All Questions

Question 1

In which plane are changes to the architecture and tendon fibre pattern of the deep digital flexor tendon most appreciable?

A) Transverse View
B) Lateral & Medial Parasagittal Views
C) Sagittal Transsolar View
D) Lateral Oblique Transverse View

Answer 1

B) Lateral & Medial Parasagittal Views

Question 2

The primary pathophysiological mechanism through to be responsible for supporting limb laminitis is…

A) Acyclic Loading Causing Reduced Lamellar Blood Flow
B) Systemic Inflammation
C) Hyperinsulinemia
D) Degenerative Change

Answer 2

A) Acyclic Loading Causing Reduced Lamellar Blood Flow

Question 3

Distension of the navicular bursa with approximately 2 mL of fluid for MR contrast bursography in horses would help to distend/separate which portion of the navicular bursa?

A) Distension of the proximal recess of the normal navicular bursa.
B) The deep digital flexor tendon and the distal sesamoidean impar ligament.
C) The deep digital flexor tendon and the collateral sesamoidean ligament.
D) The deep digital flexor tendon and the navicular bone.

Answer 3

A) Distension of the proximal recess of the normal navicular bursa.

Question 4

What would be the best method with the least complications for contrast enhanced ultrasound of the distal limb in horses?

A) Intravenous administration of 5 mL of agitated saline.
B) Intra-arterial administration of 1 mL of agitated saline.
C) Intravenous administration of 5 mL of decafluorobutane gas encapsulated within lipid shells.
Intra-arterial administration of 0.5 mL of D) decafluorobutane gas encapsulated within lipid shells.

Answer 4

D) Intra-arterial administration of 0.5 mL of decafluorobutane gas encapsulated within lipid shells.

Question 5

Which of the following statements is false?

A) PD and STIR sequences are most useful for visualizing adhesions, although they are usually identifiable on a T2W sequence as well.
B) Navicular bursa adhesions are often found in conjunction with additional navicular bursa, navicular bone and deep digital flexor tendon abnormalities.
C) The clinical significance of navicular bursa adhesions is not known.
D) Even though well-defined tissue is not identified between the two structures, a diagnosis of an adhesion can be made confidently.

Answer 5

D) Even though well-defined tissue is not identified between the two structures, a diagnosis of an adhesion can be made confidently.

Question 6

Which of the following statements is true?

A) Desmitis of the collateral ligaments of the distal interphalangeal joint was the most common injury.
B) Deep digital flexor tendonitis was the second most common injury.
C) Acute tendon and ligament injuries have increased signal intensity in both T1W and T2W images and sometimes fat suppressed images, but more chronic injuries may have abnormal signal intensities only in T1W images.
D) Combined injuries of the DDFT and navicular bone or primary navicular bone abnormalities generally have a good prognosis.

Answer 6

C) Acute tendon and ligament injuries have increased signal intensity in both T1W and T2W images and sometimes fat suppressed images, but more chronic injuries may have abnormal signal intensities only in T1W images.

Question 7

Which of the following statements is true?

A) Because of increased water content, the hoof capsule was hyperintense on GRE sequences making it difficult to identify the attachment of the keratoma to the adjacent lamina.
B) On CT, keratomas appeared as soft tissue masses originating from the third phalanx.
C) On nuclear scintigraphy, keratomas were best visualized on dorsal views.
D) Because of inadequate water content, the hoof capsule is not evident in MR images and the attachment of the keratoma to the hoof capsule cannot be reliably identified.

Answer 7

D) Because of inadequate water content, the hoof capsule is not evident in MR images and the attachment of the keratoma to the hoof capsule cannot be reliably identified.

Question 8

Which two sequences provided the most meaningful information to evaluate prognosis and should be included in standard protocols?

A) T2W and T1W
B) T1W AND STIR
C) PD AND T1W
D) STIR AND T2W

Answer 8

B) T1W AND STIR

Question 9

Ultrasonographic examination of an acute soft tissue injury is best performed approximately…

A) Immediately after an accident
B) 1 day after an incident
C) 2-3 days after an accident
D) 1 week after an incident

Answer 9

C) 2-3 days after an accident

Question 10

Which of the following is true regarding the detection of cartilage damage in the equine distal interphalangeal joint using low-field MRI?

A) Low field MRI is highly sensitive in the detection of cartilage damage: a normal articular cartilage contour means that the cartilage is healthy.
B) Low field MRI is highly specific in the detection of cartilage damage: if an abnormal articular cartilage contour is observed and suggestive of cartilage damage, it is likely to be real.
C) The injection of saline or gadolinium into the distal interphalangeal joint increases the sensitivity of cartilage damage detection.
D) T2W FSE sequences were found to be less sensitive compared to T1W GRE sequences in low field MRI in detection of cartilage damage of the distal interphalangeal joint.

Answer 10

B) Low field MRI is highly specific in the detection of cartilage damage: if an abnormal articular cartilage contour is observed and suggestive of cartilage damage, it is likely to be real.

Question 11

Which of the following MRI findings may be encountered in histologically normal oblique sesamoidean ligaments?

A) The presence of strands extending to the straight sesamoidean ligament.
B) An increased cross-sectional area at the origin of the ligament.
C) The presence of hyperintense regions within the ligament fibers.
D) A reduction in ligament striations.

Answer 11

A) The presence of strands extending to the straight sesamoidean ligament.

Question 12

Which of the following statements is true?

A) Osteochondral fragmentation at the pastern joint is commonly associated with lameness and poor performance.
B) Osteochondral fragmentation at the pastern joint is more frequently visualized on the DMPLO view
C) Yearling presenting with osteochondral fragmentation at the pastern joint on hind limbs had lower career earning compared to the control population.
D) Osteochondral fragments at the pastern joint originate more commonly from the medial side of the proximal phalanx.

Answer 12

D) Osteochondral fragments at the pastern joint originate more commonly from the medial side of the proximal phalanx.

Question 13

Which of the following is true regarding equine osteosarcoma?

A) Biopsy is often not required to confirm the presumptive diagnosis.
B) Pathologic fractures are not commonly associated with equine osteosarcoma.
C) The overall incidence of equine osteosarcoma is greater than that of canines.
D) The most common site of occurrence is within the skull (maxillary and mandibular).

Answer 13

D) The most common site of occurrence is within the skull (maxillary and mandibular).

Question 14

What is the typical MR appearance of the collateral ligament of the distal interphalangeal joint?

A) Heterogeneous signal pattern with a peripheral region of increased signal intensity.
B) Hyperintense signal pattern with a peripheral region of increased signal intensity.
C) Hypointense signal pattern with a peripheral hyperintense signal intensity.
D) Heterogeneous signal pattern

Answer 14

A) Heterogeneous signal pattern with a peripheral region of increased signal intensity.

Question 15

Which of the following is true regarding ultrasonography of the equine distal limb?

A) Superficial digital flexor tendon lesions are often bilateral with a more severe lesion within the lateral branch.
B) Ultrasonographic diagnoses are much improved with regards to sensitivity and specificity if the contralateral limb is examined as well.
C) Superficial cutaneous injuries do not interfere with ultrasonographic evaluation of the equine distal limb.
D) Chronic tendonitis results in a typical hypoechoic lesion with no notable enlargement or thickening of the distal digital ligament lobe.

Answer 15

B) Ultrasonographic diagnoses are much improved with regards to sensitivity and specificity if the contralateral limb is examined as well.

Question 16

Distal condylar fractures of metacarpal/metatarsal bone 3 are thought to be due to…

A) Systemic inflammation weakening the distal aspect of the third metacarpal/metatarsal bone.
B) Compromised vascular supply of the third metacarpal/metatarsal bone.
C) Underlying endocrinopathy causing uncoordinated fetlock movements.
D) High tensile forces of the suspensory apparatus compressing the proximal sesamoids and intersesamoidean ligament into the condylar groove of the third metacarpal/metatarsal bone.

Answer 16

D) High tensile forces of the suspensory apparatus compressing the proximal sesamoids and intersesamoidean ligament into the condylar groove of the third metacarpal/metatarsal bone.

Question 17

Where is the most common location of bone marrow lesions in sports and pleasure horses on standing MRI examination?

A) Palmar aspect of the lateral condyle
B) Palmar aspect of the medial condyle
C) Dorsal aspect of the medial condyle
D) Dorsal aspect of the lateral condyle

Answer 17

C) Dorsal aspect of the medial condyle

Question 18

What is true regarding osseous cyst-like lesions of the proximal sesamoid bones in horses?

A) This process is always aseptic in nature, associated with sterile inflammation of the surrounding soft tissue structures.
B) Osseous cyst-like lesions are fairly common with a good prognosis if caught early.
C) Radiography is often sufficient to diagnose the vast majority of osseous cyst-like lesions of the proximal sesamoid bones.
D) Enthesopathy and osteochondrosis are both possible underlying etiologies of this type of lesion.

Answer 18

D) Enthesopathy and osteochondrosis are both possible underlying etiologies of this type of lesion.

Question 19

Below which angle is considered a normal angle of the long linear echo angulation within the superficial digital flexor tendon?

A) 25 degrees
B) 10 degrees
C) 13 degrees
D) 30 degrees

Answer 19

C) 13 degrees

Question 20

What is your diagnosis? (See image).

A) MC/MT condylar fracture
B) Proximal P1 bone contusion
C) MC/MT transverse diaphyseal fracture
D) Palmar osteochondral disease

Answer 20

D) Palmar osteochondral disease

Question 21

What is true regarding the proximal diffusion of local anesthetic agents with regards to the equine distal limb?

A) Multiple pathological lesions are not common within the metatarso/metacarpophalangeal joint.
B) Examination of the suspensory branches, PSBs and distal MCIII/MTIII bones remains important despite a positive response to palmar nerve blocks at the base of the PSBs.
C) A positive response to abaxial sesamoid nerve block always indicates pathology distal to the proximal phalanx.
D) Previous experiment studies showed contrast medium was unable to reach the digital flexor tendon sheath or diffuse to the level of the mid-metacarpal/metatarsal bone.

Answer 21

B) Examination of the suspensory branches, PSBs and distal MCIII/MTIII bones remains important despite a positive response to palmar nerve blocks at the base of the PSBs.

Question 22

Which of the following statements is true?

A) Osseous trauma in the proximal phalangeal sagittal groove is more commonly located at the palmar/plantar region of the groove.
B) Osseous trauma in the proximal phalangeal sagittal groove is more commonly located at the dorsal region of the groove.
C) Osseous trauma in the proximal phalangeal sagittal groove is more commonly located at the central region of the groove.
D) Osseous trauma in the proximal phalangeal sagittal groove usually extends to the sagittal ridge of the third metacarpal/tarsal bone.

Answer 22

C) Osseous trauma in the proximal phalangeal sagittal groove is more commonly located at the central region of the groove.

Question 23

When performing an MRI examination of the fetlock, which of the following structures is the most reliably assessed (highly specificity and sensitivity for lesion detection when compared to histopathology)?

A) Trabecular bone
B) Cartilage
C) Subchondral bone
D) Synovium

Answer 23

A) Trabecular bone

Question 24

Which of the following statements concerning mean quantitative CT density the distal third metacarpal bone of racehorses is true?

A) Mean quantitative CT density was associated with lesion severity or number of lesions.
B) Mean quantitative CT density correlated well with subchondral bone tissue to total tissue ratio.
C) Both metacarpal bones had similar differences in mean quantitative CT density measurements.
D) A strong correlation was found between mean quantitative CT density and gross histopathology score.

Answer 24

B) Mean quantitative CT density correlated well with subchondral bone tissue to total tissue ratio.

Question 25

Which of the following is true regarding palmar cortical (fatigue) fractures of MCIII?

A) Round to ovoid areas of hypoattenuation in the proximal palmar metacarpus with hypoattenuating lines coursing distally is a typical presentation for this pathology.
B) The characteristic lameness pattern is described by a consistent low-grade lameness throughout the entire examination with no significant variability.
C) Radiographic and ultrasonographic changes are common and preclude the need for advanced imaging in most cases.
D) Palpation of the proximal palmar metacarpus is a reliable tool for the localization of proximal metacarpal lesions.

Answer 25

A) Round to ovoid areas of hypoattenuation in the proximal palmar metacarpus with hypoattenuating lines coursing distally is a typical presentation for this pathology.

Question 26

Name the structure indicated by the arrow (see image).

A) Suspensory ligament
B) Accessory ligament of the deep digital flexor tendon
C) Superficial digital flexor tendon
D) Annular ligament

Answer 26

B) Accessory ligament of the deep digital flexor tendon

Question 27

Which of the following statements is true?

A) Microfracture induced T2 and STIR hyperintense lesions within the plantar region of MT3 that persisted throughout the duration of the study.
B) Microfracture induced PD low signal within the trabecular bone of MT3 that persisted from Day-30 until study end.
C) Microfracture induced increased cross-sectional area of the proximal suspensory ligament that persisted throughout the duration of the study.
D) Microfracture induced high-signal lesions within the muscle or adipose tissue regions of the PSL that persisted throughout the duration of the study.

Answer 27

B) Microfracture induced PD low signal within the trabecular bone of MT3 that persisted from Day-30 until study end.

Question 28

Which of the following is true regarding proximal metacarpal(metatarsal) pain and associated lameness?

A) Increased radiographic opacity and increased radiopharmaceutical uptake of the proximal/lateral aspect of MTIII can represent normal findings due to increased loading.
B) Proximal suspensory ligament injuries are similar with regards to prognoses and diagnostic imaging findings between the forelimbs and hindlimbs.
C) Chronic, low-grade lameness with an insidious onset is commonly associated with avulsion fractures of MCIII.
D) The intensity of radiopharmaceutical uptake in the proximal metacarpus(tarsus) is well correlated with both severity and the duration of injury.

Answer 28

A) Increased radiographic opacity and increased radiopharmaceutical uptake of the proximal/lateral aspect of MTIII can represent normal findings due to increased loading.

Question 29

What is the cause of the observed bone marrow edema type signal pattern in the palmaromedial aspect of the metaphyseal and proximal diaphyseal aspect of the third metacarpal bone?

A) Repetitive loading of the proximal metacarpus
B) Solitary trauma
C) Suspensory ligament enthesopathy
D) Normal variant

Answer 29

A) Repetitive loading of the proximal metacarpus

Question 30

Which of the following osseous changes is the most accurate earliest warning signs of a forming bone stress injury which may ultimately lead to a condylar fracture?

A) Palmar osteochondral disease
B) Bone densification
C) Bone marrow lesion
D) Fissure in the parasagittal groove

Answer 30

C) Bone marrow lesion

Question 31

Which is true regarding the diagnosis and treatment of osseous cyst-like lesions?

A) A variable, delayed response to perineural anesthesia can be seen in cases of OCLL which communicate with a joint.
B) A multimodal diagnostic imaging approach is often not required for definitive diagnosis of OCLLs.
C) There are no viable surgical treatment options proven to be beneficial of OCLLs.
D) OCLLs are often found in isolation with no other diagnostic imaging findings associated with the lesions.

Answer 31

A) A variable, delayed response to perineural anesthesia can be seen in cases of OCLL which communicate with a joint.

Question 32

What is respectively the cause of the high and intermediate signal in T1W and T2W sequences intensity observed on MRI in the proximal aspect of the suspensory ligament?

A) High signal intensity: adipose tissue; intermediate signal intensity: muscle tissue
B) High signal intensity: muscle tissue; intermediate signal intensity: adipose tissue
C) High signal intensity: edema; intermediate signal intensity: muscle tissue
D) High signal intensity: adipose tissue; intermediate signal intensity: mineralization

Answer 32

A) High signal intensity: adipose tissue; intermediate signal intensity: muscle tissue

Question 33

Which of the following statements is true regarding decreased signal intensity in T1W and T2W images in the medial aspect of the carpal bones and the proximal metacarpal region?

A) This MRI finding is always considered abnormal when observed.
B) This MRI finding is most commonly accompanied by increased signal in the STIR sequence.
C) This clinical significance of this lesion can be established by comparing it with the contralateral non-lame limb.
D) This uncommon carpal MRI finding represents sclerosis/mineralization of the bones.

Answer 33

C) This clinical significance of this lesion can be established by comparing it with the contralateral non-lame limb.

Question 34

Which of the following soft tissue injuries is most commonly associated with carpal sheath effusion?

A) Accessory ligament of the superficial digital flexor tendon
B) Deep digital flexor tendons
C) Superficial digital flexor tendons
D) Thickening of the synovial lining

Answer 34

C) Superficial digital flexor tendons

Question 35

Which of the following statements is true? (See image)

A) The radial facet represented by the red circle is the most common site for carpal slab fractures in racing TBs.
B) The radial facet represented by the green circle is the most common site for carpal slab fractures in racing TBs.
C) The intermediate facet represented by the red circle is the most common site for carpal slab fractures in racing TBs.
D) The intermediate facet represented by the green circle is the most common site for carpal slab fractures in racing TBs.

Answer 35

A) The radial facet represented by the red circle is the most common site for carpal slab fractures in racing TBs.

Question 36

Which is true regarding diagnostic imaging of the palmar aspect of the carpus?

A) CT arthrography and MRI both allow for adequate evaluation of the fibre structure of the ligaments in this region.
B) Ultrasonographic examination of the area remains challenging but the dorsopalmar thickening of the palmar carpal ligament can be routinely evaluated.
C) The image quality associated with low-field MRI in standing, sedated patients is too poor to definitely diagnose soft tissue lesions in this area.
D) Ultrasonographic abnormalities are always readily apparent after injury and do not change drastically over time.

Answer 36

B) Ultrasonographic examination of the area remains challenging by the dorsopalmar thickening of the palmar carpal ligament can be routinely evaluated.

Question 37

What is the largest and most medially located structure when imaging the dorsolateral aspect of the carpus in horses?

A) Extensor Carpi Radialis Tendon
B) Ulnaris Lateralis Tendons
C) Lateral Collateral Ligament
D) Lateral Digital Extensor Tendon

Answer 37

A) Extensor Carpi Radialis Tendon

Question 38

Where is the most common for increased radiopharmaceutical uptake in humeral fractures of Standard breed racehorses?

A) Distal cranial medial aspect of the humerus
B) Caudal humeral cortex
C) Distal cranial lateral aspect of the humerus
D) Cranial humeral cortex

Answer 38

B) Caudal humeral cortex

Question 39

With regards to catastrophic scapular fractures in racehorses, which of the following CT changes indicate pre-existing bone modeling?

A) Periosteal bone proliferation that bridged the transverse fracture line at the distal end of the spine and radiolucent feature in the compact bone subjacent the periosteal proliferation.
B) Periosteal bone proliferation that bridged the frontal fracture line in the distal fragment of the glenoid and radiolucent feature in the compact bone subjacent the periosteal proliferation.
C) Periosteal bone proliferation that bridged the transverse fracture line at the distal end of the spine and shoulder osteoarthritis.
D) Periosteal bone proliferation that bridged the frontal fracture line in the distal fragment of the glenoid and shoulder osteoarthrosis.

Answer 39

A) Periosteal bone proliferation that bridged the transverse fracture line at the distal end of the spine and radiolucent feature in the compact bone subjacent the periosteal proliferation.

Question 40

The main characteristic(s) of congenital anomaly of the bicipital apparatus in horses is…

A) Hypoplasia/aplasia of the minor tubercle causing luxation of the bicipital tendon
B) Narrowing of the space between the major and intermediate tubercles.
C) Rounded biceps brachii tendon entirely located between the major and intermediate tubercles.
D) Remodeling of the supraglenoid tubercle with enthesopathy of the bicipital tendon.

Answer 40

A) Hypoplasia/aplasia of the minor tubercle causing luxation of the bicipital tendon

Question 41

Which of the following statements is true?

A) All deltoid tuberosity fractures were identified on the cranio45 medial-caudo-lateral oblique projection.
B) All deltoid tuberosity fractures were identified on the medial to lateral projection
C) The medial to lateral projection allowed to definitively diagnose a deltoid tuberosity fracture in 60% of the cases.
D) The cranio45 medial-caudo-lateral oblique projection allowed to definitively diagnose a deltoid tuberosity fracture in 60% of the cases.

Answer 41

A) All deltoid tuberosity fractures were identified on the cranio45 medial-caudo-lateral oblique projection.

Question 42

Which of the following is true regarding imaging of the equine shoulder?

A) Radiography is always superior to ultrasonography in the diagnosis of humeral tubercle fractures.
B) Nuclear scintigraphy is a useful modality in the specific and definitive diagnosis of shoulder lesions.
C) A perpendicular angle of incidence in the evaluation of the biceps brachii tendon is important in the prevention of beam-angle artifacts.
D) The intermediate tubercle presents as a distinctly hyperechoic structure ultrasonographically in all ages.

Answer 42

C) A perpendicular angle of incidence in the evaluation of the biceps brachii tendon is important in the prevention of beam-angle artifacts.

Question 43

Which of the following is true regarding ulnar fractures in the equine patient?

A) Kick-induced fractures generally fall into the classification system proposed by Swor et al. (2003)
B) Standing removal of ulnar fragments results in a good prognosis in all ulnar fracture cases.
C) Return to full function is common with conservative management of nonarticular and nondisplaced fractures
D) Visibility of the triceps apparatus is the main factor in determining whether standing removal of ulnar fragments can be utilized.

Answer 43

D) Visibility of the triceps apparatus is the main factor in determining whether standing removal of ulnar fragments can be utilized.

Question 44

What is the structure identified on ultrasound examination of the shoulder joint? (See image)

A) Infraspinatous bursa
B) Bicipital bursa
C) Shoulder joint
D) Seroma

Answer 44

B) Bicipital bursa

Question 45

What normal structure is identified on this transverse PD weighting sequence of the hindlimb of a horse obtained just distal to the tarsometatarsal joint? (See image)

A) Lateral digital flexor tendon
B) Plantar ligament of the distal tarsus
C) Accessory ligament of the deep digital flexor tendon
D) Long digital flexor tendon

Answer 45

A) Lateral digital flexor tendon

Question 46

You are consulted on referral tarsal radiographs for an incoming appointment on a horse presenting for left hindlimb lameness. You identify a large spur on the dorsoproximal aspect of MTIII, what is your comment or recommendation to the clinician regarding this finding?

A) This is an incidental finding unlikely to be the cause of the lameness.
B) Perform intra-articular analgesia of the tarsometatarsal joint.
C) Desensitize the fibularis and tibialis nerves with ultrasound guidance.
D) Consider nuclear scintigraphy to confirm the clinical relevance of this finding.

Answer 46

A) This is an incidental finding unlikely to be the cause of the lameness.

Question 47

Which of the following is true regarding equine osteochondromas?

A) Common histopathological findings include cortical bone mixed with cartilaginous tissue.
B) The prognosis associated with uncomplicated removal is generally poor due to the para-articular origin and associated soft tissue damage.
C) Malignant transformation has been routinely reported in both human and equine literature as a complication in older patients.
D) The most common site of occurrence is the caudal distal radial metaphysis but other sites including the distal tibia, calcaneus, and the spine have been reported.

Answer 47

D) The most common site of occurrence is the caudal distal radial metaphysis but other sites including the distal tibia, calcaneus, and the spine have been reported.

Question 48

Which of the following lesions are most likely to be diagnosed with CT but missed with other imaging modalities?

A) Subchondral cyst-like lesions, osteolytic lesions are fissure fracture of the distal tibia.
B) Osteolytic lesions, degenerative changes of the small tarsal joints and fissure fracture of the distal tibia.
C) Subchondral cyst-like lesions, degenerative changes of the small tarsal joints and injury of the collateral ligaments of the tarsus.
D) Subchondral cyst-like lesions, osteolytic lesions and degenerative changes of the small tarsal joints.

Answer 48

D) Subchondral cyst-like lesions, osteolytic lesions and degenerative changes of the small tarsal joints.

Question 49

The image below depicts a lesion (white arrows) identified upon a dorsoplantar radiograph of the equine tarsus. Which is true regarding the utilization of other imaging modalities for this pathology? (See image)

A) Radiographic signs are often present with this pathology and no further imaging modalities are required.
B) Due to the high specificity associated with nuclear scintigraphy, it is a recommended modality to pursue if lameness can be definitely isolated to the tarsus.
C) Ultrasonographic evaluation of the region can provide a definitive diagnosis if there are no significant radiographic findings.
D) After survey radiographs are performed to reveal this lesion, MRI would be indicated to better characterize the soft tissue structures associated with this pathology.

Answer 49

C) Ultrasonographic evaluation of the region can provide a definitive diagnosis if there are no significant radiographic findings.

Question 50

What structure does this transverse T2* weighted sequence of the left hindlimb denote? (See image)

A) Long plantar ligament
B) Deep plantar ligament
C) Medial digital flexor tendon
D) Accessory ligament of the deep digital flexor tendon

Answer 50

A) Long plantar ligament

Question 51

Which of the following is the most common location of cyst-like lesions in the equine tarsus?

A) The medial malleolus
B) The intertrochlear groove of the talus
C) The lateral malleolus
D) The distal intermediate ridge of the tibia

Answer 51

A) The medial malleolus

Question 52

Which of the following structures (arrows) is better assessed ultrasonographically vs. arthroscopically?

Answer 52

Picture D

Question 53

The _______ of ultrasound for lesion detection in the medial trochlear ridge was ______ than radiographs.

A) Specificity, higher
B) Sensitivity, higher
C) Specificity, lower
D) Sensitivity, lower

Answer 53

B) Sensitivity, higher

Question 54

Which radiographic projection allows better evaluation for osteochondral lesions of the medial trochlear ridge?

A) Lateral-medial
B) Ca60*L-CrMO
C) Caudocranial
D) Flexed LM

Answer 54

A) Lateral-medial

Question 55

What statement concerning ultrasound evaluation of injuries to the intermediate patellar ligament is true?

A) A lesion is commonly seen at the insertion in a craniomedial to caudolateral direction.
B) The intermediate patellar ligament injury was commonly the sole lesion on ultrasound examination.
C) Prognosis for return to work is guarded.
D) Lesions were commonly found after a horse had been rested for several months.

Answer 55

D) Lesions were commonly found after a horse had been rested for several months.

Question 56

Which of the following is true in reference to the image below? (See image)

A) IRU at the lateral trochlear ridge of the femur suggests an injury of the long digital extensor.
B) IRU at the origin and insertion of the lateral collateral ligament suggests an injury of this structure.
C) IRU as noted below likely represents a variant of normal with no underlying pathology.
D) IRU at the lateral aspect of the distal femur suggests an injury of the superficial digital flexor tendon.

Answer 56

D) IRU at the lateral aspect of the distal femur suggests an injury of the superficial digital flexor tendon.

Question 57

Which of the following is true regarding this retrospective study and diagnostic imaging of the equine stifle?

A) Meniscus lesions were noted in the majority of cases with an equal distribution between the lateral and medial menisci.
B) Degenerative changes were noted more frequently in the medial meniscus and tearing was noted more frequently in the lateral meniscus.
C) Post-MRI arthroscopy was able to confirm the majority of lesions and their severity relative to the MRI findings.
D) Meniscopathies were underrepresented in this study due to reliable ultrasonographic detection.

Answer 57

A) Meniscus lesions were noted in the majority of cases with an equal distribution between the lateral and medial menisci.

Question 58

Which of the following descriptions matches with this radiographic projection? (See image)

A) Latero-medial
B) Caudolateral 60* craniomedial oblique
C) Craniolateral 60* caudomedial oblique
D) Caudoproximal 10* craniodistal oblique

Answer 58

B) Caudolateral 60* craniomedial oblique

Question 59

Considering differences in human vs. equine anatomy and physiology, what is one of the main limitations of the EDWI extrapolated from the human literature?

A) The cervical vertebral spine of horses has a different morphology, curvature and shape relative to the rigid human spine. Therefore, the effect of equine cervical spine position may affect the EDWI.
B) The composition of the equine intervertebral disc being different, degeneration has possibly a different effect on intervertebral disc space width compared to species with a less fibrous nucleus pulposus.
C) The lifespan of horses being shorter than humans, the EDWI measurement is unlikely to show a difference overtime suggestive of intervertebral disc narrowing from degeneration.
D) Maximal spinal loading occurs in the thoracic spine of horses vs. cervical spine of humans. Therefore, implementing the EDWI on the cervical spine in horses is unlikely to be of clinical relevance.

Answer 59

B) The composition of the equine intervertebral disc being different, degeneration has possibly a different effect on intervertebral disc space width compared to species with a less fibrous nucleus pulposus.

Question 60

In the study, catheter placement is performed at C1-2 opposed to the commonly used atlanto-occipital space. What is the main advantage of this technique?

A) Nociception stimulation at the time of dural puncture is decreased in intensity.
B) The risks of inadvertent spinal cord puncture and hemorrhage are lower.
C) There is a shorter distance of needle passage to enter the subarachnoid space.
D) There are no requirements for general anesthesia to have the neck in flexion.

Answer 60

D) There are no requirements for general anesthesia to have the neck in flexion.

Question 61

Which of the following is true regarding equine cervical osteochondromas and the comparative humane and canine literature?

A) Equine osteochondroma arises most commonly within skeletally immature animals with an early onset of clinical signs.
B) The cervical region is the most common site of equine osteochondromas.
C) Malignant transformation of has been definitively documented in all three species.
D) Human literature suggests that most of these lesions are amenable to surgical removal which carries a good prognosis.

Answer 61

D) Human literature suggests that most of these lesions are amenable to surgical removal which carries a good prognosis.

Question 62

How is morphology of the intervertebral disc in the horse different than that of the dog?

A) The annulus pulposus is thicker dorsally.
B) The nucleus pulposus is larger than the annulus pulposus.
C) The dorsal longitudinal ligament is thickest over the cervical spine.
D) The annulus and nucleus consists of cartilage and fibrocartilage.

Answer 62

D) The annulus and nucleus consists of cartilage and fibrocartilage.

Question 63

A six-year-old Warmblood gelding was presented for neck stiffness, ataxia, and unilateral front limb lameness. Computed tomographic myelography was performed to reveal the changes noted in the associated image. Which of the following is true? (See image)

A) Myelographic attenuation caudal to C5 is not common, and concurrent pathology in the cranial cervical spine is likely.
B) The vast majority of osteoarthritis-associated attenuation is dorsal in nature with a small portion of cases presenting dorsolaterally.
C) A static neural-extended neck position may have contributed to a decreased sensitivity of the detection of concurrent mid-cervical lesions.
D) The most common presentation for cervical vertebral stenotic myelopathy is at a young age in female patients.

Answer 63

C) A static neural-extended neck position may have contributed to a decreased sensitivity of the detection of concurrent mid-cervical lesions.

Question 64

Which image represents the normal vertebral anatomy of the 7th cervical vertebra of the horse? (See image)

A) A
B) B
C) C
D) D

Answer 64

Image A

Question 65

Which of the following describes better the ultrasound approach used to enter the cervical articular process joints (CAPJs)?

A) A ventro-cranial approach was used at C5-C6 and a dorso-cranial approach was used at C6-C7.
B) A ventro-caudal approach was used for all the CAPJs.
C) A dorso-cranial approach was used at C5-6 and a ventro-cranial approach was used at C6-C7.
D) A dorsal-cranial approach was used for all CAPJs.

Answer 65

D) A dorsal-cranial approach was used for all CAPJs.

Question 66

What statement is true regarding fractures of the third trochanter of the femur of the horse?

A) Ultrasound is an accurate modality to evaluate healing of a fracture of the third trochanter.
B) Ultrasound can be used as the sole modality to evaluate for fractures of the third trochanter.
C) The degree of radiopharmaceutical uptake of the third trochanter was positively correlated with the duration of lameness.
D) A craniocaudal radiographic projection of the third trochanter is the best view to evaluate for fractures and fragmentation.

Answer 66

B) Ultrasound can be used as the sole modality to evaluate for fractures of the third trochanter.

Question 67

Which of the following statements is true regarding the diagnosis of acetabular fractures by ultrasound?

A) Transrectal ultrasound allowed to make a definitive diagnosis in approximately 90% of the cases with acetabular fracture.
B) Transrectal ultrasound allowed to make a definitive diagnosis in approximately 50% of the cases with acetabular fracture.
C) Percutaneous ultrasound allowed to make a definitive diagnosis in approximately 50% of the cases with acetabular fracture.
D) Percutaneous ultrasound allowed to make a definitive diagnosis in approximately 90% of the cases with acetabular fracture.

Answer 67

C) Percutaneous ultrasound allowed to make a definitive diagnosis in approximately 50% of the cases with acetabular fracture.

Question 68

Which of the following is true regarding transrectal ultrasonographic evaluation of the sacroiliac joints?

A) This technique allows for the diagnosis of interosseous sacroiliac ligament desmopathy/enthesopathy.
B) Previous reports indicate this technique correlates well to findings with nuclear scintigraphy.
C) Lesion severity is often more severe in females due to the narrow joint space and larger, round pelvic inlet.
D) Overt lameness is a common presentation for high grade (3-4) osteoarthritic lesions.

Answer 68

B) Previous reports indicate this technique correlates well to findings with nuclear scintigraphy.

Question 69

A parasagittal ultrasound image of the intermediate part of the sacroiliac joint (cranial is to the left) is attached. What is the structure labelled 3 in the attached image? (See image)

A) Interosseous sacroiliac ligament
B) Sacral wing
C) Iliac wing
D) Ventral sacroiliac ligament

Answer 69

D) Ventral sacroiliac ligament

Question 70

What is the most common direction of coxofemoral subluxation identified in the horse?

A) Caudodorsal
B) Craniodorsal
C) Caudoventral
D) Cranioventral

Answer 70

B) Craniodorsal

Question 71

Considering the anatomy as depicted in figure 7, what is the main risk of performing injections of the sacroiliac joints using the caudal approach? (See image)

A) Performing an intramuscular injection.
B) Anesthetic solution diffusion to the sciatic nerve.
C) Injecting anesthetic solution in the vertebral canal.
D) Needle interference with the gluteal artery and vein.

Answer 71

B) Anesthetic solution diffusion to the sciatic nerve.

Question 72

Considering the above regarding the site of latex injection obtained with each technique, which technique is the safest to use with live patients?

A) Craniomedial
B) Medial
C) Caudal
D) Modified caudal

Answer 72

A) Craniomedial

Question 73

A 10-year-old Warmblood mare is presented for coughing, exercise intolerance and weight loss of a chronic duration. Radiography reveals a single cranioventral opacity and ultrasonography reveals thickening of the pleural surface and reduced pleural movement on the right side only. Pleural effusion appears scant to absent and no ventral thoracic or pectoral edema is noted. Which of the following is true regarding the primary differential diagnosis for this case presentation?

A) This likely represents mediastinal lymphoma and tracheobronchial lymphadenomegaly.
B) This likely represents a pulmonary granular cell tumour and surgical resection could be considered.
C) Neoplasia is not strongly suspected and other differentials such as pulmonary abscessation should be considered.
D) This likely represents mesothelioma despite the lack of pleural effusion present.

Answer 73

B) This likely represents a pulmonary granular cell tumour and surgical resection could be considered.

Question 74

The associated radiograph represents the cranial dorsal lung field of an 8-year-old Warmblood gelding diagnosed with EMPF. Which of the following is true regarding EMPF?

A) The presence of tracheobronchial lymph node enlargement and pulmonary masses was more prevalent in non-survivors.
B) The severity of thoracic radiographic changes is a strong predictor of survival time.
C) Although a variety of radiographic pulmonary patterns can be present, a predominantly craniodorsal distribution is expected.
D) Human pulmonary fibrosis literature revealed an association between imaging score with CT and histopathological severity.

Answer 74

D) Human pulmonary fibrosis literature revealed an association between imaging score with CT and histopathological severity.

Question 75

You perform an esophagram on a foal presenting for choke. After the administration of 2.5 mls/kg of 30% barium through a nasogastric tube, you acquire a series of radiographs. How do you interpret the following finding?

A) Normal redundant esophagus
B) Incomplete esophageal stricture
C) Normal esophageal mucosal fold
D) Pulsion esophageal diverticulum

Answer 75

C) Normal esophageal mucosal fold

Question 76

What kind of pattern would you expect to see in an M-mode ultrasound examination of a horse with a small volume of pneumothorax?

A) Multiple perpendicular lines below the level of the pleural line.
B) Multiple horizontal lines above and below the level of the pleural line.
C) A homogeneous granular/sandy pattern below the level of the pleural line.
D) A heterogenous granular/sandy pattern above and below the level of the pleural line.

Answer 76

B) Multiple horizontal lines above and below the level of the pleural line.

Question 77

A middle-aged patient presents for intermittent coughing. Thoracic radiographs are consistent with a moderate caudodorsal bronchial pattern. Bronchoscopy reveals excessive mucus in the airways and bronchoalveolar lavage is consistent with a moderate to severe increase in neutrophils. What is your diagnosis?

A) Inflammatory airway disease
B) Recurrent airway obstruction
C) Mild to moderate equine asthma
D) Further diagnostic tests are required

Answer 77

B) Recurrent airway obstruction

Question 78

At what time after birth would you expect to see clearance of fluid from a newborn foal?

A) Immediately
B) 30 minutes
C) 3 hours
D) 6 hours

Answer 78

D) 6 hours

Question 79

This ultrasound image was taken at the 10th intercostal space on the right side with a 2.5 MHz convex probe at a scanning depth of 15 cm. The hypoechoic structure located in the center of the image is compatible with…

A) A fluid pocket contained within a large abscess.
B) A transverse section of an artery.
C) A transverse section of colonic mesenteric vessels.
D) An organized seroma.

Answer 79

A) A fluid pocket contained within a large abscess.

Question 80

A 9 year old Thoroughbred horse presents for colic, you ultrasound the right ventral flank and find a colonic wall thickness of approximately 9mm. What is your primary differential diagnosis?

A) Right dorsal displacement of the colon
B) Large colon torsion
C) Left dorsal displacement of the colon
D) Colonic impaction

Answer 80

B) Large colon torsion

Question 81

You are asked to perform an ultrasound examination on a horse presenting for colic. You ultrasound the left kidney using the technique described, and obtain the following image. What is your diagnosis?

A) Large nephrolith
B) Peritoneal gas
C) Mineralized renal tumor
D) Nephrosplenic entrapment

Answer 81

D) Nephrosplenic entrapment

Question 82

Which of the following is true regarding acute pancreatitis in horses?

A) The majority of cases of equine pancreatitis are primary in nature with no known underlying cause.
B) Cases generally present systemically with very little local effect on adjacent abdominal organs.
C) Most cases of equine pancreatitis present in an acute fashion with a very high (>90%) mortality rate.
D) As in people, type-A C. perfringens may be implicated in cases of acute necrotizing pancreatitis in horses.

Answer 82

D) As in people, type-A C. perfringens may be implicated in cases of acute necrotizing pancreatitis in horses.

Question 83

A 3-year-old gelding with an unknown medical history is purchased and the seller assures you the horse underwent castration. However, the specifics of the procedure are unclear, and the gelding begins exhibiting stallion-like behavior. Which of the following is true regarding the next steps in ultrasonography to evaluate the gelding for cryptorchidism?

A) Structures presumed to be testis cannot be definitively differentiated from other intra-abdominal structures.
B) Transrectal/inguinal and transabdominal/inguinal ultrasound both have good to excellent sensitivity and specificity.
C) Unilateral cryptorchidism is more common than bilateral, and testis are most commonly found within the caudal abdomen.
D) Transrectal/inguinal ultrasonography and hormonal assays are unlikely to be accurate due to the patients’ age.

Answer 83

B) Transrectal/inguinal and transabdominal/inguinal ultrasound both have good to excellent sensitivity and specificity.

Question 84

Although ultrasonography cannot replace radiography in the assessment of gastrointestinal sand, in which scenario could ultrasonography be more clinically applicable relative to radiography?

A) Document the presence of gastrointestinal sand in a miniature horse.
B) Monitor the resolution of sand during the course of treatment.
C) Differentiate between gastrointestinal sand vs. food impaction.
D) Investigate the presence of sand in the right or left dorsal colon.

Answer 84

B) Monitor the resolution of sand during the course of treatment.

Question 85

Which one of the following statements I true regarding these 2 ultrasound images?

A) The left image shows the right kidney and the duodenum and the right image shows a horse with a left dorsal displacement of the large colon.
B) The left image shows a horse with a left dorsal displacement of the large colon and the right image shows a horse with a normal renosplenic space
C) The left image shows the right kidney and an abnormally thickened duodenum and the right image shows a normal renosplenic space
D) The left image shows the left kidney and a thicken SI loop and the right image shows a horse the left dorsal displacement of the large colon.

Answer 85

C) The left image shows the right kidney and an abnormally thickened duodenum and the right image shows a normal renosplenic space

Question 86

Please choose the CORRECT answer concerning ultrasound examination of equine lymphoma.

A) Multicentric lymphoma was the most commonly reported.
B) Thoroughbred horses are the most prevalent breed.
C) The cecal lymph nodes are most commonly involved.
D) A diffusely hypoechoic lymph node with through enhancement was commonly identified.

Answer 86

A) Multicentric lymphoma was the most commonly reported.

Question 87

Which of the following is true regarding radiographic and computed tomographic evaluation of equine skull fractures?

A) Axial temporomandibular joint involvement is often significantly underestimated radiographically.
B) Simple fractures are commonly misinterpreted as multiple fractures within the cranioventral skull.
C) The number of fragments is likely mildly underestimated radiographically, compared to CT evaluation.
D) Involvement of other structures (teeth, eyes, airway) can often be assessed appropriately radiographically.

Answer 87

A) Axial temporomandibular joint involvement is often significantly underestimated radiographically.

Question 88

What is the lesion identified by the green arrow?

A) Central vascular channel
B) Central linear cemental defects
C) Apical cemental hypoplasia
D) Sub-occlusal infundibular caries

Answer 88

C) Apical cemental hypoplasia

Question 89

What is the MOST correct statement concerning equine sinonasal neoplasia?

A) Radiographs were able to evaluate masses in the caudal maxillary, frontal and sphenopalatine sinuses.
B) The majority of equine sinonasal tumors are hyperattenuating to masseter muscle.
C) CT allowed differentiation between sinus cysts and sinusitis.
D) Sinusitis uncommonly causes osteolysis.

Answer 89

D) Sinusitis uncommonly causes osteolysis.

Question 90

Please describe how to acquire a lateral radiograph on a horse with maximal pharyngeal diameter.

A) Head in a dorsal position with the neck in a flexed position.
B) Head position neutral with the neck in an extended position.
C) Head in a dorsal position with the neck in an extended position.
D) Head position neutral with the neck in a neutral position.

Answer 90

B) Head position neutral with the neck in an extended position.

Question 91

Which of the following is true regarding radiographic and computed tomographic (CT) evaluation of the equine head?

A) Radiographic sensitivity of pathology of the caudal maxillary/conchofrontal sinuses is poor (<50%) compared to CT.
B) The temporomandibular joint can be assessed upon oblique radiographic projections and CT offers little additional benefit.
C) Radiographic and CT evaluation of dental disease is congruent (>95%) in the identification of affected teeth.
D) Sinonasal cystic structures can be challenging to assess with both modalities depending upon location and mineralization.

Answer 91

D) Sinonasal cystic structures can be challenging to assess with both modalities depending upon location and mineralization.

Question 92

A horse previously diagnosed with an ethmoid hematoma was treated with several formalin injections. The patient presents for a CT examination of the head due to recurrence of clinical signs. What are two anatomic changes you may expect to find on computed tomography?

A) Multifocal disease, cribriform plate involvement
B) Bilateral disease, paranasal sinus involvement
C) Unilateral disease, bony destruction or erosion
D) Generalized disease, anatomy distorsion

Answer 92

B) Bilateral disease, paranasal sinus involvement

Question 93

Which one of the following is the most common neoplasm of the equine head?

A) Adamantinoma
B) Squamous cell carcinoma
C) Ossifying fibroma
D) Melanoma

Answer 93

B) Squamous cell carcinoma