September Quiz Answers!

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Quiz based on Musculoskeletal Imaging Requisites Chapters 6, 7, and 8

Elbow
1. Line drawn through the center of the radial shaft should bisect the capitellum on any view is known as the ... Radiocapitellar line (1 pt)

2. If the anterior humeral line passes through the anterior capitellum, you should be concerned for? Distal humeral fracture (1 pt)

3. This is one of the more common sites of rheumatoid nodules? Extensor surface of the elbow and proximal forearm (1 pt)

4. Seeing this on a lateral radiograph is abnormal?

a. Anterior fat pad
b. Spinnaker sail sign
c. Posterior fat pad
d. All the above
e. b and c (1 pt)

5. The second most common pediatric elbow fracture

a. Supracondylar
b. Radial head
c. Lateral condylar (1 pt)
d. Medial epicondylar

6. Medial epicondyle entrapment is when the medial epicondylar fragment is between ___ and ___
    Trochlea and ulna (2 pt)

7. Why is critical to diagnose a medial epicondyle entrapment? Entrapped medial epicondyle will fuse to the ulna within a few weeks resulting in permanent disability (1 pt)

8. Fracture of this is the most common bone fractured in the elbow of adults? What are the 2 most common types of this fracture? Proximal radius - 1. Single longitudinal fractue in proxmal articular surface of the radial head; 2. Impaction of an intact radial head into the radial neck (3 points)

9. Essex-Lopresti fracture is? Comminuted fracture of head and neck with dislocation of the DRUJ and tear of the interosseous ligament (1 pt)

10. This epicondylitis is commonly found in baseball pitchers and tennis players? Medial Epicondylitis. This epicondylitis is found in carpenters and golfers? Lateral Epicondylitis (2 pt total)

11. The distal biceps has a tendon and an aponeurosis. The biceps aponeurosis is also referred to by what other name? Lacertus Fibrosus (1 pt)

12. What is Panner disease? Osteochondritis dissecans of the capitellum. (1 pt)

13. What is Galeazzi fracture? Radial shaft fracture and dislocation of the distal ulna. Monteggia? Dislocation of the radial head with fracture of the proximal ulnar shaft.  (2 pt total)

18

Wrist
14. Kienbock disease is associated with what type of ulnar variance? Ulnar minus (1 pt)

15. Under what conditions can the extensor carpi ulnaris sheath communicate with the DRUJ? Trauma with capsular injury or rheumatoid arthritis (1 pt)

16. What are the common wrist and distal forearm fracture patterns based on age? 4-10 - buckle fractures of distal ulna and radius; 11-16 - distal radius SH II and dorsal displacement; 17-40 - scaphoid +/- triquetrum; >40 Colles fracture (4 pt)

17. What are the components of the TFCC? TFC, dorsal and volar radioulnar ligaments, ECU, ulnotriquetral an ulnolunate ligaments, meniscal homolgue (5 pt)

18. There is ulnar impaction (ulnar abutment) syndrome an ulnar impingement synrome. What are they and how can treatment of one lead to the other? Ulnar impaction - impingement of distal lateral ulna against the TFCC and proximal carpal row. Ulnar impingement - impaction of markedly shortened ulna against radial metaphysis. Shortening of the ulna for ulnar impaction could theoretically lead to ulnar impingement (3 pt)

19. Where does the scaphoid develop avascular necrosis? In the proimal pole. Why does this happen anatomically? Blood supply to proximal pole enters at the scaphoid waist and courses proximally. Since fracture is commonly at the waist it can negatively affect the blood supply (2 pt total)

20. Stress fracture of this structure is found in carpenters and golfers: Hook of the hamate (1 pt)

21. What was not clearly communicated in the book is that in the setting of an arc of Gilula (pbuh) injury the fractures have Trans- as the prefix and if there is dislocation state whether it is perilunate or lunate. So if you see a scaphoid and triquetral fracture with volarly tilted lunate that maintains alignment with the distal forearm. How would you describe this injury? Transcaphoid, transtriquetral perilunate fracture-dislocation (1 pt)

22. What portion of the scapholunate ligament is most important? Dorsal portion. For the lunotriquetral? Volar portion (2 pt)

23. Pathognomonic scapholunate dissociation can be called when you notice what on a PA radiograph? Distance between the scaphoid and lunate of 4 mm or more (1 pt)

24. End stage degenerative changes in the proximal wrist due to scapholunate dissociation is called what? Scapholunate advanced collapse (SLAC wrist) Similar finding associated with scaphoid nonunion is called what? Scaphoid nonunion advanced collapse (2 pt)

25. What tendons are involved in de Quervain disease? Extensor pollicis brevis and abductor pollicis longus (1 pt)

26. Symptomatic chondromalacia and subchonral edema in the proximal hamate pole and occasionally the adjacent hamate is seen with what type of hamate? Type II hamate (1 pt)

25

Hand
27. Why is it important to diagnose a Bennett fracture early? The majority of the 1st metacarpal will sublux or dislocate dorsally (1 pt)

28. Gamekeeper's thumb is associated with what injury? Ulnar collateral ligament injury (1 pt)

29. What is a Stener lesion? In the setting of complete tear of the UCL, the thumb adductor tendon aponeurosis is interposed between the UCL and 1st metacarpal (1 pt)

30. What is a volar plate fracture? Avulsion fracture of proximal volar aspect of the middle phalanx (1 pt)

31. What is a jersey finger? Avulsion of the flexor digitorum profundus tendon from insertion to volar base of the distal phalanx (1 pt)

32. What is a mallet finger? Dorsal base of the distal phalanx fracture due to avulsion of the common extensor tendon (1 pt)

33. What happens in a flexor annular pulley injury? Bowstring deformity of the flexor tendon in relation to the phalanges during flexion (1 pt)

7
7 + 18 +25 = 50
Total points possible 50

Bonus - The real answer is all or none - whichever you prefer.  As a "Gen X-er", I find the whole everyone in a 20 year span to be all in one type of mindset or anything as a little annoying. My parents are Boomers but they aren't anything like traditional boomers. I never felt that the media portrayal of my generation to make sense and now we are simply forgotten which is fine. There may be some generalities or stereotypes but we are all individuals and different. I am Hayekian in my philosophy - no simple explanation can explain all things. Occam's razor works well for diseases but not for generational descriptors as a predictor of a single individual. I enjoyed your answers.