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FRCR 2A > MSK > Flashcards

MSK Flashcards

1
Q

What is an abnormal distance between the scaphoid & lunate?

What is a SLAC wrist?

What is a SNAC wrist?

2 important imaging findings?

Treatment options?

A

More than 3 mm.

Stands for scapho-lunate advanced collapse
Secondary to injury/degeneration of the scapho-lunate ligament

Scaphoid non-union advanced collapse

Arthritis at the radio-scaphoid joint; proximal migration of the capitate

Wrist fusion or proximal row carpectomy

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2
Q

Carpal dislocations

What is a perilunate dislocation? Associated with what kind of fracture?

What is a midcarpal dislocation? Associated with what kind of fracture?

What is a lunate dislocation?

A

Dislocation of the capitate from the lunate; associated with scaphoid #

Dislocation of capitate from lunate and subluxation of lunate in relation to distal radius; triquetral #

Subluxation of lunate in relation to distal radius

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3
Q

DISI

What does DISI stand for?

Follows what kind of injury?

What happens?

A

Dorsal intercalated segmental instability

Radial-sided injury/injury to S-L ligament

Lunate rocks dorsally and there is widening of the S-L angle >60 degrees

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4
Q

VISI

What does VISI stand for?

Follows what kind of injury?

What happens?

A

Volar intercalated segmental instability

An ulnar-sided injury/damage to the luno-triquetral ligament

Lunate gets tilted volar and the S-L angle <30 degrees

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5
Q

Hand/wrist/elbow

Bennett’s?
Rolando’s?
Gamekeeper’s?
Stener lesion?
Essex-Lopresti?
Galeazzi?
Monteggia?

A

fracture at the base of the thumb metacarpal

comminuted fracture at the base of the thumb metacarpal

fracture at the base of the proximal thumb phalanx with UCL injury

fibres of adductor pollicis caught in torn UCL secondary to fracture proximal thumb phalanx

radius head or neck fracture with DRUJ dislocation

radial shaft fracture with DRUJ dislocation

ulnar fracture with PRUJ dislocation

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6
Q

Knee

Segond?
Reverse Segond?
Arcuate?
Deep intercondylar notch?
Tibial plateau?

A

Fracture of the lateral
tibial plateau; associated with ACL tear

Fracture of the medial tibial plateau; associated with PCL tear

Avulsion fracture of the fibular head; 90% cruciate ligament injury (PCL)

Impaction fracture of lateral femoral condyle; ACL injury

Schatzker classification - most common is type II - depression and fracture of lateral tibial plateau

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7
Q

Ankle

Tillaux
Pilon
Triplane
Maisonneuve

A

Salter Harris type 3 fracture through distal tibial epiphysis

Fracture involving the tibial plafond and articular surface with the talus

Salter Harris type 4 fracture through the distal tibial epiphysis and metaphysis

Fracture of the medial tibial malleolus/widening of the distal tib-fib syndesmosis + fracture of the proximal fibular shaft

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8
Q

Osteochondroses

Kohler’s
Freiberg
Sever’s
Panner’s
Perthes’
Kienbock’s

A

Tarsal navicular
2nd metatarsal head
Calcaneal apophysis
Capitellum
Femoral head
Lunate

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9
Q

Ulnar abutment syndrome? What is it secondary to?

Kienbock’s - association?

A

Positive ulnar variance with impaction of distal ulna on carpus (especially the lunate) secondary to TFCC injury

Negative ulnar variance

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10
Q

Panner’s vs OCD of the elbow

Area affected?
Age of patient?
MRI findings?
Intra-articular loose bodies?
Prognosis?

A

Capitellum in both cases
Panner’s - 5-10; OCD - teenager
Low T1, high T2
Panner’s - no; OCD - yes
Panner’s is self-limiting; OCD may require surgery

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11
Q

Types of external impingement of the rotator cuff?

A

Primary external impingement - due to an abnormality of the coracoacromial arch
1. Hooked acromion
2. Subacromial osteophyte
3. Subcoracoid impingement - congenital or post-trauma

Secondary external impingement - microtrauma and laxity of shoulder means that the rotator cuff is pushed up against coracoacromial arch

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12
Q

Types of internal impingement of the rotator cuff?

A

Posterior-superior - occurs in athletes who throw overhead - rotator cuff gets caught in between greater tuberosity and labrum

Anterior superior - biceps tendon/subscap tendon gets caught between glenoid rim

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13
Q

What does SLAP lesion stand for?

What is a type IV tear?
Associated with instability?
Mimic?

A

Superior labrum anterior posterior tear

Extension into the long head of biceps tendon
No
Sublabral recess/sulcus

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14
Q

More tear mimics:

Sublabral foramen - what is it?

Buford complex - what is it?

A

Incomplete attachment of antero-superior labrum in 1-3 position

Absent antero-superior labrum with thickened middle glenohumeral ligament

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15
Q

Differential for an ivory vertebra

A

LIMPH

Lymphoma
Infection - TB
Metastasis - prostate, breast TCC
Paget’s
(Haemangioma)

Really you are thinking cancer or Paget’s

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16
Q

Causes of biconcave vertebra

A

Osteoporosis
Osteomalacia
Renal osteodystrophy
OI

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17
Q

High on T1?

A

My Best Friend is Pretty Cool

Melanin
Blood
Fat
Protein
Contrast

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18
Q

What is a HAGL?

A

Humeral avulsion of the glenohumeral ligament - specifically the inferior glenohumeral ligament

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19
Q

Differential diagnosis for a sequestrum?

A

Osteomyelitis
Eosinophilic granuloma/LCH
Fibrosarcoma
Lymphoma

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20
Q

Top three most common primary bone cancers?

A

Myeloma/plasmacytoma
Osteosarcoma
Chondrosarcoma

21
Q

Types of osteosarcoma? (4)

Focusing on conventional intramedullary osteosarcoma, what age are patients usually?

Location of tumour?

Most common site of metastasis?

Causes of secondary osteochondroma?

A

Intramedullary, periosteal, parosteal, telangiectatic

10-20 yrs

Femur (40%), proximal tibia (15%)

Lung

Paget’s, previous radiotherapy

22
Q

Bone lesion with fluid-fluid levels on MRI?

A

Aneurysmal bone cyst
Giant cell tumour
Osteosarcoma (telangiectatic)
Chondroblastoma

23
Q

Ewing’s presentation?

Appearance on radiograph?

Age?

Location?

Further investigations?

A

In addition to pain, swelling, lump, often presents with symptoms of infection - fever, raised CRP

Permeative lesion, aggressive periostitis, often a large associated soft tissue mass

Primarily children and adolescents, definitely <30

Extremities, ribs and pelvis

MRI/CT to characterise lesion, CT chest to look for lung mets, PET-CT for staging

24
Q

Chondrosarcoma imaging appearance?

Age?

Main differential?

Risk factors?

A

Bone or soft tissue mass with snowflake calcification

> 40

Enchondroma

Osteochondroma, Maffuci’s, Paget’s

25
Q

Chordoma - location?

Age?

Imaging?

A

Occur in the spine, in the midline. Most common is sacrum, followed by clivus, followed by vertebral body.

30 - 60

T2 hyperintense, enhance

In clivus - aggressive, lobulated, cause destruction with mass effect on the pons and displacement of vascular structures. Calcific fragments often evident.

26
Q

Most common soft tissue sarcoma?

Second most common soft tissue sarcoma?

Ball-like lesion in an extremity in a young patient?

A

PUS - pleomorphic undifferentiated sarcoma

Liposarcoma

Synovial sarcoma

27
Q

Lesions that can occur in the epiphysis?

Malignancy in epiphysis?

A

Aneurysmal bone cyst
Infection
Giant cell tumour
Chondroblastoma

Clear cell chondrosarcoma

28
Q

Differential diagnosis for vertebra plana?

A

MELT

Myeloma/metastasis
EG
Lymphoma
TB/Traum

29
Q

Osteoid osteoma clinical features?

MRI appearance?

Location?

Osteoid osteoma larger than 2 cm?

A

Pain, joint pain/back pain, painful scoliosis, relieved by salicylates

Lots of oedema

Long bones or posterior elements of the spine

Osteoblastoma

30
Q

Causes of osteoblastic (sclerotic) metastases?

A

Prostate
Breast
TCC
Carcinoid
Medulloblastoma

31
Q

Aneurysmal bone cyst
- age of patient?
- two most common locations?
- appearance MRI?
- association with other tumour?

A

<30
Tibia and posterior element of spine
Fluid-fluid levels
GCT

32
Q

Causes of AVN of the hip?

A

Perthes
Sickle cell anaemia
Gaucher’s
Steroid use
Post-traumatic

33
Q

Madelung deformity
- imaging findings?
- aetiology?

A

Bowing of distal radial shaft, increased interosseous space and subluxation of the ulna dorsally at the DRUJ. The proximal carpal row is V-shaped. Often there is positive ulnar variance.

HIT DOC

Hurler
Infection
Trauma

Dyschondrosteosis
Osteochrondromatosis, Ollier
Congenital - Turner, achrondroplasia, nail patella

34
Q

Ankylosing spondylitis
- if diagnosed in spine, what investigation should happen next?

  • what are Romanus lesions?
A

CT Chest - looking for upper lobe fibrosis, pericardial effusion and aortic root dilatation

Also known as “shiny corners”, increased signal at the antero-superior corners of the vertebral bodies

35
Q

Femoroacetabular impingement
1. what is it?
2. what is a CAM deformity?
3. pincer morphology?
4. who gets CAM?
5. who gets pincer?
6. how common is mixed?
7. which type does protrusio acetabuli predispose you to?

A
  1. Clinical syndrome of painful or restricted hip movement caused by morphological abnormalities of the femoral head/neck junction and acetabulum
  2. An ovoid protrusion at the femoral head/neck junction leading to loss of sphericity
  3. Acetabular abnormality, in particular acetabular overcoverage
  4. CAM - athletes, young men
  5. Pincer - middle-aged women
  6. 80% of cases have mixed
  7. Pincer type
36
Q

Congenital mixed bag

  1. Which type of OI has deafness?
A
  1. OI type I
37
Q

Arthritides with no demineralisation present?

A

PONGS

Psoriatic arthritis
Osteoarthritis
Neuropathic joint
Gout
Sarcoidosis

38
Q

Joint space & mineralisation in:
1. PVNS?
2. Haemophilia
3. Haemochromatosis

A
  1. Preserved until late. Erosions & joint effusions are common.
  2. Osteoporosis, chronic degenerative change. Growth deformities.
  3. Loss of joint space, subchondral cysts, osteopenia/osteoporosis
39
Q

Differential for widening of the intercondylar notch?

A

Haemophiliac arthropathy
JIA
TB

40
Q

Differential for sclerotic bones?

A

Renal osteodystrophy
Sickle cell disease
Myelofibrosis
Osteopetrosis
Pyknodysostosis
Metastases
Mastocytosis
Paget’s
Athletes
Fluorosis

41
Q

Differential for solid periostitis?

A

Infection
Eosinophilic granuloma/LCH
Benign bones lesions (e.g. osteoid osteoma)
Hypertrophic osteoarthropathy
DVT

42
Q

McCune-Albright Syndrome?

What cancer is this syndrome associated with?

A

Triad of cafe au lait spots, polyostotic fibrous dysplasia and precocious puberty/endocrine hyperactivity

Pancreatic tumours

43
Q

Differential for expansile lytic lesion in posterior elements of the spine

A

GO TAPE

GCT
Osteoblastoma/osteoid osteoma

TB
ABC
Paget’s
EG

44
Q

Causes of a superscan appearance?

A

Neoplastic
- prostate (most common)
- breast

Metabolic
- hyperparathyroidism
- renal osteodystrophy
- thyrotoxicosis
- Paget’s

45
Q

Benign bone lesions that are hot on bone scintigraphy?

A

Fibrous dysplasia
ABC
GCT
Osteoid osteoma
Osteoblastoma

46
Q

Three phase hot on bone scan?

A

Osteomyelitis
Tumour
Osteoid osteoma
Fracture
Charcot
reflex sympathetic dystrophy

47
Q

Causes of chondrocalcinosis

A

5H + A + C

Hyperparathyroidism
Hypothyroidism
Hypomagnesaemia
Haemochromatosis
Haemosiderosis
Alkaptonuria
CPPD

48
Q
A

FRCR 2A (10 decks)

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