Clinical Imaging 4 Exam 1 Review

e. emergency room

40 year old female with swollen and painful finger. What referral is most appropriate in this case? a. orthopedist b. PCP c. no referral needed d. Rheumatologist e. emergency room

d. pancake vertebra

Anterior and posterior vertebral body collapse due to a pathologic process is termed: a. burst fracture b. vertebra convex c. banana fracture d. pancake vertebra

b. yes, absolute contradiction

Are these findings a contraindication to chiropractic manipulation? a. yes, relative contradiction b. yes, absolute contradiction c. no, no contraindication

aggressive

Based on the radiograph findings present, is this lesion most likely aggressive or non aggressive?

aggressive

Based on the radiographic findings present, is this lesion most likely aggressive or non aggressive?

non aggressive

Based on the radiographic findings present, is this lesion most likely aggressive or non aggressive?

b. osteoblastic

Elevation of alkaline phosphate is most common in which type of osseous metastasis? a. osteolytic b. osteoblastic

b. emergency department

What is the appropriate referral for image A? a. neurologist b. emergency department c. orthopedist d. endocrinologist e. no referral necessary f. primary care provider

a. no referral necessary

What is the appropriate referral for image A? a. no referral necessary b. primary care provider c. emergency department d. orthopedist

e. no referral necessary

What is the appropriate referral for image B? a. neurologist b. emergency department c. orthopedist d. endocrinologist e. no referral necessary f. primary care provider

c. emergency department

What is the appropriate referral for image B? a. no referral necessary b. primary care provider c. emergency department d. orthopedist

a. Emergency room

What is the correct referral for this patient? a. Emergency room b. PCP c. MRI d. CT

c. spondylodiscitis

What is the diagnosis for image A? a. chordoma b. reactive arthritis c. spondylodiscitis d. degenerative disc disease e. ankylosing spondylitis f. neuropathic arthropathy

f. degenerative joint disease

What is the diagnosis for image A? a. tuberculosis b. septic arthritis c. Ewing sarcoma d. calcium pyrophosphate dihydrate deposition disease e. Brodie abscess f. degenerative joint disease

c. osteoid osteoma

What is the diagnosis for image B? a. acute osteomyelitis b. Brodie abscess c. osteoid osteoma d. osteoblastoma e. septic arthritis f. chondroblastoma

d. degenerative disc disease

What is the diagnosis for image B? a. chordoma b. reactive arthritis c. spondylodiscitis d. degenerative disc disease e. ankylosing spondylitis f. neuropathic arthropathy

b. septic arthritis

What is the diagnosis for image B? a. tuberculosis b. septic arthritis c. Ewing sarcoma d. calcium pyrophosphate dihydrate deposition disease e. Brodie abscess f. degenerative joint disease

b. spondylodiscitis

What is the diagnosis for the findings at C3/C4 on image B? a. disc herniation b. spondylodiscitis c. modic change type 1 d. modic change type 2

c. septic arthritis

What is the diagnosis? a. rheumatoid arthritis b. degenerative joint disease c. septic arthritis d. ankylosing spondylitis

a. lymphatic dissemination

What is the least common pathway of metastatic spread to bone? a. lymphatic dissemination b. direct extension c. hematogenous dissemination

a. metastasis

What is the most common malignancy of bone? a. metastasis b. multiple myeloma c. chondrosarcoma d. osteosarcoma

d. leukemia

What is the most common malignant disease in childhood? a. lymphoma b. Ewing sarcoma c. osteosarcoma d. leukemia

a. leukemia

What is the most common malignant disease of childhood? a. leukemia b. Ewing sarcoma c. lymphoma d. osteosarcoma

c. hematogenous dissemination

What is the most common pathway of metastasis spread to bone? a. lymphatic dissemination b. direct extension c. hematogenous dissemination

c. osteosarcoma

What is the most common primary malignancy of bone in the pediatric population? a. osteoblastoma b. Ewing sarcoma c. osteosarcoma d. chondrosarcoma

d. Brodie abscess

What is the most likely diagnosis? a. acute osteomyelitis b. chondroblastoma c. septic arthritis d. Brodie abscess e. osteoblastoma f. osteoid osteoma

c. involucrum

What is the name for the finding pointed to by the blue arrow? a. cloca b. sequestrum c. involucrum d. sinus tract

a. moth-eaten to permeative osteolytic

What pattern of destruction is present? a. moth-eaten to permeative osteolytic b. osteoblastic c. mixed d. geographic osteolytic

b. osteoblastic

What pattern of destruction is present? a. scalloped b. osteoblastic c. osteolytic d. fibrous

c. endosteal scalloping

What radiographic finding are the blue arrows pointing to? a. cortical thickening b. cortical saucerization c. endosteal scalloping d. solid periosteal reaction

a. cartilaginous

What type of matrix is present in this lesion? a. cartilaginous b. osseous c. fibrous d. fatty

d. fibrous

What type of matrix is present in this lesion? a. osseous b. cartilaginous c. fatty d. fibrous

a. osseous

What type of matrix is present in this lesion? a. osseous b. fibrous c. fatty d. cartilaginous

b. geographic osteolytic

What type of pattern of destruction is present? a. moth-eaten to permeative osteolytic b. geographic osteolytic c. osteoblastic d. mixed

b. spiculated

What type of periosteal reaction is located within the blue bracket? a. codman triangle b. spiculated c. laminated d. solid

b. laminated

What type of periosteal reaction is located within the blue bracket? a. solid b. laminated c. codman triangle d. spiculated

a. solid

What type of periosteal reaction is most often associated with a non-aggressive process? a. solid b. spiculated c. codman triangle d. laminated

b. codman triangle

What type of periosteal reaction is pointed to by the blue arrow? a. spiculated b. codman triangle c. solid d. laminated

c. proximal femoral diaphysis

Where is the lesion located? a. proximal femoral metaphysis b. proximal femoral epiphysis c. proximal femoral diaphysis

c. neuropathic arthropathy e. chronic osteomyelitis

Which TWO diagnosis could be considered on the differential list for this case? a. psoriatic arthritis b. hypertrophic osteoarthropathy c. neuropathic arthropathy d. reactive arthritis e. chronic osteomyelitis f. acute osteomyelitis

c. Ewing sarcoma

Which aggressive lesion is characteristically located in the diaphysis of long bones in pediatric pateints? a. giant cell tumor b. osteosarcoma c. Ewing sarcoma d. osteomyelitis

d. rain drop skull

Which characteristic skull finding is seen in multiple myeloma? a. Osteoporosis circumscripta b. spoke-wheel appearance c. generalized osteopenia d. rain drop skull

b. pathological fracture

Which characteristic suggests malignant degeneration of an enchondroma? a. periosteal reaction b. pathological fracture c. intact cortical margin d. flocculent calcific center

c. cortical thickening d. eccentric lesion location

Which features are present on image B and NOT on image A? a. multi-septated appearance b. medullary based lesion c. cortical thickening d. eccentric lesion location

d. anterior scalloping

Which finding, is present at an ivory vertebra, would be most suggestive of a diagnosis of lymphoma? a. cortical thickening b. osseous enlargement c. posterior buttressing d. anterior scalloping

a. true

A permeative osteolytic typically suggests an aggressive pathology a. true b. false

e. osteosarcoma

An 11 year old male presents with a painful mass on his left arm. It has enlarged over the past several months. What is the most likely diagnosis? a. chrondrosarcoma b. lymphoma c. Ewing sarcoma d. metastasis e. osteosarcoma f. osteoblastoma

f. metastasis

63 year old female with back pain. What is the most likely diagnosis? a. osteoblastoma b. lymphoma c. Eqing sarcoma d. chondrosarcoma e. osteosarcoma f. metastasis

b. spondylodiscitis

63 year old female with neck pain. What is the diagnosis? a. degenerative disc disease b. spondylodiscitis c. ankylosing spondylitis d. rheumatoid arthritis

c. septic arthritis

72 year old female with thumb pain, swelling, and redness. What is the diagnosis? a. Psoriatic arthritis b. degenerative joint disease c. septic arthritis d. erosive osteoarthritis

a. lung

A "cookie bite lesion" is most often seen in association with which primary carcinoma? a. lung b. breast c. prostate d. kidney

c. chondrosarcoma

A 50 year old male presents with pain on the right side of his low back and notable scoliosis. What is the most likely diagnosis? a. lymphoma b. osteosarcoma c. chondrosarcoma d. metastasis e. osteoblastoma f. Ewing sarcoma

b. osteoblastic metastasis

A 52 year old male presents with low back pain and a history of bronchogenic carcinoma. Radiographs of the lumbar spine reveal an osteoblastic vertebral body at L2 without anterior vertebral body scalloping, osseous expansion, or cortical thickening. What is the most likely diagnosis? a. Paget disease b. osteoblastic metastasis c. giant cell tumor d. Hodgkin lymphoma

b. false

A geographic, osteolytic lesion will have a long/wide zone of transition a. true b. false

b. both osteolysis and osteoblastic destruction

A pattern of destruction described as "mixed" exhibits which of the following features? a. a geographic region of osteolysis b. both osteolysis and osteoblastic destruction c. a permeative pattern of osteolytic destruction d. a diffuse pattern of osteoblastic changes

b. image A shows increased prevertebral soft tissue dimension c. image A demonstrates abnormal air densities in soft tissues d. image A has severe disc height loss at an uncommon location

How do the findings on image A differ from those on image B? select ALL a. image A has osteophytes b. image A shows increased prevertebral soft tissue dimension c. image A demonstrates abnormal air densities in soft tissues d. image A has severe disc height loss at an uncommon location

a. there is fascial plane distension on this case b. there is loss of the subchondral white line on this case c. there is osteolysis on this case

How do the imaging findings differ in this case compared to expected findings in degenerative joint disease? a. there is fascial plane distension on this case b. there is loss of the subchondral white line on this case c. there is osteolysis on this case d. there is osteophyte formation on this case

b. chronic

Is this an example of acute, subacute, or chronic osteomyelitis? a. acute b. chronic c. subacute

aggressive

Is this lesion likely aggressive or non-aggressive?

d. 30-50%

Metastatic lesions become radiographically apparent when ______ of the bone is destroyed. a. 0-10% b. 5-25% c. 70-90% d. 30-50%

b. old

Most malignant osseous neoplasms occur in which age group? a. young b. old

a. chronic lymphoid leukemia

Osseous changes in adults with leukemia are most likely seen in which form? a. chronic lymphoid leukemia b. acute myelogenous leukemia c. acute lymphoid leukemia d. skeletal hanged will not be seen in an adult with leukemia

a. prostate

Osteoblastic metastasis in an adult male patient likely originated from a primary carcinoma of the ________. a. prostate b. lung c. breast d. liver

c. breast

Osteolytic metastasis in an adult female patient likely originated from a primary carcinoma of the ________. a. liver b. bone c. breast d. lung

a. true

Plastacytoma is a solitary form of myeloma a. true b. false

a. soft tissue defect c. sclerosis d. osteolysis e. sclerosis f. involucrum

Select all imaging findings present: a. soft tissue defect b. sequestrum c. sclerosis d. osteolysis e. sclerosis f. involucrum

a. short c. narrow

Select all of the appropriate terms for this lesion's zone of transition a. short b. wide c. narrow d. long

a. metastasis b. lymphoma

Select all the appropriate differentials for an ivory vertebra a. metastasis b. lymphoma c. chordoma d. plasmacytoma

a. sequestrum b. solid periosteal reaction d. osteolytic destruction

Select all the radiographic findings present: a. sequestrum b. solid periosteal reaction c. laminated periosteal reaction d. osteolytic destruction

b. uniform joint space loss d. osteolytic destruction e. soft tissue distension

Select findings present on Image B which are NOT present on image A. a. osteophyte formation b. uniform joint space loss c. patella alta d. osteolytic destruction e. soft tissue distension f. enthesopathy

erosion, loss of subchondral white line, uniform joitn space loss, and permeative osteopenia

What are the findings on Image B?

a. fibrous

The ground glass appearance with which type of matrix? a. fibrous b. cartilaginous c. fatty d. osseous

d. Staphylococcus aureus

The most common overall causative agent in septic arthritis is ________ a. Streptococcus pyogenes b. treponema pallidium c. Mycobacterium tuberculosis d. Staphylococcus aureus

a. osteolytic

The most common pattern of destruction in hodgkin lymphoma is: a. osteolytic b. osteoblastic c. mixed

b. monostotic

The presence of multiple lesions in one bone is best described as a ________ distribution a. polyostotic b. monostotic c. pauciostotic

d. Cartilaginous

The terms flocculent and sclerotic are best applied to which type of matrix? a. fibrous b. osseous c. fatty d. Cartilaginous

a. true

There is a soft tissue mass present a. true b. false

IHOP - idiopathic - Hodgkins lymphoma - osteoblastic mets - Paget's disease

What acronym do we use for an ivory vertebra?

ICE - bone infarction - chondrosarcoma - enchondroma

What acronym do we use for calcification in medullary cavity of a long bone?

5 B's LICK POLLEN - bronchogenic - breast - bowel - blader - brain - lymphoma - prostate

What acronym do we use for primary malignancies which cause osteoblastic mets?

RATS - renal cell carcinoma - adrenal malignancy - thyroid carcinoma - skin cancer

What acronym do we use for primary malignancies which lead to expansile, osteolytic metastasis?

MMLC - multiple mueloma - metastasis - lymphoma - chordoma - chondrosarcoma

What are the aggressive lesions in an adult?

OELLO - osteosarcoma - Ewing sarcoma - lymphoma - leukemia - osteomyelitis

What are the aggressive lesions in an child?

osteophytes, medial joint space loss, and enthesopathy

What are the findings of Image A?

b. increased density (osteoblastic/ sclerotic)

What density will a mineralized osseous matrix display radiographically? a. decreased density (osteolytic/ radiolucent) b. increased density (osteoblastic/ sclerotic)

c. multiple myeloma

What diagnosis can present with multiple punched out osteolytic lesions of approximately the same size and shape? a. lymphoma b. metastasis c. multiple myeloma d. Paget disease

c. sequestrum

What finding is pointed to by the blue arrow? a. sinus tract b. involucrum c. sequestrum d. cloaca

c. Bence Jones proteinuria

What finding may be seen on urinalysis of a patient with multiple myeloma? a. hypercalcemia b. reversal of the A:G ratio c. Bence Jones proteinuria d. M-spike

a. endplate destruction

What imaging finding suggests a diagnosis of spondylodiscitis? a. endplate destruction b. osteophyte formation c. increased fluid signal in a vertebral endplate d. decreased disc height loss

c. MRI

What imaging modality would best demonstrate osseous and soft tissue changes for image A? a. CT b. bone scan c. MRI d. ultrasound

b. M-spike on serum protein electrophoresis

What is a likely laboratory finding in a patient with multiple myeloma? a. hypocalcemia b. M-spike on serum protein electrophoresis c. normal A:G ratio d. hypouricemia

c. chondrosarcoma

What is the 2nd most common primary malignancy in the adult population on radiograph? a. multiple myeloma b. osteosarcoma c. chondrosarcoma d. Ewing sarcoma

a. fibrosarcoma

Which lesion is typically associated with a prominent soft tissue mass? a. fibrosarcoma b. intraosseous lipoma c. hemangioma d. NOF

b. clavicle

Which location is the least likely for a chordoma? a. spheno-occiput b. clavicle c. C2 VB d. sacrococygeal

a. geographic region of osteopenia by a rim of sclerosis

Which of the following is NOT part of Phemister triad? a. geographic region of osteopenia by a rim of sclerosis b. gradually narrowing joint space c. peripherally located osseous erosions d. juxtaarticular osteoporosis

c. Ewing sarcoma

Which of the following is a metadiaphyseal, permeative, osteolytic lesion with aggressive periosteal changes and saucerization of the cortex that is found in patients younger that 30 years of age? a. multiple myeloma b. giant cell tumor c. Ewing sarcoma d. Simple bone cysts

b. renal cell

Which primary carcinoma is most likely to cause an expansile focus of osteolytic metastasis? a. breast b. renal cell c. prostate d. bronchogenic

a. Ewing sarcoma

Which primary malignancy of bone is most likely to metastasize to bone? a. Ewing sarcoma b. multiple myeloma c. osteosarcoma d. chondrosarcoma

b. non-hodgkin

Which type of lymphoma is most likely to primarily effect the bone? a. hodgkin b. non-hodgkin

b. solid

Which type of periosteal reaction may be seen with beging, slow-growing lesions? a. sunburst b. solid c. spiculated d. laminated