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FRCR 2a Flashcards > MSK > Flashcards

MSK Flashcards

1
Q

Name some causes of posterior vertebral scalloping?

A

Intra dural spinal masses - ependymoma, NF1

Dural ectasia - Marfan’s disease, ehlers danlos

Congenital - achondroplasia

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2
Q

Name some causes of anterior vertebral scalloping?

A

AAA
Lymphoma
Downs syndrome

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3
Q

What is Kienbock disease?

A

AVN of the lunate.
Can be associated with negative ulnar variance.

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4
Q

What is Kümmel disease?

A

AVN of the vertebral body.
Usually with collapse and vacuum cleft

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5
Q

Causes of Chondrocalcinosis?

A

C,C,Cs

Crystals - gout, pseuodogout (COPD)
Cation - calcium, copper, iron
Cartilage degeneration - OA

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6
Q

What is the most common craniosynostosis?

A

Scaphocephaly
Premature closure of sagittal suture.
Elongated skull

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7
Q

What are the features of nail patella syndrome?

A

Hypoplastic nails
Hypoplastic patella - recurrent dislocations
Posterior iliac horns - Fongs prongs

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8
Q

Radiographic features of tenosynovial giant cell tumour?

A

Also called PVNS
Plain radio graph can have joint effusion
CT shows hypertrophic synovium, possible hyperdense due to blood.
MRI - Low T1 and low T2

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9
Q

What is Caplan syndrome?

A

Rheumatoid arthritis and pneumoconiosis.
Bilateral peripheral and upper lobe nodules that can cavitate

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10
Q

Osteoid osteomas are considered osteoblastomas when over what size?

A

> 2cm

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11
Q

Segond fracture is associated with rupture of what ligament?

A

Anterior cruciate ligament

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12
Q

What is a Clayshoveler’s fracture?

A

Fracture of the spinous process from hyperextension

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13
Q

What is a chance fracture?

A

Forceful flexion of the spine, causing anterior wedge compression fracture and fracture of the posterior elements.
Highly unstable.

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14
Q

What is a Jefferson fracture?

A

C1 blowout fracture due to axial loading i.e. jumping head first into a shallow pool

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15
Q

What is a hangman’s fracture?

A

Fracture of the bilateral pars of C2

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16
Q

What is Subacute Combined Degeneration of the spinal cord and it’s imaging appearance?

A

Vitamin B12 deficiency.
High signal in the posterior cord in an inverted V shape

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17
Q

What bacteria is associated with Guillain Barre syndrome?

A

Campylobacter

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18
Q

What is the most common spinal cord tumours in kids Vs adults?

A

Kids - Astrocytoma
Adults - Ependymoma

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19
Q

Which part of the scaphoid is most at risk of AVN?

A

Proximal pole

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20
Q

What is DISI?

A

Instability of the wrist where the lunate tilts dorsally.
Increased scapho-lunate angle >60⁰
(Scaphoid tilts volar normally, so as lunate tilts dorsally, the angle between them increases)

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21
Q

What is VISI?

A

Instability of the wrist where the lunate tilts volar.
Reduced scapho-lunate angle <30⁰
(Scaphoid tilts volar normally, so as lunate tilts volarly, the angle between them decreases)

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22
Q

What is a perilunate dislocation and what is it associated with?

A

Where the lunate stays put and the capitate dislocates.
Associated with scaphoid fractures

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23
Q

What are the associated injuries for positive and negative ulnar variance?

A

Positive - Lunate degeneration (Ulnar impaction syndrome)
Negative - Lunate AVN (Kienbock disease)

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24
Q

What is ulnar impaction syndrome?

A

Ulnar impacts the lunate, breaking the TFCC, and causing degeneration of the lunate

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25
Q

What is a Barton fracture Vs reverse Barton

A

Intra articular fracture of the distal radius extending to the dorsal surface. With dorsal radial carpal dislocation.

Reverse Barton is to the volar surface.

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26
Q

What is contained within the carpal tunnel?

A

FDP
FDS
FPL
Median nerve

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27
Q

What is a classic finding in TB tenosynovitis?

A

Diffuse tenosynovitis that spares the muscle.
Filling defects within the fluid called “rice bodies”

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28
Q

Where does De Quervain tenosynovitis typically affect?

A

First extensor compartment of the wrist.
Extensor pollicis brevis and Abductor pollicis longus

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29
Q

What is the difference between a Bennet’s fracture and a Rolando fracture?

A

Both are fractures of the base of 1st metacarpal (thumb).
Rolando fracture is comminuted.

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30
Q

What is Gamekeepers thumb?

A

Chronic avulsion fracture of the ulnar collateral ligament of the 1st MCP joint

Acute avulsion fracture is skiiers thumb.

Creates a Stener lesion if the adductor polisis muscle gets caught in the torn UCL.

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31
Q

Fracture of the proximal ulnar, with anterior dislocation of the radial head is what?

A

Monteggia fracture.

GRUesome MURder

G: Galeazzi R: radius fracture U: ulna dislocation

M: Monteggia U: ulna fracture R: radial head dislocation

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32
Q

Fracture of the distal radius, with dislocation of the ulnar carpal joint is what?

A

Galeazzi fracture.

GRUesome MURder

G: Galeazzi R: radius fracture U: ulna dislocation

M: Monteggia U: ulna fracture R: radial head dislocation

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33
Q

What is Little Leaguer’s Elbow?

A

Chronic injury to the medial epicondyle i.e. stress fracture, avulsion, delayed closure of the apophysis…

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34
Q

Where do complete biceps tear typically occur?

A

Avulsion off the labrum

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35
Q

What is associated with triceps rupture?

A

Salter Harris II fracture of the olecranon

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36
Q

What is the most common rotator cuff to tear?

A

Supraspinatus

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37
Q

What types of rotator cuff tears do you get and which is most common?

A

Articular (underside) - most common
Bursal (top side)

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38
Q

How bad does a rotor cuff tear need to be to require surgical intervention?

A

> 50% thickness

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39
Q

What is the classical imaging feature of adhesive capsulitis?

A

Thickened join capsule.
Decreased glenohumeral joint volume.
Loss of fat in the rotator cuff interval.

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40
Q

What are the types of Bankart lesions?

A

They are all injury to the labrum.

Perthes - detachment of the labrum, but intact periosteum
ALPSA - detachment of the labrum, intact periosteum, but medial displacement
Bankart lesion - detachment of the labrum, with broken periosteum
GLAD - Glenolabral Articular Disruption, labrum and ARTICULATAR CARTILAGE injury

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41
Q

What are the signs for quadrilateral space syndrome?

A

Compression of the axillary nerve in the quadrilateral space.
Atrophy of the teres minor muscle.

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42
Q

Name the attachments:
Illiac crest
ASIS
AIIS
Greater trochanter
Lesser trochanter
Ischial tuberosity
Pubic symphysis

A

Illiac crest - abdominal muscles
ASIS - Sartorius
AIIS - Rectus femoris
Greater trochanter - Gluteal muscles
Lesser trochanter - Illiopsoas
Ischial tuberosity - Hamstrings
Pubic symphysis - ADDuctors

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43
Q

What are the classic imaging features of Illiopsoas bursa?

A

Fluid collection anterior to the femur

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44
Q

What is a segond fracture and what is its association?

A

Avulsion fracture of the lateral tibial plateau
Associated with ACL tear.

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45
Q

What is the arcuate sign and association?

A

Avulsion fracture of the proximal fibula.
Associated with PCL tear.

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46
Q

What type of meniscal tear can form a bucket handle tear?

A

Vertical longitudinal tear.

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47
Q

What does the double PCL sign indicate?

A

Bucket handle meniscal tear

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48
Q

What is a Masonneuve fracture?

A

Widened medial malleolus/medical malleolus fracture + proximal fibular fracture.

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49
Q

What other injury is associated with bilateral calcaneal fractures?

A

Bilateral”Lover’s fractures” should prompt looking at the spine for burst fractures

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50
Q

What tendon does Os Peroneus lie within?

A

Peroneus Longus

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51
Q

What are:
Sequestrum
Involucrum
Cloaca
Sinus tract

A

Sequestrum - piece of necrotic bone surround by granulation tissue
Involucrum - thickened bone overlying chronic bone infection
Cloaca - defect in the periosteum caused by infection
Sinus tract - channel from bone to skin lined by granulation tissue

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52
Q

How do you differentiate Pott disease from bacterial discitis?

A

Pott disease is TB osteomyelitis.
Spares the disc space
Multi level involvement
Large paraspinal abscess
Develop “Gibbous deformity” (focal kyphosis caused by infection)

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53
Q

What are the different bone lesions that can have multiple fluid-fluid levels?

A

Telangiectatic osteosarcoma
Aneurysmal bone cyst
Giant cell tumour

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54
Q

How to differentiate Osteosarcoma from Ewing’s Sarcoma?

A

Ewing’s:
- Diaphysis femur
- Rarely calcifies
- Onion skin periosteal reaction
- Mets to bones and lung

Osteosarcoma:
- Metaphysis distal femur
- Amorphous calcification
- Sun burst periosteal reaction
- Mets to bones and lung with pneumothorax

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55
Q

How to differentiate enchondroma from chondrosarcoma?

A

Chondrosarcoma:
Cause pain,
Cortical destruction/scalloping,
Typically >5cm in size.

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56
Q

What are the epiphyseal lesions?

A

Chondroblastoma
Clear cell chondrosarcoma
Geode
GCT
Infection

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57
Q

What are the lucent bone lesions?

A

F - Fibrous dysplasia
E - Enchondroma, eosinophilic granuloma
G - GCT
N - NOF
O - Osteoblastoma
M - Myeloma, metastases
A - ABC
S - Solitary bone cyst
H - Hyperparathyroidism
I - Infection
C - Chondroblastoma

58
Q

What are the two syndromes associated with polyostotic fibrous dysplasia?

A

MC Cune Albright - also gets Cafe au lait spots and precocious puberty

Mazabraud - also gets soft tissue myxomas

59
Q

What is the difference between a NOF and a Fibrous Cortical Defect?

A

NOF are larger than 3cm

60
Q

What is the difference between Olliers and Maffucci syndrome?

A

Both are multiple Enchondromas

Maffucci also have haemangiomas and increased risk of chondrosarcoma

61
Q

What is the classical imaging appearances of a solitary bone cyst?

A

Fallen fragment sign.

62
Q

Pathognomic signs of Pagets disease in:
Skull
Spine
Pelvis

A

Skull
- Tam O Shanter sign,
- Osteoporosis circumscripta

Spine
- Picture frame vertebra

Pelvis
- Pelvic brim sign

63
Q

Classical imaging feature of Undifferentiated Pleomorphic Sarcoma?

A

Large malignant soft tissue tumor

Old people
Proximal limbs
T2 heterogenous/dark due to necrosis, haemorrhage, calc

(Bone infarct malignant transformation)

64
Q

Classic imaging findings of Synovial sarcoma?

A

Young people
Periphal limb (Knee/foot)
T2 “triple sign” - necrosis, soft tissue, calc
Bowl of grapes - blood, fluid fluid levels

65
Q

What are the differences between RA and Psoriatic arthritis?

A

RA - symmetric, proximal (MCP), osteoporosis instead of bone proliferation.

PA - Asymettric, distal (IPJs), boneproliferation instead of osteoporosis (periostitis), enthesitis.

66
Q

What is Reiters triad?

A

Cant see, cant pee, cant climb a tree.

Urethritis
Conjuctivitis
Arthritis

67
Q

What is Milwaukee shoulder?

A

Destructive shoulder arthropathy due to deposition of hydroyapatite crystals.

68
Q

Classic imaging features of skeletal sarcoidosis?

A

Lace like honeycomb destruction of phalanges. Preservation of joint space

Lytic lesions in the skull and spine. Preservation of disc spaces

69
Q

Most common skeletal abnormality in NF1?

A

Kyphoscoliosis

70
Q

Classic imaging appearances of an intervertebral haemangioma?

A

Corduroy or jailbar appearance
(Axial CT will look like polka dots)

71
Q

Classic location for a chondromyxoid fibroma?

A

Proximal tibial metaphysis

72
Q

What is the treatment for osteoid osteomas?

A

Radiofrequency ablation

73
Q

Which part of the spine does Ewing’s sarcoma affect most commonly?

A

1st Sacrum
2nd Lumbar
3rd Thoracic
4th Cervical

74
Q

Classic imaging features of Rickets?

A

Fraying and cupping of the metaphyses.
Bowed legs with looser zones - pseudofracture of the compression side.

75
Q

Classic spinal signs for achondroplasia?

A

Decreased interpeduncular distance
Anterior inferior bullet shaped vertebrae
Posterior vertebral scalloping
Gibbus deformity

76
Q

First extensor compartment wrist

A

APL
EPB

De Quervain’s Tenosynovitis

77
Q

Second extensor compartment wrist

A

ECR L
ECR B

Intersection syndrome

78
Q

Third extensor compartment wrist

A

EPL

Drummer’s wrist
Traumatic rupture (distal radius #)

79
Q

Fourth extensor compartment wrist

A

Extensor digitorum

Extensor Tenosynovitis

80
Q

Fifth extensor compartment wrist

A

EDM

Vaughn Jackson syndrome

81
Q

Sixth extensor compartment wrist

A

ECU

Snapping ECU

82
Q

Most common type of tibial plateau fracture?

A

Schatzer II - splitting AND depression of the lateral tibial plateau

83
Q

Classic knee xray findings of haemophilia?

A

Widened intercondylar notch
Squared inferior margin of the patella

84
Q

Classic imaging findings of osteopetrosis?

A

Bone within bone appearance
Sandwich vertebrae
Erlenmeyer flask deformity

85
Q

Where does the lisfranc ligament attach?

A

Medial cuneiform to 2nd metatarsal base

86
Q

What is housemaids knee?

A

Pre-patella bursitis.

87
Q

Most common site for mandibular fractures?

A

Mandibular condyle

88
Q

Long bone appearance of skeletal lymphoma?

A

Lytic lesion with permeative bone destruction

89
Q

Classic site for chondromyoid fibroma?

A

Proximal tibial metaphysis.

90
Q

Classic imaging appearance of chondromyoid fibroma?

A

Proximal tibial metaphysis.
Eccentric.
Lytic.
Narrow zone of transition.
Geographic bone destruction.

91
Q

General imaging features of fibrous dysplasia?

A

“Ground glass” matrix

Meta diaphyseal
Medullary
Expansile
Narrow zone of transition
Mixed cystic and sclerotic

92
Q

Causes of ivory vertebra

A

LIMPHOMA

Lymphoma
Infection - TB
Metastases - Prostate/breast mets
Paget’s disease
Haemangioma
Osteosarcoma
MA - Mastocytosis

93
Q

Classic imaging appearance of a brown tumour?

A

Cortically based
Lytic
Narrow zone of transition
No sclerotic border

94
Q

What is SAPHO syndrome?

A

S: synovitis

A: acne

P: pustulosis

H: hyperostosis

O: osteitis

95
Q

What is Madelung deformity of wrist?

A

Bowing of distal radius.
Positive ulnar variance.
V shaped carpal rows.

96
Q

What are common hand xray findings in Turners?

A

Madelung deformity
3rd and 4th metacarpal shortening
Osteopenia

97
Q

What is a Pilon fracture?

A

A pilon fracture is a type of distal tibial fracture involving the tibial plafond.
Typically high energy injuries and occur as a result of an axial loading which drives the talus into the tibial plafond.

98
Q

Most common patella tumour?

A

Giant Cell Tumour
Chondroblastoma

99
Q

How does LCH manifest in the skeleton?

A

Eosinophilic granuloma.

Skull - punched out lytic lesion, double contour sign.

Spine - vertebra planar

Long bones - Metadiaphysis, permeative. Can have soft tissue mass.

100
Q

Typical imaging features of a chondroblastoma?

A

Epiphyseal
Lucent
Narrow zone of transition
Cloud like with rings and arcs

T2 LOW - The only epiphyseal lesion that is NOT high T2 signal

101
Q

Features of acromegally?

A

Skull and spine:
- Calvareal thickening
- Vertebral body fractures without loss of mineral density

Hand and feet:
- Spade like phalanx
- Heel pad thickness >25mm

102
Q

Imaging features of spontaneous osteonecrosis of the knee?

A

Acute onset of severe pain without significant trauma:

  • Flattening of the medial femoral condyle
  • Subchondral radiolucency
103
Q

Most common cause of septic arthritis?

A

Streptococcus

104
Q

Classic MSK presentation of haemochromotosis?

A

Hook like osteophytes, 2nd 3rd metacarpal
Chondrocalcinosis

105
Q

Marked ulnar deviation at the MCP joints occurring post-rheumatic fever?

A

Jaccoud arthropathy

Ulnar subluxation and deviation at the metacarpophalangeal joints is correctable or reducible with physical manipulation

106
Q

Iron deficiency anaemia MSK manifestations?

A

Hair on end appearance of skull
Osteoporosis of long bones

107
Q

Secondary complications of Pagets disease?

A

Conductive hearing loss - otosclerosis
Hydrocephalus - basilar invagination
Osteosarcoma - 1% of patients

108
Q

Features of Rheumatoid Arthritis?
Hands, elbows, shoulder

A

Hands:
- marginal erosion MCP joints
- juxta-articular osteoporosis

Elbows/knees:
- Joint effusion

Shoulder:
- Erosion of distal clavicle

109
Q

What is a Stener lesion?

A

Caused by gamekeepers/skiers thumb (tear of the 1st MCP ulnar collateral ligament), when APL tendon gets caught in the torn ligament.
Will not heal by itself and needs surgical repair.

110
Q

How do you differentiate between Morquio and Hurler syndrome?

A

Both are mucopolysaccharidoses (lysosomal storage disorder).
Both have platyspondyly.

Morquio has anterior CENTRAL vertebral body beaking.
Hurler has anterior INFERIOR vertebral body beaking.

Remember H comes before I (Hurler Inferior).

111
Q

What is cherubism?

A

Variant of fibrous dysplastia
Bilateral expansile multiloculated cystic masses with symmetric involvement of the mandible and maxilla.

112
Q

Types of tenosynovial giant cell tumour and most common joints affected.

A

Diffuse - knee joint most affected
Localised - fingers most affected

113
Q

What is Caffey’s disease?

A

Infantile cortical hyperostosis
Self limiting disorder

Primarily affects the mandible
Periosteal reaction+ new bone formation

HOT on bone scan

114
Q

Causes of vertebra plana

A

LL MMM

LCH
Lymphoma

Metastases
Myeloma
Medication - steroids

115
Q

Causes of basilar invagination?

A

PARF (of least resistance)

Paget’s disease
Achondroplasia
Rheumatoid
Fibrous dysplasia

116
Q

Describe the modic endplate changes

A

Modic 1 - oedema
T1 low
T2 high
Gd enhancement

Modic 2 - conversion to fatty marrow
T1 high
T2 high

Modic 3 - subchondral bony sclerosis
T1 low
T2 low

117
Q

MRI findings of carpal tunnel syndrome?

A

Palmar bowing of the flexor retinaculum
Caliber change of the median nerve
Oedema or loss of fat in carpal tunnel

118
Q

Most common cause of vertebra plana in children?

A

LCH

119
Q

Imaging findings of dermatomyositis?

A

“Sheet like” calcification in the soft tissues

120
Q

Associated conditions with dermatomyositis

A

Interstitial lung disease
Generalised increased risk of malignancy

121
Q

Different subtypes of femoro acetabular impingement syndrome?

A

Cam type - anterior superior bump on femoral neck causing impingement

Pincer type - over coverage of the femoral head by the acetabulum causing impingement. (Coxa profunda, or protrusion acetabulum are potential causes)

122
Q

How can you differentiate coxa profunda and protrusio acetabuli?

A

Protrusio acetabuli - the femoral head projects beyond the ilioischial line (i.e. into the pelvis)

123
Q

What is Lofgren syndrome?

A

Systemic sarcoidosis

(LEAFgren syndrome)

Lymphadenopathy (hilar)
Erythema nodosum
Arthritis
Fever

124
Q

What does erythema nodosum look like?

A

Painful red patches over the shins

Caused by panniculitis - inflammation of the subcutaneous fat

125
Q

Causes of erythema nodosum?

A

Infection - TB
Inflammatory bowel disease
Sarcoid - Lofgren syndrome

126
Q

3 stages of an intraosseous lipoma?

A

Majority found in lower limb metaphysis.

Stage 1 - Homogeneously fat signal
Stage 2 - Predominantly fatty with central calc or necrosis
Stage 3 - Heterogeneous, fat containing lesions, with extensive calc or necrosis

127
Q

What is popliteal entrapment syndrome?

A

Intermittent claudication caused by compression or occlusion of the popliteal artery.

Usually by the medial head of gastrocnemius or popliteus muscle.

128
Q

Long bone signs of Achondroplasia?

A

Long bones:
Symmetrical shortening of all long bones
Metaphyseal flaring
Trident hand (Spock hand)

129
Q

Classic imaging features of scurvy (vitamin c deficiency)

A

Osteopenia
Periosteal reaction
Hemarthrosis

130
Q

What is Sprengle deformity and it’s association?

A

Congenital elevation and rotation of the scapular.

Associated with Klippel Feil syndrome.

131
Q

Imaging appearance of mastocytosis?

A

Bone bowel liver lymph

Bone lesions - lytic or sclerotic
Diffuse small bowel thickening
Hepato-splenomegaly
Lymphadenopathy

Kind of like a cross between myeloma and lymphoma

132
Q

Skeletal manifestations of sickle cell disease?

A

Bone infarcts

Vertebral infarctions causing H shaped vertebrae

Hand foot syndrome - swelling of hands and feet caused by vaso-occlusive crisis

133
Q

What are the Salter Harris fractures?

A

SALTR

I - Slipped epiphysis
II - Above (metaphyseal
III - Lower (epiphyseal)
IV - Through (metaphyseal and epiphyseal)
V - Rammed (crush type)

134
Q

Lucent bone lesions without a sclerotic rim?

A

BAG

Brown tumour
Aneurysmal bone cyst
Giant cell tumour

135
Q

Which disease causes picture frame vertebrate Vs sandwich vertebrae?

A

Picture frame - Paget’s disease
Sandwich vertebrae - Osteopetrosis

136
Q

C spine findings for JIA?

A

Atlantoaxial subluxation
Odontoid erosions
Facet joint fusion

137
Q

What is Still’s disease?

A

Systemic onset Juvenile Idiopathic Arthritis

(Can occur in adults)

138
Q

Still’s disease triad?

A

Salmon coloured rash
Arthralgia
Fevers

139
Q

Skull signs for Achondroplasia?

A

Tiny cisterna magna (basilar invagination)

Large ventricles and supracella cistern

Increased tentorial angle (steep cerebellum)

140
Q

What makes up the pes anserinus?

A

Anterior to posterior

(Say Grace Before Tea, Mum)

  • Sartorius
  • Gracilis
  • Semitendinosus

(Semi membranosus is next)

FRCR 2a Flashcards (11 decks)

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