Musculoskeletal and Trauma - Warm Up

Question 1

1. Regarding ultrasound of the ankle: (T/F)

a) Tendons appear as hyperechoic structures

b) Peroneus longus tendon runs anterior to the lateral malleolus

c) The normal Achilles tendon has a flattened crescentic appearance on axial scans

d) The tibialis posterior, flexor digitorum and flexor hallucis longus tendons run posterior to the medial malleolus

e) A high frequency probe is used

Answer 1

1.

a) True

b) False - posterior

c) True

d) True

e) True

Question 2

2. Concerning metabolic and endocrine arthritides: (T/F)

a) Gouty tophi are deposits of sodium urate in peri-articular soft tissues

b) Gout is seen more commonly in females

c) Haemochromatosis in the hand commonly affects the 2nd and 3rd metacarpophalangeal joints

d) Alkaptonuria is an autosomal recessive inherited disorder

e) Alkaptonuria most commonly involves the small joints of the hands

Answer 2

2.

a) True - gout is characterised by punched out lesions and peri-articular soft tissue tophi.
Great toe most commonly affected=podagra

b) False - commoner in males and post-menopausal women

c) True

d) True - deposition of brown-black pigment in the intervertebral disks and articular cartilage

e) False

Question 3

3. With regards to the cervical spine: (T/F)

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 hangman’s fracture is usually secondary to a hyperflexion injury

e) A swimmer’s view can be used for better demonstration of the C1/C2 junction

Answer 3

3.

a) False - C4

b) True - < 3 mm in adults, < 5 mm in children

c) True - caused by a blow to vertex of the head while in a neutral position. Fracture of anterior and posterior arches of C1

d) False - (Hyperextension injury resulting in bilateral fractures of the pedicles of C2.
Unstable injury. Accounts for 4-7% of all spinal fractures

e) False - for visualisation of C7/C8/T1

Question 4

@#e 4. Concerning dislocations: (T/F)

a) Anterior dislocation of the hip accounts for 10-20% of all hip dislocations

b) Posterior dislocations of both radius and ulna account for 80-90% of elbow dislocations

c) Anterior dislocation of the shoulder accounts for more then 90% of glenohumeral dislocations

d) A Bankhart lesion is a fracture of the anterior aspect of the superior rim of the glenoid

e) Dislocation of the patella is usually medial

Answer 4

4.
a) True - lies medial and inferior to acetabulum on pelvis X-ray

b) True - isolated dislocation of the radial head is rare

c) True - 97% are anterior dislocations. Associated with a FHill-Sachs lesion which is a defect in the posterolateral aspect of the humeral head

d) False - inferior rim

e) False - lateral

Question 5

5. Anatomy of the knee joint: (T/F)

a) The popliteus muscle tendon passes through a portion of the posterior horn of the lateral meniscus

b) The normal medial meniscus is seen as low signal on T1 weighted spin echo and high signal on T2 weighted spin echo MRI images

c) The medial and lateral collateral ligaments are best assessed on sagittal MRI images of the knee

d) The posterior cruciate ligament is attached to the inner aspect of the medial femora! condyle

e) The commonest site of meniscal injury is the posterior horn of the lateral meniscus

Answer 5

5.

a) True

b) False - low signal on T1 and T2

c) False - coronal

d) True

e) False - posterior horn of medial meniscus is most commonly injured

Question 6

6. Causes of ‘Bone within Bone’ appearance include: (T/F)

a) Congenital syphilis

b) Infantile cortical hyperostosis

c) Sickle cell disease

d) Oxalosis

e) Paget’s disease

Answer 6

6.

a) True

b) True

c) True

d) True

e) True - acromegaly and radiation are also causes

Question 7

7. Features of diaphyseal aclasia (hereditary multiple exostosis) include: (T/F)

a) Autosomal recessive inheritance

b) Exostoses have a cap of 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) Malignant transformation to chondrosarcoma occurs in 35-40%

Answer 7

7.

a) False - AD, presents at 2-10 years of age

b) True

c) False - arise from metaphysis of long bones near epiphyses and point away from the joint

d) True

e) False - <5%

Question 8

8. 8 Features of Marfan’s syndrome include: (T/F)

a) Pectus excavatum

b) Dural ectasia

c) Disproportionate shortening of the hallux

d) Ligamentous laxity

e) Progressive protrusio acetabuli

Answer 8

8.

a) True

b) True

c) False - causes disproportionate lengthening

d) True

e) True - other features include arachnodactyly, tall stature, muscle hypoplasia, osteopaenia,
pes planus, kyphoscoliosis

Question 9

9. 9 Desmoid tumours: (T/F)

a) Are malignant fibrous tumours

b) Are multiple in 40-50% of cases

c) Only rarely occur in the shoulder

d) Are usually of high signal on T1 weighted MRI images

e) Calcify in more than 90%

Answer 9

9.

a) False - benign. Presents in <40-year-olds. M:F 1:1

b) False - 10-15%

c) False - common location as are thigh and pelvis

d) False - low signal intensity on T1 and T2 with some intermediate areas on T2 MRI images.
Heterogenous echo pattern on US

e) False

Question 10

@# 10. Regarding osteochondritis dissecans: (T/F)

a) The average age of onset is within the 2nd decade

b) Lesions in the knee are bilateral in 20-30%

c) Lesions in the knee most commonly involve the lateral aspect of the femoral condyle

d) A high signal intensity line around the lesions on T2 weighted MRI images is indicative of instability

e) A grade 2 osteochondritis dissecans lesion is characterised by a displaced fragment

Answer 10

10.

a) True - about 15 years of age

b) True

c) True

d) True

e) False -
Grade 4 (displaced fragment/loose body in the joint)
Grade 3 (fragment partially detached)
Grade 2 (defect in cartilage)
Grade 1 (focal softening/fissuring)

Question 11

@# 11. Concerning normal anatomical angles: (T/F)

a) Pes cavus can be diagnosed when the calcaneo-fifth metatarsal angle is <150 degrees

b) A Bohler’s angle of <20 degrees suggests a calcaneus fracture

c) The sulcus angle, formed by lines along the condyles on a skyline view of the patella, is 120-125 degrees

d) The normal angle between femoral neck and shaft is <140 degrees in all age groups

e) Coxa vara is associated with a decrease in femoral neck angle

Answer 11

11.

a) True

b) True

c) False - 140 degrees

d) False - in children angle is 150 degrees at birth. Adults normally 120-135 degrees

e) True

Question 12

@# 12. Causes of symmetrical periosteal reaction in adults include: (T/F)

a) Venous insufficiency

b) Hypertrophic osteoarthropathy

c) Thyroid acropachy

d) Fluorosis

e) Phenytoin therapy

Answer 12

12.

a) True

b) True

c) True

d) True

e) False

Question 13

@# 13. With regards to radiofrequency ablation: (T/F)

a) It is used for treatment of osteoid osteoma

b) Ultrasound guidance is the imaging technique of choice

c) Small lesions can be treated with a single electrode

d) It can be performed as a day case

f) It has a role in the palliative treatment of painful vertebral metastases

Answer 13

13.

a) True

b) False - CT guidance is used

c) True - large lesions are treated with cluster electrodes

d) True

e) True

Question 14

14. Regarding glomus tumour of bone: (T/F)

a) Malignant transformation is common

b) It is most commonly found in a subungal location

c) It appears hyperechoic on ultrasound

d) Lesions are of high signal intensity on T1 weighted spin echo images

e) 20-30% of patients present with multiple lesions

Answer 14

14.

a) False - rare

b) True

c) False - hypoechoic appearance on US

d) False - low signal intensity on T1

e) False

Question 15

@#e 15. Malignant fibrous histiocytoma: (T/F)

a) Is the commonest soft tissue sarcoma in adults >45 years of age

b) Presents as a painless soft tissue mass

c) Rarely calcifies

d) Is most commonly found in a retroperitoneal location

e) Angiomatoid malignant fibrous histiocytoma is frequently seen in <20-year-olds

Answer 15

15.

a) True

b) True - imaging features of low signal on T1 /high signal on T2 with variable contrast enhancement

c) True

d) False - 75% are found in the extremities, lower limb > upper limb

e) True

Question 16

@#e 16. Regarding myositis ossificans: (T/F)

a) 10-20% of lesions undergo malignant transformation

b) In the acute stages lesions undergo no contrast enhancement on MRI

c) On a plain radiograph lesions are seen to be in contact with the periosteum

d) It affects the large muscles of the extremities in 80-90% of cases

e) Burns are a recognized predisposing factor

Answer 16

16.

a) False - non-neoplastic condition of ossification in muscles. Commoner in adults. M:F 1:1

b) False

c) False - separated from periosteum by lucent zone

d) True

e) True

Question 17

@#e 17. Telangiectatic osteosarcoma is: (T/F)

a) The commonest type of osteosarcoma

b) Painless

c) Highly aggressive

d) Low intensity signal on T2 weighted MRI

e) Most commonly found in patients 60-80 years of age

Answer 17

17.

a) False

b) False

c) True

d) False - high signal T2. Low signal T1

e) False - 15-35 years of age

Question 18

@#e 18. Regarding eosinophilic granuloma: (T/F)

a) Lesions in proximal long bones are usually diaphyseal

b) The commonest site is the skull

c) On MRI, it appears as a well defined lesion of low signal intensity on T1

e) Lesions rarely elicit a periosteal reaction

f) It is a recognized cause of ‘floating teeth’ appearance

Answer 18

18.

a) True

b) True

c) False - increased signal on T1 due to xanthomatous histiocytes

d) False - expansile lytic lesion with periosteal reaction, endosteal scalloping

e) True

Question 19

19. Imaging features of the arthropathy of haemochromatosis include: (T/F)

a) Generalised osteoporosis

b) Most commonly seen in males over 40 years of age

c) Bilateral symmetrical arthropathy

d) Chondrocalcinosis is seen in up to 30% of patients

e) Subchondral cysts

Answer 19

19.

a) True

b) True

c) False - asymmetrical

d) True

e) True - other features include osteopaenia, joint space narrowing, subchondral sclerosis.
Arthropathy resembles degenerative joint disease + CPPD

Question 20

20. Regarding pathology of the knee: (T/F)

a) Anterior cruciate ligament tears are associated with >70% of Segond fractures

b) Bone bruises are evident on plain radiographs following trauma

c) Meniscal cysts are well defined high signal intensity lesions on T2 weighted MRI

d) Discoid menisci are less prone to meniscal tears

e) Blount disease is characterised by deformity of the lateral tibial epiphysis

Answer 20

20.

a) True - Segond fracture is an avulsion injury at the insertion of the middle third of the capsular ligament on the upper lateral tibia

b) False - easily detected on MRI

c) True

d) False

e) False - medial tibial epiphysis

Question 21

@# 21. Regarding carpal injuries: (T/F)

a) Fractures through the proximal pole of the scaphoid account for 15-20% of scaphoid fractures

b) Scaphoid fractures involving the distal pole have a high incidence of non-union and osteonecrosis

c) Osteonecrosis most frequently becomes apparent 3-4 weeks after injury

d) Triquetral bone fractures are best demonstrated on the AP film

e) In dorsal intercalated segment instability (DISI) the scapholunate angle is less than 30 degrees

Answer 21

21.

a) True - waist fractures are commonest 80%

b) False - proximal pole

c) False - 3-6 months. Characterised by sclerosis and fragmentation

d) False - lateral film

e) False - the normal scapholunate angle is 30-60 degrees. In DISI it is > 60-70 degrees. In
VISI it is < 30 degrees

Question 22

22. Fractures: (T/F)

a) Rolando fracture is an extra-articular comminuted fracture of the base of the 1st metacarpal

b) Calcaneus fractures are bilateral in 5-10%

c) Muscular contraction of the sartorius muscle can result in avulsion of the anteroinferior iliac spine

d) The fracture line in patellar fractures is most commonly longitudinal

e) In adults, clavicle fractures are commonest in the medial third

Answer 22

22.

a) False - intra-articular fracture

b) True

c) False - sartorius inserts into anterior superior iliac spine. Rectus femoris inserts into anterior inferior iliac spine

d) False - transverse

e) False - middle third

Question 23

@# 23. The following conditions can present as multiple sclerotic bone lesions: (T/F)

a) Osteopoikilosis

b) Mastocytosis

c) Breast metastases following radiotherapy

d) Tuberous sclerosis

e) Sudeck’s atrophy

Answer 23

23.

a) True

b) True

c) True

d) True

e) False

Question 24

24. The following statements are correct: (T/F)

a) Paget’s disease has a prevalence of 10% in people over the age of 80 years of age

b) Ankylosing spondylitis is found more commonly in Black than Caucasian populations

c) Developmental dysplasia of the hip is more common in males

d) Diffuse idiopathic skeletal hyperostosis commonly presents in children

e) The highest incidence of fibrous dysplasia is between 30-50 years of age

Answer 24

24.

a) True - unusual in under 40-year-olds

b) False - ratio of 3:1

c) False - much commoner in girls

d) False - usually presents in over 50-year-olds

e) False - the highest incidence of fibrous dysplasia is at 3-15 years of age. 75% are seen below 30 years of age

Question 25

@# 25. The following conditions have a malignant potential: (T/F)

a) Osteopoikilosis

b) Bone Island

c) Fibrous cortical defect

d) Intra-osseous ganglion

e) Tumoral calcinosis

Answer 25

25.

a) False

b) False

c) False

d) False

e) False

Question 26

@#e 26. Features of adamantinoma include: (T/F)

a) Most common presentation in patients >50 years of age

b) Over 90% occur in the tibia

c) Osteosclerotic lesion

d) Lung metastases

e) Avascularity

Answer 26

26.

a) False - 10-50-year-olds

b) True - mostly in the middle third

c) False - osteolytic

d) True - 10% of cases

e) False - prominent vascularity

Question 27

27. Regarding simple bone cysts: (T/F)

a) Distal third of the humerus is the commonest site

b) 70% of patients are between 13-18 years of age

c) Usually cause asymmetrical expansion of bone

d) May have a periosteal reaction in the absence of a pathological fracture

e) Recurrence rate after curettage is up to 10%

Answer 27

27.

a) False - proximal third of the humerus is commonest, then proximal third of the femur

b) False - 70% are aged 4-10 years and 90% are <20 years of age

c) False - symmetrical. Aneurysmal bone cysts are eccentric

d) False

e) False - 50%

Question 28

28. The following are causes of a premature closure of the growth plate: (T/F)

a) Homocystinuria

b) Sickle cell anaemia

c) Radiotherapy

d) Trauma

e) Juvenile idiopathic arthritis

Answer 28

28.

a) False

b) True

c) True

d) True

e) True

Question 29

@# 29. Epidermoid inclusion cysts: (T/F)

a) Are characterised by a florid lamellar periosteal reaction

b) Commonly calcify

c) Are more commonly found in the right than the left hand

d) When involving the fingers, the terminal phalanx of the ring finger is the most common site

e) Are preceded by a history of trauma

Answer 29

29.

a) False

b) False - no calcification

c) False - left >right

d) False - middle finger

e) True

Question 30

30. Regarding bone metastases: (T/F)

a) Prostate metastases are always sclerotic

b) Metastases can be excluded in a patient with bone scintigraphy showing no abnormal uptake

c) Metastases located in the medulla are of reduced signal on T1 and increased signal on fat suppressed T2 MRI images

d) Identification of a ‘halo’ of high signal intensity around a lesion on T2 weighted MRI suggests a benign lesion

e) Melanoma metastases are usually lytic

Answer 30

30.

a) False - in a small percentage the metastases can be entirely lytic

b) False - lesions which outgrow their blood supply appear photopaenic

c) True

d) False - highly specific for metastases

e) True

Question 31

31. Primary lymphoma of bone: (T/F)

a) Usually involves the epiphyses

b) Pelvis is involved in > 50%

c) Invasion of the soft tissues occurs early

d) Response to radiotherapy is good

e) Predominantly sclerotic tumour is found in 60-70%

Answer 31

31.

a) False - diaphysis

b) False -15%

c) False - relatively late

d) True

e) False - 20%. Increased sclerosis post-therapy

Question 32

32. Radiographical centering points for the following X-rays are correct: (T/F)

a) PA view of the hand - 4th MCPJ

b) Lateral view of the elbow - lateral epicondyle

c) AP view of the shoulder - coracoid process

d) AP view of the knee - 2.5 cm above the lower pole of the patella

e) Lateral view of the ankle - medial malleolus

Answer 32

32.

a) False - 3rd MCPJ

b) True

c) True

d) False - 2.5 cm below the lower pole of the patella

e) True

Question 33

@#e 33. The following statements regarding seronegative arthritides are correct: (T/F)

a) Ankylosing spondylitis and inflammatory bowel disease typically cause bilateral symmetrical sacroiliac joint disease

b) Large joint involvement in psoriatic arthropathy is common

c) Reiter’s syndrome more commonly involves the feet than the hands

d) The interphalangeal joint of the great toe is rarely affected in Reiter’s syndrome

e) Psoriatic arthropathy is associated with bilateral syndesmophytes

Answer 33

33.

a) True - psoriatic arthropathy and Reiter’s syndrome usually produce an asymmetrical pattern of sacroiliac disease

b) False - small joint rheumatoid-like arthritis

c) True

d) False - commonly affected

e) False - usually unilateral syndesmophytes

Question 34

34. Features of an osteoid osteoma: (T/F)

a) Pain is typically more intense at night

b) Are more common in flat bones than osteoblastoma

c) In the hands, the distal phalanx is the commonest site of involvement

d) Observed most frequently in patients >25 years of age

e) The nidus may contain calcification

Answer 34

34.

a) True - relieved by salicylates

b) False - osteoblastoma commoner in flat bones and vertebrae. Osteoid osteoma commoner in long tubular bones 50-60% in femur/tibia

c) False - rare, found in the proximal phalanges

d) True - some cases are found in very young and elderly. M:F 3:1

e) True - usually is uniformly radiolucent < 1 cm but can contain calcification

Question 35

35. Regarding Giant Cell Tumour (GCT): (T/F)

a) In long bones, GCTs are usually located in the metaphysis

b) 70-80% are located in the femur

c) Rarely produces expansion

d) Recurrence of 25-35% of cases

e) Multiple primary GCTs in the same patient are seen in 10-20% of cases

Answer 35

35.

a) True

b) False - femur 30%, tibia 25%, radius 10%, humerus 6%. Rare in the skull

c) False - expansile osteolytic lesion with cortical thinning

d) False - 40-60%. Usually seen within first 2 years after treatment

e) False - 0.5-5% multiple GCTs may be seen in Paget’s disease

Question 36

@#e 36. Features of periosteal osteosarcoma: (T/F)

a) This is the second commonest subtype of osteosarcoma

b) Typically involves the diaphyses of long tubular bones

c) Extension of tumour usually involves the medullary cavity

d) Prognosis of this tumour is better than that of parosteal osteosarcoma

e) Commonly, appearances are of a pedunculated lesion

Answer 36

36.

a) False - rare. Seen in 10-20-year-olds

b) True - femur and tibia commonest

c) False - medullary cavity uninvolved. Extension into adjacent soft tissues is common

d) False - worse

e) False - tumour base attaches to cortex over entire extent of tumour

Question 37

@# 37. Regarding tumoral calcinosis: (T/F)

a) Autosomal dominant inheritance

b) More common in Caucasians

c) Associated with an elevated parathyroid hormone

d) Most commonly are found in a para-articular location around the knees

e) Low tendency to recur

Answer 37

37.

a) True - autosomal dominant disorder characterised by nodular juxta-articular calcified soft tissue masses

b) False - commoner in blacks. Onset 1st-2nd decade

c) False - normal calcium, alkaline phosphatase, renal function, parathyroid hormone

d) False - knees are almost never affected. Hips are commonest, then elbows, shoulders, feet

e) False - high recurrence rate

Question 38

38. Causes of hypertrophic osteoarthropathy include: (T/F)

a) Thymoma

b) Bronchogenic carcinoma

c) Binswanger disease

d) Amyloidosis

e) Chronic active hepatitis

Answer 38

38.

a) True

b) True

c) False - Binswanger disease is a progressive neurological disorder caused by arteriosclerosis and thromboembolism affecting the blood vessels that supply the white-matter, basal ganglia and thalamus.

d) True

e) True

Question 39

39. Synovial sarcoma: (T/F)

a) Is commonly intra-articular

b) Is typically painless

c) Most commonly involves the knee

d) 30-40% exhibit amorphous calcification

e) Is low signal on T1 and T2 weighted MRI images

Answer 39

39.

a) False

b) False

c) True - also commonly seen in hips, ankles, elbows, feet and hands

d) True

e) False - low T1 and high T2

Question 40

@#e 40. Skeletal features of thalassaemia major include: (T/F)

a) Erlenmeyer flask deformity

b) Arthropathy

c) Osteoporosis

d) Narrowing of medullary cavity

e) Premature fusion of epiphysis

Answer 40

40.

a) True

b) True - secondary to haemochromatosis and CPPD

c) True

d) False - marrow hyperplasia

e) True - seen in 10%

Question 41

41. Endosteal chondrosarcoma: (T/F)

a) Is the most common primary bone tumour

b) Usually involves the diaphyses

c) Hyperglycaemia is a recognized paraneoplastic syndrome

d) Associated soft tissue mass is uncommon

e) Flocculent chondroid calcification is characteristic

Answer 41

41.

a) False - 3rd commonest after multiple myeloma and osteosarcoma

b) True

c) True - in 85%

d) False - usual

e) False - this is a characteristic feature of exostotic chondrosarcoma

Question 42

@# 42. Regarding chondromyxoid fibroma: (T/F)

a) 70% of patients are under 40 years of age

b) Tumour is common in the skull

c) In long tubular bones they are commonly eccentrically situated diaphyseal lesions

d) Calcification is identified in 50-60%

e) Commonly are of high signal intensity on T2 weighted spin echo MRI

Answer 42

42.

a) True - commonest in 2nd-3rd decade. Slightly more frequent in men than women

b) False - found in long tubular bones. 70% in lower extremity. Rare also in sternum, ribs, spine, facial bones

c) False - metaphyseal

d) False -13%

e) True

Question 43

@#e 43. Concerning Brodie’s abscess: (T/F)

a) Staphylococcus aureus is the commonest organism

b) Most common in the elderly

c) Tibial metaphysis is commonest location

d) It is usually associated with dense marginal sclerosis

e) Gives a ‘double-line’ effect on MRI

Answer 43

43.

a) True

b) False - children

c) True

d) True

e) True - high signal intensity of granulation tissue surrounded by low signal - due to marked
bone sclerosis

Question 44

@#e 44. Regarding hyperparathyroidism (HPT): (T/F)

a) Brown tumours occur more frequently in secondary HPT

b) Rugger Jersey spine occurs more frequently in primary HPT

c) Chondrocalcinosis is seen in 15-20%

d) Increased incidence of slipped upper femoral epiphysis is associated with HPT

e) A normal bone scan in about 80%

Answer 44

44.

a) False - primary

b) False - secondary

c) True - more frequent in secondary HPT

d) True

e) True

Question 45

45. Features of neurofibromatosis Type 1: (T/F)

a) Solitary neurofibromas are most commonly of low attenuation on CT

b) On MR I are of low signal on T1 and high signal on T2

c) Plexiform neurofibromas are pathognomonic for von- Recklinghausen’s disease

d) In neurofibromatosis Type 1, approximately 50% of neurofibromas undergo malignant transformation

e) The most common skeletal abnormality is rib notching

Answer 45

45.

a) True

b) True

c) True

d) False - 5%

e) False - scoliosis is commonest abnormality. Other features include: posterior vertebral scalloping; increase in size of intervertebral foramina; bowing of long bones;
pseudoarthrosis; cystic osteolytic lesions; ‘ribbon ribs’ due to superior and inferior rib
notching

Question 46

@# 46. Concerning radionuclide imaging: (T/F)

a) Radiotherapy is associated with a focal increased uptake of radioisotope

b) A superscan characteristically shows diffuse increased bone and renal uptake of MDP radioisotope

c) In a patient with a known primary cancer and vertebral skeletal hot spot, there is a 50% chance that the hot spot represents metastases

d) A bone scan is useful in the routine staging of multiple myeloma

e) Following a scaphoid fracture it is normal for the bone scan to remain positive for up to 12 months

Answer 46

a) False - the endarteritis associated with radiotherapy treatment reduces uptake of radioisotope

b) False - increased bone but loss of visualisation of the kidneys

c) False - in a patient with a known primary cancer 80% of vertebral hot spots represent metastases

d) False

e) False - a positive bone scan at 12 months represents nonunion/avascular necrosis

Question 47

@#e 47. Regarding ultrasound of soft tissue masses: (T/F)

a) Ganglion cysts show posterior acoustic enhancement

b) Ganglion cysts can communicate with the tendon sheath

c) Superficial masses are best examined with a 9-13 MHz Frequency Linear Transducer

d) Schwannomas can be differentiated from neurofibromas by ultrasound appearances

e) Lipomas commonly have increased vascularity

Answer 47

47.

a) True

b) True

c) True

d) False

e) False

Question 48

48. Features of sarcoid bone involvement include: (T/F)

a) Well defined lytic lesions

b) Vertebrae are usually involved

c) Reticulated trabecular pattern in the distal phalanges

d) Joint involvement in 70-80%

e) Paravertebral soft tissue mass

Answer 48

48.

a) True

b) False - unusual

c) True

d) False - rarely involved

e) True

Question 49

49. Concerning enchondromas: (T/F)

a) Most frequent tumour found in the small bones of the hands

b) In the hands, diaphyses is the most common site

c) Calcification is rare

d) MRI appearances are of low signal on T1 and high signal on T2 spin echo images

e) Maffuci syndrome is characterised by multiple enchondromas and soft tissue cavernous haemangiomas

Answer 49

49.

a) True - 40-50% of cases

b) True

c) False - common

d) True

e) True

Question 50

@#e 50. Features of Paget’s disease: (T/F)

a) Pelvis is most commonly affected

b) Increased density of vertebra - ‘ivory vertebra’

c) Thickening of ileopectineal line

d) Candle flame lysis

e) Sarcomatous transformation in 10-15%

Answer 50

50.

a) True - 75%

b) True

c) True

d) True - v-shaped lytic defect in diaphyses of long bones

e) False