*MOVED*Advanced Internal Derangements Flashcards
What is the most common ATRAUMATIC cause of avascular necrosis? A. Corticosteroids B. Lupus C. Barotrauma D. Sickle cell
A. Corticosteroids
Partial loss of muscle strength, some torn fibers, and interstitial blood within a muscle is classified as? A. Delayed-onset muscle soreness B. Grade I muscle strain C. Grade Il muscle strain D. Grade III muscle strain
C. Grade Il muscle strain
Your patient demonstrates anterior and posterior fat pad signs at the elbow in the absence of trauma. Which of the following would you suspect? A. Pannus B. Olecranon bursitis C. Osteochondritis dissecans D. Secondary synoviochondrometaplasia
A. Pannus
What anatomic structure acts as the ulnar attachment of the distal flexor retinaculum? A. Hook of hamate B. Pisiform C. Triquetral tubercle D. Base of 5th metacarpal
A. Hook of hamate
Deficient growth of the medial aspect of the radial plateau results in what? A. Positive ulnar variance B. Medelungs deformity C. Negative ulnar variance D. Radial styloideum
B. Medelungs deformity
Decreased sensation to the 4th and 5th fingers indicates nerve compression at what site? A. Tunnel of Guyon B. Arcade of Frohse C. Pronator teres D. Quadralateral space
A. Tunnel of Guyon
Which of the following is a contraindication to gadolinium enhancement of an MRI? A. Bone neoplasia B. Renal failure C. Thyroid carcinoma D. Prostate enlargement
B. Renal failure
Which of the following conditions is not associated with ulnar nerve neuropathy in the elbow? A. Thickening of the cubital tunnel retinaculum (Osborne’s ligament) B. Arcade of Struthers C. Anomalous muscle (anconeus epitrochlearis) D. Ostechondritis dissecans of the capitellum
D. Ostechondritis dissecans of the capitellum
The presence of a displaced ulnal collateral ligament beneath the proximal edge of the adductor aponeurosis at the metacarpo-phalangeal joint of the thumb is called… A. Gamekeeper’s thumb B. Rolando’s fracture C. Stener lesion D. Bennett’s fracture
C. Stener lesion
Your patient is highly claustrophobic. In order to obtain an MRI, which of the following would be indicated? MARK ALL THAT APPLY, 1-3 CORRECT ANSWERS A. MD referral for Valium B. Open MRI C. Gadolinium enhancement D. No correct answer listed
A. MD referral for Valium B. Open MRI
Wrist radiographs reveal a Terry Thomas sign and increased scapholunate angle. What is the diagnosis? A. Scapholunate dissociation B. Dorsal intercalated segmental instability C. Lunotriquetral ligament tear D. Ventral intercalated segmental instability
B. Dorsal intercalated segmental instability
Which of the following is NOT a contraindication to a lumbar spine MRI? A. Pacemaker B. Cerebral aneurysm clips C. Total hip arthroplasty D. implanted TENS unit
C. Total hip arthroplasty
Increased pressure within a closed fascial boundary and compromised circulation following injury is defined as: A. Chronic compartment syndrome B. Acute compartment syndrome C. Exertional compartment syndrome D. Paradoxical compartment syndrome
B. Acute compartment syndrome
The “catch up clunk” is a finding of what condition? A. Midcarpal instability B. Ulnar impaction syndrome C. Ulnar impingement syndrome D. Kienbocks disease
A. Midcarpal instability
Which of the following conditions occurs when hemorrhage or-edema within elosed fascial boundaries leads to localized increased pressure with compromise of the circulation? A. Delayed onset muscle soreness (DOMS) B. Compartment syndrome C. Cellulitis D. Necrotizing fasciitis
B. Compartment syndrome
Pigmented villonodular synovitis involving a tendon sheath is also known as what? A. Giant cell tumor B. Extra-articular synovial osteochondromatosis C. DeQuervains disease D. Sanguine dactylitis
A. Giant cell tumor
The most sensitve modality for the early detection of avascular necrosis of the femoral head is…? A. MRI B. Scintigraphy C. CT D. Radiography
A. MRI
Which of the following is NOT true regarding frequency-selective (chemical) fat saturation? A. Requires a 1.0 tesla or higher field strength for adequate separation of the fat and water peaks. B. Utilizes a “spoiler” pulse that wipes out the signal from fat. C. is not sensitive to magnetic field inhomogeneties. D. Can be utilized after the intravenous administration of gadolinium.
C. is not sensitive to magnetic field inhomogeneties.
Fatty atrophy and edema of the supinator muscle are seen in entrapment of which nerve? A. Radial B. Median C. Ulnar D. Musculocutaneous
A. Radial
Triangular fibrocartilage tear is associated with which of the following? A. Positive ulnar variance B. Scaphoid fracture C. Distal radioulnar synostosis D. Bartons fracture
A. Positive ulnar variance
Which of the following is NOT on the differential list for a distended olecranon bursa? A. CPPD B. Gout C. HADD D. PVNS
A. CPPD
What is the most common-source of osteochondral debris in a hip? A. Degeneration B. Synoviochondrometaplasia C. CPPD D. PVNS
A. Degeneration
Which of the following conditions is not usually associated with scapholunate ligament tear on MRI? A. Scapholunate gap increased to over 3 mm B. Volar (palmar) flexion of the scaphoid on sagittal images C. Dorsal intercalated segmental instability (DISI) D. Volar intercalated segmental instability (VISI)
D. Volar intercalated segmental instability (VISI)
A hyperintense T2 fluid collection is noted between the iliopsoas tendon and the anterior hip capsule in a patient with groin pain. What do you suspect? A. Hip effusion B. Iliopsoas bursitis C. Ganglion cyst D. Tenosynovitis
B. Iliopsoas bursitis
Which of the following MRI features is not usually seen with nerve sheath tumors: A. String sign B. Split fat sign C. Target pattern D. Yo-yo sign
D. Yo-yo sign
What is the relationship of slice thickness to structure resolution in MRI? A. Increase thickness, increase resolution B. Increase thickness, decrease resolution C. Decrease thickness, decrease resolution
B. Increase thickness, decrease resolution
Hypointense T1 thicknening of the iliotibial tract adjacent to the greater trochanter is noted. What is the syspected diagnosis? A. Snapping hip syndrome B. IT band syndrome C. Muscular contusion D. Trochanteric bursitis
A. Snapping hip syndrome
Thickening and increased signal intensity on fluid-sensitive images at the origin of the pronator teres and flexor carpi radialis tendons is a sign of: A. lateral epicondylitis B. medial epicondylitis C. ulnar neuritis D. coronoid osteoarthritis
B. medial epicondylitis
What is the MRI imaging characteristic of late stage/chronic avaseular neerosis of the proximal pole of the scaphoid? A. T1: hyper T2: hyper B. T1: hypo T2: hyper C. T1: hyper T2: hypo D. T1: hypo T2 hypo
D. T1: hypo T2 hypo
De Quervain Syndrome is associated with to which of the following? A. Idiopathic B. Pregnancy C. Repetitive trauma D. All of the above E. None of the above
D. All of the above
Femoroacetabular impingement syndrome results in injury to what soft tissue structure? A. Acetabular labrum B. Teres ligament C. Iliopsoas tendon D. Femoral vascular supply
A. Acetabular labrum
A traction apophysitis of the secondary ossification center at the medial epicondyle of the elbow, resultant from chronic valgus stress injuries, is know as: A. Epicondylar osteochondritis B. Lateral epicondylitis C. Little leaguer’s elbow D. Golfer’s elbow
C. Little leaguer’s elbow
Which of the following is not a likely complication of compartment syndrome without treatment? A. Necrosis B. Neurologic damage C. Infection D. Volkmann’s contracture
C. Infection
On axial imaging of the wrist, there is volar displacement of the ulna relative to the sigmoid notch of the radius. What ligament injury do you suspect? A. Dorsal distal radioulnar B. Volar distal radioulnar C. Radial collateral D. Ulnar collateral
A. Dorsal distal radioulnar
What is the mechanism most associated with biceps brachii distal tendon rupture? A. Eccentric contraction of a flexed elbow B. Isometric contraction of a flexed elbow C. Isometric contraction of an extended elbow D. Concentric contaction of an extended elbow
A. Eccentric contraction of a flexed elbow
How do you differentiate the high signal intensity of a tendon tear from a high signal intensity created by the magic angle phenomenon within a tendon on T2* (gradient echo)? A. A tear will be hyperintense to muscle on T2* B. A tear will be hypointense to muscle on T2* C. A tear will be isointense to muscle on T2* D. The magic angle phenomenon will disappear on T1
A. A tear will be hyperintense to muscle on T2*
Injury of what nerve is associated with posterior elbow dislocation? A. Median B. Ulnar C. Radial D. Musculocutaneous
B. Ulnar
Edema of the first dorsal extensor compartment (abductor pollicis longus and extensor pollicis brevis) of the wrist is named? A. De Quervain’s tenosynovitis B. Intersection syndrome C. Wartenberg’s syndrome D. Dupuytren’s tenosynovitis
A. De Quervain’s tenosynovitis
Which of the following MRI sequence is best used to identify a cartilaginous defect on both high field and low field magnets? A. T1-weighted spin echo B. T2-weighted fast spin echo without fat saturation C. Proton density spin echo without fat saturation D. STIR
D. STIR
Which linelangle is altered in pediatric patients with a supracondylar fracture of the humerus? A. Anterior humeral line B. Radiocapitellar line C. Carrying angle D. Humeral articular line
A. Anterior humeral line
What is the most common elbow fracture in adults? A. Radial head B. Supracondylar C. Osteochondral D. Coronoid
A. Radial head
Acetabular labral tears predispose a patient to the formation of what? A. Paralabral cyst B. lliopsoas tendinosis C. Trochanteric bursitis D. Hip dislocation
A. Paralabral cyst
A tear-drop shaped-fluid collection on axial MRI seen anterior to (and communicating with) the hip joint capsule and medial to the iliopsoas tendon represents most likely which of the following conditions: A. Greater trochanteric bursitis B. lliopsoas bursitis C. Rectus femoris strain D. Piriformis syndrome
B. lliopsoas bursitis
A circular lesion with low T1 and high T2 signal communicates with the scapholunate interval. What does this most likely represent? A. Ganglion cyst B. Radiocarpal effusion C. Median neuroma D. Rheumatoid arthritis
A. Ganglion cyst
What zone of the disc should be interposed between the mandibular condyle and temporal bone, regardless of jaw position? A. Anterior B. Intermediate C. Medial D. Posterior
B. Intermediate
Loss of what joint space correlates strongly with the presence of rheumatoid arthritis? A. Superior B. Axial C. Medial
B. Axial
Which of the following explains why tendons appear dark on MRI sequences? A. They contain little hydrogen B. They contain little to no fluid C. They have a density similar to cortical bone D. The hydrogen is tightly bound
D. The hydrogen is tightly bound
Tears of the lunotriquetral ligament predispose to what? A. VISI B. HADD C. SNAC D. SLAC
A. VISI
What MRI pulse sequence uses a flip angle other than 90 degrees? A. PD FS B. T2* C. STIR D. MRA
B. T2*
What is the MRI imaging characteristic of acute Kienbocks disease? A. T1: hyper T2: hyper B. T1: hypo T2: hyper C. T1: hyper T2: hypo D. T1: hypo T2 hypo
B. T1: hypo T2: hyper
What is the relationship between scan time and signal to noise ratio (SNR) in MRI? A. Increase scan time, increase SNR B. Decrease scan time, decrease SNR C. Increase scan time, decrease SNR
C. Increase scan time, decrease SNR
A higher signal intensity within a normal tendon oriented obliquely (55) to the direction of the main magnetic field seen on MR images with short TEs represents: A. An example of partial volume averaging B. Magic angle phenomenon C. A time-of-flight effect D. A wraparound artifact
B. Magic angle phenomenon
What elbow ligament do we suspect injured in a baseball pitcher? A. MCL B. LCL C. Annular
A. MCL
An MRI shows an intramuscular hematoma that has an intermediate signal intensity on T1WI and low signal intensity on T2WI. How old is this lesion? A. Hyperacute B. Acute C. Subacute D. Chronic
B. Acute
What are the bone scan findings of acute avascular necrosis of the proximal pole of the scaphoid? A. Severe increased uptake “hot” B. Mild increased uptake “warm” C. Photopenia D. Double density
C. Photopenia
What is the most sensitive imaging modality for the detection of a suspected acetabular labral tear? А. СТ B. CT +contrast C. MRI D. MR arthrogram
D. MR arthrogram
A serpentine appearance of an enlarged median nerve seen on axial sequences of a magnetic resonance imaging scan of the wrist is distinctive of: A. Carpal tunnel syndrome B. Fibrolipomatous hamartoma C. A Morton neuroma D. A neurofibroma
B. Fibrolipomatous hamartoma
Which muscle is usually affected first in patients with lateral epicondylitis? A. Extensor carpi radialis brevis B. Extensor digitorum C. Extensor digiti minimi D. Extensor carpi ulnaris
A. Extensor carpi radialis brevis
What contrast enhancement pattern will be seen in early avascular necrosis on MRI when compared to adjacent normal bone marrow? A. Increased enhancement B. Isointense enhancment C. Decreased enhancement
C. Decreased enhancement
Midcarpal instability is associated with which of the following? A. VISI B. SLAC C. SNAC D. DISI
A. VISI
What pulse sequence is most sensitive for the evaluation of fibrocartilage? A. T1 B. T2 C. PD D. STIR
C. PD
Which of the following signs visualized on MRI of the wrist is not classically associated with carpal tunnel syndrome? A. Cross sectional enlargement of the median nerve at the level of the pisiform B. Hyperintensity of the median nerve on fluid sensitive images C. Thickening of the extensor carpi ulnaris tendon D. Palmar bowing of the flexor retinaculum at the level of the hamate
C. Thickening of the extensor carpi ulnaris tendon
On arthrography, communication between the distal radioulnar compartment and the radiocarpal compartment is classically associated with? A. Kienbock’s disease B. Lunotriquetral dissociation C. Triangular fibrocartilage tear D. Extensor carpi ulnaris tendonitis
C. Triangular fibrocartilage tear
What conditions are associated with acetabular labral tears? MARK ALL THAT APPLY, 1-4 CORRECT ANSWERS A. Legg Calve Perthes B. Slipped capital femoral epiphysis C. Femoroacetabular impingement syndrome D. No correct answer listed E. Degenerative hip arthrosis
A. Legg Calve Perthes B. Slipped capital femoral epiphysis C. Femoroacetabular impingement syndrome E. Degenerative hip arthrosis
cute or chronic injury to the ulnar collateral ligament of the thumb at the 1st metacarpophalangeal joint is named? A. Bennett lesion B. Rolando lesion C. Gamekeeper’s thumb D. Chauffeur’s thumb
C. Gamekeeper’s thumb
A positive ulnar variance severe enough to allow transfer of excessive compressive forces from the ulna to the triquetrum and lunate via the triangular fibrocartilage, leading to early degenerative changes, is termed: A. Ulnar impingement syndrome B. Ulnar impaction syndrome C. Kienböck’s disease D. Calcium pyrophosphate dihydrate deposition disease
B. Ulnar impaction syndrome
A depressed fracture of the lunate fossa of the distal radius is termed? A. Colles B. Smiths C. Die punch D. Renfield
C. Die punch
In an adult patient with elbow pain, you see a groove in the posterior aspect of the capitellum. What does this post likely represent? A. Panners disease B. Osteochondritis dissecans C. Pseudodefect D. LCL avulsion
C. Pseudodefect
Non-reversible avascular necrosis (AVN) of the hip can be differentiated from idiopathic transient osteoporosis of the hip (ITOH) on MRI because: A. ITOH usually involves the acetabular region, sparing the femoral head B. The bone marrow edema is more prominent in AVN C. ITOH doesn’t demonstrate joint effusion D. AVN will demonstrate a double line sign
D. AVN will demonstrate a double line sign
Your patient is a machinist. What x-ray must be done prior to obtaining an MRI to evalute for metallic foreign bodies? A. PA hands B. Waters skull C. Submentovertex D. Ballcatchers
B. Waters skull
Which of the following statements is NOT true regarding fat saturation utilizing the STIR technique ? A. is not sensitive to magnetic field inhomogeneties. B. Utilizes a “spoiler” pulse that wipes out the signal from fat C. Signal intensity from gadolinium will be saturated along with fat due to similar relaxation properties. D. is based on the relaxation properties of fat protons.
B. Utilizes a “spoiler” pulse that wipes out the signal from fat
In what instance would contrast help in the differential diagnosis? A. cystic vs solid mass B. abscess vs cyst C. disc herniation vs solid mass D. phlegmon vs necrosis
A. cystic vs solid mass
Evaluation of which of the following conditions would NOT warrant the addition of intravenous gadolinium to an MRI study? A. Septic arthritis B. Post-surgical back pain C. Osteochondral fragment D. Suggested bony neoplasia
C. Osteochondral fragment
Fracture of the ulnar styloid is associated with injury to what structure(s)? A. Triangular fibrocartilage B. Radial collateral ligament C. Hook of the hamate D. Proximal radioulnar ligaments
A. Triangular fibrocartilage
I have exhausted the citable resources available to me for writing questions, but I can’t end at 74 questions, it isn’t a nice round number. Take a point just to make it out of 75. A. Are you sure? B. Yep! C. Really? D. Yeah!
D. Yeah!
