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2nd Year - MSK > Imaging - Key Points > Flashcards

Imaging - Key Points Flashcards

1
Q

What do x-rays show?

A

Bones

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2
Q

What do CT scans show?

A

Bones in more detail

Some soft tissue structures e.g. lumbar discs

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3
Q

What do MRI scans show?

A 
Bones in less detail
Bone marrow
Discs
Ligaments
Spinal cord and nerves
(i.e. all soft tissue structures)
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4
Q

What imaging modalities show bones?

A

X-rays
CT
MRI

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5
Q

What imaging modalities show soft tissues?

A

CT

MRI (especially)

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6
Q

Where does the neural foramen lie on the vertebrae?

A

Inferior to the pedicle

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7
Q

Name of the joint that forms between the articular processes of 2 adjacent vertebrae?

A

Facet joints

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8
Q

How does C1 vary from the other vertebrae?

A

No vertebral body

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9
Q

How does C2 differ from the other vertebrae?

A

Has an odontoid process (projects superiorly into C1 forming a joint with its anterior arch)

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10
Q

When is CT used to image spinal trauma?

A

X-ray show fracture -> more details required, ? any more fractures present
X-ray normal but high clinical suspicion of fracture

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11
Q

What does abnormal vertebral alignment on x-ray or CT imply?

A

Ligament damage and an unstable spine

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12
Q

Why type of imaging can be used to directly see intervertebral ligaments?

A

MRI

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13
Q

Colour of normal and abnormal ligaments on MRI?

A 
Normal = black
Abnormal = light
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14
Q

When is MRI used to image spinal trauma?

A

To provide detail of the spinal ligaments
In patients with neurological deficit which is not explained by x-ray or CT -> to show soft tissue abnormality e.g. acute prolapsed IV disc, epidural haematoma, spinal cord damage

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15
Q

What unique features about bony tumours of the spine can MRI tell you (in comparison to x-ray and CT)?

A

Bone marrow infiltration
Extradural mass
Spinal cord compression

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16
Q

What mode of imaging is best for viewing the IV discs?

A

MRI (CT can also be used but not as good)

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17
Q

What is the only imaging modality which adequately shows the spinal cord?

A

MRI

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18
Q

What are the 4 main (broad) causes of spinal cord disease?

A

Trauma
Demyelination
Tumour
Ishcaemia

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19
Q

Are x-rays useful in patients with sciatica?

A

No

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20
Q

What are the 2 main roles of imaging in arthritis?

A

Making diagnosis

Monitoring disease activity and response to treatment

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21
Q

Is OA joint involvement normally symmetrical?

A

No

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22
Q

What leads to sclerosis of subchondral bone in OA?

A

Increased subchondral bone cellularity and vascularity excites bone turnover leading to sclerosis

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23
Q

Wha causes joint deformity in OA?

A

Weakened bone caves in

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24
Q

Is RA normally symmetrical?

A

Yes

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25
Q

What spinal levels can RA affect?

A

C1/ C2

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26
Q

What causes soft tissue swelling in RA?

A

Synovial proliferation and reactive joint effusion

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27
Q

What causes periarticular osteoporosis in RA?

A

Hyperaemia causing bone demineralisation

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28
Q

What detroys bone at the joint margins in RA?

A

Inflammatory pannus

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29
Q

What leads to subluxation and deformity in RA?

A

Capsular and ligamentous softening

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30
Q

What can cause ankylosis (bone fusion) in RA?

A

Exposed eroded bone ends

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31
Q

What seronegative arthritis tends to affect the small joints of the hands and feet as well as DIP hints, IP joint of great toe?

A

Psoriatic arthritis

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32
Q

What seronegative arthritis tends to cause scattered lower limb large joint arthritis and lower limb entheses?

A

Reiters Syndrome

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33
Q

What type of scan cause show increased vascularity around joints which accompanies synovitis?

A

Isotope bone scan (allows RA to be diagnosed before joint damage occurs)

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34
Q

What scan can be used to show thickening of synovium and increased blood flow within it?

A

Colour Doppler Ultrasound

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35
Q

Purpose of MRI of inflammatory joint disease?

A

Can show periarticular bone marrow oedema which often precedes significant joint erosion/ damage -> early evidence of joint disease

36
Q

How many x-ray views of trauma are often required?

A

2

37
Q

What 2 areas require more than 2 views of trauma x-raying?

A

Cervical spine

Scaphoid

38
Q

What are the 3 views required for trauma x-raying the cervical spine?

A

AP
Lateral
Odontoid peg (AP with mouth open)

39
Q

What are the 4 views required when x-raying the scaphoid?

A

AP
Lateral
2 obliques

40
Q

How to tell if a bony entity is an evulsion fracture or a mimic?

A

Avulsion fracture is incompletely corticated unlike a mimic which will be surrounded in dense cortex

41
Q

What are 3 examples of avulsion fracture mimics?

A

Sesamoid bones
Accessory ossification centres
Old non-united fractures

42
Q

What are sesamoid bones?

A

little bones that sit at joints lubricating the passage of tendons

43
Q

What is the posterior fat pad sign a sign of?

A

An elbow effusion -> trauma is a common cause of an effusion (always abnormal -> sensitive indicator of elbow trauma)

44
Q

What is another name for a grow plate?

A

Physis

45
Q

What type of classification is used to trade growth plate fracture?

A

Salter Harris classification

46
Q

What is the weakest part of a developing bone

A

Growth plate

47
Q

What does a femoral fracture of a baby suggest?

A

NAI

48
Q

What material of foreign bodies can be seen on x-ray?

A

Metal and glass

49
Q

What material of foreign bodies can’t be seen on x-ray?

A

Plastic and wood

50
Q

What tends to cause focal pathological fractures?

A

Metastatic deposit

51
Q

What tends to cause diffuse pathological fractures?

A

Osteoporosis

Other metabolic bone disease

52
Q

What type of fracture would an elderly patient with osteoporosis get from a FOOSH?

A

Colles fracture

53
Q

What type of fracture would a child get from a FOOSH?

A

Radial buckle fracture

54
Q

What type of fracture would a young man get from a FOOSH?

A

Scaphoid fracture

55
Q

What type of fracture would a post-menopausal female get from a FOOSH?

A

Surgical neck of the humerus fracture

56
Q

What type of x-ray view would show a posterior shoulder dislocation?

A

Oblique view

57
Q

How many patients will be dead 1 year following a proximal femoral fracture?

A

20-35% (46% over 80 years)

58
Q

What imaging modality provides detailed information about undisplaced fractures?

A

MRI (can see bone marrow)

59
Q

What type of imaging can provide high resolution images of superficial soft tissue structures?

A

US

MRI also provides high resolution images of soft tissue structures including those deep (which US struggles with)

60
Q

Typical lower limb sites of impacted fractures?

A

Femoral neck
Tibial plateau
Clacaneus

61
Q

Whites the primary imaging type of all polytrauma patients?

A

CT scan

62
Q

Best imaging for assessment of pelvic soft tissue injury?

A

MRI

63
Q

What commonly causes acute pelvic soft tissue injury?

A

Muscle tear

Tendon avulsion

64
Q

Typical direction of acetabular fracture?

A

Posterior (with acetabular rim fracture)

65
Q

Complications of hip dislocation?

A

Femoral head AVN

Early OA

66
Q

What complications are intra-capsular proximal femoral fractures prone to?

A

AVN

Non-union

67
Q

How is intra-capsular proximal femoral fractures treated?

A

hemiarthroplasty

Unless undisplaced or young patient = reduction and screw fixation

68
Q

How is extra-caspular proximal femoral fracture treated?

A

Internal fixation with DHS

69
Q

What should you do if high clinical suspicion of proximal femoral fracture but x-ray normal?

A

Repeat x-ray after 10 days or immediate MRI

70
Q

2 main risks with a femoral shaft fracture?

A

Blood loss

Fat embolus

71
Q

What is lipohaemarthrosis a specific sign of?

A

Intra-articular fracture of knee

72
Q

What type of imaging and plane may show a lipohaemarhtrosis?

A

Horizontal beam lateral x-ray

73
Q

What condyle do most tibial plateua fractures affect?

A

Lateral condyle (due to values force with foot planted -> “bumper injury”)

74
Q

What imaging modality is good for showing extensor tendon injuries?

A

US

75
Q

What imaging modality is used to visualise intra-articular soft tissue knee injuries?

A

MRI

76
Q

Standard ankle x-ray planes?

A

AP

Lateral

77
Q

What is the posterior malleolus?

A

Posteroinferior tibia

78
Q

What type of ankle fracture can excessive in/eversion cause?

A

Talar dome margin fractures

79
Q

What imaging modality can diagnose a talar dome margin fracture which is invisible on x-ray?

A

MRI

80
Q

How is the central peak of the normal calcaneus measured?

A

Using Bohler’s angle

81
Q

What is located at the base of the 5th metatarsal in adolescents?

A

Accessory ossification centres

82
Q

What is normally seen along the posterior calcaneus in children?

A

A fragmented ossification centre

83
Q

What is the name of the sesamoid within the lateral head of the gastrocneumius (often visible posterior to the distal femur)?

A

Fabella

84
Q

What is the name of the accessory ossification centre often seen posterior to the talus?

A

Os trigonum

85
Q

What is often the best imaging modality for assessing ankle tendon injury?

A

US (can also use MRI but less comfortable for patients)

86
Q

What plane is used to assess 1st and 2nd TMT joint congruity?

A

AP view

87
Q

What plane is used to assess 3rd to 5th TMT joint congruity?

A

Oblique view

2nd Year - MSK (23 decks)

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