Investigations

Question 1

For T1, T2 and STIR sequencing of MRI imaging.

Describe the colours of fat and fluids in each

Answer 1

T2: fat and fluids are both BRIGHT
T1: (FLUD) fluid is dark and fats are bright
STIR: (opposite to T1) fluids are bright and fats are dark

Question 2

In a lumbar puncture, describe the anatomical landmark that should be used to help locate the correct plane?

Answer 2

The supracristal plane which transects the highest point of the iliac crest and passes through the L4 spinous process

Question 3

On X-rays, is fat denser than blood?

Which one will appear darker?

Answer 3

Fat is less dense than blood so appears darker (as it absorbs less x-rays)

Question 4

Discuss the test done for an Achilles tendon rupture?

Answer 4

Postive Simmonds test. Squeeze the calf of the affected foot and will see no ankle plantar flexion - thus have a ruptured Achille’s tendon.

Question 5

Describe a positive Hoffmann’s test

Answer 5

1) Hold the middle phalanx of the middle finger
2) Flick the middle nail
3) If there is then movement of the index finger and thumb then this is a positive Hoffmann’s test (shows signs of myelopathy)

Question 6

What is L’Hermitte’s phenomenon?

Answer 6

Sensation of intermittent electric shocks of the limb exacerbated by neck flexion

Question 7

In an effusion, e.g. haemarthrosis, what sign would be seen on an x-ray?

Answer 7

Sail sign/fat pad sign

Question 8

What are the four classical X-ray features of rheumatoid arthritis?

Answer 8

1. Joint space narrowing
2. Periarticular osteopenia
3. Subluxation and gross deformity
4. Juxta-articular/Marginal bony erosion

Question 9

If you cannot initially see the scaphoid bone fracture on an x-ray, why should you do a repeat x-ray in 10-14 days?

Answer 9

Fracture line is now more visible due to increased bone reabsorption

Question 10

Describe how you will do the Schober’s test

What does it assess?

Give 3 possible reasons for a positive Schober’s test.

Answer 10

1. Find the PSIS (Posterior superior iliac spine)
2. Mark the midline of the PSIS on the spinal process with some pen
3. Mark 10cm above 2
4. Mark 5cm below 2
5. Bend forward and touch your toes. Measure the distance between 3 and 4, should be greater than 20cm

This test assesses the amount of lumber flexion. If flexion is not a minimum of 20cm, it could indicate:

• ankylosing spondylitis
• pain in the lumbar region (thus reducing range of movement)
• segmental fusion