact

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46
Q

If the glenoid is intact what are the options

A

Cuff intact
- resurfacing/Hemi

Cuff buggered
- Hemi or reverse

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47
Q

If glenoid is buggered

A

Cuff intact
- TSA

Cuff buggered
- reverse

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48
Q

What is the most common shoulder prosthesis complication?

A

loosening of the glenoid component

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49
Q

shoulder op complication

Anterior escpae

A

subscapularis fails, whole humeral head migrates anteriorly

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50
Q

femoral nek fractures

medial are what type

A

stress fracture

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51
Q

femoral neck fractures

lateral are what type

A

bisphosphonate related fractures

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52
Q

hip dislocoation

which direction is most common

A

posterior

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53
Q

femur fracture at risk of AVN is what

A

displaced intracapuslar fracture

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54
Q

snapping syndrome what are the three types?

A

External
internal
intra-articular

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55
Q

External snapping syndrome

A

ITB over greater trochanter

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56
Q

internal snapping syndrome

A

Iliopsoas over iliopectineal eminence/femoral head

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57
Q

intra-articular snapping syndrome

A

labrel tares

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58
Q

what are the two types of femoroacetabular impingmenT?

A

CAM

PINCER

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59
Q

CAM

A

young men
anterior superior femoral neck protrusion.
pistol grip deformity

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60
Q

Pincer impingment

A

middle aged women
over coverage of the femoral head by the acetabulum

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61
Q

most common location for an acetabular labral tear?

A

anterior superior

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62
Q

what are the 5 testable pathologies of the sacrum?

A

SI degenerative change
unilateral SI infection
chordoma
sacral agenesis
insufficiency fracture

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63
Q

sacral insuffiicency fracture most common in

A

postmenopausal women with osteoporosis

also in RA, pelvic radiation, steroid use

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64
Q

Honda sign on nuclear medicine

A

Sacral insufficienc signs

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65
Q

Knee

what is a segond fracture?

A

Fracture of the lateral tibial plateau

Ax with ACL tear in 75%

occurs with internal rotation

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66
Q

what is a reverse Segond fracture

A

medial tibial plateau fracture

PCL and medial meniscus injury is ax

external rotation

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67
Q

fibula - what is the arcuate sign?

A

avulasion of the proximal fibula

90% ax with PCL injury

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68
Q

what is the deep intercondylar notch sign

A

depression of the lateral femoral condyle (terminal sulcus) that occurs secondary to an impaction injury.

This is ax with ACL tears

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69
Q

Patella dislocated in which direction?

A

lateral

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70
Q

which ligament is damaged with lateral patella dislocaiton

A

medial patello femoral ligament

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71
Q

What is patella alta

A

high ridingin patella

(can be from old patella ligament injury)

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72
Q

what is patella baja

A

low riding patella

quadriceps injury

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73
Q

tibial platea fracture - which side is more common to injury?

A

lateral plateau

Schatzker classificaiton - type 2 most common

split and depressed

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74
Q

Pilon fracture - what is it

A

tibial plafond fracture

impaction

75% will have fracture of distal fibula

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75
Q

Tillaux fractures is what slater harris

A

slater harris 3
anterlateralaspect of the distal tibial epiphyis

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76
Q

Triplane fracture is SH calssifciaton of what

A

4.
vertical component through the epiphysis

horizontal through the component of the physis.

oblique through the metaphyiss

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77
Q

Maisonneuve fracture
what is it

A

unstable fracture

medial tibial malleolous
disruption of the distal tibiofibular syndesmosis.

PROXIMAL fibula fracture

does NOT extend into the hindfoot

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78
Q

What is a casanova fracture?

A

axial loading pattern for burst lumbar fracture

in the context of bilateral calcaneal fractures.

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79
Q

what angle of bohlers is concerning

A

less than 20

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80
Q

what is a jones fracture?

A

fracture at the base of the 5th metatarsal.

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81
Q

base of 5th avulsion fracture is pulling fromwhat muscle

A

lateral cord of the plantar aponeurosis or peroneus brevis

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82
Q

Should you be concerned about a 5th metatarsal stress fracture

A

yes

hard to heal

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83
Q

LisFranc injury

what is it dislocation

A

lisfranc ligament connects medial cuneiform to 2nd metatarsal base plantar side.

Get homolateral and divergent pattern

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84
Q

Lisfranc injkury cant be excluded on q

A

non weight bearing images

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85
Q

Lisfranc injury ax pattern

A

base of 2nd metatarasal

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86
Q

Fractures on a compressive do….

A

well

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87
Q

Fractures on the tensile side….

A

do badly

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88
Q

what does SONK stand for

A

Spontaenous Osteonecrosis of the knee

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89
Q

what is SONK

note now called Subchondral insufficiency fracture

A

insufficiency fracture

unilateral
ax with meniscal injur y

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90
Q

Navicular stress fractures affect who?

A

runners on hard surfaces

high risk of AVN

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91
Q

March fracture is seen in the

A

metatarsals

common

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92
Q

what is a calcaneal stress fracture?

A

fracture of the bone.
fracture line will be perpendicular to the trabeculae

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93
Q

Where are the foot high risk fractures?

A

Sesamoid great toe
tarsal naviuclar
talus
5th metatarsal

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94
Q

what are the leg high risk fractures

A

femoral neck with tensile side
transverse patellar fracture
anterior tibial fracture (midshaft)

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95
Q

What is meatn by osteopenia?

A

lucent bones

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96
Q

What is osteomalacia?

A

soft bone due to excessive calcified osteoid

vit D issues

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97
Q

Features of osteomalacia

A

Ill defined travbeculae
ill defined corticomeduallary junction
bowing
loosers zones

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98
Q

What are loosers zones

A

wide lucent bands
right angle to the cortex

think osteomalacia

type of insufficiency fracture

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99
Q

what is osteoporosis?

A

low bone density
normal ratio

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100
Q

what are the imaging features of osteoporosis ?

A

thin sharp cortex
prominent trabecular bars
lucent metaphyseal bands
spotty lucencies

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101
Q

DEXA - what is the T score

A

Density relative to young adult

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102
Q

T score over 1

A

normal

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103
Q

T score of down to 2.5 is

A

osteopenia

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104
Q

Less than 2.5 is

A

osteoporosis

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105
Q

Z score is what?

A

density relative to aged match control

Za Zame age

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106
Q

DEXA - things to cause a false negative?

A

excessive osteophytes
dermal calc
metal
compresson fractures

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107
Q

What is reflex sympathetic dystrophy?

A

occurs after over active sympathetic system

eg after trauma or infeciton

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108
Q

what does reflex sympathetic dystrophy look like?

A

unilateral RA with preserved joint spaces

3 phase hot bone scan
vascular synovial membrane

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109
Q

What are the two types of transient osteoporosis ?

A

Of the hip

regional migratory osteoporosis

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110
Q

Transient osteoporosis of the hip

affects who

A

pregnant patient, can be men too
normal joint spaces
resolves

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111
Q

Regional migratory osteoporosis is what?

A

idiopathic disorder
pain in a joint but moves to different joints

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112
Q

Osteoporotic compression fracture on MRI

A

Band like fracture line dark on T1

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113
Q

Spinal mets, when will collapse happen

A

once invaded whole vertebral body

think of this if invading posterior margin

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114
Q

What is osteochondritis dissecans (OCD) ?

A

Asecptic seperation of an osteochondral fragment

lead to fragmentation and OA

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115
Q

Classic location of the OCL?

A

femoral condyle
knee
patella talus
capitellum

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116
Q

OCD staging stages - how many ?

A

4

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117
Q

Stage 1 OCD

A

Stable, covered intact

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118
Q

Stage 4 OCD

A

dislocated fragment

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119
Q

How can you call an OCD fragment unstable?

A

on MRI

if there is T2 signal undercutting it

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120
Q

What are osteochondroses?

A

normally in kids
involve epiphyses

collapse, sclerosis, fragmentation

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121
Q

Kohlers osteochondritis - where and who>?

A

tarsal navicular

male 4-6. no surgery

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122
Q

Freiberg osteochondritis - where adn who?

A

Second metatarsal head

teenage girls. leads to OA

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123
Q

Severs osteochondritis - where and who

A

Clacaneal apophysis

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124
Q

Panners ostechondritis

A

Capitellum

kid 5- 10

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125
Q

Perthes osteochondritis

A

femoral head

caucasion kid, 4- 8

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126
Q

Kienbock osteochondritis - where and who?

A

carpal lunate

20 - 40 year old.

negative ulnar variance

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127
Q

which tendons are affected in de Quervains?

A

APL and EPB

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128
Q

how many extensor compartments are there

A

6

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129
Q

What is in the carpal tunnel

A

FPL
median

8 digitorum superficial / profundus

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130
Q

what 4 bony bits give the carpal tunnel the roof?

A

hook of hamate
pisiform
scaphoid tubercle
trapezium tubercle

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131
Q

which spaces are used for wrist arthography?

A

pisiform recess and radiocarpal joint

they communicate

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132
Q

should glenohumeral and subacromial bursa communicate

A

no

implies full thickness rotator tear

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133
Q

Ankle joint and common peroneal tendon sheath

do they communicate?

A

no

implies calcaneofibular ligament tear

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134
Q

achilles tednon and posterior subtalar joint

A

not communicate

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135
Q

young person, tear on ulnar side of the triangular fibrocartilage

acute or chronic

A

acute

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136
Q

Scapholunate ligament tear has a sign called

most important band for stability

A

Terry thomas gap

dorsal band.

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137
Q

intersection syndrome affects who

A

rowers

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138
Q

intersection syndrome affects what compartment

A

extensor carpi radialis brevis and longus tenosynovitis

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139
Q

What are the two categories for tenosynovitis?

A

diffuse

focal

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140
Q

list two diffuse tenosynovities

A

nontuberculous mycobac infection

Rheumatoid arthritis

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141
Q

nontuberculous mycobac infection affects where

A

hand and wrist

affects those who are immunocompromised

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142
Q

describe types of focal tenosynovitis

A

overuse

infection - this is an emergency

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143
Q

isolate 6th flexor compartment tenosynovitis think

A

early RA

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144
Q

types of finger tip tumours

A

Glomus
Giant cell tumour of tendon sheath
fibroma

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145
Q

What is a glomus tumour

A

benign vascular tumour.

T1 low
T2 bright
enhance avidly

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146
Q

Giant cell tumour of tendon sheath 0 what is it?

A

PVNS of tendon
erosions on the underlying bone

T1 and T2 dark
blooms on gradient

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147
Q

Finger fibroma - what is it

A

benign overgrowth of tendon collagen
low T1 and T2. Will not bloom like GCT on gradient

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148
Q

cubital tunnel syndrome from repetitive what

A

valgus stress

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149
Q

Elbow T sign on MRI has damage to what

A

ulanr collateral ligament

throwers

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150
Q

How to differentiate
Panners osteochondritis from osteochondritis dissecanxs

A

Panner is 5-10 not teenager
Same MRI
No loose bodies in Panner. OCD is loose bodies

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151
Q

what is lateral epicondylitis

A

tennis elbow
extensor tendon injury

radial collateral ligament complex - tears due to varus stress

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152
Q

Medial epicondylitis affects

A

golfers

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153
Q

Golfers elbow is what pathology

A

common flexor origin. ulnar nerve may enlarge

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154
Q

epitrochlear lymphadenopathy

ax with

A

cat scratch

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155
Q

dialysis elbow is inflammation of what

A

olecronon bursitis

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156
Q

Two types of impingement are

A

external and internal

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157
Q

external impingment does what

A

impingement of rotator cuff overlying the bursal surface

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158
Q

what is the coracoacromial arch formed of

A

coracoid process
acromion
coracacromial ligament

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159
Q

Primary external impingement causes are considered due to an

A

abnormal coracoacromial arch

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160
Q

Types of primary external impingment

A

Hooked acromion

Subacromial osteophyte fomraiton

subcoracoid impingement

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161
Q

Subcoracoid impingement happens to wht

A

impinge subscapularis between coracoid process and lesser tuberosity

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162
Q

Secondary external causes (ie normal coracoacromiial arch)

A

Multidirectional glenohumeral instability.
- microtrauma from micro subluxation.

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163
Q

Internal causes of shoulder impingement refers to what process happening

A

impingement of rotator cuff on the under surface along the glenoid labarum and humeral head.

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164
Q

Internal impingement.
Posterior superior
- what are the details

A

postero superior rotator cuff involved. (supra and infraspinatus tendons)

comes into contact with the psoterior superior glenoid.

Throwers shoulder

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165
Q

Internal impingement.
Anterior superior
- what are the details

A

horizontal adduction and internal rotation.
Here - undersurface of biceps and subscapularis tendon impinge against

anterior superior glenoid rim

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166
Q

Subacromial impingment damages which tendon

A

supraspinatus

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167
Q

Subcoracoid impingment damages which

A

subscapularis

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168
Q

Posterior superior internal impingement damages what

A

infraspinatus

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169
Q

which rotator muscle is most common to tear

A

supraspinatus

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170
Q

massive rotator cuff tear refers to

A

at least 2 of the 4 rotator cuff muscles torn

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171
Q

how to know its a full thickness tear

A

Gad in the bursa on MRI

high T2 signal in location of the tendon

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172
Q

laberal tear favour which margin

A

superior

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173
Q

SLAP
labral tears track which direction

A

ant to posterior

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174
Q

is SLAP tear ax with instability

A

no

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175
Q

What is the SLAP mimic

A

sublabral recess

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176
Q

Labral tear mimic

A

sublabral foramen
- unattache dprotion from 1 to 3 o clock.

buford complex
- absent ant/sup labrum + thickened middle glenohumeral ligmanet

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177
Q

Bankart is caused by what dislocation

A

anterior

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178
Q

Types of bankart lesion

A

GLAD
Perthes
ALPSA
Bankart - cartilage
Bankart - osseous

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179
Q

GLAD stands for

A

Glenolabral articular disruption

superfiicla partial labral injury, cartilage defect

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180
Q

Shoulder Perthes is what

A

detachement of the anteroinferior labrum with medially stripped but INTACT periosteum

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181
Q

ALPSA stands for what

A

Anterior labral periosteal sleeve avulsion

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182
Q

ALPSA causes what

A

Medially displaced labroligamentous complex with absence of the labrum on the glenoid rim. INTACT periosteum

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183
Q

True bankart is what

A

periosteum is disrupted.

often ax Hill Sach’s fracture

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184
Q

What is a HAGL? Shoulder injury.

A

non bankart lesion

Humeral Avulasion Glenohumeral Ligament
- avulsed inferior glenohumeral ligament.

from ant shoulder dislocation

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185
Q

Subscapularis attaches to what

A

lesser tuberosity

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186
Q

how can the biceps tendon sublux

A

normal fixed by some subscapularis transverse fibres

if damaged, can come out - MEDIAL dislocaiotn

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187
Q

how can the biceps tendon sublux

A

normal fixed by some subscapularis transverse fibres

if damaged, can come out - MEDIAL dislocaiotnw

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188
Q

what is quadrilateral space syndrome?

A

compression of axilary nerve in the quadrilateral space
- normally from fibrotic bands

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189
Q

borders of the quadrilateral space

A

Teres minor above
major below
Long head triceps diagnoal side
humerus other sided

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190
Q

what is parsonage - turner syndrome

A

muscles affected b pathology in two or more nerve distributions.
Conditon has idiopathic involvement of the brachial plexus

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191
Q

how many bundles does the ACL have

A

two

192
Q

which acl bundle tightens the knee in flexion

A

long one
anteromedial

193
Q

which acl bundle tightens the knee in extension

A

short
posterior lateral

194
Q

medial miniscus is thickenr in the

A

posterior

195
Q

knee meniscofmeoral ligaments that can mimic meniscal tears

A

Wrsiberg and Humphry

196
Q

Humphry ligament is found

A

anterior knee

197
Q

the knee conjoint tendon is formed by

A

biceps femoris and LCL

198
Q

meniscal cysts are associated with what kind of injury?

A

horizontal cleavage tears

199
Q

meniscocapsular seperation in the knee is associated with what injury

A

MCL injury.
weak inner layer, first to break

200
Q

what is a bucket handle tear

A

usually medial meniscus

flips to lie anterior to the pcl looks like a double PCL

201
Q

what is a meniscal ossicle?

A

focal ossification of the posterior horn of the medial mensicus, secondary to truam or development.

ax with radial root tears

202
Q

what fracture is ax with acl tears

A

segond fracture

203
Q

what is O’donaghues unhappy triad

A

acl tear
mcl tear
medial meniscal

204
Q

Why is posterior lateral corner important

A

complex anatomy of IT band, LCL, biceps demoris and poplietus.

Missed PLC injury can cause ACL reconstruction failure

205
Q

ACL reconstruction complications

A

roof impingement - need tibial tunnel to be in correct plain

maintaining isometry

arthrofibrosis - focal or diffuse. Cyclops lesion

Graft tear

206
Q

what is ACL mucoid degeneration?

A

mimic acute or chronic acl tear.
no secondary signs o injury.

predisposes to ACL gnaglion cysts.

T2 celery stalks - striated
T1 drumstick

207
Q

patella dislocation - injury to which ligament?

A

medial patellar femoral ligament

208
Q

what is the master knot of Henry in ankle anatomy

A

Dick crosses over Harry

FDL crosses over FHL at medial ankle

209
Q

which ligament in the foot/ankle is the weakest?

A

Anterior talofibular ligament

(inversion injury)

210
Q

What is posterior tibial tendon injury / dysfunction?

A

Acute pain at the navicular insertion.

Chronic will be tears at the medial malleolus.

results in progressive flat foot deformity

211
Q

posterior tibial tendon injury / dysfunction
what happens to the hindfoot?

A

Valgus deformity
unopposed peroneal brevis action.

212
Q

progression of posterior tibial tendon injury / dysfunction

A

PTT out, then spring ligament out

sinus tarsi jacked.

painful heel strike on a flat foot –> plantar fascitiis

213
Q

what is a split peroneus breivs?

A

inversion injuries cause longitudinal splits in ligament

C shaped tendon

214
Q

what is sinus tarsi syndrome?

A

between lateral talus and clacaneus
haemorrhage / inflammation of the synovial recess.

obliterated fat in the space is seen on MRI

215
Q

what is tarsal tunnel syndrome?

A

tibial nerve compression.
pain in first 3 nerves

216
Q

achilles rupture, loss of plantar flexion is lost unless….

A

plantris muscle is intact

217
Q

Xanthoma sign in achilles

A

thickened

affects people with familial hypercholesterolemia

218
Q

what does a mortons neuroma look like?

A

dumbell T1 dark scar between the 3rd and 4th metatarsals

219
Q

Osteomyelitis in spine think

A

IV drug user

220
Q

Osteomyelitis in Spine with kyphosis think

A

Gibbus deformity - TB

221
Q

Unilateral SI joint infection?

A

IV drug user (again)

222
Q

Psoas muscle abscess think…

A

TB

223
Q

What is a brodies abscess

A

chronic bone abscess

224
Q

brodies abscess will appear as

A

osseus sequestrum

225
Q

what is sequestrum

A

necrotic bone surounded by granulation tissue

226
Q

involucrum means

A

thick sheath of periosteal bone around equesterum

227
Q

cloaca means

A

tract to where the dead bone lives

228
Q

3 categories of acute bacterial osteomyelitis

A

hematogenous seeeding

contiguous spread

direct inoculation post operation

229
Q

haematogenous spread of osteomyleitis ends up in…

A

the long bones, metaphysis

230
Q

what are the MRI findings of osteomyeltiis

A

Low signal bone marrow on T1 imaging

231
Q

Discitis source of infection in adults

A

recent surgery,orocedure or systemic infection

232
Q

Discitis in children from

A

haematogenous spread

233
Q

discitis signs on MRI

A

T2 bright disc signal
paraspinal and epidural inflammation

234
Q

What is Potts disease

A

TB of the spine

235
Q

How does Potts disease present on imaging

A

spare the disc space
multi level thoracic skip involvement
Large paraspinal abscess
calcified psoas abscess
gibbusdeformity

236
Q

What can mimic TB in the spine?

A

Brucellosis (unpasterized milk)

237
Q

how quickly can septic arthritis destroy a joint

A

48 hours

238
Q

Risk factors for necrotizing fasciits

A

HIV
transplant
diabetics
alcoholics

239
Q

what bug causes nec fas

A

polymicrobial

or

group A strep

240
Q

What is nec fasc called in the scrotum

A

Fournier Gangrene

241
Q

what are rice bodies

A

sloughed, infarcted synovium seen in end stage RA and TB infection of joints.

242
Q

What is TB dactylitis?

A

kids more than adults.

short tubular bones of hands and feet.

periosteal reaction.

diaphyseal expansile lesion

243
Q

what are the most common primary osseous malignancies?

A

myeloma / plasmacytoma
osteosarcoma
chondrosarcoma

244
Q

Subtypes of osteosarcoma

A

conventional intramedullary
parosteal
periosteal
telanciectactic

245
Q

feature of all osteasarcomas is that they produce

A

bone/osteoid from neoplastic cells

246
Q

Conventional intramedullary osteosarcoma affects

who?
where?

Appearance of lesion ?

A

young (10-20)
femur

sunburst
codman triangle
lamellated

247
Q

where does osteosarcoma met to

A

lungs

248
Q

Type of lesions that risks of pathological fracture?

A

Lytic lesions
lesions over 3cm
lesions involving more than 50% of the cortex

249
Q

Paraosteal ostesarcoma main features

size
marrow
grade

A

Bulky and big
marrow extension
low grade

250
Q

Paraosteal osteosarcoma radiolucent line seperating bulky tumour from the cortex is called the

A

string sign

251
Q

Periosteal osteosarcoma features

age
location
prognosis

A

worse prognosis than parosteal
(15-25)
occurs in diaphyseal regions like medial distal femur

252
Q

telangiectatic osteosarcoma - main feautures on mRI

A

Fluid - fluid levels on MRI is classic.
High T1 from methemoglobin

253
Q

what are the differentials for Fluid fluid levels in bones

A

Telangiectactic osteosarcoma
aneurysnal bone cyst
Giant cell tumour

254
Q

Chondrosarcoma - main features

who
grade type
location

A

older adults
male more than female
mostly low grade

intramedullary or peripheral

255
Q

risk factors for chondrosarcoma

A

pagets or anything affecting the cartilage

256
Q

Permeative lesion in the diaphysis of a child - diagnosis is…

A

Ewings

257
Q

What is a similar feature of ewings and osteosarcoma?

A

Ewings scleroses (bone only)
Osteosarcoma will lay down osteoid

can mimic

258
Q

chordoma is seen in what age group

A

30 - 60

259
Q

chordoma most common location is

A

sacrum

260
Q

MRI feature of chordoma is that they are

A

very bright on T2

261
Q

Midline bone tumour think… .

A

chordoma

262
Q

List some aggressive soft tissue lesions

A

Fibrosarcoma
pleomorphic undifferentiated sarcoma

Synovial sarcoma
liposarcoma

263
Q

Fibrosarcoma - on MRI they are

A

NOT T2 Bright (most other tumours are)V

264
Q

Fibrosarcoma appear as

A

lytic
moth eaten / permeative

265
Q

Pleomorphic undifferentiated sarcoma “PUS” / MFH (malignant fibrous histiocytoma) (same thing)

to note will look the same as

A

radiologically look the same sas fibrosarcoma

266
Q

synovial sarcoma is seen where and what age group

A

lower extremities of those aged 20 - 40
mostly dont involve the joint

267
Q

bunch of grapes sign?

A

synovial sarcoma

268
Q

ball like tumour in the extremity of a young aduly think

A

synovial sarcoma

269
Q

fatty mass in the retroperitoneum think

A

liposarcoma

270
Q

liposarcoma affects what age group

A

middle aged

271
Q

Myxoid liposarcoma MRI appearance

A

T2 bright but T1 dark
don’t mix with a cystic lesion

272
Q

how to treat osteosarcoma

A

chemo then wide excisiton

273
Q

how to treat ewings

A

chemo and radiation then wide excision

274
Q

how to treat chondrosarcoma

A

wide excision

275
Q

GCT how to treat

A

arthroplasty as often extends into the articular surface

276
Q

what does Myositis ossificans look liek?

A

circumferential calcifications with lucent center

277
Q

Corticol desmoid appearance

A

can be hot on bone scan
posterior medial epicondyle of the distal femur

278
Q

What is the mnemonic for cystic bone lesions

A

FOGMACHINES

279
Q

Cystic bone lesions by age

under 30

A

EG
ABC
NOF
Chondroblastoma and SOlitary bone cysts

280
Q

cystic bone lession by age

over 40

A

Mets and myeloma

281
Q

they say

malignant epiphyseal you sa

A

Clear cell chondrosarcoma

282
Q

Epiphyseal bone cyst lesions

A

AIG C

ABC
Infection
GCT
Chondroblastoma

283
Q

cystic bone lesions in the metaphysis

A

most of them

due to good blood supply especially bone mets and infeciton

284
Q

what is fibrous dysplaia?

A

skeletal developmental anomaly of osteoblasts

failure of normal maturation and differentiation

285
Q

What can fibrous dysplasia look like?

A

anything

286
Q

McCune albright facts to know

A

precocious puberty
cafe au laits spots
girls

polyostotic fibrous dusplasia

287
Q

Mazabraud facts to know

A

Polyostotic fibrous dysplasia

women
soft tissue myxomas
increased osseous malignant transformation

288
Q

what is an adamantinoma

A

tibial lesion that resembles fibrous dysplasia. Potentially malignant.

289
Q

Enchondroma is found where

A

medullary cavity - composed of hyaline cartilage

290
Q

apperance of an enchondroma

A

lytic lesion with irregularly speckled clacification of chondroid matrix.

ARCS AND RINGS

though not found in fingers and toes

291
Q

how to differentiate enchondroma vs low grade chondrosarcoma

A

history of pain

292
Q

All the Ms of Maffucci relates to what

A

MORE .haemangiomas than enchondromas.
Malignant potential

293
Q

Eosinophilic Granuloma (EG) classic apperance

A

vertebra plan in a kid
skull with beveled edge lesion

floating tooth with lytic lesion in alveolar ridg

294
Q

Ddx for vertebra plana

A

MELT

Mets
EG
Lymphoma
Trauma/ TB

295
Q

DDx for osseous sequestrum

A

OM
Lymphoma
fibrosarcoma
EG
Osteoid osteoma can mimic

296
Q

What must the physis be in GCT

A

closed

297
Q

Features of GCT

A

non sclerotic border
abut an articular surface

298
Q

GCT most common in age

A

20 - 30

299
Q

relationship of GCT and ABC

A

ABC can turn into GCT

300
Q

Non ossifying fibroma seen in

A

children

301
Q

Non ossifying fibroma classically found in

A

the knee

302
Q

border feature of Non ossifying fibroma

A

sclerotic thin border

(GCT are thin walled)

303
Q

what is a non ossifying fibroma called when less than 2cm?

A

fibrous cortical defect

304
Q

NOF and fibrous corticl defects can also be called together

A

fibroxanthoma

305
Q

what is Jaffe Campanacci syndrome

A

multiple NOF, cafe au laits mental retardation, hypogonadism and cardiac malforamations

306
Q

night pain relieved by aspirin

A

osteoid osteoma

307
Q

osteoid osteoma is found where

A

meta/diaphyiss of long bones.
spine

308
Q

lots of oedema around a lesion

A

think osteoid osteoma

309
Q

associations of osteoid osteoma

A

painful scoliosis
growth deformity
synovitis
arthritis

310
Q

what is an osteblastoma

A

osteoid osteoma greater than 2cm

311
Q

classically bone lytic metastases

A

RCC and thyroid

312
Q

classic blastic lesions for bone mets

A

prostate
carcinoid
medulloblastoma

313
Q

What is Multiple myeloma ?

A

Plasma cell proliferation increases surrounding osteolytic activity

314
Q

appearance of MM in spine

A

Vertebral body destruction with sparing of the posterior elements

315
Q

what is a plasmacytoma ?

A

discrete solitaroy neoplastic monclonal plasma cells in bone or soft tussues

counterpart to MM

316
Q

Mini brain appearance

A

plasmacytoma in vertebral body

317
Q

ABC are what?

A

aneurysma lesions, thin walled and blood filled.
(fluid fluid level on MRI)

can develop following trauma
think tibia

normally young patients

318
Q

fallen fragment sign think

A

solitary bone cyst

319
Q

Brown tumour is ax with what condition

A

hyperparathyroidism

320
Q

what is a brown tumour

A

accumulation of giant cells and fibrous tissue

321
Q

features of chondroblastoma

A

kids

thin sclerotic rim
extends across physeal plate
periostitis

NOT T2 BRIGHT

322
Q

chondromyxoid fibroma

A

least common benign lesion of cartilage

patients young than 30

osteolytic typically,
elongated in shape
eccentrically located

metaphyseal lesion with corticol expansion

323
Q

hip intertrochanteric region

ddx

A

lipoma
solitary bone cyst
monostotic fibrous dysplasia

324
Q

benign lesion differentials for no pain / periostitis

A

fibrous dysplasia
enchondroma
NF
Solitary bone cyst

325
Q

Multiple benign lesions differentials

A

Fibrous dysplasia
EG
Enchondroma
Mets/ Myeloma
hyperparathyroidism

326
Q

liposclerosing myxofibroma location at the

A

intertrochanteric region of the femur

geographic lytic lesion with a sclerotic margin.

10% undergo malignant transofrmaiton

327
Q

Osteochondroma associated with what treatment

A

radiation

328
Q

Multiple osteochondroma - condition

A

multiple hereditoary exostosis

329
Q

Trevor disease is also called

A

Dysplasia epiphysealis hemimelica

330
Q

what is trevor disease?

A

oseochondromas in an epihpysis, serious joint deformity . O

331
Q

Osteochondroma vs Supracondylar spurr?V

A

Osteochondroma points away from the joint

332
Q

Periosteal chondroma

found where and what age group

A

lesion in the finger of a kid

333
Q

What is osteofibrous dysplasia

what is appearnace
who does it affect

A

benign lesion found in tibia or fibula of children

anterior tibial bowing

334
Q

Tibial bowing ax with NF1

A

NF1 antierior with fibular pseduoarthrosis

335
Q

three categories of arthritis

A

Degenerative (OA, Neuropathic)

inflammatory (RA, Variants)

Metabolic (Gout, CPPD)

336
Q

most common degenerative arthritis is

A

osteoarthritis

337
Q

surgical like marings with arthritis think

A

neuropathic joint

338
Q

gullwing in post menopaual women at the DIP joints

A

erosive osteoarthritis

339
Q

Features of rheumatoid arthritis?

A

osteoporosis
soft tissue swelling
marginal erosision
unifrom joint space narrowing

bilateral and symmetric

spares the DUP joints

340
Q

features of felty syndrome

A

RA for >10 years
splenomegaly
neutropenia

341
Q

caplan syndrome

A

RA and pneumoconiosis

342
Q

RA vs OA of th hip

A

OA is up and medial

RA is at an angle (10pM)

343
Q

List some rheumatoid variants

A

Psoriatic arthritis
reisters syndrome (reactive arthritis)
Ank Spond
Inflammatory bowel disease

344
Q

Psoriatic arthritis affects which joints

A

IP joint more than MCP joints

starts in the margins

345
Q

ank spond in the hand, Pencil in cup, mouse ears all describe

A

Psoriatic arthritis of the phalanges

346
Q

features of psoritatic arthritis

A

Asymmetric
distal IP joints
no osteoporosis
bone proliferation
causes mutilans if severe

347
Q

features of RA

A

symmetric
proximal MCP
osteoporosis
no bone proliferation
causes mutilans if severe

348
Q

reactive arthritis is similar to psotiatic arthritis except

A

found in feet

349
Q

SI joints and ank spond

A

widens initially and then narrows

hits SI joints first!

350
Q

in ank spond worry about any trauma always do

A

the CT spine

351
Q

unilateral abnormal SI joints think

A

infeciton

352
Q

asymmetric but both abnormal SI joints think

A

Psoriasis or reactive arthritis

353
Q

symmetric both wrong SI joints think

A

INflammatory bowel or Ank Spond

354
Q

Gout earliest sign

A

joint effusion

355
Q

Gout has erosions located where?

A

juxta articular.

spares joint space until late in disease

356
Q

phrases for gout

A

punched out lytic lesions
overhanging edges
soft tissue tophi

357
Q

Gout on MR

A

juxta articular soft tissue mass low on T2

tophys will normally enhance

358
Q

Gout mimickers what are they

A

RAASH

Amyloid
RA
reticular histocytosis
sarcoid
hyperlipidaemia

359
Q

what does CPPD (pseudo gout) stand for

A

Clacium pyrophsophate disease

360
Q

what is pseudogout in relation to CPPD

A

CPPD + synovitis is pseudo gout

361
Q

CPPD favourited joints

A

TFC of wrist
peri odontoid tissue
intervertebral disks

362
Q

what is a Milawaukee shoulder

A

destroyed shoulder due to hydroxyapatite crystals in the shoulder

363
Q

how does haemochromatosis link to calcium pyrophsophate deposition

A

iron overload causes the deposition of CPPD

get chondrocalcinosis .

364
Q

superiosteal bone resoroption on radial side of fingers think….

A

hyperparathyroidism

365
Q

rugger jersey spine think

A

hyperparathyroidism

366
Q

brown tumours assocaited with

A

hyperparathyroidism

367
Q

terminal tuft erosions think

A

hyperparathyroidism
scleroderma
psoritatic arthritis

JPA
RA

368
Q

Initial consideration of hand XR as to whether inflamatory or degenerative?

A

Inflamatory will be symmetric joint space norrowing with erosions

degenerative will be asymetric and osteophytes

369
Q

if hand pathology is though to be inflammatory what does one joint vs multiple mean?

A

one joint means likely infeciton

multiple then think is there bony proliferation and what is the distribution

370
Q

Erosion, multiple joints, proximal distribution
no bony proliferation

A

RA

371
Q

Erosion, multiple joints

distal distribution and bony proliferation ddx are

A

AS
psoriasis
reactive arthritis
inflammatory bowel related

372
Q

if asymmetric joint space narrowing
osteophytes

how to seperate types of degenerative

A

Typical joints - OA

Atypical joints / age - Post truama, gout/CPPD, hemophilia

Severe destruction - neuropathic

373
Q

flowing syndesmophytes think

A

Ank SPond

374
Q

Diffuse paravertebral ossifications think

A

DISH

375
Q

focal lateral paravertebral ossification

A

psortiatic arthritis

376
Q

Which conditions erode the dens

A

CPPD and RA

377
Q

which condition gives bad Kyphosis

A

NF1

378
Q

appearance of reducible deformity without erosions

A

SLE

379
Q

what is Jaccoud arthropathy

A

Similar to SLE, non erosive arthropathy with ulnar devition of 2-5 mcp.

post rheumatic fever

380
Q

what does DISH stand for

A

Diffuse idiopathic skeletal hyperostosis

381
Q

What is DISH image features

A

anterior longitudinal ligament ossificaiotn more than 4 levels.

382
Q

What is OPPL stand for

A

Ossficiation of the psoterior longidutindal ligament

383
Q

who does destructive spondylarthropathy affect and where does it impact

A

those on dialysis

C spine

considered due to amyloid deposition

384
Q

appearance of Juvenile idiopathic arthritis

A

wash out hand with proximal distribution (carpals buggered)

under 16
6 weeks duration

systemic onset - Stills - salmon pink rasdh and fever

385
Q

Amyloid arthropathy appears as what

A

severe pattern of destruction

bilateral involvement of shoulder, hips, carpals, knees.

get carpal tunnel syndrome

386
Q

post total hip athroplasty what is particle disease?

A

macrophages eat any particles (metal) spew enzymes everyhwere

387
Q

What is stress shielding?

A

stress stransferred through the metallic stem, so bone is not loaded.

Wolffs Law.

Unloaded bone gets resorbed.

388
Q

In who does stress shielding occur moer in ?

A

uncemented arthroplasty

389
Q

stress shielding can cause

A

increase risk of fracture

390
Q

is polyethylene wear normal

A

no

superior lateral to athroplasty, not normal

391
Q

Heterotopic ossifications

what does it cause

A

stiff hip

392
Q

Three components that exist in marrow

A

Trabecular
Red - making RBC
yellow - fat

393
Q

what happens to red marrow as we grow up

A

replaced by yellow marrow.

can get some perisiting in femoral and humeral heads

394
Q

What replaces marrow in osteoporosis

A

yellow marrow

395
Q

How to differentiate red marrow from yellow

A

MRI

T1 fat bright for yellow. Red is darker

396
Q

order of marrow conversion

A

epihpyses convert after ossification

then diaphysis then metaphysis

397
Q

What happens in leukaemia?

A

proliferation of leukemic cells results in replacement of red marrow

marrow looks darker than muscle on T1.

398
Q

which marrow diseases are not diffuse?

A

Waldenstroms macrolglobulinemia (infarcts)

Multiple myeloma ( focal deposits)

399
Q

name a calcium hydroxyapatite deposition disease

A

calcific tendonitis

400
Q

common location for calcium hydroxyapatite deposition disease

A

shoulder

supraspinatus tendon at insertion by the greater tuberosity

401
Q

what is Osteopoikilosis?

A

bone islands

usually in epiphyses

inherited or sporadic

benign

402
Q

How to differentiate between metastases and osteopoikilosis?

A

Osteopoikilosis will be joint centred. Sclerotic mets will be all over the place

403
Q

Osteopathia striata is what>

A

In metaphysis of long bones.
linear, parallel and longitudinal lines

404
Q

What is engelmanns disease?

A

progressive diaphyseal dysplasia or PDD.

Fusiform bony enlargement with sclerosis of the long bones.

bilateral or symmetric
long bones
hot on bone scan
can cause optic compression

405
Q

Why does hip in acromegaly develop osteoarthritis

A

grows and out strips it blood supply .

406
Q

What is pigmented villonodular synovities (PVNS)

A

uncommon benign neoplastic process

may involve synovium of the joint diffusely or focally.

can also affect the tendon sheath

407
Q

PVNS of the tendon is called what

A

Giant cell tumour of the tendon sheath

408
Q

Giatn cell tumour of the tendon sheath can cause what to underlying bone

A

erosion

409
Q

Giant cell tumour of tendon sheath on MRI

A

T1 and T2 dark

410
Q

Glomus tumour on MRI

A

T1 dark
T2 bright

411
Q

Primary synovial chondromatosis what type are there

A

primary and secondary types

412
Q

Primary synovial chondromatosis

secondary causes

A

degenerative causes

413
Q

Primary synovial chondromatosis

primary causes

A

metaplastic / true neoplastic process forming

  • multiple cartilagenous nodules in the synovium of joints, tendon sheaths and bursa
414
Q

Benign neoplasia
Associated haemarthrosis
never calcifies

is it

Synovial chondromatosis or is it PVNS

A

PVNS

415
Q

Bengin neoplasia
NOTE ax with haemarthrosis
may calcify

A

synovial chondromatosis

416
Q

Diabetic myonecrosis

what is it, who does it affect

A

infected muscle
poor T1DM control

417
Q

soft tissue hemangioma can enalrge during

A

pregnancy

418
Q

soft tissue haemnagioma on CT

A

intralesion fat

419
Q

Lipoma arborescens

what is it and buzzword

A

synovial lining of joints and bursa affected.

frond like depositions of fatty tissue

420
Q

Lipoma arborescens affects who

A

50s and 70a

421
Q

Lipoma arborescens seen in normal knee but also in

A

OA
chronic RA
prior trauma

422
Q

Lipoma arborescens MRI features

A

T1 and T2 bright

423
Q

What are the names of the signs for AVN of the hip

A

Double line sign

Rim sign

Crescent sign

424
Q

AVN hip - what is the double line sign

A

T2, inner bright line of granulation tissue.
outer dark line of sclerotic bone.

425
Q

AVN hip RIM sign

A

T2, signal line sandwiched between two low signal lines.

represents fluid between sclerotic borders of osteochondral fragment

(implies instability)

426
Q

AVN hip crescent sign

A

seen on XR.
suchondral lucency, indicated imminent collapse

427
Q

What are the stages of osteonecrosis

A

0 - normal

1 - normal xr, oedema on MR
2 - mixed lytic / sclerotic
3 - crescent sign
4 - secondary osteoarthritis.

428
Q

Thalassemia is a defect in what

A

haemoglobin chain

429
Q

What happens to sinuses in Thalassemia

A

obliterates

430
Q

wide bones with thick trabecula think

A

Pagets

431
Q

Three stages of pagets are

A

lytic to mixed to sclerotic

432
Q

Pagets sign

Blade of grass sign

A

lucent leading edge in long bone

433
Q

Pagets sign
Osteoprosis circumscripta

A

blade of grass in skull

434
Q

Picture frame vertebra.

Pagets sign

A

all sides thickened

435
Q

Pagets sign
cooton wool bone

A

thick disorganized trabeculae

436
Q

Banana fracture
Pagets sign

A

insufficency fracture of a bowed bone

437
Q

Pagets sign
Tam O’shanter sign

A

thick skull

438
Q

xPagets sign
Saber shin

A

bowing of the tibia

439
Q

Ivory vertebra.
Pagets sign

A

ddx include mets.
Pagets will be expansile

440
Q

Complication of pagets

most common

A

deafness

441
Q

pagets complications
general

A

spinal stenosis
cortical stress fracture
cranial nerve paresis
CHF
second hyperparathyroidism

442
Q

Which tumour can pagets turn into

common

A

Osteosarcoma

443
Q

what does pagets involve in the pelvis?

A

always incolves the iliopectineal line

444
Q

thickness of plantar fascia is greater than 4mm

with loss of usual fibrillar pattern

A

fascitiis

445
Q

split brevis happens in

A

inversion injury

outward convexity of the retroalleolar groove pushes into the PB. split it

446
Q

who gets tear of posterior tibial tendon

A

old fat diabetic woman on chronic steroids

447
Q

if lose posterior tibial what is the next

A

spring ligament

if that goes then los arch of the foot

448
Q

Is there meatn to be fat in the sinus tarsi

A

yes

449
Q

what causes sinus tarsi syndrome

A

dysfunction of the stability in the joint

450
Q

common cause of acl reconstruction failure

A

missed posterolateral corner injury

451
Q

oedeam in the fibular head think

A

is there a posterolateral corner injury

452
Q

double PCL sign

A

bucket handle meniscus tear

shows the acl must be intact. . in order for it to flip like that

453
Q

discoid minuscus

A

always lateral
high risk of tears

Wrisburg is most high risk

454
Q

lipoma arborsecns

A

frond like shrub

sinovium gfull of fat from chronic inflammation

455
Q

celery stick acl

A

mucoid degeneration

mimic an acl tear.

456
Q

sublime tubercle of elbow

A

where UCL attaches and can tear from in valgus overload

457
Q

who gets AVN

A

steroids
truama
sickle cell
alcoholic

458
Q

double line sign

A

AVN

459
Q

tip of the iceberg fracture on greter trochanter femur - next step

A

MRI to see the extent of the fracture

460
Q

buford complex

Quadrant

A

anterior superior

middle GH ligament attaches too superiorly.

absent labrum

461
Q

sublabral recess location where

A

superior

462
Q

SLAP tear located where

A

superior

463
Q

Sublabral foramen located

A

anterior superior

464
Q

bankart exist where

A

anterior inerior

465
Q

shoulder degenerative chnage happens to which structure

A

labrum

466
Q

SLAP tears happen to who

A

overhead movements

467
Q

Types of SLAP tears

A

1 - 4

4 - extension in to biceps anchor

468
Q

most common SLAP

A

t2

anterior and /or psoterior extension

469
Q

SLAP tear t3

A

bucket handle

spares the biceps tendon anchor

470
Q

T4 SLAP tear

A

bieps short head attaches corocoid, long head 12 o clock positoin.

tearing extends in to the bicep.

471
Q

Bankarts

A

glenoid

472
Q

Hillsachs on

A

humerus

473
Q

True bankart is damage to

A

BONE as well as periosteum

474
Q

Aren’t you glad its a

A

GLAD
most mild

scraped cartilage off only

475
Q

HAGL

A

avulsion of the glenohumerla ligament at the humerus

a Prometheus book FRCR Part 2A flashcards (9 decks)

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