Practise vivas Flashcards

Question

Klippel Feil

Answer 1

Two or more non-segmented cervical vertebrae Female predominant Associated with Sprengel deformity, renal anomalies (VACTERL)

Answer 2

Congenital elevation of scapula | An omovertebral bar is often present (may be fibrous or osseous

Answer 3

Benign lucent intramedullary metaphyseal (note ABC and GCT are eccentric - and are both posterior element lesions - can have UBC of posterior elements) Can rarely be seen in talus, calcaneus, iliac wing Sclerotic margin May have fallen fragment sign

Answer 4

``` Thinned ribs NF1 OI Edwards / trisomy 18 Gorham disease / progressive massive osteolysis ```

Answer 5

``` Subperiosteal resorption radial aspects of proximal and middle phalanges of index and middle fingers Subchondral bone resorption e.g. distal clavicle Acro-osteolysis Rugger jersey spine Brown tumours Salt and pepper skull Chondrocalcinosis Rib notching ``` Periarticular calcs

Answer 6

``` Bone forming tumour Painful scoliosis, concave on side of lesion, in 75% of spinal cases Central lucent nidus Surrounding reactive sclerosis Usually cortical but can appear anywhere Double density sign on NM Osteoblastoma >2cm Variable nidus MR signal - surrounding oedema ```

Answer 7

Wide histo differential so radiology important Often coexistent ABC (and fluid fluid level) 10% malignant, lung mets have excellent prognosis May appear aggressive Knee, distal radius, sacrum, vertebral body\ Only occur with closed growth plate (cf. ABCs), extend to articular surface, eccentric Solid components enhance - helps differentiate GCT with ABC from just ABC Narrow zone of transition, without sclerotic rim, metaphyseal lesion extending into epiphysis to articular surface, eccentric, no matrix, cortex may be thinned, may have periosteal reaction, may have soft tissue mass Areas of low signal on T2 from haemosiderin and fibrosis

Answer 8

=PVNS of tendon Free movement of tendon within lesions Localised nodules, low MR signal (haemosiderin) May cause pressure erosions Fibroblasts, foamy histiocytes, multinucleate giant cells and inflammatory cells in fibrous stroma Most commonly in hand Local recurrence in 10-20%

Answer 9

TB - disc preserved until late. Subligamentous spread. Typically 5-10 vertebrae. Skip lesions. Preferential anterior involvment - gibbus deformity. Posterior elements often involved. May lead to vertebra plana or ivory vertebra. Almost always have bone desctruction at time of imaging. 50% have lung disease. Abscesses common. Psoas abscess may be calcified. Absence of reactive sclerosis or periosteal reaction. Pyogenic. Starts in discs in children, endplates adults. Rapid loss of height favours pyogenic. Reactive sclerosis. Multilevel in 10%

Answer 10

Distal predominant Combination of erosion and bone proliferation Enthesites, pencil-in-cup, subluxations and ankyloses, periostitis, assymetric SI joint involvement, paravertebral ossificaiton and sparing of facet joints. Ivory phalanx - increased density from periosteal and endosteal proliferation. Unique to PA.

Answer 11

Starts in subchondral area and advances into diaphysis. Rarely diaphyseal only - in tibia. Cotton wool skull (sclerotic), and osteoporosis circumscripta

Answer 12

Asians, men Associated with DISH, ank spond May cause cord compression

Answer 13

.Haemochromatosis more likely to involve all the joints rather than just 2nd and 3rdd

Answer 14

``` Mets (prostate, breast, TCC, carcinoid, mucinous adeno, medullyblastoma, neuroblastoma, lymphoma) TB Pagets Haemangioma, chordoma Vertebroplasty ```

Answer 15

Ochronosis - nucleus pulposis, begins in lumbar spine and ascends CPPD, haemachromatosis HPT Others

Answer 16

Dilated distal 2/3 of oesophagus and leads to Barrets Hidebound small bowel Acro-osteolysis Soft tissue calcification UIP, occasionally NSIP (something previous has suggested NSIP>UIP) Severe resorption of 1st CMC joint Finger tip atrophy and rib contractures Periarticular osteoporosis, joint space narrowing, erosions ANA non specific AntiScl70 / antiDNA topoisomerase antibody highly specific, present in 10-20% (or majority)

Answer 17

Terminal: Scleroderma, thermal, Raynauds, HPT, Psoriatic arthritis, infection (leprosy), trauma, Reiters Drugs - ergotamine, phenytoin Midshaft - hajdu Cheney, PVC, HPT

Answer 18

Flexion distraction, usually upper lumbar | Association with pancreatic, duodenal injury

Answer 19

Mostly secondary to trauma, but may also occur in paraplegics Painful enlarging mass Peripheral well organised mature lamellar bone, intermediate osteoid, central non-ossified cellular (fibroblast) focus) Histologically similar to osteosarcoma Calcification 2-6 weeks after appearance. Assumes typical peripheral calc usually around 4 weeks. Becomes smaller and denser with time Differential of parosteal osteosarc (calc starts centrally), and other sarcs. Can have fluid fluid level.

Answer 20

Sublabral foramen - anterosuperiorly, does not extend beyond 3. Separation of labrum from glenoid. Buford complex - absent anterosuperior labrum, 1-3 o'clock, and thickened (cord-like) middle glenohumeral ligament

Answer 21

Glenolabral articular disruption - anterior inferior labral tear (forced adduction). Glenoid articular cartilage defect. Superior labral anterior posterior - superior labrum at biceps insertion Anterior labroligamentous periosteal sleeve avulsion - similar to a Bankart but labrum does not leave the periosteum Perthes - anteroinferior labral tear, lifted from glenoid. ALPSA and Perthes similar but in ALPSA the labrum displaces inferomedially, and inferior glenohumeral ligament bunched up and medially displaced

Answer 22

``` Bankart, bony bankart ALPSA Perthes GLAD HAGL (humeral avulsion of the glenohumeral ligament - can have GAGLs or midsubstance tears) Bony HAGL ```

Answer 23

``` OI Rickets Downs Hajdu Cheney Kinky hair Cleidocranial dysostosis Pyknodysostosis ```

Answer 24

Histology can look similar to sarcomas, so radiology important Low signal due to haemosiderin May be inflammatory or neoplastic (Robbins says neoplastic clonal) Synovial proliferation. May cause marginal erosions. Differential of synovial chondromatosis on plain film. Treat with synovectomy Calcification excludes diagnosis GRE helps look for haemosiderin Knee, hip, ankle, shoulder, others

Answer 25

Asymmetric involvement of two layers in skull in LCH

Answer 26

``` Holt Oram (along with radial ray anomaly, and ASD and coarctation) Cleidocranial dysostosis (along with wormian bones) ```

Answer 27

Convex right thoracic, left lumbar, typical for idiopathic adult scoliosis (Normal S scoliosis)

Answer 28

Communication between joint capsule and semimembranosus / gastroc bursa Between medial gastrocnemius and semimemb tendons Bimodal peak - 4-7, and 35-70

Answer 29

``` GCT Osteoblastoma TB ABC Pagets Eosinophilic granuloma ```

Answer 30

Intraosseous abscess, subacute osteomyelitis Penumbra sign of increased T1 around the abscess. Tibial metaphysis most common

Answer 31

Usually lateral 50% bilateral Prone to tears 3 consecutive slices

Answer 32

Fibrous cortical defect <20mm, non-ossifuing fibroma >20mm Common in the skeletally immature Heal by adulthood M:F 2:1 Metaphyseal, corticeal, thin rim of sclerosis

Answer 33

Psoriatic arthritis | Or Pagets

Answer 34

50% in small tubular bones of hands and feet 50% in large tubular bones Multiple in Olliers and Maffucis Usually narrow zone of transition, cortical scalloping, rings and arcs Most are metaphyseal, many are diaphyseal. If epiphyseal more likely chondrosarcoma May see increased uptake on bone scan

Answer 35

Eccentric, metaphyseal adjacent to an unfused growth plate Expansile, lytic Can be in spine, sacrum 1/3 secondary to an underlying lesion

Answer 36

>3mm change flexion extension | Or >10 degree angle change

Answer 37

Tip of dens > 7mm above Chamberlains line, from hard palate to ospisthion (posterio margin of foramen magnum) Tip of dens 5mm above McGregor line if can't see opisthion Line is from hard palate to most caudal part of occipital curve

Answer 38

Patella tendon : length of patella >1.2 in alta <0.8 in baja

Answer 39

Trochlear dysplasia, patella alta, lateralisation of tibial tuberosity Lateral trochlear inclincation - line along lateral trochlear on topmost slice showing cartilage, and line along posterior femoral condyles. Normal is >11 degrees Trochlear facet asymmetry - Medial facet should be at least 40% that of lateral (trochlear is on the femur) Trochlear depth - same plane as asymmetry measurement, average size of the largest point of facets, minus deepest groove point. Should be >3mm Patellar translation" Tibial tubercle to trochlear groove distance, parallel to the line through posterior condyles: normal <15mm, abnormal >20mm

Answer 40

OA Or resorbption in scleroderma, along with soft tissue calc, acro-osteolysis, finger tip atrophy, periarticular osteopaenia, joint space narrowings, erosions

Answer 41

Knee, capitellum, ankle Knee typically medial condyle (lateral surface of - 70%) More rarely other surfaces including patella Knee bilateral 25% Elbow more common in throwing sports Ankle - talar dome Stage 5 disease is secondary degeneration / OA (surgical staging just goes to 4)

Answer 42

Dumbbell Target sign more common in neurofibromas - central low signal of collagenous stroma on T2 Schwanommas may occur in NF2 Haemorrhage, fat formation, and cyst formation more common in Schwanomma