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PBR 2 and 3 > Page 15 > Flashcards

Page 15 Flashcards

1
Q

Only lesion in FEGNOMASHIC that is ALWAYS CENTRAL in location

A

Solitary/simple/unicameral bone cyst

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2
Q

What are the 4 aspects of bone lesion that need to be examined to assess if it is benign or malignant?

A

Cortical destruction, periostitis, orientation/axis, zone of transition

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3
Q

What is the most useful of the 4 bone lesion criteria and why?

A

Zone of transition - easier to characterize (narrow/wide) and always present to evaluate

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4
Q

What benign conditions can cause aggressive periostitis?

A

Infection, EG, ABC, osteoid osteoma, trauma

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4
Q

What should we keep in mind about periostitis when determining if a lesion is benign or malignant?

A

Many benign lesions can cause aggressive periostitis, but malignant lesions will never cause benign periostitis

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5
Q

How do bone and soft tissue tumors usually appear on MRI?

A

Low T1, high T2 (similar to fluid); except MFH, desmoid, calcifications - low T1/T2

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5
Q

What is the usefulness of Gd in assessing msk tumors?

A

Differentiate solid mass vs fluid collection; solid-diffuse enh, fluid-peripheral enh

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6
Q

How do you differentiate central and parosteal osteosarcoma?

A

Central-destructive, usu in ends of long bones, Parosteal-originates from periosteum, grows outside of bone

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7
Q

Why is it important to distinguish parosteal osteosarcoma?

A

Considered not as aggressive or as deadly, but once it violates the cortex, it is considered as aggressive as central osteosarc

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7
Q

What is the role of cross-sectional imaging in parosteal osteosarcoma?

A

CT/MR used to assess for invasion of adjacent cortex; if with invasion - aggressive

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7
Q

What are the classic differential diagnoses for a permeative lesion in a child?

A

Ewing sarcoma, infection, EG

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8
Q

What are two mimickers of parosteal osteosarcoma?

A

Cortical desmoid, myositis ossificans

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8
Q

How do you differentiate Ewing Sarcoma and primary lymphoma of bone, which look identical radiographically?

A

Ewing-younger age group, symptomatic, PLOB-older age group, asymptomatic

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8
Q

What is the only primary tumor that virtually never presents with blastic metastatic disease?

A

Renal cell carcinoma

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8
Q

What are the two tumors that are homogeneously bright on T2 (resembling fluid collections)?

A

Neural tumors, synovial sarcomas

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8
Q

What is pathognomonic of synovial osteochondromatosis?

A

multiple calcific loose bodies in a joint

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8
Q

How do you differentiate chondrosarcoma from benign enchondroma?

A

Soft tissue mass or edema - unlikely to be enchondroma

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9
Q

The only malignant tumor that can involve a large amount of bone while the patient is asymptomatic

A

primary lymphoma of bone

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9
Q

How do we differentiate synovial sarcomas from fluid collections?

A

High T2, in a location atypical for ganglion/bursa, +gd to prove it’s solid

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10
Q

How do we differentiate PVNS from synovial osteochondromatosis?

A

PVNS virtually never has calcifications

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10
Q

Traumatic anterolisthesis of C2 over C3 with fracture of the posterior elements of C2

A

Hangman’s fracture

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10
Q

e Anterior compression of a vertebral body and avulsion fracture due to severe flexion of the cervical spine and disruption of the posterior ligaments

A

Flexion teardrop fracture

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11
Q

Oblique fracture of the spinous process of the 6th cervical - 3rd thoracic vertebrae that results from avuslsion by the supraspinous ligament

A

Clay-shoveler’s fracture

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11
Q

…mallet / baseball finger?

A

avulsion fracture at base of distal phalanx, involves extensor digitorum tendon - if not treated will result in flexion deformity

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11
Q

…gamekeeper’s thumb?

A

avulsion on ulnar aspect of first MCP joint - ulnar collateral ligament of thumb inserts - will impair normal fxn of thumb

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12
Q

…lunate/perilunate dislocation?

A

Failure to treat may result in permanent median nerve impairment

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12
Q

Why is surgical fixation important for Bennett/Rolando fracture?

A

Fracture of 1st carpometacarpal joint where adductors insert - require orif to keep alignment

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12
Q

How do you differentiate a Bennett vs Rolando fracture?

A

Base of thumb fracture with joint involvement; bennett-not comminuted, rolando-comminuted, pseudo-bennett-comminuted but not intraarticular

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13
Q

Mechanism of injury for lunate/perilunate dislocation?

A

FOOSH

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13
Q

Why is it important to catch a scaphoid fracture

A

High risk of AVN of the proximal pole, since vascular supply starts distally, and a fracture interrupts blood supply to the proximal pole

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13
Q

What is the view used to evaluate the hook of the hamate?

A

Carpal tunnel view

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13
Q

How to differentiate lunate and perilunate dislocation?

A

perilunate-capitate and the rest are dorsally displaced, lunate-only lunate is displaced volarly

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13
Q

What is AVN of the lunate called?

A

Kienbock malacia

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13
Q

What wrist pathology is associated with negative ulnar variance? positive ulnar variance?

A

Negative-Kienbock malacia; Positive-TFCC tears

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14
Q

Subluxation of the radial head in children, which is usually but not invariably transient

A

nursemaid’s elbow or pulled elbow

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15
Q

How do you differentiate Colles and Smith fractures?

A

Colles-dorsal angulation, more common; Smith-volar angulation, less common

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15
Q

How do you differentiate Monteggia and Galleazi fractures?

A

GRIMUS - Galeazzi radial fracture, inferior disloc of ulna; Monteggia ulnar fracture, superior disloc of radius

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15
Q

What should we keep in mind when we see forearm fractures?

A

Forearm bones are a two-bone system similar to a ring bone; if there is a fracture in one bone, look for another fracture or dislocation in the other. So for forearm fractures, examine the elbow for dislocation!

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15
Q

Most likely fracture site if (+) posterior fat pad in adults? in children?

A

adults - radial head; children - supracondylar fracture

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16
Q

What is a helpful indicator of occult elbow fractures?

A

Displaced posterior fat pad - in the setting of trauma, even if fracture line is not definitely identified, still treated as fracture

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16
Q

Aside from fracture, what other pathologies can also displace the posterior fat pad? This is why clinical setting is important!

A

Infection, arthritides, any elbow effusion

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17
Q

How do you diagnose pseudodislocation of the shoulder?

A

Humeral head displaced inferolaterally; in anterior disloc, HH is displaced inferomedially

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17
Q

Why is it important to properly diagnose a pseudodislocation?

A

Cause is traumatic hemarthrosis, do not attempt to reduce the dislocation; may also suggest occult humeral head fracture

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18
Q

How do you differentiate sacral stress fractures from mets?

A

Characteristic location, appearance, history of previous RT, seeing a cortical break; if bilateral, Honda sign in radionuclide scan (H logo of honda)

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18
Q

Why are avulsion injuries important to diagnose?

A

They may appear aggressive and mimic malignant lesions, but are “do not touch” lesions, so impt to diagnose so they don’t biopsy

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18
Q

What are common sites of avulsion injuries in the hip?

A

Ischium, ASIS, AIIS, iliac crest

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18
Q

What are the hallmarks of DJD?

A

Sclerosis, joint space narrowing, osteophytosis

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18
Q

What joints can have erosions as a result of DJD?

A

TMJ, AC joint, symphysis pubis, SI joint

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19
Q

Why is it important to diagnose stress fractures? Give 2 reasons

A

May appear aggressive, with aggressive periostitis, DO NOT BIOPSY; may progress to complete fractures

20
Q

How do stress fractures appear?

A

Sclerosis in weightbearing bone with horizontal/oblique linear pattern - considered as stress fracture until proven otherwise

20
Q

What view should we look at if we consider a tibial plateau fracture?

A

Cross-table lateral view to check for fat-fluid level

20
Q

What is a Lisfranc fracture-dislocation and how do we diagnose it?

A

fracture-disloc of tarsometatarsals; check alignment of 2nd MT and 2nd cuneiform

21
Q

What are examples of stress fractures?

A

Femoral neck stress fracture - most severe; femoral diaphysis, tibia, calcaneal stress fractures

21
Q

Classic triad of CPPD

A

pain, cartilage calcification, joint destruction

21
Q

What do we measure to assess if there is a calcaneal (compression) fracture?

A

Bohler angle, normal is 20-40 degrees; below 20 is suggestive of compression of the calcaneus

22
Q

What should we keep in mind in elderly patients with hip pain after trauma?

A

High index of suspicion for fracture, negative film does not exclude femoral neck fracture; MR to detect occult fracture

22
Q

Migration of femoral head in RA versus OA

A

RA - axial; OA - superolateral

23
Q

Classic triad of Charcot joint

A

joint destruction, dislocation, heterotopic new bone

24
Q

only fat pad around the hip that gets displaced with an effusion (uncommonly seen)

A

obturator internus

25
Q

Earliest sign of AVN

A

joint effusion

25
Q

Signs of AVN in temporal order

A

patchy or mottled density / sclerosis -> subchondral lucency (often not present) -> collapse of articular surface and joint fragmentation

26
Q

Triad of radiographic findings characteristic of TB arthritis?

A

Phemister’s triad: juxta-articular osteoporosis, peripherally located osseous erosions, and gradual narrowing of the interosseous space

26
Q

The only one of the four disorders in which geodes are found, that can have a normal joint and have a geode

A

AVN

27
Q

flexion at the proximal interphalangeal joints and hyperextension at the distal interphalangeal joints

A

boutonnière deformity

27
Q

hyperextension at the proximal interphalangeal joints and flexion at the distal interphalangeal joints

A

swan-neck deformity

28
Q

flexion at the metacarpophalangeal joint and hyperextension at the interphalangeal joint

A

hitchhiker’s, or Z-shaped, deformity of the thumb (also a form of boutonniere)

28
Q

loosening of the distal attachment of the extensor tendon to the distal phalanx

A

mallet or drop finger

29
Q

radial deviation of the wrist and ulnar deviation at the metacarpophalangeal joints

A

zigzag deformity

29
Q

Where is the main radiographic finding in osteoporosis (cortical thinning) most reliably demonstrated?

A

2nd metacarpal at the mid-diaphysis (should be 1/4 to 1/3 the thickness of the metacarpal)

29
Q

Why is aggressive osteoporosis considered a pseudopermeative lesion? How do you differentiate it from a true permeative lesion?

A

Intracortical holes may have a permeative/moth-eaten appearance; true permeative lesions have medullary involvement, while pseudopermeative only involves the cortex

30
Q

What are the 3 differentials for pseudopermeative lesion?

A

Aggressive osteoporosis, hemangioma, radiation

31
Q

What is the most common cause of osteomalacia?

A

Renal osteodystrophy

31
Q

What is pathognomonic for osteomalacia?

A

Looser fractures - fracture through large osteoid seams

31
Q

What are radiologic features of rickets in children?

A

Flared and irregular epiphyses, bending of long bones

32
Q

What is pathognomonic for hyperparathyroidism and where do we usually see this?

A

Subperiosteal bone resorption, most commonly seen in the radial aspect of the middle phalanges of the hand

33
Q

What are radiologic features of hyperparathyroidism?

A

Subperiosteal bone resorption, diffuse osteosclerosis, rugger-jersey spine, brown tumors

33
Q

What are radiologic features of hypoparathyroidism?

A

Calvarial thickening, basal ganglia calci

33
Q

How do you differentiate pseudohypoPTH and pseudopseudohypoPTH?

A

PseudohypoPTH have congenitally-resistant end-organs, while pseudopseudo have the same morphologic features but no end-organ resistance

33
Q

What is the effect of thyroid function on bones?

A

Affects skeletal maturation; hyperthyroidism-increased skeletal maturation, thyroid acropachy; hypothyroidism-delayed skeletal maturation, cretinism

34
Q

How does thyroid acropachy look like? (And honestly, why is it called that??)

A

Periostitis in the metacarpals and phalanges, usually ulnar aspect of 5th MC

35
Q

How do epiphyses look like in hypothyroidism?

A

Delayed ossification of epiphyses - stippled epiphyses; delayed closure or failed closure at 3rd-4th decade

36
Q

What are the characteristic features of acromegaly? (In the head? body?)

A

Head: calvarial thickening (frontal bossing), enlarged sinuses, enlarged sella turcica, prognathic jaw; body: hypertrophic phalangeal tufts (spade tufts), joint space hypertrophy, soft tissue hypertrophy

36
Q

What do you call the appearance of vertebral bodies in osteopetrosis?

A

Bone-in-bone appearance, sandwich vertebrae

36
Q

How do you differentiate gigantism from acromegaly?

A

Gigantism-before epiphyses close; acromegaly-after epiphyses close

36
Q

What are the different entities that present with osteosclerosis? (There are 10 usual ddx)

A

Regular sex makes occasional perversions much more pleasurable and fantastic. 1 renal osteodystrophy, 2 sickle cell disease, 3 myelofibrosis, 4 osteopetrosis, 5 pyknodysostosis, 6 mets, 7 mastocystosis, 8 paget dse, 9 athletes, 10 fluorosis

36
Q

What are the two types of osteopetrosis?

A

Osteopetrosis congenita-presents earlier, can be lethal; Osteopetrosis tarda-presents later, milder form

36
Q

What are other radiologic findings associated with sickle cell disease?

A

Osteosclerosis, bone infarcts, fish vertebrae, hip AVN

36
Q

What is the pathognomonic feature of pyknodysostosis (aka Toulouse-Lautrec syndrome)?

A

acro-osteolysis (resorption of distal phalanx, usually tuft) with sclerosis; distal phalanges appear as sharpened chalk

37
Q

How do you differentiate sandwich vertebrae from rugger jersey spine?

A

Sandwich vertebrae - denser, more sharply defined; Sandwich - osteopetrosis, rugger jersey - hyperPTH

37
Q

What types of carcinoma usually present with osteoblastic mets?

A

Prostate and breast, usually with cortical destruction or lytic component

37
Q

What are the 3 phases of paget disease?

A

Lytic, sclerotic, mixed lytic-sclerotic

37
Q

How can you differentiate Paget disease from others?

A

Paget usually starts at the end of a long bone (except tibia) - so if lesion is in the middle, doesn’t extend to the end of the bone, exclude Paget

38
Q

Where is Paget disease usually seen?

A

MC in pelvis, iliopectineal line usually thickened

39
Q

What is a characteristic feature of fluorosis, usually seen in the hip?

A

Ligamentous calcification, especially of the sacrotuberous ligament

40
Q

What is the typical radiographic appearance of myositis ossificans?

A

Circumferential calci with lucent center

41
Q

Where is the dorsal defect of the patella usually located?

A

Upper outer quadrant

42
Q

How do you differentiate bone islands from sclerotic mets?

A

Bone islands - oblong, with long axis in teh axis of stress on the bone, margins show bony trabeculae, spiculated

42
Q

What are the mimickers of dorsal defect of the patella?

A

Infection, osteochondritis dissecans

43
Q

Differentiate the patyspondyly seen in Morquio syndrome vs Hurler and Hunter syndromes

A

Morquio - position of beak/bony projection is central anterior; Hurler and Hunter - position of beak is anteroinferior

43
Q

Ddx for periostitis in a long bone w/o an underlying bony abnormality

A

hypertrophic pulmonary osteoarthropathy, venous stasis, thyroid acropachy, pachydermoperiostosis, trauma

43
Q

Differentiate transient osteoporosis of the hip and AVN

A

TOH - edema is greater than with AVN and no well-demarcated margin is present

43
Q

Where do overlooked tears frequently occur when ACL tears are present?

A

periphery of the meniscys and posterior horn of the lateral meniscus

44
Q

Insertion of the ACL

A

medial tibial spine

44
Q

Is discoid meniscus more common in the lateral or in the medial meniscus?

A

more common in the lateral meniscus

45
Q

3 parts of the lateral collateral ligament (LCL) and their insertion

A
  1. tendon of the biceps femoris - most posterior (head of the fibula)
  2. fibular collateral ligament - true LCL (head of the fibula)
  3. iliotibial band - most anterior (Gerdy tubercle of the tibia)
45
Q

3 tendons that make up the pes anserinus

A

sartorius, gracilis, semitendinosus

45
Q

On which side does the partial cuff tear occur more commonly?

A

Articular side

45
Q

What is the most commonly seen cuff tear on MRI?

A

Rim rent tear - articular-sided partial tear, occurs at the insertion of the cuff fibers onto the greater tuberosity

46
Q

Two normal variants in the anterosuperior labrum that can mimic a torn or detached labrum

A

sublabral foramen/recess and Buford complex

47
Q

Differentiate sublabral recess and SLAP tear

A

sublabral recess-smooth and extends medially; SLAP tear-more irregular and extends superiorly and laterally

48
Q

What are borders of the quadrilateral space?

A

teres minor superiorly, teres major inferiorly, long head of the triceps medially, and diaphysis of the humerus laterally

49
Q

What muscles does the axillary nerve innervate?

A

teres minor and deltoid

50
Q

What do you call a small bony avulsion off the fibula?

A

flake fracture

51
Q

Joint classification according to the extent of motion

A

synarthroses: fixed or rigid joints, amphiarthroses: slightly movable joints, diarthroses: freely movable joints

52
Q

Diseases Earliest recognizable pathologic abnormality in RA

A

acute synovitis

53
Q

3 early radiographic signs/characteristics of RA

A

ST swelling, regional/periarticular osteoporosis, joint space narrowing

54
Q

Ivory vertebral body is seen in Paget’s disease, mets, and lymphoma. When do you favor Paget’s disease?

A

If vertebra is enlarged, diagnosis of Paget’s is usually ensured.

55
Q

Ankylosis in TB arthritis vs pyogenic arhthritis

A

usually fibrous ankylosis in TB arthritis; usually bony ankylosis in pyogenic arthritis

56
Q

How can you differentiate TB arthritis and RA which both present with marginal erosions?

A

In TB, there is relative preservation of joint space. In RA, early loss of articular space is more typical.

56
Q

Isolated craniosynostoses

A
  1. sagittal suture (mc) increased AP diameter of the skull and decreased biparietal diameter
  2. bilateral coronal suture skull that is short in its AP diameter, often with a decrease in the depth of the orbits and maxillary hypoplasia
  3. unilateral coronal suture flatterning of the orbit on the involved side, best seen on SMV view; on frontal x-ray, harlequin-shaped orbit
  4. unilateral lambdoid suture plagiocephaly; flattening of one side of the back of the head
  5. metopic suture triangular forehead with hypotelorism

PBR 2 and 3 (41 decks)

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