EVMS Quiz November 2020

 Unofficial EVMS Reading Quiz Part 1

for 2020-2021

Everyone - Welcome Back! It has obviously been a crazy year for myself and everyone. But we are going to resume everyone's favorite monthly radiology reading quiz! Answers are due 11/07/2020 by Midnight!

1. The most important imaging in musculoskeletal tumors includes:

1. PET-CT

2. Radiograph and MRI

3. MRI

4. CT and NM MDP scan

5. The Radiograph

2. In the setting of osseous malignancy, secondary malignancy refers to:

1. A malignant transformation of a benign lesion

2. A metastatic lesion

3. Second primary lesion

4. Recurrent lesion

5. Osteoblastoma

3. The _____ relies heavily on the input of the radiologist and orthopedic oncologist

1. Pediatrician

2. Radiation oncologist

3. Pathologist

4. General surgeon

5. Plastic surgeon

4. Describing a lesion as aggressive:

1. Always means malignant

2. Refers to local behavior of tumor

3. Describes a Type I lesion

4. Means there are skip lesions

5. Describes Type 3 lesion always

5. Endosteal Scalloping:

1. Always malignant

2. Wide zone of transition margin of destruction of the outer table

3. Sharply marginated destruction of inner margin of cortical bone by medullary tumor

4. Seen only in cortically based lesions

5. Always benign

6. Tumor Margin/Pattern of Destruction:

1. Margin decided by most frequent type of margin

2. Type 2 lesion has a moth eaten appearance.

3. Lytic lesion without a sclerotic rim and wide zone of transition = Type 1B lesion

4. Type 1 lesions are always benign

5. Zone of transition has no bearing on determining Type 1 lesions

7. Bone Lesions

1. Age has no impact on the differential diagnosis

2. Periostitis is only seen in bone tumors

3. 50% of cortical bone must be destroyed before lytic lesions can be seen on x-ray

4. CT can be used to determine type of calcification if unsure on radiograph

5. Cortical breakthrough is often a benign finding

8. Differential diagnosis for low on T2 include all the following except:

1. PVNS
2. Air
3. Purulent material
4. Antibiotic laden methacrylate beads
5. Amyloidosis

9. 15 yo male who presents with right lower leg pain predominately at night and relieved by aspirin. Xray shows a lesion in the tibia - what is the best description of the likely lesion:

1. Type 3 lesion 

2. Central lucency measuring 2.5 cm with mild peripheral sclerosis

3. Type 2 lesion with sunburst periostitis. 

4. Central lucency that is 5 mm with dense reactive sclerosis in the cortex

5. Central lucency that is 5 mm with dense reactive sclerosis in the medullary space.

10. By imaging, it is very difficult to differentiate between what of the following lesions:

1. Adamantinoma, Cortical Fibrous Dysplasia, Osteofibrous Dysplasia

2. Adamantinoma, Medullary Fibrous Dysplasia, Osteofibrous Dysplasia

3. Adamantinoma, Osteoid Osteoma, Osteofibrous Dysplasia

4. Adamantinoma, Osteoid Osteoma, Cortical Fibrous Dysplasia

5. Osteosarcoma, Ewing Sarcoma, Enostosis

11. Gardner Syndrome commonly has what:

1. Numerous bone islands

2. Osteoma(s)

3. Ewing Sarcoma

4. Osteofibrous Dysplasia

12. A patient with symptomatic scoliosis is noted to have a lytic lesion on x-ray in the spine and there is “flare” phenomenon on MRI. What lesion would you consider:

1. Enostosis

2. Osteoid Osteoma

3. Hamartoma

4. Osteoblastoma

5. Adamantinoma

13. Osteosarcoma

1. X-ray defines the lesion, MRI decides surgical treatment and looks for same bone mets, CT of chest for pulmonary mets, NM bone scan for distant bone mets

2. Periosteal osteosarcoma is more frequent than parosteal osteosarcoma

3. Secondary osteosarcoma has better prognosis than primary

4. Myositis ossificans is centrally dense an peripherally less mature and less dense as a zoning phenomenon

5. Radiation is the best treatment

14. Parosteal osteosarcoma

1. Most frequently seen in children under 10

2. Intramedullary communication is commonly seen on plain film but hard to visualize on MRI

3. Slow growing

4. Terrible prognosis

5. Uncommon to wrap around the bone with a cleft

15. Telangiectatic Osteosarcoma is diagnosed on biopsy. What helped differentiate osteosarcoma from ABC or Giant cell tumor?

1. Fluid-fluid levels

2. Nodular soft tissue enhancement on MRI

3. Expansile lesion

4. The patient is 30

5. Pulmonary metastases

16. A secondary osteosarcoma is found in a patient with 1% chance of having this lesion but represents a large percentage of all patients who have secondary osteosarcoma? What is the primary process?

1. Osteoblastoma

2. Chondrosarcoma

3. Chondroblastoma

4. Chordoma

5. Pagets

17. All are true about Osteochondroma except

1. Bursa formation can be a painful complication

2. Aneurysmal formation of arteries can be seen typically after growth ends

3. Cartilage cap in adults should be less than 1 cm

4. Cortex of the osteochondroma has continuity with the medullary space of the bone of origin

5. MHE is autosomal dominant

18. Enchondromas

1. Chondrosarcoma is a common malignant transformation for enchondromas of the finger

2. Pathologic fractures are commonly treated with curettage

3. It is very difficult to differentiate enchondroma from a low grade chondrosarcoma solely by imaging

4. Commonly found in the axial skeleton of water nymphs throwing swords to young Arthurian knights

5. Ollier Disease has phleboliths

19. 15yo child with shoulder pain. Xray of a chondroblastoma:

1. Diaphyseal lesion with sclerotic margin 

2. Epiphyseal with sclerotic margin and MRI may appear more aggressive than the x-ray appearance

3. Metaphyseal lesion with very aggressive periosteal reaction and commonly metastasizes at diagnosis

4. Epiphyseal lesion treated with wide excision

5. Epiphyseal lesion with spiculated but geographic margin 

20. 13 yo boy with epiphyseal lesion which is lytic with geographic margin. On MRI, fluid-fluid levels are noted.

1. Could represent a chondroblastoma with ABC

2. Enchondroma until proven otherwise.

3. Juxtacortical chondroma

4. Trevor Disease

Bonus Question: Which of the following artists have I not seen in concert?

A. New Order

Z. Depeche Mode

3. David Lee Roth

H. Tesla

X. Erasure