Small Parts: MSK and Breast Exercise

What is the most commonly affected anatomic structure of the posterior ankle? 1) Achilles tendon 2) Plantaris tendon 3) Posterior tibialis tendon 4) Flexor digitorum tendon

1) Achilles tendon

A patient presents with a history of breast surgery to remove a benign lesion. While scanning over the incision site, you suspect you are imaging the postsurgical scar. What is the typical sonographic appearance of a scar? 1) Hypoechoic area with acoustic shadowing that is reduced or eliminated with transducer pressure 2) Hyperechoic area with acoustic shadowing that is reduced or eliminated with transducer pressure 3) Hypoechoic area with acoustic shadowing that remains constant regardless of transducer pressure or angulation 4) Hypoechoic area with hyperemia seen with color Doppler

1) Hypoechoic area with acoustic shadowing that is reduced or eliminated with transducer pressure

Which of the following shares a common insertion point with the supraspinatus tendon on the greater tuberosity of the humerus? 1) Infraspinatus tendon 2) Biceps tendon 3) Subscapularis tendon 4) Triceps tendon

1) Infraspinatus tendon

What is the most common noninvasive breast cancer? 1) LCIS 2) MIS 3) IDC NOS 4) ILC

1) LCIS; only because DCIS was not an option

Which section of the plantar fascia is most commonly affected in plantar fasciitis? 1) Medial 2) Central 3) Lateral 4) Posterior

1) Medial

Where is the majority of the glandular tissue of the breast found? 1) Upper outer quadrant 2) Upper inner quadrant 3) Lower outer quadrant 4) Lower inner quadrant

1) Upper outer quadrant

Within the mammary layer are _________________ overlapping lobes arranged in a ________________ fashion around the nipple. Each lobe contains ______________ TDLUs.

1. ___15 to 20___ 2. ___radial___ 3. ___20 to 40___

Normal skin thickness in the breast is ____________ or less, but it can be slightly thicker near the _____________ and ________________________ .

1. ___2 mm___ 2. ___areola___ 3. ___inframammary fold___

______________________ is found in the meniscus and intervertebral disk spaces and acts as a shock absorber. ______________ or ______________ cartilage lies at the terminal ends of bone in any joint.

1. ___Fibrocartilage___ 2. ___articular___ 3. ___hyaline___

______________ carcinoma occurs when a highly invasive cancer infiltrates the lymphatics of the skin. The skin becomes _________ , __________ , and ____________ with an orange peel appearance.

1. ___Inflammatory___ 2. ___red___ 3. ___warm___ 4. ___edematous__

The longest and strongest tendon of the body is the ___________________ . The ______________________ area is the most common site for rupture. This is ___________________ proximal to the insertion on the calcaneus.

1. ______achilles 2. vascular watershed 3. ___2 to 6 cm___

Evaluation of the posterior knee typically focuses on the ___________________________________________ , more commonly known as the ______________________ . This typically presents as a palpable mass in the ________________________ .

1. ______gastrocnemius-semimembranosus bursa 2. ______Baker cyst 3. ______popliteal crease

The ________________ aspect of the ankle is the most often injured area of the ankle due to __________________ foot injuries.

1. ______lateral 2. ______inversion

The tendons of the medial ankle are the PTT or _______________________ . Directly posterior is the FDL or ___________________________ , the most posterior is the FHL or _______________________________ .

1. ______posterior tibialis tendon 2. ______flexor digitorum longus 3. _____flexor hallucis longus

The supraspinatus tendon is an ___________________ of the humerus and also provides stabilization of the ______________________ in the glenohumeral joint.

1. ___abductor___ 2. ___humeral head___

Invasive cancer describes cases when malignant cells breach the __________________ of the duct and/or tubule and extend into adjacent tissues. ______________________ is the most common breast cancer.

1. ___basement membrane___ 2. ___Invasive Ductal Carcinoma Not Otherwise Specified (IDC NOS)

In mammography, the CC or _____________________ view demonstrates the ________________ , central, and _____________ breast. The MLO or ___________________ view demonstrates the breast in profile from the ____________________ to the ______________________ fold and includes a portion of the ____________________ muscle.

1. ___craniocaudal___ 2. ___medial___ 3. ___lateral___ 4. ___medial lateral oblique___ 5. ___axilla___ 6. ___inframammary___ 7. ___pectoralis___

Sonography can help differentiate ________________ from ________________ lesions. Sonography can also be useful in patients who are ___________________ , __________________ , or _____________________ , because these patients tend to have increased breast density that can limit the radiographic examination.

1. ___cystic___ 2. ___solid___ 3. ___young___ 4. ___pregnant___ 5. ___lactating___

Approximately one in _____________ women will develop breast cancer in their lifetime. The majority occur in women over the age of ___________ . Most cancers originate in a ___________ . Because it has the highest percentage of glandular and epithelial tissue, the ______________ quadrant is the most likely location for a breast cancer to develop.

1. ___eight___ 2. ___50___ 3. ___TDLU___ 4. ___upper outer___

The quadriceps tendon is an important ___________________ of the lower extremity. Over 95% of the fibers of the quadriceps tendon insert on the ____________________________ .

1. ___extensor___ 2. ______base of the patella

A condition that is the result of inflammatory and ischemic processes, frequently the consequence of breast trauma, is called ___________________ . Sonographically, initially there may be _____________________ echogenicity at the palpable area. An __________________ may form as a result displaying a fat-fluid level.

1. ___fat necrosis___ 2. (increased) 3. ___oil cyst___

The most common benign diffuse breast condition is ___________________________ . Symptoms include breast ________________________ , fullness, and ________________ . With sonography, multiple breast _________________ are commonly seen.

1. ___fibrocystic change___ 2. ___tenderness or pain___ 3. ___nodularity___ 4. ___cysts___

On the volar aspect of the wrist are the ________________ tendons and __________________ , _________________ and _________________ nerve. The most commonly evaluated area on the volar wrist is the _____________________ .

1. ___flexor___ 2. ___median___ 3. ___ulnar___ 4. ___radial___ 5. ___carpal tunnel___

Vocal _______________ is a technique using power Doppler in which a patient is asked to hum during real-time imaging. Abnormal tissues will tend to show a ________________ of color during this technique.

1. ___fremitus___ 2. ___void___

When IDC NOS is palpable, it typically is ___________ , __________ and ___________ . Lesions with _____________ can feel larger on palpation than their actual size due to the response of the surrounding tissues.

1. ___hard___ 2. ___fixed___ 3. ___painless___ 4. ___reactive fibrosis___

When imaged in the short axis, the nerve has a __________________ pattern, with the ___________________ nerve fibers surrounded by the _____________________ perineuron or connective tissue.

1. ___honeycomb___ 2. ___hypoechoic___ 3. ___hyperechoic___

Noninvasive breast cancer is called carcinoma ______________ . Types include ______________________ and ________________________ .

1. ___in situ___ 2. (lobular carcinoma in situ, ductal carcinoma in situ, LCIS, DCIS) 3. (lobular carcinoma in situ, ductal carcinoma in situ, LCIS, DCIS)

The first site of metastatic spread from a primary breast cancer is usually to the _________________ lymph nodes. The ________________ node is the first node in the drainage basin at most risk for metastasis. Distant sites for metastasis include _____________ , _____________ , ____________ and _____________ .

1. ___ipsilateral axillary___ 2. ___sentinel___ 3. ___bone___ 4. ___liver___ 5. ___lung___ 6. ___brain___

An intraductal papilloma typically occurs within a major _____________________ . This lesion may cause ____________________ of the duct, leading to cyst formation.

1. ___lactiferous duct___ 2. ___obstruction___

Image annotations should include the side being examined, _____________________ in the breast and transducer _____________________ . Distance from the __________________ is also recommended by the ACR.

1. ___location___ 2. ___scan plane___ 3. ___nipple___

Inflammation of the breast is called _________________ and it most commonly occurs in women who are __________________ or ________________ . Without treatment, an _________________ may develop.

1. ___mastitis___ 2. ___pregnant___ 3. ___lactating___ 4. ___abscess___

The ____________________________ is the primary ligamentous support structure for the medial knee. The _____________ tears generally occur from the joint space, whereas the _____________ tears can occur anywhere along the length of the tendon.

1. ___medial collateral ligament (MCL)___ 2. ___MCL___ 3. ___LCL___

The distal biceps tendon inserts ________________ on the ____________________ of the radius. Pathology can include __________________ or _____________ thickness tears.

1. ___medially___ 2. ___radial tuberosity___ 3. ___partial___ 4. ___full___

Mammography is capable of detecting suspicious patterns of ______________________ , which is typically the first imaging sign of a developing malignancy. Lesions are more readily detected in a radiolucent or _____________ breast than in a radiopaque or ________________ breast.

1. ___microcalcifications___ 2. ___fatty___ 3. ___dense___

Invasive lobular carcinoma is more often ___________ , _____________ , and bilateral than invasive ductal carcinoma is _______________ not a typical feature with ILC, as it is with IDC.

1. ___multifocal___ 2. ___multicentric___ 3. ___desmoplasia___

The ______________ major muscle lies beneath the upper two-thirds of the breast. The ________________ muscle lies beneath the major muscle.

1. ___pectoralis___ 2. ___pectoralis minor___

When evaluating the breast, sagittal and transverse planes can be used as well as _________________ and _______________________ planes.

1. ___radial___ 2. ___antiradial___

The breast is subdivided by fascial planes into three layers: the _____________________ layer, the _______________________ , and the __________________________ layer.

1. ___subcutaneous fat___ (contained in the premammary layer) 2. mammary (b/w ant and post mammary fascia) 3. ___retromammary___ (ant to pect major)

The most commonly affected section in common extensor tendinopathy is the ________________________________________ . The transducer is typically placed on top of the ______________________ in the _____________ plane to start the evaluation.

1. ___superficial fibers of the extensor carpi radialis__ 2. ___lateral epicondyle___ 3. ___LAX___

Common flexor osteotendinopathy refers to pathology of the ______________________ tendons and the ________________________ at insertion. This is also called _____________________

1. ___superficial flexor___ 2. ___pronator teres___ 3. ___golfer's elbow___

The biceps tendon is a _______________ of the forearm and ____________________ of the elbow and shoulder.

1. ___supinator___ 2. ___flexor___

Which of the following statements regarding elastography of the breast is TRUE? 1) Hard lesions tend to show more deformation or strain than soft tissues 2) A cancer will tend to be larger on the elastogram than on the conventional 2D image 3) Most benign masses tend to be stiffer on eIastography 4) A cancer will tend to be smaller on the dastogram than on the conventional 2D image

2) A cancer will tend to be larger on the elastogram than on the conventional 2D image

Lymphatic drainage from the breast occurs mostly through what? 1) Internal mammary nodes 2) Axillary nodes 3) Rotter's nodes 4) Thoracic nodes

2) Axillary nodes

A patient with a simple cyst seen on both mammography and sonography would be given which classification? 1) 13I-RADS 1 2) BI-RADS 2 3) BI-RADS 3 4) BI-RADS 4

2) BI-RADS 2

What is the most common pathology of the knee? 1) Rupture of the MCL 2) Baker's cyst 3) Quadriceps tendon rupture 4) Torn meniscus

2) Baker's cyst

Which type of breast cancer begins in the ducts and does not invade the basement membrane? 1) LCIS 2) DCIS 3) IDC NOS 4) ILC

2) DCIS

Which of the following is NOT found on the palmar wrist? 1) Flexor tendons 2) EPB and APL 3) Median nerve 4) Ulnar and radial nerves

2) EPB and APL

Which of the following structures is NOT found in the anterior elbow? 1) Median nerve 2) Illnar nerve 3) Brachial artery 4) Distal biceps tendon

2) Illnar nerve

An intramammary lymph node is identified during a breast sonogram. What is the normal measurement of an intramammary lymph node? 1) Less than 5 mm 2) L ess than 1 cm 3) Less than 2 cm 4) Normal lymph nodes are not visualized within the breast

2) L ess than 1 cm

Which breast layer is located between the anterior and posterior mammary fascia? 1) Subcutaneous fat layer 2) Mammary layer 3) Retromammary fat layer 4) Axilla

2) Mammary layer

Bone is attached to muscle by what? 1) Fibrocartilage 2) Tendons 3) Nerves 4) Ligaments

2) Tendons

What is the functional unit of the breast? 1) Radial ductal unit 2) Terminal ductal lobular unit 3) Strornal ductal unit 4) Glandular ductal unit

2) Terminal ductal lobular unit

Which of the following is NOT evaluated in a shoulder examination for rotator cuff injury? 1) Biceps tendon 2) Triceps tendon 3) Supraspinatus tendon 4) Infraspinatus tendon

2) Triceps tendon

According to ACR and A1UM guidelines, which of the following transducers is appropriate to use for breast sonography? 1) 7.5 MHz linear array 2) 7.5 MHz phased array 3) 12 MHz linear array 4) 15 MHz curvilinear array

3) 12 MHz linear array

Which of the following is NOT a sonographic characteristic of a benign mass? 1) A benign mass displaces rather than invades surrounding tissues 2) A benign mass is typically well-circumscribed 3) A benign mass is typically taller than wide 4) A benign mass typically has an oval shape

3) A benign mass is typically taller than wide

A patient presents for breast sonography after a lesion was seen on a mammogram. A cyst that does not meet all the criteria for a simple cyst is found that correlates to the area seen on mammography. Which of the following characteristics would NOT be worrisome for malignancy or neoplastic changes? 1) Thickened cyst wall >5 mm 2) A mixed cystic or solid lesion 3) A fluid-debris level that changes with patient positioning 4) Echoes along the wall of the cyst that do not change with patient positioning

3) A fluid-debris level that changes with patient positioning

When evaluating the shoulder with sonography, which of the following is NOT considered a major rotator cuff pathology? 1) Cuff atrophy 2) Absence of cuff 3) Abnormal fluid collection 4) Hyperechoic defect

3) Abnormal fluid collection

What is the most frequently injured joint in the body? 1) Knee 2) Shoulder 3) Ankle 4) Hip

3) Ankle

What is the most commonly injured ankle ligament? 1) Tibiofibular ligament 2) Calcaneal fibular ligament 3) Anterior talofibular ligament 4) Peroneus longus ligament

3) Anterior talofibular ligament

What is the term for tennis elbow? 1) Common flexor osteotendinopathy 2) Biceps osteotendinopathy 3) Common extensor tendinopathy 4) Olecranon bursitis

3) Common extensor tendinopathy

The breast tissue is attached to the skin by what? 1) TDLUs 2) Lactiferous ligaments 3) Cooper's ligaments 4) Thoracic ligaments

3) Cooper's ligaments

What is the most common breast cancer? 1) LCIS 2) DCIS 3) IDC NOS 4) ILC

3) IDC NOS

Which of the following planes are commonly used when imaging the musculoskeletal system? 1) Sagittal and transverse 2) Radial and antiradial 3) Long-axis and short-axis 4) Scan planes are not described when imaging the MSK system

3) Long-axis and short-axis

Which of the following statements regarding mammography is FALSE? 1) Mammography cannot determine whether a mass is cystic or solid 2) Mammography can be difficult in patients who have inflammatory conditions or trauma to the breast 3) Mammography can easily detect lesions in a dense breast 4) Mammography can detect microcalcifications, which may be the first sign of a malignancy

3) Mammography can easily detect lesions in a dense breast

Which of the following is an uncommon cancer that presents with redness and eczema-like crusting of the nipple and areola, nipple discharge, and itching? 1) Mondor's disease 2) Ormond disease 3) Paget's disease 4) Medullary disease

3) Paget's disease

How many tarsal bones make up the foot? 1) Three 2) Five 3) Seven 4) Nine

3) Seven

Which of the following structures is NOT contained in a neurovascular bundle? 1) Artery 2) Vein 3) Tendon 4) Nerves

3) Tendon

Which of the following is NOT a benefit of using sonography to evaluate the musculoskeletal system? 1) Sonography is more cost-effective than MRI or CT 2) Sonography does not expose the patient to ionizing radiation 3) Sonography is a dynamic examination 4) All of the above are benefits of sonography

4) All of the above are benefits of sonography

Which of the following describes the function of the plantar fascia? 1) Arch support 2) Gait 3) Distribution of weight 4) All of the above are functions of the plantar fascia

4) All of the above are functions of the plantar fascia

Which of the following characteristics make a mass suspicious for malignancy? 1) Angular or spiculated margins 2) Nipple retraction 3) Shadowing 4) All of the above are suspicious findings

4) All of the above are suspicious findings

Which of the following can help improve contrast and spatial resolution during breast sonography? 1) Harmonic imaging 2) Spatial compounding 3) Broad bandwidth transducers 4) All of the above are used to improve image quality

4) All of the above are used to improve image quality

A mass that is highly suggestive of malignancy on both mammography and sonography with multiple suspicious features would be classified as what? 1) BI-RADS 2 2) BI-RADS 3 3) BI-RADS 4 4) BI-RADS 5

4) BI-RADS 5

What is the most common cause of breast lumps in women 35 to 50 years of age? 1) Breast cancers 2) Fibroadenornas 3) Lipomas 4) Breast cysts

4) Breast cysts

What is the most common benign solid tumor of the female breast? 1) PhylIodes tumor 2) Intraductal papilloma 3) Lipoma 4) Fibroadenoma

4) Fibroadenoma

What is a retention cyst that may develop in pregnant or lactating women called? 1) Papillary apocrine metaplasia 2) Sebaceous cyst 3) Epidermal inclusion cyst 4) Galactocele

4) Galactocele

What is the most common male breast abnormality? 1) Fibmadenoma 2) Simple cyst 3) Breast cancer 4) Gynecomastia

4) Gynecomastia

Which of the following attaches bone to bone, providing needed stability and strength? 1) Fibrocartilage 2) Tendons 3) Nerves 4) Ligaments

4) Ligaments

Carpal tunnel syndrome results from compression of what? 1) Ulnar nerve 2) Radial nerve 3) Palmar nerve 4) Median nerve

4) Median nerve

Which of the following statements regarding breast sonography is FALSE? 1) Sonography is useful for differentiating cystic from solid lesions 2) Sonography is often used to guide interventional and therapeutic procedures 3) Sonography can be used to evaluate the male breast 4) Sonography is as good as mammography in detecting microcalcifications

4) Sonography is as good as mammography in detecting microcalcifications

Which of the following statements regarding the acromioclavicular joint is FALSE? 1) Abnormal fluid collections may form here in cases of supraspinatus tendon pathology 2) The joint space is wedge-shaped from posterior to anterior 3) The AC joint is a common site for arthritis and osteophytes 4) The AC joint is best evaluated in external rotation

4) The AC joint is best evaluated in external rotation

refers to the change in the properties of a structure when measured or evaluated in different directions.

___Anisotropy___

The radial fossa and coronoid fossa can be evaluated with sonography for joint effusions. Excessive fluid in the joint results in the fat pads being displaced _____________________ away from the bone.

___anteriorly___

A clinical symptom of papillary carcinoma is _____________________ .

___bloody nipple discharge___

A ________________________ is a synovial lined pouch that produces viscous fluid that aides in tendon or muscle slip.

___bursa___

The primary function of the triceps is __________________ of the elbow.

___extension___

A technique called _______________________________ involves using an abundance of gel to avoid using excessive pressure when evaluating superficial structures.

___floating the transducer___

A palpable, oval, well-circumscribed, solid mass that is enlarging in pregnancy is commonly a secretory or ______________________ .

___lactating adenoma___

A _______________________ is a collection of loose connective tissue between the sheath and tendon that aids in tendon movement.

___paratenon___

The _______________________ layer lies between the posterior mammary fascia and the pectoralis major muscle.

___retromammary fat___