Radiologic Exam of the UE and LE

Question 1

Which imaging view of the knee will assess for the following:

• superimposed femoral condyles
• pateallar positions
• suprapatella bursa
• fabella (accessory bone that may be found in the lateral head of the gastrocnemius - not present in all humans)

Answer 1

Lateral Knee

Question 2

Which type of MRI at the ankle/foot is the image?

Answer 2

Ankle and Hindfoot Arthogram

Question 3

Which imaging view of the foot will assess for the following:

• ABCs
• shifts of phalanges and metatarsals
• seasmoid bones
• bones of midfoot

Answer 3

Oblique Foot

Question 4

Which CT imaging plane assesses for the following at the knee:

• position of patella => high position infers torn patellar ligament, low position infers torn quad tendon
• fragmentation and ossification at inferior patella and patellar tendon as seen in Sinding-Larson-Johansson disease

Answer 4

Sagittal Plane CT of Knee

Question 5

Which CT imaging plane assesses for the following at the knee:

• Patellofemoral articulaiton (congruence of patella in sulcus, look for osteochondral defects)
• Tibial plateau (check for depression or split fractures => second avulsion fracture at the lateral aspect is associated with ACL tears)
• Tibal tuberosity (hypertrophy or fragmentation due to Osgood-Shlatter’s traction aphophysitis)

Answer 5

Axial Plane CT of the Knee

Question 6

Pittsburgh Knee CPR: Radiographs should be ordered after

1. ___ trauma or fall mechanism AND
2. age < ___ or > ____ AND/OR
3. Inability to walk 4 ___ steps

Answer 6

1. blunt trauam or fall mechanism, AND
2. age < 12 or >50 yo, AND/OR
3. inability to walk 4 weight-bearing steps

Question 7

Which type of image is the modality of choice when radiographs are negative for stress fractures?

Answer 7

MRI (image is sagittal T1)

Question 8

Ottowa Rules for Ankle

1. Pain in the ____ zone, AND
2. Tenderness at the tip of the ___ malleolus, OR
3. Tenderness at the tip of the ___ malleolus, OR
4. Inability to ____ both immediately and in the ER

Answer 8

1. Pain in the maellolar zone, AND
2. Tenderness at the tip of the lateral mallelous, OR
3. Tenderness at the tip of the medial malleolus, OR
4. Inability to bear weight both immediatley in the ER

Question 9

Which MRI knee plane is described by the following:

• screening plane is parallel to the tibial plateau and extends from the quadriceps to the tibial tuberosity
• articular carilage
• medial patellofemoral ligament
• patellar retinaculum
• ACL/PCL
• joint effusion
• Baker’s Cyst
• Muscles (e.g. popliteus)
• Muscle attachment (e.g. pes anserine)

Answer 9

Axial MRI of the Knee

Question 10

Which imaging view of the ankle will assess for the following:

• ABCs
• fibula superimposed behind tibia
• posterior rim of tibia (third malleolus)
• Talus, calcaneous, cuboid, and navicular

Answer 10

Lateral Ankle

Question 11

• most common congenital defomrity of the LE
• Radiographs limited due to minimal ossification
• conservative treatment and rehab for several years. surgery for irreducible subluxations
• also known as clubfoot

Answer 11

Talipes Equinovarus

Question 12

Which MRI imaging view of the ankle/foot allows visualization of the following:

• deltoid ligaments
• Calcaneofibular
• tarsal tunnel
• talar dome
• subtalar joint
• plantar fascia

Answer 12

Coronal MRI of Ankle and Hindfoot

Question 13

Longitudinal Arch Deformities

1. flat foot (can be rigid or flexible => flexible is normal in young children, usualy resolves with growth)
2. high longitudinal arch (80% known cause = malunion of hindfoot fractures, sequela of burns or compartment syndromes, neurological disorders)
3. talometarsal angle = intersection line along midshaft of ____ metatarsal and body of ____

Answer 13

1. Pes Planus
2. Pes Cavus
3. midshaft of the 1st metatarsal and the body of the talus

Question 14

Which imaging view of the foot will assess for the following:

• ABCs
• bones of the forefoot
• bones of the midfoot
• note any seasmoid bones common at the 1st, 2nd, or 3rd, met heads
• first intermetatarsal angle, 5-15 degrees

Answer 14

AP foot

Question 15

The image is what type of CT view of the Ankle and foot?

Answer 15

Coronal CT

Question 16

Routine Imaging series for the Knee includes which 4 views?

Answer 16

1. AP
2. Lateral
3. PA Axial (intercondylar fossa)
4. Tangential View (patellofemoral Joint)

Question 17

Ottowa Rules for Foot

1. Pain in the ____ zone, AND
2. Tenderness at the ____, OR
3. Tenderness at the ____, OR
4. Inability to _____ both immediatley and in the ER

Answer 17

1. Pain in the midfoot zone, AND
2. Tenderness at the 5th metatarsal base, OR
3. Tenderness at the navicular bone, OR
4. Inability to bear weight immediately and in the ER

Question 18

Which MRI knee plane is described by the following:

• meniscus
• ACL/PCL
• extensor mechanism
• articular cartilage
• bone marrow

Answer 18

Sagittal MRI of the Knee

Question 19

Which MRI imaging view of the ankle/foot allows visualization of the following:

• achilles tendon
• Tib-fib joint
• subtalar joint
• transverse tarsal joint
• plantar fascia
• sinus tarsi

Answer 19

Sagittal MRI of Ankle and Hindfoot

Question 20

Which type of imaging to use?

1. fractures/dislocations
2. instability
3. complex fractures and articular depression
4. meniscus, cruicate ligaments, collaterals, and soft tissues
5. severe fractures, dislocations with associated vascular injury, ligament and cartilage injury

Answer 20

1. Radiographs
2. stress radiographs (ankles)
3. CT
4. MRI
5. Arthrography

Question 21

Hallux Valugs (deformity of the forefoot in which the first MT deviates medially and the great toe laterally) is assessed from the lines and angles drawn from which two imaging views?

Answer 21

AP and lateral views

Question 22

The image is what type of CT view of the Ankle and foot?

Answer 22

Question 23

Which imaging view of the foot will assess for the following:

• ABCs
• Bones of midfoot and hindfoot
• boehler angle, normal value 25-40 degrees
• calcaneal inclination (pitch) => normal value 20-30 degrees (the higher the more pes cavus the foot is)

Answer 23

Lateral Foot

Question 24

Which imaging view of the knee will assess for the following:

• “tunnel appearance of the foss”
• intercondylar eminences

Answer 24

PA Axial (Intercondylar fossa)

Question 25

Which imaging view of the knee will assess for the following:

• patellar position
• femorotibial joint space
• long axes of femur and tibia

Answer 25

AP Knee

Question 26

Ottowa Knee CPR: radiographs should be ordered after trauma for pts with any of the following

1. > ___ yo
2. Tenderness _____
3. isloated tenderness of _____ => inability to flex knee to ____
4. inability to walk ___

Answer 26

1. >55 yo
2. tenderness fibular head
3. isloated tenderness of patella => inability to flex knee to 90
4. inability to walk 4 steps

Question 27

The image is what type of CT view of the Ankle and foot?

Answer 27

Axial Oblique CT

Question 28

Which imaging view of the ankle will assess for the following:

• lateral malleousl extends below medial
• medial and superior joint space is visible
• dome of talus

Answer 28

AP Ankle

Question 29

The image is an example of which type of MRI at the knee

• distension of joint capsule via injection of contrast medium allows identification of intra-articular tissues

Answer 29

Knee Arthrograph

Question 30

Indications for use of CT include:

1. severe ___
2. Fracture ____
3. loose ____
4. Tibial plateau _____ fractrues

Answer 30

1. severe trauam
2. fracture fragments
3. loose bodies
4. tibial plateau depression fractures

Question 31

Which imaging view of the knee will assess for the following:

• sunrise view
• sulcus angle
• congruence angle (bottom of sulcus angle to bottom of patella)

Answer 31

Tangential View (Patellofemoral Joint)

Question 32

MRI artography is indicated for use at the knee for:

1. ____ changes
2. ____ bodies

Answer 32

1. Meniscal changes
2. loose bodies

Question 33

Which abnormal condition of the LE can involve the following:

• Pelvis
• lumbosarcral => scoliosis
• LE contractures
• joint deformities
• DJD
• arthroplasty

Answer 33

Functional Leg Length Discrepancy

Question 34

Which MRI imaging view of the ankle/foot allows visualization of the following:

• Ankle tendons
• sinus tarsi
• Tibiofibular ligaments
• osseous structures

Answer 34

Axial MRI of Ankle and Hindfoot

Question 35

Which imaging view of the ankle will assess for the following:

• ABCs
• Normal mortise wideth is 3-4 mm over the entire surface of the talus

Answer 35

AP Oblique (mortise)