VIQ - Musculoskeletal and Trauma - Warm Up

Question 1

@# 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 1

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 2

@# 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 2

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 3

@# 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 3

12.

a) True

b) True

c) True

d) True

e) False

Question 4

@# 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 4

13.

a) True

b) False - CT guidance is used

c) True - large lesions are treated with cluster electrodes

d) True

e) True

Question 5

@# 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 5

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 6

@# 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 6

23.

a) True

b) True

c) True

d) True

e) False

Question 7

@# 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 7

25.

a) False

b) False

c) False

d) False

e) False

Question 8

@# 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 8

29.

a) False

b) False - no calcification

c) False - left >right

d) False - middle finger

e) True

Question 9

@# 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 9

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 10

@# 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 10

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 11

@# 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 11

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