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  • Some candidates seemed uncomfortable with myelogram images, openly stating that they had rarely seen or performed them.
  • The successful candidate described dorsal displacement of the spinal cord at C6-7, with diametrically opposed narrowing of the dorsal and ventral subarachnoid spaces at this level, and concluded this represented a disc associated compressive lesion.
  • Some candidates saw the widening of the spinal cord at this site on the VD projection and incorrectly interpreted this as an intramedullary lesion, forgetting that a ventral extradural compressive lesion can result in spinal cord widening on the VD projection.
  • Many candidates were bothered by the lack of contrast filling caudal to the lesion, interpreting this as an extensive pathologic lesion, rather than difficulty in filling the subarachnoid space distal to a compressive lesion after an atlanto-occipital injection.
  • Some candidates failed to recognize the narrowed C6-7 disc space as further indication of disc associated disease. The appearance of the mid-body of C6 was misinterpreted by some as a lytic lesion, rather than the normal appearance of the transverse processes superimposed on the body.
  • We expected the candidate to recognize the classic appearance of calcinosis circumscripta on the VD projection, to the right of the spine, and list this as the primary differential diagnosis