The ANSWERS! for July Quiz

Thank you very much for participating. If you played, you are a winner in my book. Congratulations to Dr. Andrews for the top score and Drs Dey, Aggarwal and Bonney for a tie at 2nd place! There will be multiple more chances to take away the lead in the coming months. Below are the answers with some explanation.

1. D. Per the article on uncommon manifestations of intervertebral disc pathologic conditions -  "Massive lumbar herniations have been defined by some authors as lumbar disk herniations occupying greater than 50% of the spinal canal at axial imaging... the findings in the literature suggest that size alone is not a rational surgical indication, particularly if the symptoms are limited to sciatica or are improving... massive disk herniations have been shown to decrease in size to a greater degree than smaller herniations" 

2. B. Per the above article - "A discal cyst, also referred to as a disk cyst, is a rare condition defined as the communication of an intraspinal extradural cyst with an intervertebral disk"

3. C. Per the above article - These giant thoracic disk herniations are often densely calcified (∼95%) and tend to erode the dura...For symptomatic thoracic disk herniations, women in the 3rd to 5th decades are most often affected...Two-thirds of symptomatic thoracic disk herniations that require surgery are located between T8 and T11

4. D. Per the above article - These giant thoracic disk herniations are often densely calcified (∼95%) and tend to erode the dura...Formation of an intradural disk herniation requires a perforation of the anulus, the posterior longitudinal ligament, and the dura...A calcified disk remnant or osteophytic spur can cause a dural defect, the resultant CSF leak, and the clinical manifestations of CSF hypotension

5. B. Per the article Imaging Characteristics of Bone Graft Materials - Osteoinduction is the process through which pluripotential mesenchymal cells are recruited from the surrounding tissue and differentiate into osteoblasts. 

6. C. Per the above article - Allografts (cadaveric bone transplants) are popular substitutes for autografts but provide mainly an osteoconductive matrix that lacks osteoinductive properties

7. A. Per the above article - In the immediate postoperative period, allo-grafts have signal hypointensity on both T1- and T2-weighted MR images. 

8. A. Per the above article - Graft combinations are often used to obtain both osteoconductive and osteoinductive properties. Allografts may be mixed with autologous platelet-rich plasma, a concentration of human platelets in a small volume of plasma, which encourages osteoinduction by supplying fundamental growth proteins that are secreted by the platelets and that initiate wound healing.

9. A. Per the article - Acute Shoulder Trauma: What the Surgeon Wants to Know - All fractures not meeting the numeric criteria for displacement or angulation are classified as one-part fractures, regardless of the actual number of fracture fragments or the degree of comminution. 

10. D. Per the above article - the risk increases further when the spur of bone derived from the medial metaphyseal cortex that remains attached to the anatomic head (the medial metaphyseal segment) is shorter than 8 mm or displaced more than 2 mm, implying that the medial periosteum is disrupted. The combination of anatomic neck fracture with a short and displaced medial metaphyseal segment yields a positive predictive value of 97% for ischemia

11. C. Per the above article - concomitant rotator cuff tears are more common in elderly individuals... Although rotator cuff tear is less common in young patients...

12. C.  Per the above article - Type VI fractures are often not reconstructible and are treated nonsurgically to preserve the remaining soft-tissue supports.

Bonus: C. This is tricky - but the key is "according to no one but the test giver". D is automatically out as it is not about NYC at all. A and B are commonly found in many people's lists of best songs about NY - google and see. But I can't find C on any of these lists including wikipedia's rather exhaustive list of songs about NY. Balloon man makes references to 6th Ave, Bryant Park, jumping of the Empire State etc. I tried to help by putting a rick roll in the New York New York link.

EVMS Journal Contest Quiz July 2018

Inaugural Quiz - If you are an EVMS radiology resident - email me your answers. If you are not and want to play to be the best nonresident - DM me at twitter @robsradiology

1. At the L4-L5 level, there is a disc herniation which involves greater than 50% of the canal on axial imaging...

a. OMG... - Call the Neurosurgeon stat and tell him/her to get the scalpel ready
b. Get the priest on the line, this is horrible
c. Whatever, surgery tomorrow, next week, whenever - it is ok so long it is eventually cut out
d. calm down padawan, it is okay, the vast majority will shrink on their own

2. If I say "there is an intraspinal extradural cyst which communicates with an intervertebral disc, I am describing a...

a. Synovial cyst
b. Discal cyst
c. Paraovarian cyst
d. Epidermoid cyst

3. Symptomatic Thoracic Disc

a. Commonly found in 65 yo men
b. Most commonly seen at T2-T3 or T3-T4
c. Giant disc herniations are commonly calcified
d. Cord infarcts are common.

4. Which of these may have a dural tear:

a. Intradural disc herniation
b. Giant calcified thoracic disc
c. Disc osseous spicule
d. All of the above

5.  Process through which pluripotential mesenchymal cells are recruited from surrounding tissue and differentiate into ostoblasts

a. Osteoconduction
b. Osteoinduction
c. Osteogenesis
d. Osteosynthesis

6. Which of these is false regarding allografts

a. Balance of osteolysis and osteogenesis must be present for adequate graft incorporation
b. Can be an in vivo antibiotic delivery system
c. It has osteoinductive properties
d. Can be used for onlay graft

7. MRI obtained immediately after allograft placement is low on T1 and T2

a. Don't worry, this is a normal initial finding
b. Call the orthopedic surgeon and inform him/her that the graft will fail
c. Call the orthopedic surgeon and recommend follow up in 3 weeks
d. Tell the orthopedic surgeon that there is osteomyelitis

8. The surgeon combined the allograft with autologous platelet-rich plasma

a. This helps provide osteoconductive and osteoinductive properties
b. This provides antibiotic properties
c. This provides essential oils to the site
d. This helps provide congruity to the joint

9. There is a comminuted fracture of all four parts of the proximal humerus without displacement or angulation. How would you classify this by Neer classification:

a. 1-part
b. 2-part
c. 4-part
d. None of the above, this is actually a Wade Wilson fracture

10. This has a 97% positive predictive value for humeral head ischemia

a. Lesser tuberosity fracture with 3 cm of separation.
b. Greater tuberosity fracture with 47 degrees of angulation
c. Articular split fracture
d. Anatomical neck fracture with shorter than 8 mm medial metaphyseal segment or displacement by more than 2 mm of the attached medial metaphyseal segment

11. Anterior shoulder dislocation with torn rotator cuff is more typically seen in

a. 29 yo waitress with a single dislocation
b. 19 yo football player
c. Retired shipbuilder who fell down stairs and dislocated
d. 10 yo boy with a single dislocation.

12. Patient has a type VI glenoid fracture

a. Reverse total shoulder arthroplasty is the best option
b. Glenoid hemiarthroplasty is the best option
c. Not treated in order to preserve soft tissue supports
d. Allograft with autologous platelet rich plasma is frequently used for reconstruction.

Bonus:
Which is the best song about New York according to no one but the test giver

A. New York New York - Frank Sinatra Could it be this one?
B. Walk on the Wild Side - Lou Reed Hmmm....maybe?
C. Balloon Man - Robyn Hitchcock and the Egyptians Is it this one?
D. London Calling - The Clash Maybe it's this one

August EVMS (not official) Journal Contest Articles

Man, it is August already. We survived the sweat house of July. The second years survived their first solo call (woo!). Now on to the halcyon days of August. Don't forget to do the quiz for July. Below are the articles for August. Much like my dad bod - we are going to focus on body issues this month. So read, learn, and enjoy and prep for the forthcoming test!

Radiographics - Acute Mesenteric Ischemia

Radiographics - CT of surgically proven Blunt Bowel and Mesenteric Injury

Radiographics - Emergent and Nonemergent Nonbowel Torsion