December Quiz

 

Saint Nicholas Not Just a Fat Guy in a Red Suit

Let's see what you got for December 2020 - Answers are due Dec 10 at Midnight

1. Fibrous Dysplasia

A. Osseous neoplasia

B. Cantankerous sailor of the 1800's

C. Hamartomatous metaplasia or dysplasia with fibrous stroma, osteoid, woven bone

D. Neoplasia with fibrous stroma, osteoid, woven bone

E. Hamartomatous metaplasia or dysplasia with cortical fibroma, osteoid, woven bone

2. Fibrous Dysplasia

A. Common in the spine

B. Polyostotic FD is usually not part of a syndrome

C. Myxomas in Mazabraud Syndrome usually found near the osseous lesion in the extremity and have low T2

D. Malignant transformation to fibrosarcoma or osteosarcoma and not rare

E. Shepherd's crook deformity is a severe varus deformity of the femoral neck due to soft bone

3. NOF

A. Very common around the knee

B. Bubbly lytic lesion with sclerotic margin in the cortical metaphyseal region

C. Occurs in 30-40% of children older than 2

D. None of the above

E. All of the above

4. Superficial Fibromatoses

A. Easy to treat with local invasion and low recurrence

B. Palmar and Plantar Fibromatosis are rare in the same patient

C. Low T1 signal and low or variable T2

D. Ultrasound has little value in evaluating these lesions

E. Palmar Fibromatosis is a fibrotic band tethering tendons causing extension contractures

5. Desmoid tumor (Aggressive Fibromatosis)

A. Found in the mesentery within the abdomen and commonly found in abdominal wall an muscles of young women

B. Locally infiltrative but does not cross compartment barriers

C. In extremities, majority are in the superficial fascia

D. Commonly metastasizes.

E. Rare malignant neoplasm of infancy

6. Undifferentiated Pleomorphic Sarcoma (which of the following are true - may be 1 or more than 1)

A. Narrow range of age

B. Specific MRI appearance

C. 5 year survival is 50-60%

D. Formerly known as malignant fibrous histiocytoma

E. Lower extremity is most common 

F. Dystrophic calcifications in 15% and hemorrhage is common

7. Intraosseous Lipoma

A. Most frequent bone is the calcaneus

B. Sclerotic margin is common and may have central fat necrosis

C. Cockade sign is not commonly seen in these lesions

D. Majority are found in the spine

E. Commonly breaks through the cortex

8. Soft tissue Lipoma (which are true - could be 1 or more than 1)

A. Irregular enhancing septations >2 mm in thickness

B. Soft tissue nodules

C. No enhancement

D. If lipoma entraps muscle fibers, the entrapped muscle fibers enhance

E. Lipoblastomas are typically 50 or older

9. Hemangioma (which are false - could be 1 or more than 1)

A. Osseous cavernous hemangiomas are found in vertebral bodies, skull, and facial bones

B. In the spine, there can be mild expansion and even a soft tissue mass which can cause neurologic symptoms by invasion

C. Skull lesions when have radiating sunburst pattern is considered pathognomonic

D. Atypical hemangiomas have bright T1 and T2 

E. Soft tissue lesions usually have no fat or phleboliths

10. What is Gorham Disease?

11. Bobby has a painful lesion of his middle finger with temperature sensitivity. On imaging, there is a well marginated scalloped defect on the dorsal aspect of the terminal phalanx in the subungual region. What lesion, should we consider?

A. Fibrous dysplasia

B. Glomus Tumor

C. Hemangiopericytoma

D. Hemangioma

E. Intraosseous lipoma

12. Metastatic Disease (which are true, could be 1 or more)

A. Lesser trochanter avulsion fracture in a child should be considered pathologic until proved otherwise

B. Solitary sternal lesion in a patient with breast cancer has 80% probability of being a metastatic focus

C. Cortically based metastatic lesions are most commonly caused by lung or breast (My mentor Dr. El-Khoury would say your 1st three differentials for cortically based metastatic lesions should be lung, lung, and lung; there are others n the differential though)

D. Expansile bubbly geographic solitary metastases are often caused by renal cell or thyroid

E. Most metastases have moth eaten or geographic pattern with wide zone of transition

13. Multiple Myeloma

A. Most commonly found in fatty marrow areas of the skeleton

B. Majority of cases are numerous focal, punched out lytic lesions with narrow zone of transition

C. Often greater than 5 cm in size

D. Never presents as generalized osteopenia

E. Whole Body MRI will often downgrade patients

14. Ewing Sarcoma (Which is false)

A. Small round cell tumor with chromosome 11;22 translocation

B. Most occur between 5-14 years

C. Classically - permeative lesion with soft tissue mass and often calcified matrix

D. Tubular bones in younger patients and flat bones and axial skeleton in adolescents and young adults

E. Ewing can be differentiated from LCH and Osteomyelitis as Ewing has slower destructive course (6-12 weeks for Ewing versus 1-2 and 2-4 for LCH and OM respectively)

15. MRI of the wrist demonstrates an enlarged median nerve with interposed fatty tissue between nerve bundles.

A. PNST

B. Morton Neuroma

C. PVNS

D. Fibrolipomatous Hamartoma

E. Giant Cell Tumor of the Tendon Sheath

16. PVNS (which are true; could be 1 or more)

A. 80% are in the knee, followed by hip and elbow

B. Should be considered when see large subchondral cysts in a hip

C. Monarticular tumorlike proliferation of synovium in joints, bursae, tendon sheaths

D. Blooming on gradient echo imaging

E. Show little enhancement

17. Synovial Cell Sarcoma

A. 90% originate from a joint

B. Most occur in the lower extremities at or distal to knee

C. Dystrophic calcification is seen in greater than 50% of cases

D. Calcified tumors have bad prognosis

E. Old patient with juxtarticular lower extremity lesion and calcification - should suggest this diagnosis

18. What is the fascicular sign in Peripheral nerve sheath tumors?

19. If you need to have a peripheral nerve sheath tumor removed, which would you prefer to have and why - Neurofibroma, Schwannoma, Malignant peripheral nerve sheath tumor

20. Giant Cell Tumor of the Tendon Sheath is often hemorrhagic and does not enhance - True or False

Bonus: Who said: "We are what we repeatedly do. Excellence, then, is not an act, but a habit."

Read Em and Weep - The Answers to the November Quiz!

 

Great Job Dr.s Winz, Klause, and Bonney!

20 points with 1 possible extra credit point.

1. E

2. A.

3. C

4. B

5. C

6. B

7. D

8. C

9. D

10. A.

11. B

12. D

13. A

14. C

15. B

16. E

17. D

18. C.

19. B

20. A

21. X - Erasure - notice the Rick Roll as part of the link. As one of the respondents also noted - x marks the spot too. But I was too dumb to realize it. 

Reading December 2020!

 

Hey everyone - hope you're ready for a new reading list!

MSK Requisites - 33, 34, 35, 36

Don't forget to to take the November quiz!

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