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Radiology > MSK > Flashcards

MSK Flashcards

1
Q

O’Donohoghue’s triad

A
  1. ACL
  2. MCL
  3. Medial meniscus
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2
Q

Adamantinoma

A
  • Sharply circumscrobed lucent lesion with sclerotic border - can be loculated.
  • Almost exclusively in the tibia - mid diaphysis
  • Has malignant potential.
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3
Q

Aneurysmal Bone Cyst

A
  • < 30 yo
  • Often present with pain.
  • Well defined, eccentric, expansile and lytic - rapid progression
  • Fluid/fluid level on X-sectional
  • Can occur anywhere.
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4
Q

Ankylosing Spondylitis

A

20 yo m

Typically statrs with symmetric envolvement of the SI joints

Contigious thoraco lumbar involvement

  • Syndesmophytes
  • Bamboo spine
  • Shiny corners of plain film
  • Romaus lesions - T2 bright anterior sup and inf end-plates
  • Ossification of interspinous and supraspinous ligaments

Assoc w/

  • IBD
  • Iritis
  • Aortitis
  • Upper lobe pulmonary fibrosis
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5
Q

Bennets fracture

A

Intra-articular MCP fractures of the thumb metacarpal.

Dorsal and radial dislocation (APL force)

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6
Q

Brown Tumour

A
  • Due to hyperparathyroidism
  • Can have any appearance. - sclerotic when HPT treated.
  • Assoc with subperiosteal bone resorption of HPT:
    • Radial aspect of phalanges
    • Clavicle
    • medial proximal tibia
    • SI joints
    • Frayed and ragged physes.
  • Renal osteodytrophy as a cause - Osteoporosis/sclerois.
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7
Q

C-spine acceptable soft tissue measurements

A

Predental space = 3mm adult, 5mm children

Nasopharyngeal space (anterior to C1) = 10mm

Retropahryngeal space (C2-C4) = 5-7 mm

Retrotrcheal space (C5-C7) = 22mm

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8
Q

Calcium Hydroxyapatite Deposition Disease. (HADD)

A
  • Periarticular CHA deposition - inflammation without structural joint abnormalities.
  • Most common sites:
    • insertion of suprspinatous
    • FCU
    • Milwaukee shoulder = rotator cuff and subacromial bursa.
    • MCPs and IPJs
    • Longus coli
    • Glut max
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9
Q

Caplan synfrome

A

pneumoconiosis, rheumatoid lung nodules and RA

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10
Q

Charcot Joint

A
  1. Joint destruction
  2. Dislocation
  3. Heterotopic new bone formation

Most typically seen in diabetics in the 1st and 2nd tarsometarsal joints

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11
Q

Chauffeur’s fracture

A

Intrarticular fracture of the radial styloid

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12
Q

Chondroblastoma

A
  • Young
  • Epiphyseal lobulated lucent epiphyseal lesion with calcification
  • Long bones
  • Tx with curettage
  • MRI:
    • prominent priosteal reaction
    • bone marrow oedema
    • soft tissue oedema
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13
Q

Chondromyxoid Fibroma

A
  • Any age
  • metaphyseal lobulated fibrous lucent lesion.
  • Resemble NOF but more readily extend to the epiphyses.
  • Chondroid matrix.
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14
Q

Chondrosarcoma

A
  • >40
  • painful long bone lesion
  • resemble enchondromas but can have periostitis and destruction.
  • Causes end osteal scalloping.
  • Soft tissue involvement with amorphous calcification.
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15
Q

Clay shovelers fracture

A
  • C6 or C7 spinous process avulsion fracture.
  • Caused by supraspinous ligament stress.
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16
Q

Desmoid Tumour

A
  • Start in soft tissues.
  • Slow growing
  • Well defined, multiloculated destructive bone lesion. ‘geographic pattern’
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17
Q

DISH (Diffuse idiopathic skelteal hyperostosis)

A

AKA Forestier’s disease

Bulky flowing osteophytes over atleast 4 vertebral bodies. (Commonly thoracic)

Associated ligamentous and tendonous ossification. - ANTERIOR LONGITUDINAL

No SI joint involvement.

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18
Q

Dorsal Intercalated Segment Instability (DISI)

A
  • Dorsal tilt of lunate
  • Capitolunate and scapholunate both increase.
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19
Q

Elastofibroma

A

>55 yo women

Pseudotumour of the posterior chest wall at the onferomedial border of the scapula.

From chronic irritation.

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20
Q

Enchondroma

A
  • Typically calcified chondroid matrix except in phalanges.
  • Endosteal scalloping
  • No periostitis
  • Multiple enchondromas Olliers Disease. With soft tissue haemangiomas Maffucci Syndrome.
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21
Q

Eosinophillic granuloma

A
  • Anysort of appearance.
  • Periostitis is thick, uniform and wavy (benign) - Can also be laminated like Ewing sarcoma.
  • Can have a bony sequestrum.
  • Almost eclusively in UNDER 30’s.

Form on Histocytosis X, Letterer-Siwe disease and Hand-Schuller-Christian disease.

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22
Q

Erdheim-Chester Disease

A
  • 55 yo
  • Multisystem granulomatosis
  • inflitration of histocytes causing painful scleroitic lesions of the appendicular skeleton.
  • Present with bone pain, diabetes insipidus, neurological signs, retroperitoneal fibrosis and and exopthalmos.
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23
Q

Essex-Lopresti

A

Radial head fracture with distal radio-ulnar dislocation

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24
Q

Ewings

A
  • <10
  • Perimiative lesion in the diaphyisis of a kid
  • periostitis - Onion skin or sunburst/amorphus
  • Mets to lung
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25
Q

Features of rheumatoid arthritis

A
  • soft tissue swelling
  • osteoporosis
  • joint space narrowing
  • marginal erosions
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26
Q

Features of staphylococcus discitis

A

No calcification Posterior elements spared Acute onset One level

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27
Q

Features of tuberculous discitis

A
  • Calcification
  • Posterior element involvement
  • Insidious onset
  • Gibbus deformity (angular kyphosis)
  • Multiple levels
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28
Q

Fibrous dysplasia

A
  • Can be mono or polyostotic (pelvis and ipsilateral femur)
  • Long lesion in long bone.
  • Ground glass/ smokey matrix.
  • DDx McCune Albright syndrome and Adamantinima
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29
Q

Flexion Teardrop Fracture.

A

Disruption of the posterior elements causing anterior compression fracture. Cord comprimise due to retropulsion of posterior elelments.

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30
Q

Galeazzi fracture

A

Radial fracture with distal radioulnar dislocation

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31
Q

Gamekeeper’s thumb

A
  • Avulsion fracture at the base of the thumb proximal phalanx where the ulnar collateral ligament inserts.
  • Caused by ski pole being jammed in the 1st web space.
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32
Q

Giant Cell Tumour

A
  • Adults
  • Exclusively at the end of long or flat bones.
  • Must have closed physes
  • Must abut the articular surface.
  • Well defined without a scerotic border.

15% have malignant potential. Can metastesise to lung.

Tx: Pack and curettage. Monitor for recurrence.

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33
Q

Glomus tumour

A

Benign vascular tumour

Well circumcribed, lytic and painful

Terminal phalangeal location.

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34
Q

Gout

A
  • Uric acid postively birefringent crystals under polarised microscopy
  • Well defined ‘marginal’/periarticular erosions - with sclerotic borders
  • Soft tissue nodules - tophi
  • Random distribution - 1st MTP most common (podagra)
  • Without marked osteoporosis
  • Joint space preserved
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35
Q

Haemochromatosis

A
  • Iron deposistion leading to fibrosis and eventual organ failure.
  • Causes degenerative joint disease which typically affects the 2nd-4th MCPJs.
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36
Q

Haemochromotosis arthropathy

A

Same distribution as CPPD

Distinctive features:

  • Hook-like osteophytes on MCP heads (fourth and fifth)
  • Generalized osteoporosis
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37
Q

Hangman’s Fracture

A
  • Unstable fracture of posterior elements of C2 with anterolithesis on C3.
  • Caused by hyperextention and distraction ( Dashboard )
38
Q

Homocystinuria

A

AR

  • Lens dislocation
  • seizures
  • dystonia
  • developmental delay
  • scoliosis
  • pectus
  • thromboembolism
  • spontaneous pneumothorax
39
Q

Intraosseous haemangioma

A

Middle aged

Vertebral body > Skull > Face

Characteristic corduroy appearance with vertical trabecular pattern of verterbral bodies. Lucent, slightly expansile intraosseous lesion.

Usually asymptomatic unless fractured or causing cord compression.

40
Q

Intraosseous lipoma

A

Prox femur, fibula and calcaneous.

lucent but may have a calcified nidus.

41
Q

Jaffe Campanacci Syndrome

A

Multiple non-ossifying fibromas, café-au-lait spots, hypogonadism, cryptorchism, mental retardation, and ocular and cardiovascular abnormalities.

42
Q

Keinbock malacia

A

Avascular necrosis of the lunate resulting in a negative ulnar variance.

43
Q

Kohler disease

A

Idiopathic avascular necrosis of the navicular in 4-6 year olds.

In adults it is known as Mueller Weiss Syndrome

44
Q

Kummel Disease

A
  • When an acute anterior wedge fracture is left untreated.
  • After 1-2 weeks can result in further compression and paraplegia.
45
Q

Lipoma Arborecens

A

Diffuse fatty infiltration of the knee synovium

Painless swelling of the knee

Fatty frond like projections in to the synovium on MR

46
Q

Lovers fracture

A

Calcaneal fracture

47
Q

Lytic mets

A

Most common:

  • Kidney
  • Lung
  • Thyroid
  • Breast
48
Q

Maffucci’s Syndrome

A
  • Multiple enchondromas
  • Associated with soft tissue haemangiomas
    • calcified phleboliths
49
Q

Malignant Fibrous Histocytoma

A
  • 40 yo
  • Lytic lesion - no ostioid or chondroid matrix
  • moth eaten fairly well defined areas of lysis
  • Can have bony sequestrum.
50
Q

Mallet finger

A
  • Avulsion fracture at the base of the distal phalanx where the externsor digitorum inserts.
  • Results in unopposed flexion.
51
Q

Mastocytosis

A

Mast cell infiltration of bone marrow, skin and other organs.

Bones: Osteosclerosis / osteoporosis

GI stuff = hepatosplenomegaly, jejunal thickeing, lymphadenopathy and ascites.

Chest = Skin changes, fibrosis and pulmonary nodules.

52
Q

Mazabraud syndrome

A

Multiple soft tissue myxoma and fibrous dysplasia

53
Q

McCune Albright Syndrome

A
  • Polyostotic fibrous dysplasia
  • Cafe au lait spots
  • Precocious puberty
54
Q

Monteggia fracture

A

Ulnar fracture with proximal radio-ulnar dislocation

55
Q

Morel-Lavallee lesion

A

Degloving injury of the proximal lateral thigh when SC tissue decome detached from muscle/fascia.

56
Q

Myelofibrosis

A

Marrow replaced by fibrosis. = Diffuse patchy osteosclerosis

Massive extramedullary haematopoiesis - hepatosplenomegaly and paraspinal masses.

57
Q

Non-Ossifying Fibroma

A
  • < 30yo
  • <2cm is known as a fibrous cortical defect.
  • Not pain. No periostits.
  • Typically cortically based in the metaphysis of long bones.
  • Thin sclerotic border with scalopping and slightly expansile.

Mx: watch and wait - result in spontaneous regression. Can be sclerotic when regressing and appear as hot on BS due to increased osteoblastic activity.

58
Q

Ochronosis

A

AR. Homgentistic acid deposition in hylane cartilage causes black/brown pigmentation.

  • Multilevel intervertbral disc calcification
  • cartilage, tendons and ligaments
  • Osteoporosis
  • OA of SI joints and peripheral joints
59
Q

Olliers disease

A

Muliple hand and feet enchondroma

25% chance of malignant transformation to chondrosarcoma

60
Q

Osteoblastoma

A
  • Expansile scerotic lesion.
    • 50% contain speckled calcification.
  • Commonly occur in the posterior elements of vertebral bodies.

DDx: ABCs

61
Q

Osteochondroma

A
  • Bony metaphyseal projection with a cartilage cap. Points away from the joint.
  • Benign and resolves by adulthood.
  • Operate is complications of mass occur.
  • assoc. w/ Multiple heriditary exostoses
  • Trevor disease (Displasia epiphysealis hemimelica)
    • intra-articular osteochondroma (knee + ankle most common)
62
Q

Osteosarcoma

A
  • <30 yo
  • Secondary (Pagets old)> Medullary > Periosteal > Parosteal - interms of lethality.
  • Ostioid mattix - mixed sclerotic.
  • Teilangectatic can be entirely lytic.
  • Parosteal prefers the posterior metaphysis of long bones.
  • Mets to lung and bone
63
Q

Ostioid Osteoma

A
  • Small benign tumours but which can be quite symptomatic.
  • Pain relieved by aspirin
  • Imaging:
    • <2cm cortically based. with a nidus.
    • Diaphyses of long bones but the posterior elements of the spine
    • MRI shows extensive bone marroy oedema
64
Q

Parsonage-Turner syndrome

A

Acute brachial neuritis - commonly affects suprascapular (+/- axillary nerve)

Causes oedema and then atrophy of supraspinatous and infraspinatous. (+/- deltoid)

65
Q

Pigmented Villonodular Synovitis

A

10-50

Diffuse and focal forms

Knee > hip > elbow > ankle.

Synovium thickened and replaced by fibrous masses that erode the bone and can redcued joint space late in disease

MR T1 and T2 low masses emanating from the synovium.

66
Q

Pilon fracture

A

Intrarticular distal tibial fracture

67
Q

Pitt’s Pit

A

Well defined oval lucent lesion in the femoral neck.

Reflects a herniation of the synovioum and soft tissues into the bone cortex.

68
Q

Poems syndrome

A

Japanese person with Polyneuropathy, Organomegaly, Endocrinopathy, M-protein (sclerotic multiplemyeloma), Skin hyperpigmentation

69
Q

Psoriatic arthritis

A

Seronegative spondyloarthropathy

Types:

  • Asymmetric oligoarthropathy
  • Spondyloarthropathy of SI joints and spine - asymmetric
  • Symmetric polyarthropathy (like RA)

Hand:

  • Sausage digit
  • Ivory phalanx
  • Tuft resorption
  • Mouse ears
  • Pencil-in-cup
  • Periostitis
70
Q

Pyknodysostosis

A

Brittle boned dwarf with wormian bones, small straight jaw and no short fingers.

  • Dwarfism
  • Micrognathia
  • Straight mandible
  • Dense fragile bones
  • Acroosteolyisis
  • Wormian bones
  • Undereveloped paranasal sinuses and mastoid aircells
71
Q

Reactive arthritis

A

Post non-gonococcal urethritis or bacillary dysentry

  • Shigella, Yersinia, Salmonella, Campylobacter and Chlamydia
  • Classic triad = Urethritis, conjuctivitis and arthritis

Radiographic features:

  • MTP erosions
  • Retrocalcaneal bursitis
  • Achilles and plantar enthesopathy
  • Asymmetric sacroiliitis
  • Thoracolumbar osteophytes with skips
  • Periostitis and pencil in cup deformity
72
Q

Rheumatoid Arthritis

A
  • Periarticular swelling
  • Periarticular osteoperosis (symmetrical)
  • Marginal bone erosions (capsular insertion)
  • Erosion of the ulnar styloid and triquetrum are classic
  • Subluxation and fibrous ankylosis (late)
  • Generalised disuse osteopaenia.
73
Q

Rolando

A

Comminuted Bennets

74
Q

SAPHO syndrome

A

Synovitis, Acne, _P_ustulosis, _H_yperostosis, and Osteitis

  • osteitis of the anterior chest wall
  • hyperostosis and soft tissue calcification between the medial clavicle, sternal manubrium, and anterior upper ribs.
75
Q

Scapholunate advanced collapse (SLAC)

A
  • Chronic scapholunate dissociation and chronic scaphoid non-union.
  • CPPD most common cause
  • Capitate subluxates dorsally on the lunate. —>becomes a DISI.
76
Q

Scelrotic Mets

A

Most common:

  • Prostate
  • Breast

Other rarer:

  • Hodgkin lymphoma
  • Carcinoid
  • Neuroblastoma
  • TCC
77
Q

Scleroderma

A

Soft tissue calcification

Acroosteolyisis

Soft tissue atrophy

Erosive changes of DIP and PIP

78
Q

Sclerotic mets

A
  1. Prostate
  2. Breast (Mixed)
  3. TCC
  4. Lymphoma
  5. Mucinous Adenocarcinoma
  6. Medulloblastoma
  7. Neuroblastoma
  8. Carcinoid
79
Q

Segond fracture

A

Avulsion fracture of the lateral tibial condyle - assoc w/ ACL injury

80
Q

SLE

A

Reversibly ulnar deviation of the metacarpals.

Bilateral and symmetric

Non-erossive

Tenosynovitis of flexor tendons

DDx Jaccouds arthropathy

81
Q

Solitary Bone Cyst.

A
  • < 30 yo
  • Centrally based.
  • Typically starts at the physes of long bones and extends into the metaphysis.
  • Painless. But present usually after a fracture. (Fallen fragment sign).
82
Q

Spondylolysis

A
  • Break or defect in pars interarticularis portion of the lamina.
  • If bilateral can cause spondylolisthesis.
83
Q

Sudeck Atrophy

A
  • after minor trauma to extremity resulting in pain and swelling.
  • causes severe patchy osteoporosis.
84
Q

Superior labral tear from anterior to posterior (SLAP)

A

Type I: fraying or tear of the superior labrum

Type II: detachment of the labral-bicipital complex from the superior glenoid

Type III: bucket-handle tear of the superior labrum

Type IV: bucket-handle tear with extension into the biceps tendon

85
Q

Synovial cell sarcoma

A

15-35 yo in the knee.

MR triple sign = T2 intensities for hemorrhage, necrosis, solid tissue, and calcification. aka Bowl of grapes sign.

86
Q

The Osteochondroses

A
  • Scheuermann disease = Spine
  • Panners = capitellum
  • Blount disease = Tibial epiphysis
  • Osgood-Schlatter disease = Tibial Tubercle
  • Sindig-Larsen-Johansson disease = Proximal patella tendon
  • Keinbock disease = Lunate
  • Kohlers = Tarsal navicular
  • Sever disease = Calcaneus
  • Freiberg infarction = 2nd Metartarsals
  • Perthes disease
87
Q

Tillaux fracture

A

Salter-Harris III through the lateral distal tibial epiphysis (older kids - medial physis is closing)

88
Q

Triplane

A

Salter-Harris 3/4 of the distal tibia

89
Q

Volar intercalated Segment Instability (VISI)

A
  • Volar tilt of lunate.
  • Increased capitolunate angle.
  • Scapholunate angle sometimes decreased.
90
Q

Which lesions contain a bony sequestrum?

A
  1. Infection
  2. Eosinophillic Granuloma
  3. Lymphoma
  4. Fibrosarcoma
  5. Ostioid osteoma (Mimic)
91
Q

Wilsons disease

A

AR disease causing copper accumulation in basal ganglia, liver, joints etc…

Same distribution as CPPD

Distinctive features:

  • Subchondral fragmentation
  • Generalized osteoporosis

Radiology (6 decks)

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