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

November Reading

Hey Everyone - Welcome back to EVMS Unofficial Reading Quiz 2020-2021

Reading for November will be - 

MSK REQUISITES - Ch 29, 30, 31, 32

The Quiz will drop on November 1!

March 2020 Answers

Sorry for the delay in the answers, so I will give you some memes to say I am sorry.

Great Job Dr. Dey, Bonney, and Lussier!

1. 30-50% (1 Point)

2. Spine, hip, proximal humerus, and distal forearm. (1 pt)

3. Mediated dysfunction of the sympathetic nervous system. (1 pt)

4. Stage I (osteolytic), II (mixed lytic and blastic), III (sclerotic) - (1 pt)

5. Skull, spine, pelvis, and femur (1 pt)

6. Osteosarcoma; 1%; Skull - Giant Cell Tumor (3 Pt)

7. 25 (1 pt)

8. C (1 pt)

9. Because normal red marrow contains a mixture of fat and cellular elements, it will show signal loss on the opposed phase of in and out of phase MRI, but a tumor will not. (1 pt)

10. Sinus tract - soft tissue channel between bone and skin (1 pt)

11. Cloaca - cortical and periosteal defect (1 Pt)

12. Sorry bad question - Osteomyelitis classically has uptake on all 3 phases of a bone scan. (1 pt)

13. Lacy lytic lesions in middle or distal phalanges (1 pt)

14. Knee, elbow, ankle (1 pt)

15. Epiphyseal overgrowth leading to flared metaphyses and enlarged epiphyses (1 pt). Can also lead to early physeal fusion and skeletal shortening. 

16. H-shaped vertebra; Osteonecrosis (2 pts)

17. Leukemic lines - lucent transverse metaphyseal bands adjacent the physis (likely due to distrubed endochondral ossification) (1 pt)

20 pts total possible 

March 2020 EVMS Unofficial Quiz

1. What percentage of women older than 60 have evidence of significant bone loss?

2. What are the most common sites of fracture in the setting of osteoporosis?

3. What is the thought to be the mediated dysfunction of complex regional pain syndrome?

4. What are the 3 stages of Paget disease?

5. What are the most frequent sites of bone involvement in Paget?

6. What is the most common neoplastic complication? What percentage of Paget Patients? What about the skull?

7. What age is fatty marrow conversion is usually complete?

8. Which of the following is not a typical red marrow converter?

     a. 37 yo AA male with AIDS

     b. 45 yo WM with hemolytic anemia

     c. 35 yo Asian couch potato who does not smoke

     d. 58 yo WF on erythropoietin

9. Why could in and out of phase imaging help distinguish tumor versus red marrow conversion?

10. What is a sinus tract?

11. What is a cloaca?

12. What is the finding on 3 phase MDP bone scan?

13. Sarcoidosis - most common x-ray finding?

14. What are the most commonly involved joints of patients with Hemophilia?

15. What effect can hemarthrosis have on young immature bone?

16. 20 yo with cholecystectomy clips and calcified small spleen. What can be seen in the spine? What about the hips?

17. What are leukemic lines?

Febuary Quiz Answers

Great job Dr. Dey, Lussier, Vosburgh, and Bonney!

Answers:

1. C (1 point)

2. C (1 point)

3. F (1 point)

4. Knee, wrist, 2nd and 3rd MCP joints (1 point)

5. Large Beak-like osteophytes (1 point) - hemochromatosis arthropathy.

6. Amyloidosis (1 point)

7. False (1 point)

8. Extent of disease in 2 planes, femoral head flattening/collapse and extent, contralateral involvement, presence of secondary osteoarthritis, an any progression over time (1 point)

9. 4 yo. More time to remodel (2 points)

10. Synovial chondromatosis; OA with loose bodies, OCD with loose bodies, AVN, chronic joint infections (2 points)

11. May represent Hypertrophic osteoarthropathy or thyroid acropachy. Should look for pulmonary (especially cancer) dz, cyanotic heart disease, IBD, GI like biliary cirrhosis, voriconazole, or hx of thyroid resection for hyperthyroidism (3 points)

12. Soft tissue thickening in phalanges and heel pad. Spade like distal phalangeal tufts.Widened metacarpals.  Excresences at tendon insertions.  Beak-like osteophytes. (3 points)

13. Widened SI joints (1 point)

14. Hyperparathyroidism - brown tumor - accumulations of osteoclasts and fibrous tissue with variable cystic change (1 point)

15. Pseudofractures - linear foci of undermineralized osteoid at sites of mechanical loading - often perpendicularly oriented to cortex of the bone and often incomplete and bilateral (1 point)

16. Rachitic rosary (flaring of costochondral junctions) (1 point)

17. Decreased central vertebral density with sclerosis of endplates that look like a Rugby Jersey - sign of renal osteodystrophy (2 points)

18. Normal, Heavy metal poisoning, Hypervitaminosis D, metaphyseal stress lines, posttreatment rickets, scurvy (1 point)

19. Myelofibrosis, Mastocystosis, Mets, Sickle cell, Paget, Pyknodystostosis, Renal osteodystrophy, osteopetrosis, fluorosis (1 point)

20. Wimberger - sclerotic epiphyseal rim, Frankel line - dense metaphyseal line adjacent the physis; Trummerfeld zone - lucency proximal to the Frankel line; Associated with Scurvy; Limey - The British Navy would use lime juice to prevent Scurvy (5 points).

Total 31+ points

March Reading

MSK REQUISITES - Ch 27, 28, 39, 40, 41

EVMS 2019-2020 February Reading Quiz!

As Always - Never Disrespect the Wu-Tang Clan! Now prepare yourself for the great EVMS Unofficial Reading Quiz of February 2020!

1. Gout may occur seconary to:

a. Sun exposure
b. Elevated HLA-B27
c. Moonshine
d. Positive birefringent crystal deposition

2. Gouty tophus -

a. Character from "that 70's show"
b. Intraarticular crystals
c. monosoduium urate crystal in bursa or periarticular soft tissues
d. a subchondral cyst

3. Gouty tophi have a universal appearance on MRI which makes them easy to diagnose. T or F

4. CPPD is most common which joints?

5. A patient has bronze skin, cirrhosis, and diabetes presents with an arthropathy - what might his MCP look like?

6. Older lady on dialysis has an MRI of the lumbar spine. Patient has irregular endplates of several levels. Nodules are noted in the adjacent soft tissue which are low in signal on all sequences. This patient might have?

7. Early osteonecrosis is pathognomonic on MRI. T or F

8. What does the clinician want to know regarding Avascular Necrosis?

9. A 4 yo or an 10 yo is more likely to have a better prognosis? Why?

10. 40 yo man has an MRI of the hip. There are erosions of the femoral neck. Multiple low signal same sized foci are noted in the joint space. What should be considered and what differential might you consider?

11. 55 yo man shows up with bilateral foot and hand xray. Images demonstrate bilaterally symmetric benign appearing periosteal reaction. When the referring doctor stops by to review the images, what do you recommend and why?

12. Andre the Giant gets hand x-ray and foot xray - what might you see?

13. A patient with elevated parathyroid hormone and abnormal calcium levels has a pelvic x-ray. What might one notice at the SI joints?

14. A hand x-ray demonstrates radial sided resorption in the phalanges. Vascular calcifications are present. The radius has a lucency which is not subchondral. What might cause this lucency?

15. A medical student walks up to you and asks "What is a looser zone"? What do you tell him/her?

16. A child is in the x-ray department with flared metaphyses in the wrists. What might the patient's ribs look like?

17. What is a Rugger Jersey? Why do I care?

18. What is the differential diagnosis for dense metaphyseal bands?

19. What is the differential diagnosis of diffuse increased bone density?

20. Define the following - Wimberger sign; Frankel line; Trummerfield zone - what disease are they associated with and what is the association between this disease and the epithet "Limey"?

Bonus: Podcast - to listen or not to listen - what do you recommend or who can you not stand?