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Clin Med 4 > MSK 1 - Radiology Principles > Flashcards

MSK 1 - Radiology Principles Flashcards

1
Q

what is the criteria to follow for ordering imaging studies?

A

The American College of Radiology (ACR) Appropriateness Criteria

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2
Q

what is the initial imaging study of choice following skeletal trauma?

A

X-ray

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3
Q

what 4 things does X-ray evaluate?

A
  • cortical integrity
  • articular surface congruity
  • joint space
  • osseous lesions
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4
Q

how many views to get for X-ray? what are they?

A

at least 2 views - AP/Lateral

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5
Q

if pt has extremity pain with negative x-ray, but still have high suspicion of fracture, what do you do?

A

treat as fracture and splint

have pt follow-up with ortho in 7-10 days

repeat x-rays may show cortical changes

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6
Q

important patient info for x-ray interpretation?

A

patients name, gender, and DOB

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7
Q

CT scan used to identify?

A

use in trauma to identify and characterize injury pattern/severity

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8
Q

how is CT better than X-ray?

A

CT better than X-ray in:

  • identifying subtle fractures
  • visualizing articular extension of fracture
  • assessing for the presence of articular step-off/gap
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9
Q

when is MRI used?

A

primarily for soft tissue evaluation

diagnosing occult (hidden) fractures (ex: femoral neck fx)

dx ligament or articular cartilage injury

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10
Q

for what is MRI the modality of choice?

A

disc herniation (get X-ray first)

to assess “internal derangement” of joints - ex: ACL tear

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11
Q

when is U/S used?

A

used in trauma setting to assess soft tissue injury

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12
Q

examples of using U/S?

A

Achille’s tendon rupture and quad tendon rupture

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13
Q

bone scan used when?

A

mets, stress fractures

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14
Q

what is a comminuted fracture?

A

> 2 fracture fragments

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15
Q

what is the least common type of fracture?

A

spiral factures

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16
Q

spiral fractures are inherently ___

A

unstable

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17
Q

what is a butterfly fracture?

A

subtype of comminuted fx with wedge-shaped fracture fragment along shaft of bone

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18
Q

what should be described for fractures?

A

location and any displacement of fracture fragments

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19
Q

most fractures appear as what line?

A

radiolucent line

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20
Q

in non displaced fox’s, Lucent line is what?

A

thin and may be difficult to appreciate

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21
Q

what do mach bands represent?

A

optical illusion - due to 2 superimposed objects

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22
Q

where do mach bands appear?

A

at sites of cortex overlap b/w two bones, or skin fold overlap of the cortex

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23
Q

mach bands most common at what site?

A

ankle radiographs (tibia overlaps fibula)

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24
Q

what type of fracture may appear as a sclerotic line?

A

compression fractures

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25
most common locations of sclerotic fracture line?
vertebral bodies and distal radius
26
what is cortical buckling?
buckling in absence of fracture line
27
where is cortical buckling seen?
distal radius - most often
28
intra-articular extension may involve?
articular cartilage only (chondral fx) both the bone and articular cartilage (osteochondral fx)
29
what is a chondral fx?
fx involving articular cartilage only
30
what is an osteochondral fx?
both the bone and articular cartilage are involved
31
what are the 3 aspects of displacement?
translation (displacement) angulation rotation
32
what is translation?
line drawn down center of bone not continuous at the fracture site
33
how do you describe translation?
direction of translation of the distal fracture component compared to proximal the amount of translation (as %age of bone width)
34
what is displacement?
loss of normal anatomic position
35
how is displacement graded?
in terms of shaft width in quartiles (25%, 50%)
36
direction of displacement is described using how many views?
two orthogonal views
37
what 2 views describe displacement?
AP view shows medial to lateral displacement lateral view shows anterior to posterior displacement
38
what does AP view for displacement?
shows medial to lateral displacement
39
what does lateral view show for displacement?
shows anterior to posterior displacement
40
displacement is described in terms of?
position of distal fragment compared to proximal
41
describe what for angulation?
direction of angulation of distal fracture component as compared to proximal amount of angulation in degrees (estimate)
42
how many views used to describe angulation?
2 orthogonal views
43
what is rotation?
turning of the distal fracture fragment in relation to proximal portion
44
why is rotation important to correct?
b/c anatomic alignment of bone is cortical to normal function
45
when is rotation seen most easily?
when looking at orientation of joints above and below fracture
46
what is distraction?
fracture separated by a gap with no overlap
47
distraction with common with what fractures?
transverse fractures that result from a tension force
48
what are examples of tension force fractures?
medial malleolar and patella fx
49
how is an avulsion caused?
by abnormal tensile stress on ligaments or tendons
50
where in hands do avulsions occur?
dorsal distal phalanx with extensor tendon avulsion
51
where in feet do avulsions occur?
base of fifth metatarsal with peroneus braves avulsion
52
where in pelvis do avulsions occur?
ischial tuberosity with hamstring tendon avulsion
53
at what locations do avulsions typically occur?
hands, feet, pelvis
54
what can help identify an underlying fracture? when is this very helpful?
soft tissue swelling | -helpful when assessing trauma to the metacarpals or phalanges
55
what can joint effusions be?
blood or inflammatory fluid (or both)
56
joint effusion in acute setting in pt with NO arthritis, is a sign of what?
hemarthrosis
57
what may hemarthrosis be a result of?
of an intra-articular injury to either the soft tissues or adjacent bone
58
what is a transverse fracture?
fx perpendicular to long axis of bone
59
transverse fx caused by?
direct force (also tension force)
60
transverse fx most common where?
in forearm/leg
61
transverse fx is stable or unstable?
stable
62
what is oblique fracture caused by?
indirect force | -compression and angulation forces combine to cause shear force
63
oblique fx is stable or unstable? repaired where?
unstable repaired in the OR
64
how are spiral fx's caused? result from?
by twisting movement thru the long bone axis result from rotation/shear forces
65
spiral fx are stable or unstable? repaired where?
unstable repaired in the OR
66
what type of fx is the LEAST common?
spiral fx
67
severity of comminuted fx's graded as?
minimal or moderate-severe
68
butterfly fx's are caused by what force?
indirect force
69
what do butterfly fx's produce?
a bending of bone
70
butterfly fragment produced alone what side?
concave, compression side
71
what is a greenstick fracture?
incomplete fracture of long bone produced on convex cortex, while concave cortex becomes bent WITHOUT visible crack
72
in who and where do greenstick fx's occur?
in forearm of young child
73
what does greenstick fx result from?
bending force applied perpendicular to shaft
74
what is a torus fracture?
a buckle fx
75
buckle fx is a type of what fx?
incomplete fx
76
where do buckle (torus fx's) occur?
at metaphysical diaphysial junction after FOOSH
77
buckle fractures common after?
after FOOSH
78
buckle fx stable or unstable?
stable
79
what are the suggested x-rays for elbow?
AP, external oblique, lateral
80
what are suggested x-rays for fingers?
AP, oblique of hand, lateral of affected finger
81
what are suggested x-rays for hand?
AP, oblique, lateral
82
what are suggested x-rays for thumb?
AP, oblique, lateral
83
what are suggested x-rays for wrist?
AP, oblique, lateral
84
what are suggested x-rays for hip?
AP pelvis, frog lateral
85
what are suggested x-rays for ankle?
AP, mortise, lateral
86
what are suggested x-rays for femur?
AP, lateral
87
what are suggested x-rays for foot?
AP, oblique, lateral
88
what are suggested x-rays for knee if under 40 y/o?
AP, lateral, tunnel, sunrise
89
what are suggested x-rays for knee if over 40 y/o?
bilateral PA weight bearing (aka 30 degrees PA flex view) bilateral tunnel, bilateral sunrise, lateral of affected knee
90
what are suggested x-rays for tib-fib?
AP, lateral
91
what are suggested x-rays for heel?
axial, lateral calcaneus
92
what are suggested x-rays for AC joint?
AP with and without weights
93
what are suggested x-rays for chest?
PA, lateral (full inspiration)
94
what are suggested x-rays for clavicle?
AP, axial (20 degree caphalad)
95
what are suggested x-rays for humerus?
AP, lateral
96
what are suggested x-rays for ribs?
AP, obliques (bilateral) Upper: inspiration Lower: expiration
97
what are suggested x-rays for SC joint?
AP, obliques (bilat)
98
what are suggested x-rays for shoulder?
AP, Grashey, Y-scapular view

Clin Med 4 (11 decks)

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