December Quiz

December Quiz for Unofficial Journal Club

Answers are due on 2/5/2022 at midnight

1. Which acute aortic syndrome (AAS) is the most common? 

a. Acute aortic dissection (AAD). 

b. Intramural hematoma (IMH). 

c. Limited intimal tear (LIT). 

d. Penetrating atherosclerotic ulcer (PAU). 

2. Why are acute type A lesions more dangerous than type B lesions? 

a. They are about twice as common as type B lesions. 

b. They require surgery to meaningfully help the patient. 

c. They have an accelerated rate and number of potentially fatal complications. 

d. They are clinically more sudden in onset. 

3. What is the most important finding in Figure 3a? 

a. A mobile intimal flap, consistent with acute dissection. 

b. Dissection involvement of the ascending aorta. 

c. Adventitial hematoma compressing the pulmonary arteries. 

d. Aneurysmal caliber of the ascending aorta. 

4. Which AAS represents an imaging finding rather than a distinct pathologic condition? 

a. IMH. 

b. LIT. 

c. PAU. 

d. Leaking or ruptured aortic aneurysm. 

5. Why are noncontrast CT images particularly helpful in evaluating AASs? 

a. They help meet the requirement in CT before contrast-enhanced imaging can be performed. 

b. They allow the patient to practice the breath hold needed for contrast-enhanced imaging. 

c. They allow differentiation of calcified plaque from surgical material. 

d. They allow evaluation for acute hemorrhage.

6. What is the most common cause of blunt traumatic aortic injury (BTAI)? 

a. Fall from a significant height. 

b. High-velocity motor vehicle collision. 

c. Pedestrian struck by a motor vehicle. 

d. Nonaccidental trauma. 

7. What is cited as the most commonly involved site of minimal aortic injury (MAI)? 

a. Ascending aorta. 

b. Origin of the right brachiocephalic artery. 

c. Aortic isthmus. 

d. Diaphragmatic crus. 

8. What imaging modality is standard to help diagnose MAI? 

a. Chest radiography. 

b. Multidetector CT angiography. 

c. MRI. 

d. Catheter-based angiography. 

9. In figure 4d, what direct sign of MAI is present? 

a. Intimal flap. 

b. Psuedoaneurysm. 

c. Small periaortic hemorrhage. 

d. Coarctation. 

10. What type of management is currently recommended for the treatment of MAI? 

a. Minimally invasive surgical repair. 

b. Open surgical repair. 

c. Transcatheter endovascular repair (TEVAR). 

d. Nonoperative medical management.

11. What parenchymal injury with its characteristic appearance is depicted on the accompanying axial CT image? 

a. Contusion, with well-defined regions of solid pulmonary consolidation. 

b. Hematoma, with solid pulmonary consolidation that usually extends to pleural margins. 

c. Contusion, with ground-glass parenchymal attenuation with 1–3 mm of subpleural sparing. 

d. Laceration, with linear and branching parenchymal attenuation confined to individual anatomical segments. 

12. On CT images, why might pulmonary hematomas pose a diagnostic dilemma for radiologists? 

a. Chronic hematomas can be mistaken for lung malignancy. 

b. They enhance heterogeneously at arterial phase imaging. 

c. They are difficult to distinguish from pulmonary contusions. 

d. When they occur near the pulmonary hila, they are suggestive of possible pulmonary arterial injury. 

13. Why are extrapleural hematomas important for radiologists to identify correctly? 

a. They can cause local mass effect, which may result in tension physiology. 

b. They do not typically respond to chest tube placement and may require surgical evacuation. 

c. They have a high association with sternal fractures. 

d. They predispose to local pleural scar formation, which may cause breathing difficulties. 

14. Which of the following has been proposed as an explanation for the frequency of right versus left main bronchus injury? 

a. The left main bronchus is more frequently injured because it is longer than the right. 

b. The left main bronchus is more frequently injured because it is shorter than the right. 

c. The right main bronchus is more frequently injured because it is longer than the left. 

d. The right main bronchus is more frequently injured because it is shorter than the left. 

15. What percentage of cases of tracheal injury are occult at CT? 

a. 5%. 

b. 29% 

c. 54%. 

d. 92%.

16. The ____ slip extends over the dorsal aspect of the proximal phalanx to insert at the dorsal aspect of the PIP Joint

17. Mallet finger

a. results from disruption of the tendon at its insertion on the volar aspect of the distal phalanx

b. Typically treated with pinning

c. most manifest with radiographic depicted fractures

d. isolated tendon injuries are best depicted on sagittal MR images

18. Tendon lacerations

a. lacerations of the extensor mechanism often result in proximal tendon retraction

b. lacerations of the flexor tendons often result in proximal tendon retraction.

c. central slip lacerations of the extensor tendon are often diagnosed radiographically

d. the course of the flexor tendon can be divided into five anatomic zone with zone I being A1 annular pulley to flexor retinaculum

19. Pulley injuries

a. A3 is the most commonly injured pulley

b. surgical correction is recommended for A2 injuries when bowstringing extends proximal to base of the proximal phalanx

c. MR imaging in the coronal plane are best for making diagnosis

d. climber's finger occurs during powerful extension

20. What is true regarding Gamekeeper's thumb

a. Stener lesion develops in cases of UCL tear and retraction with interposition of abductor aponeurosis between the insertion and torn UCL

b. Gamekeeper thumb is an injury of the UCL usually in the proximal portion

c. Stener is commonly seen as a "yo-yo on a beach" sign

d. the absence of UCL fibers spanning the MCP joint with masslike abnormality proximal to joint requires surgery. 

Additional Question: The rules - +2 points for correct answer; -5 for wrong answer; -2 for no answer

Who was the greatest president of Robert Post's lifetime?

a. Theodore Roosevelt

b. Abraham Lincoln

c. Ronald Reagan

d. JFK

e. FDR

Pictorial Review of Finger Tendons and Some Injuries from Radiographics 2002

Pictorial Series for Review from

https://pubs.rsna.org/doi/10.1148/radiographics.22.2.g02mr11237 

November 2021-2022 Unofficial Journal Quiz

Welcome Back to the EVMS Unofficial Journal Club Quiz!

2021-2022

Quiz Results will be Due 11/3/2021 by midnight in my email.

1. The standard CT protocol for evaluation of a patient with hemoptysis should extend from the lower neck through what anatomic landmark? 

a. Aortic bifurcation. 

b. Diaphragm. 

c. Renal arteries. 

d. Celiac axis. 

2. What is the normal diameter of bronchial arteries? 

a. <0.5 mm. 

b. 0.5–2 mm. 

c. 2–3.5 mm. 

d. 3.5–5.0 mm. 

3. From what vascular supply do pseudoaneurysms causing hemoptysis most commonly arise? 

a. Nonbronchial systemic veins. 

b. Pulmonary veins. 

c. Pulmonary arterial tree. 

d. Bronchial arteries. 

4. What is the most common cause of a pseudoaneurysm? 

a. Direct invasion from tumors. 

b. Infection. 

c. Iatrogenic injury. 

d. Inflammation from vasculitis, radiation therapy, or blunt or penetrating trauma. 

5. What is the most common cause of parenchymal destruction that results in hemoptysis? 

a. Interstitial lung disease. 

b. Infarction. 

c. Tumor necrosis. 

d. Acute infectious pneumonia.

6. When using 100 kVp rather than 120 kVp at CT angiography (CTA) with iodinated intravenous contrast material, which of the following best describes attenuation? 

a. Attenuation at 100 kVp is lower than at 120 kVp. 

b. Attenuation at 100 kVp is higher than at 120 kVp. 

c. The attenuation is the same, regardless of the kilovolt peak setting used. 

d. The contrast attenuation is not depicted. 

7. Which of the following is the most common cause of acute aortic syndrome? 

a. Classic aortic dissection. 

b. Penetrating atherosclerotic ulcer (PAU). 

c. Acute intramural hematoma (IMH). 

d. Mycotic aneurysm. 

8. Which of the following entities could cause a PAU? 

a. Trauma. 

b. Infection. 

c. Ulcerated atheromatous plaque. 

d. Classic dissection. 

9. What type of dissection is depicted in Figure 26f, according to the classification by Svensson et al? 

a. Not in classification. 

b. Type 1. 

c. Type 2. 

d. Type 3. 

10. Stage 1 of the elephant trunk procedure entails performing which of the following maneuvers? 

a. Arch grafting and aortic debranching. 

b. Aortic valve replacement. 

c. Cabol procedure. 

d. Endovascular repair of descending aorta.

11. What is cited as the most common site of iatrogenic tracheobronchial injuries such as those caused by bronchoscopic procedures? 

a. Cartilaginous portion of the distal thoracic trachea. 

b. Membranous portion of the proximal thoracic trachea. 

c. Origin of the right main bronchus. 

d. Anterior cervical trachea. 

12. In Figures 8a and 8b, what imaging finding is seen after tracheostomy? 

a. Normal tracheostomy tube cuff. 

b. Normal cricothyroid membrane anatomy. 

c. Herniation of the tracheostomy cuff because of a posterior membrane stylet injury. 

d. Expected anterior cartilaginous tracheostomy defect. 

13. What are the most common sites of blunt force tracheobronchial injury? 

a. Cervical trachea and laryngotrachea. 

b. Proximal intrathoracic trachea and left bronchus. 

c. Intrathoracic mid trachea and right bronchus. 

d. Distal trachea, proximal main bronchi, and carina. 

14. What is cited as an increasingly supported type of management for a 1.5-cm laceration of the posterior membrane without esophageal herniation? 

a. Nonsurgical treatment. 

b. Surgical treatment. 

c. Physical therapy. 

d. Antibiotic regimen. 

15. What is the correct placement of an endotracheal tube cuff in patients with a tracheobronchial injury? 

a. It should never be advanced beyond the injury. 

b. Inflation of the cuff distal to the injury is usually preferable. 

c. Inflation of the cuff proximal to the injury is usually preferable. 

d. A chest drain should be inserted, but no tube should be placed.

16. The ankle fracture seen in Figure 7 involves what mechanism of injury defined in the Dias-Tachdjian classification system? 

a. Supination-inversion. 

b. Supination–external rotation. 

c. Pronation–external rotation. 

d. Supination–plantar flexion. 

17. What fracture type is classified as a transitional ankle fracture? 

a. Salter-Harris type I fracture of the distal fibula. 

b. Salter-Harris type III fracture of the medial malleolus. 

c. Juvenile Tillaux fracture. 

d. Avulsion fracture of the lateral malleolus. 

18. What lower extremity bone fracture is most commonly associated with tibiotalar dislocation in children? 

a. Calcaneal fracture. 

b. Tibial fracture. 

c. Fibular fracture. 

d. Talar fracture. 

19. Avascular necrosis, when associated with displacement or a high-energy injury mechanism, is a common complication of what fracture type? 

a. Tibial plafond fracture. 

b. Talar fracture. 

c. Calcaneal fracture. 

d. Distal phalangeal fracture. 

20. Which of the following CT findings indicates the need for a surgical treatment approach to injury of the foot and ankle? 

a. Isolated fibular fracture. 

b. Minimally (<2 mm) displaced Lisfranc injury. 

c. Extra-articular calcaneal fracture. 

d. Physeal widening of greater than 3 mm.

Answers to January Quiz

Answers to the January Quiz

Congrats to Dr. Bonney, Winz, and Klause

In the current standings - there is a 3 way tie!

1. D

2. B

3. C

4. B

5. Beveled Edge on edge and concentric lytic rings en face; Severely compressed vertebral body with intact posterior elements

6. 50% decrease in the product of the 2 largest diameters is considered a good response

7.  X-ray - initial diagnostic tool. Indicates aggressiveness and at least hints to type of tumor. Nuclear Medicine - helps determine if monostotic, polyostotic, metasatatic. Chest CT - useful for lung metastases. MRI - helps define extent of lesion within the bone and soft tissues and whether there are synchronous lesions in the bone. Biopsy - Pathology of aggressive lesions. 

8. 80% of sarcomas recur within 2 years of primary tx

9. Female

10. Less than 55. 

11. Ossification

12. Rigid flatfoot and associated with myelomeningocele

13. Hindfoot equinuus, hindfoot varus, forefoot varus

14. Calcaneonavicular and talocalcaneal

15. Multiple coalitions in one hindfoot. 

Bonus - Cheap Trick - from Rockford, IL. The Rockford Peaches were the team in League of Their Own. 

January Quiz

 

January 2021 EVM Unofficial Reading Quiz

Answers due 1/20/2021 at Midnight

1. I see a lytic lesion with a linear ossific fragment in the dependent portion of the lesion.

a. This is pathognomonic for an ABC

b. The finding is due to malignant transformation. 

c. This is pathognomonic for a GCT

d. This finding could lead to spontaneous healing

2. Eccentric lytic tibial lesion with 1B margin in the metaphysis which abuts the articular surface in a 30 yo patient. 

a. Slight male predominance.

b. If found in the sacrum can cross the SI joint. 

c. Low on T1 and Bright T2 with solid enhancement

d. No recurrence or metastatic potential.

3. Eccentric lesion with fluid-fluid levels that is expansile. Surgery revealed blood filled cystic cavities with connective tissue and septa.

a. If found in the spine - it is always in the vertebral body

b. Never a primary lesion

c. Common diseases associated with this process is GCT, chondroblastoma, and fibrous dysplasia

d. Most commonly found in the metacarpals

4. Patient presents with rectal bleeding. On CT, there is a lesion in the sacrum with calcifications. 

a. Nuclear Medicine bone scan is great at showing extent of disease. 

b. Can cross the SI joint. 

c. Women more common than men

d. wicked fast at growing. 

5. What is the historical description of LCH's involvement with the skull on edge? What is a vertebra plana?

6. What decrease in tumor size is associated with a good response?

7. What is the role of the following in bone tumors - 

X-ray?

NM?

Chest CT?

MRI?

Biopsy?

8. When do most bone tumors recur?

9. What gender typically gets DDH?

10. What is the alpha angle on ultrasound that is associated with DDH?

11. What limits ultrasound's use beyond 3 months?

12. How does congenital vertical talus present and what developmental anomaly is it associated?

13. What are the 3 radiographic findings to clubfoot?

14. What are the 2 most common tarsal coalitions?

15. What is the significance of a "ball and socket ankle"?

Bonus: If you were on the team from "A League of Their Own" and you never moved and lived to see the 1980s - what band would you be obligated to support as they were the hometown heroes?

Answers to December Quiz

Merry Christmas!

Congrats to Dr. Winz, Bonney, and Klause!

All questions and bonus worth 1 point (20 points plus 1 bonus point for total of 21 possible points)

1. C 

2. E

3. E

4. C

5. A

6. D, E, F

7. B

8. C

9. B, D, E

10. Gorham Disease - multicentric angiomatosis with regional dissolution of bone, which is rapid and severely destructive, spreading contiguously across joints

11. B

12. B, C, D, E

13. B

14. C

15. D

16. A, B, C, D

17. B

18. Fascicular sign - enlarged nerve fibers are seen in cross section as multiple small ringlike structures

19. Schwannoma - they can peel the lesion from the nerve

20. False

Bonus: Will Durant - It is commonly misquoted as Aristotle but it was actually a paraphrase of something Aristotle wrote about. 

Reading for January 2021

Final Readings for MSK Requisites EVER with the January Quiz ✌💪😁- Will Return to Journal Articles for February 2021! I know you are stoked!

Chapters 37, 38, 44, 45, and 47