Imaging (MRI/CT/XRAY)

Question 1

Spondylosis

Answer 1

Pars Interarticularis (scotty dog)

Question 2

Scaphoid Fracture

Answer 2

Hand and wrist - scaphoid (MC), order XRAYS,

If untreated - at risk for AVN due to it disrupting the arterial blood supply, CT

Question 3

Proximal Humerus Fracture

Answer 3

Shoulder - surgical neck, shoulder dislocation (mobile), anterior, posterior - seizures shoulder contraction, most end up inferior and medial form dislocation,

anterior medially, posterior laterally looking

Question 4

XRAY

Answer 4

A: Inexpensive
D: Limited evaluation
Consider for low back pain
View: Open Mouth (dens/lateral masses), lateral, ap, oblique (pars interarticularis)

Question 5

OA vs RA

Answer 5

OA - degeneration of joints, catilage wear down, bone spurs, subchondral sclerosis, subchondral cysts, DIP/PIP/CMC joints

RA - Autoimmune, systemic disease, fight against synovium causing joint damage, swelling of joints, bony erosins, bone loss, late finding - subluxation, MCP and bad carpal

Question 6

Angulation

Answer 6

Angle formed between the proximal and distal fragment based off how much distal fragment deviated

Question 7

Insufficiency Fracture

Answer 7

Normal Stress on abnormal bone (elders)

Question 8

Hangman Fracture

Answer 8

Hypertension C2

Question 9

Complete Fracture

Answer 9

One cortex to the other

Question 10

Displacement

Answer 10

How much offset there is by a fracture

Question 11

Fat Pad Sign

Answer 11

Elbow (swollen - fracture indicated within joint)

Peds elbow problem because not everything is formed + take pic of normal elbow

Question 12

Clay Shoveler Fracture

Answer 12

Trauma –> Stress on C7

Question 13

Subluxation

Answer 13

Partial dislocation

Question 14

MRI

Answer 14

A: Soft Tissue
D: Expensive
Use: Disc Herination/Nerve Impingement
View: CSF (T1-dark, T2-light)

Question 15

Stress on Normal Bone

Answer 15

Stress on the normal bone casuing microfractures, periosteal reaction, 85% of xrays are normal, MRI

Question 16

Compression Fracture

Answer 16

Trauma/OP/Tumor –> Collaspe/tear in vertebrae (shorter)

Question 17

Incomplete Fracture

Answer 17

Only part of the cortex is fractures

Question 18

Dislocation

Answer 18

Bones in joint are not in apposition

Question 19

Degeneration

Answer 19

DDD, Bone spurs, Spondylothesis

XRAY

Question 20

Mechanisms of Clavicle and AC Injury

Answer 20

XRAY

Clavicle - Fractures (MC), SCM pulls medial portion of bone up (MC)

AC - Grade 3 injury to CoraClaviclaviar ligament makes clavicle and acromin not line up

Question 21

CT

Answer 21

Best for Fractures
Use: Bone lesions, tumors, fracture healing)
View: Axial

Question 22

Flexion Tear Drop Fracture

Answer 22

ALL defect –> permeant neuro defects

Question 23

Rotator Cuff Tear on MRI

Answer 23

Supraspinatus, MRI, edema present

Question 24

Dens Fracture

Answer 24

3 types (type 2 most unstable –> surgery

Question 25

Jefferson Fracture

Answer 25

Axial loading, falling on head, C1 damage View: Open Mouth

Question 26

Osteophytes

Answer 26

Bone spurs impinging on other structures

Question 27

Spondylothesis

Answer 27

Vertebrae slippage (laxity of LF)

Question 28

Comminuted

Answer 28

More than 2 fractures

Question 29

Disk Herniation

Answer 29

Nucleus Pulposus through annulus (>2 T2 signal on MRI)

Question 30

Spinal Stenosis

Answer 30

Crowding & Impingement on spinal cord

Question 31

Hip (Fracture, Dislocation)

Answer 31

* XRAY --> MRI * Hip Fractures: proximal of the femur * Shenton’s line & Lesser Trabecular more prominent * Intra vs. Extracapsular Intra: Fem Head, Fem Neck, Subcapital , Transcervical , Basicervical * Extra (HAVE Shenton's Line): Intertrochanteric (G→ L trochanter), Subtrochanteric Seen mostly in elderly Osteoporosis * Abd - neck fracture * Add - fracture dislocation * Hip Dislocation Trauma (MVA) - moves post & sup fem head CT SCAN

Question 32

AVN

Answer 32

XRAY → MRI INCREASE SCLEROSIS (WHITE) Dense Bone Peds = Leggs - Perthes Loss of blood supply to organs or bones (femoral head) Due to trauma, steroids, RA, pregnancy, SCD

Question 33

Knee

Answer 33

XRAY → MRI Severe Fracture: all 3 test ordered Patella Fracture: Quadriceps tendon pulls fragment superior Tibial Plateau Fracture: (CT) articular surface of tibial is depressed → surgery needed

Question 34

Soft Tissue

Answer 34

MRI: Meniscal Tear is suspected Criteria Signal that extends to articular surface Abnormal morphology of meniscus Ex: ACL Tear (ant tibia and post femur)

Question 35

Ankle and Foot

Answer 35

* Ottawa Ankle Rules (Test + → X RAY) : Point tenderness over **medial malleolus,**, can’t bear weight, can’t walk for 4 steps * Lisfranc Ligament - dislocation of toes**: lateral** 1st cuneiform - proximal 2nd metatarsal * Charcot Joint: **Diabetes**, Fragment/joint/destruct/deformity

Question 36

Children Fracture

Answer 36

Salter Harris Fracture - Growth Plate injury (Slippage) Type : Slipped Capital Femoral Epiphysis (Above) Type 2: GP + M (Lower) Type 3: GP + E (Through) Type 4: GP + M + E (Rupture) Type 5: Crush (MRI)