MSK - Core Clinical Sonosim study set

A complete tendon tear is characterized by complete discontinuity of tendon fibers under ultrasonography and proximal retraction of a tendon fragment during dynamic musculotendinous unit examination. A. True B. False

A. True

A linear high-frequency transducer is the preferred transducer for imaging pathologic musculoskeletal conditions. A. True B. False

A. True

A normally aligned humeral head should be seen in a posterior position relative to the glenoid rim on shoulder ultrasonography. A. True B. False

A. True

Bone displays a highly echogenic cortical margin when viewed with ultrasonography. A. True B. False

A. True

Partial tendon tears do not retract. If a tendon retracts away from the joint cavity when taken through a full range of motion, this suggests a complete tendon rupture. A. True B. False

A. True

Ultrasound can detect joint effusions as small as several milliliters in volume. A. True B. False

A. True

Water baths are especially helpful in assessing extremities and sensitive body parts since no direct contact is needed between the ultrasound probe and the patient's skin. A. True B. False

A. True

A fluid accumulation along the length of the joint capsule between the femoral head and acetabulum that measures over five millimeters in diameter is suggestive of hip effusion. A. True B. False

A. True Correct. The longest ultrasonographic intra-articular distance perpendicular to the joint capsule, from the joint capsule to the femur, should be measured. A fluid stripe greater than five millimeters, or one that demonstrates a distance greater than two millimeters relative to the unaffected side, suggests a hip effusion in an adult native hip.

Ultrasonography has a high sensitivity for the detection of joint effusions. A. True B. False

A. True Correct. Ultrasound has very good test characteristics for detecting fluid in the joint. Joint effusions as small as one to two milliliters in volume can be detected with ultrasonography.

Ultrasound of tenosynovitis reveals an anechoic collection of fluid along the affected tendon. A. True B. False

A. True Correct. What one observes with tendon inflammation is a surrounding anechoic layer of synovial fluid around the affected tendon. Fluid accumulates within the tendon sheath, with resultant tendon sheath thickening.

Anisotropy results in focal sites of hypoechogenicity within muscles and tendons that can be misinterpreted as representing muscle or tendon defects. A. True B. False

A. True (Anisotropy refers to a quality certain tissues possess that results in such tissues exhibiting ultrasound properties that differ according to the direction of ultrasound imaging. Muscles and tendons, depending on which angle you insonate them, display variable echogenicity.)

Which of the following statement(s) regarding image-guided fracture reduction is correct? A. Ultrasound is a well-documented method of guiding fracture reduction. B. Plain radiography is the sole method to real-time guide fracture reduction. C. Ultrasound-guided fracture reduction is limited by the inability to clearly delineate bony cortical margins. D. All of the above E. None of the above

A. Ultrasound is a well-documented method of guiding fracture reduction. Correct. Studies have shown that ultrasound-guidance is an accurate, simple, radiation-free method to achieve fracture reduction.

The "Seagull Sign" represents __________. A. the coming together of two bony ends at a joint space B. the cortical margin along the diaphyseal segment of a long bone C. a pathologic fracture D. a joint effusion E. None of the above

A. the coming together of two bony ends at a joint space (Correct. The "Seagull Sign" arises from the fact that the two bony ends of adjacent bones come together like the wings of a seagull at the joint space.)

Which of the following statements regarding ultrasound-guided joint aspirations is (are) incorrect? A. Ultrasound guidance can improve success rates over landmark-driven methods B. A large footprint curved-array transducer is best suited for image guidance C. The transducer is placed over the joint of interest with probe indicator pointing towards the patient's head D. All of the above E. Choices A and B only

B. A large footprint curved-array transducer is best suited for image guidance

Which of the following statements is incorrect? A. A high-frequency linear transducer is suited for evaluating the tibia. B. A low-frequency curved-array transducer is ideal for evaluating the femur. C. Administering analgesics is often advisable prior to placing an ultrasound probe on an injured area. D. Water baths can decrease the discomfort associated with ultrasound imaging. E. None of the above

B. A low-frequency curved-array transducer is ideal for evaluating the femur.

Fractures are not reliably detected with ultrasound. A. True B. False

B. False

Tendons display hyperechoic striations in a short-axis view and appear hypoechoic in a long-axis view. A. True B. False

B. False

Ultrasound examination of muscle rupture typically reveals a focal hyperechoic area that represents hemorrhage at the site of injury. A. True B. False

B. False

Ultrasound enables identification of intra-articular communication in a majority of olecranon bursitis cases. A. True B. False

B. False Correct. Olecranon bursal fluid is superficially located and is external to the elbow joint. Intra-articular communication is not found in typical cases of olecranon bursitis.

Partial tendon ruptures will retract proximally away from the joint cavity when taken through a normal range of motion. A. True B. False

B. False Correct. Partial tendon tears do not retract. If a tendon retracts away from the joint cavity when you go through a normal range of motion, this suggests a complete tendon rupture. Such injuries mandate joint immobilization and orthopedic follow-up.

The short-axis transverse view of long bones is favored over the long-axis view for identifying fractures due to an enhanced ability to identify accompanying soft-tissue edema. A. True B. False

B. False Correct. The long-axis view is the favored method for screening for long-bone fracture.

Which statement accurately characterizes tendinosis? A. Markedly increased vascularity upon Doppler inspection is a hallmark of tendinosis B. Tendinosis is intratendinous degeneration that results from overuse or chronic injury C. Tendinosis and tenosynovitis are interchangeable terms and represent the same pathologic condition D. Tendinosis is characterized by increased echogenicity within the involved tendon E. Thinning or narrowing of the involved tendon segment is a hallmark of tendinosis

B. Tendinosis is intratendinous degeneration that results from overuse or chronic injury

Which of the following statements regarding ultrasound imaging of joints is (are) correct? A. The Thompson sign helps identify a joint effusion B. The Seagull Sign helps identify the joint space C. Joint effusions have an hyperechoic appearance D. All of the above E. None of the above

B. The Seagull Sign helps identify the joint space

Which of the following best characterizes the relationship between the angle of incidence of an ultrasound signal and resultant image quality? A. There is no consistent relationship between ultrasound signal angle of incidence and image quality. B. A parallel angle of incidence relative to the structure of interest maximizes ultrasound wave signal return to the ultrasound transducer. C. An angle of incidence that is perpendicular to the structure of interest typically improves ultrasound image quality. D. A parallel angle of incidence relative to the structure of interest is an effective method of mitigating anisotropic artifact.

C. An angle of incidence that is perpendicular to the structure of interest typically improves ultrasound image quality. (The angle at which ultrasound signals encounter a structure of interest affect how that structure is represented on an ultrasound screen. This angle is termed the angle of incidence. Angle of incidence is defined as the angle that a ray entering a refracting medium makes with a line drawn perpendicular to the surface of the medium. If the angle of incidence is perpendicular to the structure of interest, more ultrasound waves are reflected back to the transducer, and less are lost to scatter. This will improve the ultrasound image. If the angle of incidence is greater, for example, 30 degrees, more ultrasound waves are lost to scatter, and less are directly reflected back to the ultrasound transducer, with resultant diminished image quality. Maintaining a perpendicular scanning angle will also minimize anisotropic artifact, which will be subsequently discussed.)

Which type of imaging artifact is represented by the arrow in this accompanying ultrasound image taken along the volar aspect of a normal finger? A. Reverberation artifact B. Comet-tail artifact C. Anisotropic artifact D. B-line artifact E. Acoustic shadowing

C. Anisotropic artifact (Correctly identifying partial or complete tendon rupture requires differentiating these conditions from anisotropic artifact. The indicator arrow in the accompanying image demarcates a seemingly hypoechoic segment (anisotropic artifact) within a normal tendon. This false hypoechogenicity results from an obliquely angled ultrasound.)

Which of the following statements regarding hip ultrasound is incorrect? A. The ultrasound transducer should be aligned along the long axis of the femoral neck during hip joint imaging. B. A high-frequency transducer is ideally suited for hip imaging. C. Ultrasound is not helpful for detecting hip joint effusions. D. All of the above E. None of the above

C. Ultrasound is not helpful for detecting hip joint effusions. Correct. Ultrasonography is a very effective method for screening for hip joint effusions. The hip is imaged in a sagittal plane, with the probe transducer aligned parallel to the long axis of the femoral neck. A high-frequency probe is ideally suited for joint imaging, with the probe indicator pointing towards the umbilicus. The patient should be in a supine position with the leg externally rotated.

Which of the following characteristics is (are) helpful in differentiating a normal joint from a bony fracture? A. Noting a smooth curved-end to both bone margins in normal joints B. Observing a "Seagull Sign" to help identify a joint C. The lack of surrounding soft-tissue edema in normal joints and bones D. All of the above E. None of the above

D. All of the above

Which of the following is (are) benefits of imaging a musculotendinous unit through its entire range of motion? A. It may help differentiate anisotropic artifact from true tendon injury. B. A dynamic exam helps determine partial versus complete tendon tears. C. It can help differentiate tendons from surrounding structures. D. All of the above E. None of the above

D. All of the above

Which of the following statements is (are) correct regarding the ultrasound characteristics of tendons? A. Tendons appear very hyperechoic on ultrasound imaging. B. A false hypoechogenicity resulting from oblique ultrasound beams can mimic tendon rupture. C. Tendons are much more hyperechoic than muscle. D. All of the above E. None of the above

D. All of the above (Tendons are easily identifiable by ultrasound. Because tendon tissue is so dense, it appears very hyperechoic. Tendons are much more hyperechoic than muscle and display a linear fibrillar pattern when viewed in long axis. Anisotropy is false hypoechogenicity resulting from an oblique ultrasound beam on something very dense, like a tendon. It is important to understand how anisotropy affects the echogenicity of a tendon or muscle, especially when evaluating a traumatized limb. One may falsely note the termination of a structure and identify it as a tendinous rupture or a muscular tear if the sonographer is not familiar with anisotropy.)

When attempting to view a structure that is close to skin, it is often helpful to create an acoustic window between the area of interest and the probe. Which of the following techniques can be used to optimize imaging? A. A sterile latex glove filled with water placed over the target area B. A commercially available "standoff pad" C. Submerge the area of interest in a water bath and scan D. All of the above E. None of the above

D. All of the above Correct. Just as the liver and bladder served as acoustic windows within the body, a standoff pad, or alternatively a water bath, can create an acoustic window outside the body. A standoff pad or water bath can aid visualization of structures that are oddly shaped (e.g., fingers and webspaces), very superficially located (e.g., wood splinters and broken glass), or are too sensitive to examine (e.g., finger felon). Ultrasound transducers are waterproof. The site where the cord and the transducer meet is not. It is very important that the cord connection site is not submerged.

Which of the following structures are matched appropriately with respective echogenicity? A. Fascia has an isoechoic appearance B. Muscle has a hyperechoic appearance C. Tendon has a hypoechoic appearance D. Bone is hyperechoic and exhibits shadowing E. None of the above

D. Bone is hyperechoic and exhibits shadowing

Which of the following structures are matched appropriately with respective echogenecity? A. Fascia has an isoechoic appearance. B. Muscle has a hyperechoic appearance C. Tendon has a hypoechoic appearance D. Bone is hyperechoic and exhibits shadowing E. None of the above

D. Bone is hyperechoic and exhibits shadowing Correct. The hyperechoic (brighter) tissues are the epidermis, bone, and fascia. Muscle and the subcutaneous tissue are the more hypoechoic (darker) tissues. As previously mentioned, echogenicity is a relative description of tissue "brightness" in relation to that tissue's surrounding structures.

Which of the following best characterizes elements of the musculoskeletal system? A. A ligament consists of dense connective tissue fibers that attach muscle to bone. B. Ligaments and tendons are examples of hard tissue. C. Cortical bone consists of a network of elements with interspersed bone marrow and blood vessels. D. Cartilage has very limited regenerative capacity.

D. Cartilage has very limited regenerative capacity. (All human tissues that are not bone, cartilage, teeth, nails, hair, or organs are termed soft tissues. Soft tissues include skin, fascia, muscles, tendons, ligaments, fibrous tissue, blood vessels, and nerves. A tendon is a cord-like structure consisting of dense connective tissue fibers that attach muscle to bone. Cortical bone consists of a network of elements with interspersed bone marrow and blood vessels. Cartilage has very limited regenerative capacity.)

Which of the following statements is (are) correct? A. Lateral cystic shadowing is also known as edge artifact. B. Lateral cystic artifact can occur when sound is redirected, as often occurs when sound waves encounter a rounded or curved structure that is hyperechoic C. Edge artifact is exclusively seen with musculoskeletal imaging D. Choices A and B E. None of the above

D. Choices A and B

Which statement regarding ultrasound examination of muscle is incorrect? A. Muscle has a hypoechoic appearance. B. Muscle has clearly visible punctate striae in a short-axis view. C. Muscle has clearly visible linear striae in a long-axis view. D. Muscle bundles are separated by hypoechoic fascial tissue.

D. Muscle bundles are separated by hypoechoic fascial tissue. (Muscle bundles are hypoechoic in appearance and are separated by hyperechoic connective tissue or fascia. Muscle striae have either a punctate or linear appearance depending on whether they are visualized in a short- or long-axis view, respectively.)

Which of the following statements regarding tendon injuries is incorrect? A. Tendon inflammation results in reduced echogenicity on ultrasonography. B. Tendons should be imaged through a complete range of motion. C. Inflamed tendons tend to have a thicker appearance relative to the unaffected side. D. Power Doppler typically reveals decreased flow at the site of inflammation. E. None of the above.

D. Power Doppler typically reveals decreased flow at the site of inflammation. Correct. The use of power Doppler around an injured tendon will reveal increased vascularity from inflammatory processes. Ultrasound imaging while a joint is taken through passive and active range of motion is recommended to determine whether a tendon has been ruptured. Tendon inflammation results in tendon thickening with an associated fluid collection along the tendon edges, which results in reduced echogenicity.

Which of the following statements regarding hip ultrasonography is incorrect? A. When imaging the hip, the transducer is placed along an oblique or sagittal scanning plane. B. The transducer should lie parallel to the long axis of the femoral neck. C. The transducer indicator should be pointing towards the umbilicus. D. A joint effusion is defined by a fluid collection measuring greater than five millimeters between the femoral head and acetabulum. E. None of the above

E. None of the above

Which statement regarding tendon imaging is incorrect? A. Tendons are easily identifiable by ultrasound. B. Tendons are much more hyperechoic than muscle. C. Tendons should be assessed as a part of a complete musculotendinous unit as a joint is taken through a full range of motion. D. Ultrasound operators must account for anisotropy when imaging tendons. E. None of the above

E. None of the above

Which of the following statements regarding musculoskeletal imaging is incorrect? A. Local or systemic analgesics are often provided prior to placing the ultrasound probe on the injured area. B. A water bath can serve as an acoustic window. C. A standoff pad can help optimize the focal point of imaging, leading to improved ultrasound image resolution. D. Using a contralateral limb for comparison can help differentiate normal anatomy from a pathologic condition. E. None of the above

E. None of the above Correct. All of the listed choices are correct statements regarding various aspects of musculoskeletal ultrasonography.