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MSK viva > Closing cases > Flashcards

Closing cases Flashcards

1
Q

Pagets

A

1) Osteosarcoma- 1%
2) High output cardiac failure
3) Insufficiency fractures ( banana)
4) Extramedullary haematopoiesis

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2
Q

Enchondroma

A

1) Malignancy- 1% if solitary
2) Malignant transformation
- Proximal location
- Endosteal scalloping >2/3
- Fracture
- Pain
- Increased lucency
- Increased activity on successive scans
- soft tissue mass

3) F/U as per orthopaedic oncologist

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3
Q

PF dislocation relocation

A

1) Medial patellar facet
2) Lateral femoral condyle
3) Tear of Medial PF retinaculum

Causes

  • IS of > 1.3
  • Shallow trochlear ( <3mm)
  • TTG >20mm

Workup
- CT PF tracking to work up dynamic relationship btwn patella and femur

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4
Q

Lunate dislocation

A
  • Triangular configuration of the lunate with bony overlap
  • Suggest malalignment of the carpus
  • No fractures to suggest greater arc injury
  • scaphoid position is normal
  • > Isolated volar dislocation of lunate
  • > Would like to look at lateral to confirm
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5
Q

HPOA

A
  • Bilateral symmetric periosteal reaction
  • In a patient with lower limb plain-> HPOA

-> If the patient is still in department , I would request a CXR

=> DD- bronchogenic mass, empyema, pleural fibroma

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6
Q

HPOA

A
  • Bilateral symmetric periosteal reaction
  • In a patient with lower limb plain-> HPOA

-> If the patient is still in department , I would request a CXR

=> DD- bronchogenic mass, empyema, pleural fibroma

Management

  • Staging CT
  • Proceed to biopsy
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7
Q

Calcaneal fracture ( axial load)

A
  • Compressed Intra-articular fracture that involves the sub-talar facet of calcaneus
  • loss of bohlers angle ( normally 20-40 deg)
  • > Collapse of the calcaneus
  • Suspect that the patient has had an axial load injury
  • > Similar fracture on other side
  • > Axial load injury of lumbar
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8
Q

Parsonage turner

A
  • Oedematous/ increased signal in supra and infra
  • Atrophy of muscle body
  • Tendon is spared
  • sparing of the other muscles

==> These appearances are in keeping with DENERVATION

-Supplied by the suprascapular nerve ( branch of the thyrocervical trunk)

  • looking for compressive lesion in Suprascapular notch i.e. paralabral cyst from labral tear
  • Could be more proximal lesion in brachial plexus

= In the absence of these lesions, the appearances are in keeping with parsonage turner syndrome

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9
Q

Popliteal lesion

A
  • Rounded lesion
  • Next to popliteal vein
  • Look for FAT SIGN on T1

DD

  • nerve sheath tumour ( TIBIAL)
  • popliteal artery aneurysm
  • Dessicated ganglion

Artery-> Black due to fast flow
Nerves-> tibial and common peroneal ( divides into superficial and deep peroneal)

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10
Q

Arthritis

A

Contiguous destruction of joints
–»>INFECTION

Marked erosive arthropathy

1) Symmetrical
2) Bone density
3) Bone mineralisation
4) Triangular fibrocartillage
5) PROXIMAL vs DISTAL
6) Erosions
- Central
- Marginal
- Juxta-articular

DD====> There is a differential for this film

  • Rheumatoid or atypical rheumatoid
  • Gout
  • Psoriasis

Diagnosis
- Rheumatoid criteria ( Rh factor, symmetric arthropathy)
- Psoriasis ( HLAB26, extensor surfaces)
-

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11
Q

Rectus femoris avulsion

A
  • Indirect–> Superior acetabulum
  • Direct–> AIIS

KICKING the ball and missed the ball

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12
Q

Transitional anatomy at lumbosacral junction with bilateral pseudoarthrosis

A
  • > Sacralisation of L5 body

- > Sacralisation of S1

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13
Q

Expansile lesion in trochanter

A
  • Are bone ends!!

DD:

  • ABC
  • GCT
  • Clear cell
  • GCT with secondary ABC
  • if soft tissue –> No touch lesion and referral to sarcoma MDT
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14
Q

Scapholunate dissociation

A
  • Widening of scapholunate interval
  • Rotatory subluxation of scaphoid with ‘ring sign’
  • Lateral radiograph DISI deformity of lunate
    ? triquetral fracture

If not fixed , get OA and then!!
–> SLACC wrist

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15
Q

Talocalcaneal coalition

A

-dorsal beaking of the talar head
- C-sign
- ball-and-socket ankle
mortise
- asymmetry of the inferior talar necks
-widening of the lateral talar process
- nonvisualization of the subtalar joint medial facet
- close approximation between the talus and calcaneus

Width of articulation < 10mm

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16
Q

Calcaneonavicular

A
  • elongation of the anterior facet of the calcaneus ( anteater )
  • The 45-degree medial oblique view is the best diagnostic radiographic projection to demonstrate this type of coalition
17
Q

Stress fracture

A

FRACTURE

  • dorsal cortex
  • Central bone
  • Vertically oriented on sagittal radiograph
18
Q

Perilunate

A

AP

  • Empty lunate
  • Overlap of gilula’s archs

LATERAL

  • Alignment btwn lunate and radius is unchanged
  • distal carpal row is dislocated dorsally
19
Q

Madelung deformity

A
  • > growth arrest of ulnar side of distal radius
  • > +ve ulnar variance ( should have neutral ulnar variance)

complications

  • > causes ulnar carpal impaction ( cysts)
  • > predispose to TFCC injury ( recommend MRI)

MRI

  • Think elongated TFCC and there is no tear
  • looking for features of ulnar carpal impaction

DD
- Turners
- Mucopolysaccharoidoses
-

20
Q

Axillary view ( sub-acromial impingement)

A

1) Decreased of the sub-acromial joint space
2) Causes of impingement
- Type 2/3 acromion
- Spur
- laterally or anteriorly sloping acromion
- thickened coracoacromial ligament

  • Ask for axillary view

–> Look at GH joint space

WORK UP
1) USS

21
Q

Super scan differential diagnosis

A

1) Hyperparathyroidism
2) Renal osteodystrophy
3) Osteomalacia
4) Mets- Prostate, breast

22
Q

Vertebral plana

A

MELT

1) Mets, Myeloma
2) EG
3) LCH
4) Trauma

23
Q

Soft tissue calcification

A
  • tumoral calcinosis ( Normal BIOCHEMISTRY)
  • Myositis ossificans
  • Dystrophic calcifi cation – scleroderma, dermatomyositis (tends to be sheetlike).
  • Tumours – synovial sarcoma, chondrosarcoma, 0steosarcoma, synovial osteochondromatosis.
  • Chronic renal failure
  • Calcium pyrophosphate dihydrate deposition disease (CPPD).
  • Hypercalcaemia – hyperparathyroidism, hypervitaminosis D, milk alkali
    syndrome, sarcoidosis.
  • Hyperuricaemia – severe tophaceous gout.
24
Q

Sclerotic bone mets

A

Which bone metastases can be sclerotic?

  • Prostate
  • Breast
  • Any adenocarcinoma
  • Carcinoid
  • Bladder
  • (Lymphoma)
25
Q

Lytic mets

A 
Lytic:
○ breast
○ bronchus
○ thyroid
○ kidney
26
Q

Terminal tuft lytic lesion

A

Met- bronchus, thyroid , renal ( expansile)
Implantation dermoid
Enchondroma
Glomus tumour

27
Q

‘cyst-like’ bone lesions of phalanges .

A 
• Implantation dermoid
• Glomus tumour
• Gout (low-signal tophi on MRI)
• Rheumatoid arthritis
• Enchondroma
-Sarcoidosis

MSK viva (2 decks)

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