March 2020 EVMS Unofficial Quiz

1. What percentage of women older than 60 have evidence of significant bone loss?

2. What are the most common sites of fracture in the setting of osteoporosis?

3. What is the thought to be the mediated dysfunction of complex regional pain syndrome?

4. What are the 3 stages of Paget disease?

5. What are the most frequent sites of bone involvement in Paget?

6. What is the most common neoplastic complication? What percentage of Paget Patients? What about the skull?

7. What age is fatty marrow conversion is usually complete?

8. Which of the following is not a typical red marrow converter?

     a. 37 yo AA male with AIDS

     b. 45 yo WM with hemolytic anemia

     c. 35 yo Asian couch potato who does not smoke

     d. 58 yo WF on erythropoietin

9. Why could in and out of phase imaging help distinguish tumor versus red marrow conversion?

10. What is a sinus tract?

11. What is a cloaca?

12. What is the finding on 3 phase MDP bone scan?

13. Sarcoidosis - most common x-ray finding?

14. What are the most commonly involved joints of patients with Hemophilia?

15. What effect can hemarthrosis have on young immature bone?

16. 20 yo with cholecystectomy clips and calcified small spleen. What can be seen in the spine? What about the hips?

17. What are leukemic lines?

Febuary Quiz Answers

Great job Dr. Dey, Lussier, Vosburgh, and Bonney!

Answers:

1. C (1 point)

2. C (1 point)

3. F (1 point)

4. Knee, wrist, 2nd and 3rd MCP joints (1 point)

5. Large Beak-like osteophytes (1 point) - hemochromatosis arthropathy.

6. Amyloidosis (1 point)

7. False (1 point)

8. Extent of disease in 2 planes, femoral head flattening/collapse and extent, contralateral involvement, presence of secondary osteoarthritis, an any progression over time (1 point)

9. 4 yo. More time to remodel (2 points)

10. Synovial chondromatosis; OA with loose bodies, OCD with loose bodies, AVN, chronic joint infections (2 points)

11. May represent Hypertrophic osteoarthropathy or thyroid acropachy. Should look for pulmonary (especially cancer) dz, cyanotic heart disease, IBD, GI like biliary cirrhosis, voriconazole, or hx of thyroid resection for hyperthyroidism (3 points)

12. Soft tissue thickening in phalanges and heel pad. Spade like distal phalangeal tufts.Widened metacarpals.  Excresences at tendon insertions.  Beak-like osteophytes. (3 points)

13. Widened SI joints (1 point)

14. Hyperparathyroidism - brown tumor - accumulations of osteoclasts and fibrous tissue with variable cystic change (1 point)

15. Pseudofractures - linear foci of undermineralized osteoid at sites of mechanical loading - often perpendicularly oriented to cortex of the bone and often incomplete and bilateral (1 point)

16. Rachitic rosary (flaring of costochondral junctions) (1 point)

17. Decreased central vertebral density with sclerosis of endplates that look like a Rugby Jersey - sign of renal osteodystrophy (2 points)

18. Normal, Heavy metal poisoning, Hypervitaminosis D, metaphyseal stress lines, posttreatment rickets, scurvy (1 point)

19. Myelofibrosis, Mastocystosis, Mets, Sickle cell, Paget, Pyknodystostosis, Renal osteodystrophy, osteopetrosis, fluorosis (1 point)

20. Wimberger - sclerotic epiphyseal rim, Frankel line - dense metaphyseal line adjacent the physis; Trummerfeld zone - lucency proximal to the Frankel line; Associated with Scurvy; Limey - The British Navy would use lime juice to prevent Scurvy (5 points).

Total 31+ points

March Reading

MSK REQUISITES - Ch 27, 28, 39, 40, 41

EVMS 2019-2020 February Reading Quiz!

As Always - Never Disrespect the Wu-Tang Clan! Now prepare yourself for the great EVMS Unofficial Reading Quiz of February 2020!

1. Gout may occur seconary to:

a. Sun exposure
b. Elevated HLA-B27
c. Moonshine
d. Positive birefringent crystal deposition

2. Gouty tophus -

a. Character from "that 70's show"
b. Intraarticular crystals
c. monosoduium urate crystal in bursa or periarticular soft tissues
d. a subchondral cyst

3. Gouty tophi have a universal appearance on MRI which makes them easy to diagnose. T or F

4. CPPD is most common which joints?

5. A patient has bronze skin, cirrhosis, and diabetes presents with an arthropathy - what might his MCP look like?

6. Older lady on dialysis has an MRI of the lumbar spine. Patient has irregular endplates of several levels. Nodules are noted in the adjacent soft tissue which are low in signal on all sequences. This patient might have?

7. Early osteonecrosis is pathognomonic on MRI. T or F

8. What does the clinician want to know regarding Avascular Necrosis?

9. A 4 yo or an 10 yo is more likely to have a better prognosis? Why?

10. 40 yo man has an MRI of the hip. There are erosions of the femoral neck. Multiple low signal same sized foci are noted in the joint space. What should be considered and what differential might you consider?

11. 55 yo man shows up with bilateral foot and hand xray. Images demonstrate bilaterally symmetric benign appearing periosteal reaction. When the referring doctor stops by to review the images, what do you recommend and why?

12. Andre the Giant gets hand x-ray and foot xray - what might you see?

13. A patient with elevated parathyroid hormone and abnormal calcium levels has a pelvic x-ray. What might one notice at the SI joints?

14. A hand x-ray demonstrates radial sided resorption in the phalanges. Vascular calcifications are present. The radius has a lucency which is not subchondral. What might cause this lucency?

15. A medical student walks up to you and asks "What is a looser zone"? What do you tell him/her?

16. A child is in the x-ray department with flared metaphyses in the wrists. What might the patient's ribs look like?

17. What is a Rugger Jersey? Why do I care?

18. What is the differential diagnosis for dense metaphyseal bands?

19. What is the differential diagnosis of diffuse increased bone density?

20. Define the following - Wimberger sign; Frankel line; Trummerfield zone - what disease are they associated with and what is the association between this disease and the epithet "Limey"?

Bonus: Podcast - to listen or not to listen - what do you recommend or who can you not stand?