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RRC DDx 2 > MSK > Flashcards

MSK Flashcards

1
Q

Classification of arthropathies

A 
Degenerative (OA)
- Primary
- Secondary (post-insult, neuropathic, other arthropathy)
- Erosive OA
Inflammatory / autoimmune
- RA
- Seronegative (psoriatic, ank spond, enteropathic, reactive)
- SLE
- Scleroderma
Infectious
- Typical bugs (rapid destruction)
- Atypical bugs (Mycobaterial / fungal / lyme)
Depositional
- Crystalline (gout, CPPD / hemochromatosis, HADD)
- Amyloid
- Hemophilic
- Sarcoid
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2
Q

Monoarticular process

A 
Arthropathy
- Infectious arthritis
- Gout
- Secondary OA (e.g. post-traumatic)
- Early undifferentiated arthropathy
Intra-articular mass (see dedicated ddx)
Mimic = epiphyseal process
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3
Q

Polyarticular process

A

Likely an arthropathy. Thus, focus on degen vs inflammatory vs depositional

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4
Q

Intra-articular mass

A 
Synovial proliferation
- Synovial osteochondromatosis
- PVNS
- Rice bodies (RA, atypical infection)
- Lipoma arborescens
Depositional diseases (gout, amyloid)
Vascular malformation (synovial hemangioma, AVM)
Neoplasm (chondroma, synovial chondrosarcoma or synovial sarcoma, synovial met)
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5
Q

Lumpy bumpy arthritides

A 
Gout
Amyloid (does give vascular calcification and dense deposits, but not erosions)
Hypercholesterolemia (xanthomas)
Multicentric reticulohistiocytosis
Sarcoid
Cystic RA
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6
Q

Arthropathy – joint spaces preserved

A

Gout
Jaccoud’s arthropathy / SLE
Juvenile idiopathic arthritis

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7
Q

Chondrocalcinosis

A

CPPD
Hemochromatosis
Hyperparathyroidism

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8
Q

Arthritis in a kid

A

Juvenile idiopathic arthritis
Septic
Hemophilia
Neuropathic (e.g. congenital insensitivity to pain)

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9
Q

Thick, nonmarginal vertebral bony bridging

A

OA
DISH
Psoriatic
Reactive

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10
Q

The 5 D’s of neuropathic joint

A 
Dislocation
Destruction
Disorganization
Debris
Density (increased)
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11
Q

Causes of neuropathic joint

A 
Peripheral
- Diabetes
- Alcoholic neuropathy
- Congenital insensitivity to pain
- Leprosy / syphilis
Central
- Trauma / paralysis
- Syrinx / cord mass
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12
Q

Atlantoaxial instability / dens pannus

A

RA

Depositional arthropathies

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13
Q

Big overgrown epiphyses

A

Juvenile idiopathic arthritis
Hemophilia
CP / neuromuscular disorders
Other causes of hyperemia

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14
Q

Sacroiliitis

A 
Unilateral (septic, OA, RA)
Bilateral asymmetric (reactive, psoriatic)
Bilateral symmetric (ank spond, enteropathic)
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15
Q

Periarticular osteopenia

A

Complex regional pain syndrome / Reflex sympathetic dystrophy
Inflammatory arthropathy
Disuse osteopenia

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16
Q

Preserved joint space

A

Gout
PVNS
TB
Complex regional pain syndrome / reflex sympathetic dystrophy

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17
Q

T2 fluid bright soft tissue mass without internal enhancement

A

Collection
Cyst (ganglion, synovial, epidermal inclusion)
Bursa

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18
Q

T2 fluid bright soft tissue mass with internal enhancement

A

Myxoma
PNST
Sarcoma (myxoid, synovial)
Necrotic tumor

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19
Q

Fat containing soft tissue mass

A 
No calcs
- Lipoma
- Atypical lipomatous tumor / Liposarcoma
Calcs
- Hemangioma
- Heterotopic ossification
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20
Q

T1 bright soft tissue mass, but not fat

A

Blood (Hematoma +/- tumor)
Protein (ganglion, abscess)
Melanin (melanoma)

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21
Q

T2 dark soft tissue mass

A 
Calcification (dystrophic, gouty tophus)
Blood (PVNS, GCT of tendon sheath, hematoma, hemorrhagic tumor)
Fibrous tissue (fibroma / fibrosarcoma, desmoid, scar, leiomyoma)
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22
Q

Soft tissue mass without flow on US

A

Neoplasm (benign or malignant)
Collection (abscess / hematoma)
Depositional

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23
Q

Indeterminate soft tissue mass

A 
Neoplastic
- Benign (PNST, desmoid, rhabdomyoma)
- Malignant (sarcoma, mets / lymphoma)
Foreign body reaction / granuloma
Deposition (tophus, amyloid)
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24
Q

Aggressive soft tissue mass young adult

A

Synovial sarcoma
Rhabdomyosarcoma
Desmoid
Alveolar soft part sarcoma

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25
Q

Soft tissue calcification

A

Dystrophic = MC (if ossified, it’s heterotopic ossification)
- Trauma
- Infection (esp. parasitic)
- Dermatomyositis / polymyositis / scleroderma
- Venous insufficiency (phleboliths)
Other causes (remember, 3 sound like cancer even though only one is):
- CPPD / HADD
- Metastatic calcification
- Tumoural calcinosis, calcinosis of chronic renal failure
- Sarcoma (synovial, osteosarc)

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26
Q

Olecranon bursitis

A

Unilateral (trauma, infection)

Bilateral (gout, RA)

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27
Q

Muscle edema

A 
Supply problem (denervation, ischemia)
Primary myopathy
Direct insult (trauma, infection, radiation)
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28
Q

Lesion in posterior elements of the spine

A 
Benign
- Osteoblastoma / osteoid osteoma
- Aneurysmal bone cyst
- Giant cell tumour
Malignant
- Myeloma
- Metastasis
- Chondrosarcoma
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29
Q

Lesion in vertebral body

A 
Chordoma
Giant cell tumour
Langerhans cell histiocytosis
Ewing sarcoma
Lymphoma
Metastasis
Myeloma
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30
Q

Lesion in rib (FAMMEE)

A 
Fibrous dysplasia
ABC
Mets 
Myeloma
Enchondroma
Eosinophilic granuloma
31
Q

Sclerotic mets (6BLP)

A 
Bone (osteosarcoma)
Breast
Brain (medulloblastoma)
Bronchus (carcinoid)
Bladder (TCC)
Bowel (mucinous)
Lymphoma
Prostate
32
Q

Mixed lytic and sclerotic lesions

A

Mets: breast, lung, cervix, testicular, prostate, ganglioneuroblastoma
Brown tumour
POEMS

33
Q

Aggressive bone lesions (adult)

A

Mets / myeloma / lymphoma
Sarcoma
Osteomyelitis
Brown tumour (sometimes)

34
Q

Aggressive bone lesions (peds)

A

Met from childhood malignancy / Ewings / lymphoma / leukemia
Sarcoma
Osteomyelitis
LCH

35
Q

Nonaggressive metaphyseal / diaphyseal bone lesions

A 
Medullary
- Fibrous dysplasia
- ABC / UBC
- Enchondroma
Cortical
- Fibroxanthoma (FCD and NOF)
- Osteoblastoma / osteoid osteoma
Either
- Brown tumour
- Chondromyxoid fibroma
36
Q

Epiphyseal lesions (adult)

A 
Neoplasm
- Giant cell tumour
- Clear cell chondrosarcoma
- Mets / myeloma / lymphoma
Osteomyelitis (Brodie's abscess)
Other lesions (geode, subchondral lesion, AVN)
37
Q

Epiphyseal lesions (peds)

A

Chondroblastoma
LCH
Osteomyelitis / Brodie’s abscess

38
Q

Polyostotic adult

A

Mets / myeloma / lymphoma
Brown tumors / HPT
Fibrous dysplasia

39
Q

Expansile lesion, fluid-fluid levels

A 
ABC
- Primary
- Secondary (GCT, osteoblastoma, chondroblastoma)
Telangiectatic osteosarcoma
Expansile met
Pseudotumor from hemophilia
40
Q

Cancers that met to cortex

A 
Bronchogenic (cookie bite sign)
Breast
Melanoma
RCC
Epidermoid
41
Q

Focal periosteal rx’n / marrow edema

A 
Stress fracture / reaction
Trauma / contusion
Osteomyelitis
Infiltrative neoplasm
Radiation
42
Q

Polyostotic periostitis

A 
Hypertrophic osteoarthropathy
- Secondary (lung malignancy, CF, endocarditis, IBD, etc.)
- Primary (pachydermo-periostitis)
Venous insufficiency
Thyroid acropachy
43
Q

Acro-osteolysis (PINCHFO)

A 
Psoriasis
Injury: thermal burn, frostbite
Neuropathy: diabetes, leprosy
Collagen vascular disease: scleroderma, Raynaud, mixed CTD
Hyperparathyroidism
Familial: Hajdu Cheney
Other: PVC exposure
44
Q

Acro-osteolysis - terminal tuft

A 
Scleroderma / Raynauld’s (look at soft tissues of fingertips and for calcs)
Psoriatic / Reactive arthritis
Thermal injury
Hyperparathyroidism
Drugs (phenytoin / ergot poisoning)
45
Q

Acro-osteolysis - midshaft / band-like

A

Hyperparathyroidism
PVC exposure
Primary acro-osteolysis (Hajdu-Cheney)

46
Q

Acro-osteolysis - single digit

A

Epidermal inclusion cyst
Glomus tumour
Subungual mets (lung, GU, breast)
Trauma

47
Q

Causes of AVN

A 
Idiopathic
Drugs (steroids, chemo, NSAIDs, alcohol)
Traumatic
Inflammatory (vasculitis, SLE, CTD, pancreatitis)
Deposition disease
Caisson disease
Pregnancy
48
Q

Ivory vertebrae

A

Mets / lymphoma / sarcoma / chordoma
Hemangioma
Paget’s
TB

49
Q

Vertebra plana

A 
Young
- LCH
- Neuroblastoma metastasis
- Leukemia / lymphoma
- Infection: bacterial, TB
- Trauma
- Ewing
Old 
- Mets / myeloma / lymphoma
- Trauma, osteoporotic compression #, Kummel's osteonecrosis (if intervertebral vacuum phenomenon)
- Infection
50
Q

Bone-in-bone

A

Focal (post-trauma, post-infectious)

Diffuse (osteopetrosis)

51
Q

Vertebral body sclerotic changes

A 
Rugger jersey spine:
- Renal osteodystrophy / HPT
Sandwich vertebrae (denser and more sharply defined):
- Osteopetrosis
Picture frame vertebral body:
- Paget
52
Q

H-shaped vertebral body

A

Sickle cell anemia

Gaucher

53
Q

Lucent metaphyseal bands (LINE P)

A 
Leukemia / lymphoma
Infection (TORCH)
Neuroblastoma mets
Endocrine: rickets, scurvy, hypervitaminosis D
(Prematurity, hospitalization)
54
Q

Dense metaphyseal bands

A 
Growth arrest lines
Healing rickets
Lead poisoning
Scurvy
Bisphosphonate therapy (zebra stripe sign)
Normal variant (look for normal fibula)
55
Q

Syndromes with multiple bone lesions

A

Osteochondromas: Multiple hereditary exostoses
Enchondromas: Ollier’s, Maffucci’s (soft tissue hemangiomas)
Fibroxanthomas: Jaffe-Campanacci
Fibrous dysplasia: McCune-Albright (café au lait spots, precocious puberty), Mazabraud (intramuscular myxomas)
Osteomas: Gardner’s (polyposis, desmoids)
LCH: Hans-Schuller-Christian (diabetes insipidus, exophthalmos), Letterer-Siwe (visceral involvement poor prognosis)
Angiomas: Cystic angiomatosis, lymphangiomatosis

56
Q

Diffuse osseous sclerosis

A 
Sclerotic mets / lymphoma/ POEMS
Myelofibrosis and mastocytosis
Renal osteodystrophy
Fluorosis
Mild osteopetrosis
57
Q

Diffuse demineralization

A 
Osteoporosis
Osteomalacia (vit D / calcium / phosphate deficiency)
Osteogenesis imperfecta
Hyperparathyroidism
Diffuse tumor (most often myeloma)
58
Q

Osteoporosis (AMEDICAL)

A 
Age
Meds (steroids, heparin, Dilantin, etc.)
Endocrine (menopause, amenorrhea, Cushing’s hypogonadism)
Diet (poor calcium intake, anorexia)
Anemia (sickle cell, thalassemia)
Liver disease
59
Q

Undertubulated bones (peds)

A 
Anemia (thalassemia, sickle cell)
Gaucher
Niemann-Pick
Leukemia
Polyostotic fibrous dysplasia
Multiple hereditary exostosis
60
Q

Erlenmeyer flask deformity (CHONG)

A 
Craniometaphyseal dysplasias
Hemoglobinopathies (sickle cell, thalassemia)
Osteopetrosis
Niemann-Pick
Gaucher’s
61
Q

Short metacarpals (BIC Pen)

A 
Basal cell nevus syndrome
Idiopathic
Chromosomal (Turners)
Pseudo and pseudopseudohypoparathyroidism
Noonan syndrome
62
Q

Localized gigantism

A

Macrodystrophia lipomatosa
Vascular lesions
Klippel-Trenaunay-Weber syndrome
Neurofibromatosis

63
Q

Wormian bones (PORKCHOPS)

A 
Pyknodysostosis
Osteogenesis imperfecta
Rickets
Kinky-hair syndrome
Cleidocranial dysostosis
Hypothyroidism / hypophosphatasia 
Otopalatodigital syndrome
Primary acro-osteolysis / Primary HOA (pachydermoperiostitis) / progeria
Syndrome of Downs
64
Q

Rhizomelic skeletal dysplasia

A

Achondroplasia

Thanatophoric dysplasia

65
Q

Mesomelic skeletal dysplasia

A

Leri-Weill dyschondrosteosis
(Acro)Mesomelic dysplasia (different types, may be mesomelic or acromesomelic)
Ellis-van Crevald (acromesomelic)

66
Q

Acromelic skeletal dysplasia

A

Jeune syndrome / asphyxiating thoracic dystrophy

Peripheral dysostosis

67
Q 
Marrow replacement
(Replaced marrow is lower in signal on T1WI than discs/skeletal muscle & does NOT drop out of signal on OOP imaging)
A 
Benign
- Myelodysplastic syndrome
- Myelofibrosis
- Mastocytosis
- Gaucher disease
Malignant
- Mets / myeloma / lymphoma / leukemia
- Waldenstrom macroglobulinemia
- Sarcoma (e.g. dense osteoid)
68
Q

Red marrow reconversion
(Red marrow is lower in signal on T1WI than yellow marrow, but NOT lower than discs/skeletal muscle
Red marrow drops out of signal on OOP imaging)

A

Physiologic (athletes, living at altitude)
Hypoxemia (smoking, anemia)
Hematopoietic stimulation (drugs, obesity)

69
Q

Serous bone marrow atrophy (aka gelatinous transformation)

T1: mildly low signal intensity
STIR: high signal intensity

A

Anorexia / cachexia / malnutrition (including alcoholism) - look for loss of subq fat
Malignancy
Heart failure
Other severe systemic illness

70
Q

Post-arthroplasty complications

A 
Periprosthetic fracture
Malalignment
Loosening
Infection
Particle disease
71
Q

Manifestations of loosening

A

Motion
> 2 mm periprosthetic lucency
New / enlarging periprosthetic lucency

72
Q

Causes of loosening

A

Aseptic (micromotion)
Infection
Particle disease

73
Q

Distal clavicular osteolysis (SHIRT)

A 
Scleroderma
Hyperparathyroidism
Infection
Rheumatoid arthritis
Trauma

RRC DDx 2 (8 decks)

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