FRCR 2A

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Musculoskeletal and Trauma

1. A 15 year old teenager develops severe right sided hip pain following a tackle during football training. A pelvic xray in A&E demonstrates an avulsion fracture from the right anterior inferior iliac spine. Which muscle (or muscle group) has been avulsed?
		Sartorious
		Iliopsoas
		Adductor
		Hamstring
		Rectus femoris

True, Rectus femoris

2. A 13 year old presents with a 3 month history of a painful left knee. There is no preceding history of trauma. An AP left knee xray demonstrates a well defined lytic lesion with a thin sclerotic rim in the periphery of the tibial epiphysis. A subsequent CT of the region demonstrates that the cortex is intact and the lesion is confined to the epiphysis. MRI shows that the lesion is high signal on STIR and T2 weighted images with surrounding marrow oedema and fluid-fluid levels. What is the most likely diagnosis?
		Primary aneurysmal bone cyst
		Simple bone cyst
		Chondroblastoma
		Chondromyxoid fibroma
		Brodies abscess

Chondroblastoma, Fluid-fluid levels are due to secondary cystic change.

3. A 41 year old gentleman presents to A&E with an inability to weight-bear on his right foot following a very minor mechanical trip. An xray of his right foot shows a fracture though a well defined lytic lesion in his calcaneum with a thin sclerotic rim and a central ossified nodule. What is the most likely diagnosis?
		Intraosseous lipoma
		Simple bone cyst
		Osteoid osteoma
		Fibrous cortical defect
		Aneurysmal bone cyst

True, Intraosseous lipoma

4. A 91 year old lady with dementia is noticed to have a swelling of the tip of her right middle finger by a nursing home worker. An xray of her hand shows a well defined lytic lesion of her terminal phalanx with marked thinning of the cortex. What is the most likely diagnosis?
		Subperiosteal lipoma
		Implantation epidermoid
		Enchondroma
		Simple bone cyst
		Haemangioma

Implantation epidermoid, An enchondroma is the main differential diagnosis but this rarely presents in the terminal phalanx.

5. A 29 year old lady presents with a 2 week history of knee pain. A knee xray demonstrates a poorly defined, lytic lesion in her proximal tibia with marked expansion of the bone and a wide zone of transition. A subsequent post IV contrast CT chest and abdomen demonstrate multiple tiny pulmonary nodules but no other significant abnormalities. What is the most likely site of the primary tumour?
		Breast
		Bladder
		Melanoma
		Ovary
		Thyroid

Thyroid cancer is a cause of military lung metastases and bone metastases are often expansile and lytic.

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