MSK

Question 1

1. Which of the following are correct regarding intra-articular osteoid osteoma:
   (a) Most commonly affects the hip.
   (b) Typically presents with nocturnal pain.
   (c) The radiolucent nidus is surrounded by extensive reactive sclerosis.
   (d) MRI is more specific than CT in detecting the nidus.
   (e) Plain radiograph have a sensitivity exceeding 90% in detecting the nidus

Answer 1

Answer:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Nocturnal pain is a feature of long bone osteoid osteoma and not of intra-articular lesions. It is also less responsive to
NSAIDs.
Extensivereactive sclerosis surrounding the nidusis a feature of long bone lesion and not of intra-articular lesion.
Nidus is often overlooked on radiographs. MRI is more sensitive than CT in detecting the nidus, however CT is more
specific. MRI is sensitive as it is highly sensitive in demonstrating perilesional edema.

Question 2

2. Typical feature of pigmented villonodular synovitis (PVNS) include:
   (a) Loss of bone density on plain film.
   (b) A dense joint effusion on plain film.
   (c) “blooming artefact” on gradient echo MR sequences.
   (d) Well defined erosions with preservation of joint space.
   (e) Soft tissue calcification on plain film.

Answer 2

Answer:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
PVNS represents part of a disease spectrum that includes diffuse and localized form of giant cell tumour of the tendon
sheath to the more diffuse intra-articular form that is PVNS. Thus it is characterized by synovial proliferation and
hemosiderin deposits. Hence, bone density is maintained and dense joint effusion is seen.
Soft tissue calcification is uncommon in PVNS

Question 3

3. Which of the following are correct regarding ankylosing spondylitis:
   (a) The hip joints are involved in more than 20% of patients.
   (b) 90 % of patients exhibit HLA-B27 antigen.
   (c) Romanus lesions are seen in end-stage disease.
   (d) Syndesmophytes are the result of ossification of the annulus fibrosus.
   (e) Peripheral arthropathy is most common in the upper limbs.

Answer 3

Answer:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Romanus lesions are seen in early stages of disease and consist of inflammation at the site of anterior longitudinal
ligament attachment to vertebrae and discs giving rise to erosions at discovertebral junction.
Extraspinal manifestations include enthesopathy and peripheral arthropathy favouring the lower limbs. Iritis, aortic
insufficiency and pulmonary fibrosis are extraskeletal manifestations of Ankylosing spondylitis

Question 4

4. Which of the following are correct regarding popliteal (Baker’s) cysts:
   (a) Are commonly associated with meniscal pathology in adults.
   (b) Are frequently associated with osteoarthritis and rheumatoid arthritis in adults.
   (c) Ultrasound can differentiate Baker’s cysts from popliteal aneurysms and ganglion cysts.
   (d) Typically extends posteriorly between the tendons of semimembranosus and the medial head of gastrocnemius.
   (e) Calcified loose bodies are a recognized complication.

Answer 4

Answer:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Popliteal cysts are fluid filled synovial lined bursa in the popliteal fossa communication with the knee joint. They are
generally located at or below the joint line. Majority of them are incidental findings. Acute rupture of Baker’s cyst
resembles DVT in clinical presentation.

Question 5

5. The following tendons / ligaments attach to the named bony prominence:
   (a) Lesser tuberosity of the humerus – infraspinatus tendon.
   (b) Anterior superior iliac spine – tendon.
   (c) Medial epicondyle of the humerus – extensor tendon origin.
   (d) Inferior pole of patella – quadriceps tendon.
   (e) Tibial eminence – anterior cruciate ligament

Answer 5

Answer:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Supraspinatus tendon attaches to lesser tuberosity of the humerus. The infraspinatus tendon attaches to greater
tuberosity of humerus.
Flexor tendon origin is at medial epicondyle of humerus and extensor tendon origin is from lateral epicondyle of
humerus.
The quadriceps tendon attaches to the superior pole of patella and patellar ligament attaches to the inferior pole of
patella.

Question 6

6. Which of the following are correct regarding giant cell tumours of bone (GCT):
   (a) Are typically subarticular in location.
   (b) Metastasise in less than 10% of cases.
   (c) Most commonly occur in the proximal humerus.
   (d) Spinal GCTs affect primarily the posterior elements.
   (e) Periosteal reaction is seen in 60-80% of cases

Answer 6

Answer:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Most common location of GCT is around knee joint (50%-65%) with distal femur accounting for 23%-30% cases.
Proximal humerus accounts for 4-8% of the cases of GCT.
Spinal GCT primarily affects the vertebral bodies with extension into the posterior elements. Vertebral body collapse
is a frequent finding.
Periosteal reaction is uncommon seen on radiograph only in 10-30% cases. Cortical penetration is however seen in
33-50% cases with associated soft tissue mass.

Question 7

7. Which of the following are correct regarding synovial osteochondromatosis:
   (a) Most commonly affects the joints of the hands.
   (b) Typically presents with a painless swollen joints.
   (c) Intra-articular nodules can be hyper-intense on T2W.
   (d) Calcification is absent in 25-30% of patients.
   (e) Chondrosarcoma is a complication

Answer 7

Answer:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
It is a benign monoarticular disorder of unknown etiology. It is more common in men usually presenting in 3rd-5th
decade. Large joints like knee, hip, shoulder and elbow are commonly involved. However smaller joints like TM
joint, AC joint and interphalangeal joint can also be involved.
It presents with joint pain, swelling and restriction of movement

Question 8

8. Which of the following are correct regarding calcium pyrophosphate deposition disease (CPPD):
   (a) Haemochromatosis is a cause.
   (b) Most commonly affects the small joints of the hand.
   (c) Hyaline cartilage calcification is typically thick and irregular.
   (d) Subchondral cyst formation is a typical feature.
   (e) Destructive arthropathy is a rare manifestation.

Answer 8

Answer:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
CPPD associated acute arthritis is known as pseudogout. 50% cases affect the knee joint. Other locations are hip,
shoulder, elbow and wrist joint. Changes are usually bilateral and symmetrical.
Fibrocartilage calcification is typically coarse and irregular. Hyaline cartilage calcification is typically fine and
linear following the contour of underlying bone.

Question 9

9. The following MRI features favour a spinal metastatic fracture rather than an osteoporotic collapse:
   (a) Convex posterior border of the vertebral body.
   (b) Diffuse paraspinal mass.
   (c) Abnormal signal in the neural arch.
   (d) Low signal intensity band on T1W MRI.
   (e) Areas of normal marrow signal vertebral body

Answer 9

Answer:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Diffuse paraspinal mass is not helpful in differentiating between metastatic and osteoporotic collapse. However focal
paraspinal mass is seen more frequently with metastatic collapse.
Low signal intensity band on T1WI and T2WI is more common in osteoporotic collapse (93%) than in metastatic
collapse (44%).
Spared normal marrow signal in a vertebral body is highly suggestive of osteoporotic collapse

Question 10

10. Which of the following are correct regarding MRI of osteonecrosis (avascular necrosis) of the femoral
    head:
    (a) Focal areas of low signal on T1W MRI suggest an alternative diagnosis.
    (b) The “double line sign (adjacent high and low intensity line on T2W MRI) is virtually diagnostic.
    (c) Fractures typically appear as low signal intensity lines on T1W images.
    (d) Intravenous contrast should be administered routinely.
    (e) MRI is less sensitive than isotope bone scan in making the diagnosis

Answer 10

Answer:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Focal areas of homogeneous or inhomogeneous low signal on T1WI are commonly found.
Contrast enhancement differentiates hypervascularized viable tissue from hypovascularized necrotic tissue. However
it is not routinely done as it can be differentiated on other sequences.
Isotope bone scan has a sensitivity of 80-85% and MRI has a sensitivity of 90-100%.

Question 11

11. Which of the following are correct regarding Langerhans cell histiocytosis (LCH) in children:
    (a) Peak incidence occurs at 10-15 years of age.
    (b) The axial skeleton is spared in the majority of cases.
    (c) In chronic LCH, bony lesions typically have an aggressive osteolytic pattern.
    (d) Vertebra plana is most commonly seen in the lumbar spine.
    (e) A bevelled edge appearance is characteristic of skull lesions

Answer 11

Answer:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
In children peak incidence of LCH is 1-4 years of age with presentation ranging from newborns to 15 years of age. It
involves any bone but more than 50% cases involve the axial skeleton. Of the long bones diaphysis of femur, tibia and
humerus are commonly involved.
Appearance of lesion depends on phase of the disease and site of involvement. In early stage lesions are aggressive
with osteolytic pattern, appear permeative with wide zone of transition and lamellated periosteal reaction.
In paediatric spine thoracic vertebrae are more commonly involved (54%) followed by lumbar (35%). The body is
affected more than posterior elements

Question 12

12. Which of the following are correct regarding trauma to the upper limb:
    (a) Non-or delayed union of humeral fracture is common.
    (b) Bilateral shoulder dislocations are usually anterior.
    (c) A fixed, abducted arm on shoulder X-ray is consistent with luxatio erecta.
    (d) Humeral shaft fractures are associated with axillary nerve injury.
    (e) The brachial artery is injured in 1-5% of humeral shaft fractures.

Answer 12

Answer:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Non-union or delayed union of humeral fracture is rare and occurs in cases secondary to excessive distraction of
fracture fragments.
Bilateral shoulder dislocation is rare and is usually posterior, mainly due to seizures.
Humeral shaft fractures are associated with radial, medial or ulnar nerve injury. Radial nerve injury is most common
(5-17%).

Question 13

13. Which of the following are correct regarding knee trauma:
    (a) Anterior cruciate ligament (ACL) tears usually occur at the tibial attachment.
    (b) “Deep lateral femoral sulcus” is a specific sign of posterior cruciate ligament (PCL) disruption.
    (c) Kissing contusions at the anterior aspect of the proximal tibial and distal femur are characteristic of
    hyperextension injury.
    (d) O’ Donoghue triad comprises complete disruption of the medial collateral ligament, ACL and posterior horn of
    medial meniscus.
    (e) Dashboard injuries are typically associated with ACL tears.

Answer 13

Answer:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
ACL tears usually occur in middle part of ligament followed by femoral attachment.
Deep lateral femoral sulcus sign is highly specific for ACL disruption and results from impaction of the lateral
femoral condyle on the posterior tibial plateau.
Dashboard injuries are typically associated with midsubstance PCL tears at the genu.

Question 14

14. Which of the following are correct regarding congenital hypothyroidism ?
    (a) It is cause of posterior scalloping of the vertebral bodies.
    (b) The incidence is higher in infants with Down’s syndrome.
    (c) A radiolucent metaphyseal band is a feature.
    (d) Sclerosis of the skull base occurs.
    (e) It is more common in males.

Answer 14

Answer:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Hypothyroidism is 3 times more common in females.
In hypothyroidism, the bones are slender with endosteal thickening and typically with a dense band at the metaphysic.
There may be hypoplasia of the vertebral bodies, particularly at the level of the first or second lumbar vertebrae.
Posterior scalloping of the vertebral bodies is seen in acromegaly.

Question 15

15. Which of the following statement are correct regarding cleidocranial dysostosis ?
    (a) It is inherited as an autosomal recessive trait.
    (b) Hypoplasia of the distal third of the clavicle is seen in the majority of cases.
    (c) It is associated with osteosclerosis.
    (d) Bladder exstrophy is a feature.
    (e) It is associated with an absent radius and fibula.

Answer 15

Answers:
(a) Not correct
(b) Not Correct
(c) Not Correct
(d) Not correct
(e) Correct
Explanation:
CCD is an autosomal dominant disease. Pyknodysostosis is an autosomal recessive disease.
Hypoplasia of the distal and middle third of the clavicle is encountered in 10% of the cases.
Osteosclerosis is a feature of Pyknodysostosis.
There is delayed ossification of the pubic bones, resulting in widening of the symphysis pubis. However this does not
result in full blown exstrophy.

Question 16

16. Which of the following statement regarding multiple myeloma are correct?
    (a) Skeletal radiograph are abnormal in the majority of patients at the time of presentation.
    (b) Sclerotic bone lesions are more commonly seen in POEMS (polyneuropathy), organomegaly, endocrinopathy,
    monoclonal gammopathy and skin changes) syndrome than in multiple myeloma.
    (c) Skeletal radiograph are more sensitive than radionuclide bone scans in detecting bony lesions.
    (d) Bony involvement typically spares the mandible
    (e) Magnetic resonance imaging (MRI) of the lumbar spine useful in the staging of patients with a normal skeletal
    survey.

Answer 16

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Unlike bony metastasis, which rarely affect the mandible, involvement of the mandible is not unusual in multiple
myeloma.
Technetium 99 diphosphonate bone scans are usually normal or show diminished uptake in multiple myeloma.

Question 17

17. Which of the following are correct regarding osteosarcoma ?
    (a) There is an increased incidence osteopetrosis.
    (b) There an association with pineoblastoma.
    (c) Telangiectatic osteosarcoma typically demonstrates fluid-fluid levels on MRI.
    (d) It frequently metastasises to other bones.
    (e) Parosteal osteosarcoma resembles myositis ossificans on radiograph

Answer 17

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
In osteosarcoma, metastatic spread is heterogeneous, as bones lack a lymphatic system. The lungs are the most
frequent size, although bones may be involved. Lymphadenopathy occurs late in the disease and is a poor prognostic
sign

Question 18

18. Which of the following statements are correct regarding congenital dislocation of the hips ?
    (a) It is more common in females
    (b) There is an association with giant cell tumour
    (c) It is most commonly seen in first-born infants
    (d) Premature osteoarthritis typically occurs between 10 and 20 years of age
    (e) It is usually bilateral

Answer 18

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Two thirds of the cases of congenital dislocation of the hip are unilateral. The left side is more frequently affected
than the right
Secondary osteoarthritis in congenital dislocation of hip is typically not apparent until 40-60 years of age .

Question 19

19. Which of the following are correct regarding Perthe’s disease ?
    (a) Bilateral hip involvement is more common in males
    (b) Female gender is associated with a pooper prognosis
    (c) There is usually a family history
    (d) An older age of onset is associated with a better prognosis
    (e) It result in coxa magna.

Answer 19

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Perthe’s disease has no increased incidence in families. However, there is reportedly an associated increased
incidence of cardiac abnormality, pyloric stenosis, renal abnormality and undescended testis.
Poor prognostic factors include the female sex, an older onset of disease, metaphysis involvement, a greater degree of
epiphysis involvement and uncovering of the lateral femoral neck.

Question 20

20. Which of the following are correct regarding musculoskeletal trauma.
    (a) Sternal fracture an indirect sign of thoracic spine injury
    (b) Atlanto-occipital dislocation is prequently fatal
    (c) Laceration of the dura is commonly associated with lumbar spine fracture
    (d) A scapholunate angle of more than 80% is suggestive of scapholunate dissociation
    (e) Epiphyseal plate fracture (Salter-Harris type I) are common in nonaccidental injury in children.

Answer 20

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Laceration of the dura is not associated with lumbar spine fracture. It is more common in patients with a burst fracture
that is associated with neurological deficit and laminae fracture.
The epiphyseal plate injuries are rarely encountered in non-accidental trauma

Question 21

21. Which of the following are correct with regards to the cervical spine:
    (a) For the erect lateral view of the cervical spine the central beam is directed horizontally to the centre of C3
    vertebra.
    (b) The space between the odontoid process and the anterior arch of the atlas (atlanto-dens interval) should not
    exceed 3 mm in adults
    (c) A Jefferson fracture is unstable
    (d) A swimmer’s view can be used for better demonstration of the C1/C2 junction.
    (e) A hangman’s fracture is usually secondary to a hyper-flexion injury

Answer 21

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
For the erect lateral view the central beam is directed to the centre of C4.
A swimmer’s view is used for better visualization of C7/C8/T1.
Hangman’s fracture is secondary to hyperextension resulting in bilateral fractures of pedicles of C2. It is unstable
injury and accounts for 4-7% of all spinal fractures.

Question 22

22. Which of the following are correct regarding anatomy of the knee joint
    (a) The popliteus muscles tendon passes through a portion of the posterior horn of the lateral meniscus.
    (b) The medial and lateral collateral ligaments are best assessed on sagittal MRI imaging of the knee
    (c) The normal medial meniscus is seen as low signal on T1W spine echo and high signal on T2W spine echo MRI
    images
    (d) The posterior cruciate ligament is attached to the inner aspect of the medial femoral condyle.
    (e) The commonest site of meniscal injury is the posterior horn of the lateral meniscus

Answer 22

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Both collateral ligaments are best assessed on coronal images.
Normal medial meniscus shows low signal on T1 and T2 images.
Posterior horn of medial meniscus is most common site for meniscal injury.

Question 23

23. Features of diaphyseal aclasia (hereditary multiple exostosis) include:
    (a) Malignant transformation to chondrosarcoma occurs in 35-40 %
    (b) Exostoses have a cap hyaline cartilage, often with a bursa formation over the cap.
    (c) Exostoses arise from the metaphysis and point towards the joint
    (d) Exostoses stop growing when the nearest epiphyseal centre fuses
    (e) Autosomal recessive inheritance.

Answer 23

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Diaphyseal aclasia is an autosomal dominant disorder presenting between 2 to 10 years of age. The exostoses arise
from the metaphysis of long bones and point away from the joint. Risk of malignant transformation to chondrosarcoma
is less than 5 %.

Question 24

24. Which of the following are correct regarding osteochondritis dissecans:
    (a) Lesions in the knee are bilateral in 20-30%
    (b) Lesions in the knee most commonly involve the lateral aspect of the femoral condyle.
    (c) The average age of onset is within the 2nd decade
    (d) A high signal intensity line around the lesions on T2W MRI images is indicative of instability
    (e) A grade 2 osteochondritis dissecans lesions is characterised displaced a displaced fragment.

Answer 24

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Grading of osteochondritis dissecans:
Grade 1- focal softening/fissuring
Grade 2- defect in cartilage
Grade 3- fragment partially detached
Grade 4- displaced fragment/ loose body in the joint.

Question 25

25. The following statements are correct:
    (a) Paget’s disease has a prevalence of 10 % in people over the age of 80 years of age.
    (b) Developmental dysplasia of the hip is more common in males
    (c) Diffuse idiopathic skeletal hyperostosis commonly presents in children
    (d) The highest incidence of fibrous dysplasia is between 30-50 %years of age.
    (e) Ankylosing spondylitis is found more commonly in Black than Caucasian populations

Answer 25

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Developmental dysplasia of hip is more common in females.
Diffuse idiopathic skeletal hyperostosis is seen in over 50 years of age.
Fibrous dysplasia presents at peak incidence of 3-15 years. 75% are seen below 30 years of age.
Ankylosing spondylitis is more common in caucasians, with a caucasian: black ratio of 3:1.

Question 26

26. Which of the following are correct regarding bone metastases
    (a) Metastases can be excluded in a patient with bone scintigraphy showing no abnormal uptake.
    (b) Prostate metastases are always sclerotic.
    (c) Metastases located in the medulla are o reduced signal on T1W and increased signal on fat suppressed T2W
    MRI images
    (d) Identification of a ‘halo’ of high signal intensity around a lesion on T2W MRI suggests a benign lesion
    (e) Melanoma metastases are usually lytic.

Answer 26

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Lesions which outgrow their blood supply appear photopenic on bone scintigraphy.
Small percentage of prostatic metastases can be entirely lytic.
‘Halo’ of high signal around a lesion on T2WI is highly suggestive of metastases.

Question 27

27. Which of the following are correct regarding hyperparathyroidism (HPT):
    (a) Brown tumours occur more frequently in secondary HPT.
    (b) Rugger Jersey spine occurs more frequently in primary HPT.
    (c) Increased incidence of slipped upper femoral epiphysis is associated with HPT.
    (d) Chondrocalcinosis is seen in 15-20 %.
    (e) A normal bone scan in about 80 %.

Answer 27

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Brown tumours occur more frequently in primary hyperparathyroidism and Rugger Jersey spine is seen more
frequently in secondary hyperparathyroidism.

Question 28

28. Which of the following are correct concerning enchondromas:
    (a) In the hand, diaphysis is the most common site
    (b) Most frequent tumor found in the small bones of the hands.
    (c) Calcification is rare
    (d) MRI appearances are of low signal on T1W and high signal on T2W spine echo images
    (e) Maffuci syndrome is characterised by multiple enchondromas and soft tissue cavernous haemangiomas

Answer 28

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Enchondromas are a relatively common benign medullary cartilaginous neoplasm, usually found in children or young
adults which can lead to pathological fractures or undergo malignant degeneration. Mostly they are an incidental
finding with benign imaging features.
Calcification especially chondroid type is common finding

Question 29

29. Which of the following are correct features of Paget’s disease:
    (a) Thickening of ileopectineal line.
    (b) Pelvis is most commonly affected.
    (c) Increased density of vertebra – ‘ivory vertebra’.
    (d) Candle flame lysis.
    (e) Sarcomatous transformation in 10-15 %.

Answer 29

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Paget’s disease of bone is a common, chronic bone disorder characterised by excessive abnormal bone remodelling.
It frequently affects the pelvis, spine, skull and proximal long bones. It is relatively common and can affect up to 4%
of individuals over 40 and up to 11% over the age of 80. Sarcomatous transformation is approximately 1%.

Question 30

30. Which of the following are correct regarding morton neuroma:
    (a) Is asymptomatic
    (b) On ultrasound, has the appearance of an ovoid hypoechoic mass orientated to the long axis of the metatarsal
    bones
    (c) Is typically found in the 4th inter-metatarsal space.
    (d) Is of high signal on T2W MRI
    (e) Has a high malignant potential

Answer 30

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Morton neuroma is a benign condition representing perineural fibrosis, likely due to chronic nerve entrapment by
inter-metatarsal ligaments.
It is most commonly found in 3rd inter-metatarsal space presenting with burning/ electric forefoot pain.
On ultrasound it appears as a round to oval hypoechoic mass and on MRI as a low signal mass lesion on T1WI and
T2WI with intense post contrast enhancement.

Question 31

31. Which of the following are correct concerning aneurysmal bone cysts:
    (a) 60-80 % of aneurysmal bone cysts are found in under 20 year old.
    (b) Periosteal reaction is a pathognomonic feature
    (c) They demonstrate a fluid-fluid level on CT
    (d) Hyper-vascularity is usually seen in the periphery of the lesion
    (e) They have a recurrence rate of 20-30 % after surgical treatment

Answer 31

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Aneurysmal bone cysts are benign expansile tumour like lesion. Periosteal reaction is not seen until associated with a
fracture.

Question 32

32. Regarding diffuse idiopathic skeletal hyperostosis which of the following are correct:
    (a) Sacroiliac joints are usually involved when the lumbar spine is.
    (b) Highest incidence in the 3rd to 5th decades.
    (c) Most commonly involves the cervical spine.
    (d) Extraspinal ligamentous hyperostosis is a feature.
    (e) In the thoracic spine the hyperostoticchanges are more prominent on the right.

Answer 32

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Diffuse idiopathic skeletal hyperostosis is a common condition characterised by bone proliferation at sites of
tendinous and ligamentous insertion of the spine affecting elderly individuals.It commonly affects the elderly more
than 50years of age with a slight male predominance.
It most commonly involves the lower thoracic spine. Sacroiliac joints are not involved. However the appearance of
spine may be similar to ankylosing spondylitis.

Question 33

33. Features of rheumatoid arthritis include:
    (a) Late involvement of the 2nd and 3rd metacarpophalangeal joints
    (b) Ulnar subluxation
    (c) Central bone erosions
    (d) Juxta-articular osteoporosis
    (e) Calcification of the triangular fibrocartilage complex

Answer 33

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
The metallic artefact is shows marginal and central erosions.
The second and third metacarpophalangeal joints are involved in early stage of the disease.
Calcification of triangular fibrocartilage complex is not usually seen in rheumatoid arthritis.

Question 34

34. The following are feature of Gaucher’s disease:
    (a) Generalized osteopenia
    (b) Marked cortical thickening
    (c) Biconcave ‘fish-mouth’ vertebrae
    (d) Endosteal scalloping
    (e) Madelung’s deformity

Answer 34

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
There is no evidence of any significant cortical thickening seen in Gaucher’s disease.
Madelung’s deformity is associated with nail-patella syndrome and not with Gaucher’s.

Question 35

35. Regarding imaging appearances of osteomyelitis:
    (a) Klebsiella is the commonest organism isolated in adult
    (b) Chronic osteomyelitis is characterised by prominent cortical thinning
    (c) The diaphysis are often spared in patients with sickle cell disease.
    (d) Radiographic findings become evident approximately 3 days after onset infection
    (e) Periosteal reaction is the earliest sign of acute osteomyelitis

Answer 35

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Radiographic findings of osteomyelitis become evident approximately at 1-2 weeks after onset of infection.
Soft tissue swelling and loss of normal fat planes is the earliest sign of acute osteomyelitis.
The staphylococcus is the commonest organism involved.
Chronic osteomyelitis is characterised by prominent cortical thickening.
In sickle cell disease, diaphysis is the primary focus of infection