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  • Smooth, well marginated focal radiolucent defect in palmar medial aspect of P3 solar margin best seen on DMPaLO
  • Mild flattening on DPA on medial aspect of P3
  • Keratoma is most likely differential
  • Focal osteomyelitis less acceptable as the smooth defect is more consistent with pressure atrophy
  • Surgery is indicated

In general, candidates did well with this case. Full credit was given if keratoma was the first (or only) differential. Candidates lost points if focal osteomyelitis/pedal osteitis was listed as the first differential, and lost more points if keratoma was not mentioned.