Review Flashcards by Beck Forsland

60 YO F. Low back pain. Progressively worse over the last several months.

Blasted mets

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55 YO M Low back pain, insidious onset. Decrease in appetite for the last several months.

Missing pedicle L1. (MC cause for missing pedicle = mets)
Lateral cervical film: C5 is missing.
Red flags in Hx
Think: mets or MM

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Which of the following is considered a MALIGNANT finding?

A. sclerotic border

B. cortical destruction

C. soap, bubbly, lytic appearance

D. expansile

B. cortical destruction

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Which of the following typically presents with multiple lesions?

A. enchondromas

B. giant cell tumors

C. multiple myeloma

D. osteoid osteoma

C. multiple myeloma

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Which of the following is NOT on the list of differential diagnosis for an ivory vertebra?

A. metastasis

B. Paget’s disease

C. osteoporosis

D. lymphoma

C. osteoporosis

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Which of the following is NOT on the list of differential diagnosis for a pathological compression fracture/pancake vertebra/universal compression fracture?

A. osteoporosis

B. fibrous dysplasia

C. multiple myeloma

D. metastasis

B. fibrous dysplasia

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50 YO M. Weakness, fatigue, back pain.

Multiple, punched out, osteolytic lesions

think: MM or mets

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15 YO M. Arm pain and swelling

Soft tissue swelling
Laminated single layer on medial side
Skeletal immature
Think: Ewing’s sarcoma, Osteosarcoma (consider: MOCE because they are the top 4 tumors) or Osteomyelitis (because its infectious)

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A 15 YO male patient presents with swelling at the R. arm, fever, radiographic findings show laminated periosteal response in the diaphyseal location. Which TWO possible diagnosis will you consider?

A. aneurysmal bone cyst

B. Ewing’s sarcoma

C. metastasis

D. osteomyelitis

B. Ewing’s sarcoma

D. osteomyelitis

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Which of the following is the most common BENIGN tumor of the hand?

A. hemangioma

B. enchondroma

C. giant cell tumor

D. osteoma

B. enchondroma

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The favorite location of this BENIGN tumor is in the facial/skull bones (eg. the sinuses), which is the correct choice?

A. osteoma

B. osteoid osteoma

C. giant cell tumor

D. enchondroma

A. osteoma

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Which one of the following typically does NOT present with erosions?

A. rheumatoid arthritis

B. ankylosing spondylitis

C. systemic lupus erythematosus

D. reactive arthritis

C. systemic lupus erythematosus

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45 YO F. Recently developed knee pain.

• Popcorn like lesion, stippled at proximal tibia.
Think:
• Enchondroma. (Painless)
• Chondrosarcoma (because Pain)

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40 YO F. Suffered an ankle injury 3 days ago.

Enchondroma

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28 YO M. No history provided.

• Lytic, soap bubbly
• Closed growth plates
• Location at the knee
Think: Giant Cell Tumor

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16 Y O M. No history provided.

• osteolytic lesion
• Open growth plates
Think: Chondroblastoma (opposite of GCT. Chondroblastoma will cross open growth plates.)

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What is the rate of malignant transformation for giant cell tumors?

A. 5-25%

B. 1%

C. 75%

D. 50%

A. 5-25%

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If you are considering metastasis as a possible diagnosis, which of the following should also be considered/ruled out?

A. osteosarcoma

B. chondrosarcoma

C. multiple myeloma

D. osteoma

C. multiple myeloma

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Which of the following is the most common BENIGN neoplasm of the spine?

A. giant cell tumor

B. osteoid osteoma

C. hemangioma

D. enchondroma

C. hemangioma

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Which of the following is NOT typically considered as a possible DDX when a patient has a painful scoliosis?

A. aneurysmal bone cyst

B. osteoblastoma

C. giant cell tumor

D. osteoid osteoma

C. giant cell tumor

What presents as blastic?
• Osteoid osteoma

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3 YO M. Several months of R. thigh pain.

Nidus
Eccentric
Relieved by aspirin
• Think: Osteoid osteoma

40 YO M. Several months of back pain.

Entire joint space gone
T12-L1 Disc is gone
• Think: Infectious discitis

32 YO M. Several months of back pain.

• Endplate destruction
• Loss of disc height /space
• Acute kyphosis at the 2 segments (might look like retrolisthesis)
Think: infectious discitis

52 YO M. Complains of difficulty with eating.

• Hyperostosis of ALL
• NORMAL disc height
• T or L shape (orange)
• Look for OPLL 85% of the time - look for this because of central canal stenosis
Think: DISH

Which of the following pathologies is NOT considered to be degenerative? A. osteoarthritis B. DISH C. gout D. synovial chondrometaplasia

C. gout (Considered to be metabolic)

A 25 YO male patient presents with low back pain. Radiographic findings include bilateral sacroiliitis, marginal syndesmophytes, and ossification of supraspinatous ligament. What is the most likely diagnosis? A. reactive arthritis B. ankylosing spondylitis C. DISH D. osteoarthritis

B. ankylosing spondylitis - MC arthropathies

A 25 YO male patient complains of heel pain that started several weeks ago. He also complains of having red, itchy, eyes. Which of the following is the most likely diagnosis? A. reactive arthritis B. enteropathic arthritis C. ankylosing spondylitis D. psoriatic arthritis

A. reactive arthritis - remember the triad

Which of the following is NOT a seronegative arthropathy? A. rheumatoid arthritis B. reactive arthritis C. psoriatic arthritis D. ankylosing spondylitis

A. rheumatoid arthritis

63 YO F. Complains of an achy neck.

• Facet degeneration Think: Osetoarthritis

25 YO M. Presents with elevated ESR of 80mm/hr (normal range: 0- 15mm/hr)

• Bi SI Erosions • Category: Seronegative • Think/most likely: **AS/Enteropathic.** ◦ However cannot r/o Psoriatic/Reactive

36 YO F. Low back pain.

• SI joints preserved • Bilateral sclerosis • Sclerosis primarily iliac side - triangle? Think: **osteitis condensions ilii (OCI)** Tx: self resolving

28 YO M. Chronic low back pain and stiffness.

• Sclerosis • Fusion of SI joints visible because of all the sclerosis • marginal syndesmophytes = bamboo spine Think: **AS/Enteropathic**

Which of the following is considered to have a combination of inflammatory and degenerative changes? A. rheumatoid arthritis B. erosive osteoarthritis C. DISH D. synovial chondrometaplasia

B. erosive osteoarthritis

Which of the following is NOT a known complication of DISH? A. carrot stick fracture B. dysphagia C. ossification of PLL D. joint space narrowing

D. joint space narrowing

Which of the following is associated with a butterfly rash on the face? A. scleroderma B. rheumatoid arthritis C. systemic lupus erythematosus D. osteitis condensans ilia

C. systemic lupus erythematosus

Which of the following is NOT typically associated with osteitis pubis? A. inflammation of the joint B. erosive changes at the joint C. pain with hip adduction D. strong female predilection

D. strong female predilection * OCI has female predisposition * Osteitis pubis M=F

53 YO M. Chronic low back pain. Presents with anterior head carriage.

DISH

45 YO F. Bilateral wrist and hand pain with swelling.

* Bilateral * DIPs are WNL * PIPs, MCP and wrist * Think: RA

65 YO F. Chronic hand and wrist pain

* Pencil-in-cup deformity * DIPs * Think: Psoriatic (MC: UE)/Reactive (MC: Feet)

50 YO F. Joint pain in the hands bilaterally.

* Gull wings * Distal joints * Think: erosive OA

Which location at the hands/wrist is usually NOT affected by rheumatoid arthritis? A. radio-carpal joint B. intercarpal joints C. MCP joints D. DIP joints

D. DIP joints

Which disease process is associated with the “gullwing” sign/appearance? A. psoriatic arthritis B. rheumatoid arthritis C. erosive osteoarthritis D. reactive arthritis

Which of the following is NOT associated with ankylosing spondylitis A. ghost joints B. dagger sign C. shiny corner sign D. pencil in cup deformity

D. pencil in cup deformity - Psoriatic/Reactive

What is a common nail deformity seen with psoriatic arthritis patients? A. paronychia B. pitted nails C. lifting of nails D. beau lines

B. pitted nails

48 YO M. Chronic wrist pain.

• decreased space • Sclerosis • Osteophytes Think: OA

56 YO F. Chronic bilateral knee and shoulder pain.

• Calcification of miniscus Think: **CPPD** **Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease**

45 YO M. Chronic knee pain.

* Decreased joint space * Subluxation caused by OA 2˚ to **_CPPD_**

48 YO M. Bilateral feet pain with inflammation and soft tissue changes.

• Subluxation **Think: Gout** DDX: neuropathic arthropathy / Charcot joint • does NOT haveC-sign

Which of the following can affect multiple systems and is primarily connective tissue based? A. scleroderma B. rheumatoid arthritis C. reactive arthritis D. enteropathic arthritis

A. scleroderma

The “pencil in cup” deformity and “fluffy new bone/periostitis” is associated with which of the following? A. ankylosing spondylitis B. reactive arthritis C. psoriatic arthritis D. enteropathic arthritis

C. psoriatic arthritis

Which of the following is NOT usually a concern for neuropathic arthropathy patients? A. diabetes B. infections C. dislocations D. malignant degeneration

D. malignant degeneration

Which of the following is NOT considered one of the 5 stages of gout? A. acute B. asymptomatic C. intermediate D. chronic

C. intermediate CORRECT: Intercritical