Internal Derangement I & II Flashcards by Jojo Barnes-Jones

A patient presents with anterior knee pain and swelling anterior to the inferior pole of the patella and proximal to the patellar tendon caused by the repetitive trauma of kneeling. What is the most likely condition?

A. Preachers knee

B. Deep infrapatellar bursitis

C. Superficial infrapatellar bursitis

D. Housemaids knee

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Sagittal MRI images of the knee reveal more than two bowtie signs. What is your primary consideration?

A. Severe osteoarthritis

B. Discoid meniscus

C. Flipped meniscus

D. Post operative meniscus

B. Discoid meniscus

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The high intensity signal plane between the achilles tendon_____ and be mistaken for a partial tear.

A. Tendon of the peroneus quartus

B. Plantaris muscle tendon

C. Tendon of the popliteus muscle

D. Tendon of the flexor hallucis muscle

B. Plantaris muscle tendon

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Which of the following does NOT mimic a tear of the posterior horn of the lateral meniscus?

A. Popliteus tendon

B. Popliteal A. pulsation

C. Magic angle phenomenon

D. Meniscocapsular separation

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Which of the following is NOT a component of the pes anserine?

A. Semitendonosis

B. Semimembranosis

C. Sartorius

D. Gracilis

B. Semimembranosis

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The double posterior cruciate ligament (PCL) sign is associated with what type of meniscal tear?

A. Flap

B. Oblique/horizontal

C. Radial

D. Bucket handle

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The absence of a low signal intensity filling defect in a fluid-filled bicipital groove on MRI is most likely associated with:

A. Full thickness tear of the supraspinatous tendon

B. Subacromial-subdeltoid bursitis

C. Rupture of the long head of the biceps tendon

D. SLAP 3 lesion

C. Rupture of the long head of the biceps tendon

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What is the common accessory muscle of the ankle is seen at the anterior medial aspect of the Achilles tendon on MRI?

A. The accessory soleus muscle

B. The peroneus quartus muscle

C. The tibialis posterior accessorius muscle

D. The subtibiale muscle

A. The accessory soleus muscle

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A synovial cyst located in the suprascapular notch has the potential to compress what nerve?

A. Suprascapular

B. Subscapular

C. Long thoracic

D. Axillary

A. Suprascapular

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An accessory articulation is noted at the distal acromion separate from the acromioclavicular joint in an adult patient complaining of shoulder impingement symptoms. What is the diagnosis?

A. Type 5 acromion

B. Normal ossification center

C. Nonunion acromial fracture

D. Os acromiale

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Which of the following is NOT a cause of tarsal tunnel syndrome?

A. Ganglion cyst

B. Bony tarsal coalition

C. Pannus formation

D. Split peroneal tendon

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Evaluation of which of the following conditions would NOT warrant the addition of intravenous gadolinium to an MRI study?

A. Septic arthritis

B. Morton’s neuroma

C. Osteochondral fragment

D. Suggested bony neoplasia

C. Osteochondral fragment

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A paralabral cyst extending from a posterosuperior labral tear into the spinoglenoid notch, without affecting the quadrilateral space, can lead to denervation of which of the following muscles?

A. Supraspinatus

B. Infraspinatus

C. Teres minor

D. Subscapularis

B. Infraspinatus

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Injuries to which tendon most likely leads to a pes planus deformity?

A. Tibialis posterior

B. Flexor hallucis longus

C. Tibialis anterior

D. Peroneus brevis

A. Tibialis posterior

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Which of the following is false concerning a partial tear of the supraspinatus?

A. Articular surface tears are most common

B. Arthrographic contrast will enter the tear if it is a superficial surface tear

C. Arthrographic contrast will not enter the tear if it is a bursal surface tear

D. Arthrographic contrast will enter the tear if it is an intrasubstance tear

B. Arthrographic contrast will enter the tear if it is a superficial surface tear

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An increased signal intensity within the meniscal substance on short TE images not extending to the articular surface represents:

A. Meniscal degeneration

B. Grade 3 meniscal tear

C. Torn meniscofemoral ligament

D. Meniscal cyst

A. Meniscal degeneration

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The MRI appearance of a bone bruise reveals which of the following?

A. Low signal intensity on T1-and T2-weighted images

B. High signal intensity on T1-and T2-weighted images

C. Low signal intensity on T1-weighted images and high signal intensity on T2-weighted images

D. High signal intensity on T1-weighted images and low signal intensity on T2-weighted images

C. Low signal intensity on T1-weighted images and high signal intensity on T2-weighted images

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Simultaneous bucket-handle tears of both menisci has been termed:

A. The “Jack and Jill” lesion.

B. The “double handle” tear.

C. The “double flipped” meniscus.

D. The “complex bucket-handle” tear.

A. The “Jack and Jill” lesion.

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A young athlete presents with shoulder pain exacerbated by internal and external rotation, and abduction. The MRI reveals subacromial/subdeltoid bursal fluid and a thickened coracoacromial ligament. What is the most likely diagnosis?

A. Rotator cuff tear

B. Repetitive stress syndrome

C. Impingement syndrome

D. HAGL lesion

C. Impingement syndrome

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An MRI of a patient’s left knee demonstrates infrapatellar tendon thickening with high signal intensity at the proximal third on a T2WI. What is the most likely diagnosis?

A. Runners knee

B. Jumpers knee

C. Housemaids knee

D. Tailors knee

B. Jumpers knee

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The appearance of partial glenoid-labral separation has been described as a normal finding and should not be mistaken for an avulsion. Which of the following anatomical structures is responsible for this described imaging finding known as “undercutting”?

A. Synovial fluid

B. Fibrocartilage

C. Hyaline cartilage

D. Adipose tissue

E. Collagen-fibrous tissue

C. Hyaline cartilage

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A “cyclops lesion” of the knee is:

A. A rounded fibrotic mass anterior to the ACL graft secondary to an ACL reconstruction

B. A fractured proximal tibial screw secondary to an ACL reconstruction.

C. A medullary tunnel through which the patellar tendon is inserted during an ACL reconstruction

D. A focal deepening of the intercondylar notch representing roof impingement secondary to an ACL reconstruction

A. A rounded fibrotic mass anterior to the ACL graft secondary to an ACL reconstruction

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A large meniscus with loss of normal semilunar shape filling the lateral compartment of the knee that can be associated with clicking is named what?

A. FLAP meniscus

B. Bucket-handle meniscus

C. Discoid meniscus

D. Flipped meniscus

C. Discoid meniscus

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Which of the following statements correctly describes the orientation of the meniscofemoral ligaments with respect to the posterior cruciate ligament (PCL)?

A. The ligament of Humphrey passes posterior to the PCL, while the ligament of Wrisberg is anterior.

B. Both ligaments pass anterior to the PCL.

C. Both ligaments pass posterior to the PCL.

D. The ligament of Humphrey passes anterior to the PCL, while the ligament of Wrisberg is posterior.

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**Which of the following is an MRI finding of Achilles tendinosis?** A. Bony erosion at the tendon insertion B. High T1 and low T2 signal surrounds the tendon C. Associated with tenosynovitis D. Fusiform tendon enlargement

D. Fusiform tendon enlargement

**Partial loss of muscle strength, some torn fibers, and interstitial blood within a muscle is classified as?** A. Delayed-onset muscle soreness B. Grade I muscle strain C. Grade 11 muscle strain D. Grade III muscle strain

C. Grade 11 muscle strain

**Which of the following is NOT a direct sign of a full-thickness tear of the supraspinatus tendon?** A. Discontinuity of the tendon seen on conventional MR studies. B. High signal intensity fluid traversing between the articular and bursal surfaces of the tendon. C. Intermediate intrasubstance signal changes on T1 and T2-weighted MR images. D. Longitudinal intrasubstance signal from the musculotendinous junction to the insertion.

C. Intermediate intrasubstance signal changes on T1 and T2-weighted MR images.

A type Ill acromion is: A. Flat B. Curved C. Hooked D. Convex

C. Hooked **Type I: flat inferiorly (12%)** **Type II: curved (56%)** --\> parallel to the humeral head with a concave undersurface; considered most common type **Type III: hooked (29%)** --\> the most anterior portion of the acromion has a hooked shape; associated with increased incidence of shoulder impingement **Type IV: convex (upturned) (3%)** --\> most recent classification of acromion process shape; the undersurface of the acromion is convex near the distal end; no convincing correlation between a type 4 acromion and impingement syndrome exists

**Conventional radiographs may demonstrate a displaced osseous fragment, but are otherwise unreliable for assessing lesion stability. MRI is able to demonstrate the fragment, overlying cartilage, and the interface between the fragment and parent bone. MRI signs (seen on T2W or STIR imaging) of an unstable fragment include all of the following except one.** A. Linear signal intensity completely surrounding the fragment B. 5mm or larger bony fragment C. 5mm or larger cystic changes between fragment and host bone D. 5mm or larger cartilage defect

B. 5mm or larger bony fragment

**An MRI shows an intramuscular hematoma that has an intermediate signal intensity on T1WI and low signal intensity on T2WI. How old is this lesion?** A. Hyperacute B. Acute C. Subacute D. Chronic

B. Acute

**A rotator interval tear can be seen with all of the following except:** A. Anterior shoulder dislocation B. Posterior shoulder dislocation C. Anterior shoulder instability D. Secondary to an arthroscopic procedure

B. Posterior shoulder dislocation

**What type of meniscal tear is the most common type and is likely degenerative in nature?** A. Vertical B. Oblique/horizontal C. Radial D. Peripheral

B. Oblique/horizontal

**Which of the following is not part of O'Donoghue's triad?** A. ACL tear B. MCL tear C. PCL tear D. Medial meniscus tear

C. PCL tear

**An impaction fracture of the anteromedial humeral head is termed what?** A. Hill-Sachs fracture B. Trough sign C. Bankart fracture D. Hachet sign

B. Trough sign

**A linear fluid signal within the superior labrum on coronal oblique shoulder images represents:** A. A HAGL lesion B. A GLAD lesion C. A cartilaginous Bankart lesion D. A SLAP lesion

D. A SLAP lesion

**Which of the following is NOT seen with lateral patellar dislocation on MRI?** A. Medial patellar facet osteochondral defect B. Lateral patellar facet bone contusion C. Anterior lateral femoral condyle osteochondral defect and/or bone contusion D. Medial patellar retinaculum tear

B. Lateral patellar facet bone contusion

**The presence of retro-Achilles bursitis, retrocalcaneal bursitis and thickening of the distal Achilles tendon associated with a superolateral calcaneal prominence is known as:** A. Hawking's sign B. Kager's disease C. Haglund's disease D. Achilles chronic strain/bursitis syndrome

C. Haglund's disease

**Which of the following locations may demonstrate a curvilinear area of persisting red marrow as a normal variant on MRI.** A. Humeral epiphysis B. Tibial plafond C. Capitellum D. Scapula

A. Humeral epiphysis

**Which of the following is not true of a mesotendon?** A. Located on the frictional tendon surface B. Forms where the tendon invaginates the sheath C. Carries blood vessels D. Low signal on MRI

A. Located on the frictional tendon surface

**Normal marrow conversion from red to yellow marrow in a long bone during youth follows which of the following sequence (first to convert \> last to convert)?** A. Epiphyses \> metaphyses \>diaphyses B. Metaphyses \> diaphyses \> epiphyses C. Epiphyses \> diaphyses \> metaphyses D. Diaphyses \> metaphyses \> epiphyses

C. Epiphyses \> diaphyses \> metaphyses

**Rotator cuff interval tears may occur secondary in which of the following causes?** A. Anterior glenohumeral dislocations. B. Anterior shoulder instability. C. Post-surgical defect resulting from arthroscopy. D. All of the above are possibilities.

D. All of the above are possibilities.

**Medial dislocation of the patella is less common than lateral dislocations, but may be associated with:** A. Patella baja. B. Muscular weakness. C. Surgical release of the lateral patellar retinaculum. D. Genu recurvatum or valgum.

C. Surgical release of the lateral patellar retinaculum.

**The presence of irregularity (fibrillation and ulceration) of the hyaline cartilage of the lateral patellar facet seen on MRI is consistent with:** A. Bipartite patella B. Dorsal defect of the patella C. Inflammation of Hoffa's fat pat D. Chondromalacia patella

D. Chondromalacia patella

**Quadrilateral space syndrome results from compression of what nerve?** A. Suprascapular B. Subscapular C. Long thoracic D. Axillary

D. Axillary

**Which of the following is NOT a feature of Osgood-Schlatter Disease?** A. Hypertrophy or fragmentation of the tibial tubercle B. Thinning of the distal patellar ligament C. Edema within the adjacent soft tissues D. High incidence if bilaterality

B. Thinning of the distal patellar ligament

**An increase in the signal intensity of the teres minor and deltoid muscles indicating denervation on STIR images is classically seen with:** A. Quadrilateral space syndrome B. Bankart lesion C. Greater tuberosity fracture D. Rheumatoid arthritis

A. Quadrilateral space syndrome

**How do you differentiate the high signal intensity of a tendon tear from a high signal intensity created by the magic angle phenomenon within a tendon on T2\* (gradient echo)?** A. A tear will be hyperintense to muscle on T2\* B. A tear will be hypointense to muscle on T2\* C. A tear will be isointense to muscle on T2\* D. The magic angle phenomenon will disappear on T1

A. A tear will be hyperintense to muscle on T2\*

**A reverse Bankart lesion is associated with what type of glenohumeral dislocation?** A. Inferior B. Superior C. Anterior D. Posterior

D. Posterior

**A late subacute intramuscular hematoma classically demonstrates the following signals on T1-weighted and T2-weighted sequences respectively?** A. Bright, dark B. Dark, bright C. Dark, dark D. Bright, bright

D. Bright, bright

**Reconversion of yellow marrow to red marrow can be seen with multiple conditions. Which of the following is not associated with bone marrow reconversion?** A. Chronic rotator cuff tear B. High level athletes training in altitude C. Hemolytic anemias D. Obese women smokers

A. Chronic rotator cuff tear

**An older active patient injured his ankle while running uphill. The anterior portion of his ankle has a mass. Which structure is most likely torn?** A. Anterior tibialis tendon B. Anterior tibiotalar ligament C. Anterior talonavicular ligament D. Extensor hallucis longus tendon

A. Anterior tibialis tendon

**The two most common locations to observe a meniscal cyst in the knee are?** A. The posterior horn of the lateral meniscus and the and the posterior horn of the medial meniscus B. The anterior horn of the lateral meniscus and the anterior horn of the medial meniscus C. The posterior horn of the lateral meniscus and the anterior horn of the medial meniscus D. The anterior horn of the lateral meniscus and the posterior horn of the medial meniscus

D. The anterior horn of the lateral meniscus and the posterior horn of the medial meniscus

**The meniscofemoral ligament can produce the appearance of a pseudo-tear at the:** A. Anterior horn medial meniscus B. Posterior horn medial meniscus C. Anterior horn lateral meniscus D. Posterior horn lateral meniscus

D. Posterior horn lateral meniscus

**The two most common locations to observe tarsal coalition are**: A. Lateral cuneiform-cuboid and talocalcaneal B. Calcaneonavicular and talocalcaneal C. Talonavicular and talocalcaneal D. Naviculocuboid and talonavicular

B. Calcaneonavicular and talocalcaneal

**A crescent-shaped hyperintense signal seen on STIR images completely surrounding an irregular osteochondral defect at the lateral aspect of the medial femoral condyle in a teenager represents:** A. Osteochondritis dissecans (OCD) - stable injury B. Osteochondritis dissecans (OCD) - unstable injury C. Spontaneous osteonecrosis of the knee (SONK) - stable injury D. Spontaneous osteonecrosis of the knee (SONK) – unstable injury

B. Osteochondritis dissecans (OCD) - unstable injury

**Which of the following describes a Type 4 acromion shape?** A. Curved B. Hooked C. Flat D. Convex

D. Convex

**In regards to meniscal injuries, which of the following statements is correct?** A. Longitudinal tears are the most frequent type encountered. B. With most types of tears, the medial meniscus is involved more frequently than the lateral meniscus. C. The posterior horn of the medial meniscus and anterior horn of the lateral meniscus are most commonly affected. D. All of the statements are correct.

D. All of the statements are correct.

**Which of the following is NOT a sign of a bucket handle meniscal tear of the knee with displaced fragment?** A. Double PCL Sign B. Parrot Beak Sign C. Double Delta Sign D. Absent Bowtie Sign

B. Parrot Beak Sign

**Which of the following condition is NOT associated with a progressively painful compression of the supraspinatus tendon and subacromial bursa between the humeral head and the coracoacromial arch?** A. Acromioclavicular joint osteoarthritis B. Subacromial enthesophyte C. Adhesive capsulitis D. Glenohumeral instability

C. Adhesive capsulitis

**An avulsion of the inferior glenohumeral labroligamentous complex from the anterior inferior glenoid while maintaining an intact anterior scapular periosteum represents:** A. Bankart lesion B. Subscapularis tear C. Adhesive capsulitis D. Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion

D. Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion

**The lateral notch sign is associated with a tear of what ligament?** A. LCL B. ACL C. PCL D. MCL

B. ACL

**A Bennett lesion in the shoulder represents:** A. A partial thickness tear of the biceps tendon in the rotator interval B. A variant of SLAP lesion involving only the posterior labrum C. A post-surgical artifact on the greater tuberosity secondary to an anchor point for a rotator cuff repair D. Heterotopic ossification posterior to the glenohumeral joint with thickening of the posterior capsule

D. Heterotopic ossification posterior to the glenohumeral joint with thickening of the posterior capsule

**Which of the following type of SLAP lesion is characterized by separation of the superior portion of the glenoid labrum and the tendon of the long head of the biceps from the glenoid rim?** A. Type 1 B. Type 11 C. Type III D. Type IV

B. Type 11

**Which of the following lesions is best described as a non-displaced labroligamentous avulsion with lifting but not disruption of the scapular periosteum?** A. The Bankart lesion. B. The Perthes lesion. C. The ALPSA lesion. D. The Buford complex.

B. The Perthes lesion.

**Which of the following statements is true concerning the vascular supply of the menisci?** A. The menisci are described as having a central vascular portion, the red zone, and an avascular peripheral portion termed the white zone. B. The menisci are completely avascular. C. The menisci are described as having a peripheral vascular portion, the red zone, and an avascular central portion termed the white zone. D. The central portion of the menisci are highly vascular.

C. The menisci are described as having a peripheral vascular portion, the red zone, and an avscular central portion termed the white zone.

**A Buford complex is:** A. A sublabral foramen at the inferior aspect of the glenoid rim B. A congenital absence of the anterior superior labrum with an enlarged middle glenohumeral ligament C. A paralabral cyst extending from the anterior labroligamentous complex D. A full-thickness tear of the subscapularis tendon with medial dislocation of the long head of the biceps tendon

B. A congenital absence of the anterior superior labrum with an enlarged middle glenohumeral ligament

**A globular low signal intensity mass on all pulse sequences of the rotator cuff tendons, often surrounded by edema or partial thickness tear, represents most likely:** A. HAGL B. GLAD C. HADD D. ALPSA

C. HADD

**What is the most common ATRAUMATIC cause of avascular necrosis?** A. Corticosteroids B. Lupus C. Barotrauma D. Sickle cell

A. Corticosteroids

C. Grade Il muscle strain

**Your patient demonstrates anterior and posterior fat pad signs at the elbow in the absence of trauma. Which of the following would you suspect?** A. Pannus B. Olecranon bursitis C. Osteochondritis dissecans D. Secondary synoviochondrometaplasia

A. Pannus

**What anatomic structure acts as the ulnar attachment of the distal flexor retinaculum?** A. Hook of hamate B. Pisiform C. Triquetral tubercle D. Base of 5th metacarpal

A. Hook of hamate

**Deficient growth of the medial aspect of the radial plateau results in what?** A. Positive ulnar variance B. Medelungs deformity C. Negative ulnar variance D. Radial styloideum

B. Medelungs deformity

**Decreased sensation to the 4th and 5th fingers indicates nerve compression at what site?** A. Tunnel of Guyon B. Arcade of Frohse C. Pronator teres D. Quadralateral space

A. Tunnel of Guyon

**Which of the following is a contraindication to gadolinium enhancement of an MRI?** A. Bone neoplasia B. Renal failure C. Thyroid carcinoma D. Prostate enlargement

B. Renal failure

**Which of the following conditions is not associated with ulnar nerve neuropathy in the elbow?** A. Thickening of the cubital tunnel retinaculum (Osborne's ligament) B. Arcade of Struthers C. Anomalous muscle (anconeus epitrochlearis) D. Ostechondritis dissecans of the capitellum

D. Ostechondritis dissecans of the capitellum

**The presence of a displaced ulnar collateral ligament beneath the proximal edge of the adductor aponeurosis at the metacarpophalangeal joint of the thumb is called...** A. Gamekeeper's thumb B. Rolando's fracture C. Stener lesion D. Bennett's fracture

C. Stener lesion

**Your patient is highly claustrophobic. In order to obtain an MRI, which of the following would be indicated? MARK ALL THAT APPLY, 1-3 CORRECT ANSWERS** A. MD referral for Valium B. Open MRI C. Gadolinium enhancement D. No correct answer listed

A. MD referral for Valium B. Open MRI

**Wrist radiographs reveal a Terry Thomas sign and increased scapholunate angle. What is the diagnosis?** A. Scapholunate dissociation B. Dorsal intercalated segmental instability C. Lunotriquetral ligament tear D. Ventral intercalated segmental instability

B. Dorsal intercalated segmental instability

**Which of the following is NOT a contraindication to a lumbar spine MRI?** A. Pacemaker B. Cerebral aneurysm clips C. Total hip arthroplasty D. implanted TENS unit

C. Total hip arthroplasty

**Increased pressure within a closed fascial boundary and compromised circulation following injury is defined as:** A. Chronic compartment syndrome B. Acute compartment syndrome C. Exertional compartment syndrome D. Paradoxical compartment syndrome

B. Acute compartment syndrome

**The "catch up clunk" is a finding of what condition?** A. Midcarpal instability B. Ulnar impaction syndrome C. Ulnar impingement syndrome D. Kienbocks disease

A. Midcarpal instability

**Which of the following conditions occurs when hemorrhage or-edema within closed fascial boundaries leads to localized increased pressure with the compromise of the circulation?** A. Delayed onset muscle soreness (DOMS) B. Compartment syndrome C. Cellulitis D. Necrotizing fasciitis

B. Compartment syndrome

**Pigmented villonodular synovitis involving a tendon sheath is also known as what?** A. Giant cell tumor B. Extra-articular synovial osteochondromatosis C. DeQuervains disease D. Sanguine dactylitis

A. Giant cell tumor

**The most sensitive modality for the early detection of avascular necrosis of the femoral head is...?** A. MRI B. Scintigraphy C. CT D. Radiography

A. MRI

**Which of the following is NOT true regarding frequency-selective (chemical) fat saturation?** A. Requires a 1.0 tesla or higher field strength for adequate separation of the fat and water peaks. B. Utilizes a "spoiler" pulse that wipes out the signal from fat. C. is not sensitive to magnetic field inhomogeneities. D. It can be utilized after the intravenous administration of gadolinium.

C. is not sensitive to magnetic field inhomogeneties.

**Fatty atrophy and edema of the supinator muscle are seen in entrapment of which nerve?** A. Radial B. Median C. Ulnar D. Musculocutaneous

A. Radial

**Triangular fibrocartilage tear is associated with which of the following?** A. Positive ulnar variance B. Scaphoid fracture C. Distal radioulnar synostosis D. Bartons fracture

A. Positive ulnar variance

**Which of the following is NOT on the differential list for a distended olecranon bursa?** A. CPPD B. Gout C. HADD D. PVNS

A. CPPD

**What is the most common-source of osteochondral debris in a hip?** A. Degeneration B. Synoviochondrometaplasia C. CPPD D. PVNS

A. Degeneration

**Which of the following conditions is not usually associated with scapholunate ligament tear on MRI?** A. The scapholunate gap increased to over 3 mm B. Volar (palmar) flexion of the scaphoid on sagittal images C. Dorsal intercalated segmental instability (DISI) D. Volar intercalated segmental instability (VISI)

D. Volar intercalated segmental instability (VISI)

**A hyperintense T2 fluid collection is noted between the iliopsoas tendon and the anterior hip capsule in a patient with groin pain. What do you suspect?** A. Hip effusion B. Iliopsoas bursitis C. Ganglion cyst D. Tenosynovitis

B. Iliopsoas bursitis

**Which of the following MRI features is not usually seen with nerve sheath tumors:** A. String sign B. Split fat sign C. Target pattern D. Yo-yo sign

D. Yo-yo sign

**What is the relationship of slice thickness to structure resolution in MRI?** A. Increase thickness, increase resolution B. Increase thickness, decrease resolution C. Decrease thickness, decrease resolution

B. Increase thickness, decrease resolution

**Hypointense T1 thickening of the iliotibial tract adjacent to the greater trochanter is noted. What is the suspected diagnosis?** A. Snapping hip syndrome B. IT band syndrome C. Muscular contusion D. Trochanteric bursitis

A. Snapping hip syndrome

**Thickening and increased signal intensity on fluid-sensitive images at the origin of the pronator teres and flexor carpi radialis tendons is a sign of:** A. lateral epicondylitis B. medial epicondylitis C. ulnar neuritis D. coronoid osteoarthritis

B. medial epicondylitis

**What is the MRI imaging characteristic of late-stage/chronic avascular necrosis of the proximal pole of the scaphoid?** A. T1: hyper T2: hyper B. T1: hypo T2: hyper C. T1: hyper T2: hypo D. T1: hypo T2 hypo

D. T1: hypo T2 hypo

**De Quervain Syndrome is associated with which of the following?** A. Idiopathic B. Pregnancy C. Repetitive trauma D. All of the above E. None of the above

D. All of the above

**Femoroacetabular impingement syndrome results in injury to what soft tissue structure?** A. Acetabular labrum B. Teres ligament C. Iliopsoas tendon D. Femoral vascular supply

A. Acetabular labrum

**A traction apophysitis of the secondary ossification center at the medial epicondyle of the elbow, resultant from chronic valgus stress injuries, is known as:** A. Epicondylar osteochondritis B. Lateral epicondylitis C. Little leaguer's elbow D. Golfer's elbow

C. Little leaguer's elbow

**Which of the following is not a likely complication of compartment syndrome without treatment?** A. Necrosis B. Neurologic damage C. Infection D. Volkmann's contracture

C. Infection

**On axial imaging of the wrist, there is volar displacement of the ulna relative to the sigmoid notch of the radius. What ligament injury do you suspect?** A. Dorsal distal radioulnar B. Volar distal radioulnar C. Radial collateral D. Ulnar collateral

A. Dorsal distal radioulnar

**What is the mechanism most associated with biceps brachii distal tendon rupture?** A. Eccentric contraction of a flexed elbow B. Isometric contraction of a flexed elbow C. Isometric contraction of an extended elbow D. Concentric contraction of an extended elbow

A. Eccentric contraction of a flexed elbow

A. A tear will be hyperintense to muscle on T2\*

**Injury of what nerve is associated with posterior elbow dislocation?** A. Median B. Ulnar C. Radial D. Musculocutaneous

B. Ulnar

**Edema of the first dorsal extensor compartment (abductor pollicis longus and extensor pollicis brevis) of the wrist is named?** A. De Quervain's tenosynovitis B. Intersection syndrome C. Wartenberg's syndrome D. Dupuytren's tenosynovitis

A. De Quervain's tenosynovitis

**Which of the following MRI sequence is best used to identify a cartilaginous defect on both high field and low field magnets?** A. T1-weighted spin-echo B. T2-weighted fast spin-echo without fat saturation C. Proton density spin-echo without fat saturation D. STIR

D. STIR

**Which line angle is altered in pediatric patients with a supracondylar fracture of the humerus?** A. Anterior humeral line B. Radiocapitellar line C. Carrying angle D. Humeral articular line

A. Anterior humeral line

**What is the most common elbow fracture in adults?** A. Radial head B. Supracondylar C. Osteochondral D. Coronoid

A. Radial head

**Acetabular labral tears predispose a patient to the formation of what?** A. Paralabral cyst B. lliopsoas tendinosis C. Trochanteric bursitis D. Hip dislocation

A. Paralabral cyst

**A tear-drop shaped-fluid collection on axial MRI seen anterior to (and communicating with) the hip joint capsule and medial to the iliopsoas tendon represents most likely which of the following conditions:** A. Greater trochanteric bursitis B. iliopsoas bursitis C. Rectus femoris strain D. Piriformis syndrome

B. lliopsoas bursitis

**A circular lesion with low T1 and high T2 signal communicates with the scapholunate interval. What does this most likely represent?** A. Ganglion cyst B. Radiocarpal effusion C. Median neuroma D. Rheumatoid arthritis

A. Ganglion cyst

**What zone of the disc should be interposed between the mandibular condyle and temporal bone, regardless of the jaw position?** A. Anterior B. Intermediate C. Medial D. Posterior

B. Intermediate

**Loss of what joint space correlates strongly with the presence of rheumatoid arthritis?** A. Superior B. Axial C. Medial

B. Axial

**Which of the following explains why tendons appear dark on MRI sequences?** A. They contain little hydrogen B. They contain little to no fluid C. They have a density similar to cortical bone D. The hydrogen is tightly bound

D. The hydrogen is tightly bound

**Tears of the lunotriquetral ligament predispose to what?** A. VISI B. HADD C. SNAC D. SLAC

A. VISI

**What MRI pulse sequence uses a flip angle other than 90 degrees?** A. PD FS B. T2\* C. STIR D. MRA

B. T2\*

**What is the MRI imaging characteristic of acute Kienbocks disease?** A. T1: hyper T2: hyper B. T1: hypo T2: hyper C. T1: hyper T2: hypo D. T1: hypo T2 hypo

B. T1: hypo T2: hyper

**What is the relationship between scan time and signal to noise ratio (SNR) in MRI?** A. Increase scan time, increase SNR B. Decrease scan time, decrease SNR C. Increase scan time, decrease SNR

C. Increase scan time, decrease SNR

**Higher signal intensity within a normal tendon oriented obliquely (55) to the direction of the main magnetic field seen on MR images with short TEs represents:** A. An example of partial volume averaging B. Magic angle phenomenon C. A time-of-flight effect D. A wraparound artifact

B. Magic angle phenomenon

**What elbow ligament do we suspect injured in a baseball pitcher?** A. MCL B. LCL C. Annular

A. MCL

**An MRI shows an intramuscular hematoma that has an intermediate signal intensity on T1WI and low signal intensity on T2WI. How old is this lesion?** A. Hyperacute B. Acute C. Subacute D. Chronic

B. Acute

**What are the bone scan findings of acute avascular necrosis of the proximal pole of the scaphoid?** A. Severe increased uptake "hot" B. Mild increased uptake "warm" C. Photopenia D. Double density

C. Photopenia

**What is the most sensitive imaging modality for the detection of a suspected acetabular labral tear?** А. СТ B. CT +contrast C. MRI D. MR arthrogram

D. MR arthrogram

**A serpentine appearance of an enlarged median nerve seen on axial sequences of a magnetic resonance imaging scan of the wrist is distinctive of:** A. Carpal tunnel syndrome B. Fibrolipomatous hamartoma C. A Morton neuroma D. A neurofibroma

B. Fibrolipomatous hamartoma

**Which muscle is usually affected first in patients with lateral epicondylitis?** A. Extensor carpi radialis brevis B. Extensor digitorum C. Extensor digiti minimi D. Extensor carpi ulnaris

A. Extensor carpi radialis brevis

**What contrast enhancement pattern will be seen in early avascular necrosis on MRI when compared to adjacent normal bone marrow?** A. Increased enhancement B. Isointense enhancement C. Decreased enhancement

C. Decreased enhancement

**Midcarpal instability is associated with which of the following?** A. VISI B. SLAC C. SNAC D. DISI

A. VISI

**What pulse sequence is most sensitive for the evaluation of fibrocartilage?** A. T1 B. T2 C. PD D. STIR

C. PD

**Which of the following signs visualized on MRI of the wrist is not classically associated with carpal tunnel syndrome?** A. Cross-sectional enlargement of the median nerve at the level of the pisiform B. Hyperintensity of the median nerve on fluid sensitive images C. Thickening of the extensor carpi ulnaris tendon D. Palmar bowing of the flexor retinaculum at the level of the hamate

C. Thickening of the extensor carpi ulnaris tendon

**On arthrography, communication between the distal radioulnar compartment and the radiocarpal compartment is classically associated with?** A. Kienbock's disease B. Lunotriquetral dissociation C. Triangular fibrocartilage tear D. Extensor carpi ulnaris tendonitis

C. Triangular fibrocartilage tear

**What conditions are associated with acetabular labral tears? MARK ALL THAT APPLY, 1-4 CORRECT ANSWERS** A. Legg Calve Perthes B. Slipped capital femoral epiphysis C. Femoroacetabular impingement syndrome D. No correct answer listed E. Degenerative hip arthrosis

A. Legg Calve Perthes B. Slipped capital femoral epiphysis C. Femoroacetabular impingement syndrome E. Degenerative hip arthrosis

**Acute or chronic injury to the ulnar collateral ligament of the thumb at the 1st metacarpophalangeal joint is named?** A. Bennett lesion B. Rolando lesion C. Gamekeeper's thumb D. Chauffeur's thumb

C. Gamekeeper's thumb

**A positive ulnar variance severe enough to allow the transfer of excessive compressive forces from the ulna to the triquetrum and lunate via the triangular fibrocartilage, leading to early degenerative changes, is termed:** A. Ulnar impingement syndrome B. Ulnar impaction syndrome C. Kienböck's disease D. Calcium pyrophosphate dihydrate deposition disease

B. Ulnar impaction syndrome

**A depressed fracture of the lunate fossa of the distal radius is termed?** A. Colles B. Smiths C. Die punch D. Renfield

C. Die punch

**In an adult patient with elbow pain, you see a groove in the posterior aspect of the capitellum. What does this post likely represent?** A. Panners disease B. Osteochondritis dissecans C. Pseudodefect D. LCL avulsion

C. Pseudodefect

**Non-reversible avascular necrosis (AVN) of the hip can be differentiated from idiopathic transient osteoporosis of the hip (ITOH) on MRI because:** A. ITOH usually involves the acetabular region, sparing the femoral head B. The bone marrow edema is more prominent in AVN C. ITOH doesn't demonstrate joint effusion D. AVN will demonstrate a double line sign

D. AVN will demonstrate a double line sign

**Your patient is a machinist. What x-ray must be done prior to obtaining an MRI to evaluate for metallic foreign bodies?** A. PA hands B. Waters skull C. Submentovertex D. Ballcatchers

B. Waters skull

**Which of the following statements is NOT true regarding fat saturation utilizing the STIR technique?** A. is not sensitive to magnetic field inhomogeneities. B. Utilizes a "spoiler" pulse that wipes out the signal from fat C. Signal intensity from gadolinium will be saturated along with fat due to similar relaxation properties. D. is based on the relaxation properties of fat protons.

B. Utilizes a "spoiler" pulse that wipes out the signal from fat

**In what instance would contrast help in the differential diagnosis?** A. cystic vs solid mass B. abscess vs cyst C. disc herniation vs solid mass D. phlegmon vs necrosis

A. cystic vs solid mass

**Evaluation of which of the following conditions would NOT warrant the addition of intravenous gadolinium to an MRI study?** A. Septic arthritis B. Post-surgical back pain C. Osteochondral fragment D. Suggested bony neoplasia

C. Osteochondral fragment

**Fracture of the ulnar styloid is associated with injury to what structure(s)?** A. Triangular fibrocartilage B. Radial collateral ligament C. Hook of the hamate D. Proximal radioulnar ligaments

A. Triangular fibrocartilage

**Which of the following syndromes is present when a patient has a Bassett lesion?** 1. Anterolateral impingement 2. Anteromedial impingement 3. Superolateral impingement 4. Straight anterior impingement 5. Straight posterior impingement

**A. Anterolateral impingement** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p2110.

**Upon MRI evaluation of the knee, there is the presence of fluid signal between the joint capsule and the posterior horn of the medial meniscus in an individual who has sustained an anterolateral rotary injury of the knee. Which of the following is the most likely conclusion?** 1. Double vertical tear of the medial meniscus 2. Meniscal cyst 3. Meniscal flounce 4. Meniscal ossicle 5. Meniscocapsular separation

**E. Meniscocapsular separation** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1684-1686.

**MRI evaluation of the knee yields the presence of a double ACL sign. Which of the following is the appropriate conclusion?** 1. Complex flap tear of the lateral meniscus 2. Discoid lateral meniscus 3. Post-operative ACL repair 4. Radial tear of the medial meniscus 5. Tear of the ligament of Humphry

**A. Complex flap tear of the lateral meniscus** Stoller, David. Magnetic Resonance Imaging in Orthopedics and Sports Medicine. 3rd ed. p432.

**A bucket handle tear of the lateral meniscus in which the posterior horn of the lateral meniscus flips and subsequently lies posterosuperior to the anterior horn of the lateral meniscus with separation by only a thin layer of synovial fluid creates which of the following?** 1. Cyclops lesion 2. Ghost meniscus sign 3. Lax meniscus sign 4. Pseudo-hypertrophy of the anterior horn 5. Pseudo-loose body

**D. Pseudo-hypertrophy of the anterior horn** Stoller, David. Magnetic Resonance Imaging in Orthopedics and Sports Medicine. 3rd ed. p450.

**MRI evaluation demonstrates the presence of an osseous excrescence noted at the lateral aspect of the proximal tibia, approximately 4mm below the joint line. A cyclops lesion is also found. Which of the following scenarios is suspected?** 1. Bosch-Bock bump from prior Segond fracture 2. Os cyamella 3. Prior bumper fracture 4. Prior osteochondral lesion of the articular surface of the lateral tibial plateau 5. Prior posterior cruciate ligament tear

**A. Bosch-Bock bump from prior Segond fracture** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1787.

**A focus of fluid signal is noted directly interposed between the lateral head of the gastrocnemius and the origin of the soleus in a tennis player complaining of leg pain. Which of the following is the appropriate conclusion?** 1. Plantaris tear at its myotendinous junction 2. Popliteus tear at its myotendinous junction 3. Baker cyst 4. Posterior compartment syndrome 5. Herniation of the soleus

**A. Plantaris tear at its myotendinous junction** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1793.

**On conventional radiographic examination of the knee, a lateral notch sign measuring 2.1mm in depth is noted. Which of the following injuries is suspected?** 1. Anterior cruciate ligament tear 2. Lateral meniscus tear 3. Medial collateral ligament tear 4. Medial meniscus tear 5. Posterior cruciate ligament tear

**A. Anterior cruciate ligament tear** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1810.

**Which of the following represents the most frequent mechanism of injury to produce an isolated tear to the posterior cruciate ligament?** 1. Direct posteriorly oriented force to the anterior aspect of the tibia of a flexed knee 2. Direct anteriorly oriented force to the posterior aspect of the tibia of a flexed knee 3. Direct posteriorly oriented force to the anterior aspect of the tibia of an extended knee 4. Direct anteriorly oriented force to the posterior aspect of the tibia of an extended knee 5. Axial loading with the knee in internal rotation

**A. Direct posteriorly oriented force to the anterior aspect of the tibia of a flexed knee** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1867.

**Which among the following locations is most common to discover intra-articular loose bodies?** 1. Axillary recess of the shoulder 2. Olecranon fossa of the elbow 3. Radial fossa of the elbow 4. Recesses of the zona orbicularis of the hip 5. Suprapatellar recess of the knee

**E. Suprapatellar recess of the knee** Helms, Clyde. Musculoskeletal MRI. 2nd ed. p120.

**Upon MRI evaluation of the ankle, three medial tendons are seen on an axial slice, and the most lateral of these three tendons demonstrates fluid signal within the tendon sheath surrounding the tendon. A joint effusion is also present at the mortise joint. Which of the following is the appropriate conclusion?** 1. Flexor digitorum longus tenosynovitis 2. Flexor hallucis longus tenosynovitis 3. Normal fluid in the flexor hallucis longus tendon sheath as it can communicate with the ankle mortise joint 4. Peroneus brevis tenosynovitis 5. Tibialis posterior tenosynovitis

**C. Normal fluid in the flexor hallucis longus tendon sheath as it can communicate with the ankle mortise joint** Helms, Clyde. Musculoskeletal MRI. 2nd ed. p391.

**The term Jagerhut patella has been correlated to patellar instability and refers to which of the following patellar characteristics?** 1. Dominance of the medial facet of the patella in regard to facet size 2. Patella alta 3. Patella baja 4. Vertically oriented lateral patellar facet 5. Vertically oriented medial patellar facet

**E. Vertically oriented medial patellar facet** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1905.

**MRI evaluation of the ankle yields the presence of linear fluid signal that is perpendicular to the long axis of the Achilles tendon, seen at the lateral aspect of the tendon, and is located 3.7cm proximal to its insertion to the calcaneus. The Achilles tendon is not enlarged. Which of the following is the appropriate conclusion?** 1. Chronic tendinosis 2. Complete tear of the Achilles tendon 3. Haglund deformity 4. Partial tear of the Achilles tendon 5. Tenosynovitis

**D. Partial tear of the Achilles tendon** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p2135.

**Which of the following is the most common muscle about the ankle to herniate?** 1. Flexor hallucis longus 2. Peroneus brevis 3. Peroneus longus 4. Tibialis anterior 5. Tibialis posterior

**D. Tibialis anterior** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p2207.

**Vertical tears of the peroneus brevis are termed peroneus brevis splits. Which of the following are also most commonly present?** 1. Anteromedial ligaments tears 2. Lateral collateral ligament tears 3. Posterior talofibular ligament tears 4. Tibiotalar ligament tears 5. Talonavicular ligament tears

**B. Lateral collateral ligament tears** Helms, Clyde. Musculoskeletal MRI. 2nd ed. p393.

**An os trigonum represents which of the following?** 1. Un-united lateral tubercle of the talus 2. Un-united posterior tubercle of the talus 3. Un-united medial tubercle of the talus 4. Non-union fracture of the posterior talar process 5. Non-union fracture of the lateral tubercle of the talus

**A. Un-united lateral tubercle of the talus** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p2160.

**Which of the following locations is implicated in the case of a Joplin neuroma?** 1. 1st interspace 2. 2nd interspace 3. 3rd interspace 4. 4th interspace 5. 5th plantar digital nerve

**A. 1st interspace** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p2223.

**MRI evaluation of the foot yields the presence of diffuse intermediate T1 signal and high T2 signal in the plantar fascia that does not enhance with gadolinium administration. The fascia is thickened near its origin. Which of the following is the most appropriate conclusion?** 1. Compartment syndrome 2. Morton neuroma 3. Plantar fascial ganglion 4. Plantar fasciitis 5. Plantar fibromatosis

**D. Plantar fasciitis** Helms, Clyde. Musculoskeletal MRI. 2nd ed. p405.

**A 48 year old male presents with left shoulder pain. Upon taking a history it is found that he had a viral infection recently and has had repetitive microtrauma to his shoulder in his past associated with work. You suspect rotator cuff pathology upon physical examination. MRI evaluation yields fluid signal intensity in the supraspinatus and infraspinatus with no other findings. Which of the following is a likely conclusion?** 1. Elastofibroma 2. Long thoracic nerve palsy 3. Parsonage-Turner syndrome 4. Phrenic nerve palsy 5. Snapping scapula syndrome

**C. Parsonage-Turner syndrome** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1070.

**A 21 year old female presents with intense right sternoclavicular joint pain and pain in the right shoulder. She plays lacrosse in college and has been exercising extensively preparing for the start of the season. CT scan yields the presence of triangular, well defined, dense, homogeneous sclerosis and enlargement of the inferomedial aspect of the medial clavicle adjacent to the articular surface of the sternoclavicular joint. No other findings. Which of the following is the appropriate conclusion?** 1. Condensing osteitis of the clavicle 2. Fatigue fracture 3. Friedrich disease 4. Osteoblastic metastasis 5. Osteoid osteoma

**A. Condensing osteitis of the clavicle** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1085.

**MRI yields the presence of tears of the coracohumeral and superior glenohumeral ligaments on their lateral aspects where they normally encase the long head of the biceps tendon, with extra-articular dislocation of the long head of the biceps tendon. Which of the following types of dislocation is present?** 1. Type II 2. Type III 3. Type IV 4. Type V 5. Type VI

**C. Type IV** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p1047.

**Which of the following lesions is identical to an anterior labroligamentous periosteal sleeve avulsion but lacks migration and rotation of the fragment?** 1. Bankart lesion 2. Basset lesion 3. Bennet lesion 4. Glenolabral articular disruption 5. Perthes lesion

**E. Perthes lesion** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p918.

**Which of the following is the most common joint in the human body to dislocate?** 1. Femoroacetabular 2. Fifth metacarpophalangeal 3. Fifth metatarsophalangeal 4. Glenohumeral 5. Patellofemoral

**D. Glenohumeral** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p848.

**Which of the following procedures represents the resection of the distal clavicle as a means of treating impingement syndrome?** 1. Darrach 2. French 3. Ganz 4. Kidner 5. Mumford

**E. Mumford** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p755.

**Which of the following is consistent with a rim rent tear?** 1. Full thickness tear at the articular surface 2. Full thickness tear at the critical zone 3. Partial thickness tear at the articular side of the tendon 4. Partial thickness tear at the bursal side of the tendon 5. Partial thickness tear at the critical zone

**C. Partial thickness tear at the articular side of the tendon** Resnick, Donald. Internal Derangements of Joints. 2nd ed. p788.

**MRI yields the presence of homogeneous low signal foci on all sequences within the subacromial/subdeltoid bursa with surrounding fluid signal. Which of the following is the appropriate conclusion?** 1. Bankart lesion 2. Calcium hydroxyapatite deposition disease 3. Calcium pyrophosphate dihydrate crystalline deposition disease 4. Myositis ossificans post-traumatica 5. Pigmented villonodular synovitis

**B. Calcium hydroxyapatite deposition disease** Helms, Clyde. Musculoskeletal MRI. 2nd ed. p213.

**A patient had an L5/S1 posterior interbody fusion, utilizing pedicle screws and interbody cages. An MRI is required to evaluate for non-responsive pain. Which of the following will minimize the magnetic susceptibility artifact created by the surgical hardware?** a. Gradient echo imaging b. Spin echo sequencing c. Increasing the echo time d. Standard fast-spin echo imaging Source: Westbrook, Catherine. MRI in Practice. 3rd edition, pp. 253-254 (question composed by Chad Warshel, DC, DACBR)

**b. Spin echo sequencing** Source: Westbrook, Catherine. MRI in Practice. 3rd edition, pp. 253-254 (question composed by Chad Warshel, DC, DACBR)

**A clinician refers an MRI for interpretation, with a history of “rule out rotator cuff tear.” Intermediate signal is noted within the supraspinatus tendon near the insertion on the T1 coronal oblique pulse sequence, but the tendon is homogeneously low signal on the T2 coronal oglique. This finding represents what?** a. Myxoid degeneration b. Tenosynovitis c. Magic angle artifact d. Complete tendon tear Source: Helms, Clyde. Musculoskeletal MRI. 2nd edition, pp. 14-15 (question composed by Chad Warshel, DC, DACBR)

**c. Magic angle artifact** Source: Helms, Clyde. Musculoskeletal MRI. 2nd edition, pp. 14-15 (question composed by Chad Warshel, DC, DACBR)

**You note intermediate signal within the supraspinatus tendon near the insertion on the T1 coronal oblique pulse sequence. Which of the following non-contrast coronal oblique pulse sequences would be most useful in determining whether this represents a true tear versus magic angle phenomenon?** a. Proton density b. T2 c. Gradient echo d. Diffusion-weighted imaging Source: Helms, Clyde. Musculoskeletal MRI. 2nd edition, pp. 14-15 (question composed by Chad Warshel, DC, DACBR)

**b. T2** Source: Helms, Clyde. Musculoskeletal MRI. 2nd edition, pp. 14-15 (question composed by Chad Warshel, DC, DACBR)

Remainder of questions derived from Resnick’s Bone and Joint Imaging, 3rd edition. **4. All of the following are components of the triangular fibrocartilage complex EXCEPT: (Pg. 905)** a. Triangular fibrocartilage b. Sheath of extensor carpi radialis tendon c. Ulnomeniscal homologue d. Dorsal and volar radioulnar ligaments

**b. Sheath of extensor carpi radialis tendon**

A positive ulnar variance is associated with ______________ whereas a negative ulnar variance is associated with \_\_\_\_\_\_\_\_\_\_\_\_\_\_. (Pg. 907) a. Ulnar impaction syndrome, Kienböck disease b. Kienböck disease, ulnar impaction syndrome c. Ulnar impaction syndrome, Preiser syndrome d. Preiser syndrome, ulnar impaction syndrome

**a. Ulnar impaction syndrome, Kienböck disease**

**While interpreting an MRI of a NORMAL wrist, all of the following are to be expected EXCEPT: (Pg. 907)** a. Intermediate T2 signal of the triangular fibrocartilage b. Bifurcated ulnar attachment of the triangular fibrocartilage c. Variable visibility of the lunotriquetral ligament d. Homogenously low signal of the scapholunate ligament

**a. Intermediate T2 signal of the triangular fibrocartilage**

**All of the following are characteristics of ulnar impaction syndrome EXCEPT: (Pg. 908)** a. Negative ulnar variance b. Approximation of the ulna to the triangular fibrocartilage complex and ulnar-sided carpal bones c. Scalloped concavity of the distal radius d. Chondromalacia of the lunate’s articular cartilage

**c. Scalloped concavity of the distal radius**

**Which type of carpal instability occurs between the scaphoid and the lunate? (Pg. 909)** a. Medial b. Lateral c. Proximal d. Distal

**b. Lateral**

T or F: **Scapholunate dissociation produces dorsal intercalated segmental instability. (Pg. 909)**

**True**

**Which of the following carpal bones is not one of the three most common sites for carpal osteonecrosis? (Pg. 910)** a. Scaphoid b. Lunate c. Capitate d. Trapezium

**d. Trapezium**

T or F: **Ulnar tunnel syndrome consists of compression of the ulnar nerve as it traverses through Guyon’s canal. (Pg. 911)**

**True**

**The lateral group of muscles surrounding the elbow consists of all of the following EXCEPT: (Pg. 914)** a. Supinator b. Brachioradialis c. Anconeus d. Wrist and hand extensors

**c. Anconeus**

**Which of the following conditions should be suspected in a patient presenting with weakness of the flexor carpi ulnaris, flexor digitorum profundus of the 4th and 5th digits and intrinsic hand muscles? (Pg. 917)** a. Median nerve entrapment b. Common flexor tendinopathy c. Ulnar nerve entrapment d. None of the above

**c. Ulnar nerve entrapment**

**Which bone (or segment of bone) associated with the elbow is most commonly affected by osteochondral fractures? (Pg. 917)** a. Trochlea b. Olecranon c. Radial tuberosity d. Capitulum

**d. Capitulum**

**Displacement of the posterior fat pad of the elbow joint is indicative of which condition? (Pg. 918)** a. Nonspecific intracapsular effusion b. Intracapsular fracture c. Dislocation d. Osteonecrosis

**a. Nonspecific intracapsular effusion**

**Which of the following is NOT true of osteonecrosis of the femoral head? (Pg. 943)** a. Bone marrow edema is present that is identical to that found in transient bone marrow edema b. Positive scintigraphic imaging findings are very specific for osteonecrosis c. The double line sign on T2-weighted MRI is pathognomonic d. A specific causative factor can frequently not be identified

**b. Positive scintigraphic imaging findings are very specific for osteonecrosis**

**The DDx list of a synovial cyst includes all of the following EXCEPT: (Pg. 942)** a. Lymphocele b. Ostechondral body c. Abscess d. Hematoma

**b. Ostechondral body**

**The findings of which condition show a striking resemblance to those of infections of the temporomandibular joint? (Pg. 511)** a. Sickle cell anemia b. Systemic lupus erythematosus c. Rheumatoid arthritis d. Progressive systemis sclerosis

**c. Rheumatoid arthritis**

T or F: **Calcium pyrophosphate crystal deposition disease is the most common cause for secondary osteoarthritis of the temporomandibular joint. (Pg. 511)**

**False**

**Which of the following is FALSE regarding internal derangement of the temporomandibular joint? (Pg. 513)** a. Equal distribution between men and women b. Diagnosis is usually made in the fourth decade of life c. They are usually attributable to ligamentous laxity d. Sagittal plane reconstructed MR imaging is the most useful in diagnosing the condition

**a. Equal distribution between men and women**

**Which of the following is NOT a characteristic MRI finding of carpal tunnel syndrome? (Pg. 911)** a. Swelling of the median nerve, best visualized at the level of the pisiform b. Flattening of the median nerve, best visualized at the level of the hamate c. Bone marrow edema of the capitate and lunate d. palmar bowing of the flexor retinaculum, best evaluated at the level of the hamate

**c. Bone marrow edema of the capitate and lunate**

**What is the most common cause of carpal tunnel syndrome? (Pg. 911)** a. Congenital defects in the formation of the flexor retinaculum b. FOOSH injury c. Inflammation of the flexor tendon sheaths d. Demyelinating diseases

**c. Inflammation of the flexor tendon sheaths**

**Which of the following is NOT a characteristic of de Quervain syndrome? (Pg. 911)** a. Tendinosis/tenosynovitis of the abductor pollicis longus b. Tendinosis/tenosynovitis of the extensor brevis c. Tendinosis/tenosynovitis of the opponens pollicis d. Involvement at the level of the radial styloid

**c. Tendinosis/tenosynovitis of the opponens pollicis**

**What is the most common location for ganglion cysts of the wrist? (Pg. 913)** a. Dorsum b. Ventral compartment c. Carpal tunnel d. Adjacent to the ulnar styloid

**a. Dorsum**

T or F: **Displacement of the torn end of the ulnar collateral ligament superficial to the opponens policis (a complication of Gamekeeper’s Thumb) is known as a Stener lesion. (Pg. 913)**

**False**

**Upon viewing an MRI of the wrist it is discovered that there is flexion of the scaphoid and extension of the lunate. Which of the following is best to evaluate the suspected torn ligament?** A. Gradient echo axial B. Gradient echo coronal C. Gradient echo sagittal D. T1 axial E. T1 coronal Helms, Clyde. Musculoskeletal MRI. 2nd ed. p245.

**B. Gradient echo coronal**

**Upon viewing an MRI of the wrist it is discovered that there is flexion of the lunate, and is resulting in a scapholunate angle of 22 degrees. Which of the following is best to evaluate the suspected torn ligament?** A. Gradient echo axial B. Gradient echo coronal C. Gradient echo sagittal D. T1 axial E. T1 coronal Helms, Clyde. Musculoskeletal MRI. 2nd ed. p245.

**B. Gradient echo coronal**

**Which of the following tendons of the wrist are frequently injured alongside the triangular fibrocartilage?** A. Extensor carpi ulnaris B. Extensor digiti minimi C. Extensor digitorum D. Extensor indicis E. Extensor pollicis longus Helms, Clyde. Musculoskeletal MRI. 2nd ed. p251.

**A. Extensor carpi ulnaris**

**Intersection syndrome involves which of the following combinations?** A. 1st and 2nd extensor compartments B. 1st and 2nd flexor compartments C. 2nd and 3rd extensor compartments D. 2nd and 3rd flexor compartments E. 3rd and 4th extensor compartments Helms, Clyde. Musculoskeletal MRI. 2nd ed. p256.

**A. 1st and 2nd extensor compartments**

**Upon viewing an MRI of the wrist it is discovered that there is fluid signal surrounding tendons on the lateral aspect of the wrist. The patient is diagnosed with de Quervain syndrome. Which of the following tendons are involved?** A. Abductor pollicis longus and extensor pollicis brevis B. Abductor pollicis longus and extensor pollicis longus C. Extensor carpi radialis brevis and extensor carpi radialis longus D. Extensor carpi radialis longus and extensor pollicis brevis E. Extensor pollicis brevis and extensor pollicis longus Helms, Clyde. Musculoskeletal MRI. 2nd ed. p255.

**A. Abductor pollicis longus and extensor pollicis brevis**

**Which of the following is the most common compressive neuropathy of the upper extremity?** A. Carpal tunnel syndrome B. Kiloh-Nevin syndrome C. Pronator teres syndrome D. Saturday night palsy E. Tunnel of Guyon syndrome Helms, Clyde. Musculoskeletal MRI. 2nd ed. p258.

**A. Carpal tunnel syndrome**

**Fibrolipomatous hamartoma frequently occurs in association with which of the following conditions?** A. Jaffe-Campanacci syndrome B. Macrodystrophica lipomatosa C. Neurofibromatosis type I D. Neurofibromatosis type II E. Tuberous sclerosis Helms, Clyde. Musculoskeletal MRI. 2nd ed. p261.

**B. Macrodystrophica lipomatosa**

**The most frequent cause of a mass involving the wrist is which of the following?** A. Ganglion cyst B. Giant cell tumor of a tendon sheath C. Rheumatoid nodule D. Synovial cyst E. Tophaceous gout Helms, Clyde. Musculoskeletal MRI. 2nd ed. p267.

**A. Ganglion cyst**

**Upon viewing an MRI of the hand, a lesion involving the proximal phalanx of the 5th digit is seen characterized by low T1 signal and high T2 signal with punctate very low signal foci within the matrix of the lesion, each compared to normal adjacent marrow. The lesion demonstrates no pathologic fracture or soft tissue extension, as well as a narrow zone of transition. Which of the following is the most appropriate conclusion?** A. Enchondroma B. Epidermoid inclusion cyst C. Glomus tumor D. Intra-osseous ganglion cyst E. Sarcoidosis Helms, Clyde. Musculoskeletal MRI. 2nd ed. p266.

**A. Enchondroma**

**Upon viewing and MRI of the elbow of a 12 year old male, an abrupt slope is noted at the posterior aspect of the capitulum. No marrow edema is noted. No intra-articular loose body is present. Which of the following is the most appropriate conclusion?** A. Acute osteochondral lesion B. Chronic deformity of an osteochondral lesion C. Erosion from pigmented villonodular synovitis D. Panner disease E. Pseudodefect of the capitulum Helms, Clyde. Musculoskeletal MRI. 2nd ed. p226.

**E. Pseudodefect of the capitulum**

**Climber elbow is diagnosed upon review of an MRI. Which of the following muscle tendons is involved?** A. Biceps B. Brachialis C. Brachioradialis D. Coracobrachialis E. Pronator teres Helms, Clyde. Musculoskeletal MRI. 2nd ed. p232.

**B. Brachialis**

**A slip of tissue is seen on MRI of the elbow extending from posterior to anterior that is impinged in the radiocapitellar joint. Which of the following ligaments is incompetent?** A. Annular B. Lateral ulnar collateral C. Radial collateral D. Struther E. Ulnar collateral Helms, Clyde. Musculoskeletal MRI. 2nd ed. p232.

**E. Ulnar collateral**

**In the presence of an anconeus epitrochlearis, which of the following nerve becomes more susceptible to compression?** A. Anterior interosseous B. Median C. Posterior interosseous D. Radial E. Ulnar Helms, Clyde. Musculoskeletal MRI. 2nd ed. p238.

**E. Ulnar**

**An MRI of the forearm demonstrates high T2 signal within the pronator quadratus compared to the normal signal of the proximal forearm muscles. There is no history of acute injury. Which of the following is the most appropriate conclusion?** A. Carpal tunnel syndrome B. Kiloh-Nevin syndrome C. Posterior interosseous nerve syndrome D. Saturday night palsy E. Ulnar tunnel syndrome Helms, Clyde. Musculoskeletal MRI. 2nd ed. p239.

**B. Kiloh-Nevin syndrome**

**In the normal situation with the mouth closed, which structure is situated at the 12 o’clock position with regard to the mandibular condyle?** A. Anterior band of the articular disc B. Articular eminence of the temporal bone C. Bilaminar zone D. Intermediate zone of the articular disc E. Posterior band of the articular disc Helms, Clyde. Musculoskeletal MRI. 2nd ed. p173.

**E. Posterior band of the articular disc**

**In a normal situation, what percent of the femoral head does the acetabulum cover?** A. 10 B. 25 C. 40 D. 60 E. 75 Helms, Clyde. Musculoskeletal MRI. 2nd ed. p325.

**C. 40**

**Avascular necrosis of the femoral heads is bilateral in what percent?** A. 10 B. 25 C. 40 D. 60 E. 75 Helms, Clyde. Musculoskeletal MRI. 2nd ed. p326.

**C. 40**

**Upon viewing an MRI of the hip in a 42 year old female, marrow edema is noted in the left femoral head. No linear or punctate regions of low T2 or low T1 signal are noted. Which of the following is the likely diagnosis?** A. Avascular necrosis B. Degenerative joint disease C. Insufficiency fracture D. Osteomyelitis E. Transient idiopathic osteoporosis of the hip Helms, Clyde. Musculoskeletal MRI. 2nd ed. p329.

**E. Transient idiopathic osteoporosis of the hip**

**An MRI evaluation of a 23 year of age male demonstrates a lesion in the femoral head characterized by low T1 signal and intermediate T2 signal as compared to normal marrow. Surrounding marrow edema is noted. No pathologic fracture is evident or soft tissue extension. Punctate low signal foci are noted within, and there is a narrow zone of transition. Which of the following is the most likely diagnosis?** A. Avascular necrosis B. Chondroblastoma C. Geode D. Giant cell tumor E. Osteomyelitis Helms, Clyde. Musculoskeletal MRI. 2nd ed. p335.

**B. Chondroblastoma**

**Which of the following is included in the rotator cuff of the hip?** a. Gemelli superior b. Gluteus maximus c. Gluteus medius d. Piriformis e. Quadratus femoris Helms, Clyde. Musculoskeletal MRI. 2nd ed. p337.

**c. Gluteus medius**

**Athletic pubalgia is typically associated with microtears in which of the following muscles?** a. Adductor brevis b. Adductor longus c. Adductor magnus d. Gracilis e. Pectineus Helms, Clyde. Musculoskeletal MRI. 2nd ed. p338.

**b. Adductor longus**

**MRI evaluation of the left hip of a 30 years of age male demonstrates the presence of globular foci of low T1 and low T2 signal. Blooming is demonstrated on gradient echo. Which of the following is the most appropriate conclusion?** a. Amyloid arthropathy b. Hemophilic arthropathy c. Milwaukee hip d. Pigmented villonodular synovitis e. Synoviochondrometaplasia Helms, Clyde. Musculoskeletal MRI. 2nd ed. p349.

**An MRI of the pelvis in an 18 years of age male demonstrates the presence of pistol grip deformity bilaterally. Clinical information provided consisted of pain localized to the pubic symphysis which is worse with activity. The MRI also demonstrates high T2 signal in the site of origin of the adductor longus and brevis. Which of the following is the most appropriate conclusion in regard to the femoral head deformity?** A. Cam type femoroacetabular impingement B. Healed Legg-Calve-Perthes C. Healed Slipped capital femoral epiphysis D. Pincer type femoroacetabular impingement E. Proximal focal femoral deficiency Helms, Clyde. Musculoskeletal MRI. 2nd ed. p346.

**A. Cam type femoroacetabular impingement**

**A gamekeeper thumb is characterized by which of the following?** a. Avulsion of the adductor pollicis insertion b. Avulsion of the radial collateral ligament from the base of the proximal phalanx of the thumb c. Avulsion of the radial collateral ligament from the metacarpal head of the thumb d. Avulsion of the ulnar collateral ligament from the base of the proximal phalanx of the thumb e. Avulsion of the ulnar collateral ligament from the metacarpal head of the thumb Helms, Clyde. Musculoskeletal MRI. 2nd ed. p253.

**d. Avulsion of the ulnar collateral ligament from the base of the proximal phalanx of the thumb**

**Insufficiency of which of the following ligaments predisposes to posterolateral rotatory instability?** a. Annular b. Lateral ulnar collateral c. Radial collateral d. Struther e. Ulnar collateral Helms, Clyde. Musculoskeletal MRI. 2nd ed. p229.

**b. Lateral ulnar collateral**

Internal Derangement I & II Flashcards

(216 cards)