Post on 05-Jan-2016
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I got a really benign appearing eccentric lucent lesion in a 17 y/o in the proximal metaphysis extending
into epiphysis. Physis looked closed. I gave diff. He showed me an mri with multiple fluid levels and
no edema. I said favor abc, even though minimally expansile if at all.
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I got a posterior dislocation of shoulder on ap confirmed with y
view.
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I got a chronic osteo with sequestration, sinus tract, dense thick smooth periosteal reaction of humerus (plain film and ct).
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I got a calcaneous stress fracture. very osteopenic and vascular
calcifications, I said maybe some calcaneal sclerosis, rec mri or bone
scan. He showed me follow up with avulsion fracture of superior calc at achilles insertion. He also asked me to put it all together. I babbled about
diabetes and osteoporosis maybe renal osteodystrophy.
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I got a bucket handle tear of medial meniscus (he didn’t show
me double pcl sign, but rather coronals).
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I got what I thought to be most likely ra of shoulder (jsn,
articular irregularity, high riding head, osteopenia, no osteophytes. Distal clav normal. I mentioned other things like cppd and post
traumatic changes, but much less likely).
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I got multiple bilateral tib, fem and fib infarcts (started with mri)
and I gave diff
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I got infer. endplate irreg and lytic changes at l4, very mild disk height
loss and I thought normal l5 in a young girl. I said infection, maybe neoplasm like leukemia, get mri. He gave me followup 10 months later, with bad disk height loss and bad
endplate changes l4/l5. I said likely infection, maybe favor
granulomatous given 10 month interval.
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I got osteochondritis of capitellum (I saw sclerosis on plain film, but for some reason started talking about
stupid irreg of ulna, then he showed me mri). He asked me what the
eponym was, and I blanked. Others I forget. He ended a little before the
first bell and we talked a bit.
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chance fracture of the lumbar spine
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sarcoidosis in hands and feet
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parosteal osteosarcoma
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simple bone cyst in the calcaneus
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a brown tumor in the distal femur (gave ddx ABC & GCT, but I got a hint that it was a brown tumor).
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I also got a very bizarro film of pediatric hand with some strange
moth-eaten lesions in the phalanges next to the physes on the
metaphyseal side, that I had no idea what it was, but the only question on
this case was "you're not going to know what this is; what book would
you use to look it up?"
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a left hip dislocation with a bone fragment in the joint after
reduction (on CT)
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Lytic changes in the distal end of one of the metacarpal bones with a history of punching someone;
probable infection of bone, joint, or both