MSK

Question 1

Multiple lytic lesions

Answer 1

Mets - thyroid, renal, lung, breast
Multiple myeloma
Lymphoma
LCH - beveled edge, button sequestrum, vertebra plane
Fibrous dysplasia
Chronic recurrent multifocal osteomyelitis –> paeds

Question 2

Sequestrum

Answer 2

Osteomyelitis
LCH
Osteoid osteoma

Question 3

Periosteal Reaction in Newborn/Infant

Answer 3

Physiological
Trauma
Infection
Prostaglandin therapy
Infantile cortical hyperostosis

Question 4

Rugger-Jersey Spine

Answer 4

Renal osteodystrophy - smudgy margins
Osteopetrosis - sharp margin - SANDWICH SIGN
Paget disease - PICTURE FRAME

Question 5

Bilateral Symmetrical Sacroiliitis

Answer 5

Ankylosing spondylitis
Inflammatory bowel disease
Rheumatoid arthritis

Question 6

Unilateral / Asymmetrical Sacroiliitis

Answer 6

Psoariatic arthritis
Reactive arthritis
Septic arthritis

Question 7

Proximal Arthropathy - MCP joints

Answer 7

RA - osteopenia, erosions
CPPD - chondrocalcinosis, NO erosions
Gout - erosions with sclerotic borders and overhanging edges
SLE - osteopenia, subluxations, dislocations, NO erosions
Haemochromatosis - subchondral cysts, hooked osteophytes

Question 8

Distal Arthropathy - IP joints

Answer 8

Osteoarthritis - DIP & PIP
Erosive osteoarthritis - DIP & PIP
Psoriatic arthritis - DIP & PIP - ray involvement, bone proliferation - pencil in cup deformity
Reactive arthritis - PIP - erosion, bone proliferation
RA - periarticular osteopenia, erosions

Question 9

Erosive Arthropathy - Foot

Answer 9

RA
Gout
Reactive arthritis
Psoriatic arthritis

Question 10

Distal clavicle erosion

Answer 10

Traumatic
RA
Hyperparathyroidism - ass w/ sub ligamentous resorption at the site of the coracoclavicular ligament
Scleroderma
Infection

Question 11

Vertebra plana

Answer 11

Adult:
Multiple myeloma
Metastasis
Trauma

Child:
LCH
Lymphoma
Osteomyelitis - bacterial vs TB

Question 12

Wormian bones

Answer 12

Idiopathic
Osteogenesis imperfecta
Cleidocranial dysostosis
Down’s syndrome
Metabolic disease

Question 13

Madelung Deformity - triangular configuration of the distal radius and ulna articulation with wedging of the proximal carpal bones

Answer 13

Idiopathic
Trauma
Infection
Skeletal dysplasia - Turner’s syndrome, Ollier disease, multiple epiphyseal dysplasia, multiple hereditary exostosis

Question 14

Osseous Lesion with Fluid-fluid levels

Answer 14

ABC
Unicameral/simple bone cyst
Telangiectatic osteosarcoma - nodularity along separations
Fibrous Dysplasia
Chondroblastoma

Question 15

Avascular Necrosis (VIVA Book)

Answer 15

Ulcerative colitis –> stoma bag
NSAIDS –> Ankylosing spondylitis –> dagger sign & ass papillary necrosis cals
Steroids –> renal transplant clips/ erected transplant calcs
Splenomegaly –> myelofibrosis & gaucher (latter also gives H vertebrae)
Chronic pancreatitis –> pancreatic calcs
Sickle cell disease –> cholecystectomy/gallstones, small calcified spleen, H shaped vertebrae

Question 16

Acro-osteolysis

Answer 16

Hyperparathyroidism
Scleroderma - bone erosions, soft tissue resorption along the distal phalanges
Trauma
Psoriasis - soft tissue swelling, periarticular erosions, fluffy periostitis, resorption of distal phalanges
Hajdu-Cheney Syndrome

Question 17

Medullary/chondroid lesion

Answer 17

Enchondroma
Bone infarct - Serpentine rim of calcification ; internal high T1 (fat)
Chondrosarcoma - esp of size >6cm, rapid growth, cortical breakthrough, deep endosteal scalloping, pain
Chronic osteomyelitis - internal low T1

Question 18

Diffusely increased bone density

Answer 18

Metabolic disorders -> renal osteodystrophy, primary hyperparathyroidism, fluorosis
Osteoblastic metastasis -> prostate, breast, pancreas, GI mucinous adenocarcinoma, TCC, carcinoid, lymphoma, medulloblastoma, neuroblastoma
Haematological disorders -> myelofibrosis, mastocytosis, sickle cell anaemia
Paget’s disease
Osteoporosis

Question 19

Loose bodies

Answer 19

Synovial osteochondromatosis
Pigmented villonodular synovitis -> low T1 and T2, blooming artefact
Rice bodies

Question 20

Expansile rib lesion in a CHILD

Answer 20

Fibrous dysplasia
Bone cyst -> unicameral or aneurysmal
Enchondroma
LCH
Ewing sarcoma
Mets

Question 21

Posterior element lytic lesion

Answer 21

ABC -> pedicle
Osteoblastoma
Infection -> TB (esp if thoracic with paraspinal abscess and sparring of the intervertebral discs)
Metastasis
LCH

Question 22

Ivory vertebral body

Answer 22

Osteoblastic metastasis - ADULT breast/prostate ; CHILD neuroblastoma/medulloblastoma
Paget disease
Lymphoma
Mastocytosis
Myeloma - POEMS syndrome

Question 23

Periarticular soft tissue calcifications

Answer 23

Calcinosis of renal failure
Myositis ossificans -> sec. to trauma/immobility, central lucency with a zone of mature ossification at the periphery
Arthropathy with calcified soft tissue nodule
Scleroderma
Soft tissue sarcoma -> reverse zoning, central calcs
Tumoral calcinosis

Question 24

Benign expansile lytic lesion

Answer 24

Fibrous dysplasia -> thick rind of reactive bone
Unicameral bone cyst
Aneurysmal bone cyst
Giant cell tumour
Eosinophilic granuloma

Question 25

Multiple sclerotic foci in the pelvis

Answer 25

Osteopoikilosis –> Voorhoeve syndrome –> osteopathia striata, melorhheostosis
Metastatic disease
Paget disease

Question 26

Vertebral body wedge fracture

Answer 26

Traumatic fracture
Insufficiency fracture –> marrow oedema limited to vertebra; smooth and rim shaped soft tissue
Pathological fracture –> abnormal marrow with ill-defined margin; abnormal marrow extends to pedicles, irregular ass soft tissue; marked enhancement

Question 27

Raindrop Skull

Answer 27

Multiple, well-defined lytic lesions of various size scattered throughout the skull

Multiple Myeloma

Question 28

Ochronosis (Alkaptunuria)

Answer 28

• severe osteoporosis
• multilevel intervertebral disc calcification and disc space narrowing

Question 29

Epiphyseal Lucent lesion

Answer 29

Chondroblastoma
GCT
LCH
Intraosseous ganglion cyst