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ST2 Radiology > MSK > Flashcards

MSK Flashcards

1
Q

What is DISH /

A

Diffuse idiopathic skeletal hyperostosis - anterior osteophtes spanning at least 4 vertebral levels with normal disc space and sacroiliac joints.
Associated with calcification of the posterior longitudinal ligament

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2
Q

What is kümmel disease ?

A

Gas within the vertebral body secondary to osteonecoriss from a compression fracture

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3
Q

What does the seagull sign refer to ?

A

erosive OA of the DIPJ - due to marginal osteophytes and medial erosion

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4
Q

In the hip joint, if there is AXIAL loss of space what does that usually mean ?

A

Associated with RA, however OA is still more common than RA in the hip

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5
Q

What is Protrusio deformity ?

A

More than 3mm or 6mm medial migration of the femoral head at the ilioishchial line

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6
Q

What joint is most commonly affected in the foot with RA ?

A

Metatarsalphalangeal joints

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7
Q

Which way do the joints subluxation in RA at the MCP ?

A

Ulna deviation

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8
Q

Why is only the inferior aspect of the sacroiliac joint affected in spodyloarthropathies ?

A

Because only the inferior portion is synovial.

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9
Q

What causes symmetrical sacroilitis ?

A

IBD associated arthropathy and ankylosing spondylitis

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10
Q

What causes asymmetrical sacroilitis ?

A

Psoriatic arthritis and reactive athropathy

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11
Q

What does the shiny corner sign signify?

A

Evolution of a prior Romans lesion

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12
Q

What is a Romanus lesion?

A

Erosion of the anterior/posterior edge of a vertebral body, early sign of a spondyloarthropathy

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13
Q

What is the dagger sign ?

A

Fusion of the spinous process - associated with ankylosing spondylosis

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14
Q

What other medical conditions is Ankylosing spondylitis assoicated with ?

A

pulmonary fibrosis
Aortitis
Cardiac conduction defects

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15
Q

What is the earliest signs of AS ?

A

Symmetrical erosions, widening and sclerosis of the sacroiliac joints

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16
Q

What is an Andersson lesions ?

A

Inflammatory involvement of the invertebrate disc by a spondyloarthropathy

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17
Q

Where does psoriatic arthritis commonly affect ?

A

The hands

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18
Q

What hands signs are classicaclly seen in psoaratic arthritis ?

A

Sausage digit
Pencil in cup

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19
Q

What conditions can lead to arthritis mutilans ? what is the classic hand finding ?

A

Psoriatic arthritis and rheumatoid
Telescoping of the fingers

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20
Q

What foot sign is seen in psoriatic arthritis ?

A

Ivory phalanx

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21
Q

What does reactive arthritis commonly affect ?

A

Knee, feet,

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22
Q

What is the key radiographic finding of SLE ?

A

Reducible subluxations of the MCP and PIP with abscence or erosive change

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23
Q

What is the characteristic sign of scleroderma ?

A

Acro-osteolysis - reabsorption of the distal portion of the distal phalanges + calcification

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24
Q

What type of crystals are deposited in calcium pyrophosphate ?

A

Rhomboid crystals are positively birefringent

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25
Q

What conditions are associated with calcium pyrophosphate ?

A

Haemochromatosis, hyperparathyroidism and hypophosphatasia

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26
Q

What causes osteomalacia ?

A

Most common is vitamin D deficiency

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27
Q

Which spinal cord lesions cause a dumbbell shaped tumour ?

A

Meningioma
Schwannomas
Neurofibromas
Ganglioneuroma
Neuroblastoma

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28
Q

What is the cockade sign ?

A

Calacaenal interosseous lipoma - well defined lytic lesion with central calcification

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29
Q

What is the arcuate sign ?

A

Avulsion fracture of the fibulae styloid - where the arcuate ligament attaches
This ligament is Y shaped and helps with knee stability

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30
Q

What radiological sign is seen in osteopetrosis ?

A

Bone within a bone - densely sclerotic bone

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31
Q

Which conditions can cause calcium pyrophosphate deposition?

A

Hemochromatosis, hyperparathyroidism, hypophosphatasia

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32
Q

What is the hallmark of gout ?

A

Marginated erosions with overhanging margins

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33
Q

What is the ultrasound sign for gout ?

A

Double contour sign - irregular hyperechoic line of urate crystals deposited on the hyperechoic cartilage

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34
Q

Where does gouty tophi like to develop ?

A

Olecranon bursa of the elbow

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35
Q

What is Calcific Tendinopathy ?

A

Deposition of calcium hydroxyapatite in tendons which are degenerating or hypoxia

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36
Q

What is the most common site of Calcific Tendinopathy ?

A

Shoulder

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37
Q

In the wrist which tendon is mostly affected by calcium hydroxyapatite deposits ?

A

Flexor carpi ulnaris tendon

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38
Q

What is Milwaukee shoulder ?

A

Intraarticular deposition of calcium hydroxyapatite, resulting in rapid destruction of the shoulder joint - including the rotator cuff and glenohumeral joint.

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39
Q

what percentage of patients with haemachromatotis develop arthropahty ?

A

50%

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40
Q

which organs are in the reticuloendothelial system ?

A

Spleen , liver suffer cells and bone marrow

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41
Q

what radiological sing in the hand might be present in haemochromatosis ?

A

hook like osteophytes at the MCP - can involve all of them

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42
Q

what happens to the joint space in early acromegaly?

A

widened joint space

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43
Q

what hand features suggest acromegaly ?

A

spade like tuffs
beak like osteophytes of the metacarpal heads

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44
Q

who is at risk of amyloid arthroapthy ?

A

patients on chronic hemodialysis - with chronic renal failure

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45
Q

what is the shoulder pad sign and what arthropathy is it associated with ?

A

predominance of the anterior deltoid - seen in amyloid athropathy

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46
Q

a patient with intervertebral disc calcification at ever level with mild disc loss height has what ?

A

ochronosis / alkaptonuria

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47
Q

if there is bilateral ankle arthorsis and erythema nodosum - what should you be worried about ?

A

sarcoidosis

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48
Q

what hand features might be seen in sarcoid?

A

lace like lytic lesions in the middle or distal phalanx

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49
Q

MSK - what does haemophilia tend to affect.

A

knees, elbows , ankles

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50
Q

what is the characteristic features of haemophilia in the elbow?

A

enlarged radial head and widened trochlear notch

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51
Q

in juvenile idiopathic arthritis, where might ankylosis occur ?

A

in the cervical spine or the wrist

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52
Q

what is the differential for ankylosis of the cervical spine ?

A

juvenile idiopathic arthritis and klippel-feil syndrome

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53
Q

what is klippel feil syndrome ?

A

failure of cervical segmentation

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54
Q

what is the most common cause of shoulder neuropathic athropathy ?

A

syringomyelia

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55
Q

What are the three most common cause of Charcot joint ?

A
  1. Diabetes
  2. Syringomeylia
  3. Leprosy
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56
Q

Which arthritis cause demineralisation ?

A

HORSE
Haemophilia
Osteomalacia
Rheumatoid and Reuters
Slceroderma
SLE

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57
Q

Which arthritis doesn’t cause demineralisation ?

A

PONGS
Psoriatic
Osteomyelitis
Neurogenic
Gout
Sarcoidosis

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58
Q

What joint is most commonly affected in SAPHO ?

A

Sternoclavicular joint

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59
Q

What does SAPHO stand for ?

A

Synovitis
Acne
Palmoplantar pustulitis
Hyperostosis
Osteoiditis

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60
Q

What is Gardner syndrome ?

A

Osteomas
Intestinal polyps
Soft tissue desmoid tumours

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61
Q

Where doe osteomas arise from ?

A

The bony cortex

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62
Q

Where do bone islands arise from ?

A

The medullary canal

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63
Q

What is the classic appearance seen in melorheostosis

A

Candle wax appearance - irregular sclerosis of the bony cortex- usually affected by a single sclerotome

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64
Q

What sign on nuclear medicine is seen with an osteoid osteoma ?

A

Double density sign

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65
Q

Where does osteosarcoma tend to metastasise to ?

A

The lungs

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66
Q

What are the 4 main subtypes of osteosarcoma ?

A
  1. Periosteal - inner periosteum
  2. Paraosteal - outer periosteum
  3. Telangectatic osteosarcoma
  4. Conventional
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67
Q

What is the most common subtype of osteosarcoma ?

A

Conventional 75%

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68
Q

What is the classic feature of paraosteal osteosarcoma?

A

A type of osteosarcoma that arises from the outer layer of the periosteum.

Cauliflower outgrowths

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69
Q

What is olliers syndrome ?

A

Multiple enchondromas

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70
Q

What is maffucis syndrome ?

A

Multiple enchondromas and vascular malformations results in phleboliths

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71
Q

In the pelvic bones, what does fibrous dysplasia look like ?

A

Cystic lesions

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72
Q

what usually happens to non ossifying fibromas ?

A

Usually spontaneously scerlosis once they reach adulthood

73
Q

what is McCune-Albright Syndrome ?

A

polystotic fibrous dysplasie
cafe au lait spots
precocious puberty

74
Q

what is Mazabraud syndrome

A

fibrous dysplasia
Intramuscular myxomas which tend to occur in the same part of the body

75
Q

which conditions are associated with giant cell tumour ?

A

hyperparathyroidism
pagets disease

76
Q

what causes eosinophilic granuloma ?

A

proliferation of histiocytes

77
Q

what might Langerhan cell histocytosis look like on skull x-ray if it affected the mandible or maxilla ?

A

floating teeth

78
Q

what does Ewings sarcoma originate from ?

A

small round cell tumours

79
Q

how might patients with Ewings sarcoma present ?

A

pain, fever, raised ESR

80
Q

what is the most common primary malignant bone tumour in patients over 40 ?

A

Multiple myeloma

81
Q

Why do you get H shaped vertebrae in sickle cell anaemia ?

A

central end plate infarction, non-involement of the periphery

82
Q

what are the main causes of H shaped vertebrae ?

A

Sickel cell diseae
Gaucher diseae

83
Q

What is a clinical feature of osteogenesis imperfects ?

A

Deafness.
Blue sclera
Normal life expectanacny
Usually present 2-6 yrs old

84
Q

Which arthropathy is most associated with HLA-B27 ?

A

1.Ankylosing spondylosis
2. Enterocolic spondylosis

85
Q

which metastases are mainly lytic ?

A

Lung
breast
thyroid
kindy
stomach

86
Q

which mets are mainly blastic

A

breast
prostate
TCC
Mucinous tumours
carcinoid

87
Q

what is myositis osifficans ?

A

bone forming in the soft tissue, usually after trauma, may look like an osteosarcoma

88
Q

which patients get brown tumours ?

A

hyperparathyroidism

89
Q

what do myxoid liposarcomas look like ?

A

large homogenous hyperintesnse mass on T2 , may not show any fat

90
Q

what features would make you more concerned about a liposarcoma vs a lipoma ?

A

nodular enhancement
thickened septa
increased size

91
Q

what is the most common site for fibrolipomatous harmatoma ?

A

median nerve

92
Q

what is the pathognomic feature of fibrolipomatous hamartoma of nerve ?

A

cable like appearance

Fibrolipomatous harmatoma of a nerve is fatty infiltration and enlargement of the nerve fibres, this causes it to look like a cable full of wires. often affects the median nerve

93
Q

what is ledderhose disease

A

fibrzomatosis of the foot

94
Q

where do elastofibroma dorsi typically occur ?

A

sub scapular region

95
Q

what syndrome is associated with Desmond fibrzomatosis ?

A

Gardner syndrome

96
Q

what is Mazabraud syndrome

A

fibrous dysplasia with intramuscular myxomas

97
Q

What percentage of fracture can be identified by MRI ?

A

90%

98
Q

What is a Segond fracture ?

A

An avulsion fracture of the tibial plateau - on the lateral aspect, and usually involves the the ACL

99
Q

If suspecting a tibial plateau fracture - what is the best imaging modality ?

A

CT

100
Q

What imaging mri sequences should you do for Knee trauma ?

A

T2*, PD , Fat sat or STIR, T1.
T1 will show fracture lines
STIR - for oedema

101
Q

Where does the lateral collateral ligament and biceps femora’s attach ?

A

Fibular head

102
Q

What attaches onto the lateral aspect of the tibia ?

A

The iliotibial band , capsule, and anterior oblique band of the lateral collateral ligament

103
Q

What is a Segond fracture ?

A

An avulsion fracture of the lateral aspect of the tibial plateau - associated with an ACL rupture

104
Q

What mri sequence should you be looking at the ACL ?

A

T2
As PD wont be accurate

105
Q

In a patella dislocation, where might you find a micro fracture ?

A

Patella always dislocates laterally, The patella impacts on the way back causing whacking
Bone bruise lateral femoral condole and medial patella

106
Q

What injury is assoicated with a patella dislocation ?

A

Medial patella retinaculum injury
Osteochondral fracture patella

107
Q

What causes locking of the knee >

A

Bucket handle tear of the meniscus
Medial collateral ligament

108
Q

What are the 3 shapes of meniscal teas ?

A

Longitudinal, radial, horizontal

109
Q

What are the 3 types of displaced meniscle tears >

A

Parrot beak,
Bucket handle
Flap tear

110
Q

What is frozen shoulder

A

GHJ capsulitis - loss of external and internal rotation

111
Q

What does supra and infra spinatous attach to ?

A

The greater tubercle of the humerus

112
Q

What does the empty notch sign indicate

A

FLuid between the lateral aspect of the intercondylar notch - this is where the ACL should be, and it indicated an injury to the acl

113
Q

What is an effective treatment for frozen shoulder

A

Steroid injection and hydro-dilatation

114
Q

What is barbotage used for ?

A

Calcific tendinitis - washing a calcified tendon

115
Q

What is the criteria for hip replacement ?

A

Night pain

116
Q

What is the most common sequence for prostate cancer bone mets ?

A

Pelvis, spine then ribs

117
Q

What is Barstraps disease ?

A

kissing spines) is a cause of low back pain characterised by interspinous bursitis and other degenerative changes of the bones and soft tissues where adjacent spinous processes in the lumbar spine rub against each other.

118
Q

What causes

A

Osteitis condensans ilii

119
Q

What will a normal thrombus look like on a. PET CT?

A

Photopenia in the blood pool

120
Q

What does a haemangioma look like ?

A

High T1, Hight T2, drop out on STIR

121
Q

If a lesion has signal drop out of >20% what would you think it is ?

A

Fat containing - likely haemangioma

122
Q

Causes of bone marrow replacement

A

Bone marrow hyperplasia
Bone marrow infiltration
haematological diseae
metabolic disease
renal osteodrystrophy

123
Q

What would a bone island look like on MR ?

A

Jet black on all sequences

124
Q

What does pure bone marrow oedema look like on T1 ?

A

Patchy low signal

125
Q

What should you be concerned of with a lesser trochanter avulsion ?

A

Metastasis

126
Q

What should you do with a lesions with rings and arcs ?

A

Chondroid lesions - should all be MR

127
Q

What is the size criteria for enchondromas ?

A

< 4cm

128
Q

what condition is the bulls head see on nuclear medicine scan

A

SAPHO
S: synovitis

A: acne

P: pustulosis

H: hyperostosis

O: osteitis

129
Q

what sesamoid bone lies within the lateral head of gastrocnemius ?

A

flabella

130
Q

what are the components of the rotator cuff ?

A

supraspinatous
infraspinatous
subscapularis
teres minor

131
Q

what connects to the lateral menisucus ?

A

nothing

132
Q

when damage to the medial collateal ligament what other injury is likely ?

A

likely injury to the medial meniscus - as the meniscus and collateral ligament are attached

133
Q

what is a rolando fracture

A

Comminuted, intra-articular fracture at the base of the thumb

134
Q

what is osteomalacia?

A

low bone mineralisation

135
Q

in osteomalacia where do loser zones typically appear ?

A

Losser zones are insufficiency fractures - usually occur where blood vessel transverse the bones. Often they are found in :

neck of femur
pubic rami
lower ribs
scapula

136
Q

in rickets- which part of the bone is prone to most changes ?

A

the metaphasis as it has the most growth

137
Q

what features of rickets might you see ?

A

frayed metaphyseal margin - at the wrists
Widened growth plate
Cupping/splaying metaphysis due to weightbearing - at the femur
Enlargement of anterior ribs. Rickety rosary
Osteopenia

138
Q

what are looser fractures?

A

stress fractures caused by normal stress applied to abnormal bone.

139
Q

what are brown tumours ?

A

large areas of cortical , subcortical and meduallary bone reabsorption

140
Q

what are the features of renal osteodrystrophy ?

A

rickets - looser zones
secondary HPT - soft tissue calcification, chondrocalcinosis and nephrocalcinosis
Osteosclerosis
Osteoporosis

141
Q

why do you get osteosclerosis in renal osteodystrophy?

A

due to aluminum toxicity in haemodialysis

142
Q

what conditions result in fusion of the spine?

A

ankylosing spondylitis
poliomyelitis
juvenile chronic arthritis

143
Q

what radiological features might you see in alkaptonuria ?

A

Bamboo spine without osteophytes
calcification of the intervertebral ligaments

144
Q

in children, is cervical disc calcification a problem>

A

no, usually self resolves

145
Q

what do bony lesions in gout usually look like ?

A

intra or extra articular, well defined erosions with sclerotic margins and an overhanging edge.
the joint space is usually well persevered.

146
Q

in CPPD which ligament is commonly calcified ?

A

triangular fibrocartilage complex

147
Q

which arthropathy stains with Congo red ?

A

amyloid arthropathy

148
Q

what is the intravertebral vacuum clef sign pathognomic for ?

A

calve kummel verneuil disease
osteonecrosis and collapse of a vertebral body

149
Q

what is Kohler disease ?

A

avascular necrosis of the tarsal scaphoid

150
Q

what is kienbocks disease ?

A

AVN of the luate

151
Q

which is Freiberg disease ?

A

AVN of the metatarsal heads

152
Q

what is clave perthes disease?

A

AVN of the femoral head

153
Q

what is scaphocephaly and what is it associated with ?

A

premature closure of the sagittal sinus which stops lateral growth. There is ongoing A->P growth which causes the head to become long and thin. This is assoicated with marfans syndrome

154
Q

what is pathagomoic of nail-patella syndrome (Fong disease)

A

bilateral, symmetrical posterior iliac horns

155
Q

what are the classic features of pagets disease?

A

Osseous expansion, coarsened trabeculation and thickening of the cortex

156
Q

which areas are commonly affected with pagets disease ?

A

skull, long bones, ribs, pelvis, and spine

157
Q

what is pigmented villonodular synovitis ?

A

benign proliferative condition affecting the synovium. this causes proliferation and haemosiderin deposits

158
Q

what is caplans syndrome

A

RA plus lung fibrosis - nodular pattern

159
Q

what is feltys syndrome ?

A

RA plus splenomegaly and neutropenia

160
Q

what are the causes of a positive bone scan with a normal radiograph ?

A

lymphoma
pagets disease
osteomyelitis
primary hyperparathyroidism

161
Q

what are the causes of an abnormal radiograph but a normal bone scan

A

acute fracture <48 hours
multiple myeloma
metabolically inactive benign conditions (bone island, exostoses, bone cysts)
osteoporosis
mets - with no osteoblastic activity

162
Q

what are the features of a giant cell tumour ?

A

eccentrically located lesion, usually at the end of long bones. The bones have closed growth plates. They extend into the epiphysis and subchondral bone.
Locally aggressive but rarely malignant

163
Q

what is the most likely mechanism of a triquetral fracture

A

falling onto an outstretched hand in ulnar deviation

164
Q

which ligament is injured in the ‘game keepers’ or ‘skiers’ thumb ?

A

ulnar collateral ligament

165
Q

what are chondroblastomas ?

A

benign tumours that arise from the epiphysis of young children - not fused.

166
Q

what are patients with pages disease at risk of developing ?

A

osteosarcoma

167
Q

what patients develop brown tumours ?

A

people with underlying hyperparathyroidism

168
Q

which part of the spine is most likely to be affected in Ewings ?

A

sacrum

169
Q

what is the condition con multiple hereditary osteochondromas ?

A

diaphysial atlasis

170
Q

where are spinal ependymomas most likely to occur ?

A

in the cervical spine

171
Q

what is a chondroblastoma ?

A

a bening cartilage forming tumours arising in skeletally immature patients. often occurs in the humerus. arises from the epiphysis ( this can include the patella)

172
Q

what bone lesions are patients with hyperparathyroidism at risk of?

A

brown tumours

173
Q

what condition is associated with absent clavicles. wormian bones, facial abnormalities

A

cleidocranial dysostosis

174
Q

what is an adrenal myolipoma

A

an adrenal mass, fat containing (so low HU) often bleed if >4cm - so increased risk of retroperitoneal hamerrahae

175
Q

why do you get abnormal scalloping of vertebrae

A

either a mass causing pressure effects on normal bone
or normal CSF movement casuing pressure effects on abnormally soft bone

176
Q

what causes anterior scalloping of the vertebrael body

A

Enlarged retroperitoneal lympho nodes - lymphoma TB
or AAA

177
Q

what causes posterior scalloping of the vertebral body

A

dural ectasia (NF1)
spinal mets
Achondropalsia
acromegaly
mucopollysaccahrides

178
Q

what is Klippel-Feil syndrome

A

vertebral segmentation anomaly, causing fusion or one or more vertebral bodies

179
Q

what other conditions is AS associated with ?

A

aortitis
pulmonary fibrosis
cardiac conduction defects

ST2 Radiology (13 decks)

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