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