Musculoskeletal and Trauma - Practice papers Flashcards
@# 1. Morton neuroma:
a) Is typically found in the 4th intermetatarsal space
b) Is of high signal on T2 weighted MRI
c) Is asymptomatic
d) On ultrasound, has the appearance of an ovoid hypoechoic mass orientated parallel to the
long axis of the metatarsal bones
e) Has a high malignant potential
1.
a) False - 3rd intermetatarsal space
a) False - low
b) False - usually presents with burning/electric forefoot pain
c) False - hyperechoic
d) False - benign lesion
@# 2. The following are recognized associations:
a) Madelung’s deformity and Turner’s syndrome
b) Superior rib notching and osteogenesis imperfecta
c) Erosion of the outer end of the clavicle and pyknodysostosis
d) Erlenmeyer flask deformity and Noonan’s syndrome
e) Arachnodactyly and homocystinuria
2.
a. True - other causes include diaphyseal aclasia, post-infection, post-trauma, Leri-Weil
disease
b) True - other causes include rheumatoid arthritis, systemic lupus erythematosus,
scleroderma, Sjogren’s disease, hyperparathyroidism, neurofibromatosis, poliomyelitis,
progeria, Marfan’s syndrome
c) True - other causes include rheumatoid arthritis, multiple myeloma, metastases,
hyperparathyroidism, cleidocranial dysplasia
d) False
e) True - Marfan’s syndrome is another cause
@# 3. Causes of acro-osteolysis include:
a) Leprosy
b) Frostbite
c) Hyperparathyroidism
d) Phenytoin toxicity
e) Syringomyelia
3.
a) True
b) True
c) True
d) True
e) True
@# 4. The following statements regarding bone marrow are true:
a) Yellow marrow decreases with age
b) Red marrow is of high signal on T1 weighted MRI images
c) Yellow marrow is of high signal on T2 weighted MRI images
d) Radiotherapy causes marked reduction in yellow marrow
e) Osteopetrosis is characterised by reduced signal on T2 weighted MRI images
4.
a) False - yellow marrow increases with age
b) False - red marrow is of low signal on T1 and high signal on T2 weighted MRI images
c) True - yellow marrow is of high signal on T1 and T2 weighted MRI images
d) False
e) True - osteopetrosis is characterised by reduced signal on T1 and T2 weighted MRI images
@# 5. Concerning aneurysmal bone cysts:
a) 60-80% of aneurysmal bone cysts are found in under 20-year-olds
b) Periosteal reaction is a pathognomonic feature
c) Hypervascularity is usually seen in the periphery of the lesion
d) They demonstrate a fluid-fluid level on CT
e) They have a recurrence rate of 20-30% after surgical treatment
5.
a) True
b) False - no periosteal reaction unless there is a fracture
c) True - peripheral hypervascularity is seen in 75% of lesions
d) True
e) True - recurrence rate of 20-30%
@# 6. Regarding blunt trauma to the pancreas:
a) Injury to the pancreas occurs in 25-30% of blunt abdominal trauma patients
b) The majority of injuries occur in the pancreatic tail
c) Isolated pancreatic injuries occur in 85-90% of cases
d) A pancreatic laceration appears as a high attenuation lesion on contrast-enhanced CT
e) Integrity of the pancreatic duct is an important factor in determining outcome following
pancreatic injury
6.
a) False - pancreatic injury occurs in 2%
b) False - two thirds of injuries occur in the pancreatic body
c) False - 90% of cases have associated injuries, especially to the liver, spleen, duodenum and
stomach
d) False - low attenuation lesion
e) True - pancreatic duct disruption is associated with increased fistula and abscess formation,
and increased mortality
@# 7. Shoulder anatomy:
a) In an intact rotator cuff there is communication between the glenohumeral joint and the
subacromial-subdeltoid bursae
b) Subscapularis, infraspinatus and teres minor insert onto the greater tuberosity
c) Rotator cuff tears most commonly involve the supraspinatus portion of the cuff
d) Long head of biceps runs in the bicipital groove to insert into the infraglenoid tubercle
e) Normal glenoid labrum is of high signal on a T2 weighted fat- saturated MRI image
7.
a) False - no communication
b) False - supraspinatus, infraspinatus and teres minor attach to the greater trochanter,
subscapularis attaches to the lesser tuberosity
c) True
d) False - supraglenoid tubercle
e) False - low signal
@# 8. Desirable properties of a radionuclide for imaging are:
a) Decay to a stable daughter
b) A physical half-life of a few minutes
c) Decay by electron capture
d) Decay by isomeric transition
e) Emit gamma rays of energy 350-550 kiloelectron volts (keV)
8.
a) True
b) False - if too short, much more activity must be prepared than is actually injected.
Therefore, a half-life of a few hours is preferred
c) True
d) True
e) False - 50-300 keV
@# 9. Regarding diffuse idiopathic skeletal hyperostosis:
a) Highest incidence in the 3rd to 5th decades
b) Most commonly involves the cervical spine
c) Sacroiliac joints are usually involved when the lumbar spine is
d) Extraspinal ligamentous hyperostosis is a feature
e) In the thoracic spine the hyperostotic changes are more prominent on the right
9.
a) False - >50 years. Males. Females
b) False - lower thoracic spine
c) False - no sacroiliac joint involvement though sometimes appearances in the spine are
similar to ankylosing spondylitis
d) True - most often seen at the pelvis, patella, calcaneum, olecranon
e) True - pulsating aorta on left side reduces ossification
@# 10. Vertebroplasty:
a) Has no role in patients with osteolytic vertebral metastases
b) Use of percutaneous vertebroplasty in patients with multiple myeloma prevents subsequent
radiation therapy
c) Extensive vertebral destruction is a contraindication to vertebroplasty
d) For the lumbar spine, a 12-15-gauge needle is used
e) Methyl methacrylate polymer cement is used
10.
a) False - common indications are metastases, osteoporotic collapse, vertebral haemangiomas
b) False - radiation has no effect on the constitution of cement
c) False - significant destruction/collapse makes the procedure difficult but not a
contraindication. Contraindications include infection, coagulation disorders, if facilities for
emergency decompression surgery are not available
d) False - lumbar and lower thoracic - 10-11-gauge, cervical and upper thoracic - 12-15-gauge
e) True
@#e 11. The following descriptions of the fractures are correct:
a) Monteggia fracture - ulnar fracture with dislocation of the radial head
b) Galleazi fracture - distal radial fracture with dislocation of distal radioulnar joint
c) Segond fracture - cortical avulsion fracture of proximal lateral tibia
d) Chauffer’s fracture - triangular fracture of radial styloid process
e) Pott’s fracture - tibia fracture above an intact tibiofibular ligament
11.
a) True
b) True
c) True
d) True
e) False - fibula fracture
@# 12. Trauma to the spleen:
a) In blunt abdominal trauma the spleen is injured in 50-60% of significant abdominal injuries
b) Hypotension is a presenting symptom of splenic trauma in less than 40% of cases
c) At least 500 ml of intra-abdominal fluid is required for detection by focused abdominal
ultrasonography in trauma (FAST)
d) Splenic injury can be reliably excluded by the absence of free fluid in the peritoneal cavity
e) Acute splenic lacerations appear as hyperechoic regions on ultrasound
12.
a) False- 20-30%
b) True - 25-30%
c) False - about 100 mls
d) False - 12% have no free fluid
e) False - hypoechoic lesion
@# 13. Regarding lumbar spondylolisthesis:
a) Degenerative spondylolisthesis most commonly affects L5/S1
b) Spondyloptosis is a complete slip of L5 on S1
c) Degenerative spondylolisthesis is commoner in men
d) Facet joint synovial cysts are associated with degenerative spondylolisthesis
e) Traumatic spondylolisthesis accounts for 20-30% of spondylolistheses
13.
a) False - L4/5
b) True
c) False - 4 times more in women
d) True
e) False - rare
@# 14. Causes for a superscan on bone scintigraphy include:
a) Renal osteodystrophy
b) Osteomalacia
c) Hyperparathyroidism
d) Hyperthyroidism
e) Diffuse skeletal metastases
14.
a) True
b) True
c) True
d) True
e) True
@# 15. The following are features of hypervitaminosis D:
a) Increased density of the skull
b) Widened zone of provisional calcification
c) Soft tissue calcification
d) Osteoporosis
e) Nephrocalcinosis
15.
a) True
b) True
c) True
d) True - late feature
e) True
@# 16. Features of rheumatoid arthritis include:
a) Late involvement of the 2nd and 3rd metacarpophalangeal joints
b) Central bone erosions
c) Ulnar subluxation
d) Juxta-articular osteoporosis
e) Calcification of the triangular fibrocartilage complex
16.
a) False
b) True - marginal and central erosions
c) True
d) True
e) False
@# 17. The following are skeletal features of tuberous sclerosis:
a) Multiple bone islands
b) Periosteal reactions
c) Cystic bone lesions
d) Rib expansion
e) Multiple non-ossifying fibromas
17.
a) True
b) True
c) True
d) True
e) False - this is a feature in neurofibromatosis
@# 18. The following statements regarding Sudeck’s dystrophy are true:
a) It affects 5-10% of all trauma patients
b) Plain radiograph appearances are of patchy osteopaenia
c) Have increased uptake on a 3-phase bone scan
d) It is associated with Raynaud’s phenomenon
e) Atrophy of the soft tissues occurs early
18.
a) False - 0.01 % of all trauma patients are affected
b) True - patchy osteopaenia is seen in 50% as early as 2-3 weeks after symptom onset
c) True
d) True
e) False - this is an end-stage feature
@# 19. The following are features of Gaucher’s disease:
a) Generalised osteopaenia
b) Marked cortical thickening
c) Endosteal scalloping
d) Biconcave ‘fish-mouth’ vertebrae
e) Madelung’s deformity
19.
a) True
b) False
c) True
d) True
e) False
@# 20. Regarding stress fractures:
a) 16-detector multislice CT is more accurate than skeletal scintigraphy at identifying stress
fractures
b) Stress fractures account for less than 1 % of all significant sporting injuries
c) A stress fracture is characterised by reduced uptake at the fracture site on a 99m technetium
MDP bone scan
d) Stress fractures only occur in an osteoporotic skeleton
e) Zwas’ system consists of criteria used for diagnosing stress fractures
20.
a) False
b) False - account for more than 10%
c) False - increased uptake at the fracture site on 99m technetium MDP bone scan
d) False - stress fractures occur as a result of a repetitive strain on a bone that has not
accommodated itself to this. Insufficience fractures occur when a normal physiologic stress
is applied to abnormal bone
e) True
@# 21. Features found in pigmented villonodular synovitis:
a) Predominantly polyarticular distribution
b) Haemorrhagic ‘chocolate’ effusion
c) Calcification in 50-60%
d) Joint space narrowing is early
e) MRI appearances of high signal on T1 weighted spin-echo MRI images
21.
a) False - monoarticular
b) True
a) False - no calcification
b) False - joint space narrowing is a late feature
c) False - characteristic appearances of low signal on T1 and T2 weighted spin-echo MRI
images due to presence of iron
@# 22. Regarding arthrography:
a) 10 ml of air is appropriate for a double-contrast knee arthrogram in an adult
b) Perthes’ disease is an indication for hip arthrography
c) A 22-gauge lumbar puncture needle is commonly used for shoulder arthrography
d) In ankle arthrography 6-8 ml of LOCM 240 is used
e) Presence of intra-articular loose bodies are a recognized contraindication to knee
arthrography
22.
a) False - 40 ml of air is required
b) True - other causes include developmental dysplasia of the hip, trauma, arthropathy
c) True
d) True
e) False
@# 23. The following statements regarding musculoskeletal MRI are true:
a) A surface coil gives an improved resolution than the body coil
b) Gradient echo sequences can differentiate articular cartilage from effusion
c) A total hip replacement is usually an absolute contraindication to MRI
d) T wave elevation on ECG is a recognized physiological change by the static magnetic field
of the MRI scanner
e) Claustrophobia may occur in as many as 20% of patients
23.
a) True
b) True
c) False - most orthopaedic implants are safe
d) True
e) False - 10%, 1 % of investigations are curtailed
@# 24. Regarding imaging appearances of osteomyelitis:
a) Radiographic findings become evident approximately 3 days after onset of infection
b) Periosteal reaction is the earliest sign of acute osteomyelitis
c) Klebsiella is the commonest organism isolated in adults
d) Chronic osteomyelitis is characterised by prominent cortical thinning
e) The diaphyses are often spared in patients with sickle cell disease
24.
a) False - 1-2 weeks
b) False - soft tissue swelling and loss of normal fat planes
c) False
d) False - thickening
e) False - infection focus at diaphyseal infarcts
@# 25. The following statements regarding the imaging of acute cervical spine injuries are true:
a) 10-20% of significant cervical spine injuries are not identified on plain radiographs
b) Flexion/extension views are of little use in the acute setting
c) CT is the imaging modality of choice for soft tissue injuries
d) A fall of greater than 3 metres is a high risk parameter for cervical spine injury
e) T2 fat-saturated images are useful in assessing for bone marrow oedema
25.
a) True - due to poor radiography, errors of image interpretation and absence of signs
b) True - delayed flexion/extension views helpful in identifying soft tissue injuries
c) False - MRI
d) True
e) True - increased signal areas
@# 26. The following are causes of painful sclerosis of the medial end of the clavicle:
a) Osteoarthritis
b) Sternoclavicular pyoarthrosis
c) Condensing osteitis
d) Sternocostoclavicular hyperostosis
e) Freidrich’s disease
26.
a) True
b) True
c) True
d) True
e) True - other causes include sclerotic metastases, osteoid osteoma, osteosarcoma, Paget’s
disease and fibrous dysplasia
@# 27. Regarding imaging of periosteal reactions:
a) Periosteal reaction becomes apparent 10-20 days following insult
b) Single layered periosteal reaction is a physiological appearance in premature infants
c) Osteomyelitis is a recognized cause of solid periosteal reaction
d) Sunburst periosteal reaction is seen in relation to aggressive tumours
e) Aggressive malignant primary bone tumours are a cause of Codman’s triangle
27.
a) True
b) True - physiological appearance in premature infants up to 6 months old
c) True
d) True - osteosarcoma is commonest
e) True - osteomyelitis and trauma are other causes
@# 28. Regarding trauma:
a) Salter Harris 2 fractures involve the articular surface
b) A posterior fat pad can be a normal finding on a lateral X-ray of the elbow
c) Avulsion of the flexor tendon results in a mallet finger
d) Tracking McGregor’s line 1 will help to identify a fracture through the inferior orbital rim
e) In a fracture of the 5th metatarsal the fracture line is usually longitudinal to the long axis of
the metatarsal
28.
a) False - Salter Harris 3 and 4 are intra-articular
b) False
c) False - extensor tendons
d) False - line 2 passes through the zygomatic arch and inferior orbital rim
e) False - the fracture line is transverse to the long axis of the metatarsal
@# 29. The following statements regarding a burst fracture of a vertebral body are true:
a) This is most commonly associated with a shearing injury
b) It is most commonly found from T4-T8
c) Other spinal injuries are associated in up to 10-15% of cases
d) Reduced interpedicular distance is a sign on an AP film
e) Concavity of the posterior cortical line is a sign on lateral film
29.
a) False - vertical compression injury
b) False -T12-L2
c) False - other spinal injuries are associated in up to 40% of cases
d) False - increased interpedicular distance is a sign on an AP film
e) False - convexity of the posterior cortical line is a sign on lateral film
@# 30. The following are features of transient osteoporosis of the hip:
a) Usually painless
b) Joint space narrowing
c) Reduced uptake on bone scan
d) Pathological fractures are rare
e) Usually bilateral and symmetrical
30.
a) False
b) False
c) False - increased
d) False - common
e) False
