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Clinical Radiology 2A > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What does FEGNOMASHIC stand for?

A

Fibrous dysplasia

Enchondroma/ eosinophilic granuloma

Giant cell tumour

Nonossifying fibroma

Osteoblastoma

Metastatic diseases/ myeloma

Aneurysmal bone cyst

Solitary bone cyst

Hyperparathyroidism/ haemangioma

Infection

Chondroblastoma/ chondromyxoid fibroma

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2
Q

What are the common sites of fibrous dysplasia?

A

Pelvis, proximal femurs, ribs, skull

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3
Q

Differential for lytic lesion with bony sequestrum?

A

Lymphoma

Langerhans’ cell histiocytosis or eosinophilic granuloma

Osteomyelitis

Fibrosarcoma

Osteoid osteoma will give appearance of sequestrum when nidus is partially calcified

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4
Q

What is the differential for lytic bone lesion in the epiphysis in patients under 30?

A

Osteomyelitis

Chondroblastoma

Giant cell tumour

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5
Q

Skull lucencies in a geographic appearance are seen in which condition?

A

Langerhans’ cell histiocytosis or eosinophilic granuloma

(also have bevelled/scalloped appearance)

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6
Q

What are the three features of McCune Albright syndrome?

A

Multi-focal fibrous dysplasia

Café-au-lait spots

Precocious puberty

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7
Q

What are the causes of a pseudopermeative process

i.e. cortical process with cortical holes?

A

Osteoporosis

Haemangioma

Radiation

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8
Q

What is the differential for diffuse osteosclerosis?

A

Renal osteodystrophy

Sickle cell disease

Myelofibrosis

Osteopetrosis

Pyknodysostosis

Metastatic carcinoma

Mastocytosis

Paget’s disease

Athletes

Fluorosis

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9
Q

What is the differential for fluid-fluid levels in bone lesions?

A

Aneurysmal bone cyst

Telangiectatic osteosarcoma

Giant cell tumour

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10
Q

Which lesions affect the epiphysis?

A

Aneurysmal bone cyst

Infection

Giant cell tumour

Chondroblastoma

Clear cell chondrosarcoma

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11
Q

What is the classic differential for lucent lesion in the posterior elements?

A

ABC

Osteoblastoma

TB

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12
Q

In which disorders can you get subchondral cysts/geodes?

A

Degenerative joint disease

Rheumatoid arthritis

CPPD

AVN

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13
Q

What are the causes of a high riding humeral head?

A

Rheumatoid arthritis

Torn rotator cuff

CPPD

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14
Q

What are the radiographic hallmarks of rheumatoid arthritis?

A

Loss of joint space

Osteoporosis

Soft tissue swelling

Erosions (marginal)

*Femoral head also migrates axially, rather than superiorly as seen in OA

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15
Q

Which conditions have classically MARGINAL SYMMETRICAL SYNDESMOPHYTES?

A

Ankylosing spondylitis

Inflammatory bowel disease

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16
Q

What conditions classically have NON MARGINAL, ASSYMETRIC SYNDESMOPHYTES?

A

Psoriatic arthritis

Reactive arthritis

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17
Q

What are the imaging features of gout?

A

Well defined erosions with sclerotic borders and overhanging edges

Soft tissue nodules (can calcify presence of renal failure)

WITHOUT marked osteoporosis

Random distribution

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18
Q

Marked soft tissue wasting in the hands with ulnar deviation of the phlanges are hallmarks of what disease?

A

Systemic lupus erythematosis

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19
Q

What are the hallmarks of haemochromatosis in the hands?

A

Degenerative joint diseases 2nd-4th MCPs

Squaring of metacarpal heads

“Drooping” osteophytes (also seen in CPPD)

50% also have CPPD- look for chondrocalcinosis

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20
Q

What conditions cause epiphyseal enlargement (overgrowth)?

A

Juvenile idiopathic arthritis

Haemophilia

Paralysis

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21
Q

12 yr old female with joint pain, soft tissue swelling, osteopenia, loss of joint space, erosions, growth disturbance and hepatosplenomegaly

A

Juvenile Idiopathic Arthritis (JIA)

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22
Q

Aggressive osteoporosis, pain, soft tissue swelling and skin atrophy following minor trauma is called what?

A

Sudeck atrophy

(complex regional pain syndrome/ reflex sympathetic dystrophy)

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23
Q

What is the characteristic skin lesion seen in mastocytosis?

A

Urticaria pigmentosa

(Patients with mastocytosis also have uniformly increased bone density and thickened small bowl folds with nodules)

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24
Q

Where would you typically find a CORTICAL DESMOID and which muscle attaches there?

A

Medial supracondylar ridge of distal femur (posterior)

ADDUCTOR MAGNUS tendon attaches here.

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25
Q

What is the differential for a periosteal reaction in a long bone without an underlying bone lesion?

A

Hypertrophic (pulmonary) osteoarthropathy

Venous stasis

Thyroid acropachy

Pachydermoperiostosis

Trauma

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26
Q

Regions of sclerosing bone, cortical thickening with a “dripping wax” appearance

A

Melorheostosis

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27
Q

55 yr old with metadiaphyseal sclerosis with sparing of epiphyses, diabetes incipidus, exophthalmos and bone pain

A

Erdheim-Chester disease

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28
Q

What are the imaging characteristics of a Morton’s neuroma?

A

Low signal on T1, T2 and STIR

Usually enhance with gadolinium

Hypoechoic mass on ultrasound

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29
Q

In which conditions would you see a “Shepherd’s crook” deformity of the proximal femur?

A

Fibrous dysplasia

Paget’s disease

Osteogenesis imperfecta

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30
Q

What is the differential diagnosis for widening of the intercondylar notch?

A

Rheumatoid/JIA

Psoriatic arthropathy

Haemophilia

TB

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31
Q

What is a differentiating feature of malignant fibrous histiocytoma (MFH) vs myositis ossificans?

A

Myositis ossificans can cause a periosteal reaction but WILL NOT cause bony erosions, MFH can cause cortical erosion.

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32
Q

What are the names of the 9 flexor tendons which pass through the carpal tunnel?

A

Flexor digitorum profundus (x4)

Flexor digitorum superficialis (x4)

Flexor pollicis longus (x1)

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33
Q

32 yr old man with osteonecrosis, splenomegaly and Erlenmeyer flask deformity. Diagnosis?

A

Gaucher disease

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34
Q

What is a Madelung deformity?

A

Bowing of the radial shaft with ↑ interosseous space and dorsal subluxation of distal radio-ulnar joint

Decreased carpal angle < 120°

“V-shaped” proximal carpal row

Positive ulnar variance

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35
Q

What is the differential for arthritis with NO demineralisation?

A

NO DEMINERALISATION

Psoriatic

O​steomyelitis

Neuropathic joint

Gout

Sarcoidosis

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36
Q

What is the differential for arthritis with demineralisation?

A

DEMINERALISATION

Haemophilia

O​steomalacia

Rheumatoid/Reiters

Scleroderma

ESLE

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37
Q

Name the different aetiologies of a Madelung deformity.

A

Dysplastic (Ollier, osteochondromatosis, achondroplasia, mucopolysaccharidosis, MHE)

Idiopathic

Genetic (Turner syndrome most common)

Infection

Traumatic

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38
Q

What are the imaging features of tuberculous discitis?

A

Calcification (almost pathognomonic)

Involvement of posterior elements

Insidious onset

Less loss of disc space

Gibbus deformity (angular kyphosis)

Multiple levels involved

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39
Q

Which dermatome supplies the area over the deltoid?

A

C5

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40
Q

Which dermatome supplies the middle finger?

A

C7

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41
Q

Which dermatome supplies the xiphisternum?

A

T8

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42
Q

Which dermatome supplies the thumb?

A

C6

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43
Q

Which dermatome supplies the little finger?

A

C8

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44
Q

Which dermatome supplies the ischial tuberosity area?

A

S3

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45
Q

Which dermatome supplies the perianal region?

A

S4/5

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46
Q

Which dermatome supplies the nipple line?

A

T4

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47
Q

Which dermatome supplies the umbilicus?

A

T10

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48
Q

Which dermatome supplies the medial aspect of the calf?

A

L4

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49
Q

Which dermatome supplies the web-space between the 1st and 2nd toes?

A

L5

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50
Q

Which dermatome supplies the lateral border of the foot?

A

S1

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51
Q

What is the differential for a block vertebra (failure of separation of two or more adjacent vertebral bodies)?

A

Klippel-Feil syndrome

Rheumatoid arthritis

Ankylosing spondylitis

Post-operative

Post-traumatic

Post-TB infection

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52
Q

What is the most common congenital shoulder abnormality?

A

Sprengel deformity

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53
Q

Patients with Sprengel deformity of the shoulder often have which other abnormalities?

A

Klippel-Feil syndrome

Spina bifida

Kyphoscoliosis

Torticollis

Under-development of the clavicle or humerus

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54
Q

What are the features of a Sprengel shoulder?

A

Elevation and rotation of the scapula with the inferior angle directed laterally.

Omovertebral bar (fibrous, cartilaginous and/ or osseous connection between the scapula and cervical spine).

Hypoplasia or atrophy of regional muscles.

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55
Q

Which spinal level is supplies quadriceps, patella reflex and sensation over the knee/ shin?

A

L3 /4

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56
Q

Which spinal level supplies the iliopsoas and hip adductors and the anterior thigh sensation?

A

L1 /2

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57
Q

Which spinal level supplies hip extension, extension of the big toe, ankle inversion, ankle reflex and sensation to the sole of the foot?

A

L5/S1

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58
Q

Which spinal level supplies iliopsoas and hip adductors and medial thigh and knee sensation?

A

L2 /3

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59
Q

Which spinal level supplies dorsiflexion of the foot, ankle eversion and sensation to the lateral calf?

A

L4 /5

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60
Q

What is the differential for posterior vertebral body scalloping?

A

Syringomyelia

Achondroplasia

Tumours (ependymoma, lipoma, dermoid, neurofibroma)

Acromegaly

Neurofibromatosis type 1

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61
Q

What is the most reliable sign of AVN?

A

Dark signal on T1

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62
Q

What is O’Donoghue’s triad?

A

ACL tear

MCL tear

Medial meniscal injury

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63
Q

What are the causes of erosion of the lateral clavicles?

A

Hyperparathyroidism

Rheumatoid arthritis

Scleroderma

Psoriatic arthropathy

Cleidocranial dysostosis

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64
Q

What is the differential for an ivory vertebra in an adult?

A

Paget

TB spondylitis

Haemangioma

Metastases

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65
Q

What is the differential for an ivory vertebra in a child?

A

Lymphoma

Osteosarcoma

Osteoblastoma

Ewing sarcoma

Metastatic medulloblastoma

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66
Q

Which fracture is associated with a perilunate dislocation?

A

Scaphoid in 60%

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67
Q

Describe the features of perilunate dislocation in terms of the scapholunate and capitolunate angles.

A

Lunate remains in articulation with the radius

Reduced scapholunate angle (<30) and increased capitolunate angle (>60)

Associated with a scaphoid fracture

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68
Q

Which other injuries are associated with a midcarpal dislocation?

A

Triquetrolunate interosseous ligament disruption

Triquetral fracture

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69
Q

What other injury is associated with a lunate dislocation?

A

Dorsal radiolunate ligament injury

70
Q

Describe the features of a lunate dislocation.

A

Lunate displaced and volarly rotated

Disruption of all perilunate ligaments

71
Q

Describe a midcarpal dislocation

A

Dislocation of the capitate from the lunate and subluxation of the lunate from the radius

72
Q

What happens to the scapholunate angle with dorsiflexion of the lunate in dorsal intercalated segmental instability?

A

Widens to >60

73
Q

The pull of which tendon is responsible for the dorsolateral dislocation in a Bennett fracture?

A

Abductor pollicis longus

74
Q

What is the eponymous name for an avulsion fracture of the base of the proximal 1st phalanx associated with ulnar collateral ligament disruption?

A

Gamekeepers thumb

75
Q

What is a Stener lesion?

A

Following gamekeepers thumb there is slippage of the torn end of the ulnar collateral ligament superficial to the adductor pollicis muscle so that there is interposition of the adductor pollicis muscle between the ulnar collateral ligament and the MCP joint.

76
Q

Guyon’s canal is formed by which bones?

A

Pisiform and hamate

77
Q

What passes through Guyon’s canal?

A

Ulnar nerve, artery and vein

78
Q

Posterior dislocation at the elbow is associated with what fracture?

A

Capitellum

79
Q

What is a Monteggia fracture?

A

Fracture of the proximal ulna with anterior dislocation of the radial head

80
Q

What is a Galeazzi fracture?

A

Radial shaft fracture

Anterior dislocation of the ulna at the distal radioulnar joint

81
Q

A Hill Sachs fracture is best seen on which view?

A

Internal rotation view

82
Q

Inferior dislocation normally results in an injury to what structure?

A

Axillary nerve

83
Q

Fracture of the iliac crest results from an avulsion of which muscle?

A

Abdominal muscles

84
Q

Fracture of the ASIS results from an avulsion of which muscle?

A

Sartorius

85
Q

Fracture of the AIIS results from an avulsion of which muscle?

A

Rectus femoris

86
Q

Fracture of the greater trochanter results from an avulsion of which muscle?

A

Gluteal muscles

87
Q

Fracture of the lesser trochanter results from an avulsion of which muscle?

A

Illiopsoas

88
Q

Fracture of the symphysis results from an avulsion of which muscle?

A

Adductors

89
Q

Fracture of the ischial tuberosity results from an avulsion of which muscle?

A

Hamstrings

90
Q

Which patients get pincer type femoroacetabular impingement?

A

Middle aged women

91
Q

Which patients get cam type femoroacetabular impingement?

A

Young males

92
Q

What is pincer type femoroacetabular impingement?

A

Over-coverage of the femoral head by the acetabulum

93
Q

What is cam type femoroacetabular impingement?

A

Bony protrusion on the antero-superior femoral head-neck junction

94
Q

A segond fracture is a fracture of where?

A

Lateral tibial plateau

(occurs with internal rotation)

95
Q

An avulsion fracture of the proximal fibula at the insertion of the arcuate ligament complex is associated with what other injury in 90%?

A

Cruciate ligament, usually PCL

96
Q

What is commonly associated with a patellar tendon tear?

A

SLE

(but also trauma, RA, elderly)

97
Q

Which tendons can become entrapped with lateral calcaneal fractures?

A

Peroneal tendons

98
Q

Spontaneous osteonecrosis of the knee is commonly found in what location?

A

Medial femoral condyle

99
Q

What is a T-score in regards to DEXA scanning?

A

Bone density relative to a young adult

100
Q

What is a normal T score on DEXA scan?

A

> 1.0

101
Q

What is the osteopenia T-score range?

A

-1.0 to -2.5

102
Q

What is the T-score for osteoporosis?

A

< -2.5

103
Q

Which tendons are affected in De Quervains tenosynovitis?

A

Abductor pollicis longus and extensor pollicis brevis (1st compartment)

104
Q

AVN of the lunate (Kienbocks) is associated with what?

A

Negative ulnar variance

105
Q

What are the MRI features of a glomus tumour of the finger?

A

T1 low, T2 bright, avid enhancement

106
Q

What are the MRI features of a giant cell tumour of the tendon sheath of the finger?

A

T1/T2 dark

blooming artefact on gradient

107
Q

What are the MRI features of a fibroma of the finger?

A

T1/2 dark

Will not have blooming artefact like the giant cell tumour

108
Q

Where is the most common location for an acetabular labral tear?

A

Anterior superior labrum

109
Q

Intersection syndrome is a repetitive use issue resulting in tenosynovitis of which tendons?

A

Extensor carpi radialis brevis and longus

110
Q

Diffuse tenosynovitis of the hand and wrist with sparing of the muscles in an immunocompromised patient. Diagnosis?

A

Non-tuberculous mycobacterial infection

111
Q

Which accessory muscle can classically cause cubital tunnel syndrome?

A

Anconeus epitrochlearis

112
Q

Which tendon is classically injured in lateral epicondylitis?

A

Extensor carpi radialis brevis

113
Q

A SLAP tear involves the labrum at the insertion of which tendon?

A

Long head of biceps

114
Q

Describe the features of the normal variant sublabral recess.

A

Incomplete attachment of the labrum at 12 o’clock which follows the contour of the glenoid and has smooth margins

115
Q

Describe the features of the normal variant sublabral foramen.

A

Unattached (but present) portion of the labrum at the 1 o’clock to 3 o’clock positions (anterior/superior)

116
Q

What is the Buford complex?

A

Absent anterior/ superior labrum (1-3 o’clock). Thickened middle glenohumeral ligament.

117
Q

What is the mildest Bankart-type lesion?

A

Glenolabral articular disruption (GLAD)- superficial anterior inferior labral tear with associated cartilage damage

118
Q

What is the difference between Perthes lesion and anterior labral periosteal sleeve avulsion (ALPSA)?

A

In Perthes the anterior labrum is avulsed but undisplaced whereas in ALPSA the labrum is displaced inferomedially. The inferior glenohumeral ligament remains attached to periosteum in Perthes but is displaced medially in ALPSA.

119
Q

What is a Bankart lesion?

A

Disruption of the periosteum and torn labrum

120
Q

Which ligament is avulsed in a humeral avulsion glenohumeral ligament (HAGL) injury?

A

Inferior glenohumeral ligament

121
Q

A subscapularis tear can result in dislocation of what structure?

A

Medial dislocation of the long head of biceps

122
Q

A cyst at the level of the suprascapular notch will affect which muscle(s)?

A

Supraspinatus and infraspinatus

123
Q

A cyst at the level of the spinoglenoid notch will affect which muscle(s)?

A

Infraspinatus

124
Q

Compression of the axillary nerve in the quadrilateral space will result in atrophy of which muscle?

A

Teres minor

125
Q

What would you find at the superior border of the quadrilateral space?

A

Teres minor

126
Q

What would you find at the inferior border of the quadrilateral space?

A

Teres major

127
Q

What would you find at the lateral border of the quadrilateral space?

A

Humeral neck

128
Q

What would you find at the medial border of the quadrilateral space?

A

Triceps

129
Q

Sudden onset pain with profound weakness in 1-2 days in muscles affected by two or more nerve distributions (eg suprascapular and axillary) and no history of trauma. Diagnosis?

A

Parsonage-Turner syndrome

130
Q

What is the primary stabiliser of the longitudinal arch of the foot?

A

Posterior tibial tendon

131
Q

What is the most common soft tissue sarcoma in adults?

A

Pleomorphic undifferentiated sarcoma

132
Q

Painful soft tissue mass in the lower extremity of a 20-40 year old which has soft tissue calcification and bony erosions.

A

Synovial sarcoma

133
Q

What are the features of Mazabraud syndrome?

A

Polyostotic fibrous dysplasia.

Soft tissue myxomas.

133
Q

What is Ollier’s syndrome?

A

Multiple enchondromas

134
Q

What are the features of Maffuci’s syndrome?

A

Multiple enchondromas.

Haemangiomas.

Chondrosarcoma.

Other malignancies.

135
Q

Plasmacytoma in a vertebral body has which classic appearance?

A

“mini-brain”

136
Q

What is the name from osteochondromas which develop in epiphyses causing joint deformity?

A

Trevor disease

AKA dysplasia epiphysealis hemimelica

137
Q

Gullwing appearance is seen in which joints and which condition?

A

DIP joints.

Erosive osteoarthritis.

138
Q

What are the features of Felty syndrome?

A

Rheumatoid arthritis.

Splenomegaly.

Neutropenia.

139
Q

Hooked osteophytes can be seen in which conditions?

A

CPPD.

Haemochromotosis.

140
Q

Rugger Jersey spine is classically seen in which condition?

A

Hyperparathyroidism

141
Q

Big bridging lateral osteophytes are classically seen in which condition?

A

Psoriatic arthritis

142
Q

Patients with Jaccoud’s arthropathy (non-erosive arthropathy with ulnar deviation of the 2nd-5th fingers at the MCP joints) usually have a history of what?

A

Rheumatic fever

(also seen in association with SLE)

143
Q

“Frond-like” deposition of fatty tissue in the supra-patellar bursa of the knee. Diagnosis?

A

Lipoma arborescens

144
Q

What is the syndrome seen most commonly in young athletic males with repetitive shoulder movements where by there is compression and thrombosis of the subclavian vein as it enters the thorax?

A

Paget Schroetter syndrome

145
Q

Which disease is characterised by bone pain, exophthalamus, retroperitoneal fibrosis, diabetes incipidus and dyspnoea?

A

Erdheim Chester disease

146
Q

Oedema of flexor carpi ulnaris and ulnar nerve thickening suggests which diagnosis?

A

Cubital tunnel nerve entrapment

147
Q

Posterior interosseous nerve entrapment can result in the atrophy of which muscle group?

A

Extensor muscles

148
Q

Anomalous aconeous epitrochlearis muscle can result in entrapment of which nerve?

A

Ulnar nerve

(cubital tunnel syndrome)

149
Q

The posterior interosseous nerve is a branch of what nerve?

A

Deep branch of the radial nerve in the forearm

150
Q

Where is the most common site of posterior interosseous nerve entrapment?

A

Superficial head of the supinator muscle along the arcade of Frohse

151
Q

Which arthropathy affects the shoulders, carpal bones and hips in a bilateral fashion with subchondral cysts, juxta-articular swelling and low-to-intermediate soft tissue within and around the joint?

A

Amyloid arthropathy

(typically associated with long-term renal dialysis)

152
Q

What is the disease characterised by tendinosis of the proximal origin of the patella?

A

Sinding-Larsen’s disease

153
Q

At what distance is the tibial tuberosity to trochlear groove distance abnormal and associated with transient patellar dislocation?

A

>20mm

154
Q

What are the imaging features of haemophilic arthropathy?

A

Widening of the intercondylar notch

Flattening of the condylar surfaces

Squaring of the patella

Epiphyseal enlargement

155
Q

Bowing of the tibia (tibia vara) with wedge-shaped or fragmented epiphysis, depressed/ beak-like protuberance of the metaphysis and metaphyseal-diaphyseal angle >11. Diagnosis?

A

Blount disease

156
Q

What are the skeletal features of primary and secondary hyperparathyroidism?

A

Primary: Brown tumours, chondrocalcinosis

Secondary: osteosclerosis (Rugger-Jersey spine)

Both: subperiosteal bone resorption, soft tissue calcification

157
Q

What are the features of vitamin C deficiency (Scurvy)?

A

Bleeding gums

Metaphyseal bony spurs (“Pelkan spurs”)

Sclerotic line around perimeter of the epiphysis secondary to osteopenia (Wimberger line)

Ground glass osteoporosis

Cortical thinning

158
Q

What are the features of Milwaukee shoulder?

A

Degenerative change: loss of joint space, subchondral sclerosis/ cysts (not osteophytes)

Destruction of subchondral bone

Intra-articular loose bodies

Capsular calcification

Joint effusion

Complete rotator cuff tear

159
Q

What are the features of Thalassaemia?

A

Widened diploic space

“Hair on end” appearance of the skull

Sparing of the occipital bone

Absent/ reduced pneumatisation of the paranasal sinuses (spares ethmoid)

Erlenmeyer flask deformity (also seen in Gaucher disease)

160
Q

What are the features of a scapholunate dissociation and which view can be carried out to emphasise this?

A

Scapholunate joint > 3mm

Clenched fist view will worsen

161
Q

What is the pattern of bone bruising in a pivot shift injury?

A

Postero-lateral tibial plateau and lateral femoral condyle

162
Q

What is the pattern of bone bruising in a knee hyperextension injury?

A

Anterior tibial plateau and anterior femoral condyle

163
Q

What is the pattern of knee bone bruising in a dashboard injury?

A

Anterior tibia

164
Q

What is the pattern of knee bone bruising in a clip injury?

A

Lateral femoral condyle and lateral tibial plateau

165
Q

Which ligament is commonly injured in a pivot shift injury to the knee?

A

ACL

166
Q

Which ligament is commonly injured in a hyperextension injury to the knee?

A

ACL, PCL

167
Q

Which ligament is commonly injured in a dashboard injury to the knee?

A

PCL

168
Q

Which ligament is commonly injured in a clip injury to the knee?

A

MCL

169
Q

Patient aged 20-40 with a painful soft tissue mass near the joint. This has soft tissue calcification, bone erosion and fluid-fluid levels. What is the diagnosis?

A

Synovial sarcoma

Clinical Radiology 2A (8 decks)

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