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39 Cards in this Set
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- Back
- 3rd side (hint)
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Sedimentation level on CT is seen in which of the following?
a. PVNS b. Tophaceous gout c. Tumoral calcinosis d. Synovial sarcoma |
tumoral calcinosis
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Hereditary metabolic dysfunction of phosphate regulation associated with massive periarticular calcinosis. Distinguished from metastatic calcifications. Usually normal serum calcium, elevated serum phosphate. Affects hip (greater trochanter) > elbow > shoulder > foot > wrist. Plain film (typical appearance): amorphous, cystic, and multilobulated calcification located in a periarticular distribution. CT: lobulated cystic calcifications, often communicate with bursa, with fluid-fluid levels caused by calcium layering, termed sedimentation sign. Decreased metabolic activity, lesion may appear homogeneous. No erosion or osseous destruction. MR: generally inhomogeneous high T2 signal, inhomogeneous low T1.
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Biceps tendon tear/avulsion/medial dislocation associated with injury or rupture to what rotator cuff structure most frequently?
a. supraspinatous tendon b. infraspinatous tendon c. subscapularis tendon d. teres minor e. teres major f. superior glenohumeral ligament g. inferior glenohumeral ligament |
subscapularis tendon
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When evaluating a potential tendon dislocation, it is critical to take note of the integrity of the transverse humeral ligament and the subscapularis tendon to correctly classify the biceps tendon dislocation. They are associated with tears of the subscapularis tendon and the coracohumeral ligament. Two types of biceps tendon dislocation:
1. Extra-articular: anteromedial displacement of the biceps tendon with intact subscapularis muscle and tendon. 2. Intra-articular: subscapularis attachment defect on lesser tuberosity & displacement of tendon into glenohumeral joint. |
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Intra-articular (intracapsular) biceps tendon dislocation. What is torn:
a. superior glenohumeral ligament b. inferior glenohumeral ligament c. subscapularis muscle d. supraspinatus tendon e. intraspinatus tendon f. avulsion of long head of biceps g. avulsion of short head of biceps |
superior glenohumeral ligament
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Subscapularis tendon and coracohumeral ligament are the stabilizing structure for the biceps tendon. Once they are injured, biceps will dislocate medially out of bicipital groove. The superior glenohumeral ligament also stabilizes, but less important. For dislocation of the biceps tendon, there has to be disruption/tear of the transverse humeral ligament which normally transverses greater and lesser tuberosities. Proximal biceps tendon injury, if a rotator cuff structure is involved. Intra-articular dislocation of the biceps tendon is associated with tear of the subscapularis TENDON. Extra-articular dislocation results from a superficial tear of subscapularis resulting in prolapse of biceps tendon into partially torn subscapularis. If biceps tendon is displaced anteromedially, the subscapularis tendon may be intact. If the biceps tendon is displaced medially, it is always associated with tear of subscapularis tendon at its attachment to the lesser tuberosity. The GHL contribute to shoulder stability. Supraspinatus tendon tears are associated with avulsion of long head of biceps.
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Lateral epicondylitis is most associated with the following:
a. extensor carpi radialis brevis b. common flexor tendon origin c. annular ligament d. radial collateral ligament e. anconeus |
ECRB
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The cause of lateral epicondylitis is microscopic tearing with formation of reparative tissue (ie, angiofibroblastic hyperplasia) in the origin of the extensor carpi radialis brevis (ECRB) muscle. Lateral epicondylitis involves degeneration of common extensor tendon at origin of humerus, most often the ECRB. EDC sometimes involved. Radial collateral ligament sometimes with some degeneration or partial tearing, but ECRB universally involved.
Tennis elbow (lateral epicondylitis) = due to repetitive varus stress of extensor muscles with degeneration and tearing. ECRB often partially avulsed from lateral epicondyle. Can be associated with radial collateral ligament disruption. Medial epicondylitis = Little leaguer/golfer’s elbow. Due to repetitive valgus stress of flexor-pronator muscle group. |
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Segond fracture associated with injury to (ACL NOT an option):
a. PCL b. Lateral collateral ligament c. Lateral capsular ligament d. Arcuate complex e. Fibular collateral ligament |
lateral CAPSULAR ligament
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Answer: Lateral capsular ligament
Segond fracture is avulsion injury of proximal tibia, immediately distal to lateral plateau, at the insertion of the middle third of the lateral caspsular ligament. High association with ACL tears (75-100%), also with meniscal injuries (66-75%), and posterolateral corner injuries. Avulsion of meniscotibial portion of the middle third of lateral capsular ligament from the lateral tibial plateau, associated with varus stress. Frequent association with IT band and a band of the fibular collateral ligament (also known as lateral collateral ligament). PCL tears are associated with reverse Segond fractures, which are rare, which are an avulsion at tibial insertion site at deep portion of MCL associated with PCL & peripheral medial meniscus tear. |
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2. Which muscles constitute the pes anserinus?
a. sartorius, gracilis, rectus femoris b. sartorius, semitendinosus, semimembranosus c. sartorius gracilis and semitendonosus d. gracilis, semitendinosus, semimembranosus e. semimembranosus, biceps tendon, quadriceps |
SGSt
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3. A 15 year old male presents with knee pain and edema involving the superior patella tendon edema on MRI. The most likely etiology is?
a. Osgood Schlater b. patellar sleeve injury c. jumper's knee d. Haglunds syndrome |
jumpers knee
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patellar tendinosis - myxoid degeneration of tendon
PATELLAR SLEEVE AVULSION: - aka patellar avulsion fracture, sleeve fracture - occurs when inferior pole of patella in a child or adolescent is pulled off - type of osteochondral fracture |
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4. Most common benign/solitary rib lesion in adult:
a. Bone cyst b. ABC c. Giant cell Tumor d. Fibrous Dysplasia e. EG |
FD
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Fibrous dysplasia, 2nd most common is EG. Monostotic fibrous dysplasia is the most common benign lesion of rib cage. Giant cell tumors, ABCs, and UBCs may rarely be found in the ribs.
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5. Morton’s Neuroma is best classified as:
a. Hamartoma b. Normal variant c. Enlarged nerve d. Neoplasia e. Reactive psuedotumor |
Reactive pseudotumor
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metatarsalgia and localized enlargement of the interdigitial nerve between 3rd and 4th metatarsal heads… Entrapment neuropathy related to compressive forces against deep transverse intermetatarsal ligament. Fibrotic response, not a true tumor. perinerual fibrosis and nerve degeneration occurring in the interdigital space.
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6. A patient with knee replacement that shows loosening. Surgical biopsy demonstrates a giant cell reaction. This is due to which of the following:
a. synovitis b. osteomyelitis c. reaction to the cement d. polyethylene small particle reaction |
PE small particle rx
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Wear of the ultra-high-molecular-weight polyethylene (UHMWPE) components in total knee arthroplasties is a potential long-term problem. Wear particles of UHMWPE can result in adverse tissue reaction with cellulitis, giant cell reaction, and necrotic tissue, and these effects could be cumulative with time. There is some evidence that particles can lead to bone resorption, including at the implant-bone interface, which could accelerate loosening.
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8. 40y/o woman presents with pain in the wrist with ulnar deviation. Plain film shows cysts and sclerosis in the lunate, triquetrum, and ulnar styloid process. What is the diagnosis?
a. Ulnar Impaction Syndrome b. SLAC c. RA d. Triangular fibrocartilage tea e. Keinbocks |
Ulnar Impaction syndrome
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Radiographs show an ulnar positive variant and, often, cysts in the triquetrum and ulnar one half of the proximal lunate. MRI can be helpful in the diagnosis by revealing signal change and edema in the ulnar head, triquetrum, and lunate. Associated with ulnar positive variance, TFCC often torn.
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9. Which of the following is most likely with a mass in the suprascapular notch
a. Supraspinatus spasm b. Infraspinatus atrophy c. subscapularis atrophy d. Sprengel deformity e. erosion of the coracoid |
InfraSpinatus atrophy
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Supraspinatus nerve entrapment. Initially described in weightlifters. As suprascapular nerve courses through suprascapular notch, it provides motor innervation to supraspinatus and infraspinatus muscles. More distally in the spinoglenoid notch, it provides motor innervation to infraspinatus only. Most common cause of nerve compression is ganglion cyst, usually associated with a superior labral tear.
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10. A SLAP lesion of the glenoid is most likely associated with?
A. overhead throwing B. skiing downhill C. weightlifting D. rowing |
overhead throwing
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The SLAP injury is found most commonly in athletes involved with overhead throwing motions but may also occur in patients who have fallen or who have received a blow on the shoulder. Present with pain during overhead activity (can mimic impingement).
Weightlifting (especially the bench-press) commonly causes injury to the posterior labrum. |
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11. Which of the following is not associated with posterior scalloping of the vertebral body.
• Neurofibromatosis • Achondroplasia • Osteopetrosis • Morquio’s Syndrome • Marfan’s Syndrome |
osteopetrosis
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1. INCREASED INTRASPINAL PRESSURE
A. Communicating hydrocephalus B. Ependymoma 2. MESENCHYMAL TISSUE LAXITY A. Neurofibromatosis (secondary to dural ectasia, spinal tumor) B. Marfan syndrome C. Ehlers-Danlos D. Posterior meningocele 3. BONE SOFTENING A. Mucopolysaccharidoses: Hurler’s, Morquio, Sanfilippo B. Ankylosing spondylitis C. Acromegaly D. Achondroplasia Mnemonic: DAMN MALE SHAME Osteopetrosis = sclerotic bone, thick but structurally weak. Bone in bone appearance, sandwich vertebrae/rugger jersey spine. Get transverse fractures, frequently terminates in acute leukemia. |
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13. A patient with knee pain following trauma demonstrates bone contusions on the lateral femoral condyle and on the medial patellar facet. Which of the following is most likely injured:
A. medial patellar retinaculum B. lateral patellar retinaculum C. ileotibial band D. rectus femorus tendon E. Patellar tendon |
MPR
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Lateral dislocation of the patella causes a characteristic contusion on the anterolateral femoral condyle ; there may or may not be a kissing contusion on the medial side of the patella. The medial patellar retinaculum is always injured, although a frank tear can be difficult to appreciate.
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15. Plain films of the hand reveal acro-osteolysis and subperiosteal resorption of the phalanges?
A. Pyknodysostosis B. hyperparathyroidism C. scleroderma D. psoriasis |
Hyperparathyroidism
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• PINCH FO
• Psoriasis • Injury (thermal/frostbite) • Neuropathy (congenital insensitivity to pain, diabetes, leprosy, myelomeningocele) • Collagen vascular disease (Scleroderma, Raynaud's) • Hyperparathyroidism • Familial (Hadju-Cheney) • Other (Polyvinyl chloride exposure, snake/scorpion venom) |
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17. Avulsion off of the base of the fifth metatarsal. What is typically involved?
a. Peroneous longus b. Peroneous brevis c. Posterior tibial tendon d. Peroneous quadratus |
PBrevis
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20. Radiographic characteristics of transient osteoperosis include:
• ground glass • subchondral bone loss • insufficiency fracture • subperiosteal resorption • cortical thinning |
Subchondral cortical thinning
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classically described as subchondral cortical thinning, in reality this equates with diffuse osteopenia of femoral head and neck
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21. Of the following, which represents the most severe injury to the wrist.
A) scapholunate dissociation B) mid-carpal dislocation C) triquetrolunate dislocation D) lunate dislocation E) peri-lunate dislocation |
lunate doslocation
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24. A 58-year-old diabetic female presents with chronic foot pain, a pes planus deformity, as well as periosteal reaction along the distal aspect of the medial malleolus on plain film. The most likely diagnosis is:
A) charcot joint B) Plantar fascitis C) Posterior tibial tendon rupture D) Peroneus longus tendon rupture E) Stress fracture |
Posterior tibial tendon rupture
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25. Acquired flatfoot is associated with an abnormality involving which of the following:
A. Anterior tibialis tendon B. Peroneus longus tendon C. Posterior tibialis tendon D. Flexor hallicus longus tendon |
Posterior tibialis tendon
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26. 12 yo girl with painless soft tissue calcifications around the shoulders, hips, and knees
A) Juvenile gout B) Lesch-Nyhan C) Polymyagia rheumatica D) Tumoral calcinosis E) Myositis ossificans |
tumoral calcinosis
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28. Fracture of the medial patellar facet can be seen in:
A) lateral patellar dislocation B) avulsion of various muscles C) quadriceps tendon insertion injury D) medial meniscus tear E) ACL tear |
Lateral patellar dislocation
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29. The following could be used to describe a medial meniscal tear on a T2 sequence except:
A) globular signal within the posterior horn meniscal substance B) blunted appearance of free margin C) irregular, truncated appearance of the medial meniscus D) linear T2 signal in the meniscus involving the inferior articular surface |
globular signal within the posterior horn meniscal substance
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Choice A pertains to mucinous, hyaline, or myxoid degeneration. Other choices describe various grades of menical tears. The medial meniscus is most commonly injured. The lateral meniscus is less commonly injured because it has greater mobility. Injuries to the lateral meniscus are associated with discoid variant. Types of meniscal injuries include: vertical, horizontal, oblique, bucket-handle, peripheral (meniscocapsular separation), truncated (resorbed or displaced fragment).
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31. Intraarticular dislocation of the biceps tendon is associated with injury to which of the following?
A) Subscapularis muscle B) Middle glenohumeral ligament C) superior glenohumeral ligament D) supraspinatus tendon E) avulsion of long head of the biceps |
subscapularis muscle
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In order for subluxation or dislocation of the biceps tendon to occur, there must be disruption of the transverse humeral ligament that normally bridges the lesser and greater tuberosities and holds the long head of the biceps tendon in place. Usually, a tear of the subscapularis tendon also coexists. With dislocation, the long head of the biceps tendon usually displaces anteromedially. If the biceps tendon is displaced anteromedially, the subscapularis tendon may or may not be intact. If the biceps tendon is displaced medially, it is always associated with tear of subscapularis tendon at its attachment to the lesser tuberosity.The glenohumeral ligaments contribute to shoulder stability. Supraspinatus tendon tears are associated with avulsion of the long head of the biceps.
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32. What is the most likely mechanism of injury in a patient with horizontal fractures of both superior and inferior pubic rami.
A) AP compression B) lateral compression C) vertical shear D) avulsion injury E) stress injury |
lateral compression
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Sedimentation level on CT is seen in which of the following?
a. PVNS b. Tophaceous gout c. Tumoral calcinosis d. Synovial sarcoma |
tumoral calcinosis
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Hereditary metabolic dysfunction of phosphate regulation associated with massive periarticular calcinosis.
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Biceps tendon tear/avulsion/medial dislocation associated with injury or rupture to what rotator cuff structure most frequently?
a. supraspinatous tendon b. infraspinatous tendon c. subscapularis tendon d. teres minor e. teres major f. superior glenohumeral ligament g. inferior glenohumeral ligament |
Subscapularis tendon and coracohumeral ligament
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When evaluating a potential tendon dislocation, it is critical to take note of the integrity of the transverse humeral ligament and the subscapularis tendon to correctly classify the biceps tendon dislocation. They are associated with tears of the subscapularis tendon and the coracohumeral ligament. Two types of biceps tendon dislocation:
1. Extra-articular: anteromedial displacement of the biceps tendon with intact subscapularis muscle and tendon. 2. Intra-articular: subscapularis attachment defect on lesser tuberosity & displacement of tendon into glenohumeral joint. MRI plays a leading role in the diagnosis of tears of the long head of the biceps tendon because it can detect the empty bicipital groove, the medially dislocated biceps tendon, and the associated subscapularis injury. Biceps short head origin: tip of coracoid process adjacent to the coracobrachialis. Long head origin: superior rim of glenoid at the bicipital tubercle and labrum. Restraints of the long head tendon: coracohumeral ligament, superior glenohumeral ligament, transverse humeral ligament, contributions from the subscapularis tendon. |
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Intra-articular (intracapsular) biceps tendon dislocation. What is torn:
a. superior glenohumeral ligament b. inferior glenohumeral ligament c. subscapularis muscle d. supraspinatus tendon e. intraspinatus tendon f. avulsion of long head of biceps g. avulsion of short head of biceps |
Transverse humeral ligament, subscapularis tendon, coracohumeral ligament, superior glenohumeral ligament
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Subscapularis tendon and coracohumeral ligament are the stabilizing structure for the biceps tendon. Once they are injured, biceps will dislocate medially out of bicipital groove. The superior glenohumeral ligament also stabilizes, but less important. For dislocation of the biceps tendon, there has to be disruption/tear of the transverse humeral ligament which normally transverses greater and lesser tuberosities. Proximal biceps tendon injury, if a rotator cuff structure is involved. Intra-articular dislocation of the biceps tendon is associated with tear of the subscapularis TENDON. Extra-articular dislocation results from a superficial tear of subscapularis resulting in prolapse of biceps tendon into partially torn subscapularis. If biceps tendon is displaced anteromedially, the subscapularis tendon may be intact. If the biceps tendon is displaced medially, it is always associated with tear of subscapularis tendon at its attachment to the lesser tuberosity. The GHL contribute to shoulder stability. Supraspinatus tendon tears are associated with avulsion of long head of biceps.
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Segond fracture associated with injury to (ACL NOT an option):
a. PCL b. Lateral collateral ligament c. Lateral capsular ligament d. Arcuate complex e. Fibular collateral ligament |
Lat CAPSULAR lig
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Segond fracture is avulsion injury of proximal tibia, immediately distal to lateral plateau, at the insertion of the middle third of the lateral caspsular ligament. High association with ACL tears (75-100%), also with meniscal injuries (66-75%), and posterolateral corner injuries. Avulsion of meniscotibial portion of the middle third of lateral capsular ligament from the lateral tibial plateau, associated with varus stress. Frequent association with IT band and a band of the fibular collateral ligament (also known as lateral collateral ligament).
PCL tears are associated with reverse Segond fractures, which are rare, which are an avulsion at tibial insertion site at deep portion of MCL associated with PCL & peripheral medial meniscus tear. |
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Most commonly injured ligament in ankle sprain/injury:
a. anterior talofibular ligament b. anterior tibiofibular ligament c. posterior talofibular ligament d. posterior tibiofibular ligament e. calcaneofibular |
Ant TALOfibular lig
Calcaneofibular is second. |
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Acetabular fracture which involves both iliopectineal and ischiopectineal lines (also recalled as iliopectineal and ilioischial lines). What type of fracture?
a. anterior column b. posterior column c. anterior wall d. posterior wall e. transverse |
Transverse
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Which is the LEAST common acetabular fracture:
a. Anterior wall b. Posterior column c. Tranverse d. T-shaped |
Ant column
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Posterior wall (27%) > Transverse (9%) > T-shaped (6%) > Anterior or posterior column (4-5%) > Anterior wall (2%). The 3 most common are both column, transverse with posterior wall, and elementary posterior wall fractures, accounting for 66% of all fractures.
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Which has highest chance of malignant transformation?
a. Multiple hereditary exostoses b. Enchondromatosis c. Melorrheostosis d. Polyostotic fibrous dysplasia e. Cortical desmoid |
Enchondromatosis
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Enchondromatosis (Ollier's disease) has a rate of malignant transformation of 5-30% (some say up to 50%) with a much higher rate in Marfucci's syndrome which is enchondromas + soft tissue hemangiomas.
Multiple hereditary exostoses has a lower rate of malignant transformation of around 20%. Polyostotic FD: McCuhn-Albright: Precocious puberty, café-au-lait spots; fibrous dysplasia FD rarely at 1%. Melorrheostosis: benign bony proliferative disease. Dripping candle wax appearance. In sclerotomal distribution. |
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Most specific finding on arthogram for (full thickness) rotator cuff injury (contrast in which compartment is most specific sign of rotator cuff tear?):
a. Contrast in subacromial/subdeltoid bursa b. Contrast in axillary recess c. Contrast in subscapularis bursa d. Contrast along biceps tendon e. Contrast in subcoracoid bursa |
SA/SD bursa
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Fluid in SA/SD bursa on MR arthrogram confirms full-thickness RC tear. Should not see SA/SD fluid if only a partial tear.
The subacromial and subdeltoid bursas are synonymous. Remember that the subdeltoid bursa communicates with the subacromial bursa. Other MRI findings: Direct signs - discontinuity of supraspinatus & possibly infraspinatus tendons, fluid signal in the tendon gap, retraction of musculotendinous junction. Associated findings - subacromial / subdeltoid bursal fluid, muscle atrophy, fatty atrophy in chronic cases. |
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What attaches at the pisiform:
a. Flexor carpi ulnaris b. Adductor digiti minimi c. Opponens digiti minimi d. Flexor digitorum profundus e. Flexor pollicus longus |
Flex carpis ulnaris
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Most prominent abnormality of the hindfoot in neonates with clubfoot deformity:
A. Pes planus B. Increased talocalcaneal angle C. Hindfoot varus D. Hindfoot valgus E. Increased calcaneal angle from the floor |
Hindfoot varus
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Radiographic feature of clubfoot is talocalcaneal parallelism. Measure the talocalcaneal angle in the AP and lateral films. AP lines are drawn through the center of the long axis of the talus (parallel to the medial border) and through the long axis of the calcaneum (parallel to the lateral border), and they usually subtend an angle of 25-40°. Any angle less than 20° is considered abnormal. Decreased talocalcaneal angles is indicative of hindfoot varus (club foot). Increased talocalcaneal angles are consistent with hindfoot valgus.
Clubfoot (Talipes Equinovarus): common, bilateral in 50%;typically 4 separate components on AP and lateral view: * Hindfoot varus is KEY: decreased talocaclcaneal angle < 20° on AP view (normal 20-40°) * Equinus deformity of the heel: plantar flexion (not pes planus) of the hindfoot with respect to the tibia on lateral view and decreased talocalcaneal angle on lateral view < 35° (normal 35-50°) * Metatarsus adductus, ie. adduction or varus deformity of forefoot: 1st metatarsal bone is displaced medially with respect to the long axis of the talus. * Talonavicular subluxation: medial subluxation of navicular bone |
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The Hawkins classification is used for fracture of what?
a. fibula b. tibia c. calcaneus d. talus e. tarsonavicular |
Talus
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Type I - Non-displaced fractures of talar neck without dislocation.
Type II - Displaced fracture of talar neck with subluxation or dislocation of the subtalar joint. Ankle remains aligned. Talocalcaneal ligament disrupted. Type III - Displaced fracture of talar neck with dislocation of talus body from both subtalar joint and ankle joint. 90% risk of AVN. Type IV - Talar neck fracture with dislocation of head. Subtalar, tibiotalar & talonavicular joint sublux/ dislocation. |
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55 year-old patient with SLAC wrist deformity. This is most associated with?
A. Sodium urate crystals B. Hydoxyapatite crystals (HADD) C. Scapholunate ligament tear D. Calcium pyrophosphate crystal deposition (CPPD) E. TFCC tear F. Gout |
CPPD
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Scapholunate advanced collapse (SLAC) is a specific pattern of OA associated with chronic scapholunate dissociation and chronic scaphoid nonunion. Scapholunate dissociation is caused by disruption of the scapholunate interosseous ligament and the extrinsic ligaments that stabilize this articulation. CPPD is the most common etiology but chronic trauma may also result in this process. The radioscaphoid joint is initially involved, followed by degeneration in the unstable lunatocapitate joint as the capitate subluxes dorsally on the lunate. The capitate migrates proximally into the space created by scapholunate dissociation. The radiolunate joint is spared. In end stage SLAC, the midcarpal joint collapses under compression and the lunate assumes a dorsal tilt.
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