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
Saturday, February 29, 2020
Saturday, February 1, 2020
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?
Monday, January 20, 2020
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 +
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 +
Saturday, January 4, 2020
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
Friday, January 3, 2020
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
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
Subscribe to:
Comments (Atom)
