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Radiology > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Polyostotic fibrous dysplasia: unilateral or bilateral

A

Unilateral and monomelic (one limb)

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2
Q

What aggressive lesion can present as an expansile, well-defined lytic lesion with endosteal scalloping?

A

Chondrosarcoma

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3
Q

Name 4 joints that exhibit erosions as a manifestation of degenerative joint disease

A

TMJ

AC joint

SI joints

Pubic symphysis

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4
Q

Name 4 bony lesions that can have sequestrum

A

Osteomyelitis

Lymphoma

EG

Fibrosarcoma

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5
Q

What’s associated with +ve and -ve ulnar variance?

A

Positive: TFCC tear

Negative: Kienbock disease

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6
Q

Difference between tibial stress fracture and shin splint on bone scan?

A

Stress fracture: focal, fusiform activity

Shin splint (medial tibial stress syndrome): linear increased activity along posteromedial tibial cortex

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7
Q

Young fit man (no fever) with acute knee pain- symmetrical joint space narrowing and osteophytes.

A

Reactive arthritis: uniform joint space narrowing, erosions and osteophytes

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8
Q

How often do gouty tophus calcify?

A

Rare, unless renal failure

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9
Q

30M with soft tissue mass (low T2) around knee. Lots of calcifications on CT.

A

Synovial sarcoma (20-40 Y) and 30% calcify

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10
Q

RA typical age and sign of early joint involvement?

A

40-70 F and juxta-articular osteopaenia

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11
Q

Cause of low back pain radiating down legs in dwarfism

A

Short pedicles

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12
Q

Morton neuroma- common location and MRI features

A

Symptomatic perineural fibrosis

Low T1/ T2 and intense enhancement. High on PD FS and STIR

3rd WS most common followed by 2nd WS

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13
Q

80M with rib pain and fusiform uptake in single rib on bone scan

A

Fracture (mets usually multiple and myeloma had poor sensitivity on bone scan)

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14
Q

False regarding OA

A

Reduced mineralisation. Usually get sclerosis

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15
Q

Best views of tendons on X-ray

A

ER: supra and infra

IR subscap and teres minor

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16
Q

Best view on X-ray for Hill-Sachs

A

Internal rotation

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17
Q

Focal vs broad-based disc herniation

A

Focal is less than 25%

Broad-base is 50-25%

Disc bulge is more than 50%

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18
Q

DISH

A

Diffuse idiopathic skeletal hyperostosis:

florid osteophyte formation

eventually ankylosis

disc space preserved

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19
Q

What causes annular tears?

A

Chronic wear and tear

Not acute trauma

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20
Q

Modic changes on MRI

A

Modic type I: low T1 high T2 (water)

Modic type II: high T1/ T2 (fatty marrow)

Modic type III: low T1/ T2 (sclerosis)

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21
Q

What percentage of Morton neuroma bilateral?

A

10%

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22
Q

What bone in foot/ ankle is NOT a toddler’s fracture?

A

Navicular

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23
Q

What is T-score and Z-score in DEXA?

A

Z-score is age-matched

T-score compares BMD to healthy young adult

Both are sex-matched

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24
Q

What is osteopaenia and osteoporosis in terms of T score?

A

Normal: T score > -1

Osteopaenia: between -2.5 to -1

Osteoporosis: less than -2.5

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25
Q

Where do SS tears start?

A

Critical zone: 1 cm medial to insertion anteriorly

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26
Q

Fibrous cortical defect- painful?

A

No. Unless fractured

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27
Q

Vertebral haemangioma- complication?

A

Rarely may be aggressive with epidural extension and cord compression

Bone scans usually NORMAL

28
Q

Vertebral haemangioma- complication?

A

Rarely may be aggressive with epidural extension and cord compression

Bone scans usually NORMAL

29
Q

Neonatal viral infection- bony changes?

A

Vertical metaphyseal lucent bands- celery stalk sign

30
Q

Location of Brodie’s abscess

A

Typicallly metaphyseal. Can be epiphyseal in infants

31
Q

Not a cause of Erlenmeyer flask deformity?

A

NF

Common causes: thalassaemia, osteopetrosis, leukaemia, olliers

32
Q

False re: SUFE?

A

Chondrolysis is reversible

20-40 bilateral and AVN 15%

33
Q

Cervical spine injuries in kids

A

Atlanto-axial dislocation 5X more common

In less in 5 years, most injuries occiput to C2

Anterior wedging of C5 in a 3 year old can be normal. But abnormal if 8-9 years

34
Q

Most common location for parosteal sarcoma?

A

Metaphysis most common (periosteal sarcoma diaphysis)

Lucency b/w tumour and bone (string sign)

35
Q

Most common location for parosteal sarcoma?

A

Metaphysis most common (periosteal sarcoma diaphysis)

Lucency b/w tumour and bone (string sign)

36
Q

Vit C def vs Vit D def

A

Scurvy: reduced osteoid but normal mineralisation

Rickets: normal osteoid but reduced mineralisation

37
Q

Where do skin rheumatoid nodules occur?

A

Regions of skin subjected to pressure: ulnar aspect of forearm and elbow

38
Q

Gouty tophi?

A

Pathognomonic for gout

39
Q

Name 3 benign cartilaginous lesions that can give rise to chondrosarcoma.

A

Osteochondroma

Enchondroma

Chondroblastoma

40
Q

Name 3 morphological variants of chondrosarcoma

A

Conventional intramedullary

Juxtacortical (arise from osteochondroma)

Clear cell (young patients and epiphyseal)

41
Q

Lytic phase of Paget on histolgy. What virus has been implicated?

A

Large, multinucleated osteoclasts in the lytic phase

New bone is woven or lamellar and remodelled into lamellar bone in a haphazard manner- mosaic or jigsaw pattern

Paramyxovirus

42
Q

How to differentiate chondrosarcoma from other chondroid lesions on histology?

A

Intramedullary chondroid matrix surrounding trabeculae

43
Q

How do bisphosphonates work?

A

Reduce osteoclastic activity

44
Q

Chondrosarcoma vs enchondroma in terms of location

A

CS rarely involves peripheral bones. Usually central: pelvis, shoulder, ribs, skull base

45
Q

Name 4 conditions associated with CPPD

A

Hyperparathyroidism

Haemochromatosis

Gout (40% of gout have CPPD)

Hypomagnesaemia

46
Q

What’s Letterer-Siwe and Hand-Schuller-Christian?

A

Aggressive forms of LCH

LS: less than 2 years with prominent extra-osseus involvement. Multiple lytic lesions in skull- raindrop skull

HSC: associated with DI (infiltration of posterior pituitary)

47
Q

Name 2 cxs of GCT

A

5% lung mets and 10% sarcomatous transformation

48
Q

Histology of GCT. Can it be associated with Paget?

A

Multinucleated osteoclast-like giant cells on a background of mononuclear cells.
May be associated with Pagets

49
Q

Interspinous inflammation in spine

A

Baastrup disease

50
Q

Sacral GCT

A

2nd most common primary sacral tumour after chordoma

Low T1 with areas of low T2 due to haemosiderin/ fibrosis

51
Q

What percentage of sacral chordomas are calcified?

A

70%

52
Q

What percentage of scaphoid fracture missed on initial film?

A

30%

53
Q

Minimum volume of free fluid detected by FAST scan?

A

200 mls

54
Q

Name 3 features of melorrheostosis

A

Sclerotomal distribution

Soft tissue calcifications and contractures

NO malignant transformation

55
Q

Perthes lesion of shoulder?

A

Undisplaced Bankart with periosteal stripping

56
Q

GLAD lesion of shoulder?

A

Anteroinferior labral tear

Associated glenoid cartilage injury

57
Q

GCT: what percentage malignant and mets?

A

10% malignant

5% mets but excellent prognosis (benign metastasizing GCT)

58
Q

Name the 4 types of acromion

A

Flat, curved, hooked (impingement) and upturned

59
Q

Painless osteosarcoma?

A

Paraosteal osteosarcoma: slow growing and best Px

60
Q

What nerve is most commonly damaged in knee dislocation?

A

Common peroneal nerve

61
Q

Bone scan: infection vs loosening of hip prosthesis

A

Fracture and infection will show increased uptake on blood pool due to hyperaemia. Loosening usually not.

WC scan can distinguish between infection and loosening

62
Q

Inclusion body myositis

A

Flexors of hand and wrists

Starts DISTALLY as opposed to dermatomyositis and polymyositis

63
Q

Signal characteristics of gouty tophus?

A

Intermediate T1, low T2 and enhances

64
Q

Plantar fibromatosis: M vs F?

A

More common in males

65
Q

Not associated with short limbs?

A

Cleidocranial dysplasia (AD)

66
Q

Chondrosarcoma- Px and Rx

A

Mostly indolent

Needs wide excision. Chemo and XRT usually not useful.

Radiology (16 decks)

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