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."
