Clinical imaging Flashcards
Conditions and presentations
Aneurysm imaging
*MRI
* Catheter cerebral angiography
Difficulty speaking
- Non contrast head CT
- cranial MRI with diffusion imaging
Double vision
Pre and post contrast MRI
Make sure attention to orbits, optic nerves, tracts and optic radiations.
What is an extradural (epidural) haematoma?
A collection of blood between the skull and the dura, typically caused by trauma.
What is the classical presentation of a patient with an extradural haematoma?
Initially loses, briefly regains, and then loses consciousness after a low-impact head injury.
What is the ‘lucid interval’ in the context of extradural haematomas?
A brief regain of consciousness after a head injury before losing it again due to expanding haematoma.
What imaging appearance characterizes an extradural haematoma?
A biconvex (lentiform), hyperdense collection around the surface of the brain.
What is the definitive treatment for an extradural haematoma?
Craniotomy and evacuation of the haematoma.
What are the Ottawa Rules for ankle x-rays?
An x-ray is required if there is pain in the malleolar zone and any one of the following:
* Bony tenderness at the lateral malleolar zone
* Bony tenderness at the medial malleolar zone
* Inability to walk four weight-bearing steps.
What are the common features of a hip fracture?
- Pain
- Shortened and externally rotated leg
- Non-displaced or incomplete neck of femur fractures may allow weight bearing.
What is the Garden classification for hip fractures?
- Type I: Stable fracture with impaction in valgus
- Type II: Complete fracture but undisplaced
- Type III: Displaced fracture, usually rotated and angulated
- Type IV: Complete bony disruption.
What is the management for a displaced intracapsular hip fracture?
Total hip replacement or hemiarthroplasty, with total hip replacement favored if the patient is fit.
What are the common sites of metatarsal fractures?
The proximal 5th metatarsal is the most commonly fractured, while the 1st metatarsal is the least commonly fractured.
What is a stress fracture?
A fracture that occurs due to repeated mechanical stress.
What are the clinical features of metatarsal stress fractures?
- Pain and bony tenderness
- Swelling
- Antalgic gait.
What is De Quervain’s tenosynovitis?
An inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons.
What is Finkelstein’s test used to diagnose?
De Quervain’s tenosynovitis.
What is the classic presentation of lateral epicondylitis (tennis elbow)?
Pain and tenderness localized to the lateral epicondyle, worsened by resisted wrist extension.
What characterizes a Colles’ fracture?
Transverse fracture of the radius, 1 inch proximal to the radio-carpal joint, with dorsal displacement.
What is a Boxer fracture?
A minimally displaced fracture of the fifth metacarpal, typically from punching a hard surface.
What are the features of supracondylar fractures?
- Typically seen in children
- Result from a fall onto an outstretched hand
- Pain and swelling over the elbow.
What is the Salter-Harris classification used for?
Classifying growth plate fractures in children.
What is a common sign of a proximal 5th metatarsal fracture?
Proximal avulsion fractures (pseudo-Jones fractures) occurring at the proximal tuberosity.
What are the management options for undisplaced patella fractures?
Non-operatively managed in a hinged knee brace for 6 weeks with full weight bearing.
What is the primary concern with displaced fractures of the hip?
Risk of avascular necrosis due to blood supply disruption.
What does an isotope scan or MRI help establish in the case of suspected stress fractures?
The presence of a stress fracture when X-rays are often normal.
What does growth plate tenderness typically indicate?
An underlying fracture, even if the x-ray appears normal.
Which types of injuries usually require surgery?
Types III, IV, and V injuries.
List some indicators of non-accidental injury in children.
- Delayed presentation
- Delay in attaining milestones
- Lack of concordance between proposed and actual mechanism of injury
- Multiple injuries
- Injuries at sites not commonly exposed to trauma
- Children on the at-risk register
What genetic condition may cause pathological fractures?
Osteogenesis imperfecta.
What is osteogenesis imperfecta characterized by?
- Defective osteoid formation
- Failure of maturation of collagen in connective tissues.
What does radiology show in osteogenesis imperfecta?
- Translucent bones
- Multiple fractures, particularly of long bones
- Wormian bones
- Trefoil pelvis.
What are the four subtypes of osteogenesis imperfecta?
- Type I: Normal collagen quality, insufficient quantity
- Type II: Poor collagen quantity and quality
- Type III: Poorly formed collagen, normal quantity
- Type IV: Sufficient collagen quantity, poor quality.
What is osteopetrosis?
A condition where bones become harder and denser.
What is a common cause of scaphoid fractures?
Falling onto an outstretched hand (FOOSH).
What is the blood supply risk associated with scaphoid fractures?
Avascular necrosis due to interruption of blood supply.
What are the typical signs of a scaphoid fracture?
- Point of maximal tenderness over the anatomical snuffbox
- Wrist joint effusion
- Pain on telescoping of the thumb
- Tenderness of the scaphoid tubercle
- Pain on ulnar deviation of the wrist.
What imaging is considered definitive for confirming a scaphoid fracture?
MRI.
What is the initial management of suspected scaphoid fractures?
- Immobilization with a splint or backslab
- Referral to orthopaedics
- Clinical review in 7-10 days.
What are the complications of scaphoid fractures?
- Non-union
- Avascular necrosis.
What characterizes a Colles’ fracture?
- Transverse fracture of the radius
- 1 inch proximal to the radio-carpal joint
- Dorsal displacement and angulation.
What is a Smith’s fracture?
A reverse Colles’ fracture with volar angulation of the distal radius fragment.
What is a Bennett’s fracture?
An intra-articular fracture at the base of the thumb metacarpal.
What is a Monteggia’s fracture?
Dislocation of the proximal radioulnar joint in association with an ulna fracture.
What is a Galeazzi fracture?
Radial shaft fracture with associated dislocation of the distal radioulnar joint.
What is Barton’s fracture?
Distal radius fracture with associated radiocarpal dislocation.
What are the main physical signs of scaphoid fractures?
- Swelling and tenderness in the anatomical snuffbox
- Pain on wrist movements
- Pain on longitudinal compression of the thumb.
What is the most common cause of posterior heel pain?
Achilles tendon disorders.
What are common features of Achilles tendinopathy?
- Gradual onset of posterior heel pain
- Pain worse following activity
- Morning pain and stiffness.
What should be suspected in an Achilles tendon rupture?
Audible ‘pop’, sudden onset significant pain, inability to walk.
What is the initial imaging modality of choice for suspected Achilles tendon rupture?
Ultrasound.
What are the components of the ankle joint?
- Distal tibia
- Distal fibula
- Superior aspect of the talus.
What is a sprain?
A stretching, partial or complete tear of a ligament.
What is the most common mechanism for low ankle sprains?
Inversion injury.
What is the RICE protocol for treating sprains?
- Rest
- Ice
- Compression
- Elevation.
What characterizes high ankle sprains?
Severe injuries to the syndesmosis, often with external rotation of the foot.
What is iliotibial band syndrome?
A common cause of lateral knee pain in runners.
What is the most commonly injured knee ligament?
Anterior cruciate ligament (ACL).
What is a typical presentation of an ACL injury?
- Sudden ‘popping’ sound
- Knee swelling
- Instability.
What does Thessaly’s test assess?
Meniscal tears by weight bearing and twisting the knee.
What is plantar fasciitis?
The most common cause of heel pain seen in adults.
What is the management for plantar fasciitis?
- Rest the feet
- Good arch support shoes
- Insoles and heel pads.
What should be considered in case of isolated deltoid ligament injuries?
Look for Maisonneuve fracture of the proximal fibula.
