VIQ - MSK

Question 1

@# 14) In the spectrum of perilunate ligamentous injuries and instability, volar tilt of the lunate, seen as a triangular or ‘pie-shaped’ lunate on the AP projection of the wrist, is most commonly a feature of which of the following?

a. scapholunate dissociation

b. perilunate dislocation

c. lunate dislocation

d. volar intercalated segmental instability

e. dorsal intercalated segmental instability

Answer 1

c. lunate dislocation

The lesser arc refers to the arc of ligamentous attachments around the lunate.

These ligaments become disrupted in a stepwise four-stage fashion.

Stage I injury is to the scapholunate ligament, leading to dissociation with rotary subluxation of the scaphoid.

Stage II is radiographically characterized by perilunate dislocation, caused by additional injury to the capitolunate joint. The carpus migrates dorsally and the lunate maintains a normal relationship with the radius.

Stage III involves the triquetrolunate ligaments,

and stage IV is complete disruption of the perilunate ligaments, allowing dislocation and rotation of the lunate. It is this rotation that creates the triangular outline on AP radiographs. Segmental instabilities relate to the spectrum of dynamic scaphoid instability.

Question 2

@# 33) A 23-year-old man falls onto his outstretched right hand with his elbow flexed. AP and lateral radiographs of the mid-forearm reveal a fracture of the middle third of the radius. Which additional radiograph should be performed?

a. clavicle

b. shoulder

c. elbow

d. oblique forearm

e. wrist

Answer 2

e. wrist

A Galeazzi fracture–dislocation is a pattern of injury sustained by falling on an outstretched hand with a flexed elbow. It most commonly consists of a fracture of the radial diaphysis with dislocation or subluxation of the distal radioulnar joint. It is associated with a high rate of non-union, and one or both components are usually treated with surgical fixation.

It is important therefore that the radiologist can recognize potential patterns of injury and radiographically demonstrate their full extent. As a general rule, fractures should be viewed in two orthogonal planes, as should the joint above and below any fracture.

The opposite pattern, of an ulnar shaft fracture with dislocation of the proximal radial head, is termed a Monteggia fracture–dislocation.

A mnemonic for remembering the two is Glasgow Rangers (Galeazzi, radius) and Manchester United (Monteggia, ulna), which indicates for each injury which of the forearm bones is fractured.

Question 3

@# 48) A young male patient sustains an external rotational injury to his left ankle and is unable to bear weight. A plain radiograph of the ankle performed in accident and emergency shows no fracture but does show soft-tissue swelling over the medial malleolus and widening of the ankle joint space medially (lateral talar shift). Which of the following additional view(s) should be performed?

a. mortise view

b. calcaneus

c. foot

d. knee

e. contralateral ankle

Answer 3

d. knee

The Maisonneuve fracture is a spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

The medial component of the injury may be an associated fracture of the medial malleolus or rupture of the deep deltoid ligament.

The ankle joint is effectively a bony ring that extends up to the knee.

Interruption of the ring in this way allows lateral displacement of the fibula and so disruption of the congruence of the ankle mortise, resulting in an unstable ankle injury that requires surgical fixation.

Question 4

@# 51) At which of the following skeletal locations does avascular osteonecrosis typically only occur in the presence of an associated fracture?

a. medial tibial condyle

b. second metatarsal head

c. lunate

d. femoral head

e. proximal scaphoid pole

Answer 4

e. proximal scaphoid pole

Osteonecrosis may be caused by two mechanisms: interruption of arterial supply, and intra- or extra-osseous venous insufficiency.

Interruption of vascular supply is usually associated with a fracture, as seen in the proximal scaphoid following waist fractures.

Femoral head osteonecrosis can occur with subcapital fractures, or without fracture as in Legg–Calve´ –Perthes disease.

Other common locations that may develop osteonecrosis without overt fracture include the medial tibial condyle (Blount’s disease), metatarsal head (Freiberg’s infraction) and the lunate (Kienbock’s disease).

Radiographic findings often lag several months behind the injury or onset of symptoms, and MR is the most sensitive imaging modality.

Radiographic signs include focal radiolucencies, sclerosis, bone collapse and loss of joint space.

Question 5

@#e2 57) Of the following eponyms associated with fractures, which relates to a fracture–dislocation?

a. Segond

b. Jones

c. Smith

d. Barton

e. Hutchinson

Answer 5

d. Barton

The use of eponymous names for fractures allows quick and accurate identification and communication of bone injuries while simultaneously alerting clinicians to the potential complications associated with a given fracture pattern. This is also particularly useful when describing complex radiographic appearances to someone remote from the images. The full value of such eponyms depends on accurate use and understanding of their meaning:

Barton’s fracture–dislocation is an intra-articular fracture of the dorsal margin of the distal radius with dorsal dislocation of the radiocarpal joint;

Segond’s fracture is an avulsion fracture of the proximal lateral tibia;

Jones’ fracture is a transverse fracture of the base of the fifth metatarsal, at the junction of the diaphysis and metaphysis;

Smith’s fracture is a distal radial fracture with ventral displacement;

and Hutchinson’s fracture is a triangular fracture of the radial styloid.

Question 6

@#e2 62) A middle-aged woman falls on an outstretched hand, which becomes immediately painful and swollen. A lateral radiograph shows a small fracture fragment dorsal to the carpus, and the AP radiograph appears normal. Which carpal bone is most likely to be fractured?

a. scaphoid

b. lunate

c. triquetrum

d. capitate

e. hamate

Answer 6

c. triquetrum

Carpal fractures in general are much less common than fractures to the distal radius. The two bones most commonly injured are the scaphoid (75%) followed by the triquetrum (14%), and these provide a greater diagnostic challenge radiographically than distal radial fractures.

Triquetrum fractures generally occur on the dorsal surface due to avulsion of the dorsal radiocarpal ligament, or shearing forces from impaction with the ulnar styloid or hamate in hyperextension.

Less commonly, the body of the bone can fracture in a transverse pattern.

A posterior chip fragment can often be seen with dorsal surface fractures, but is only visualized on the lateral view.

Such an injury may be a primary triquetrum injury (such as avulsion) or related to a perilunate fracture–dislocation.

Question 7

@#e2 24 A 32 year old man falls on his outstretched right wrist whilst playing football. Wrist X-ray reveals a displaced, oblique intraarticular fracture of the dorsal lip of the distal radius. What is the fracture type described?

(a) Barton’s

(b) Chauffeur’s

(c) Calles’

(d) Smith’s

(e) Salter Harris Type II

Answer 7

(a) Barton’s

A Barton’s fracture refers to an intra-articular fracture through the distal radius. The conventional Barton fracture involves the dorsal rim of the radius, the reverse Barton involves the volar rim.

Salter-Hanis fractures involve the growth plate before closure;

the other types described are not intra-articular.

Calles’ and Smith’s are fractures of the distal radius with dorsal and volar displacement of the distal fragments, respectively.

A chauffeur fracture is a triangular fracture of the radial styloid process.

Question 8

@#e2 36 A patient has injured his right shoulder. An AP view demonstrates an acromio-clavicular distance of 12 mm and a coraco-clavicular distance of 10 mm. The clavicle is not otherwise grossly displaced. What is the grade of the acromio-clavicular joint injury?

(a) Grade I

(b) Grade II

(c) Grade Ill

(d) Grade IV

(e) Grade V

Answer 8

(b) Grade II

Question 9

@# 53 A 15 year old boy presents with a history of right knee clicking, locking and intermittent swelling. There is no clear history of trauma. MRI shows a focus of abnormal signal in the subarticular marrow, a defect in the overlying cartilage, a loose intra-articular body and a small effusion.
What is the likeliest site of the cartilaginous defect?

(a) Medial aspect of the lateral condyle

(b) Lateral aspect of the lateral condyle

(c) Medial aspect of the medial condyle

(d) Lateral aspect of the medial condyle

(e) Posterior surface of the patella

Answer 9

(d) Lateral aspect of the medial condyle

Osteochondritis dissecans is the fragmentation and sometimes separation of a portion of the articular surface usually seen in adolescent males. It is most commonly related to repetitive
microtrauma although associations with other conditions such as Osgood-Schlatter’s and Scheuerman’s disease have been reported. It is most common in the medial femoral condyle although the humerus, capitellum and talus may be involved. It is bilateral in 10-20%.

Question 10

@# 17 A young man avulses his anterior inferior iliac spine whilst kicking a football. The origin of which muscle will be affected?

(a) Adductor magnus

(b) lliopsoas

(c) Rectus femoris

(d) Sartorius

(e) Tensor fasciae latae

Answer 10

(c) Rectus femoris

The anterior inferior iliac spine is the origin of rectus femoris.

Question 11

@#e2 51 A patient presents with wrist pain subsequent to a fall. Carpal instability is suspected and a lateral radiograph is taken of the wrist in neutral alignment. The scapholunate angle is 70° and the capitolunate angle is 10°. What is the most appropriate description?

(a) Normal

(b) Scapholunate dissociation

(c) Volar intercalated segment instability

(d) Dorsal intercalated segment instability

(e) Scapholunate advanced collapse

Answer 11

(b) Scapholunate dissociation

Question 12

@#e2 6. A 60-year-old woman undergoing follow-up CT under the care of the oncologist develops a new expansile lytic lesion. Which of the following primary tumours usually causes an expansile lytic metastasis?

A. Cervix

B. Uterus

C. Ovary

D. Thyroid

E. Rectum

Answer 12

D. Thyroid

Renal cell carcinoma also causes expansile lytic metastases.

Question 13

@# 24. Plain film, CT and MRI are performed for the investigation of suspected chordoma. Which is the best answer?

A. Radiographic appearances show sacral osteosclerosis

B. Coarse calcification often present with associated soft tissue

C. Areas of low attenuation within a mass on CT

D. Intermediate SI on T2

E. Arise from the spinal canal

Answer 13

C. Areas of low attenuation within a mass on CT

Chordoma usually appears as a low attenuation mass on CT.

Question 14

@# 12) A female adult patient with right shoulder pain is shown to have multiple markedly expansile lytic lesions within the scapula and clavicle secondary to metastatic malignant spread. Which of thefollowing is most likely to be the primary site of malignancy?

a. renal

b. breast

c. cervical

d. colon

e. bronchus

Answer 14

a. renal

The common cancers that typically metastasize to bone are breast, lung, thyroid, renal and prostate. Due to the high prevalence of colon cancer, even though only a relatively small proportion metastasizes to bone, it forms a significant proportion of bone metastases.

Prostatic metastases are typically sclerotic, whereas breast deposits are mixed.

Colonic bone metastases are usually lytic, with renal metastases typically lytic and expansile due to their highly vascular nature.

Other less frequent sources of lytic expansile metastases include thyroid, melanoma andphaeochromocytoma.

Question 15

@# 13) A ‘fallen fragment’ seen within a lytic bone lesion is most commonly associated with which of the following?

a. aneurysmal bone cyst

b. unicameral (simple) bone cyst

c. giant cell tumour

d. eosinophilic granuloma

e. chondroblastoma

Answer 15

b. unicameral (simple) bone cyst

The fallen fragment is virtually pathognomonic for a simple bone cyst. It represents a fragment from a pathological fracture through the lesion, which has fallen to lie in a dependent location in the cyst matrix.

Question 16

@#e2 (Ped) 22) A 4-year-old boy is investigated for abnormal gait, with swelling and deformity of the right lower leg. Radiographs reveal epiphyseal irregularity and multiple abnormal ossifications around the medial portions of the distal femoral, and proximal and distal tibial epiphyses of the affected leg, with normal appearances of the lateral epiphyses and the whole of the contralateral lower limb. MRI demonstrates that the ossifications lie within the epiphyseal cartilage. What is the described condition?

a. hereditary multiple exostoses

b. Trevor’s disease

c. Ollier’s disease

d. Morquio’s syndrome

e. warfarin embryopathy

Answer 16

b. Trevor’s disease

Trevor’s disease (also called dysplasia epiphysealis hemimelica) is a rare developmental bone dysplasia.

It primarily occurs in children aged 2–4 years and affects boys more commonly than girls.

It shows a preponderance for the lower limbs, most commonly affecting the knee and ankle, and demonstrates single or multiple osteocartilaginous tumours arising from epiphyses.

The lesion is characteristically hemimelic, involving either the medial (two-thirds of cases) or lateral aspect of the ossification centres. Cases can be classified as localized, classic or generalized.

Question 17

@#e2 53) Of the following subtypes of osteosarcoma, which is associated with the most favourable 5-year survival?

a. multicentric

b. periosteal

c. paraosteal

d. telangiectatic

e. soft-tissue

Answer 17

c. paraosteal

Osteosarcoma is the second most common primary malignancy of bone after multiple myeloma, accounting for 15% of all primary bone tumours. It usually affects those aged 10–30.

Ninety-five per cent are of the primary osseous type and, of these, paraosteal osteosarcoma has the most favourable 5-year survival rate of 80%.

Other osteosarcomas of the primary osseous type include periosteal (5-year survival rate 50%) and telangiectatic (less than 20%).

Multicentric refers to synchronous osteoblastic osteosarcomas at multiple sites. It occurs exclusively in children aged 5–10, and carries an extremely poor prognosis.

The soft-tissue type is rare, representing only 1.2% of all soft-tissue tumours. These lesions are primary soft-tissue tumours with no attachment to bone. Death occurs within 3 years in the majority of cases, tumour size being the major predictor of outcome.

Question 18

@# 54) A 30-year-old woman undergoes plain radiographic imaging of the hand for a palpable, painful hard lump on the dorsum. Plain radiographs show a well-defined bony mass applied closely to the diaphysis of the second metacarpal. CT shows a wide-based pedunculated lesion with a perpendicular orientation to the diaphysis, no cartilage cap and a matrix of mature trabeculated bone. What is the most likely diagnosis?

a. osteochondroma

b. multiple osteocartilaginous exostoses

c. bizarre paraosteal osteochondromatous proliferation

d. Codman’s tumour

e. dysplasia epiphysealis hemimelica

Answer 18

c. bizarre paraosteal osteochondromatous proliferation

Bizarre paraosteal osteochondromatous proliferation (also known as Nora’s lesion) is a rare condition usually seen in adults in the third and fourth decades of life. Osteochondroma-like lesions are seen most commonly at the proximal and middle phalanges, followed by the metacarpals and metatarsals. A relationship to trauma has been suggested but not proven. Other locations that may be affected include the long bones (especially those of the upper extremity), skull and jaw. It is thought to be a similar process to that which gives rise to lesions in myositis ossificans, reactive periostitis and subungual exostosis. On plain radiographs, a well-defined bony mass is seen attached to the surface of the parent bone.

Features differentiating this from osteochondroma are the absence of angulation away from the nearby physis and a wide base.

Question 19

@#e2 A 43-year-old man is investigated for pain related to his left arm. Plain radiography demonstrates a well-defined, lytic lesion in the proximal humerus, with chondroid matrix mineralisation and a narrow zone of transition. There is deep endosteal cortical scalloping and the suggestion of bone expansion. What is the most likely diagnosis?

A Chondroblastoma

B Chondroma

C Chondromyxofibroma

D Chondrosarcoma

E Osteochondroma

Answer 19

D Chondrosarcoma

Question 20

@#e QUESTION 36 An 80-year-old man undergoes skeletal scintigraphy for multifocal skeletal pain, malaise and weight loss. The scintigram shows diffusely increased activity throughout the skeleton, with absent renal activity. What is the most likely diagnosis?

A Metastatic bladder cancer

B Metastatic colon cancer

C Metastatic gastric cancer

D Metastatic lung cancer

E Metastatic prostate cancer

Answer 20

E Metastatic prostate cancer

Question 21

@#e QUESTION 55
An incidental finding on plain film is a 2-cm lucency within the diaphysis of the right humerus, which exhibits chondroid calcification. Which clinical or radiological feature would favour a diagnosis of chondrosarcoma rather than enchondroma?

A Age less than 20 years

B Circular, curvilinear or nodular calcific densities

C Periosteal reaction

D Slow growth

E Well-defined round or elliptical margin

Answer 21

C Periosteal reaction

Outside the hands and feet, chondrosarcoma is five times more common than enchondroma.

Question 22

@#e 23. Features of diaphyseal aclasia (hereditary multiple exostosis) include: (T/F)

(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 22

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 23

@# 21. Which of the following is associated with anteromedial ankle impingement syndrome?

A. Usually occurs from eversion injury only

B. Well-defined signal intensity on T1 and T2 in the deep deltoid ligament related to scarring

C. Large corticated ossicles are seen

D. Lateral displacement of the tibialis posterior tendon

E. Post-traumatic synovitis

Answer 23

E. Post-traumatic synovitis

Anteromedial ankle impingement syndrome was previously thought to be from eversion injury but recent studies are showing inversion is the causative injury.

There is associated amporphous SI in ATTL (Anterior tibiotalar ligament) with heterotopic bone formation and small corticated ossicles.

Post-traumatic synovitis and fibrosis are recognised.

The tibialis posterior tendon may be displaced medially.

Question 24

@# 85) Radiographic arthrography of the shoulder with injection of contrast into the glenohumeral joint is performed for a painful joint with a globally reduced range of movement. Which single finding is most likely to indicate a diagnosis of adhesive capsulitis?

a. pain on injection of contrast

b. small axillary recess

c. contrast tracking along the subscapularis muscle

d. contrast in the subacromial space

e. obliteration of the subcoracoid fat

Answer 24

b. small axillary recess

Adhesive capsulitis or frozen shoulder is clinically characterized by restriction of both active and passive elevation and external rotation.

Patients are commonly 40–70 years old and predominantly female. It may be idiopathic, preceded by trauma, or associated with diabetes mellitus or other conditions.

Patients have been shown to have a significantly thickened coracohumeral ligament and joint capsule, and an axillary recess significantly reduced in volume.

Obliteration of the fat triangle between the coracohumeral ligament and the coracoid process is specific when seen on MR arthrography.

Treatment options include physiotherapy, intra-articular corticosteroid injection, manipulation under anaesthetic and surgical capsulotomy.

Question 25

@# 39. A 72 year old woman presents to her GP with pain in her right shoulder which is worse on movement. Plain films of the right shoulder show loss of subacromial space and superior subluxation of the humeral head. She is referred for an ultrasound with a suspected supraspinatus tear. Which is the best position of the arm for visualization of the free edge of the supraspinatous tendon?

a. Adduction and internal rotation

b. Abduction and internal rotation

c. Adduction and external rotation

d. Abduction and external rotation

e. Flexion and internal rotation

Answer 25

39. a. Adduction and internal rotation

The best position for visualising the supraspinatous tendon is with the patient’s arm in adduction and internal rotation. Often the patient may be asked to place the back of their hand onto their back, or alternatively asking them to simulate putting the hand into the back pocket of their trousers. The most medial part of the tendon when imaged transversely is the free edge – this is where the majority of supraspinatous tears occur.

Question 26

@#e QUESTION 25
A 28-year-old tennis player undergoes a MR arthrogram to investigate recurrent right shoulder instability following a previous glenohumeral dislocation. The MRI reveals a tear of the anterosuperior labrum, closely related to the insertion of the biceps tendon. How are these appearances best described?

A Anterior labral tear

B Bankart lesion

C Hill-Sachs lesion

D Reverse Hill-Sachs lesion

E Superior labrum from anterior to posterior (SLAP) lesion

Answer 26

E Superior labrum from anterior to posterior (SLAP) lesion

Question 27

@#e A young man undergoes an MRI of the right knee due to clinical suspicion of an acute rupture of the ACL. The ACL is indistinct, and cannot be visualised in either the coronal or sagittal plane. Which additional features would be supportive of a diagnosis of ACL rupture?

A Bunching up of the PCL

B Oedema within the medial collateral ligament

C Posterior translation of the femur on the tibial condyles

D Straightening of the patellar ligament

E Tear of the medial meniscus

Answer 27

A Bunching up of the PCL

Question 28

@#e QUESTION 69
A 40-year-old tennis player undergoes an MRl following a 3-month history of left ankle pain. The Achilles tendon has a convex anterior margin and exhibits a small linear area of increased signal within the tendon on T2- and T2*-weighted images. What is the most likely diagnosis?

A Achilles paratendonitis

B Achilles tendinosis

C Achilles tendinosis with complete tear

D Achilles tendinosis with cystic degeneration

E Achilles tendinosis with partial tear

Answer 28

E Achilles tendinosis with partial tear

Question 29

@# 69) Plain radiographs of the knees are performed in a teenage girl with growth retardation and painful, deformed lower limbs. Which radiographic finding would suggest a diagnosis of scurvy rather than rickets?

a. pathological fractures

b. bowing deformity

c. widened growth plate

d. frayed metaphysis

e. sclerotic epiphyseal rim

Answer 29

e. sclerotic epiphyseal rim

Rickets is a deficiency of vitamin D in a child that results in osteomalacia of the immature skeleton.

Scurvy is a deficiency of vitamin C and is a disorder of collagen synthesis that can occur in children or adults.

Pathological fractures may be seen in both conditions.

Ground-glass osteoporosis is characteristic of scurvy, with other features including

a sclerotic line in the metaphyseal zone of preparatory calcification (white line of Frankel),

a radiolucent zone immediately to the diaphyseal side of the white line (Trummerfeld’s zone),

corner fractures (Parke’s corner sign)

and a sclerotic ring around the epiphysis (Wimberger’s sign).

In addition, bleeding diathesis is seen in scurvy; therefore, subperiosteal haematoma and haemarthrosis are also features.

Question 30

@#e2 87) On plain radiographs of the long bones or the spine, which of the following is not a recognized cause of a ‘bone within a bone’ appearance?

a. infant physiology

b. sickle cell anaemia

c. nutritional disturbance

d. renal osteodystrophy

e. metastatic disease

Answer 30

d. renal osteodystrophy

‘Bone within a bone’ is a term used to describe a radiographic appearance in which one bone appears to arise within another. It can be a physiological finding in a neonate or infant due to new bone formation. Pathological conditions that can cause the appearance include periosteal new bone formation, cortical splitting, subcortical osteopenia, altered bone growth, impairment of osteoclastic activity, altered bone metabolism, crystal deposition, and iatrogenic and technical radiological factors. It is not a feature of renal osteodystrophy but is seen in hypervitaminosis D and in healing rickets.

Question 31

@#e2 4 .A stress fracture in which of the following areas would be most indicative of a pseudofracture (Looser’s zone) of osteomalacia?

(a) Axillary margin of the scapula

(b) Distal 1/3 ulna

(c) Greater trochanter of the femur

(d) Lateral femoral neck

(e) Proximal 1/3 radius

Answer 31

(a) Axillary margin of the scapula

Pseudofractures (Looser’s zones) are insufficiency stress fractures with poor healing due to mineral deficiency. These are classically associated with osteomalacia, but can also be due to Paget’s disease, osteogenesis imperfecta, or fibrous dysplasia. The fractures are typically bilateral and symmetrical and are at right angles to the cortical margin. Other common locations include distal 1/3 radius, proximal 1/3 ulna, lesser trochanter, medial femoral neck, ischial tuberosity, clavicle, long bones of the feet and hands.

Question 32

@#e2 72 A 56-year-old woman is found to have uniform osteopaenia, cortical thinning, acetabular protrusion, indistinct trabeculae and pseudofractures involving the femoral necks on a pelvic radiograph. Which of the following is least likely to cause these appearances is?

(a) Paraneoplastic syndrome

(b) Biliary disease

(c) Phenobarbitone

(d) Dietary phosphorous deficiency

(e) Renal tubular acidosis

Answer 32

(a) Paraneoplastic syndrome

These are the classic radiographic findings of osteomalacia. Other causes relate to interference with vitamin D metabolism such as previous partial gastrectomy, or decreased calcium deposition in bone such as in bisphosphonate treatment in Paget’s disease.

Question 33

@#e QUEESTION 30
An asymptomatic 65-year-old woman on long-term steroids for rheumatoid disease undergoes dual energy X-ray absorptiometry (DX.A). Her Z score is -2 and her T score is -2.7. What is the WHO definition of osteoporosis?

A T score less than -1

B T score less than -2.5

C Z score less than

D Z score less than -2.5

E Mean of T and Z score less than -2

Answer 33

B T score less than -2.5

density can be measured in relation to an age and sex-matched population (Z score) or in relation to a population of young adults of the same sex (T score). The WHO defines osteoporosis as a T score less than -2.5, therefore relating bone mineral density to sex-matched peak bone mass.

Question 34

@#e 25. 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) 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 34

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 35

@#e2 70 A 35 year old intravenous drug abuser presents complaining of pain in his great toe. On questioning, he has been using foot veins to inject drugs. Which of the following statements is incorrect regarding his risk of osteomyelitis?

(a) Staphylococcus aureus is the likeliest organism

(b) Initial plain radiographs may be normal

(c) Localized soft tissue swelling occurs within 2 weeks

(d) A sequestrum is not seen until at least a month after the insult

(e) Radiographs are not sensitive detectors of osteomyelitis

Answer 35

(a) Staphylococcus aureus is the likeliest organism

Pseudomonas is the commonest responsible organism in drug users.

S. aureus is the commonest responsible organism in non-diabetics.

Diabetic patients typically have multiple responsible organisms.

Plain films can be normal for up to 2 weeks.

The earliest sign is soft tissue swelling. Other signs include osteolysis, endosteal erosion, and the formation of an involucrum, followed by a sequestrum.

Question 36

@#e2 A 75-year-old diabetic man underwent a left below knee amputation 3 months ago for osteomyelitis of the distal tibia. Since then, he has experienced recurrent episodes of fever and malaise. MRI is contraindicated due to a metallic aortic valve. Which is the best investigation to exclude an occult focus of osteomyelitis?

A CT

B US

C Scintigraphy using gallium

D Scintigraphy using indium-labelled white cells

E Scintigraphy using technetium (Tc-99m) monodiphosphonate

Answer 36

E Scintigraphy using technetium (Tc-99m) monodiphosphonate

Although an indium-labelled white cell study is more specific, a bone scintigram using Tc-99m monodiphosphonate is a more sensitive test to exclude osteomyelitis.

Question 37

@#e2 29. Considering the imaging features of extraarticular Pigmented Villonodular Synovitis (PVNS):

A. Typically manifests as a soft tissue mass in 20% of cases

B. Osseous abnormalities are present in the vast majority

C. Extrinsic erosion is the most common osseous abnormality

D. Radiographs are normal in 80% of cases

E. Extensive erosions are more common in the knee

Answer 37

C. Extrinsic erosion is the most common osseous abnormality

Manifests as a soft tissue mass in 50-70% of cases, with normal radiographs in 20% and osseous abnormalities in 5-25%.

The most common osseous abnormality are extrinsic erosions which are more often present in the ankle and foot.

Question 38

@# 41 A 35 year old woman presents with gradually progressive knee pain over several years with locking of the joint. Plain radiographs show multiple round, well defined calcified loose bodies in the joint with no osteoporosis, and widening of the joint space. Which of the following is the likeliest diagnosis?

(a) Synovial osteochondromatosis

(b) Pigmented villonodular synovitis

(c) Lipoma arborescens

(d) Synovial sarcoma

(e) Osteochondritis dissecans

Answer 38

(a) Synovial osteochondromatosis

Cross sectional imaging shows a soft tissue mass of near water attenuation on CT containing calcifications, and a lobulated intraarticular mass which is isointense to muscle on T1 W and hyperintense on T2W with foci of low signal intensity.

Question 39

@#e2 QUESTION 48
A 30-year-old man complains of intermittent painful swelling of his left knee over the past year. Radiographs show several small articular erosions, whilst subsequent MRI reveals foci of low T2/T2* signal intensity within the synovium. Which is the most likely diagnosis?

A Alkaptonuria

B Calcium pyrophosphate arthropathy

C Pigmented villonodular synovitis

D Psoriatic arthropathy

E Synovial chondromatosis

Answer 39

C Pigmented villonodular synovitis

Question 40

@#e The radiograph of a 40-year-old man with a painful knee shows multiple calcified loose bodies, each of similar size, within the joint. The joint space is preserved. What diagnosis is most likely?

A Calcium pyrophosphate arthropathy

B Gout

C Pigmented villonodular synovitis

D Rheumatoid arthritis

E Synovial osteochondromatosis

Answer 40

E Synovial osteochondromatosis

Question 41

@#e QUESTION 68
A 50-year-old woman complains of painful swelling of the joints of the hands and wrists. Radiographs show evidence of an erosive arthropathy. Which radiological feature would favour a diagnosis of rheumatoid rather than psoriatic arthritis?

A Early reduction in bone mineralisation

B Erosions of the terminal tufts of the distal phalanges
C Joint ankylosis

D Pencil-in-cup deformities of the middle phalanges

E Periosteal reaction

Answer 41

A Early reduction in bone mineralisation

Juxta-articular osteopenia is one of the earliest radiographic abnormalities in rheumatoid arthritis, distinguishing it from psoriatic arthropathy, in which bone mineral density is preserved until late in the disease process.