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 +