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MSK > Imaging > Flashcards

Imaging Flashcards

1
Q

What is the differences in what x-ray; CT and MRI are able to see anatomically?

A

x-rays only show bony outlines; CT shows bone outlines in more detail and some soft tissue structures; MRI shows bone outlines in less detail but shows all soft tissue structures

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2
Q

How should consecutive vertebrae appear in contrast to each other?

A

have similar size

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3
Q

When is a CT used to image spinal trauma?

A

when x-ray shows # but more detail is required or wonder if there are more# or if x-ray is noram but there is a high clinical suspicion of #

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4
Q

What is the function of ligaments in the spine?

A

ligaments tether vertebrae together and are responsible for spinal stability

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5
Q

How can you know if there are intact ligaments on x-ray and CT if they cannot be seen?

A

seeing normal vertbral alignments implies this

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6
Q

How do normal and damaged ligaments appear on MRI?

A

normal appear black whereas if damaged they appear white

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7
Q

When would MRI be used to image spinal traume?

A

if a pt has neuro which isnt explained by x-ray or CT

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8
Q

What might be seen on x-ray and CT with a bone tumour of the spine?

A

bone destruction; vertebral collapse (pathological #); bone sclerosis

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9
Q

What may be seen on MRI in a bony tumour?

A

early- bone marrow infiltration

late- extradural mass and spinal cord compression

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10
Q

What is the only mode of imaging that adequately shows the spinal cord?

A

MRI

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11
Q

What can cause spinal cord disease?

A

trauma; demyelination; tumour; ischaemia

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12
Q

What type of pattern of joints affected is seen in OA

A

asymmetrical

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13
Q

What joints are infected in primary OA?

A

weight bearing or active joints- spine, hip, knee, thumb base , DIP

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14
Q

what is secondary OA?

A

when unexpected joints are affected by OA because there is overuse, previous injury or previous arthritis

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15
Q

Why is there sclerosis of subchondral bone in OA?

A

increased subchondral bone cellulairty and vascularity which excites bone turnover leading to sclerosis

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16
Q

What leads to osteophyte formation?

A

increased vascularity stimulates the periosteum to increase the joint SA to share the load

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17
Q

What results in joint deformity in OA?

A

weakened bone caves in

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18
Q

What is the distribution of affecgted joints in RA?

A

symmetrical- MCP;MTP; IP; wrists; hips; knees; hsoulders; atlanto-axial

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19
Q

What causes soft tissue swelling in RA?

A

synovial prolferation and reactive joint effusion

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20
Q

What else is seen on x-ray in RA?

A

periarticular osteoporosis; destroyed bone-marginal erosions

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21
Q

what destroys the bone in RA?

A

inflammatory pannus- inflamed thicked synovium

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22
Q

What are the hallmark lesions of RA?

A

marginal erosions

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23
Q

What causes joint subluxation and deformity in RA?

A

the bones become eroded and shorter which makes the ligaments and capsules lax and inflam also softens the ligamnets which stretch further leading ot increased subluxation and joint deformity

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24
Q

Why might ankylosis be seen in RA?

A

if the eroded bones become exposed to each otehr and then fuse

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25
Q

What joints tend to be affected in psoriatic arthritis?

A

small joints of hands and feet; DIP joints; Ip joint of hallux

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26
Q

what joints are affected in AS?

A

scattered lwoer limb large joints- (and sacro-iliac joints

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27
Q

What is Reiters syndrom?

A

Reactive arthritis with uveitis and urethritis/cervicitis

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28
Q

What might be shown on an isotope bone scan?

A

increased vascularity around joints which accompanies synovitiis- i.e showing inflam

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29
Q

What is the use of US in arthritis?

A

thickening of synovium and increased blood flow

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30
Q

Why is an MRI useful in early disease?

A

shows bone marrow oedema which often precedes significant joint erosion/damage

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31
Q

Why do you need more than one x-ray view?

A

fractures may be invisible on one view and alignment cannot be seen

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32
Q

What circumstances do you need more than 2 views?

A

cervical spine and scaphoid

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33
Q

What does a bone fracture ususally look like?

A

lucency crossing bone

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34
Q

How does an impaction fracture appear?

A

dense as opposed to lucent

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35
Q

What is an avulsion fracture?

A

when part of a bone is pulling away by a tendon or ligament

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36
Q

What features help differentiate an avulsion fracture from their mimics?

A

all avulsion fracture mimics have a completely corticated contour

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37
Q

What are examples of avulsion fracture mimics?

A

seasmoid bones; accessory ossification centres; old non-united fractures

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38
Q

How do you assess bony alignment at the radio-capitellar joint?

A

draw a line alone radius and it should interst the capitulum

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39
Q

How can you assess the bony alignment of the humero-capitella joint?

A

draw a line down the humerus and it should bisect the capitulum

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40
Q

Why is it important to asses the humero-capitellar alignment?

A

supra-condylar fractures are common and easy to miss

41
Q

What causes the posterior fat pad sign?

A

an elbow effusion which displaces fat posterior to the distal humerus

42
Q

What does the posterior fat pad indicate?

A

it is always abnormal and an effusion is usually caused by trauma-so tells you there was trauma in that area

43
Q

What happens to childrens bones in repsonse to trauma in comparison to adults bones?

A

bend or bow rather than snap and spinter, can have incomplete fractures

44
Q

What is seen in a buckle fracture?

A

the metaphyses isn’t smooth- it has a bump

45
Q

What is seen with a greenstick fracture?

A

the fracture only transverses a portion of the bone

46
Q

Why are avulsion fractures common in children?

A

the bones are soft so it is fairly easy for ligamnets or tendons to avulse their soft bony attachments

47
Q

What is the growth plate on imaging?

A

a lucency between the epiphysis and metaphysis that may simulate a fracture

48
Q

Why is the growth plate prone to injury?

A

it is the weakest part of a developing bone

49
Q

What is a Salter-Harris fracture?

A

when the epiphysis is not centred on the metaphysis due to a fracture invovling the growth plate

50
Q

What are examples of bony rings in the body?

A

spinal canal; pelvis; forearm and lower leg

51
Q

What is important in assessing injuries to bony rings?

A

you should expect to see 2 or more disruptions because it is difficult to disrupt a ring in only one place

52
Q

What is the point of a bony ring?

A

to help share the transmission of force and increase strength

53
Q

What must be present if the radius is displaced?

A

there must be an ulnar injury because otherwise the ulnar would splint the radius in place

54
Q

What foreign bodies are invisible on x-ray?

A

plastic and wood

55
Q

What may cause focal skeletal weakening?

A

metastatic deposits

56
Q

What may cause diffuse skeletal weaknening?

A

osteoprosis or other metabolic bone disease

57
Q

What is a Colles fracture?

A

a fracture of the radius in the wrist, with a characteristic backward displacement of the hand.

58
Q

What view should be obtained if a posterior shoulder disolcation is suspected?

A

an oblique view

59
Q

What artery can be damaged in a supracondylar fracture?

A

brachial artery

60
Q

Why are scaphoid fractures important to diagnose?

A

blood supply can be disrupted leading to non-union or AVN leading to early wrist OA

61
Q

What is Bennett’s fracture?

A

a fracture involving the articular surface of the first metacarpal base, tendons pulling on the thumb distal to the fracture cause displacement and if this is missed leads to defomrity, dysfunction and arthritis

62
Q

What can result from immobility through lower limb injury?

A

dehydration adn starvation; DVT/PE; pneumonia

63
Q

What is the benefit of MRI over US?

A

MRI can show soft tissues deep inside the body whereas US is only useful for superficial structures

64
Q

What are the typical sites of impacted fractures?

A

femoral neck; tibial plateau; calcaneus

65
Q

Why do many lower limb fractures appear sclerotic?

A

often involve axial force with bone impaction

66
Q

What typically causes high energy pelvic ring fractures?

A

RTA or fall from a height

67
Q

What imaging modality is used in patients with polytrauma?

A

CT

68
Q

What is acute pelvic soft tissue injury typically caused by?

A

muscle tear or tendon avulsion

69
Q

What causes hip disolcation?

A

RTA or contact sports where the hip is flexed

70
Q

What tends to occur with hip dislocation?

A

tends to be posterior with an acetabular rim fracture

71
Q

What are risks with femoral shaft fractures?

A

risk of blood loss, fat embolus

72
Q

What can small avulsed bone fragments sometimes indicate in the knee?

A

significant soft tissue injury

73
Q

What ususally accompanies a significant soft tissue injury in the knee?

A

an effusion which fills the suprapatellar space

74
Q

What does a lipohaemarthrosis in the suprapatellar recess indicate?

A

it is a specific sign of an intra-articular fracture

75
Q

Why is it important to check the bony alignment at the knee carefully?

A

dislocation are often largely reduced by the time of the x-ray due to the action of tendons adn ligaments

76
Q

What artery can be damaged in a knee dislocation?

A

popliteal artery

77
Q

Which tibial plateau is most commonly fractured?

A

80%- lateral condyle

78
Q

What injury causes a lateral condyle fracture?

A

valgus force with foot planted

79
Q

What mode of imaging is useful in assesing extendor mechanism injuries?

A

US

80
Q

What type of injury causes mensical tears?

A

twisting injuries

81
Q

What will patients whose torn meniscus has displaced present with?

A

a locked knee

82
Q

What is the injury mechanism with ankle fractures?

A

inversion or eversion

83
Q

What may indicate the site of injury?

A

soft tissue swelling

84
Q

What indicates instability (often with accompanying ligamentous damage) on x-ray?

A

non-unifrom joint spcae

85
Q

What creates the posterior malleolus?

A

posterioinferior tibia

86
Q

What injuries are imaged using an MRI?

A

scaphoid; pelvic ring injuries; femoral head/neck; knee

87
Q

What can 5th MT base fractures be confused with in adolescents?

A

ossification centres

88
Q

How can 5th MT base fractures be differentiated from normal ossification centres?

A

fractures in the 5th MT base are transverse whereas the ossification is longitidunial

89
Q

What type of injury usually causes a calcaneal fracture?

A

usually follows axial compression- falling from height onto the heel

90
Q

How does a calcaneal fracture appear?

A

loss of the calcaneal central peak and increased bone density; often comminuted- multiple pieces

91
Q

What is often seen at slong the posterior calcaneus in children?

A

a fragmented accessory ossification centre

92
Q

What can be seen in some people posterior to teh distal femur?

A

the fabella- a seasmoid within the lateral head of gastrocnemius

93
Q

What is os trigonum?

A

an accessaory ossification centre see posterior to the talus

94
Q

What can be seen on the medial and lateral plantar aspects of the 1st metatarsal head?

A

rounded sesamoid bones

95
Q

What can predispose to tendon rupture?

A

diabetes; RA and steroid use

96
Q

How are ankle tendon injuries assessed?

A

US or MRI

97
Q

What is key to diagnosing TMT joint injury?

A

alignment

98
Q

What are TMT joint injuries also known as?

A

Lisfranc

99
Q

What is seen on x-ray with a Lisfranc fracture?

A

the TMTs a misaligned- there shouldnt be a step, it whould be smooth and the joint space should be equal

MSK (39 decks)

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