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Multiple-choice questionnaire: Musculoskeletal radiology

Up to 6 Credits per year may be obtained through journal CME.

Answers will be printed in Imaging 16(2), and will also be available on the BIR's website www.bir.org.uk following the above submission deadline.

	Questions

Top Questions

 
Question 1
Regarding trauma of the appendicular skeleton:

1. The Segond fracture is highly associated with posterior cruciate injuries.
   
2. The trochlear ossification centre develops before the medial epicondyle ossification centre.
   
3. The Monteggia fracture-dislocation comprises a fracture of the ulna and a radial head dislocation.
   
4. The most common ligament injured following inversion of the ankle is calcaneofibular ligament.
   
5. Weber A fractures of the ankle tend to be more stable than Weber C fractures.
   

Question 2
Regarding trauma of the appendicular skeleton:

1. A normal Boehler's angle measures 60–90°.
   
2. With lunate dislocations the lunate rotates 90° in the volar plane.
   
3. In the adult an elbow effusion following trauma most often relates to a radial head or neck fracture.
   
4. The Schatzker classification refers to ankle injuries.
   
5. Lisfranc injuries invariably involve the base of the second metatarsal.
   

Question 3
Regarding the imaging of synovitis:

1. On MRI, short tau inversion recovery sequences are the gold standard for demonstrating synovitis.
   
2. Ultrasound with power Doppler is more sensitive than MRI for synovitis.
   
3. On MRI normal synovium enhances with intravenous gadolinium.
   
4. On ultrasound synovium typically appears hyperechoic.
   
5. On MRI subchondral marrow oedema precedes erosions.
   

Question 4
Regarding inflammatory arthropathies:

1. Joint space loss usually occurs in the weight-bearing portion of the joint.
   
2. Preservation of bone density is a feature of Reiter's disease.
   
3. Ultrasound detects erosions earlier than conventional radiography.
   
4. Synovitis is a recognised feature of osteoarthritis.
   
5. Joint involvement in systemic lupus erythematosus typically results in erosions.
   

Question 5
Regarding the elbow:

1. Ruptures of the biceps tendon usually involve the proximal long head.
   
2. Medial collateral ligament injuries are more common in North America than Europe.
   
3. Olecranon bursitis is usually due to infection.
   
4. Osteochondritis dissecans usually occurs in children aged 7 to 12 years.
   
5. Lateral epicondylitis is more common than medial epicondylitis.
   

Question 6
Regarding the elbow:

1. Synovial osteochondromatosis usually affects multiple joints.
   
2. The pseudodefect of the capitellum is located anteriorly.
   
3. Ulnar nerve entrapment results in the "supinator syndrome".
   
4. On MRI articular cartilage is best seen on T₁ sequences after intravenous gadolinium.
   
5. Haemosiderin deposition is most conspicuous on gradient echo sequences.
   

Question 7
Regarding the hip:

1. Fracture lines are best seen on T₁ weighted sequences.
   
2. Bone scintigraphy, although less specific, is more sensitive than MRI for occult fractures.
   
3. The "double line sign" is considered pathognomonic for avascular necrosis.
   
4. Transient osteoporosis is most commonly encountered in pregnant women.
   
5. On MRI small subchondral fractures are often encountered in transient osteoporosis.
   

Question 8
Regarding the hip:

1. MR arthrography is required for accurate diagnosis of acetabular labral tears.
   
2. In Europe most acetabular labral tears occur in the anterosuperior labrum.
   
3. The "snapping hip" syndrome is usually encountered in middle-aged females.
   
4. The synovial herniation pit occurs in the head of the femur.
   
5. Femoral head avascular necrosis occurs more often after extracapuslar than intracapsular fractures.
   

Question 9
Regarding the wrist:

1. The vascularity of the distal pole of the scaphoid is at risk from scaphoid waist fractures.
   
2. Kienbocks disease is associated with positive ulnar variance.
   
3. On arthrography communication is seen between the radiocarpal joint and midcarpal row in up to 20% of subjects.
   
4. Traumatic triangular fibrocartilage complex (TFCC) tears usually involve the peripheral portion of the cartilage.
   
5. De Quervain's tenosynovitis typically occurs in manual workers.
   

Question 10
Regarding the wrist and hand:

1. The majority of ganglions arise in the region of the dorsal scapholunate ligament.
   
2. The most common solid lesion is the giant cell tumour of the tendon sheath.
   
3. Dorsal intercalated segment instability (DISI) is associated with scapholunate ligament tears.
   
4. On ultrasound the most reliable sign of carpal tunnel syndrome is increased echogenicity of the nerve.
   
5. Without intra-articular contrast MRI is unreliable for detection of intrinsic ligament tears.
   

Question 11
Regarding rotator cuff:

1. Full thickness tears can be confidently diagnosed on T₁ weighted images.
   
2. Partial tears are more commonly seen on the bursal surface of the tendon.
   
3. MRI is significantly more sensitive than ultrasound in identifying full thickness tears.
   
4. There is a correlation between the presence of the subacromial fluid and rotator cuff tear.
   
5. Degeneration of the cuff is usually seen as a diffuse reduction in echogenicity on ultrasound.
   

Question 12
Regarding meniscal tears:

1. Horizontal oblique tears are commonly associated with degenerative disease.
   
2. Radial tears of the lateral meniscus most commonly involve the posterior third.
   
3. The meniscofemoral ligament can result in an apparent tear of the posterior third of the medial meniscus.
   
4. Lateral meniscal tears are more common in children.
   
5. A meniscocapsular separation can be diagnosed if there is anterior subluxation of the medial meniscus greater than 0.5 cm.
   

Question 13
Regarding swellings of the knee:

1. A confident diagnosis of pigmented villonodular synovitis can be made on ultrasound due to the unique echogenic pattern.
   
2. Lipoma arborescens is best diagnosed on the T₂ weighted MRI sequences.
   
3. 80% of meniscal cysts detected on MRI involve the medial meniscus.
   
4. Although a Baker's cyst can be identified on ultrasound MRI is usually required to differentiate this entity from other cystic lesions.
   
5. The most common periarticular soft tissue malignant tumour in a young adult is a synovial sarcoma.
   

Question 14
Regarding tendinosis around the ankle:

1. Tibialis posterior is more commonly affected than flexor digitorum longus.
   
2. Achilles tendinosis typically occurs at the musculotendinous junction.
   
3. Longitudinal split occur more commonly in peroneus brevis than peroneus longus.
   
4. Excessive fluid within the flexor hallicus longus sheath usually implies tendinosis.
   
5. In over 95% of Achilles tendon rupture there is underlying Achilles tendinosis.
   

Question 15
Regarding the diabetic foot:

1. Intramedullary high signal on MRI is a reliable way of differentiating infection from neuropathic arthropathy.
   
2. In approximately 50% of cases of infection there is an associated communicating ulcer.
   
3. Following intravenous gadolinium reactive oedema only enhances in 10% of cases aiding differentiation from infection.
   
4. Mid foot abnormality favours the diagnosis of neuropathic foot rather than infection.
   
5. Technetium 99m bone scan is useful in differentiating an infected from a neuropathic joint.
   

Question 16
Regarding total hip replacement:

1. Technetium 99 m bone scan is a reliable method of differentiating loosening from infection.
   
2. A 1 mm lucency at the entire bone cement interface at the acetabular component implies loosening.
   
3. A break in the cement implies loosening.
   
4. Infection is usually seen later than 2 years following implant insertion.
   
5. A sclerotic pedestal at the tip of an uncemented femoral component is associated with loosening.
   

Question 17
Regarding shoulder replacements:

1. The glenoid component is more susceptible to loosening compared with the humeral component.
   
2. Lucency at the bone cement interface of the glenoid component is a common finding in the immediate post-operative period.
   
3. Subsidence of the humeral prosthesis may result in impingement.
   
4. A hemiarthroplasty is usually used in patients with rheumatoid arthritis.
   
5. Symptomatic heterotopic ossification is seen in approximately 15% of patients.
   

Question 18
Regarding malignant bone tumours:

1. The proximal femur is the most common site for a parosteal sarcoma.
   
2. Cortical destruction is diagnostic of an aggressive malignant tumour.
   
3. Ewing's sarcoma typically involves the metaphysis.
   
4. Scintigraphy is highly sensitive technique for myeloma.
   
5. Osteogenic sarcoma is the most common secondary tumour in Paget's disease.
   

Question 19
Regarding benign tumours of bone:

1. Osteofibrous dysplasia involves the tibia in 40–50% of cases.
   
2. Fibrous dysplasia results in focal increased uptake of isotope on bone scintigraphy.
   
3. Ostefibrous dysplasia is bilateral in approximally 30% of cases.
   
4. Chondroblastoma is most commonly found in the epiphysis.
   
5. Osteoid osteoma is typically seen as lytic lesion on CT.
   

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