Em Es Kay Flashcards
1
Q
Giant Cell Tumour (GCT or osteoclastoma)
A
Occurs in GIANTS - Got Closed PlaTes
• Skeletally mature patient (20-45)
• Starts at metaphyseal side of growth plate and extends into epiphysis.
• Eccentric. Lytic. Abuts articular surface.
• Well defined but non-sclerotic border.
• Cortical expansion.
*DD for fluid-fluid levels.
2
Q
Aneurysmal Bone Cyst (ABC)
A
Is literally a blood-filled thin-walled cyst.
• Respects the growth plate
• Eccentric
• Expansile
• Normally younger (75% under 20yrs)
DD for fluid-fluid level.
3
Q
Respects growth plate
A
ABC
4
Q
Skeletally mature patient.
Lucent lesion.
A
GCT
“Got Closed plaTes”
Extends through the growth plate (epiphyseal extension)
5
Q
Order for assessing shoulder tendons on US?
A
Bi-Sub-Sup-IT
6
Q
Shoulder US positions:
Biceps tendon (long head)
A
Arm down
Arm flexed at 90 degrees pointing straight forward
Palm up
7
Q
Shoulder US positions:
Subscapularis tendon
A
Arm down
Flexed 90 degrees with palm facing up
Arm externally rotated out to side
8
Q
Shoulder US positions:
Supraspinatus tendon
A
Hand in back pocket
9
Q
Shoulder US positions:
Infraspinatus and Teres minor tendons
A
Arm across chest
Palm on contralateral shoulder
*Teres minor harder to see so not that useful
10
Q
Like Osgood-Schlatter but inferior pole of patella affected
A
Sinding-Larsen-Johansson syndrome
Traction tendinitis of patellar tendon at patellar insertion.
11
Q
Iliac horns
A
Nail-Patella syndrome (hereditary onycho-osteodysplasia)
• Nail dysplasia
• Patella hypoplasia
• Elbow hypoplasia
• Iliac horns
12
Q
Mucopolysaccharidosis (MPS) with no intellectual impairment.
A
Morquio syndrome
• Severe dwarfism.
• Anterior central vertebral body beaking.
• Posterior vertebral body scalloping.
• C2 (dens) abnormalities (main cause of death).
13
Q
Pellegrini-Steida lesion
What ligamentous injury does this represent?
A
MCL
(Most Citrussy Liquid)
Valgus stress causing MCL avulsion with calcification adjacent to Medial femoral CondyLe.
14
Q
Anterior draw sign on knee examination
A
ACL tear
15
Q
O’donoghue’s unhappy triad
A
ACL tear
MCL tear
Medial meniscal tear
16
Q
Dreaded complication of PCL tear
A
Popliteal dissection
17
Q
Double PCL appearance on knee MRI
A
Bucket handle tear (usually medial meniscus)
18
Q
Baker’s cyst location
A
MaG-knee-SiuM (MG-Sm)
Between medial head of Gastrocnemius and SemiMembranosus
19
Q
Normal Bohler’s angle
A
20-40°
<20° = calcaneal fracture
20
Q
Lisfranc ligament location
A
Between 2nd metacarpal base and medial cuneiform
Homolateral
1st MTP joint remains congruent
Divergent
Medial dislocation of the 1st metatarsal
21
Q
Plantar fasciitis thickness?
A
> 4mm
“Pain worst in morning/with use after period of rest”
22
Q
Kienbock
A
Lunate
(K is next to L)
23
Q
Kohler’s
A
Navicular
(Koh-ler = Navicu-lar)
24
Q
Scheuermann
A
(S)cheuermann is in the (S)pine
• 3 adjacent levels with wedging >5° and kyphosis
• T spine >40°, thoracolumbar >30°.
• >75° need surgery.
25
Panner’s
Capitellum
PANNing for gold like a capitalist
26
Polyostotic fibrous dysplasia syndromes
McCune-Albright
Mazabraud
27
Mazabraud syndrome
Polyostotic fibrous dysplasia
Soft tissue Myxomas
*Mazabraud = Myxoma
28
Fallen fragment sign
Solitary (unicameral) bone cyst
CENTRAL location.
29
Chondrosarcoma vs enchondroma
Chondrosarcoma is PAINFUL
30
Chondrosarcoma vs chondroblastoma
Chondroblastoma seen in kids.
Chondrosarcoma adults.
31
Intraosseus lipoma
CENTRAL calcification.
32
Blade of grass sign
Pagets
33
Picture frame vertebra
Pagets
34
Rugger jersey spine
Hyperparathyroidism
Sclerotic endplates with normal centres looking like striped rugby jersey.
35
H-shaped vertebrae
Sickle cell disease
36
3 phases of Paget disease
1. Lytic (eg osteoporosis circumscripta in skull)
2. Mixed
3. Sclerotic
Expanded bones with thickened/coarse trabeculae.
37
Painful malignant lesion in foot/ankle.
Synovial sarcoma
(Usually younger)
38
“Frond-like” fatty deposition in joint
Lipoma aborescens
39
“Frond-like” fatty deposition in joint
Lipoma aborescens
40
Gull wing (central) erosions
**Erosive OA**
Favours DIP joints.
41
Unilateral SIJ inflammation
Infection
42
Asymmetric sacroiliitis
**Psoriatic arthritis**
**Reactive arthritis** (previously Reiter’s)
**(P)** - A - I - **(R)**
43
Symmetrical sacroiliitis
Ankylosing spondylitis
IBD related
P - (**A**) - (**I**) - R
44
Spares joint space, punched out juxta-articular erosions.
Gout
45
Destructive bone mass in leukaemia patient
Chloroma (granulocytic sarcoma)
46
Enlargement of the paranasal sinuses, posterior vertebral body scalloping.
Acromegaly
47
Dripping candle wax
**Melorrheostosis**
*Can skip across a joint to involve adjacent bone*
48
Hand-Schüller-Christian disease
On the spectrum of histiocytosis.
Triad of **lytic bone lesions, diabetes insipidus and proptosis**. Often also have hepatosplenomegaly and dermatitis.
49
Seronegative arthropathy without osteoporosis
Psoriatic arthritis
50
DISI vs VISI
Dis Is more common in the >60s SiLly.
Dorsal fin points up - SL angle >60 and CL angle >30
51
Anterior inferior vertebral beaking
Hurler’s syndrome
Achondroplasia
Down’s syndrome
52
Arthritis with no bone proliferation
RA
53
RA features
Symmetrical
Proximal (MCPJs first + spares DIPJs)
Osteoporosis
No bone proliferation
54
Gout crystals
**“MSg UR NOODLES”**
**Monosodium urate** crystals which are **needle shaped** and **negatively bifringent**
55
Mnemonic for posterior vertebral body scalloping
**SALMON**
Spinal cord tumour
Achondroplasia
Loeys-Dietz syndrome and other connective tissue disease eg Marfans
Mucopolysaccharidoses eg Morquio’s, Hurler’s
Osteogenesis imperfecta
NF1
56
Causes of Erlenmeyer flask deformity mnemonic
**Lead GNOME**
**L** - Lead poisoning
**G** - Gaucher’s disease
**N** - Niemann-Pick disease
**O** - Osteopetrosis, osteochondromatosis, Ollier’s
**M** - Metaphyseal dysplasia/fibrous dysplasia
**E** - (E)matological eg thalassaemia, sickle cell
57
Traumatic incomplete spinal cord syndrome
**Central cord syndrome.**
• **Most common** incomplete cord syndrome.
• **C spine** most commonly affected. Usually **hyperextension** injury.
58
Prosthetic loosening lucent zone thickness
>2mm lucent line at cement/prosthesis interface is suspicious for loosening.
59
Prosthetic loosening lucent zone thickness
>2mm lucent line at cement/prosthesis interface is suspicious for loosening.
60
Osteochondroma malignant transformation
**Chondrosarcoma**
**Cartilage cap thickness >20mm** is most useful for determining sarcomatous change.
(Some sources say >15mm)
61
Hereditary multiple exostosis / osteochondromas
aka
**Diaphyseal aclasis** (due to broadened shaft appearance at end of long bones).
Need **2 or more** osteochondromas.
Greater risk of **malignant transformation** than if solitary.
62
Post-discectomy fibrosis vs recurrent disc herniation
Both can have similar T1/T2 but fibrosis enhances **early** with Gadolinium.
63
Opposite of swan neck deformity
Boutonnière
64
Most common tarsal coalition
1. **Calcaneonavicular** (45%)
2. Subtalar (usually involving the middle facet)
65
AVN of 2nd or 3rd metatarsal head
**Freiberg disease**
Freiberg = Foot
Usually 2nd metatarsal (66%)
66
Best osteosarcoma to have?
Parosteal type.
~90% 5 yr survival.
67
HPOA
• Osteitis/periosteal reaction of long bones (usually symmetrical)
• Arthritis
• Clubbing
*Tram track sign on MDP bone scan.
68
Pubic diastasis
Abnormally widened pubic symphysis.
>10mm diagnostic.
69
Marrow reconversion
Replacement of fatty marrow by red marrow to compensate for **increased haematopoietic demand**.
• Chemo
• Sickle cell, spherocytosis, thalassaemia
• Smoking, obesity
• Endurance athletes
• High altitude living
• Diabetes
70
Marrow reconversion pattern
Axial skeleton first and spreads outwards/distally.
Malignant infiltration more random distribution and enhances with Gadolinium.
71
Sinus tarsi syndrome on MRI
Replacement of T1 bright fat signal in sinus tarsi by fluid or scar tissue.
72
Hook of hamate fracture vignette
Sport which involves **repetitive trauma whilst gripping** eg golf, tennis, baseball.
May cause ulnar nerve compression.
73
SAPHO
**S** - Synovitis
**A** - Acne
**P** - Pustulosis
**H** - Hyperostosis
**O** - Osteitis
Sternoclavicular joint commonly affected
74
Communication of radiocarpal and mid-carpal compartments on injection
Scapholunate or lunptriquetral ligament tear
75
Ankylosing spondylitis lung fibrosis pattern
Upper zones and apices
76
Prevertebral soft tissue thickness:
C2/3
7 mm
*Remember 3s and 7s*
C3 + 7 = 10
77
Prevertebral soft tissue thickness:
C6/7
21 mm
*Remember 3s and 7s*
C7 x 3
78
Reverse Colle’s fracture
Smith fracture
Volar angulation
79
Distal radius fracture. Intra-articular. Dorsal subluxation of radiocarpal joint.
Barton fracture
80
Doughnut sign on bone scintigraphy
**GCT**
**ABC**
**Simple bone cyst**
Increased peripheral uptake with photopenic centre.
81
Most common form of craniosynostosis
Scaphocephaly
82
Scaphocephaly is premature closure of ______________…
Sagittal suture
SS
83
Brachycephaly
BraChycephaly is BiCoronal
BC-BC
84
Well circumscribed lucent lesion in proximal humeral metaphysis
Simple (unicameral) bone cyst
85
Conus medullaris is at what level in newborns?
L2-L3
86
Old patient. Pain in medial femoral condyle.
SONK
• Subchondral insufficiency fracture causing rapid subchondral collapse of weight bearing side.
• May be associated with minor trauma.
87
Old patient. Pain in medial femoral condyle.
SONK
• Subchondral insufficiency fracture causing rapid subchondral collapse of weight bearing side.
• May be associated with minor trauma.
88
Dural ectasia associations
Marfan’s (60-90%)
Ehlers-Danlos syndrome
NF-1
Loeys-Dietz syndrome (Marfan-like)
*results in posterior vertebral body scalloping
89
Multiple odontogenic keratocysts
**Gorlin-Goltz** (basal cell naevus syndrome)
• Multiple **BCCs**
• Multiple **keratocysts**
• MSK abnormalities eg bifid ribs, short 4th metacarpals, Sprengel deformity, craniofacial abnormalities
90
VISI
SL angle <30 degrees
CL angle >30 degrees
Lunotriquetral ligament often torn.
91
Bone within bone appearance mnemonic
**GHOST DRAGON**
**G** - growth arrest lines
**H** - hypoparathyroidism, hypothyroidism
**O** - osteopetrosis
**S** - sickle cell anaemia, scurvy, syphilis
**T** - thalassaemia, tuberculosis
**D** - disease of Caffey, hypervitaminosis D
**R** - rickets, radiation therapy
**A** - acromegaly
**G** - Gaucher disease
**O** - oxalosis
**N** - normal (thoracic/lumbar vertebrae in infants
92
Perthes vs SUFE
• Perthes usually **younger** (peak at 5-6yrs) and idiopathic.
• SUFE (10-15 yrs). Obesity and sports are associated.
*both are more common in boys
93
Isolated iliac wing fracture
Duverney fracture
Stable but may operate if displaced.
94
Unstable pelvic fractures
• **Malgaigne**
• **Open book** - fracture diastasis of symphysis and SIJs
• **Straddle** - both obturator rings
• **Bucket handle** - SIJ fracture with contralateral ischiopubic ramus fracture
95
Chondrocalcinosis mnemonic
**HOGWASH**
**H** - hyperparathyroid, hypothyroid
**O** - ochronosis
**G** - gout
**W** - Wilson’s disease
**A** - arthritis (RA, amyloid, acromegaly)
**S** - pSeudogout (CPPD)
**H** - haemochromatosis, haemophilia
*CPPD most common
96
Lucencies around hip prosthesis with “smooth endosteal scalloping”
Particle disease (histiocytic reaction/aggressive granulomatosis)
97
Stress shielding
Local bone **demineralisation** due to the alleviation of normal weightbearing stresses after hip arthroplasty.
If severe can **predispose to fracture**.
98
Modic endplate changes:
Type 1
Oedema and inflammation
**Water is bright on 1 sequence = type 1**
High T2 signal
99
Modic endplate changes:
Type 2
Fatty marrow
**Fat is bright on 2 sequences = type 2**
Conversion of normal haematopoietic red marrow into **fatty yellow marrow** due to marrow **ischaemia**.
High T1 and T2.
100
Modic endplate changes:
Type 3
Subchondral **sclerosis**
The other one.
Low on T1 and T2
101
Anteaters nose appearance of calcaneum on lateral film
**Calcaneonavicular coalition**
Most common tarsal coalition.
102
Platyspondyly
**Flattened** vertebral bodies
Causes include:
Morquio’s
Severe Gaucher’s disease
Osteogenesis imperfecta
Acromegaly
103
Still disease
Subtype of **juvenile idiopathic arthritis** with peak age 1-5 yrs.
• **Arthritis**
• **Salmon pink rash**
• **Fever**
• Hepatosplenomegaly
• Lymphadenopathy
• Pericardial effusion
104
Leg bowing and genu varum deformity in young child
**Blount disease**
• Relative lack of growth of **medial proximal tibial physis**.
• Epiphysis may appear **wedge-shaped, fragmented or absent.**
• Unilateral or bilateral. Infantile form often bilateral whilst juvenile type is often unilateral and due to obesity.
105
Scurvy
**See picture**
Generalised osteopenia
Wimberger sign - circular outline around epiphysis
Pelkan spur - metaphyseal spur
Trümmerfeld zone - lucent metaphyseal band
Frankel line - dense zone of calcification
106
Ivory phalanx
Psoriatic arthritis
Rare but **pathognomic**.
107
Arthropathy with widened intercondylar notch, squaring of inferior patella, flattened condylar surfaces, bulbous femoral condyles
**Haemophilic arthropathy**
Recurrent **haemarthrosis**. Results in **iron deposition**.
*^Knee** most common site followed by elbow.
108
Klippel-Feil associations
Chiari 1 malformation
Sprengel deformity of the shoulder
Wildervanck syndrome
109
Primary synovial chondromatosis
• **Monoarticular** synovial metaplasia
• Intraarticular **cartilaginous nodules** • Nodules break off to become **loose bodies**. Balls of **rings and arcs**.
• Some may **calcify**.
• Primary type **younger** (40s)
• **Knee** most common site
*secondary form has larger and fewer loose bodies, pts will be **older** with significant degenerative changes or history of trauma
110
Basilar invagination mnemonic
**PF ROACH**
Dens should sit **>5mm below McRae line** or may cause **brainstem compression**.
**P** - Paget’s disease
**F** - fibrous dysplasia
**R** - rheumatoid arthritis
**O** - OI, osteomalacia
**A** - achondroplasia
**C** - chiari I/II, cleidocranial dysostosis
**H** - hyperparathyroidism
111
Most specific MRI sign of carpal tunnel syndrome
**Abrupt change in median nerve diameter**
Other signs include:
• Bowing of retinaculum
• Nerve enhancement
• Oedema/loss of fat in carpal tunnel
*diabetes, hypothyroid, acromegaly, pregnancy, RA
112
5 D’s of Charcot/neuropathic joint
Normal bone Density
Debris
Dislocation
Distension of joint space
Destruction of articular cartilage
Foot - diabetes, alcohol
Shoulder - syringomyelia
Spine - traumatic spinal cord injury
113
Cloaca, involucrum & sequestrum are all features of ______________
Osteomyelitis
114
Loss of lamina dura
Hyperparathyroidism
Scleroderma
Paget’s disease
115
Most common site of Ewing’s metastases
1. Lung
2. Bone
116
Most common Salter-Harris fracture
Type 2 (A for above)
117
Madelung deformity
**HIT DOC**
**H** - Hurler syndrome
**I** - infection
**T** - trauma
**D** - dyschondrosteosis (Leri-Weill)
**O** - osteochondroma (diaphyseal aclsasia)
**C** - congenital, e.g. Turner syndrome, nail-patella syndrome, achondroplasia, Ollier’s
118
Lucent metaphyseal lesion with sclerotic outline and channel communicating with growth plate in a child
Brodie abscess
119
Acro-osteolysis mnemonic
**CHOP FINger**
**C** - collagen vascular disease, e.g. scleroderma, Raynaud disease
**H** - hyperparathyroidism
**O** - other, e.g. polyvinyl chloride exposure
**P** - psoriasis/pyknodysostosis/progeria
**F** - familial, e.g. Hajdu-Cheney syndrome
**I** - injury, e.g. thermal burn, frost bite
**N** - neuropathy, e.g. diabetes mellitus, leprosy, syringomyelia
120
Features suggestive of osteochondroma sarcomatous transformation
**GLAD PaST**
**G** - growth after skeletal maturity
**L** - lucency (new)
**A** - additional scintigraphic activity
**D** - destruction (cortical)
**P** - pain after puberty
and
**S** - soft tissue mass
**T** - thickened cartilage cap >1.5 cm
121
Osteochondroma considerations
Complications:
• Bursa formation and secondary bursitis
• Fracture
• Nerve impingement/vascular compression
• Sarcomatous transformation
Syndromes:
Diaphyseal aclasis
