November 2019 Unofficial EVMS Reading Answers

Congrats to - Dr. Yoni, Dey, Vosburgh, Lussier, and Bonney!

1. Layering in the joint space - lipohemarthrosis. This signifies either fracture or bone bruise (2 points)

2. Schatzker II. Depression and gap at the articular surface. CT - better define the fracture preoperatively (3 points)

Large arrow shows depressed portion. The smaller arrow points to the vertical cleft.

Image source - Orthopedics and Traumatology Vol 99, Issue 7, Nov 2013

3. Double PCL sign. Bucket handle tear of the meniscus. Medial (3 points)

4. Anteromedial tibia and fibular styloid. MRI to evaluate for cruciate injury and posterolateral corner injury (1 each for fracture; 1 for MRI, 1 for why; 4 points)

5. Soft tissue mass anterior to the ACL reconstruction - Arthrofibrosis - cyclops lesion; Hates him. Limited extension. ACL reconstruction (3)

6. Comminuted patellar fracture. No. ORIF - Often with circlage wires and sometimes additional screws (3 points)

Bipartite and multipartite patellas - typically are more lateral than diffuse. There is a type involving the inferior patella - but medial is rare. This example is extensively fragmented - therefore it is more likely to be fractured.

Source - Multipartite patella EPOS

7. Quadriceps tear. Rectus femoris (superficial), conjoint vasus lateralis and medialis (middle), vastus intermedius (deep) - (2 points)

8. Prepatellar bursitis. Maid, carpenter, someone working long periods on their knees. (2 points)

same knee as the x-ray

9. Limits abduction and may result in anterior dislocation (when hip is placed in forced abduction) (1 point)

10. Stress Shielding - the bone that is not under stress is resorbed (1 point)

11. migration of component, change in alignment of a component with adjacent bone, lucency at bone-hardware interface > 2mm, fracture of cement or hardware in setting of cemented hardware. (2 points)

12. Scapular notching along axillary border of the scapula is often a precursor to loosening and failure (1 point)

bonus - variable answers (2 points possible)

Total possible - 27 points + 2 possible bonus points

December Reading

Reading for December 2019. MSK Requisites Ch. 14, 15, 42, 43

November 2019 Unofficial EVMS Quiz

It's November - Let's Do This

1. 

What about this image makes me think of Neapolitan Ice Cream? What is the significance?

2. What Schatzker classification would you give this case? What significant findings would you want to comment on? What next study would you recommend and why?

3. 

What is the sign on the lateral images? What is the diagnosis? Which side is most likely involved?

4. 

This is an oblique view. What is fractured? Based on imaging findings - what would you recommend and why?

5.  

What is the significant finding? How does this finding feel about Odysseus? How would this patient present? What surgery did they have previously?

6. 

What is the finding? Is it a normal variant? How is it treated?

7. 

What is the finding? What are the layers and list them superficial to deep?

8. 

What is the finding? What are possible occupations?

9. In hip arthroplasty, why do we not want a decreased lateral opening angle?

10. What is stress shielding?

11. What are 2 findings that suggest loosening?

12. What is the significance of scapular notching in the setting of a reverse total shoulder arthroplasty?

Bonus:
Share a Youtube video of your current favorite song or song that has greatly inspired you and give short no more than 3 sentence reason as to why. All styles and genres are acceptable. 

October 2019 Quiz Answers

Congrats to - Dr. Dey, Bonney, Vosburgh, Lussier, and The Great Yoni

Answers!

Spine

1. 3; Anterior (anterior 1/2 of vertebral body and ALL), Middle (posterior 1/2 of the vertebral body and PLL), and posterior (posterior elements, facets, associated ligaments) (4 points)

2. 2 to 3 columns (1 point)

3. 2/3 width of C2 body level at C3 and C4 and no more than 14 mm at C6 (1 point)

4. 1 - Anterior vertebral line, 2. Posterior vertebral line, 3. spinal laminar line, 4 - posterior spinous line; Posterior spinous line is least likely to be associated with significant instability (2 points)

5. 2.5 mm; 5 mm (1 point)

6. Hypoglossal canal or jugular foramen; Cranial nerves IX and XII (2 points)

7. Type 1 - Tip; 2 - waist or base; 3 - extend into the body (1 point)

8. Flexion teardrop (1 point)

9. c (1 point)

10. b (a would have been 100%) (1 point)

15 points

Pelvis

11. d (1 point)

12. inferior (1 point)

13. AP compression, lateral compression, vertical shear (1 point)

14. iliac crest (abdominal muscles), anterior superior iliac spine (sartorius), anterior inferior iliac spine (rectus femoris), inferior pubic ramus (adductor muscles), ischial tuberosity (hamstrings) - (5 points)

15. Anterior wall, posterior wall, transverse, anterior column, posterior column (1 point)

16. Separates the upper hemipelvis from the lower hemipelvis and can occur above, at, or inferior to the roof of the acetabulum (1 point)

10

Hip and Femur

17. medial and lateral circumflex femoral arteries from the profunda femoris artery (1 point)

18. Greater in profile; lesser - hidden (1 point)

19. AVN (1 point)

20. e (1 point)

21.  10-16; males, AA, obese, delayed skeletal maturation (2 points)

6

Total - 31 points +/- bonus

November 2019 Reading

MSK Requisites Ch. 12, 13, 24

October Quiz

October Quiz - Get Your Geek On!

Spine

1. Spine stability can be thought of through the ___ column model. How many columns and what make them up?

2. Disruption of how many columns lead to instability?

3. In general, what are the rules for prevertebral thickness in kids?

4.

What are the lines? Of the lines, which is likely the least significant for stability?

5. What is the normal atlantodental space in adults? In children?

6. In the setting of an occipital condyle fracture, what canals might be involved? What respective cranial nerves may be injured?

7. What are the 3 types of odontoid fractures?

8. Anterior inferior corner fragment with widening of the posterior disc space and spinous processes is concerning for what type of injury?

9. Extension injuries are associated with?

a. Widened spinous process distance
b. PLL disruption and facet dislocation
c. tear or stretch of ALL and disruption of the anterior annulus fibrosus
d. tear or stretch of PLL and disruption of the anterior annulus fibrosus

10. 90% of thoracic and lumbar fractures occur?

a. T1-L5
b. T11-L4
c. T12-L2
D. T10-L3

Pelvis

11. Fracture of what suggests the presence of occult sacral fractures?

a. L5 body
b. L4 transverse process
c. L4 body
d. L5 transverse process
e. b and c

12. The superior or inferior margin of the pubic symphysis is allowed some step off.

13. What are the 3 major types of pelvic ring fractures?

14. What are the 5 apophyses and what muscle attachment that are associated with pelvic apophyseal avulsion fractures?

15. What are the 5 primary fracture patterns of the acetabulum?

16. What is a transverse acetabular fracture?

Hip and Femur

17. What is the major blood supplier of the femoral head?

18. When the femur is internally rotated, which trochanter is in profile and which is hidden?

19. What complication increases significantly with the length of time till reduction of a dislocated hip?

20. If a patient is osteoporotic with hip pain and/or inability to walk and a normal x-ray - what study should be recommended?

a. Repeat x-ray with weight bearing
b. CT
c. CT arthrogram
d. US
e. MRI

21. SCFE - what age group and what types of patients get the process?

Bonus - If I form a new band - which name should I choose - Points based on explanation

a. The MR Shims

b. Bros Before Defacography Hose

c. Flight of the Barium

d. Anna Phylaxis

e. Ultra Sound

f. HIDA the Money

G. Clash of the Liver US

H. How Low Can UR Gastrograffin Go

i. I Don't Chiari I Bit

J. Other - your suggestion

September Quiz Answers!

Congrats to

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.