Revisão MSK Prova Seriada CBR 2025

Summary

In this live revision session, Dr. Eduarda Bernal, a radiologist from the Libanese Hospital in São Paulo, conducts a thorough review of musculoskeletal topics relevant to the CBR exam. The session covers common issues in radiology such as epiphyseal lesions, osteomyelitis, and fractures, with an emphasis on understanding key diagnostic imaging techniques. Dr. Bernal explains complex concepts, including condroblastoma, osteomyelitis, and the anatomical features of the hip and wrist, while engaging the audience with interactive questions. Viewers are encouraged to ask questions in the live chat, and Dr. Bernal shares valuable insights for exam preparation.

Takeaways

• 😀 The session is a live review for the CBR exam, focused on musculoskeletal topics.
• 😀 Dr. Eduarda Bernal, a radiologist, prepared a concise review of key themes likely to appear on the exam.
• 😀 The main focus of the session is on explaining exam questions, providing comments, and clarifying frequently tested topics.
• 😀 Participants are encouraged to actively ask questions through the live chat for immediate responses.
• 😀 The first case discusses a 12-year-old male patient with a lesion in the proximal humerus, with a diagnosis of chondroblastoma, a benign tumor.
• 😀 Chondroblastoma typically occurs in young patients with open epiphyses and is characterized by a halo of low signal in imaging and heterogenous signal within the lesion.
• 😀 The next case discusses a 23-year-old female with lower back pain due to an old trauma, showing signs of spondylolisthesis and the 'Scottie dog' sign in radiographs, suggesting an isthmic fracture.
• 😀 The session highlights how to recognize osteomyelitis (bone infection), explaining how it appears on radiographs and MRI, with a focus on Brodie's abscess and how it differs from tumors.
• 😀 Chronic osteomyelitis is identified by a periosteal reaction called the involucrum and a sequestrum, which can perpetuate the infection if not properly managed.
• 😀 The manguito rotador (rotator cuff) muscles and their functions were reviewed: subscapularis (internal rotation), supraspinatus (abduction), infraspinatus (external rotation), and teres minor (external rotation).
• 😀 The session concluded with tips on the anatomy of the hip and wrist, as well as a brief discussion on the muscle groups and their insertion points related to the pelvis and thigh.

Q & A

What is the most common tumor affecting young patients with an open epiphysis, according to the script?

The most common tumor affecting young patients with an open epiphysis is the chondroblastoma. It is often located in the epiphysis and can show a sclerotic halo in imaging studies.

What clinical characteristics are associated with the condition discussed in the case of a 12-year-old male patient?

The condition described is consistent with chondroblastoma, which is common in young patients, especially males, with symptoms such as shoulder pain that worsens at night and improves with non-steroidal anti-inflammatory drugs (NSAIDs).

What imaging findings are typical for a chondroblastoma?

Chondroblastomas typically show a circumscribed lesion in the epiphysis, with a sclerotic halo on X-ray, and heterogeneous signal with calcification foci on MRI. It may also present mild edema in the adjacent bone marrow and some enhancement on post-contrast sequences.

What imaging technique is most useful for identifying a lumbar spine lesion in a 23-year-old female patient with chronic lower back pain?

The oblique radiographic view is the most useful for identifying the lesion, especially for detecting an isthmic fracture (L5 spondylolysis), which can present as the 'Scottie dog' sign on oblique X-rays.

How does an abscess differ from a chondroblastoma in imaging?

An abscess, such as Brodie's abscess, typically shows a lytic lesion with well-defined borders and a surrounding sclerotic halo, along with a central area of purulent content on imaging, whereas a chondroblastoma is a benign tumor with calcification foci and no such purulent center.

What is the significance of a cloaca in chronic osteomyelitis?

A cloaca is a channel formed by osteomyelitis, allowing the infectious material to drain to the surface. It results from the breakdown of cortical bone, which can allow for the release of necrotic bone and infected tissue.

What is the role of sequestration in chronic osteomyelitis?

Sequestration refers to a fragment of necrotic bone that is separated from the viable bone and surrounded by granulation tissue. This sequestrum can perpetuate the infection and lead to recurrence or exacerbation of chronic osteomyelitis.

What structures are included in the rotator cuff based on the provided content?

The rotator cuff is composed of four muscles: subscapularis, supraspinatus, infraspinatus, and teres minor. These muscles are responsible for the rotation and movement of the shoulder joint.

What is the significance of the 'Scotty dog' sign in X-rays of the lumbar spine?

The 'Scotty dog' sign is used to identify spondylolysis, a condition where there is a fracture in the pars interarticularis of the vertebra. In the X-ray, the dog’s 'neck' represents the broken pars interarticularis.

Which muscles insert at the greater trochanter of the femur, as mentioned in the script?

The gluteus muscles (gluteus minimus and gluteus medius) insert at the greater trochanter of the femur. These muscles are important for abduction and stabilization of the hip.