Achilles lump: xanthoma or tear?

Question 1What separates a xanthoma from a complete tear on ultrasound?

1. aA xanthoma shows a fluid-filled gap
2. bThe fibres stay continuous in a xanthoma
3. cA tear is always on both sides
4. dA xanthoma is always thinner

Question 2Which movement opens the gap of a complete Achilles tear?

1. aPlantarflexion
2. bNo movement changes the gap
3. cInversion of the foot
4. dGentle passive dorsiflexion

Question 3Both Achilles tendons are smoothly thickened, painless and continuous. What should you consider?

1. aBilateral complete tears
2. bNormal tendons
3. cInfection
4. dXanthomas from familial hypercholesterolaemia, so check a lipid profile

Question 4Why keep the beam at right angles to the tendon?

1. aAn oblique beam makes normal fibres look dark, like a tear
2. bTo avoid aliasing
3. cTo see the calcaneus better
4. dTo measure blood flow

Question 5About how thick is a normal adult Achilles tendon from front to back?

1. aThickness cannot be measured
2. bAbout 25 mm
3. cAbout 15 mm
4. dLess than about 6 mm