MSK

Question 1

Pathological vertebral fracture vs osteoporotic

Answer 1

Question 2

Bone marrow on MRI

Answer 2

Question 3

Tarlov cyst
-Dilatation of posterior nerve root sheath.

Answer 3

Dural ectasia
- Ballooning of the dural sac resulting in posterior vertebral scalloping

Question 4

Disc Bulging and nerve compression
- In cervical spine C3/C4 will affect C4 etc

Answer 4

Question 5

Causes of Marrow Reconveresion

Answer 5

Question 6

Myelofibrosis

Answer 6

Bone marrow is gradually replaced by fibrous tissue
Fibrous tissue contains fewer water molecules
Low signal T1 + T2

Concurrent hepatosplenomegally
Cause of a super scan

Question 7

Vertebral haemangioma

Answer 7

Typical: High signal T1 + T2 (Lipid rich)
Atypical: Low T1, high T2 (Lipid poor)
Avid enhancement

Sign—lateral (corduroy)

Question 8

Differential for permeative bone destruction

Answer 8

Question 9

Nerve compression secondary to disc bulging

Answer 9

Question 10

Answer 10

Question 11

Posterior vertebral scalloping
- SATAN

Answer 11

Question 12

Anterior vertebral scalloping

Answer 12

Question 13

Myotomes

Answer 13

Question 14

Answer 14

Question 15

Dermatomes

Answer 15

Question 16

Osteoporosis v mets

Answer 16

Question 17

Causes for block vertebrae:

Question 18

Sprengel shoulder

Answer 18

Can occur in isolation or as part of Klippel-Feil syndrome
- both associated with renal anomalies

Congenital abnormality where scapula is attached to the cervical vertebrae by fibrous or osseous (omovertebral) connection

Result is elevation and medial rotation of hypoplastic scapula.

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Question 19

Klippel - Feil syndrome

Answer 19

Segmentation anomaly with cervical fusion of 2or more vertebrae. C2-C3 most commonly involved.

Other associations:
Renal abnormalities
Scoliosis
Sprengel shoulder
Deafness (SN) (Nbb microtia, deformed ossicles)
Cervical ribs
Congential heart disease - ASD

Question 20

Ivory vertebrae - dense sclerosis of a solitary vertebrae without change in size/shape

Answer 20

Question 21

Holt-Oram syndrome

Answer 21

Associated with numerous skeletal and cardiac malformations

Cardiac : ASD, VSD, tetralogy of Fallot, coarctation.

MSK: Radial ray hypoplasia - absence of one or both thumbs

Question 22

Ependymoma
T1 hypointense, foci high T2 signal
Predominate in 4th ventricle (roof)
Toothpaste tumour

Spinal cord ependymoma is slightly different - most common intramedullary tumour in adult which shows intense enhancement
Can be associated with syrinx
NF2 - spinal ependymoma

Answer 22

Hemangioblastoma
Cyst with enhancing nodule
ISO or high T1, high T2.
Sometimes cause polycythaemia.

Question 23

Phemister triad - features of articular tuberculosis

Tuberculous spondylitis known as Pott disease
- L1 usually first affected
- anterior vertebrae affected first because of bacterial spread anterior longitudinal ligament

Answer 23

1. Juxta-articular osteoporosis
2. Marginal erosions
3. Gradual reduction in joint space

Question 24

Tuberculous spondylitis v pyogenic spondylitis

Answer 24

Question 25

Widened interpedicular distance

Answer 25

Diastomatomyelia Split cord Two Dural sac type 1, one sac type 2

Question 26

Disc terminology

Answer 26

Question 27

Increased Atlantodental interval Normal - adults <3mm - children <5mm Also prevertebral space - <7mm at c2 - <5mm C3/4 - <22mm C6 (14mm kids)

Answer 27

Question 28

Paget’s disease Lytic phase: radiolucency with flame or blade of grass shape extends along the diaphysis. Osteoporosis circumscripta (lucent areas in skull). Mixed phase: lytic and sclerotic Sclerotic phase: densely sclerotic eg ivory vertebrae.

Answer 28

Clinically : Raised ALP, normal Ca and phosphate Pathological fracture although sclerotic CN palsy secondary to neural foramina compression Enlarging head/hat - Tam O’Shanter Radiologically: bony expansion with coarsening of trabecular and cortices.

Question 29

Hyperparathyroidism PTH increases calcium levels prompting renal re absorption or acting on osteoclasts to increase bone resorption.

Answer 29

Therefore generalised osteopenia, cortical thinning of subperiosteal bone.

Question 30

Osteoporosis - loss of bone mass Susceptible to fracture - typically Colles fracture - NOF fracture

Answer 30

DEXA Density of bone calculated Z score Causes:

Question 31

Osteogenesis Imperfecta Chromosome 7/17 Abnormal type 1 collagen - Autosomal dominant fashion

Answer 31

On imaging diffuse undermineralisation of skeleton and cortical thinning. Soft bones become bowed Acetabula protrusion Basilar invagination (C-spine v base of skull) Wormian bones

Question 32

Madelung deformity - problem with ulnar side of the distal radius - distal radioulnar joint subluxes and ulna displaces dorsally - positive ulnar variance - lunate is triangular - radioulnarcarpel joint angle <120 degrees

Answer 32

Question 33

Pseudo gout - CPPD

Answer 33

Can be acute or subacute - similar characteristics to OA Particular joint involvement - patellofemoral joint - TFCC calcification - Radiocarpal joint

Question 34

Median nerve supply

Answer 34

L lateral 2 lumbricals O Opponens policis A Abductor pollicis brevis F Flexor pollicis brevis

Question 35

Carpel tunnel

Answer 35

Question 36

Alkaptonuria (Ochronosis)

Answer 36

Autosommal recessive Raised enzyme - HGA Affinity for collagen and accumulates in CT throughout the body. Causes a black staining Chondrocalcinosis most prominent feature Calcification and destruction intervertebral discs. Premature OA changes hands, feet, shoulders, hips, knees.

Question 37

Haemachromatosis Primary - excessive dietary iron accumulation Secondary - blood transfusions with too little chelation.

Answer 37

On MRI Iron paramagnetic, and therefore liver will be lower than expected, but spleen normal Transfusion also siderosis spleen/bone marrow affected.

Question 38

Wilsons - excess copper

Answer 38

Question 39

Enteropathic arteropathy