Answers Jan MSK reading Quiz

Great Job - Dr. Dey, Bonney, Lussier and Vosburgh!

1. Question may not have been clear - My intention was - 5 of these 6 options - Clinical evaluation, age and gender, lab values, distribution of joints, joint deformities, inflammatory erosive versus productive bony change. In hindsight - I understand choosing - Alignment, bone, cartilage, distribution, erosions, and soft tissues. (I will give 1 point for either answer)

2. Pannus - inflammatory granulation tissue (inflammatory synovial proliferation would also be acceptable) - destroys cartilage and bone by means of lytic enzymes and by direct interference with movement of nutrition across the joint surface. (1 point)

3. Ankylosis - fibrous, cartilaginous, or osseous fusion across a joint. (1 point)

4. Erosions - focal sbucortical loss of bone - 3 types -
     - marginal - along periphery of joint space in bare areas of bone within joint capsule but not covered by articular cartilage
     - nonmarginal - Further removed from the joint margin and usually have sharp sclerotic borders (gout)
     - subchondral - as name implies in subchondral areas - can be confused with subchondral cysts - but don't have well marginated borders like subchondral cysts

(2 points)

5. Rheumatoid arthritis is the most common purely erosive inflammatory arthropathy. (1 point)

6. Purely erosive, fusiform soft-tissue swelling, periarticular osteoporosis, uniform cartilage destruction, bilaterally symmetric (1 point)

7. Similar to systemic JIA - intermittent fever, rash, pleuritis, pericarditis, lymphadenopathy, and hepatosplenomegaly; carpal disease predominates. (1 point)

8. JIA (1 point)

9. Osteoarthritis (1 point)

10. Endplate marrow changes - 3 types - Type 1 (edema - Low T1, Bright T2), Type 2 (Fatty - Bright T1 and T2), Type 3 (sclerotic - Low T1 and Low T2) (2 points)

11. Atrophic Charcot (Charcot  or Neuropathic Arthropathy was acceptable); Syringomyelia (Syrinx) (2 points)

12. No - this is a fused spine and nondisplaced fractures are commonly missed. Therefore, CT or MRI should be obtained. MRI is best as it will show cord injury or epidural hematoma. (2 points)

13. HLA-B27 (1 point)

14. Romanus lesion - marrow edema at the anterior inferior or anterior superior corner of the vertebral body (Low T1 and bright T2) (1 point)

15. Periostitis (productive change would also be accepted) (1 point)

16. Reactive arthritis (1 point)

17. SLE (there are others but this is based on the book reading) (1 point)

18. Scleroderma (1 point)

19. Thermal (burn or frostbite), PVC, Metabolic (Hyperparathyroidism, Lesch-Nyhan), Arthritis (psoriasis, Charcot), Connective Tissue Disease (scleroderma, vasculitides), Infection (leprosy and others), Congenital (Pyknodysostosis, Hajdu-Cheney, Epidermolysis bullosa) (1 point)

20. To determine where to biopsy - not the atrophic area, but the area with bright T2 and enhancement. (1 point)

Bonus - variable

Total - 24 +

Feb 2020 Reading

MSK Requisites Ch. 21, 22, 23, 25, 26

EVMS Unofficial Radiology Reading Quiz January!

It is January 2020! Let's start this year out right! Let's live life like the good book says - "Blessed are those who find wisdom, those who gain understanding, for she is more profitable than silver and yields better returns than gold." Proverbs 3:13-14

Questions base on Ch 16-20

1. Name 5 important considerations in evaluating arthritis radiographs:

2. What is pannus?

3. What is ankylosis?

4.  What are the 3 types of erosions?

5. Rheumatoid Arthritis is the most common purely ___ inflammatory arthropathy.

6. What are 5 general key concepts of Rheumatoid Arthritis?

7. What is adult Still Disease?

8. Enlarged Epiphyses and shortened limb - patient may have had what process?

9. If I say the patient has asymmetric joint space narrowing, osteophyte formation, subchondral sclerosis and subchondral cysts, what disease am I most likely describing?

10. What are Modic changes? What types are there?

11. On a shoulder x-ray, the humeral head is absent and appears almost surgically excised at the anatomical neck, what process should be considered? What spinal disease is this associated?

12. Patient has DISH diffusely involving the spine and has a fall and complaining of back pain. The x-ray is negative. I can tell the ER to send the patient home - why or why not?

13. Ankylosing spondylitis, psoriatic arthritis, and reactive arthritis are highly associated with what positivity on what laboratory test?

14. What is a Romanus Lesion?

15. I am debating between RA and psoriatic arthritis in an adult hand x-ray - the presence of what will sway me toward psoriasis?

16. Heel pain which can be debilitating is seen in 61% of patients with what disease?

17. Reducible ulnar subluxation of the MCP joints is seen in patients with what disease?

18. I have a patient with acroosteolysis, subcutaneous calcifications and erosive changes. What disease should I include in my differential?

19. What is the differential diagnosis for Acroosteolysis (no more than 5)?

20. What is the role of MRI in the setting of polymyositis/dermatomyositis?

Bonus: Share with me a funny meme - extra points if I laugh out loud

December Quiz Answers

Congrats to Dr. Dey, Bonney, and Lussier!

1. Fusion of the medial growth plate starting at Kump's bump - therefore, the lateral growth plate is still open and able to be fractured in a Salter-Harris pattern such as Tillaux and Triplane fractures (1 point)

2. Pilon fractures (1 point)

3. Tenosynovitis of the Achilles Tendon - The Achilles tendon does not have a tendon sheath - it has a peritenon. Therefore, it has a peritendinitis (2 point)

4. Posterior Tibial osteophytes or os trigonum (1 point)

5. 3 (1 point)

6. The high risk of osteoarthritis (1 point)

7. Jones fractures have a high risk of delayed or nonunion (1 point)

8. False (1 point)

9. Growth Arrest Lines - thin sclerotic lines within metaphysis and parallel to the physis. Associated with periods of childhood stress such as illness or trauma - (2 points)

10.  Badly worded question - sorry - used my phrase versus what is in the book - should have used lucent metaphyseal bands - rickets, leukemia, metastatic neuroblasotma (2 points)

11. Erlenmeyer flask deformity - undertubulation - rickets, osteopetrosis, FD, multiple osteochondromas, dwarfism, storage disease (2 ooints)

12. Would never get an IRB to obtain the data (1 point)

13. Congenital (1 point)

14. Neurofibromatosis - can have devastating rapid progression to severe angulation and subluxation which can lead to paralysis. (2 points)

15. Idiopathic is a diagnosis of exclusion and in the setting of pain - should search for tumor, stress fracture or infection (2 points)

16. Ok - sorry - again went away from the book on this one - they say break in the dog's neck, but I say the lucency is the collar on the dog's neck versus all the others without a collar - sorry - it means spondylolysis of the pars. (2 points)

Bonus - up to 2 points

25 points possible