Musculoskeletal Radiology (Fractures, Bone Tumors, Arthritis) MCQs

Radiology · 43 free questions with answers & explanations.

1. A 16-year-old boy presents with knee pain and swelling. Plain radiograph shows an eccentric lytic lesion in the distal femoral metaphysis with a narrow zone of transition, a thin sclerotic rim, and no periosteal reaction or soft-tissue extension. MRI confirms a fluid-filled lesion that does not cross the physis. What is the most likely diagnosis?
2. A 14-year-old boy presents with severe knee pain and fever. Radiograph shows aggressive periosteal reaction in the proximal tibia described as an 'onion-skin' laminated pattern with a large soft-tissue mass. The metaphysis and diaphysis are involved. Which diagnosis is most consistent?
3. A 50-year-old woman with rheumatoid arthritis has radiographs of both hands showing periarticular osteopenia, symmetric joint space narrowing predominantly at the metacarpophalangeal and proximal interphalangeal joints, marginal erosions, and ulnar deviation of the fingers. Which additional radiographic finding, if present, would best distinguish this from osteoarthritis?
4. A 13-year-old boy presents with progressively worsening pain at the knee. Radiograph shows a dense sclerotic lesion in the distal femoral metaphysis with an aggressive periosteal reaction forming a triangular elevation of the periosteum at the tumor margin and radiating spicules perpendicular to the cortex. What is this periosteal reaction called?
5. A 25-year-old man has a radiograph of the wrist after a fall showing a fracture through the waist of the scaphoid. He is initially treated in a cast. Six months later, a follow-up radiograph shows a sclerotic proximal pole of the scaphoid with mild collapse. What complication has occurred?
6. On MRI, a malignant bone tumor shows low T1 signal and high T2 signal with heterogeneous post-contrast enhancement and cortical destruction. Which sequence is MOST useful for determining the intramedullary extent of tumor for surgical planning?
7. A 16-year-old boy has a painful lytic lesion of the proximal tibial metaphysis on X-ray with aggressive periosteal reaction showing multiple parallel layers. This 'onion-skin' periosteal reaction is most characteristic of:
8. In the radiological grading of rheumatoid arthritis, which Larsen grade indicates the presence of large erosions with extensive destruction of joint architecture while the original bone outline is still partly visible?
9. On plain X-ray, a lesion shows 'ground-glass opacity with a thin sclerotic rim' (rind sign) in the proximal femoral shaft. The most likely diagnosis is:
10. Which of the following is the MOST accurate imaging feature on CT that differentiates a pathological fracture through a metastasis from an insufficiency (osteoporotic) vertebral fracture?
11. MRI of a 16-year-old male shows a lesion in the distal femoral metaphysis with low signal on T1, heterogeneous high signal on T2, and a well-defined dark 'blooming' on gradient-echo sequence. Fluid-fluid levels are present within the lesion. What is the most likely diagnosis?
12. On MRI, the 'double-line sign' in the femoral head is pathognomonic of which condition?
13. Periosteal reaction described as 'sunburst' pattern on plain radiograph is most characteristic of which bone tumor?
14. A 65-year-old patient with known multiple myeloma has a whole-body low-dose CT scan. Which feature on CT best differentiates an active myeloma lesion from a sclerotic metastasis?
15. Erosions at the 'bare area' of the metacarpophalangeal joint on MRI in early rheumatoid arthritis are best identified using which sequence?
16. MRI of a knee shows a T2 hyperintense, T1 hypointense band parallel and adjacent to the articular surface of the medial femoral condyle with overlying cartilage thinning. This subchondral low-signal band on T1 is called the 'double-line sign' on T2 (inner bright/outer dark). What is the diagnosis?
17. Plain radiograph of the pelvis in a 55-year-old with bone pain shows patchy sclerosis and lysis with cortical thickening, enlargement of the pelvic bones, and a coarsened 'cotton-wool' trabecular pattern. Serum alkaline phosphatase is markedly elevated. Which radiographic sign in the skull would clinch the diagnosis?
18. A 15-year-old male presents with swelling around the distal femur. X-ray shows a lytic lesion in the metaphysis with Codman's triangle and a 'sunburst' periosteal reaction. MRI shows the lesion breaching the cortex with a soft tissue mass showing heterogeneous T2 signal. The most characteristic MRI feature that indicates tumour matrix mineralisation in osteosarcoma is:
19. A radiograph of the hand in a patient with long-standing rheumatoid arthritis shows uniform joint space narrowing at the MCP and PIP joints, periarticular osteopenia, and bony erosions at the bare areas. The 'bare area' of a joint, where RA erosions preferentially occur, is located at:
20. On MRI of the knee, a posterior cruciate ligament (PCL) appears as a continuous low-signal band on all sequences but shows a focal region of intrasubstance T2 heterogeneity with thickening. A plain radiograph shows a small avulsion fragment at the posterior tibial plateau. This constellation best represents:
21. On MRI, a bone tumor in the distal femur metaphysis shows low T1 signal, high T2 signal, and marked surrounding soft tissue edema. On T1 post-gadolinium sequence, the tumor shows peripheral nodular enhancement and central non-enhancement. Which diagnosis is MOST likely?
22. A 25-year-old presents with hip pain. MRI shows low T1 and T2 signal in the femoral head with a 'double-line sign' on T2 sequences at the subchondral region. Diagnosis and mechanism are:
23. On plain radiograph, periosteal reaction with a 'Codman triangle' is most specifically indicative of:
24. On MRI of the knee, the anterior cruciate ligament (ACL) is evaluated on which sequence and orientation MOST accurately?
25. On MRI of the knee, the 'double PCL sign' is pathognomonic of which injury?
26. On plain radiograph, an aggressive bone lesion in the proximal tibia metaphysis of a 16-year-old shows the 'Codman's triangle' and sunburst pattern. On MRI, the mass shows heterogeneous signal with an intact cortex in some areas but cortical breakthrough elsewhere. The MOST likely diagnosis is:
27. On bone scintigraphy with Tc-99m MDP, the 'superscan' pattern is characterised by:
28. On MRI, which signal characteristic of a bone lesion on T1-weighted images MOST reliably indicates that the lesion contains fat, consistent with a lipoma or bone infarct?
29. The 'ring and arc' calcification pattern on plain radiograph or CT within a bone lesion is characteristic of which tissue type?
30. MRI of the knee shows a vertical tear of the medial meniscus with the inner fragment displaced into the intercondylar notch, appearing as a 'double PCL sign' on sagittal images. This is called:
31. Plain X-ray of the knee in a 15-year-old male shows an eccentric lytic lesion in the distal femoral metaphysis with cortical thinning and a non-sclerotic border, oriented longitudinally, reaching the physis. The most likely diagnosis is:
32. MRI shoulder in a 30-year-old after anterior dislocation shows a compression fracture of the posterosuperior humeral head and anteroinferior glenoid bone loss. These are termed respectively:
33. A 16-year-old boy has knee pain and X-ray shows an eccentric lytic lesion in the distal femur metaphysis with a ground-glass matrix centrally, no periosteal reaction, and cortical expansion. MRI reveals fluid-fluid levels within the lesion. What is the most likely diagnosis?
34. A 40-year-old man has hip pain. MRI shows subchondral T1 hypointense, T2 hyperintense crescent-shaped area in the femoral head without femoral head collapse. The 'double line sign' is seen on T2-weighted MRI. What does the double line sign represent and what is the diagnosis?
35. On plain X-ray, a 35-year-old man with known psoriasis shows 'pencil-in-cup' deformity at the DIP joints of the hands and feet. This pattern is diagnostic of which arthropathy?
36. A 25-year-old male athlete sustains a hyperextension injury to the knee. MRI shows a 'bone bruise' (marrow edema) in the posterolateral tibial plateau and the anterolateral femoral condyle, with an anterior cruciate ligament (ACL) tear. What specific mechanism and pivot shift injury pattern does this 'kissing contusion' pattern represent?
37. On whole-body MRI for staging of multiple myeloma, diffuse homogeneous low T1 signal in the marrow (below paraspinal muscle signal) replacing normal fat signal is seen. What does this indicate compared to a normal pattern?
38. A 15-year-old male presents with night pain relieved by aspirin. Plain X-ray shows a small <2 cm lucent nidus surrounded by dense reactive cortical sclerosis in the proximal femur. What is the most likely diagnosis and definitive treatment?
39. On plain radiograph of a child's wrist, the Greulich-Pyle atlas is used. A 10-year-old girl's bone age matches a skeletal age of 13 years (3 SD above mean). This advanced bone age in the context of precocious puberty, café-au-lait spots, and fibrous dysplasia is seen in which syndrome?
40. On plain radiograph, 'Looser zones' (pseudofractures) are ribbon-like translucent lines perpendicular to the bone cortex with sclerotic margins. In which condition are they characteristically bilateral and symmetrical?
41. On X-ray of a patient with gout, 'overhanging edge' or 'rat bite' erosions are most characteristically located:
42. A 17-year-old male has knee pain and a destructive metaphyseal lesion of the distal femur on X-ray with aggressive periosteal reaction showing a 'sunburst' pattern and 'Codman's triangle'. MRI shows extension through the cortex into the soft tissues. These findings are MOST consistent with:
43. X-ray of hands in a 55-year-old with symmetric polyarthritis shows loss of joint space, periarticular osteopaenia, marginal erosions, and 'boutonniere deformity'. MRI shows pannus formation in the wrist. These imaging findings are MOST characteristic of: