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Clinical Med I > MSK/Rheumatolgy - Radiology - Exam 3 > Flashcards

MSK/Rheumatolgy - Radiology - Exam 3 Flashcards

1
Q

What is the first line choice of imaging for all MSK complains?

A

Plain radiography (x-ray)

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2
Q

On a radiograph, what appears black and what appears white?

A

Black - air

White - bone

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3
Q

What are indications for radiography?

A

First line and usually order before advanced imaging
Fractures
Dislocations

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4
Q

What are radiograph contraindications?

A

Exclusively soft tissue injuries

Caution with excessive repeat images and unnecessary radiation

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5
Q

What are advantages for radiography?

A 
Readily available
Reproducible
Inexpensive 
Patient ease
Technical training not required
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6
Q

What are limitations for radiography?

A

Superimposed structures (3D data on a 2D image)
Radiation exposure
Low sensitivity for subtly fractures and soft tissue injuries

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7
Q

What imaging technique produces tomographic images to put data into sections to create a 3D image?

A

Computed Tomography (CT)

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8
Q

What are indications for a CT?

A 
Combined with contrast to image joints
Stereotactic frame (biopsies, surgical planning)
Angiography 
Small intraarticular fragments
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9
Q

What are CT limitations?

A 
Unnecessary imaging 
Significant metal in area to be imaged
Allergy to contrast dye
Pregnancy 
Claustrophobia
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10
Q

What are advantages to CT imaging?

A

Tomography
Best bone assessment modality
Higher contrast resolution (iodine based)

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11
Q

What are limitations to CT imaging?

A 
Artifacts (blurring from pt movement, beam hardening)
Limited use for soft tissue
Weight limitations, 300-400lbs
Cost (higher than X-ray lower than MRI)
Radiation exposure
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12
Q

How do you interpret a CT image?

A

R side of pt is on the L side of the screen
Axial images: looking from the pts feet toward the head
Coronal: patient is facing you
Sagittarius: looking from the side

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13
Q

What plane divides superior and inferior?

A

Axial

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14
Q

What plane divides anterior and posterior planes?

A

Coronal

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15
Q

What divides right and left planes?

A

Sagittal

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16
Q

What type of imagining utilized a strong magnetic field with radio frequency pluses and collects differences in tissue signal intensities?

A

Magnetic Resonance Imaging (MRI)

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17
Q

What are advantages to MRIs?

A

Superior contrast resolution
Ideal for soft tissue pathology while still good for bone pathology
Highly sensitive
Contrast compounds generally safer than CT contrast medium (gadolinium based)

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18
Q

What are MRI limitations?

A 
Magnetic field
Large shielded imaging site
Claustrophobia 
Expensive
One exam = one body part
Takes an average of 45min
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19
Q

What are indications for an MRI?

A

Intraarticular soft tissue structures
MR arthrography
Superior sensitivity in the diagnosis of early detection of bone marrow conditions, stress fractures, osteomyelitis, and malignancy
Problem solver tool instead of initial screening tool

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20
Q

What test has the most radiation?

A

CT

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21
Q

What test has the least radiation?

A

MRI and ultra sound

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22
Q

What are contraindications of MRIs?

A

Pacemakers
Mechanical pumps
Electronic stimulators
Metal products

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23
Q

What type of MRI is better for anatomical assessment? And how does it present?

A

T1

Fat is bright and typically fluid is dark (gadolinium)

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24
Q

What type of MRI is better for fluid assessment? And how does it present?

A

T2
Fat/fluid are both bright (adding fat saturation a,lows for fat to be dark)
Highlights soft tissue injuries

25
What type of imaging transmits sound waves and detects reflected sound waves to produce a tomographic image?
Ultrasound
26
What is echogenicity?
Frequency of sound waves Low- cystic High- solid mass
27
What does a Doppler measure?
Motion
28
What are advantages to ultrasound?
``` Beneficial for soft tissues (tendons and muscles) Low cost No known harmful effects Highly portable Unossified epiphyses ```
29
What are limitations to ultrasound?
Artifacts Limited skills by provider Minimal use in evaluating bone
30
What are indications of ultrasound?
Common study of choice for infants Soft tissue conditions Guided assistance for joint injections, biopsies, soft tissue drainage
31
What are contraindications of ultrasound?
None
32
What is a bone scintigraphy?
Nuclear medicine imaging bone scan IV injection of radioisotope bound to phosphate (tracer) Imaging may be completed at different phases between 1min and 24 hours following injections Tracer distributes in metabolically active bone at 2-4 hrs Produces single or cross sectional projection
33
What are advantages to bone scans?
Very sensitive for skeletal pathology Negative = negative Mildly sensitive for soft tissues
34
What are limitations to bone scans?
Non specific Lack detail Lower sensitivity in early fractures with slow healing potential Radiation exposure
35
What are the 3 types of complete fractures?
Transverse Oblique Spiral
36
What are the 3 types of incomplete fractures?
Greenstick Torus Bowing
37
What is a comminuated fracture?
Fracture resulting in many bone pieces
38
What is an avulsion fracture?
Injury to the bone where a tendon or ligament attaches
39
What is an impact fracture?
Occurs when the broken ends of the bone are jammed together by the force of the injury
40
What is a fissure fracture?
Only the outer layer of the bone is broken
41
What is a greenstick fracture?
Fracture in which one side of the bone is broken and the other only bent (break doesn't go all the way through)
42
What is a torus fracture?
Occurs when a bone slightly crushes in on itself
43
Why do pediatric fractures typically heal faster?
The periosteum covering the bones is more metabolically active, thicker, and more durable
44
What are apophyseal injuries?
Fracture occurring in adolescents that separates the growth plate (apophysis) of a bone from the main osseous tissue at a point of strong tendinous or ligamentous attachment
45
What is the Salter-Harris Classification system?
Severity classification of fractures involving the physeal (growth plate)
46
What is a type I Salter-Harris fracture?
Physis only | least severe
47
What is a type II Salter-Harris fracture?
Metaphysis and physis
48
What is a type III Salter-Harris fracture?
Physis and epiphysis
49
What is a type IV Salter-Harris fracture?
Metaphysis, physis, and epiphysis
50
What is a type V Salter-Harris fracture?
Physis only; crushing injury | most severe
51
What type of physis fracture is most common?
Type II (metaphysis and physis)
52
Are are concerning features of bone tumors and lesions?
``` Indistinct margins Abnormal periosteal reaction Soft tissue mass Rapid growth Pathologic fracture ```
53
What are the 5 types of displacements?
``` Translation Angulation Rotation Shortening Distraction ```
54
What is a translation displacement?
Sideways motion of the fracture, usually described as a percentage of movement
55
What is an angulation displacement?
The normal axis of the bone has been altered such that the distal portion of the bone points off in a different direction, usually measured in degrees
56
What is a rotational displacement?
Rotation of the distal fracture fragment in relation to the proximal portion
57
What is a shortening displacement?
Shortening is the amount a fracture is collapsed, measured in cm of overlap. Also called a bayonete apposition
58
What is a distraction displacement?
Fracture resulting in increased bone length due to widening of the compartment between the broken bones (basically the opposite of an impaction/compression)
59
What is an occult fracture?
Does not appear well on an X-ray "hidden"

Clinical Med I (24 decks)

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