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OSCE podiatry > medical imaging > Flashcards

medical imaging Flashcards

1
Q

how long does a CT take?

A

minutes

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2
Q

who is most at risk of stress #?

A

post-menopausal women, anyone with OA and/or fat pad atrophy

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3
Q

what is a “C-sign” and what does it indicate

A

c shaped line from medial outline of talar dome and inferior outline of sustentaculum tali.

indicates STJ coalition

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4
Q

define arthropathy please and while you’re at it give some examples

A

the term given to any disease of the joint

e.g. OA, psoriatic arthritis, RA, gout, osseus impingement, osteochondroses, exostosis

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5
Q

what would you do for an acute nerupathic charcot arthropathy? remember the case from the lecture where it looked like a lisfranc and it wasn’t even WB..

A

get that guy to ED! total contact casting required. surgery probably too risky- also the condition would still be heaps active . shit bro

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6
Q

what can a subtle lisfranc separation mean?

A

early acute charcot arthropathy

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7
Q

what does IDDM stand for?

A

insulin dependent diabetes mellitus

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8
Q

what are the pros and cons of MRI?

A

PROS: multiple planes. gr8 for soft tissue, bone marrow, vascular structures, no radiation (what a treat!)
CONS: contraindicateed in pts with metal implants, pacemakers, long scan time, claustrophobia

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9
Q

what does MRI pick up real good?

A

health of bone marrosw, tumours of bone and soft tissue, oedema, infection, OM, neuropathic charcot foot, , fibrous coalitions, tendons/ligaments/cartilage
absolutely cracker at detecting oedema

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10
Q

what can we use nuclear medicine for?

A

stress #, bone tumour, OM, arthritis

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11
Q

what are pros and cons of nuclear medicine?

A

PROS: can evaluate physiology of specific organ. can detect changes earleir than plain x-ray. radiation = plain x-ray
CONS: limited anatomy detail, need GP/spec referral, invasive –> catheterisation of vessel being imaged

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12
Q

when would you need angiography?

A
  • high risk foot
  • PVD
  • ischemic ulcers
  • angioplasy
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13
Q

why is CT angiography different to regular angiography?

A

CT is less invasive, more advanced reconstruction software –> 3D imaging of vessels

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14
Q

what are some cons of CT angiography?

A
  • calcified arteries may give a false reading for the evaluation of artery calibre
  • time consuming in reconstructing images
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15
Q

what is islin’s apophysitis? what causes it? how to dx.?

A
  • inflam of growth plate (apophysis)
  • due to repetitive traction of per brev tendon at site of its attachment (base 5th met)
  • predisposing factors = running/jumping
  • best Dx.: oblique radiography but try US too
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16
Q

what is a normal calcaneal inclination angle (on x-ray lateral view)

A

20 degrees +/- 3

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17
Q

why would you order a WB lateral ankle x-ray in DF/PF

A
  • to see beaking of tibia (ant/post)
  • tibiotalar osseus impingement
  • ostrigonum
  • compensatory STJ and MTJ pronation
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18
Q

what is an os trigonum?

A

bony ossicle on talus. type of accessory bone. fuses at 16-20 years

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19
Q

what is a possible complication of lisfranc injury?

A

potential ligament tear/subluxation

can lead to acute charcot

20
Q

describe what a stress # looks like on plain x-ray

A

fluffy periosteal callus

subtle radiolucent thin line

21
Q

what is a jone’s #?

A

prox. 5th metatarsal shaft. inversion injury . non union common

22
Q

what is os peroneum

A

a bone accessory found in the tendon of the peroneals longus

23
Q

osteochondritis dissicans of talus

A

separation of small segment of bone due to lack of vasc supply.
post. ankle inv injuries

24
Q

you suspect your patient has OM. how would you dx.?

A

plain x-ray: poor sensitivity in 1st 3 wks
nucmed bone scan: higher sensitivity but low specificity (false negatives)
MRI: YASSS THIS GR8

appearance: loss of trabecular pattern, bone destruction, disruption in cortical margins

25
Q

what is the neurovasc theory of neuropathic charcot foot

A

damaged autonomic neves, increased supply to bone, increased bone resorption (osteoclasts break down bone) and weakening, #s and deformities

26
Q

outline the neurotrauma theory of neuropathic charcot foot

A

neuropathic joints undergo repetitive trauma –> fracturing and deformity

27
Q

how do you dx. a suspected neuropathic charcot foot?

A

x-ray: unable to differentiate between charcot neuropathy and OM in acute stages.
MRI better but dometime can’t differentiate between acute charcot, active degenerative arthropathy and OM. acute charcot commonly occurs near midfoot joints with increased marrow oedema.

28
Q

what are the 5 Ds of radiographic appearance of neruopathic charcot foot?

A
  1. joint distention
  2. dislocation
  3. increased density
  4. debris
  5. disorganisation
29
Q

what’s Ewing’s sarcoma?

A

very aggressive cancer of bone cells
common in young people
rare in feet but can occur in calc, talus metatarsals
appears as ill defined bone destruction with periosteal reaction. can mimic OM

30
Q

whats the difference between osteosarcoma and chondrosarcoma?

A

CHONdrosarcoma: older adults, cartilagenous commonly migrates into bone(calc/talus) large cartilagenous mass
OSTEOsarcoma: highly malignant. younger people. common in calc. “sunburst” appearance due to excessive periosteal reaction

31
Q

what is a normal 1st intermetatarsal angle? (found on DP projection)

A

8-10 deg.

32
Q

what is a normal hallux abductus angle? (found on DP angle)

A

0-20 degrees

33
Q

which bone in the foot is the last to ossify?

A

navicular. at age 2-4 years

cuneiforms are 2nd slowest @ 1 year

34
Q

how can you tell the difference between a # site and an epiphyseal growth plate/secondary ossification centre?

A

fun idea: bilateral imaging!! compare to other foot WOW

35
Q

what are the ABCDS ? strategy in reading a report

A 
A: alignment
B: bone mineralisation
c: cartilage space
D: distal to proximal examination
S: soft tissue evaluation (calcification within tendons, arteries, tophi, bursael, oedema,)
36
Q

which view would show the lateral column best? i.e. if you suspected an issue with 5th met

A

medial oblique view

37
Q

what is best imaging for stress #?

A

MRI

38
Q

what is the difference between a mortise view of the ankle and an AP view?

A

this is when you internally rotate the foot and take an x-ray whereas AP you don’t manipulate the foot

39
Q

what does gout look like?

A
  • 1st MPJ usually
  • tophi
  • early stages may be undetectable on x-ray
  • “rat bit erosions” sharply defined punched out bone erosions
40
Q

what heals better? a jones # or an avulsion fracture of the 5th met tuberosity?

A

avulsion is way better.

jones has a variable healing rate: non-union is common (surgical referral)

41
Q

define osteochondroses and give 2 examples.

A

//interruption of normal osseus and chondral formation. local trauma or ischaemia.

e. g. frieberg’s: irregular increased density and flattening of metatarsal head
e. g. kohler’s: increased and irregular density, flatening/collapse of the navicular. may mimic osteonecrosis

42
Q

what is the difference between acute and chronic charcot?

A

acute: the line running along the top of the foot is straight.
chronic: midfoot collapse (that line is bent as bro)

43
Q

what is ddx. of OM?

A
  • plantar ulcer: esp. in xrays

- ewing’s sarcoma

44
Q

what are clinical signs that indicate need for imaging investigation?

A
  • nocturnal bone pain
  • malaise/generally unwell/fatigue
  • night sweats
  • soft tissue swelling, bone deformity, enlargement
  • sx. may mimic OM
45
Q

if you want to see the lateral column what x-ray would you order?

A

medial oblique

46
Q

if you want to check out the medial column what view would order on x-ray?

A

lateral oblique

47
Q

if you suspect a calcaneal stress # or STJ arthropathy/coalition which view on an x-ray would you order?

A

harris and beath

OSCE podiatry (6 decks)

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