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Flashcards in MSK Deck (129)
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1

Macrodystrophia lipomatosa

rare form of localised gigantism
painless enlargement of the 2nd or 3rd digit of the hand or foot. It is usually unilateral but may involve adjacent digits in the distribution of the median or plantar nerves

2

What other injury is associated with perilunate dislocation?

scaphoid fracture

3

What ages do you see physiologic periostial reaction?

1-6 months

4

Infant has more than usual physiologic periosteal reaction, diffusely - what is it from?

prostaglandin treatment to keep ductus arteriosis patent

5

Ddx of periosteal rxn in an infant:

Prostaglandin therapy, Caffey's disease, congenital syphilis, hypervit. A, multifocal osteomyelitis, lymphoma/leukemia

6

What's Caffey's disease?

infantile cortical hyperostosis a largely self-limiting disorder which affects infants. It causes bone changes, soft-tissue swelling, and irritability
The mandible, ulna and clavicle are most common sites

7

Radiation therapy, what do you worry about 10-40 years out?

Radiation induced sarcoma

8

Soft tissue calcification ddx:

Dystrophic (amorphous, may ossify)
CPPD (usually in cartilage)
*metastatic Ca2+ (elevated Ca2+ levels)
Tumoral calcinosis (fluffy, periarticular)
metastatic osteosarc
primary soft tissue sarcoma
Sarcoid

9

Ddx for dystrophic calcification in soft tissues:

post-traumatic (heterotopic ossification)
scleroderma
cistercercosis (or other parasite)
osteosarc
hyper Vit. D
dermatomyositis
Venous insufficiency

10

Causes of elevated serum Ca2+

primary hyperparathyroidism, chronic renal disease, milk-alkali, hyper Vit. D, widespread bone destruction

11

hip pain in a 12 year old

Slipped Capital Femoral Epiphysis
early - widened epiphysis
late - capital slips posterioinferomedially

12

Flowing syndesmophytes, no sacral involvement =

DISH (Diffuse Idiopathic Skeletal Hyperostosis)

13

Severe destruction/derangement of a joint - think... What might be the cause in the upper extremity?

Neuropathic joint
upper extremity: syringomyelia
otherwise, usually diabetes

14

Name findings of renal osteodystrophy

osteomalacia:
2ndary hyperpara: subperiosteal bone resorption, soft tissue calcs, brown tumors (eg ribs, hands), sclerosis (rugger jersey spine, salt and pepper skull)

15

What is cherubism?

progressive fibrooseous lesions of mandible and maxilla in childhood, some think related to fibrous dysplasia

16

What syndromes are occasionally seen with polyostotic fibrous dysplasia?

McCune-Albright (also has precocious puberty and cutaneous pigmentation)
Mazabraud (soft tissue myxomas, increased risk of malignant transformation)

17

What's the syndrome of polyostotic fibrous dysplasia and soft tissue lesions? What are the lesions? What's the concern?

Mazabraud. Soft tissue myxomas.
Increased risk of malignant transformation.

18

Differential for multiple lucent bone lesions:

Fibrous dysplasia
LCH
Mets, myeloma
hyperpara (brown tumors)
infection

19

What's the order of appearance of ossification centers in the elbow?

Capitellum
Radial head
Internal (medial) epicondyle
Trochlea
Olecrenon
External (lateral) epicondyle

20

Infant foot deformity - talus looks vertical

Congenital vertical talus
"opposite" of club foot
causes hindfoot valgus and flatfoot

21

Ddx for multiple wormian bones

PORKCHOPS:
pyknodysostosis
*osteogenesis imperfecta
rickets
kinky hair syndrome
*cleidocranial dysostosis
hypothyroidism
hypophosphatasia
otopalatodigital syndrome
primary acroosteolysis (Hajdu-Cheney syndrome)
pachydermoperiostosis
progeria
down Syndrome

22

Partially absent clavicle - what cause?

hyperparathyroidism : subperiosteal bony resorption
rheumatoid arthritis : bilateral or unilateral changes with soft tissue swelling, erosion of the outer third of the clavicle
scleroderma
cleidocranial dysostosis
pyknodysostosis (rare)
trauma
myeloma, mets
infection

23

features of psoriatic arthropathy

bilateral asymmetric, distal joints
erosions, pencil-in-cup, ankylosis, sausage digit

24

features of achondroplasia

spine: posterior scalloping, narrow interpedicular distance in lower lumbar (stenosis)
Flat, tombstone iliac wings
short, flared bones, esp femur and humerus (rhizomelic)
skull: frontal bossing
trident hands
Gibbus deformity of vertebral body

25

what's the significance of "vacuum vertebral body"?

air means it's a non-neoplastic, non-infectious fracture - nothing there to fill space, so nitrogen gas

26

Bony features of Marfan syndrome

acetabular protrusion, lumbosacral dural ectasia, pectus excavatum/carinatum

27

synovial sarcoma features

soft tissue mass near knee or elbow (not in joints, just near them)
can calcify 30%

28

osteochondral fx of lateral condyle associated with:

ACL tear

29

features of gout

punched out lytic lesions with overhanging edges, tophi

30

Erlenmeyer flask deformity:

gaucher, thalassemia, sickle cell, fibrous dysplasia, metaphyseal dysplasia (Pyle's)