MSK Autumn 2013
1. Vertebrae with an area of increased signal on T1 and T2 in a middle aged
woman ?hamenagioma ? melanoma met
2. Ivory vertebrae
3. Glenohumeral instability evaluation - ?US/MRI/plain films
4. A 27yr old runner with right lumbrosacral pain – fluid in right SI joint,
increased CRP, WBC, increased STIR signal ?Reuters
5. Xray demonstrates abnormal vertebrae with scalloping of the posterior
elements of L3-L5 ?TB ? lymphoma
6. Man with HCC and faint TFF cartilage calcification –peri arthritic
7. Investigation of peri-prosthetic infection – Xray/Bone scan/WBC labelled scan
8. Table question-needed to select the correct 3 combinations:
Base of 5th metatarsal fracture
Is 90/lateral to diaphysis: stable/unstable: associated with
avulsion of peroneus brevis/longus
9. HPOA in a smoker- next best investigation is CXR/chest CT/Bone scan/local
CT/MRI
10. Osteoid osteoma in a young girl on xray
11. ?signs of recurrent lymphoma on MRI - ??serpinginous lines
12. A 75yr old female is having an MRI for investigation of a suspicious ovarian
lesion-had Grade 3 breast cancer 15years ago, which was node negative. Now
incidental multiple sclerotic foci in pelvic bones (cant remember if
solitary/multiple) with increased uptake on bone scan - ?bone islands ?mets
from ovarian cancer ?stress fractures
13. Findings on an ankle xray that sound like HPOA – next best investigation
14. Soft tissue calcification adjacent to lesser trochanter – which ligament is it
in?(teres minor etc)
15. Combination of injuries following an anterior dislocation of shoulderBankart/Hill Sachs…
16. Bony abnormality on lateral view of carpal bones ? triquetral instability
17. Nailbed tumour in a 15 year old girl which is avascular –? glomus
keratoacanthoma?
18. C-spine abnormality in a child: What is abnormal-a lucent line : anterior and
posteriorly within the vertebral body, 1 lucent line anteriorly or 1 lucent line
posteriorly etc
19. An 8year old boy is suspected of having atlantoaxial instability – what is the
best investigation: AP and lateral with PEG view/dynamic CT/normal CT/MRI
20. Occipital head injury in a fall from standing- has neck pain and bilateral
lower limb weakness- choose investigations: MRI/CT head/C-spine/clear Cspine
21. A 6 week old injury to the lateral malleolus: now found to be
unstable: ?disruption to which ligament-anterior fibulo/talar/fibulocalcaneal
22. Painful sole with tenderness at the site of insertion at the medial malleolus
and plantar muscle swelling-which tendon
23. 16 year old boy with a permeative lesion with 15cm soft tissue swelling- no
bony matrix (I think) ?Ewings ?ostesarcoma
24. A 40 yr old postman with right groin pain for 6 weeks
25. Classic description of intraosseus lipoma
26. Diagnosis: Brown spots and endosteal scalloping and distal flaring of
metaphysis, limb shortening and pain
27. Which option is “less likely for Perthes” (?epiphyseal plate widening)
28. Which option is “less likely for psoriatic arthropathy” (?osteoporosis)
29. Another tendon insertion question..
30. An avulsion fracture in an elderly lady which is supposed to be
pathonomonic for malignancy: lesser trochanter /ASIS/ISIS/greater trochanter
31. Ischial tuberosity avuslion fracture
32. Segond fracture
33. O’Donaghue’s unhappy triad
34. 15year old with a densely calcified lesion at the elbow ?tumoral calcinosis
35. ALVAL (lymphocyte-dominated vasculitis-associated lesion) a periprosthetic complication most likely with what prosthesis (= inserted 2 years
ago)..? metal on metal/plastic..
36. Middle aged woman had radiotherapy for chordoma 5 years ago, now has
neural problems-spastic bladder etc; Xray shows erosion of the symphysis pubis
and an expansile high T2 and low T1 lesion - ?radiolucent
osteosarcoma ?chordoma mets
37. Epipyhseal widening and metaphyseal flaring in a 2 year old - ?rickets
38. A 15th month old started walking 3 months ago. Weight bearing, but bowed
legs, bloods are normal-GP wants whole leg views – what to do ?frog
leg?nothing?hip?whole leg
39. Shoulder views should be taken at the level of the acromion/clavicular etc
40. ?Zygomatic fracture – which view ?OM ? OM <30
41 Which option is “less likely for a pathological vertebral fracture” ?complete
bowing of posterior cortex
42. A 25year old female on steroids with fish-shaped vertebrae? Osteoporosis?
AVN ?
43. 35year old male with rash, abdominal pain and sclerotic bone
leions ?mastocytosis
44. 15month old baby with a big heart, enlarged spleen ?periosteal
reaction ?ribs is ?marfans ?sickle
45. AVN, spleen and bony infarcts in adult - ?Gauchers
46. Humeral head abnormality with painless
neuropathy ?cause ?syringomyelia ?DM
47. 50year old make with long standing painless foot deformity and sclerosis ?
tabes dorsalis.. ?DM ?syringomyelia
48. Fibrous dysplasia – most likely place for a monostotic
presentation : ?ribs ?calvarium
49. Back pain and signal abnormalities at corners of vertebrae on MRI ?AS
50. 72 year old female with right hip pain, XR shows left ileum and pelvis
expansion and course trabeculations – dx - ?Pagets
51. Best position for assessing a Mortons neuroma on ultrasound ? passive
dorsiflexion ? standing on tip toes with active dorsiflexion
52. Torn tendon medial to bicipital groove ?supraspinatus
53. Soft tissue shoulder lesion – on ultrasound its ovoid and hyperechoic to fat
- on MRI – increased signal ? lipoma
54. Knee pain and locking-sounded like PVNS but nothing about blooming on
MRI!
55. ?synovial sarcoma findings
56. Painful epiphyseal lesion in a young girl with a dense sclerotic rim (but didn’t’
exactly fit with osteoid osteoma) ? chondroblastoma ?enchondroma
57. C spine soft tissue amount that’s abnormal in an adult: pick the finding from a
table: eg 4mm before C1
58. Ossification centre table:pick the combination: e.g for internal
epicondyle/radial head 1-3/3-5 years
59. Sudek’s atrophy findings combination: perfusion is
increased/decreased/delayed with or without osteoporosis
60. Medial end of clavicle erosion with a normal joint
space ?SAPHOS ?osteomyelitis
61. MRI discitis changes
62. Parachutist lands on their feet: which carpal bone is most susceptible to AVN
63. osteoid osteoma- sclerotic medulla with periosteal reaction – not Codmans
triangle., what is the most specific investigation: bone scan/MRI/ limited CT
64. A rock climber with a painful index finger ?injury
65. Put together the fracture and the associated deviation:
avulsion base of 1st MTP: and lateral displacement of the 2nd MTP relative to the
intermediate cuneiform /medial displacement…