MSK (Core Qs & Others) Flashcards
1
Q
Most common location for meniscal ossicle at the knee
A
Posterior horn of the medial meniscus
2
Q
Where is the fabella located?
A
Lateral head of the gastroc muscle
3
Q
Where is the cyamella located?
A
Within the popliteus tendon
4
Q
The lucent area at the proximal humerus is known as
A
Pseudocyst of the humeral head
5
Q
What is the most common accessory muscle of the ankle?
A
Peroneus quartus
6
Q
Order of elbow ossification
A
"CRITOE" (ages 1-10 yo) Capitellum Radial head Internal epicondyle Trocheal Olecranon External epicondyle
7
Q
Avascular necrosis of the navicular is called
A
Kohler disease
8
Q
What is the most common carpal coalition?
A
Lunotriquetral
9
Q
Plexiform neurofibromas are most commonly seen with what syndrome?
A
Neurofibromatosis Type I
10
Q
Bipartite patellas often present with what clinical symtpom?
A
Anterior knee pain
11
Q
Differential diagnosis for acro-osteolysis of multiple distal phalanges include
A
Scleroderrma Raynaud disease Psoriatic arthritis Thermal injuries Trauma Hyperparathyroidism Congenital insensitivity to pain
12
Q
Fibrodysplasia ossificans progressive typically begins where?
A
Sternocleidomastoid
13
Q
What is seen more commonly in primary hypertrophic osteoarthropathy as compared to secondary hypertrophic osteoarthropathy?
A
Phalangeal tuft acro-osteolysis
14
Q
The most likely diagnosis for multiple congenital block vertebra
A
Klippel-Feil syndrome
15
Q
Types of osteogenesis imperfecta
A
Type I: least severe
Type II: most severe
Type III: most severe for individuals that survive past childhood
16
Q
The most common location for melorheostosis
A
Lower extremities
17
Q
Movement of an os odontoideum on flexion and extension views
A
It moves with the atlas on flexion and extension
18
Q
The primary etiology that leads to osteopetrosis
A
Abnormal osteoclast function
19
Q
A limbus vertebra is located where?
A
Typically at the superior-anterior corner of a vertebral body
20
Q
What is the most common cause of scoliosis?
A
Idiopathic (85%)
21
Q
A common complication that results from developmental dysplasia of the hip (DDH)
A
Coxa magna: broad femoral head with short and wide femoral neck
22
Q
What is the most common site of osteomyelitis in the foot of a diabetic patient?
A
Areas of increased pressure: 1st and 5th metatarsal heads, calcaneus, and phalanges
23
Q
What is the earliest radiographic finding of septic arthritis?
A
Joint effusion
24
Q
Pyomyositis (bacterial infection of skeletal muscle) is often seen at what location for IV drug users?
A
Within the glute muscles
25
Which T1W signal pattern is most reliable in diagnosing osteomyelitis of the foot?
Low geographic, medullary T1 signal
26
What is the characteristic appearance of the fibrous capsule of an abscess on MRI?
Thick and enhancing
27
What causes the majority of cases of necrotizing fasciitis?
Polymicrobial
28
What is the earliest osseous radiographic sign of osteomyelitis?
Indistinct cortical lines
29
What MRI features often suggest superimposed osteomyelitis in a neuropathic foot?
Soft tissue abscess
30
The distribution of skeletal lesions in Ollier disease is best described as
Predominantly unilateral and asymmetric, typically at the metaphyseal regions
31
Ewing's sarcoma characteristically occurs in which part of the bone?
Metadiaphysis
32
What is the most frequent donor site for cancellous bone grafting?
Iliac crest: the anterior iliac crest is easily accessible
33
What is the typical process of osteofibrous dysplasia?
They tend to spontaneously regress without much residual skeletal deformity
34
What is another name for bizarre parosteal osteochondromatous proliferation (BPOP)
Nora lesion
35
Gardner syndrome is characterized by
Multiple osteomas
36
If malignant transformation was to occur in hereditary multiple exostosis (HME), what is the most likely malignancy?
Chondrosarcoma
37
What characteristics would suggest malignant transformation of a osteochondroma to a chondrosarcoma?
Lucent areas of destruction in the interior portion of the lesion
38
The most common location for an osteoid osteoma
The femur
39
What is a common MRI appearance of a synovial sarcoma?
It can have foci of low signal resulting from areas of mineralization
40
A simple bone cyst (aka unicameral bone cyst) is best described as having what location in bone?
Intramedullary and central
41
Which lesion occurs in the subarticular region of long bones in a skeletally mature individual?
Giant cell tumor
42
Which lesion occurs in the epiphysis of a long bone in a skeletally immature individual?
Chondroblastoma
43
Lymphangiomas (benign, primarily soft tissue tumors) most commonly occur where?
Neck (75%), followed by axilla (20%)
44
Which radiologic feature best differentiates enchondroma from chondrosarcoma?
Soft tissue mass
45
What is a typical MRI feature of intraosseous hemangioma?
Coarsened trabecular
46
Where are intraosseous hemangioma most commonly located?
Vertebral body
47
Sarcomatous degeneration occurs in approximately what percentage of patients with Paget disease?
1%
48
What is the most common sarcoma associated with Paget degeneration?
Osteosarcoma
49
Where is the most common site of metastasis from primary chondrosarcoma?
Lungs
50
Which is the most common site of origin for primary chondrosarcoma?
Innominate bone and femur
51
In Langerhans cell histiocytosis, osseous lesions are the most common manifestation. What is the most common extraosseous location?
Skin (55%)
52
What is the most common age range for diagnosing Langerhans cell histiocytosis?
0-10 yo
53
McCune-Albright syndrome is described as polyostotic fibrous dysplasia in conjunction with what?
Endocrine abnormalities
54
Myxomas are characterized pathologically as lesions with abundant myxoid storm and bland spindle cells. How do they appear on MRI?
Hyperintense on T2 with a heterogenous appearance
55
Myxomas have a predilection for which tissue?
Muscle
56
Mazabraud syndrome is characterized by myxomas and what else?
Fibrous dysplasia
57
What can help differentiate between an aneurysmal bone cyst and telangiectatic osteosarcoma?
Cortical destruction
58
PVNS has a pathognomonic _____ signal on T2
Low
59
Spiculated periosteal response is most commonly associated with what malignancy?
Conventional osteosarcoma
60
Which subtype of osteosarcoma has the best long term prognosis?
Parosteal osteosarcoma
61
What radiographic finding would be diagnostic of a hemangioma in the hand?
Phleboliths
62
For conventional osteosarcomas, what percentage of cases have pulmonary metastases at the time of diagnosis?
5-10%
63
Radiographic apparence of malignant fibrous histiocytoma (MFH) typically lacks what?
Periosteal reaction
64
Where do nodular fasciits most frequently occur?
Upper extremities
65
Where do adamantinomas characteristically like to occur?
Anterior tibia
66
What is a radiographic characteristic of an Adamantinoma?
Expansile
67
What are the 2 most common neoplasms of the patella?
Chondroblastoma and giant cell tumors (primary patella tumors are usually benign)
68
What most accurately describes the cellular origin of hemangioendotheliomas?
Tumor of endothelial cells or their precursors
69
What is another name for periosteal chondroma?
Juxtacortical chondroma. They are benign and arise on the surface of bone, deep to the periosteum
70
Periosteal and parosteal osteosarcomas are surface lesions. Which periosteal response is more characteristic of a periosteal osteosarcoma?
Sunburst appearance due to calcified spicules of bone perpendicular to the cortex
71
Metastasis from renal cell carcinoma (RCC) typically have what kind of appearance on radiographs?
Osteolytic, expansile, highly vascular
72
Osseous lymphoma are often associated with what?
Soft tissue mass
73
In the setting of an ankle injury, what following radiographs should be taken?
Tibia/fibula radiographs
74
A common location for paralabral cysts at the shoulder
Spinoglenoid notch
75
Compression of the supra scapular nerve in the spinoglenoid notch classically results in denervation of what muscle?
Infraspinatus
76
What is AVN of the lunate called?
Keinboch disease
77
What wrist abnormality is associated with Keinboch disease?
Negative ulnar variance
78
What structure can prevent proximal retraction of the biceps tendon even with complete disruption of the tendon?
Lacertus fibrosis
79
Which muscle attaches at the ASIS?
Sartorius
80
Which muscle attaches at the AIIS?
Rectus femoris
81
What is the most common cause of posterior shoulder dislocations in adults?
Seizure
82
Where can you find the Lisfranc ligament?
From the medial cuneiform to the second metatarsal
83
A fat blood interface sign (FBI sign) at the knee indicates what?
An occult fracture
84
Where is a Jones fracture located?
The metadiaphyseal region of the 5th metatarsal
85
Anterior "kissing contusions" in the knee are seen with which injury mechanism?
Hyperextension
86
Distal clavicle osteolysis is often caused by what activity?
Weightlifting and/or overhead lifting of some kind
87
Which pattern of dislocation most common occurs at the glenohumeral joint?
Anterior shoulder dislocation, infracoracoid location
88
Achilles tendon tears are most likely to occur in which location?
Midsubstance, the "avascular zone" approximately 2-6cm proximal to the calcaneal insertion
89
Which tendon causes the retraction of the fracture fragment seen in a Bennet fracture?
Abductor pollicis
90
The acetabular labrum is most commonly torn in which quadrant?
Anterior superior
91
Which position of the shoulder will improve visualization of the anterior inferior labrum?
"ABER": abduction and external rotation
92
A grade III injury of the AC joint means complete disruption of which ligament?
Coracoclavicular ligament
93
What is the name of a retracted avulsion fracture of the fibular head?
Arcuate Sign
94
What is a Stener lesion at the thumb?
Entrapment of the ulnar collateral ligament due to a fracture of the proximal phalanx at the thumb
95
What is the definition of Gamekeepers thumb?
Injury to the ulnar collateral ligament
96
Which structure prevents healing of a Stener lesion at the thumb?
Adductor aponeurosis
97
Which modality is best to estimate the stability of a osteochondral lesion?
MRI
98
What are MRI findings that would indicate an unstable osteochondral lesion?
Fluid signal interface with the donor bone
99
What is the first radiographic manifestation of fracture healing?
Widening of the fracture line with blurring of fracture margins
100
Avulsion at the base of the 5th metatarsal is caused by what structure?
Lateral plantar aponeurosis
101
Rotator cuff tears most commonly involves which tendon?
Supraspinatus
102
The Pellegrini-Stieda lesion indicates injury to which structure?
MCL
103
The Segond fracture is associated with what other injury?
ACL (more than 90%)
104
Injuries that are caused by high-voltage electrical burns can also produce what?
Dystrophic calcification or heterotypic ossification
105
What is the name of a radial head fracture with disruption of the distal radioulnar joint?
Essex-Lopresti fracture
106
A fracture to which region of the scaphoid is most susceptible to developing AVN?
Proximal pole
107
The reverse Segond fracture has a high associated with injury to which structure?
PCL
108
Which proximal femoral fracture is most susceptible to AVN
Subcapital
109
Which nerve is entrapped in a patient with forearm pain and weakness of extensors and preserved sensation?
Posterior interosseous nerve, known as deep radial nerve syndrome aka supinator syndrome
110
Thickening of the infra-stellar tendon is known as what?
Jumper's knee
111
Long head of biceps tendon rupture most commonly occurs in which location?
Proximal intra-articular portion
112
What is included in Haglund deformity with retrocalcaneal bursitis?
Enthesophytes
Enlarged posterior process of calcaneus
Retrocalcaneal bursitis
113
An ostechondral defect at the knee most commonly occurs where?
Lateral aspect of the medial femoral condyle
114
What is the definition of a perilunate dislocation?
Posterior displace of the carpals except the lunate, which remains in articulation with the radius on lateral view
115
Lesser arch injuries of the wrist follow a predictable pattern, name the injuries from least to greatest severity
Scapholunate
Lunocapitate
Lunotriquetral
116
Looser zones in osteomalacia are typically located where in the femur?
Medial subtrochanteric region
117
What is the earliest radiographics sign of hyperparathyroidism?
Subperiosteal resorption of the radial surface of the 2nd and 3rd middle phalanx
118
What percentage of primary hyperparathyroidism cases results from a parathyroid adenoma?
75-85%
119
In acromegaly, a heel pad thickness of greater than _____ cm is characteristic for males?
2.3cm for males, 2.15cm for females
120
Cortical hypertrophy with a cortical fracture in an elderly patient with osteoporosis is likely caused by what?
Biphosphonate
121
What is the best imaging test to diagnose osteoporosis?
DEXA scan
122
What is the most common location for periosteal new bone formation in thyroid acropachy?
Metacarpals
123
In myelofibrosis, what is a characteristic bone marrow MRI appearance?
T1W bone marrow signal is lower than muscle or intervertebral disc signal
124
What is the most common location to see hemophilia arthropathy?
Knee
125
Besides the knee, what is the next most common location to see hemophilia arthropathy?
Elbow, ankle, hip, shoulder
126
Calcaneal insufficiency avulsion (CIA) is associated with which systemic disease?
Diabetes mellitus
127
Which portion of bone converts red marrow to yellow marrow last?
Metaphysis
128
Which disease shows soft tissue calcifications without the other soft tissue changes seen in scleroderma?
Polymyositis
129
"Sausage digit" is seen with which arthropathy?
Psoriatic arthritis
130
Which bones in the feet most commonly undergoes ankylosis with juvenile idiopathic arthritis?
Carpal bones
131
The 2 most common arthropathies that present with "hooked osteophytes" at the metacarpals
CPPD and hemochromatosis
132
The deposits of gout are made up of what substance?
Monosodium urate crystals
133
Rheumatoid arthritis shows the earliest erosions in which location?
Ulnar styloid process and carpal bones of the wrist
134
Most common radiographic finding at the hands of an individual with SLE includes
Joint deformities without erosions
135
Which disease can cause opacification of disc spaces on radiographs?
Ochronosis
136
What is the classic triad seen in reactive arthritis?
Urethritis
Conjunctivitis
Arthritis typically involving the lower extremities
137
Which organism is associated with reactive arthritis?
Chlamydia trachomatis
138
In seronegative arthropathies, where do erosions and sclerosis typically present at the SI joints?
Iliac side of the inferior SI joint
139
Cartilage loss in weight-bearing portions of a joint, bone proliferation, and subchondral cyst formation are characteristic of which arthropathy?
Osteoarthritis
140
Progressive osteoarthritis of the great toe consisting of osteophyte formation, joint space narrowing, and subchondral sclerosis can lead to what condition?
Hallux rigidus
141
What is the earliest sign of rheumatoid arthritis at the hands?
Soft tissue swelling and juxta-articular osteoporosis
142
Which disease is characterized by periarticular tendinous thickening, thickened synovium and large erosions?
Amyloidosis, a multisystem disorder with abnormal deposition of extracellular protein
143
Diffuse periosteal response without underlying bone disease is most consistent with what?
Hypertrophic arthropathy (secondary), non-small cell lung carcinoma being the most common cause
144
What is the most common appearance of sarcoidosis within the hands?
Lace-like trabecular pattern and cortical erosions
145
The "blade of grass" appearance is characteristic of which disease?
Paget disease
146
Hypertrophic osteoarthritis (HOA) is characterized by what?
Periosteal response of long bone without underlying bone disease, abnormal soft tissue proliferation, clubbing of fingers. Known as primary HOA if there are no underlying pathologies
147
What is another name for primary hypertrophic osteoarthritis?
Pachydermoperiostosis, a self-limiting autosomal dominant disease
148
Name 3 lab findings associated with multiple myeloma
Reverse A/G ratio (low albumin and high globulin)
Ben Jones proteins
Decreased/normal alkaline phosphatase due to impaired osteoblastic function (unless there's a pathological fracture)
149
"Punched out lesions" and "raindrop skull" is associated with what disease?
Multiple myeloma
150
What is the most common primary malignant bone neoplasm?
Multiple myeloma
151
Where in the spine is the most common location for spondylodiskitis?
Lumbar spine, but can be seen anywhere
152
What is the distribution of spondylodiskitis?
Single level (65%)
Multiple contiguous levels (20%)
Multiple non-contiguous levels (10%)
153
What is the most common organism to cause spondylodiskitis?
Staph. Aureus (60%)
154
Tuberculous spondylitis (Potts disease) is most commonly seen where?
Lower thoracic spine and upper lumbar spine
155
The most common MSK location for tuberculosis is where?
Vertebral involvement (spine)
156
Increased width of the skull is called what?
Brachycephaly (involves coronal and lambdoidal suture)
157
Increased AP diameter of the skull is called what?
Scaphocephaly/doliocephaly (involves sagittal suture)
The most common form of craniosynostosis
Associated with Marfans disease
158
Craniosynostosis that involves asymmetric coronal and/lambdoidal sutures is called what?
Plagiocephaly
159
Which type of craniosynostosis is associated with the "Harlequin eye deformity"?
Plagiocephaly
160
What is seen with the "Harlequin eye deformity"?
Elevation of superolateral orbital corner
| Unilateral/bilateral with plagiocephaly
161
Craniosynostosis that creates a triangular appearance of the frontal skull is called
Trigonocephaly (involves the metopic suture)
162
Which eye deformity is associated with trigonocephaly?
Orbital hypotelorism (abnormal closeness of the eyes)
163
Which type of craniosynostosis is the most severe?
Oxycephaly/turricephaly (involves all sutures)
| Characterized by the "tower-like" skull
164
What are some characteristics associated with "tower-like" skull?
CN VIII lesion (vestibulocochlear)
Optic nerve compression
Mental deficiency
Syndactyly
165
List 2 differential diagnosis for thyroid acropachy
Hypertrophic osteoarthritis
| Hypervitaminosis A
166
Approximately 1% of those with thyroid acropachy also has which disease?
Graves disease
167
What is the most common cause of acromegaly?
Pituitary adenoma
168
Name some of the changes seen at the skull of someone with acromegaly
Enlarged frontal sinus
Enlarged sella turcica
Enlarged mandible
Thickened calvarium
169
Camurati-Engelmann disease is also known as what?
Progressive diaphysial dysplasia
170
Metaphyseal disease is also known as what?
Pyle disease
171
What is "hawkins" sign of the talus?
Subchondral lucency at the talar dome
| It occurs secondary to subchondral atrophy 6-8 weeks post fracture
172
Name the types of spondylolisthesis based on the Wiltse classification system
Type I: dysplastic/congenital
Abnormality not located at the pars
Type II: ischmic
The most common type
Involves pars stress fracture
Most commonly seen at L5
Type III: degenerative
Due to bilateral facet arthrosis
Most commonly seen at L4
Never more than 50% of slippage
Type IV: post-traumatic
Due to fractures
Type V: pathological
Due to diffuse/local disease
Type VI: iatrogenic
173
What is the most common location for Paget disease?
Pelvis and sacrum
174
The capitolunate angle should be less than how many degrees in neutral?
30 degrees
175
What is considered the normal range for the scapholunate angle in neutral?
30-60 degrees
176
What is the differential diagnosis list for spotty carpals?
```
"GS RAT"
Gout
Sudecks atrophy
Rheumatoid arthritis
Tuberculosis
```
177
If a third condyle is present, where is it usually located?
Between the basion (bottom of the clivus) and the anterior tubercle of C1, extra-cranial
178
If thalassemia is suspected, what other pathology should be included as a differential diagnosis?
Gaucher disease
179
In an individual with sickle cell disease, which of the following 3 diagnosis is usually the most likely: enchondroma, chondrosarcoma, or bone infarct
Bone infarct is commonly seen in sickle cell disease patients
180
What is the most common skeletal location for Langerhans cell histiocytosis?
Skull 50%
Pelvis 23%
Femur 17%
181
Skull lesions seen in Langerhans cell histiocytosis has a specific appearance, what is that sign called?
"Beveled edge" sign where the outer cranial table is more involved compared to the inner cranial table
182
Gaucher disease is most commonly seen in which specific population?
Ashkenazi Jews
183
What does bone infarct typically look like on CT?
Clear border of demarcation
Sclerotic rim
"Hollow" center appearance
Irregular contour
184
"Rodent" or "Chipmunk" facies is associated with what disease?
Thalassemia
185
Erlenmeyer flask deformity/metaphyseal flaring is seen in which pathologies?
```
"Lead GNOME"
Lead poisoning
Gaucher disease
Niemann-Pick disease
Osteopetrosis
Metaphyseal dysplasia (aka Pyle disease)
'Ematological diseases (Thalassemia, Sickle cell disease)
```
186
How does Gaucher disease affect the spleen and liver?
Hepatosplenomegaly is commonly seen
187
What is the most common suture involved in premature fusion (craniosynostosis)?
```
Sagittal suture (approximately 50%)
Creates increased A-P diameter (scaphocephaly)
```
188
When does the anterior fontanelle close?
Approximately 18-24 months after birth
| After closure it is known as the bregma
189
When does the posterior fontanelle close?
Approximately 2-3 months after birth
| After closure it is known as the lambda
190
At what age does the coronal suture close?
Approximately 24 years old
191
At what age does the sagittal suture close?
Approximately 22 years old
192
At what age does the lambdoid suture close?
Approximately 26 years old
193
At what age does the metopic suture close?
Approximately 3-9 months old
194
At what age does the squamosal suture close?
It may not completely close until approximately 60 years old
195
At what age does the sphenosquamosal suture close?
Approximately 6-10 years old
196
Which sinus is spared in thalassemia?
Ethmoid (due to lack of red bone marrow)
197
Aneurysmal bone cysts are typically seen in which age group?
Younger than 20 years old
198
What is the most common cause of primary hyperparathyroidism?
Parathyroid adenoma
199
Which cranial bone is spared in thalassemia?
Occipital bone (due to lack of red bone marrow)
200
What is the most common location site for chondromyxoid fibroma?
```
Proximal tibia (knee)
Most are within the metaphyseal region of long bone, they may extend to the epiphyseal region but usually never subarticular
```
201
What is the most common complication following a scaphoid fracture?
Avascular necrosis
202
What is Preiser disease?
Idiopathic avascular necrosis of the scaphoid
203
In what age group are most chondrromyxoid fibromas diagnosed?
Younger than 30 years old
204
What are some findings associated with hemochromatosis?
```
Hook osteophytes at the metacarpals
Bronze skin pigmentation (90%)
Hepatomegaly (90%)
Arthralgia (50%)
Diabetes (30%)
```
205
What is the most common cause of secondary hyperparathyroidism?
Renal osteodystrophy
206
What are the 2 name signs associated with hemangioma of the skull?
"Sand dollar" sign
| "Spoked wheel" sign
207
What is the most common type of hemangioma?
Cavernous hemangioma
208
How would you describe Blount disease?
A disturbance of growth at the medial aspect of the proximal tibia epiphysis and/or metaphysis (results in tibia vara)
209
"Picture frame vertebra" sign is associated with which pathology?
Paget disease
210
What is the most common primary malignancy of bone?
Multiple myeloma
211
What structure does multiple myeloma arise from?
Red bone marrow
212
What is the typical age for multiple myeloma?
Patients > 40 years old
213
What are some characteristic lab findings of multiple myeloma?
Reverse A/G ratio (decreased albumin, increased globulin)
Bence Jones proteins in urine
Decreased/normal alkaline phosphatase (unless there's a pathological fracture)
214
Does multiple myeloma prefer axial or appendicular skeleton in location?
```
Axial skeleton:
Spine is the most common location
Others include:
Ribs
Skull
Pelvis
Shoulder girdle
```
215
"Punched out lesions" and "raindrop skull" are name signs associated with what condition?
Multiple myeloma
216
What is the all-encompassing name for juvenile arthritis types?
Juvenile chronic arthritis
217
What is the "anteater nose" sign (foot) associated with?
Tarsal coalition of calcaneonavicular
218
What is the "c" sign (foot) associated with?
Tarsal coalition of talocalcaneal
219
What are the 2 most common types of tarsal coalition?
Calcaneonaviular
| Talocalcaneal
