Final Review Flashcards
What clinical examination confirms that a scoliosis is structural rather than functional?
Adam test
You note an anteater sign. What pattern of tarsal coalition does this represent?
Calcaneonavicular
Your patient has 2/5 strength of the wrist flexors. Which intervertebral foramen contains the nerve that is involved?
C7 nerve root
What imaging modality is the gold standard for the evaluation of bone density?
DEXA
The distal femurs demonstrate an Erlenmeyer flask deformity. The patient’s T-score is +2.0. What is the first item on your differential?
Osteopetrosis
Rickets and hyperparathyroidism coexist in what condition?
Renal osteodystrophy
What is the name of the system for grading skeletal maturation based on the iliac apophysis?
Riser
A new mom presents with SI pain. There are triangular foci of sclerosis in a bilateral asymmetric distribution. What is the diagnosis?
Osteitis Condensans ilii
A 35 year old underwater welder presents with a stippled lesion in the medullary cavity of the proximal humeral metaphysis. The lesion has a serpiginous contour. Which should be the first item on your differential?
Medullary Infarct
Which condition should you suspect when a PA chest radiograph reveals a pectus excavating and a 4-5cm thoracic aorta?
Marfan syndrome
You suspect your patient has a non-emergent abdominal aortic aneurysm. What is the most appropriate imaging follow-up?
Doppler with ultrasound
Which arthritis, when untreated, has the greatest association with Osteonecrosis?
SLE
What imaging tool is the definitive diagnostic test for complex regional pain syndrome?
3 phase bone scan
What is the minimum Meyerding grade for bilateral facet dislocation?
3
Which injuries are associated with child abuse? SELECT ALL THAT APPLY
a. Skull fractures
b. Rib fractures
c. Metaphyseal corner fractures
d. Multiple fractures in various stages of healing
e. None of the above
a. Skull fractures
b. Rib fractures
c. Metaphyseal corner fractures
d. Multiple fractures in various stages of healing
Which MRI pulse sequence is most sensitive for edema?
STIR
A geographic lytic expansile lesion is present in the distal femoral metaphysis of a 32yo patient. There is a short zone of transition, no periostea’s reaction, no matrix pattern and no soft tissue mass. The lesion grows directly to the Trochlear groove. What is the diagnosis?
GCT
Intoxication with which mineral is associated with gout?
Lead
An 8 year old presents with 5 weeks of ankle pain. Radiographs reveal a geographic lytic lesion in the medullary cavity of the distal tibial metaphysis. There is no periostea’s reaction, no matrix calcification, no periosteal reaction, no matrix calcification and no soft tissue mass. Past medical history is remarkable for pneumonia 8 weeks ago. What is the diagnosis?
Brodie abscess
What condition is a well established cause of Osteonecrosis?
a. Marram syndrome
b. Cleidocranial dysplasia
c. Anabolic steroid treatment
d. Caisson disease
Caisson disease
You patient has torticollis. Radiographs reveal globular calcification immediately inferior to the anterior arch of C1. What is the diagnosis?
Hydroxyapatite deposition disease (HADD)
What is the biggest clinical concern in a patient with a degenerative spondylolisthesis?
Central stenosis
Which condition is hall marked by bony horns growing off the posterior aspect of the ilia?
Osteoonychodystrophy
Which portion of the SI joints best demonstrates the erosive changes of ankylosing spondylitis?
Lower/iliac
What is the radiographic latent period for osteomyelitis of the distal radius?
7-10 days
14-17 days in spine.
Which feature helps distinguish hemophilia from JCA?
a. Ballooning of the epiphysis
b. Increased intercondylar notch
c. Osteopenia
d. Uniform joint space loss
Increased intercondylar notch
What is the MRI findings for a hemangioma?
High T1, High T2
Why does a cervical spine burst fracture have a higher rate of neurologic compromise than a lumbar spine burst fracture?
The presence of the spinal cord
Which of these bone diseases is x-ray sensitive for?
a. Osteoporosis
b. Fracture
c. Malignancy
d. Infection
e. None of the above
None of the above
Which findings are more common in thalassemia than in sickle cell anemia? MARK ALL THAT APPLY 1-4.
a. Hair on end skull
b. Osteonecrosis
c. Erlenmeyer flask deformity
d. H-shaped vertebra
Hair on end skull
Erlenmeyer flask deformity
Which organism is the most common to cause osteomyelitis in a user of IV heroin?
S. aureus
A 53 year old underwater welder presents with a stippled medullary lesion in the proximal humeral metaphysis. What should be the first item on the differential diagnosis list?
Chondrosarcoma
Which is the primary diagnostic criteria for Scheuermann disease?
3 segments with 5 degrees of wedging (anterior)
What is the most common organism to cause osteomyelitis?
S. Aureus
Which cervical spine manifestation of rheumatoid arthritis is the most clinically significant?
Increased ADI
Your patient has positive Ottawa criteria for the knee. Radiographs reveal an obliquely oriented radiolucent line in the patella, with corticated margins. What is the diagnosis?
Vertical patellar Fx
Which of these conditions represents an absolute contraindication to HVLA manipulation of the spine and extremities?
a. Ehlers Danlos
b. Achondroplasia
c. Rheumatoid arthritis
d. Cervical ribs
Ehlers Danlos
Which condition does NOT have generalized osteopenia as a radiographic finding?
a. Osteopetrosis
b. Osteogenesis imperfecta
c. Hyperparathyroidism
d. Osteomalacia
Osteopetrosis
Multiple geographic lytic lesions with hazy internal calcification is present in the proximal femurs, with an accompanying bilateral shepherds crook deformity in a 52yo. What is the diagnosis?
Polyostotic fibrous dysplasia
Which finding in the hands and feet is strongly suggestive of acromegaly?
Spade tufts
AP and lateral bilateral knee views on a 20yo demonstrate excessive bowing of the femurs and tibiae. Mild generalized osteopenia is noted. In the distal tibiae, there are radiolucent lines extending approximately 1/3 of the way through the bone. What is the diagnosis?
Osteomalacia
Which type of Modic change is characterized by high T1 and low T2 signal on MRI?
2
On a 12yo patient, the AP ankle demonstrates a fracture through the tibial epiphysis, running into the growth plate. On the lateral view there is a metaphyseal fracture of the tibia, also running into the growth plate. What type of salter Harris fracture is described?
4
A bone is noted extending from the Lamina of C5 to the greater angle of the scapula. This is seen in frequent association with which condition?
Klippel Feil syndrome
Which of the 5 cervical lines is the most reliable to determine the presence of a spondylolisthesis?
Posterior body line (Georges Line)
Which feature aids in distinguishing Myositis Ossificans from osteosarcoma?
Zonal phenomenon
Soft tissue infection with clostridium perfringens will demonstrate which of the 4 radiographic densities?
Air
Your patient has decreased sensation along the lateral aspect of the leg, running anterior to the lateral malleolus, and extending along the dorsum of the foot. Which disc herniation(s) would be consistent with the finding? MARK ALL THAT APPLY 1-6 ANSWERS
a. L4/L5 foraminal
b. L4/L5 subarticular
c. L5/S1 foraminal
d. L3/L4 subarticular
e. L5/S1 subarticular
f. L3/L4 subarticular
g. None of the above
L4/L5 subarticular
L5/S1 foraminal
What is the most likely location in the musculoskeletal system for tuberculosis to disseminate?
Spine
A football player presents with severe neck pain after tackling an opponent while leading with his helmet. Radiographs reveal anterior wedging of C6, as well as convex posterior body margin. What is the diagnosis?
Compression fracture
Your patient has a 23 degree right convexity from T1-T6 and a 34 degree left convexity from T6-T11. What term would be applied to this finding?
Double primary
There is a fracture fragment at the anterior inferior body margin of C6. What is the mechanism of injury?
Flexion
Your patient presents with back pain 2 weeks after abdominal surgery, with normal radiographs. What is the best follow up imaging?
MRI with contrast
The idea behind imaging decision making is to decrease population radiation dose as much as possible. What is the term applied to this concept?
ALARA
In what paragraph of the radiology report would the following statement go: A rib is noted arising from C7 on the left
A (Anatomy)
Which condition has Wormian bones and osteopenia as the primary findings?
Osteogenesis imperfecta
Frontal radiographs demonstrate a short segment, high angles scoliosis. What would you expect to find in the apical region?
a. Lateral hemivertebra
b. Posterior scalloping
c. Tall vertebra
d. Twisted ribbon ribs
Lateral hemivertebra
What is the threshold for translational instability in the lumbar spine?
4.5 mm
A 14 year old patient has a left lumbar scoliosis. Radiographs reveal a sclerotic right pedicle of L2. What is the etiology of the scoliosis?
Tumor-related
Which radiographic appearance is most suggestive of chronic osteomyelitis?
Achondroplasia (also NF-I, Marfans, and Acromegaly)
Select all conditions with posterior vertebral body scalloping as a feature.
a. Achondroplasia
b. AAA
c. Hodgkin lymphoma
d. No correct answer listed
Achondroplasia (also NF-I, Marfans, and Acromegaly)
According to the most up to date evidence based information, what is the best imaging to determine the presence of an active fatigue fracture of the pars interarticularis?
SPECT
What is the term applied to pain associated with a lumbosacral transitional segment?
Bertolotti syndrome
What condition has an epiphyseal osteochondroma as a feature?
Trevor disease
Numerous hyperpigmented cutaneous macules with a smooth outer border are consistent with what condition?
Neurofibromatosis (Coast of California)
What is the term applied to the bone destruction of permeative osteolytic in osteomyelitis?
Involucrum
Select 2 conditions which both have generalized osteoporosis and osteonecrosis as features.
a. Marfans
b. Cushings
c. Acromegaly
d. Sickle cell anemia
b. Cushings
d. Sickle cell anemia
What imaging follow up should be performed on patients with neck pain and a congenital fusion?
Flexion/extension radiographs
What would you include on the differential for a clavicle in 2 separate pieces, both ends having smooth well rounded corticated margins?
a. No correct answer listed
b. HPT
c. Non-union fracture
d. PTOC
e. Cleidocranial dysplasia
Cleidocranial dysplasia
Avascular necrosis of the lunate is associated with which of the following?
a. Lunate dislocation
b. Scapholunate dissociation
c. Negative ulnar variance
d. Fischer fracture
e. No correct answer listed
Negative ulnar variance
Which metabolic arthritis is associated with ‘crowned dens syndrome’?
CPPD
A 14 year old track athlete presents with complaints of ‘patellar tendinitis’. Radiographs demonstrate fragmentation of the apex of the patella. What is the diagnosis?
Sinding Larsen Johansson
When involving the cervical spine, which condition is frequently associated with dysphasia?
DISH (Also stylohyoid ligament ossification/ Eagle Syndrome)
Which of these would be a cause of a functional scoliosis?
a. Neurofibromatosis type 1
b. Leg length inequality
c. Cerebral palsy
d. Moderate DJD
Leg length inequality
When looking for rib fractures on a rib x-ray series, which cortex is the most sensitive for displaying fracture?
Superior
Following a FOOSH injury, your patient has numbness of the thumb, index and middle fingers. What injury do you suspect?
Lunate dislocation
A 13 year old running athlete presents complaining of progressively worsening leg pain. Radiographs reveal cortical thickening in the tibial diaphysis. There are no other abnormalities. Which do you suspect?
Fatigue fracture
The L2 vertebral body is wedged anteriorly. The posterior body margin is concave. The posterior elements are intact. There is a step defect in the anterior body cortex. What is the diagnosis, and is this acute or old?
Compression fracture
Acute
Which conditions should be included in a widened medial hip joint space in a pediatric patient?
a. SCFE
b. Septic arthritis
c. LCP
d. Osteoid osteoma
e. No correct answer listed
SCFE
LCP
You suspect acromegaly. What imaging should be ordered?
MRI with pituitary protocol
Your patient has unilateral sacroiliac irregularity and sclerosis, and also complains of hand pain and stiffness. What is the most likely diagnosis?
Psoriatic arthritis
What is the most common geographic lytic lesion in the foot?
Enchondroma
An AP and frog leg hip radiograph on an 8 year old reveals sclerosis, flattening and fragmentation of the femoral head. What is the diagnosis?
Legg Calve Perthes
The technetium 99-MDP used in bone scintigraphy is taken up by which type of bone cell?
Osteoblasts
You note conduit wall calcification in the 3 view hand radiograph of your patient. What is the underlying cause?
Atherosclerosis
A pediatric patient has bulbous costochondral junctions. Which condition do you suspect?
a. Chondrodysplasia punctata
b. Hemophilia
c. Rickets
d. Osteogenesis imperfecta
Hemophilia
A skier’s thumb is a disruption of which ligament?
Ulnar collateral ligament at the MCP
A 7 year old patient has an eccentric, geographic lytic lesion in the distal tibial metaphysis. There is a narrow zone of transition, ground glass matrix, no soft tissue mass. The x-ray was taken because the child has twisted their ankle. What is the diagnosis?
Fibrous cortical defect
Which imaging modality does not utilize ionizing radiation?
a. Bone scan
b. Ultrasound
c. Radiographs
d. Computed tomography
Ultrasound
A 54 year old patient with a 3cm blastic lesion in the sacrum. The lesion is found to be warm on bone scan. What is the diagnosis?
a. Blastic Mets
b. Chondrosarcoma
c. Enostoma
d. Osteoma
Enostoma
Which condition is associated with shoulder impingement syndrome?
a. Bankart fracture
b. Humeral pseudotumor
c. Cleidocranial dysplasia
d. Os acromiale
Os acromiale
Knee radiographs in a 32 year old reveal intracapsular effusion and destruction of the subarticular cortex at the trochlear groove. What is the diagnosis?
a. PVNS
b. Septic arthritis
c. Primary SCM
d. GCT
GCT
What is the most common wrist fracture in a 65 year old patient with a FOOSH injury?
Colle’s
A subarticular lucent cleft is noted in the top of the femoral head. What stage of AVN does this indicate?
Revascularization
There is an anterior translation of C1 with an ADI measuring 7mm. What conditions should be included in the differential diagnosis? SELECT ALL THAT APPLY
a. Down syndrome
b. Jefferson fracture
c. Os odontoideum
d. Odontoid agenesis
e. Rheumatoid arthritis
f. No correct answer included
All are included
You detect an ivory vertebra in a 61 year old. There is no anterior scalloping or vertebral enlargement. What is the first item on your differential?
Metastatic disease
Lumbar radiographs reveal generalized osteopenia, widened bilateral SI joints, and several soft tissue calcifications. A rheumatoid panel is negative. What is the diagnosis?
a. Acromegaly
b. Scleroderma
c. Enteropathic arthritis
d. Hyperparathyroidism
Enteropathic arthritis
Lumbar radiographs in a 38 year old reveal a missing pedicle at L2 on the right. The contralateral pedicle is mildly enlarged. What should be the first diagnosis on the differential list?
Agenesis
There is motheaten osteolysis with a wide zone of transition in the right ilium of a 57 year old female. There is no periosteal reaction, matrix pattern, or soft tissue mass. What is the correct differential?
a. Metastatic disease, multiple myeloma, lymphoma
b. Metastatic disease, lymphoma, multiple myeloma
c. Multiple myeloma, lymphoma, metastatic disease
d. Multiple myeloma, metastatic disease, lymphoma
Metastatic disease, multiple myeloma, lymphoma
AP and frogleg radiographs on a 5 year old patient showing a small femoral head, a steeply inclined shallow acetabulum and superolateral femoral displacement. What is the diagnosis.
DDH
