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