Review Flashcards
60 YO F. Low back pain. Progressively worse over the last several months.
Blasted mets
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
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
Which of the following typically presents with multiple lesions?
A. enchondromas
B. giant cell tumors
C. multiple myeloma
D. osteoid osteoma
C. multiple myeloma
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
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
50 YO M. Weakness, fatigue, back pain.
Multiple, punched out, osteolytic lesions
think: MM or mets
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)
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
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
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
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
45 YO F. Recently developed knee pain.
• Popcorn like lesion, stippled at proximal tibia.
Think:
• Enchondroma. (Painless)
• Chondrosarcoma (because Pain)
40 YO F. Suffered an ankle injury 3 days ago.
Enchondroma
28 YO M. No history provided.
• Lytic, soap bubbly
• Closed growth plates
• Location at the knee
Think: Giant Cell Tumor
16 Y O M. No history provided.
• osteolytic lesion
• Open growth plates
Think: Chondroblastoma (opposite of GCT. Chondroblastoma will cross open growth plates.)
What is the rate of malignant transformation for giant cell tumors?
A. 5-25%
B. 1%
C. 75%
D. 50%
A. 5-25%
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
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
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
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
