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P-CTC > MSK > Flashcards

MSK Flashcards

1
Q

Liposclerosing Myxofibroma

A

Intertrochanteric lytic lesion with sclerotic margin. 10% malignant degeneration.

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2
Q

Radiation induced benign skeletal tumor.

A

Osteochondroma

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3
Q

Multiple hereditary ostosis inheritance pattern is?

A

Autosomal dominant.

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4
Q

Trevor disease

A

Epiphyseal osteochondromas.

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5
Q

Supracondylar (avian) spur

A

Normal variant. Ligament of Struthers compress the median nerve.

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6
Q

Cortical desmoid. What is it?

A

Scoop like lucency at posterior medial aspect of distal femoral metaphysis. Don’t biopsy it. Don’t MRI it.

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7
Q

Most common locations of calcific tendinitis in calcium hydroxyapatite deposition disease. 2

A

Supraspinatus tendon.

Longus colli muscle: anterior atlas to T3.

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8
Q

Calcium hydroxyapatite deposition disease causes:

A 
Primary (idiopathic)
Secondary:
-chronic renal disease
-Collagen vascular disease
-Tumoral calcinosis
- Hypervitaminosis D
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9
Q

 Osteopoikilosis, versus Mets?

A

Osteopoikilosis is joint centered.

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10
Q

Engelman‘s disease

A

Fusiform osseous enlargement with sclerosis of the long bones. Bilateral symmetric. ‏Hot on bone scan.

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11
Q

AVN signs:

A

Double line sign: T2 inner outer dark.
Rim sign: high T2 middle with two low signal lines.
Crescent sign: xray frog leg view subchondral lucency.

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12
Q

What are the three phases of Paget disease In order

A

Lytic to mixed to sclerotic

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13
Q

What are the subtypes of Paget disease

A

Monostatic and polyostotic subtypes

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14
Q

What’s the most common complication of Paget’s disease

A

Deafness

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15
Q

What’s the most common tumor can arise from Paget’s disease

A

Osteosarcoma.

Rarely giant cell tumor.

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16
Q

Paget’s disease complications

A 
Deafness.
Spinal stenosis.
Cranial nerve paresis.
Congestive heart failure (high output).
Secondary hyperparathyroidism.
Osteosarcoma.
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17
Q

Ivory vertebrae

A

Paget’s disease

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18
Q

Picture frame vertebrae

A

Paget’s disease

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19
Q

Rugger jersey spine

Sandwich vertebra

A

Renal osteodystrophy
And
Osteopetrosis

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20
Q

H shaped vertebrae

A

Sickle cell disease

Gaucher’s disease

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21
Q

How to differentiate between active Paget’s disease versus malignant transformation?

A

Malignant transformation will lose the normal T1 Signal. Best assessed on T1 pre contrast images

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22
Q

Anterior lateral unilateral tibial bowing? Diagnosis

A

NF-1

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23
Q

Lateral bilateral symmetrical tibial Bowing Any patient between 18 months to two years? Diagnosis

A

Physiologic bowing

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24
Q

Lateral osseous bowing In a newborn

A

Hypophosphatasia

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25
Q

Lateral bilateral fraying of the metaphysis widening of the growth plates? Diagnosis

A

Rickets disease

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26
Q

Tibia vara , Fat kid

A

Blount disease

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27
Q

Short limbs bowed Long bones

A

Dwarfism

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28
Q

Tibial bowing involving all long bones

A

Osteogenesis imperfecta

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29
Q

Dark to intermediate T2 soft tissue lesion In an old patient; often with spontaneous hemorrhage? Who am I

A

Pleomorphic undifferentiated sarcoma

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30
Q

Pleomorphic undifferentiated sarcoma

A

Dark to intermediate on T2
Spontaneous hemorrhage
Bone in foreskin turn into PUS
Radiation is a risk factor

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31
Q

Patient under 20 years old with T2 bright and T1 dark lesion (Cyst like) but with post contrast enhancement

A

Myxoid liposarcoma

Synovial sarcoma could be a ddx

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32
Q

T2 soft tissue mass with flow voids, Infiltrate between the fascial boundaries. Enhances intensely. Contain fat. What’s the next step.

A

Plain film to assess for phleboliths. Hemangioma.

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33
Q

Treatment: osteosarcoma

A

Chemo first then wide excision

34
Q

Treatment: Ewings sarcoma

A

Chemo radiation then wide excision

35
Q

Treatment: chondrosarcoma

A

Wide excision

36
Q

Treatment: giant cell tumor

A

Arthroplasty. If extends to articular surface

37
Q

Pigmented Villonodular synovitis. What is it

A

Synovial proliferation plus hemosiderin deposition

38
Q

Pigmented Villonodular synovitis. Signal on MR. calcifications?

A

Low signal on T1 and T2 weighted images. Blooming on gradient echo. Never calcify

39
Q

Pigmented villonodular synovitis versus giant cell tumor.

A

Giant cell tumor: typically seen in hand palmar tendons can cause erosion of underlying bone. Soft tissue density T1 and T2 dark

40
Q

Primary synovial chondromatosis versus pigmented Villonodular synovitis

A

Primary synovial chondromatosis: Not associated with hemarthrosis. May calcify.

41
Q

Diabetic myonecrosis. Trivia. MRI. Biopsy?

A

Infarction. 80% thigh.
MRI: irregular areas of marked edema with enhancement.
Never biopsy

42
Q

Lipoma Arborescens: what is it. MR appearance. Associations.

A

Arborescent= resembling a tree.
Frond-like appearance= frond is a leaf or leaf like
Which makes it fat resembling a tree.
Frond-like fat.
MR Signal Fellow fat. Even in chemical shift.
Associations: osteoarthritis, chronic rheumatoid arthritis, prior trauma

43
Q

What is cortical desmoid

A

Not a desmoid
Tug lesion from medial gastrocnemius and adductor magnus.
Location: posterior medial epicondyle of the distal femur

44
Q

Charcott foot end result deformity?

A

Rocker bottom deformity

45
Q

Erosive osteoarthritis most common appearance and what does it describe.

A

Gull wing appearance which describes central erosion.

46
Q

Erosive osteoarthritis

A

Gullwing appearance
Postmenopausal woman
Distal interphalangeal joints (DIP)

47
Q

Rheumatoid arthritis versus Osteoarthritis

A

Osteoarthritis: degenerative and bone forming.

Rheumatoid arthritis: inflammatory, not bone forming

48
Q

Rheumatoid arthritis features: in general

A 
Osteoporosis
Soft tissue swelling
Marginal erosions
Uniform joint space narrowing
Bilateral and symmetric
Spares DIP
49
Q

Arthritis: Involve the DIP

A

Erosive osteoarthritis

50
Q

Arthritis: gull wing appearance

A

Gullwing appearance of the DIP: erosive osteoarthritis

51
Q

Arthritis: first involvement: first CMC joint.

A

Osteoarthritis involve first CMC joint early

52
Q

Arthritis: last joint to be involved is the first CMC joint

A

Rheumatoid arthritis

53
Q

Felty syndrome

A

Rheumatoid arthritis more than 10 years.
Splenomegaly.
Neutropenia.

54
Q

Caplan syndrome

A

Rheumatoid arthritis.

Pneumoconiosis. 

55
Q

Erosive changes with bone perforation

A

Psoriatic arthritis

56
Q

Psoriatic Arthritis erosions progression

A

Start in the margins of the joints and progress to involve the central portion

57
Q

Psoriasis arthritis description/buzzwords

A 
Erosive Changes with bone Proliferation.
Interphalangeal joints
Pencil in cup
Fuzzy appearance
Sausage digit
Ivory phalanx
Ankylosis in the fingers
Mouse ears
Acro osteolysis
58
Q

Ankylosis in the hands: which arthritis: 2 types.

A

Erosive osteoarthritis

Psoriasis arthritis

59
Q

Reiters (reactive arthritis) versus Psoriasis arthritis

A

Reiters: urethritis, conjunctivitis, arthritis.
Rare in the hands, favors feet.
They are similar in bone proliferation, erosion, asymmetric sacroiliac joints involvement. PAIR

60
Q

Ankylosing spondylitis, Sacroiliac and spine manifestations

A

Symmetric sacroiliac joint involvement first. Then spine involvement (bamboo spine).

61
Q

Gout arthritis buzz words: 5 tings

A 
Joint effusion.
Juxta articular erosion.
Punched out lytic lesions.
Overhanging edges.
Soft tissue tophi.
62
Q

Gout arthritis mimickers: 5

A 
Amyloid disease
Rheumatoid arthritis (cystic)
Reticular histocytosis
Sarcoid disease
Hyper lipidemia
63
Q

Gout on MR

A

Just articular soft tissue mass low on T2

Tophus will typically enhance

64
Q

CPPD common locations for chondrocalcinosis. Name 3

A

1- Triangular fibrocartilage of the wrist
2- Peri-odontoid tissue
3- Intervertebral disks

65
Q

Hemachromatosis arthritis vs CPPD

A 
Similar to CPPD
Chondrocalcinosis. Hooked osteophytes.
Difference is Hemachromatosis has 1/uniform joint space loss.
2/ Involves all MCP joints
3/ CPPD papers index and middle fingers
66
Q

What is Milwaukee shoulder

A

Destructive shoulder arthropathy.
Due to deposition of hydroxyapatite crystals.
Affect older woman with history of trauma to the region.

67
Q

Hyperparathyroidism: bone/arthritis section

A
  1. Subperiosteal bone resorption (radial aspect of second and third fingers).
  2. rugger-jersey spine.
  3. brown tumors.
  4. Terminal tuft erosion.
68
Q

Differentiates DISH from AS in general

A

DISH has no sacroiliitis

69
Q

Diagnosis: ossification of the anterior longitudinal ligament involving more than four levels sparing the disk spaces.

A

Diffuse idiopathic skeletal hyperostosis. DISH

70
Q

Reducible deformity of joints without articular erosion

A

Systemic lupus erythematosus (appearance due to ligament laxity)

71
Q

Norgaard view

A

Ball catcher view

Used for multiple things but in CTC showed SLE athropathy reducible with PA view vs norgaard view

72
Q

Patient with ulnar deviation of the fingers on Norgaard view Which is reducible on PA view and patellar dislocation. No erosions. Diagnosis?

A

SLE arthropathy.

73
Q

Diagnosis: knee: widened intercondylar notch, enlargement of the epiphysis.

A

Juvenile idiopathic arthritis.

Similar findings seen in hemophilia.

74
Q

Arthropathy in Patient On dialysis. Bilateral joint involvement or carpal tunnel syndrome. Diagnosis?

A

Amyloid arthropathy

75
Q

Patient x-ray with widening of the joint space (adult patient) follow up x-rays show collapsed joint space with early onset osteoarthritis. Diagnosis?

A

Pituitary gigantism.

Cartilage grow until they outgrow blood supply and collapse.

76
Q

How yellow marrow replaces red marrow in general and in long bones?

A

From extremities to axial skeleton.

Long bone: Epiphysis first, then Diaphysis, then distal metaphysis, then proximal Metaphysis.

77
Q

Normal yellow/red marrow on the T1.

A

Yellow marrow signal on T1.
Red marrow is dark but never darker than disk or muscle.
If bone marrow is darker than the muscle or disc this is a bad sign.

78
Q

What’s the diagnosis: destructive hyperdense in NECT mass in the skull With another lesion noted within the intraparenchymal brain. It shows post contrast enhancement on MRI. The patient is known to have leukemia.

A

Chloroma
Correct name: granulocytic sarcoma.
It is some kind of colloid tumor.

79
Q

What is anisotropy?

A

Normal tendon is hyperechoic when US is perpendicular on it.

Anisotropy Is when the exact same tendon is hyperechoic when US it’s not perpendicular on it.

80
Q

On ultrasound focal hyperechoic area within the tendon? Diagnosis

A

Tendon tear.
Look for tendon retraction. Partial or full thickness.
Other ddx is Anisotropy which will be involved the whole Tinton.

81
Q

Fluid within the tendon sheath equals tenosynovitis what should you look for next?

A

Peritendenous subcutaneous hyperemia on Doppler ultrasound. When present it means active tenosynovitis.

P-CTC (3 decks)

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