MSK Flashcards
(81 cards)
1
Q
Liposclerosing Myxofibroma
A
Intertrochanteric lytic lesion with sclerotic margin. 10% malignant degeneration.
2
Q
Radiation induced benign skeletal tumor.
A
Osteochondroma
3
Q
Multiple hereditary ostosis inheritance pattern is?
A
Autosomal dominant.
4
Q
Trevor disease
A
Epiphyseal osteochondromas.
5
Q
Supracondylar (avian) spur
A
Normal variant. Ligament of Struthers compress the median nerve.
6
Q
Cortical desmoid. What is it?
A
Scoop like lucency at posterior medial aspect of distal femoral metaphysis. Don’t biopsy it. Don’t MRI it.
7
Q
Most common locations of calcific tendinitis in calcium hydroxyapatite deposition disease. 2
A
Supraspinatus tendon.
Longus colli muscle: anterior atlas to T3.
8
Q
Calcium hydroxyapatite deposition disease causes:
A
Primary (idiopathic) Secondary: -chronic renal disease -Collagen vascular disease -Tumoral calcinosis - Hypervitaminosis D
9
Q
 Osteopoikilosis, versus Mets?
A
Osteopoikilosis is joint centered.
10
Q
Engelman‘s disease
A
Fusiform osseous enlargement with sclerosis of the long bones. Bilateral symmetric. Hot on bone scan.
11
Q
AVN signs:
A
Double line sign: T2 inner outer dark.
Rim sign: high T2 middle with two low signal lines.
Crescent sign: xray frog leg view subchondral lucency.
12
Q
What are the three phases of Paget disease In order
A
Lytic to mixed to sclerotic
13
Q
What are the subtypes of Paget disease
A
Monostatic and polyostotic subtypes
14
Q
What’s the most common complication of Paget’s disease
A
Deafness
15
Q
What’s the most common tumor can arise from Paget’s disease
A
Osteosarcoma.
Rarely giant cell tumor.
16
Q
Paget’s disease complications
A
Deafness. Spinal stenosis. Cranial nerve paresis. Congestive heart failure (high output). Secondary hyperparathyroidism. Osteosarcoma.
17
Q
Ivory vertebrae
A
Paget’s disease
18
Q
Picture frame vertebrae
A
Paget’s disease
19
Q
Rugger jersey spine
Sandwich vertebra
A
Renal osteodystrophy
And
Osteopetrosis
20
Q
H shaped vertebrae
A
Sickle cell disease
Gaucher’s disease
21
Q
How to differentiate between active Paget’s disease versus malignant transformation?
A
Malignant transformation will lose the normal T1 Signal. Best assessed on T1 pre contrast images
22
Q
Anterior lateral unilateral tibial bowing? Diagnosis
A
NF-1
23
Q
Lateral bilateral symmetrical tibial Bowing Any patient between 18 months to two years? Diagnosis
A
Physiologic bowing
24
Q
Lateral osseous bowing In a newborn
A
Hypophosphatasia
25
Lateral bilateral fraying of the metaphysis widening of the growth plates? Diagnosis
Rickets disease
26
Tibia vara , Fat kid
Blount disease
27
Short limbs bowed Long bones
Dwarfism
28
Tibial bowing involving all long bones
Osteogenesis imperfecta
29
Dark to intermediate T2 soft tissue lesion In an old patient; often with spontaneous hemorrhage? Who am I
Pleomorphic undifferentiated sarcoma
30
Pleomorphic undifferentiated sarcoma
Dark to intermediate on T2
Spontaneous hemorrhage
Bone in foreskin turn into PUS
Radiation is a risk factor
31
Patient under 20 years old with T2 bright and T1 dark lesion (Cyst like) but with post contrast enhancement
Myxoid liposarcoma
| Synovial sarcoma could be a ddx
32
T2 soft tissue mass with flow voids, Infiltrate between the fascial boundaries. Enhances intensely. Contain fat. What’s the next step.
Plain film to assess for phleboliths. Hemangioma.
33
Treatment: osteosarcoma
Chemo first then wide excision
34
Treatment: Ewings sarcoma
Chemo radiation then wide excision
35
Treatment: chondrosarcoma
Wide excision
36
Treatment: giant cell tumor
Arthroplasty. If extends to articular surface
37
Pigmented Villonodular synovitis. What is it
Synovial proliferation plus hemosiderin deposition
38
Pigmented Villonodular synovitis. Signal on MR. calcifications?
Low signal on T1 and T2 weighted images. Blooming on gradient echo. Never calcify
39
Pigmented villonodular synovitis versus giant cell tumor.
Giant cell tumor: typically seen in hand palmar tendons can cause erosion of underlying bone. Soft tissue density T1 and T2 dark
40
Primary synovial chondromatosis versus pigmented Villonodular synovitis
Primary synovial chondromatosis: Not associated with hemarthrosis. May calcify.
41
Diabetic myonecrosis. Trivia. MRI. Biopsy?
Infarction. 80% thigh.
MRI: irregular areas of marked edema with enhancement.
Never biopsy
42
Lipoma Arborescens: what is it. MR appearance. Associations.
Arborescent= resembling a tree.
Frond-like appearance= frond is a leaf or leaf like
Which makes it fat resembling a tree.
Frond-like fat.
MR Signal Fellow fat. Even in chemical shift.
Associations: osteoarthritis, chronic rheumatoid arthritis, prior trauma
43
What is cortical desmoid
Not a desmoid
Tug lesion from medial gastrocnemius and adductor magnus.
Location: posterior medial epicondyle of the distal femur
44
Charcott foot end result deformity?
Rocker bottom deformity
45
Erosive osteoarthritis most common appearance and what does it describe.
Gull wing appearance which describes central erosion.
46
Erosive osteoarthritis
Gullwing appearance
Postmenopausal woman
Distal interphalangeal joints (DIP)
47
Rheumatoid arthritis versus Osteoarthritis
Osteoarthritis: degenerative and bone forming.
| Rheumatoid arthritis: inflammatory, not bone forming
48
Rheumatoid arthritis features: in general
```
Osteoporosis
Soft tissue swelling
Marginal erosions
Uniform joint space narrowing
Bilateral and symmetric
Spares DIP
```
49
Arthritis: Involve the DIP
Erosive osteoarthritis
50
Arthritis: gull wing appearance
Gullwing appearance of the DIP: erosive osteoarthritis
51
Arthritis: first involvement: first CMC joint.
Osteoarthritis involve first CMC joint early
52
Arthritis: last joint to be involved is the first CMC joint
Rheumatoid arthritis
53
Felty syndrome
Rheumatoid arthritis more than 10 years.
Splenomegaly.
Neutropenia.
54
Caplan syndrome
Rheumatoid arthritis.
| Pneumoconiosis. 
55
Erosive changes with bone perforation
Psoriatic arthritis
56
Psoriatic Arthritis erosions progression
Start in the margins of the joints and progress to involve the central portion
57
Psoriasis arthritis description/buzzwords
```
Erosive Changes with bone Proliferation.
Interphalangeal joints
Pencil in cup
Fuzzy appearance
Sausage digit
Ivory phalanx
Ankylosis in the fingers
Mouse ears
Acro osteolysis
```
58
Ankylosis in the hands: which arthritis: 2 types.
Erosive osteoarthritis
| Psoriasis arthritis
59
Reiters (reactive arthritis) versus Psoriasis arthritis
Reiters: urethritis, conjunctivitis, arthritis.
Rare in the hands, favors feet.
They are similar in bone proliferation, erosion, asymmetric sacroiliac joints involvement. PAIR
60
Ankylosing spondylitis, Sacroiliac and spine manifestations
Symmetric sacroiliac joint involvement first. Then spine involvement (bamboo spine).
61
Gout arthritis buzz words: 5 tings
```
Joint effusion.
Juxta articular erosion.
Punched out lytic lesions.
Overhanging edges.
Soft tissue tophi.
```
62
Gout arthritis mimickers: 5
```
Amyloid disease
Rheumatoid arthritis (cystic)
Reticular histocytosis
Sarcoid disease
Hyper lipidemia
```
63
Gout on MR
Just articular soft tissue mass low on T2
| Tophus will typically enhance
64
CPPD common locations for chondrocalcinosis. Name 3
1- Triangular fibrocartilage of the wrist
2- Peri-odontoid tissue
3- Intervertebral disks
65
Hemachromatosis arthritis vs CPPD
```
Similar to CPPD
Chondrocalcinosis. Hooked osteophytes.
Difference is Hemachromatosis has 1/uniform joint space loss.
2/ Involves all MCP joints
3/ CPPD papers index and middle fingers
```
66
What is Milwaukee shoulder
Destructive shoulder arthropathy.
Due to deposition of hydroxyapatite crystals.
Affect older woman with history of trauma to the region.
67
Hyperparathyroidism: bone/arthritis section
1. Subperiosteal bone resorption (radial aspect of second and third fingers).
2. rugger-jersey spine.
3. brown tumors.
4. Terminal tuft erosion.
68
Differentiates DISH from AS in general
DISH has no sacroiliitis
69
Diagnosis: ossification of the anterior longitudinal ligament involving more than four levels sparing the disk spaces.
Diffuse idiopathic skeletal hyperostosis. DISH
70
Reducible deformity of joints without articular erosion
Systemic lupus erythematosus (appearance due to ligament laxity)
71
Norgaard view
Ball catcher view
| Used for multiple things but in CTC showed SLE athropathy reducible with PA view vs norgaard view
72
Patient with ulnar deviation of the fingers on Norgaard view Which is reducible on PA view and patellar dislocation. No erosions. Diagnosis?
SLE arthropathy.
73
Diagnosis: knee: widened intercondylar notch, enlargement of the epiphysis.
Juvenile idiopathic arthritis.
| Similar findings seen in hemophilia.
74
Arthropathy in Patient On dialysis. Bilateral joint involvement or carpal tunnel syndrome. Diagnosis?
Amyloid arthropathy
75
Patient x-ray with widening of the joint space (adult patient) follow up x-rays show collapsed joint space with early onset osteoarthritis. Diagnosis?
Pituitary gigantism.
| Cartilage grow until they outgrow blood supply and collapse.
76
How yellow marrow replaces red marrow in general and in long bones?
From extremities to axial skeleton.
| Long bone: Epiphysis first, then Diaphysis, then distal metaphysis, then proximal Metaphysis.
77
Normal yellow/red marrow on the T1.
Yellow marrow signal on T1.
Red marrow is dark but never darker than disk or muscle.
If bone marrow is darker than the muscle or disc this is a bad sign.
78
What’s the diagnosis: destructive hyperdense in NECT mass in the skull With another lesion noted within the intraparenchymal brain. It shows post contrast enhancement on MRI. The patient is known to have leukemia.
Chloroma
Correct name: granulocytic sarcoma.
It is some kind of colloid tumor.
79
What is anisotropy?
Normal tendon is hyperechoic when US is perpendicular on it.
| Anisotropy Is when the exact same tendon is hyperechoic when US it’s not perpendicular on it.
80
On ultrasound focal hyperechoic area within the tendon? Diagnosis
Tendon tear.
Look for tendon retraction. Partial or full thickness.
Other ddx is Anisotropy which will be involved the whole Tinton.
81
Fluid within the tendon sheath equals tenosynovitis what should you look for next?
Peritendenous subcutaneous hyperemia on Doppler ultrasound. When present it means active tenosynovitis.
