Sports Medicine Imaging — MCQs
Which MRI finding is suggestive of a torn meniscus in the knee?
What is the investigation of choice for diagnosing a stress fracture?
Investigation of choice in an unstable patient with suspected intra-abdominal injury is -
What is the condition commonly referred to as 'draughtsman's elbow'?
An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?
The rephrased question is:What is the most common complication of a fractured talus?
In which condition is the cleavage plane sign typically observed?
What is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?
Earliest investigation for diagnosis of Ankylosing spondylitis:
Which imaging modality is best for evaluating retinoblastoma?
Sports Medicine Imaging Indian Medical PG Practice Questions and MCQs
Question 1: Which MRI finding is suggestive of a torn meniscus in the knee?
- A. Loss of cartilage
- B. Increased signal intensity in the meniscus (Correct Answer)
- C. Effusion
- D. Bone marrow edema
Explanation: ***Increased signal intensity in the meniscus*** A torn meniscus on MRI typically shows **increased signal intensity** within the meniscal substance that **extends to at least one articular surface**, which is the key diagnostic criterion. This high signal indicates **fluid within the tear** or degenerative changes. The signal must reach the surface to differentiate a true tear from intrasubstance degeneration, which shows signal that does not reach the surface. *Loss of cartilage* **Cartilage loss** is characteristic of **osteoarthritis** or chronic degenerative joint disease, not specifically an acute meniscal tear. While it can coexist with meniscal tears as part of degenerative joint disease, it is not a direct indicator of a tear within the meniscus itself. *Effusion* A **knee effusion** (fluid within the joint) is a general sign of joint irritation or injury and can be present with various conditions, including meniscal tears, ligament injuries, and arthritis. However, it is a **non-specific finding** and does not directly confirm a meniscal tear. *Bone marrow edema* **Bone marrow edema** is often seen with **bone bruises**, stress fractures, or osteonecrosis. It indicates stress or injury to the bone rather than soft tissue injury, and is not directly indicative of a meniscal tear.
Question 2: What is the investigation of choice for diagnosing a stress fracture?
- A. X-ray
- B. CT scan
- C. MRI (Correct Answer)
- D. Bone scan
Explanation: ***MRI*** - **Magnetic Resonance Imaging (MRI)** is the most sensitive and specific imaging modality for diagnosing **stress fractures**, especially in their early stages. - It can detect **bone marrow edema** and **periosteal reactions** indicative of stress injury before cortical changes are visible on plain radiographs. *X-ray* - **X-rays** are often the initial investigation, but they have low sensitivity for **stress fractures** in the early stages as bone changes may not be apparent for several weeks. - A positive X-ray for stress fracture typically shows a **sclerotic line** or **periosteal reaction**, but this indicates a more advanced injury. *CT scan* - **CT scans** provide excellent detail of **cortical bone** and can detect subtle fractures not seen on X-rays. - While more sensitive than X-rays, CT has **higher radiation exposure** and is generally less sensitive than MRI for early detection of **bone marrow edema** associated with stress injuries. *Bone scan* - **Bone scans** (scintigraphy) are highly sensitive for detecting increased **osteoblastic activity** associated with stress fractures. - However, they are **less specific** as various conditions can cause increased uptake, and they do not provide detailed anatomical information, making MRI superior for definitive diagnosis and staging.
Question 3: Investigation of choice in an unstable patient with suspected intra-abdominal injury is -
- A. USG (FAST) (Correct Answer)
- B. CT scan
- C. X-ray abdomen
- D. DPL
Explanation: ***USG*** - **Focused assessment with sonography for trauma (FAST) exam** is the investigation of choice in an **unstable patient** due to its rapid, non-invasive nature and ability to detect free fluid (blood) in the peritoneal, pericardial, and pleural spaces. - It can be performed at the **bedside** without moving the patient, making it ideal for hemodynamically unstable individuals with suspected intra-abdominal injury. *CT scan* - While a **CT scan** provides detailed anatomical information, it requires the patient to be stable enough for transport to a radiology suite and prolonged scanning time. - It is often difficult to obtain in **unstable patients** who may require continuous resuscitation and monitoring. *X-ray abdomen* - An **X-ray abdomen** has limited utility for detecting intra-abdominal injuries and primarily identifies issues like free air under the diaphragm (suggesting hollow organ perforation) or foreign bodies. - It is **not sensitive** for detecting free fluid (hemoperitoneum) or solid organ injuries, which are critical in trauma. *DPL* - **Diagnostic peritoneal lavage (DPL)** is an invasive procedure that involves inserting a catheter into the peritoneal cavity to detect blood or other fluid. - While sensitive, it is **invasive**, can complicate subsequent imaging, and has largely been replaced by the FAST exam due to the latter's non-invasive nature and comparable diagnostic accuracy for free fluid.
Question 4: What is the condition commonly referred to as 'draughtsman's elbow'?
- A. Lateral epicondylitis
- B. Medial epicondylitis
- C. Medial epicondyle avulsion fracture
- D. Olecranon bursitis (Correct Answer)
Explanation: ***Olecranon bursitis*** - This condition is colloquially known as **"draughtsman's elbow"**, **"student's elbow"**, or **"baker's elbow"** due to its association with prolonged leaning on the elbow. - It involves inflammation and swelling of the **olecranon bursa**, which is located at the posterior aspect of the elbow. *Lateral epicondylitis* - This condition is commonly known as **"tennis elbow"** and involves inflammation of the **extensor tendons** originating from the lateral epicondyle. - It typically presents with pain on the **lateral aspect of the elbow**, worsened by gripping and wrist extension. *Medial epicondylitis* - This condition is commonly known as **"golfer's elbow"** and involves inflammation of the **flexor-pronator tendons** originating from the medial epicondyle. - It causes pain on the **medial aspect of the elbow**, worsened by activities involving wrist flexion and pronation. *Medial epicondyle avulsion fracture* - This is a traumatic injury where a fragment of the **medial epicondyle** is pulled away from the humerus, often seen in overhead throwing athletes. - It usually involves acute pain, swelling, and sometimes **nerve dysfunction**, which differs significantly from the inflammatory process of olecranon bursitis.
Question 5: An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?
- A. Posterior Cruciate Ligament
- B. Anterior Cruciate Ligament (Correct Answer)
- C. Lateral Collateral Ligament
- D. Medial Collateral Ligament
Explanation: ***Anterior Cruciate Ligament*** - The **Lachman test** is the most sensitive clinical test for diagnosing an **ACL tear**, indicating anterior tibial translation. - **Pivoting injuries** and **hemarthrosis** (blood in the joint) are classic signs of a severe ACL injury, often involving bone bruising. *Posterior Cruciate Ligament* - PCL injuries are less common and typically result from a direct blow to the **anterior tibia** while the knee is flexed or a hyperextension injury. - The primary test for PCL integrity is the **posterior drawer test**, which assesses posterior tibial translation. *Lateral Collateral Ligament* - LCL injuries usually result from a **varus stress** to the knee, often in contact sports, and can cause pain on the lateral aspect of the knee. - The **varus stress test** is used to assess LCL integrity, but it does not cause hemarthrosis as frequently as an ACL tear. *Medial Collateral Ligament* - MCL injuries are common and result from a **valgus stress** to the knee (a blow to the outside of the knee). - The **valgus stress test** assesses MCL integrity, causing pain on the medial aspect of the knee and typically not resulting in acute hemarthrosis unless other structures are also injured.
Question 6: The rephrased question is:What is the most common complication of a fractured talus?
- A. Avascular necrosis (AVN) (Correct Answer)
- B. Osteoarthritis of the subtalar joint
- C. Nonunion of the talus
- D. Osteoarthritis of the ankle joint
Explanation: ***Avascular necrosis (AVN)*** - The talus has a **precarious blood supply**, with arterial branches entering at multiple points but often centrally, making it vulnerable to **ischemia** after fracture. - Fractures, especially neck fractures, can disrupt these delicate vessels, leading to **osteonecrosis** and collapse of the bone. *Nonunion of the talus* - While possible, talar nonunion is **less common** than AVN due to the talus's dense cortical bone and limited muscle attachments. - Nonunion is more frequently seen with fractures of other bones, such as the **scaphoid**. *Osteoarthritis of the subtalar joint* - **Subtalar osteoarthritis** can occur post-talar fracture, often as a **secondary complication** of disrupted articular surfaces or AVN. - However, the **initial and most common direct complication** stemming from the blood supply disruption is AVN. *Osteoarthritis of the ankle joint* - **Ankle osteoarthritis** can also develop after certain talar fractures, particularly those involving the talar dome or leading to incongruity of the ankle joint. - Similar to subtalar arthritis, it is often a **later or secondary sequela**, rather than the immediate and most frequent direct complication like AVN.
Question 7: In which condition is the cleavage plane sign typically observed?
- A. Parosteal osteosarcoma (Correct Answer)
- B. Ewing's sarcoma
- C. Chondrosarcoma
- D. Metastasis
Explanation: ***Parosteal osteosarcoma*** - The **cleavage plane sign** refers to the presence of a fat-filled or fibrous plane separating the tumor from the underlying cortex, which is characteristic of **parosteal osteosarcoma**. - This sign indicates the **juxtacortical (parosteal) growth pattern** of the tumor, which begins on the bone surface and typically grows outwards. *Ewing's sarcoma* - **Ewing's sarcoma** is a highly aggressive malignant bone tumor that originates in the bone marrow, often presenting with an **"onion-skin" periosteal reaction** due to its intramedullary growth. - It does not typically exhibit a clear cleavage plane between the tumor and the cortex as it grows from within the bone. *Chondrosarcoma* - **Chondrosarcoma** is a malignant tumor of cartilage, often showing **popcorn-like calcifications** and endosteal scalloping, indicating its cartilaginous matrix and intramedullary growth. - While it can be juxtacortical, it does not typically present with a distinct fat or fibrous cleavage plane from the underlying bone like parosteal osteosarcoma. *Metastasis* - **Bone metastases** are secondary cancers that have spread to the bone, often presenting as **lytic or blastic lesions** depending on the primary tumor type. - These lesions typically originate within the bone marrow and invade the bone structure, rather than growing from the surface with a distinct cleavage plane.
Question 8: What is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?
- A. CT scan (Correct Answer)
- B. Angiography
- C. Colour doppler imaging
- D. IVP
Explanation: ***CT scan*** - **CT scan** with contrast is the gold standard for diagnosing renal cell carcinoma and evaluating the extent of tumor thrombus into the **IVC**. - It provides detailed anatomical information on the tumor, staging, and involvement of adjacent structures. *Angiography* - **Angiography** is an invasive procedure primarily used for mapping the vascular supply of the tumor preoperatively or for embolization, not as a primary diagnostic tool. - It carries risks associated with contrast agents and catheterization and provides less comprehensive detail on tumor extension compared to CT. *Colour doppler imaging* - While useful for detecting blood flow and confirming the presence of a thrombus, **color Doppler imaging** (ultrasound) has limitations in accurately assessing the cranial extent of an IVC thrombus. - Its diagnostic accuracy is highly operator-dependent and less reliable for deep structures like the IVC compared to CT. *IVP* - **Intravenous Pyelogram (IVP)** assesses the urinary tract's structure and function but has limited utility in detecting soft tissue masses like renal cell carcinoma or IVC thrombus. - It involves radiation exposure and contrast material, and has largely been replaced by more advanced imaging techniques like CT and MRI for renal masses.
Question 9: Earliest investigation for diagnosis of Ankylosing spondylitis:
- A. CT scan
- B. Bone scan
- C. X-ray
- D. MRI STIR sequence (Correct Answer)
Explanation: ***MRI STIR sequence*** - An **MRI STIR (Short Tau Inversion Recovery) sequence** is highly sensitive for detecting early inflammatory changes in the **sacroiliac joints** and spine, such as **bone marrow edema**, which is a hallmark of early ankylosing spondylitis. - It can identify disease activity and structural changes *before* they are visible on conventional X-rays, making it the earliest diagnostic tool. *CT scan* - While a **CT scan** provides excellent detailed images of bone, it is not as sensitive as MRI for detecting early inflammatory changes like **bone marrow edema** in the sacroiliac joints. - It involves significant **radiation exposure** and is typically used for more advanced structural assessment rather than early diagnosis. *Bone scan* - A **bone scan** (scintigraphy) shows areas of increased bone turnover but is **not specific** for ankylosing spondylitis and has lower spatial resolution compared to MRI. - It can indicate inflammation or increased metabolic activity but cannot differentiate specific causes or provide detailed anatomical information as effectively as MRI. *X-ray* - **X-rays** are often the initial imaging modality due to their accessibility, but they only show **structural changes** (like erosions, sclerosis, or fusion) in the sacroiliac joints and spine at a later stage of the disease. - Early inflammatory changes, such as **bone marrow edema**, are typically not visible on plain radiographs, leading to a delay in diagnosis compared to MRI.
Question 10: Which imaging modality is best for evaluating retinoblastoma?
- A. Ultrasonography
- B. CT scan
- C. CT scan and MRI (Correct Answer)
- D. MRI
Explanation: **Explanation:** Retinoblastoma is the most common primary intraocular malignancy in children. The diagnosis and staging require a multi-modal imaging approach, making **CT scan and MRI** the combined gold standard. * **Why CT and MRI are both essential:** * **CT Scan:** It is the most sensitive modality for detecting **intraocular calcification**, which is the hallmark of retinoblastoma (seen in >90% of cases). CT is crucial for confirming the diagnosis when clinical findings are ambiguous. * **MRI:** It is the modality of choice for **staging**. MRI provides superior soft-tissue contrast to evaluate for optic nerve invasion, extraocular extension, and intracranial involvement (such as trilateral retinoblastoma involving the pineal gland). Crucially, MRI avoids ionizing radiation, which is vital in these patients who often have a genetic predisposition to secondary malignancies (RB1 mutation). **Analysis of Incorrect Options:** * **A. Ultrasonography:** While useful for initial screening and detecting calcified masses (showing high reflectivity with acoustic shadowing), it is operator-dependent and cannot assess posterior extension or intracranial spread. * **B & D. CT or MRI alone:** While both are powerful, neither is sufficient on its own for a complete evaluation. CT excels at identifying pathognomonic calcification, while MRI is mandatory for assessing the extent of the disease and planning management. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** Leukocoria (white pupillary reflex) in a child under 3 years. * **Trilateral Retinoblastoma:** Bilateral retinoblastoma associated with a pineal gland tumor (Pineoblastoma). * **Imaging Sign:** "Cloud-like" or "clumpy" calcification on CT. * **Management Tip:** Avoid biopsy (fine-needle aspiration) due to the high risk of tumor seeding along the needle track. Diagnosis is based on clinical exam and imaging.
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