4.1 of 49 Ratings
A 24-year-old male presents with complaints of recurrent left knee effusions for the past 3 years. He believes this pain is exacerbated with exercise. He denies any history of trauma or instability. Physical examination is remarkable for a boggy, nontender effusion with near full range of motion of the knee. He undergoes a diagnostic knee arthroscopy as seen in Figure A. This condition is most likely driven by?
Overexpression of ubiquitin-specific protease 6 (USP6)
Underexpression of ubiquitin-specific protease 6 (USP6)
Overexpression of colony-stimulating factor 1 (CSF-1)
Underexpression of colony-stimulating factor 1 (CSF-1)
Overexpression of mouse double minute-2 homolog (MDM2)
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A 33-year-old female has had three years of right ankle pain that has been refractory to conservative management. You obtain an x-ray and MRI, which are shown in Figures A-C. Based on these imaging findings, what is the most likely diagnosis?
Giant cell tumor
Pigmented villonodular synovitis
Figures A is the MRI image of a 31-year-old female who presents with complaints of worsening ankle pain and limited motion for the past 10 months. She denies any trauma to the ankle. She ambulates without issue but admits to recurrent swelling and redness of the ankle. She is afebrile and CBC, ESR, and CRP are unremarkable. She underwent an aspiration which revealed 1,100 WBCs with 40% PMNs and >50,000 RBCs. She undergoes a biopsy of the lesion and the histologic finding is seen in Figure B. Which is the most appropriate next step in management?
Arthroscopic or open resection of the lesion
Chemotherapy with wide resection of the lesion
External beam radiation followed by radical resection of the lesion
Observation with serial radiographs
Physical therapy with a repeat MRI in 6 months
A 38-year-old male presents with right knee pain that is progressively worsening over the past 5 months. He is unable to perform his occupation as a construction worker and had to stop playing tennis. He denies constitutional symptoms. The patient had an effusion that was drained by his primary care provider 2 months ago and he took a picture of it on his cell phone to show you (Figure A). On examination there is an effusion in the knee and there is tenderness along the parapatellar region. He has full knee extension and flexion, but open chain knee extension exacerbates his pain. His Lachman examination demonstrates 3 mm of anterior translation with an endpoint noted. A radiograph is shown in Figure B and MRI images are shown in Figure C and D. What is the next most appropriate step in management?
Neoadjuvant chemotherapy, surgical resection, adjuvant chemotherapy
Neoadjuvant external beam radiation, wide surgical resection, and adjuvant chemotherapy
Observation with serial radiographs and physical therapy for lower leg and core strengthening
Arthroscopic or open plica removal and lateral retinacular release
A 24-year-old man presents with pain and a mass in the anterior ankle. Plain radiographs are normal, MRI is shown in Figure A (arrrows indicate the mass), and biopsy is shown in Figure B. What is the most likely diagnosis?
Aneurysmal bone cyst
Pigmented villonodular synovitis (PVNS)
Intralesional surgical resection is considered standard of care for which of the following conditions?
High grade sarcoma surrounding a major nerve
Intermediate grade solitary fibrous tumor
Atypical lipomatous tumor
A 31-year-old woman has increasing pain and tightness in her right knee, with occasional stiffness and recurrent hemorrhagic effusions. MRI scans are shown in Figures 2a and 2b. What is the most likely diagnosis?
A 45-year-old male presents with a 6-month history of recurrent knee effusions and pain. There is no history of trauma. Exam shows a large joint effusion, decreased range of motion, and a nodularity surrounding the knee. MRI and arthroscopic intra-articular picture are shown. What is the most likely diagnosis?