Basics of MSK Radiology (Bennett)

Question 1

gold standard for diagnosis of osteoarthritis

Answer 1

radiography

Question 2

All of the following are features of osteoarthritis EXCEPT:

A. Uniform joint space narrowing

B. Osteophyte formation

C. Subchondral sclerosis

D. Weight bearing joints affected

E. Subchondral cysts

Answer 2

A. Non-uniform joint narrowing is what’s seen in OA

Question 3

What feature is seen on the radiograph below?

Answer 3

subchondral cysts

Question 4

Which of the following is NOT a hallmark of rheumatoid arthritis?

A. Symmetric bilateral proximal involvement of the hands

B. More common than osteroarthritis

C. Shows fusion of carpals and joint subluxation

D. Uniform joint space narrowing

E. Periarticular (darker on radiography) osteopenia

Answer 4

B

Question 5

Why is joint space narrowing uniform in RA?

Answer 5

this is due to an autoimmune process that results in digestion of cartilage

Question 6

With MSK trauma, you should always start with what type of imaging?

Answer 6

plain films, two perpendicular views

Question 7

type of fracture?

Answer 7

oblique

Question 8

type of fracture?

Answer 8

buckle

*notice the bump on the lateral edge of the radius

Question 9

type of fracture?

Answer 9

pathologic; the dark circle is a tumor

Question 10

type of fracture below, correlated with diabetes:

Answer 10

alvusion fracture (CIA fracture)

Question 11

type of fracture?

Answer 11

intra articular fracture (a fracture that extends into the joint space - ex, salter harris type III and IV)

Question 12

type of fracture?

Answer 12

greenstick fracture

Question 13

type of fracture?

Answer 13

spiral (toddler) fracture

Question 14

pediatric Salter-Harris fractures that are most likely to have a physeal bar

Answer 14

Salter-Harris type IV and V

*A physeal bar or partial premature physeal arrest is a result of injury or infection to an unfused physis. It consists of a bony bridge crossing the growth plate that results in growth disturbance and/or deformity

Question 15

type of Salter-Harris fracture indicated by black arrow?

Answer 15

type III (fracture is below the physis, as indicated by the lighter arrow)

Question 16

type of Salter-Harris fracture?

Answer 16

type I (slipped)

Question 17

type of Salter Harris fracture?

Answer 17

type IV - goes through both the metaphysis and epiphysis

Question 18

3 types of injury highly associated with non-accidental trauma

Answer 18

1. bucket handle fracture (wisps of bone coming of the metaphyseal corners)
2. periosteal hemorrhage
3. multiple fractures of varying ages

Question 19

radiographic signs of this include destruction of bone, periosteal reaction, tissue swelling, and abscess formation

Answer 19

osteomyelitis

Question 20

formation of new bone in response to injury or other stimuli

Answer 20

periosteal reaction

Question 21

what does soft tissue gas on an xray indicate?

Answer 21

fulminant infection such as gangrene with a gram negative rod that is gas producing; has a mottled or linear appearance on x-ray

Question 22

osteomyelitis may spread hematogenously, with seeding in the ____ metaphysis where blood flow is the slowest

Answer 22

distal

Question 23

what adult population is direct implant osteomyelitis associated with?

Answer 23

diabetics

Question 24

most sensitive and specific test for osteomyelitis

Answer 24

MRI

*although plain film is used first and is considered the gold standard for diagnosing osteomyelitis, signs often do not appear for a week or more. MRI can pick up signs of OM in 24-48 hours of onset)

Question 25

In a patient who is 40 or older and the radiograph shows a lytic dark bone tumor proximal to elbows or knees what will the diagnosis be 99% of the time?

Answer 25

either metastasis or multiple myeloma

Question 26

A 49 year old woman presents with pain in the knee. After doing a H&P you believe she may have osteoarthritis and you order an xray. The film shows a dark lytic bone lesion proximal to the knee. What is the next step you would take in confirming this woman’s diagnosis?

Answer 26

this is likely multiple myeloma or a metatasis. since metastasis occurs the majority of the time from breast or lung in this patient population, you would order a chest xray and do a breast exam and/or order a mammogram

Question 27

wispy projections that look like hair coming off the bone indicates what?

Answer 27

osteosarcoma