Cervical Spine Anatomy & Pathology: Exam Review, Exams of Radiology

Download Cervical Spine Anatomy & Pathology: Exam Review and more Exams Radiology in PDF only on Docsity! 1 / 115 Radd Quality Final Exam Study Guide Review Questions with Answers 1.a. Fusion of posterior elements b. Wasp-waist deformity g. Rudimentary disc space: What are the findings on this image? a.Fusion of posterior elements b.Wasp-waist deformity c.Omovertebral bone d.Sprengel's deformity e.Osteophytosis f.Decreased disc space g.Rudimentary disc space 2.Anterior VB concavity: Wasp-Waist deformity AKA 3.Klippel-Feil Syndrome: Wasp-waist deformity, Anterior vertebral body concavity, and fusion of the posterior elements are all seen with what condition? 4.c. Omovertebral bone d. Sprengel's deformity: What are the radiographic findings on this image? What are the findings on this image? a.Fusion of posterior elements b.Wasp-waist deformity c.Omovertebral bone d.Sprengel's deformity e.Osteophytosis f.Decreased disc space g.Schmorl's nodes 5.b. Sprengel's deformity: An undescended scapula is seen in what condition? a.Klippel-Feil syndrome b.Sprengel's deformity c.Spondyloschesis d.Scheuermann's disease 6.b. Yes, Flexion/Extension to evaluate instability: A cervical spine series shows multiple blocked vertebra, anterior body concavity, and rudimentary disc space at C2-C4 and C6-C7. Would you want any other x-rays? a.Yes, dependent on patient's presentation b. Yes, Flexion/Extension to evaluate instability c.No, they're safe to adjust 2 / 115 d.No, they must be referred immediately 7.c. Refer to a neurologist (possibly D after they've been seen): A patient who's been diagnosed with Klip- pel-Feil syndrome is having cape-shawl like pain and paresthesia from their cervical spine into their extremities. What is the proper follow up for this patient? a.Adjust them b.Do a flexion-extension cervical series to evaluate instability c.Refer to a neurologist d.Ask for a MRI to evaluate the syrinx 8.** c. Disc degeneration d. Osteophytosis f. Occipitalization: What are the findings in this cervical series? a.Multiple blocked vertebrae b.Posterior element fusion c.Disc degeneration d.Osteophytosis e.Spondyloschesis f.Occipitalization g.Spina bifida occulta 9.a. True (Flexion/Extension): A patient with occipitalization needs additional x- rays. a.True b.False 10.b. False: A patient without neurological symptoms and occipitalization needs follow up imaging and cannot be adjusted. a.True b.False 11.Fuch's view: What view is this? 12.b. Non-union of the base of the dens: Os odontoideum is: a.Fracture of the base of the dens b.Non-union of the base of the dens c.Fracture of the tip of the dens d.Non-union of the tip of the dens 13.a. Posterior ponticus: What finding(s) are seen in this lateral cervical film? a.Posterior ponticus b.Posterior element fusion 5 / 115 a.Posterior ponticus 6 / 115 b.Os odontoideum c.Spondyloschesis d.Agenesis of the posterior arch 21.b. No (spondylolischesis): Any other x-rays needed for this patient? a.Yes b.No 22.b. no (spondylolischesis): Any other images needed for this patient? a.yes b.no 23.Yes (spondylolischesis): Can you adjust this patient? a.yes b.no 24.g. Agenesis of the posterior arch: What are the radiographic finding(s) on this lateral cervical view? a.Posterior ponticus b.Posterior element fusion c.Os odontoideum d.Osteophytosis e.Spondyloschesis f.Occipitalization g.Agenesis of the posterior arch 25.Yes, Flexion/Extension for Instability: Is there additional imaging needed for agenesis of the posterior arch of C1? 26.Cervical rib: What is the radiographic finding on this series? 27.b. Posterior element fusion e. Rudimentary disc spaces g. Anterior body concavity: What are the findings on this image? a.Multiple blocked vertebrae b.Posterior element fusion c.Disc degeneration d.Osteophytosis e.Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity 28.d. Butterfly vertebra (T10): What is the radiographic finding on this film? 7 / 115 a.Multiple blocked vertebrae b.Posterior element fusion c.Disc degeneration d.Butterfly vertebra e.Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity 29.d. Butterfly vertebra (T7): What is the radiographic finding on this film? a.Multiple blocked vertebrae b.Posterior element fusion c.Disc degeneration d.Butterfly vertebra e.Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity 30.d. Butterfly vertebra: What is the radiographic finding on this film? a.Multiple blocked vertebrae b.Posterior element fusion c.Disc degeneration d.Butterfly vertebra e.Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity 31.Cervical series (APLC, APOM, Lateral cervical): Mr. Mark is a 42-year-old office manager who's complaining of progressive numbness/weakness in his left upper extremity that has been evolving over the past few weeks. He notes intermittent numbness and tingling in his left arm and hand. The pain is localized to the left shoulder and cervical region. What x-rays would you order? 32.1. Spondyloschesis 2. Multiple congenital block vertebrae 3. Spina bifida C6 4. Omovertebral bone 5. Cervical rib: What are the most pertinent findings on Mr. Mark's cervical x-rays? 33.Klippel-Feil syndrome: What are the impression's of Mr. Mark's x-rays? 10 / 115 42.b. Secondary: Trauma and abnormal biomechanics are examples of which type of degenerative change? a.Primary b.Secondary 43.c. Gout: Monosodium urate crystals are seen in which condition? a.Pseudogout b.HADD c.Gout d.CPPD 44.a. Pseudogout d. CPPD: Which of the following is most commonly found in the knee? a.Pseudogout b.HADD c.Gout d.CPPD 45.b. HADD: Which of the following is most commonly found in the shoulder? a.Pseudogout b.HADD c.Gout d.CPPD 46.d. Supraspinatus: Which tendon is HADD most common in? a. Infraspinatus b.Teres minor c.Biceps tendon d.Supraspinatus 47.b. HADD: Calcification of the tendon is due to which of the following? a.Pseudogout b.HADD c.Gout d.CPPD 48.c. Chondrocalcinosis: Calcification in the joint is known as: a.Pseudogout b.Hydroxyappetite deposition disease c.Chondrocalcinosis d.Pryophosphate arthropathy 49.d. Pryophosphate arthropathy (Chondrocalcinosis leads to pyrophosphate arthropathy): Which of the follow- ing is a secondary result of calcification in the joint? 11 / 115 a.Pseudogout 12 / 115 b.Hydroxyappetite deposition disease c.Chondrocalcinosis d.Pryophosphate arthropathy 50.1. Decreased joint space (DIPs) 2. Subchondral sclerosis (DIPs) 3. Osteophytosis (DIPs): What are the radiographic findings on this radiograph? 51.1. Decreased joint space 2. Osteophytosis at medial and lateral margins of knee 3. Sclerosis 4. Hardware due to previous trauma: What are the radiographic findings on this image? 52.1. IVD 2. Facet 3. Uncinate: What 3 joints should always be checked in the cervical region? 53.1. DJD at C3-C4, C5-C6 (Lateral) 2. Facet arthrosis at C4-C5, C5-C6 (APLC): What are the radiographic findings on these images? 54.e. Adjust them: In a patient with DJD in the cervical region with no other significant findings, what other follow ups are needed? a.Flexion/Extension views b.MRI c.Referral to an orthopedist d.Blood work e.Adjust them 55.a. MRI of the cervical spine (or refer to neurologist): This patient is having canal symptoms and the Pavlov ratio measures 0.76. What follow up would you like for this patient? a.MRI of the cervical spine b.Refer to an endocrinologist c.Arthritic panel d.Flextion/Extension views 56.b. >0.8: A pavlov ratio of or less indicates canal stenosis. a.>0.6 b.>0.8 c.0.9 d.1.0 15 / 115 65.a. PIP c. DIP (Interphalangeal joints): What joints are affected in patients with EOA? a.PIP b.MCP c.DIP e. Wrists 66.c. Post-menopausal women: What population is EOA most commonly seen in? a.Elderly men b. Young women c.Post-menopausal women d.Young men 67.c. Bilateral, symmetric: EOA is and a.Unilateral, symmetric b.Bilateral, asymmetric c.Bilateral, symmetric d.Unilateral, asymmetric 68.d. EOA: What is the most likely diagnosis based on the radiographic findings? a.Rheumatoid arthritis b.Degenerative joint disease c.CPPD d.EOA e.Pyrophosphate arthropathy 69.a. Yes (pain permitting): Can you adjust a patient with EOA? a.Yes b.No 70.d. Arthritic panel: If Rheumatoid Factor is suspected in a patient, what should be ordered to confirm this? a.Metabolic panel b.CBC c.Rheumatoid panel d.Arthritic panel 71.1. RF 2. ANA 3. C-Reactive Protein (CRP) 4. CBC 5. Comprehensive Metabolic Panel (CMP): What 5 things does an arthritic 16 / 115 panel test for? 17 / 115 72.d. Gout: A lumpy bumpy overhanging margin sign is seen with what condition? a.CPPD b.Pyrophosphate arthropathy c.Chondrocalcinosis d.Gout e.HADD 73.d. Gout: Erosions are pathognomonic for which of the following crystal deposi- tion disease? a.CPPD b.Pyrophosphate arthropathy c.Chondrocalcinosis d.Gout e.HADD 74.d. Gout: This AP foot and spot projection demonstrates what condition? a.CPPD b.Pyrophosphate arthropathy c.Chondrocalcinosis d.Gout e.HADD 75.c. Blood work (for uric acid): What would be the proper follow up for this patient? a.MRI b.Surgery c.Blood work d.Adjustment 76.d. Elevated Uric Acid levels: What lab value(s) would you expect to find in this patient? a.RF+ b.ANA c.Elevated CRP levels d.Elevated Uric Acid levels e.Elevated A1C levels 77.a. Primary care provider: Who should a patient with gout be referred to? a.Primary care provider b.Rheumatologist c.Orthopedist d.Podiatrist 20 / 115 a.True b.False 87.d. Erosions: What is the main characteristic finding for inflammatory arthritis? a.Decreased joint space b.Subchondral sclerosis c.Vacuum phenomenon d.Erosions e.Osteophytes 88.PEAR 1. Psoriatic arthritis 2. Enteropathic arthritis 3. Ankylosing spondylitis 4. Reactive arthritis: What are the Seronegative Spondyloarthropathies? 89.c. Ankylosing spondylitis: What is the most common seronegative inflamma- tory spondyloarthropathy? a.Psoriatic arthritis b.Rheumatoid arthritis c.Ankylosing spondylitis d.Enteropathic arthritis e.Scleroderma f.SLE 90.b. Seropositive: Which is RF +? a.Seronegative b.Seropositive 91.d. Rheumatoid arthritis: What is the most common seropositive spondy- loarthropathy? a. Juvenile RA b.SLE c.Ankylosing spondylitis d.Rheumatoid arthritis e.Reactive arthritis f.Scleroderma 92.RF+, ANA+, CRP, and ESR: What lab value(s) are likely seen in a patient with Rheumatoid Arthritis? 93.f. Inflamatory arthritis: Focal indentations into the articular surface are charac- teristic for which kind of conditions? a.Degenerative arthritis b.Congenital variants 21 / 115 c.Traumatic injuries 22 / 115 d.Hematological disorders e.Spondylo discitis f.Inflamatory arthritis 94.Erosions: "Focal indentations into the articular surface" is describing: 95.c. Ankylosing spondilitis g. Enteropathic arthritis: Which seronegative inflammatory arthropathies are bilat- erally symmetric? a.Rheumatoid arthritis b.Psoriatic arthritis c.Ankylosing spondilitis d.SLE e.Reactive arthritis f.Scleroderma g.Enteropathic arthritis 96.b. Psoriatic arthritis e. Reactive arthritis: Which seronegative inflammatory arthropathies are bilaterally asymmetric? a.Rheumatoid arthritis b.Psoriatic arthritis c.Ankylosing spondilitis d.SLE e.Reactive arthritis f.Scleroderma g.Enteropathic arthritis 97.d. AS and Enteropathic: Which seronegative inflammatory arthropathies can- not be differentiated radiographically (have identical appearance)? a.AS and Psoriatic b.Psoriatic and Enteropathic c.Enteropathic and Reactive d.AS and Enteropathic e.AS and Reactive 98.a. True (90%) (BUT don't have RF): Seronegative inflammatory arthropathies are typically HLA-B 27+ a.True b.False 99.c. Sclerosis d. Symmetrical loss of joint space 25 / 115 104. a. Sacroiliitis: This image demonstrates: a.Sacroiliitis b.Bone islands c.Ghost sign d.Bilateral destruction 105. b. Symmetrical loss of joint space d. Erosions at metatarsal heads 3-5: What are the significant radiographic findings on this medial oblique foot image? a.Erosions at the DIP b.Symmetrical loss of joint space c.Sesamoid bone at the first metatarsal head d.Erosions at metatarsal heads 3-5 106. b. Psoriatic arthritis: Using this AP and Medial oblique foot, what is the most likely diagnosis? a.Ankylosing spondylitis b.Psoriatic arthritis c.Degenerative Joint Disease d.Rheumatoid arthritis e.Pyrophosphate arthropathy 107. d. RF- and HLA B27 (Psoriatic): What lab value(s) would you expect to see in this patient? a.RF+ and ANA b.RF- and ANA c.RF+ and HLA B27 d.RF- and HLA B27 e.RF+ and CRP 108. d. Flexion/Extension view of cervical spine: Anyone suspected of having inflammatory arthropathies must have what type of follow up? a.MRI/other imaging b.Adjustments c.Referral to an orthopedist d.Flexion/Extension view of cervical spine 109. d. RF- and HLA B27 (Psoriatic b/c asymmetrical erosions): What lab value(s) would you expect to see in this patient? a.RF+ and ANA b.RF- and ANA c.RF+ and HLA B27 26 / 115 d.RF- and HLA B27 e.RF+ and CRP 110. c. 30-50: What age(s) is psoriatic arthritis most commonly seen in? a.15-35 b.40-70 c.30-50 d.35-65 111. a. 15-35: What age(s) is ankylosing spondylitis most commonly seen in? a.15-35 b.40-70 c.30-50 d.35-65 112. a. 15-35: What age(s) is reactive arthritis most commonly seen in? a.15-35 b.40-70 c.30-50 d.35-65 113. b. 40-70: What age(s) is Rheumatoid Arthritis most commonly seen in? a.15-35 b.40-70 c.30-50 d.35-65 114. d. 35-65: What age(s) is Scleroderma (PSS) most commonly seen in? a.15-35 b.40-70 c.30-50 d.35-65 115. d. Rheumatologist: A patient with inflammatory arthritis should be referred to a: a.Hematologist b.Endocrinologist c.Orthopedist d.Rheumatologist 116. a. True!: A patient with suspected inflammatory arthritis 27 / 115 ALWAYS need flex- ion/extension views a.True b.False 117. b. False, Arthritic panel: A CBC must be ordered for a patient with inflamma- tory arthritis. If false, what is the correct panel? 30 / 115 e.Ankylosing spondylitis f.Gout 125. b. Enteropathic arthritis e. Ankylosing spondylitis: Which of the following are indistinguishable on plain film? a.Rheumatoid arthritis b.Enteropathic arthritis c.Psoriatic arthritis d.Reactive arthritis e.Ankylosing spondylitis f.Gout 126. b. Enteropathic arthritis e. Ankylosing spondylitis (Erosions + Sclerosis @ SI joint = Sacroiliitis): Most likely diagnosis for this presentation? a.Rheumatoid arthritis b.Enteropathic arthritis c.Psoriatic arthritis d.Reactive arthritis e.Ankylosing spondylitis f.Gout 127. b. Vertebral body squaring e. Shiny corner sign: What are the radiographic features on this film? a.Anterior vertebral body concavity b.Vertebral body squaring c.Fusion of the posterior elements d.Dagger sign e.Shiny corner sign f.Trolley track sign 128. f. Trolley track sign d. Dagger sign: What are the radiographic features on this film? a.Anterior vertebral body concavity b.Vertebral body squaring c.Fusion of the posterior elements d.Dagger sign e.Shiny corner sign f.Trolley track sign 129. d. RF-,HLAB27+ (AS or Enteropathic): What lab value(s) would you expect to see in this 31 / 115 patient? 32 / 115 a.RF- and CRP b.RF+, CRP, and ESR c.RF+, ANA, and elevated A1C d.RF-,HLAB27+ 130. c. Synovial: What types of joints do inflammatory arthropathies affect? a.Fibrous b.Cartilaginous c.Synovial d.Amphiarthrotic 131. c. Referral to a Rheumatologist/Neurologist: What would be the proper follow up for this patient? a.Flexion/Extension series to evaluate ADI instability b.CBC c.Referral to a Rheumatologist/Neurologist d.Adjustment 132. 1. Sella turcica 2. ADI 3. Pre-vertebral soft tissues: What 3 spots must be checked on EVERY lateral cervical projection? 133. b. Staphylococcus aureus: What is the most common organism resulting in infection? a.Streptococcus pyogenes b.Staphylococcus aureus c.Klebsiella pneumoniae d.Coccidioidomycosis 134. a. Metastasis respects joint space: What is the differentiating factor radi- ographically between infection and metastasis? a.Metastasis respects joint space b.Infection does not cross joint space c.Metastasis crosses joint space d.Mets and infection can't be differentiated 135. c. Spondylodiscitis (infection): The lack of cortex, loss of joint space, and destruction of endplates seen in this patient at C4-C5 indicates which? a. Inflammatory arthropathies b.Metastasis c.Spondylodiscitis d.Degenerative changes 35 / 115 143. b. CBC + Differential: What blood work would you want on this patient? a.Arthritic panel b.CBC + Differential c.Complete Metabolic Panel (CMP) d.A1C levels 144. a. Fungus b. Virus d. Spirochetes: Non-suppurative infection is likely due to: (Select all that apply) a.Fungus b.Virus c.Bacteria d.Spirochetes 145. c. Bacteria: Supppurative infection is due to: a.Fungus b.Virus c.Bacteria d.Spirochetes 146. b. Coccidiodomycosis c.Tuberculosis (acts like fungus) e. Blastomycosis g. Syphilis: Which of the following are considered non-suppurative? a.Septic arthritis b.Coccidiodomycosis c.Tuberculosis d.Brodie's abscess e.Blastomycosis f.Suppurative osteomyelitis g.Syphilis 147. a. Septic arthritis d. Brodie's abscess f. Suppurative osteomyelitis: Which of the following are considered suppurative? a.Septic arthritis b.Coccidiodomycosis c.Tuberculosis d.Brodie's abscess e.Blastomycosis f.Suppurative osteomyelitis 36 / 115 g.Syphilis 37 / 115 148. c. Coccidioidomycosis (Cavitations and Consolidation = Coccidioidomycosis): Cavitations and Con- solidation are seen in which type of infection? a.Histoplasmosis b.Blastomycosis c.Coccidioidomycosis d.Brodie's abscess 149. a. Histoplasmosis: Which of the following disseminates to the lungs, liver, and spleen? a.Histoplasmosis b.Blastomycosis c.Coccidioidomycosis d.Brodie's abscess 150. b. Blastomycosis (Blasto to Bone): Which of the following has skin lesions and disseminates to bone? a.Histoplasmosis b.Blastomycosis c.Coccidioidomycosis d.Brodie's abscess 151. c. Maduromycosis: Which of the following is a fungal infection of the foot? a.Blastomycosis b.Coccidioidomycosis c.Maduromycosis d.Histoplasmosis e.Tuberculosis f.Syphilis 152. f. Syphilis: Charcot's joint is associated with which? a.Blastomycosis b.Coccidioidomycosis c.Maduromycosis d.Histoplasmosis e.Tuberculosis f.Syphilis 153. e. Tuberculosis: Which condition often affects the Lung apices such as seg- ment 1 and segment 6? a.Blastomycosis b.Coccidioidomycosis 40 / 115 159. d. Suppurative osteomyelitis: Cortical destruction with soft tissue swelling and periosteal reactions is seen with: a.Coccidiodomycosis b.Histoplasmosis c.Brodie's abscess d.Suppurative osteomyelitis e.Septic arthritis 160. 1. Debris 2. Destruction 3. Density change 4. Dislocation 5. Distention 6. Disorganization: What are the 6 D's associated with a Charcot's joint? 161. c. Brodie's abscess: A Chronic low grade infection is seen with which of the following? a.Septic arthritis b.Tuberculosis c.Brodie's abscess d.Suppurative osteomyelitis e.Blastomycosis 162. c. Brodie's abscess: A dense sclerotic lesion with a central lucency describes which of these? a.Septic arthritis b.Tuberculosis c.Brodie's abscess d.Suppurative osteomyelitis e.Blastomycosis 163. a. Septic arthritis: Which of the following does not respect the joint space? a.Septic arthritis b.Tuberculosis c.Brodie's abscess d.Suppurative osteomyelitis e.Blastomycosis 164. a. Septic arthritis: UTI symptoms are seen along side which? a.Septic arthritis b.Tuberculosis c.Brodie's abscess d.Suppurative osteomyelitis 41 / 115 e.Blastomycosis 42 / 115 165. b. 2-6: A majority of studies report a delay of months after the onset of symptoms in a patient with septic arthritis. a.1-3 b.2-6 c.7-9 d.10-12 166. b. Back pain that increases in severity over several days: What is the most common presentation of infection? a.Debilitating neck pain b.Back pain that increases in severity over several days c.A high fever alongside decreased ROM d.Redness and positive orthopedic tests 167. c. Osteoid osteoma: What is the differential diagnosis for a Brodie abscess? a.Osteomyelitis b.Osteosarcoma c.Osteoid osteoma d.Osteopoikilosis 168. d. Spondylodiscitis: What is the most likely diagnosis for this patient? a.Tuberculosis b.Juvenile Rheumatoid Arthritis c.Brodie's abscess d.Spondylodiscitis e.Syphilis 169. None: What other x-rays are needed in this patient? 170. b. CBC + Differential: What blood work would you want on this patient? a.Arthritic panel b.CBC + Differential c.Complete Metabolic Panel (CMP) d.A1C levels 171. b. CBC + Differential: All infection should have which blood follow up? a.Arthritic panel b.CBC + Differential c.Complete Metabolic Panel (CMP) 45 / 115 b.T12 c.L2 d.T10 46 / 115 180. d. Spondylodiscitis: This cortical destruction and anterior body concavity are seen with which diagnosis? a.Brodie's Abscess b.Psoriatic arthritis c.Metastasis d.Spondylodiscitis 181. a. Cortical destruction with anterior vertebral body concavity and con- comitant joint space destruction: What are the radiographic findings in this im- age? a.Cortical destruction with anterior vertebral body concavity and concomitant joint space destruction b.Cortical destruction with posterior element destruction and concomitant joint space preservation c.Anterior vertebral body concavity with cortical and joint space preservation d.Cortical destruction and posterior element destruction with joint space destruction 182. c. Spot shot: What other x-rays would be recommended in this patient? a.Flexion/Extension b.Oblique c.Spot shot d.PA 183. b. MRI with contrast: What other imaging is recommended for this patient? a.Flexion/Extension views b.MRI with contrast c.CT d.PET CT 184. d. MRI with contrast: The follow-up imaging for infection is ALWAYS? a.None needed b.PET CT c.MRI without contrast d.MRI with contrast 185. d. Septic arthritis: What is the most likely diagnosis for this 47 / 115 patient? a.Rheumatoid arthritis b.Psoriatic arthritis c.Pyrophosphate arthropathy d.Septic arthritis 50 / 115 193. b. Urine assay: What type of blood work should be done in a patient with blastomycosis? a.Enzyme assay (EIA) b.Urine assay c.PSA d.CBC e.Arthritic panel 194. b. Urine assay (Blasto): What type of blood work should be done on this patient? a.Enzyme assay (EIA) b.Urine assay c.PSA d.CBC e.Arthritic panel 195. a. Enzyme assay (EIA): What type of blood work should be done in a patient with coccidioidomycosis? a.Enzyme assay (EIA) b.Urine assay c.A1C d.CBC e.Arthritic panel 196. a. Coccidiodomycosis: What is the most probable diagnosis? a.Coccidiodomycosis b.Blastomycosis c.Tuberculosis d.Madurymycosis 197. a. Coccidiodomycosis: What is the most likely diagnosis? a.Coccidiodomycosis b.Blastomycosis c.Tuberculosis d.Madurymycosis 198. a. Enzyme assay (EIA): What type of blood work should be done on this patient? a.Enzyme assay (EIA) b.Urine assay c.A1C d.CBC e.Arthritic panel 51 / 115 199. a. Coccidiodomycosis: Cavitation is most closely associated with which? a.Coccidiodomycosis b.Blastomycosis c.Tuberculosis d.Madurymycosis 200. c. Simple: A closed fracture that does NOT penetrate the skin a.Greenstick b.Comminuted c.Simple d.Insufficient e.Transverse f.Torus 201. b. Comminuted: A fracture that has more than 2 fragments a.Greenstick b.Comminuted c.Simple d.Insufficient e.Transverse f.Torus 202. b. Comminuted: A "butterfly fragment" is seen with which of the following fractures? a.Greenstick b.Comminuted c.Simple d.Insufficient e.Transverse f.Torus 203. a. Greenstick: A fracture is an incomplete fracture seen in the long bones of children a.Greenstick b.Comminuted c.Simple d.Insufficient e.Transverse f.Torus 204. d. Insufficient: Normal loads resulting in abnormal response of bone is which fracture? a.Greenstick 52 / 115 b.Comminuted 55 / 115 218. Intra-articular fracture: What type of fracture predisposes one to degenera- tion? 219. d. Fracture of the distal radius with posterior displacement: Which is/are the appropriate finding(s) on these images? a.Fracture of the distal ulna with posterior displacement b.Fracture of the distal radius with anterior displacement c.Fracture of the distal ulna with anterior displacement d.Fracture of the distal radius with posterior displacement 220. b. Colle's fracture: Fracture of the distal radius with POSTERIOR displace- ment is called which of the following? a.Nightstick fracture b.Colle's fracture c.Monteggia fracture d.Smith's fracture 221. d. Smith's fracture: Fracture of the distal radius with ANTERIOR displacement is called which of the following? a.Nightstick fracture b.Colle's fracture c.Monteggia fracture d.Smith's fracture 222. MRI for articular derangement: What type of follow up imaging is appropriate for a Colle's/Smith's fracture? 223. a. MRI with contrast (for internal derangement) (Trauma from FOOSH injury): What type of follow up imaging is appropriate for this patient? a.MRI with contrast b.CT c.Bone Scan d.MRI without contrast 224. c. 10-16: A pars defect most often occurs at what ages? a.At birth b.2-5 c.10-16 d.25+ 225. d. None (Pars fx): What additional x-rays would you request on this patient? a.Flexion/Extension b.Spot shot 56 / 115 c.Oblique d.None 226. d. None: What additional imaging would you request on this patient? a.MRI with contrast b.MRI without contrast c.CT d.None 227. f. None: What is the appropriate referral for this patient? a.Orthopedist b.Vascular surgeon c.Nephrologist d.Hematologist e.PCP f.None 228. ONLY when symptomatic: When do you adjust a pars defect? 229. d. 3 and 4: What grade(s) of anterolisthesis are surgical? a. 2 b. 1 and 2 c. 2 and 3 d. 3 and 4 230. a. Compression fractures: What is seen on this image? a.Compression fractures b.Spondylodiscitis c.Reactive arthritis d.DJD 231. c. Orthopedist: Who should a patient with compression fractures be referred to? a.PCP b.Neurologist c.Orthopedist d.No one, adjust 232. b. Type 2: What is the most common type of Salter Harris? a.Type 1 b.Type 2 c.Type 3 d.Type 4 e.Type 5 233. e. Type 5: Which Salter Harris type is the worst and stunts 57 / 115 growth? a.Type 1 60 / 115 243. d. AVN: A mixed cystic density with articular collapse describes what condi- tion? a.Osteoporosis b.Leukemia c.Hemochromatosis d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 244. e. Medullary bone infarct: "Serpinginous density in the medullary portion of bone" describes what condition? a.Osteoporosis b.Leukemia c.Hemochromatosis d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 245. a. Osteoporosis: Thin cortex with ACCENTUATED VERTICAL TRABECULA- TION is seen with which condition? a.Osteoporosis b.Leukemia c.Hemochromatosis d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 246. c. Osteoporosis (Thin cortex with ACCENTUATED VERTICAL TRABECULATION): All hematolog- ical/endocrine disorders have what radiographic appearance? a.Lucency b.Sclerosis c.Osteoporosis d.Mixed cystic density with articular collapse 247. b. Sickle Cell Anemia: An H-shaped vertebra and hair on end skull are seen in which conditions? a.Osteoporosis b.Sickle Cell Anemia 61 / 115 c.Hemochromatosis 62 / 115 d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 248. c. Hemochromatosis: Degeneration with beak or hook osteophytes at the metacarpals is seen in: a.Osteoporosis b.Sickle Cell Anemia c.Hemochromatosis d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 249. f. Hemophilia: BIG joints, BIG effusion, BIG swelling are all seen in: a.Osteoporosis b.Sickle Cell Anemia c.Hemochromatosis d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 250. g. HPT: Rugger jersey spine is seen in which condition? a.Osteoporosis b.Sickle Cell Anemia c.Hemochromatosis d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 251. g. HPT: Salt and pepper skull and periosteal resorption are seen in which condition? a.Osteoporosis b.Sickle Cell Anemia c.Hemochromatosis d.AVN e.Medullary bone infarct f.Hemophilia g.HPT 65 / 115 a.A1C 66 / 115 b.CBC w/ differential c.Urine Assay d.Parathyroid immunoassay (PTH) e.Comprehensive Metabolic Panel (CMP) f.Arthritic panel g.Enzyme assay (EIA) 266. e. Elevated serum Ca++, phosphorus, and vitamin D levels: What lab value(s) would you expect to find in this patient? a.RF+ b.HLA B27+ c.Elevated CRP levels d.Elevated Uric Acid levels e.Elevated serum Ca++, phosphorus, and vitamin D levels 267. c. Endocrinologist: Who should a patient with HPT be referred to? a.Orthopedist b.PCP c.Endocrinologist d.Urologist 268. CHANDLER'S AVN!!!!: What is the most likely diagnosis in this patient? 269. None: What other x-rays would you like with this patient? 270. MRI of BOTH hips: What other imaging would you like for this patient? 271. Yes if there's an underlying cause No if no underlying cause: Would you like any blood work on this patient? 272. Refer to an Orthopedist: What would be the appropriate referral/treatment for this patient? 273. NO: Can you adjust this patient? 274. c. Preisner's disease: What is the most likely diagnosis? a.Rheumatoid arthritis b.EOA c.Preisner's disease d.CPPD 275. b. MRI with contrast: What follow up imaging is needed for AVN? a.CT b.MRI with contrast c.MRI without contrast d.Bone scan 276. 1. Medullary infarct 67 / 115 2. Enchondroma 70 / 115 common primary bone tumors? 71 / 115 291. Pneumonic for bone tumors: M = Multiple Myeloma O = Osteosarcoma C = Chondrosarcoma E = Ewing's sarcoma F = Fibrosarcoma: What does MOCEF stand for? 292. c. Multiple Myeloma: What is the most common primary bone tumor? a.Osteosarcoma b.Ewing's sarcoma c.Multiple Myeloma d.Chondrosarcoma e.Metastasis f.Fibrosarcoma 293. e. Metastasis: What is the most common cause of a scondary bone tumor? a.Osteosarcoma b.Ewing's sarcoma c.Multiple Myeloma d.Chondrosarcoma e.Metastasis f.Fibrosarcoma 294. e. Metastasis: What is the most common OVERALL cause of bone tumors? a.Osteosarcoma b.Ewing's sarcoma c.Multiple Myeloma d.Chondrosarcoma e.Metastasis f.Fibrosarcoma 295. a. Osteosarcoma: What is the most common primary malignancy of "proper" bone? a.Osteosarcoma b.Ewing's sarcoma c.Multiple Myeloma d.Chondrosarcoma e.Metastasis f.Fibrosarcoma 296. a. Benign: A well-defined lesion typically indicates that it's: 72 / 115 a.Benign b.Malignant 75 / 115 b.Well-defined cortex and sacroiliitis c. Ill-defined, lytic, cortical destruction d.Mixed cystic density with articular collapse 305. a. Colon cancer: What is the most likely cause of this? a.Colon cancer b.Ankylosing spondylitis c.AVN d.Osteopoikilosis 306. None: What other x-rays are needed with metastasis? 307. b. PET CT d. MRI: What other imaging is needed with metastasis? a.CT b.PET CT c.X-ray d.MRI 308. b. PET CT (to visualize metabolic activity of whole body): Which imaging is used if there's known metastasis? a.CT b.PET CT c.X-ray d.MRI 309. d. Oncologist: Who should this patient be referred to? a.Adjust them b.Orthopedist c.Endocrinologist d.Oncologist e.Hematologist 310. 1. Blastic 2. Lytic 3. Mixed: What are the 3 types of metastasis? 311. 1. Paget's 2. Lymphoma 3. Mets: What are the DDX for Ivory White Vertebra? 312. b. Paget's: A "Picture Frame" vertebra is seen with which condition? a.Metastasis b.Paget's c.Lymphoma 76 / 115 d.Chordoma 77 / 115 313. c. Lymphoma: Anterior vertebral body scalloping seen in conjunction with an ivory white vertebra is likely caused by which condition? a.Metastasis b.Paget's c.Lymphoma d.Chordoma 314. c. Ivory white vertebra at C2 and C6: Which are the most accurate radi- ographic findings for these images? a.Picture frame vertebra with ivory white vertebra b.Thick, flowing ossification seen at the anterior aspects of vertebral bodies with relative preservation of disc space c. Ivory white vertebra at C2 and C6 d.Calcification posterior to the posterior arch of atlas 315. b. Metastasis: What is the most probable diagnosis for this patient? a.Lymphoma b.Metastasis c.Primary bone malignancy d.Paget's 316. c. PSA: What type of blood work would you recommend for a patient with blastic metastasis? a.Enzyme assay (EIA) b.Urine assay c.PSA d.CBC e.Arthritic panel 317. c. PSA: What type of blood work would you recommend for this patient? a.Enzyme assay (EIA) b.Urine assay c.PSA d.CBC w/ differential e.Arthritic panel f.A1C g.Parathyroid immunoassay (PTH) h.Comprehensive Metabolic Panel (CMP) 318. d. Acid phosphatase: What type of blood work would you recommend for a patient with Paget's disease? 80 / 115 a.AC separation b.Osteosarcoma c.Ewing's sarcoma d.HADD 326. e. Fibrous Dysplasia: A well-defined, ground glass matrix describes what condition? a.Neurofibromatosis b.Chordoma c.Ewing's sarcoma d.ABC e.Fibrous Dysplasia f.GCT 327. e. Fibrous Dysplasia: What is the most likely diagnosis in this patient? a.Neurofibromatosis b.Chordoma c.Ewing's sarcoma d.ABC e.Fibrous Dysplasia f.GCT 328. NONE: What other imaging/x-rays are needed for fibrous dysplasia? 329. YES: Can you adjust a patient with Fibrous Dysplasia? 330. c. Osteochondroma: What is the most common tumor of the APPENDICU- LAR skeleton? a.Osteosarcoma b.Chordoma c.Osteochondroma d.Ewing's sarcoma e.Fibrosarcoma f.Enchondroma 331. c. Osteochondroma: What is the most likely diagnosis? a.Osteosarcoma b.Chordoma c.Osteochondroma d.Ewing's sarcoma e.Fibrosarcoma f.Enchondroma 332. c. MRI of the knee: A patient with an osteochondroma of the 81 / 115 knee is complain- ing of worsening pain. What imaging would you request? a.Flexion/Extension films 82 / 115 b.Tunnel view c.MRI of the knee d.CT 333. c. Orthopedist (Osteochondroma = Benign): Who should a patient with an osteochondroma be referred to? a.Oncologist b.Hematologist c.Orthopedist d.PCP e.Endocrinologist 334. a. True: You can adjust an osteochondroma patient. a.True b.False 335. d. Osteosarcoma: This spiculated periosteal reaction is most likely caused by what? a.Ewing's sarcoma b.Multiple myeloma c.Osteochondroma d.Osteosarcoma e.Fibrosarcoma 336. : According to this image, what is the most likely diagnosis? a.Ewing's sarcoma b.Multiple myeloma c.Osteochondroma d.Osteosarcoma e.Fibrosarcoma 337. a. A complete Tib/Fib series: What x-rays would be requested for this patient? a.A complete Tib/Fib series b.None, referral c.AP and Lateral ankle d.AP and Lateral knee 338. a. MRI of the lower limb c. Chest series (X-ray) (For cannon ball mets): What additional imaging would be requested for a suspect- ed osteosarcoma in this patient? (Pick 2) a.MRI of the lower limb b.MRI of the chest 85 / 115 c.Chordoma d.Hemangioma 345. c. Central canal/neurological symptoms: What is the ONLY time we don't adjust a patient with a hemangioma? 86 / 115 a.Asymptomatic b.Cardiovascular symptoms c.Central canal/neurological symptoms d.When GI symptoms are present 346. a. Less than 20: What ages are Aneurysmal Bone Cysts commonly seen in? a.Less than 20 b.20-40 c.50+ d.Any age 347. b. 15-35: What ages are Enchondromas commonly seen in? a.10-30 b.15-35 c.20-40 d.40+ e.Any age 348. b. 20-40: What ages are Giant Cell Tumors commonly seen in? a.Less than 20 b.20-40 c.50+ d.Any age 349. b Ollier disease: Multiple Enchondromas is termed: a.Maffucci syndrome b Ollier disease 350. a. Maffucci syndrome: Multiple Hemangiomas is termed: a.Maffucci syndrome b Ollier disease 351. a. 5-10: What ages are Simple Bone Cysts seen in? a.5-10 b.10-20 c.15-35 d.20-40 352. b. GCT: Which is well-defined, lucent soap bubble appearance, eccentric, found in the epiphysis, quasi-malignant? a.SBC b.GCT c.ABC 87 / 115 d.Osteochondroma 353. c. ABC: Which is well-defined, lucent soap bubble appearance, central, found in the metaphysis, and benign? 90 / 115 b.Solid mass c.Concretion d.Cyst wall 91 / 115 366. a. Conduit wall: Which term is used to describe something lining a tube that conveys a fluid? a.Conduit wall b.Solid mass c.Concretion d.Cyst wall 367. a. Conduit wall: Atherosclerosis or Vas deferens calcification should be de- scribed by which term? a.Conduit wall b.Solid mass c.Concretion d.Cyst wall 368. b. Solid mass: A leiomyoma and lymph node calcification are described as: a.Conduit wall b.Solid mass c.Concretion d.Cyst wall 369. d. Cyst wall: A is found within the wall of a fluid filled cyst or hollow organ that measures greater than 5 cm a.Conduit wall b.Solid mass c.Concretion d.Cyst wall 370. a. True: The kidneys are "posterior" meaning that nephrolithiasis will superim- pose the vertebral bodies a.True b.False 371. c. A retroperitoneal calcification: Which of the following is seen on this film? a.Conduit wall calcification anterior to the vertebral body b.A solid mass anterior to the vertebral bodies c.A retroperitoneal calcification d.A cyst wall calcification anterior to the vertebral bodies 372. 1. Kidneys 2. Pancreas: What 2 organs are retroperitoneal? 373. Kidney stones: What is seen on this image? 374. c. CT (Kidney = Solid organ = CT): What additional imaging is needed for this 92 / 115 patient? a.MRI b.US 95 / 115 b.GFR c.None d.A1C 96 / 115 389. b. Vascular surgeon (or PCP): What is the appropriate referral for this patient? a.Endocrinologist b.Vascular surgeon c.Nephrologist d.Hematologist e.Gastroenterologist 390. Yes (but need referral, too): Can you adjust this patient? 391. b. Vas deferens calcification c. Phleboliths: What are the findings on this radiograph? a.Leiomyoma b.Vas deferens calcification c.Phleboliths d.Avascular necrosis e.Sacroiliac erosions 392. b. Type 2 diabetes (Vas deferens ca++ = Type 2 diabetes!): What other examination findings would you expect in this patient? a.Dysuria b.Type 2 diabetes c.Hyper-Parathyroidism d.Sickle cell anemia 393. d. Type 2 diabetes: Vas deferens calcification is associated with which condi- tion? a.HPT b.Multiple Myeloma c.Hemochromatosis d.Type 2 diabetes e.AVN 394. a. A1C (vas deferens ca++): What blood work would you request for this patient? a.A1C b.CBC w/ differential c.Urine Assay d.Parathyroid immunoassay (PTH) e.Comprehensive Metabolic Panel (CMP) f.Arthritic panel g.Enzyme assay (EIA) 97 / 115 395. d. PCP: What is the appropriate referral for this patient? a.Endocrinologist b.Vascular surgeon c.Nephrologist d.PCP e.Gastroenterologist 396. : Can you adjust this patient? 397. d. Cystic wall calcification superior to the common iliac arteries: What is the appropriate way to describe this radiograph? a.Conduit wall calcification anterior to the vertebral bodies without dilation b.A solid mass anterior in the right lower quadrant c.Multiple concretion calcifications in the right lower quadrant d.Cystic wall calcification superior to the common iliac arteries 398. b. US c. CT: What additional imaging would you request for this patient? a.MRI b.US c.CT d.None 399. : What blood work would you request for this patient? a.CBC w/ differential b.GFR c.None d.A1C 400. b. Vascular surgeon: What is the appropriate referral for this patient? a.Gynecologist b.Vascular surgeon c.Nephrologist d.PCP e.Gastroenterologist 401. NO! (AAA): Can you adjust this patient? 402. Leiomyoma (Look at base of image in pelvic basin): What is the radiographic finding on this image? 403. b. US: What additional imaging would you request for this patient?