MSK Chapter - Pictures

Answer 1

Codman triangle

from elevation of periosteum

Definitely associated with osteosarcoma, may be associated with other things

Answer 2

Onion skin appearance in bone

May be associated with ewing sarcoma, osteomyelitis, osteogenic sarcoma

Answer 3

Sunburst pattern on X-ray

Definitely associated with osteosarcoma, may be associated with other things

Answer 4

Soap bubble appearance - giant cell tumor

Question 5

*

Answer 5

Salt and pepper sign of the calvaria refers to multiple tiny hyperlucent areas in the skull vault caused by resorption of trabecular bone in hyperparathyroidism.

Question 6

*

Answer 6

Osteopetrosis

Question 7

*

Answer 7

Osteopetrosis

Question 8

*

Answer 8

Rickets

Question 9

*

Answer 9

Rickets

Question 10

*

Answer 10

Achondroplasia

Question 11

*

Answer 11

Heberden’s nodes - associated with osteoarthritis

Question 12

What disease?

Answer 12

Osteoarthritis

Question 13

*

Answer 13

Bouchard’s node - Osteoarthritis

Question 14

*

Answer 14

Baker’s cyst - associated with Rheumatoid arthritis

Question 15

*

Answer 15

Eburnation - associated with osteoarthritis

Question 16

*

Answer 16

Subchondral cyst - associated with osteoarthritis

Question 17

*

Answer 17

Osteophyte - association with osteoarthritis

Question 18

*

Answer 18

Tophus - gout

Question 19

*

Answer 19

Tophus

Question 20

*

Answer 20

Bamboo spine - ankylosing spondylitis

Question 21

*

Answer 21

Dactylitis -

Usually associated with psoriatic arthritis

Dactylitis can occur in seronegative arthropathies, such as psoriatic arthritis and ankylosing spondylitis, and in sickle-cell disease as result of a vasoocclusive crisis with bone infarcts, and in infectious conditions including tuberculosis and leprosy. In Reiter syndrome, sausage fingers occur due to synovitis.[2]

Question 22

*

Answer 22

Pencil in cup deformity - psoriatic arthritis

Question 23

*

Answer 23

Lupus pernio - associated with sarcoidosis -

Cutaneous lesions of sarcoidosis (lupus pernio). Red-to-purple indurated plaques and nodules affecting the nose and cheeks.

Question 24

*

Answer 24

Lupus pernio lesions are indurated and violaceous and range from a few small lesions to large lesions as in this patient

Question 25

*

Answer 25

Schaumann body - calcium and protein inclusion inside Langhans giant cells - associated with:

• Sarcoid
• Hypersensitivity pneumonitis
• Berylliosis
• Crohn’s, TB (rarely)

Answer 26

This cytoplasmic Schaumann body (arrow) is common in sarcoidosis but is nonspecific.

• Sarcoidosis
• Hypersensitivity pneumonitis
• Berylliosis
• Crohn’s, TB (rarer)

Question 27

*

Answer 27

Asteroid body

An asteroid body, is a microscopic finding seen within the giant cells of granulomas in diseases such as sarcoidosis and foreign body giant cellreactions.[1]

Question 28

*

Answer 28

Gottron papules - associated with dermatomyositis

Question 29

*

Answer 29

Heliotrope rash - dermatomyositis

Question 30

*

Answer 30

Shawl and face rash - dermatomyositis

Question 31

*

Answer 31

Shawl and face rash - dermatomyositis

Question 32

*

Answer 32

Mechanic’s hands

Polymyositis and dermatositis

People with dermatomyositis or polymyositis may develop “mechanic’s hands,” a roughening and cracking of the skin of the tips and sides of the fingers, resulting in irregular, dirty-appearing lines that resemble those of a manual laborer

Question 33

*

Answer 33

Myositis ossificans - metaplasia of skeletal muscle to bone following muscular trauma

Question 34

*

Answer 34

Scleroderma

Question 35

*

Answer 35

Swan neck deformity - RA

Question 36

*

Answer 36

Melasma / Chloasma - hyperpigmentation associated with pregnancy

Question 37

*

Answer 37

Ephelis - Freckle

Ephelis: A form of freckle. A flat red or light-brown spot on the skin that typically appears during the sunny months and fades in the winter. They are most often found in people with light complexions and in some families, they are an hereditary (genetic) trait. The regular use of sunscreen during times of sun exposure helps to suppress the appearance of the ephelis-type freckle.

Question 38

*

Answer 38

Verrucae - warts caued by HPV

Question 39

*

Answer 39

Hairy leukoplakia

Associated with EBV, occurs in HIV positive patients

Question 40

*

Answer 40

Pemphigus vulgaris - note the reticular net-like pattern

Question 41

*

*

Answer 41

Bullous pemphigoid immunohistohemistry - IgG antibody against hemidesmosomes

Antibodies are below the epidermis

Question 42

*

Answer 42

Erythema multiforme - associated with infections, drugs, cancers, autoimmune disease. Presents with multiple types of lesions.

Looks like targets with multiple rings and dusky center showing epithelial disruption.

Question 43

*

Answer 43

Actinic keratosis - this is the one that precedes squamous cell carcinoma

Question 44

*

Answer 44

Erythema nodosum

Painful inflammatory lesions of subcutaneous fat on anterior shins

Remember: The leper crone cooked the hissing sardines on the table in the street.

Sarcoidosis

Coccidiomycosis

Histoplasmosis

TB

Strep infections

Leprosy

Crohn’s

Question 45

*

Answer 45

Lichen planus

Pruritic, purple, polygonal planar papules and plaques

Question 46

*

Answer 46

Wickham striae are whitish lines visible in the papules of lichen planus and other dermatoses, typically the macroscopic appearance of the histologic…

You get wickham striae with lichen planus mucosal involvement

Question 47

*

Answer 47

Pityriasis rosea - herald patch followed days later by christmas tree distribution. Multiple plaques with collarette scale. Self resolving in 6-8 weeks.

Question 48

*

Answer 48

Keratin pearl (2) associated with squamous cell carcinoma

Question 49

*

Answer 49

Basal cell carcinoma - note the palisading at the margins

Question 50

*

Answer 50

Wickham striae - lichen planus oral version, take 2