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MSK SB > Radiology > Flashcards

Radiology Flashcards

1
Q

signs suggesting OA

A

asymmetrical joint involvement

weight bearing/active joints

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2
Q

what is seen on an x-ray in OA

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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3
Q

what causes a loss of joint space in OA

A

asymmetric cartilage wear

weakened bones caves

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4
Q

what causes subchondral sclerosis in OA

A

increased subchondral bone cellularity and vascularity excites bone turnover

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5
Q

what causes subchondral cysts in OA

A

synovial fluid dissects into bone

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6
Q

what causes osteophyte formation in OA

A

periosteal stimulation

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7
Q

signs suggesting RA

A

symmetrical joint involvement
affects synovial joints
commonly - MCP, MTP, PIP, C1/2 (atlantoaxial joint), wrist/hip/knee/shoulder

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8
Q

what joint in the hands are not affected by RA

A

DIP

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9
Q

radiographic features of RA

A 
LESS
Lost of joint space (joint subluxation)
Erosions (Destruction of bone at joint margins)
Soft tissue swelling
Soft bones (osteopenia)
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10
Q

what causes soft tissue in RA

A

synovial proliferation and reactive joint effusion

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11
Q

what cause periarticular osteoporosis in RA

A

Hyperaemia causing bone demineralisation resulting

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12
Q

what causes destruction of bone in RA

A

inflammatory pannus

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13
Q

what causes joint subluxation/deformity

A

capsular and ligamentous softening

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14
Q

what fuses in RA

A

Exposed eroded bone ends may fuse (ankylosis)

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15
Q

features of seronegative arthritis

A

Sacroiliac joint and spine involvement

Ill-defined periarticular bone formation

Tendency to joint ankylosis

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16
Q

psoriatic arthritis joint distribution

A

small joints of hands and feet

DIP joints, IP joint great toe

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17
Q

AS joint distribution

A

scattered lower limb large joints

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18
Q

reactive arthritis distribution

A

scattered lower limb large joints

lower limb entheses

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19
Q

why are x-rays not often used to diagnose arthritis

A

can only see late stage damage
should be prevented
other lab tests first line

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20
Q

how can increased vascularity around joints be seen

A

isotope bone scan

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21
Q

what can a Doppler US show in arthritis

A

Thickening of synovium and increased blood flow

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22
Q

what do each Ix show

A

x-ray - bone but no soft tissues

CT - bone in more detail and some soft tissue

MRI - bone in less detail and all soft tissues

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23
Q

which vertebra has no body and what is it called

A

C1

Atlas

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24
Q

when is CT used to image spinal trauma

A

X-ray shows # but

  • more detail required
  • any more fractures present ?

X-ray normal but
high clinical suspicion of #

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25
Q

what tether vertebrae together are are responsible for spinal stability

A

intervertebral ligaments

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26
Q

are ligaments seen on x-ray or CT

A

no

but seeing normal alignment on test test implies intact ligaments and a stable spine

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27
Q

how do ligaments appear on MRI

A

normal - black

damaged - light

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28
Q

when is MRI used in spinal trauma

A

To provide detail of the spinal ligaments

In patients with neurological deficit, which is not explained by x-ray or CT, to show soft tissue abnormality, such as:
acute prolapsed intervertebral disc
epidural haematoma
spinal cord damage

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29
Q

pathogenesis of intervertebral disc disease

A
  • discs dehydrated as a prelude to disease
  • disc material herniates through disc lining into spinal canal
  • press on spinal nerve
  • sciatica
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30
Q

what imaging is used for intervertebral disc disease

A

CT and MRI

MRI is best showing early disc dehydration preceding herniation

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31
Q

what Ix is used to see spinal cord

A

MRI

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32
Q

principles of imagine

A
  • Clinical features are there to help you
  • One view is rarely enough
  • Fracture appearance is variable
  • Always assess bony alignment
  • Check for soft tissue abnormality
  • Children can sustain a unique set of injuries
  • Don’t switch off after finding one abnormality
  • Only dense foreign bodies are shown by x-rays
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33
Q

features of Hx/Ex that help guide x-ray interpretation

A
  • MOI
  • site of bone tenderness
  • presence of deformity
  • patient age
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34
Q

** views for cervical spine

A

AP
Lateral
Odontoid peg

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35
Q

** views for scaphoid

A

AP
Lateral
Two obliques

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36
Q

what are avulsion fracture mimics

A

sesamoid bone
accessory ossification centres
old non-united fracture

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37
Q

what is the posterior fat pad sign

A

elbow effusion most commonly caused by trauma

displaced fat pad visible posterior to distal humerus

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38
Q

is seeing the posterior fat pad sign normal

A

no it is always abnormal

sensitive indicator of elbow trauma

39
Q

why do children sustain a unique set of injuries

A

bones are soft
they ‘bend or bow’ rather than ‘snap and splinter’

fractures are often incomplete

40
Q

what is a buckle fracture

A

incomplete fractures of the shaft of a long bone with a bulging of the cortex
often distal radial metaphysis

41
Q

what is a greenstick fracture

A

incomplete fractures of long bones

commonly mid-diaphysial affecting forearm and lower leg

42
Q

what is common in fractures in children

A

common for ligaments or tendons to avulse their soft bony attachments.

43
Q

what can mimic a fracture in children

A

the growth plate/physis

44
Q

where is the weakest part of the bone in children

A

the growth plate - prone ton injury

45
Q

what is used to classify growth plate fractures

A

Salter-Harris

46
Q

why would injury of femur in a baby be suspicious

A

isn’t rolling/walking

NAI suspected

47
Q

where are examples of bony rings in the body

A

spinal canal
pelvis
forearm and lower leg

48
Q

what should be suspected in a bony ring with a fracture

A

that there is more than 1 fracture

49
Q

what foreign bodies can be seen on x-ray

A

metal + glass

Plastic and wood cannot be seen

50
Q

when should a pathological fracture be suspected

A

when bone abnormality seems out of proportion to the mechanism of injury

51
Q

Colles fracture

A

elderly with osteoporosis
dorsal angulation of radius
associated ulnar styloid #

52
Q

radial buckle fracture

A

children with soft bones

53
Q

scaphoid fracture

A

young males
pain in anatomical snuffbox
commonly mid-scaphoid (waist)

54
Q

surgical neck humerus fracture

A

post-menopausal females
sclerosis indicates impaction
often comminuted
can damage axillary nerve

55
Q

what should be obtain in posterior shoulder dislocation

A

oblique view

56
Q

what can supracondylar fractures damage

A

brachial artery

57
Q

complications of scaphoid fracture

A

proximal scaphoid blood supply can be disrupted by a fracture, making it prone to non-union (on right) or avascular necrosis leading to early wrist osteoarthritis

58
Q

what is Bennett’s fracture

A

fracture of the base of the first metacarpal bone (thumb) which extends into the carpometacarpal (CMC) joint

59
Q

why do lower limb fractures have higher morbidity and mortality

A

Immobility through lower limb injury may lead to:
dehydration and starvation
DVT or pulmonary embolus
pneumonia

60
Q

pelvic ring fracture - high energy

A

young people
RTA or fall from height
usually multiple fractures

61
Q

what is the Ix used in polytrauma patients

A

CT scan

62
Q

pelvic ring fracture - low trauma

A

affect elderly patients with osteoporosis
typically due to a minor fall, may be of insidious onset
MRI test of choice (invisible on x-ray)

63
Q

what is used to show acute injuries affecting superficial structures

A

USS

64
Q

sports related pelvic injuries

A 
acute hamstring tendon avulsion
hip dislocation (can also be due to RTA)
65
Q

hip dislocation

A

CT - detailes fracture anatomy to assist surgical planning

can have femoral head AVN or early OA

66
Q

useful fracture classification

A

intra vs extra capsular

67
Q

features of intra-capsular fractures

A

interfere with blood supply to femoral head prone to femoral head AVN or non-union

68
Q

Tx of intra-capsular fractures

A

treated by hemiarthroplasty, unless undisplaced or young patient when reduction and screw fixation may be tried

69
Q

features of extra-capsular fractures

A

don’t affect blood supply to femoral head

don’t get femoral head AVN or non-union

70
Q

Tx of extra-capsular fractures

A

internal fixation using DHS

71
Q

when should an x-ray be repeated if a fracture is suspected

A

10 days after

72
Q

femoral shaft fractures

A

usually high energy

risk of blood loss, fat embolus

73
Q

fractures of knee

A

X-ray initially
CT - clarify fracture anatomy
US + MRI - assess soft tissues

74
Q

what does significant soft tissue injury in the knee cause

A

effusion in the supra patellar space

lipohaemarthrosis (blood and fat collecting)

75
Q

standard trauma imaging of the knee

A

X-ray - AP, lateral

76
Q

tibial plateau fracture

A

lateral condyle
follows valgus force with foot planted ‘bumper injury’
well shown by CT

77
Q

Ix for extensor mechanism injury

A

US

78
Q

common test in acute knee trauma and why

A

MRI

Can show things hidden by swelling

79
Q

What is MRI an Ix for

A

Ligament tear
Hyaline cartilage injury
Meniscal tears
Undisplaced fractures

80
Q

what does hyaline cartilage damage predisposes to

A

early OA

81
Q

what does the tibia and fibula form

A

bony ring

injuries usually involve > 1 site

82
Q

Ix for ankle injuries

A

clinical examination

x-ray - AP and lateral

83
Q

what is a pilon fracture

A

fracture of the distal part of the tibia, involving its articular surface at the ankle joint

84
Q

what are used for complex ankle fractures

A

CT scan

85
Q

what is talar dome margin fractures

A

injury to the cartilage and underlying bone of the talus within the ankle joint

86
Q

5th metatarsal bone fracture

A

follows inversion and clinically resembles a lateral malleolar #, so check this area on the lateral x-ray
are transverse

87
Q

Calcaneal fracture

A 
axial compression (falling from height onto the hell)
causes loss of the park and increased bone density
88
Q

how is the normal calcaneus central peak measured

A

using Bohler’s angle

89
Q

where are accessory ossification centres seen

A

5th metatarsal - in teens
posterior calcaneus - in children
os trigonum

90
Q

sesamoid bone

A

fabella - within lateral head of gastrocnemius
rounded sesamoid bone seen in the foot
medial and lateral plantar aspects of 1st metatarsal head

91
Q

what predispose tendon rupture

A

diabetes
RA
Steroid use

92
Q

Ix for tendon rupture

A

US - allows dynamic assessment

MRI - 2nd line

93
Q

midfoot fracture views

A

AP - 1st and 2nd TMT joint

Oblique - 3rd and 5th TMT joint

MSK SB (15 decks)

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