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Ortho > Radiology > Flashcards

Radiology Flashcards

1
Q

What are reasons for ordering radiographic tests in ortho?

A
  • hx of blunt trauma
  • deformity of bone or jt following injury
  • hx of pain, swelling, or loss of motion of a jt, sense of instability
  • infection
  • fb
  • night pain
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2
Q

Use of MRI in general?

A
  • provides good contrast b/t diff soft tissue of body, makes it especially useful in imaging brain, muscles, heart, cancers compared w/ other medical imaging techniques
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3
Q

Use of MRI in ortho?

A
  • eval soft tissue injury as apposed to bony injury. Ex is ligament injury, tendon injury, muscle
  • better eval of soft tissue mass
  • R/O fluid collection in body
  • define abnormalities w/in bone seen on x-ray
  • r/o stress fracture or infection (osteomyelitis)
  • eval spinal injury (gold standard for spine)
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4
Q

Specific structures we analyze w/ MRI?

A
  • knee: ACL, MCL, PCL, LCL, meniscus, loose body
  • shoulder: rotator cuff, biceps, labrum
  • elbow: ulnar and radial ligaments, extensor and flexor tendon insertion for epicondylitis, biceps tendon rupture, loose body
  • wrist: extensor carpi ulnaris injury, TFCC tear
  • ankle and foot: anterior tibial tendon injury, peroneal, tibial tendon, achilles tendon partial tear
  • hip: labral tear
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5
Q

Soft tissue masses seen on MRI?

A
  • lipoma
  • hematoma
  • osteosarcoma
  • ganglion cyst
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6
Q

Fluid collection that can be seen on MRI?

A
  • effusion of jt, shoulder, hip
  • no need for MRI olecranon bursitis, patellar bursitis
  • infection fluid collection w/in soft tissue compartments
  • baker’s cyst in knee
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7
Q

Bone abnorm you can see on MRI?

A
  • stress fracture: tibia, metatarsals, tibial plateau, femoral neck
  • lytic or blastic lesions seen on xray
  • bone contusion
  • r/o occult fracture, scaphoid
  • avascular necrosis
  • osteomyelitis
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8
Q

Spine pathology that you can dx on MRI?

A
  • herniated disc
  • bulged disc
  • spinal stenosis
  • compression fx, acute vs chronic
  • neoplasm
  • pars defect (acute vs chronic)
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9
Q

Reasons for ordering CT scan in ortho?

A
  • cervical injury: due to mult overlapping shadows and images on xray, CT scan better r/o cervical fx after trauma
  • reconstructing and better defining communited fx such as: acetbaular fx, calcaneous, articular**
  • eval jts for preop eval for surgery
  • better for bony surfaces
  • CT myelogram of spine for individuals that can’t undergo MRI due to pacemaker or other metal objects. Myelogram is CT w/ radiographic dye injected into dura
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10
Q

What is a bone scan? Used for?

A
  • nuclear medicine study: inject small amt of radioactive material and then scanned w/ gamma camera
  • scan may be full body or localized: SPECT
  • will show bone turn over and osteoblastic activity, but won’t show osteoclastic activity
  • used for bone mets: prostate, less for lytic lesions (MM), also used for stress fracture, infection, occult fx
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11
Q

Ways to describe fx on xray? How many xrays should be done?

A
  • displacement
  • angulation (where is apex of fx?)
  • avulsion
  • impaction
  • intra-articular
  • comminuted
  • spiral
  • greenstick
  • buckle
  • transverse vs oblique
  • number depends on location and injury: usually 2 views of 90 degrees to eachother, re-xr in a week
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12
Q

How many xray shoulder views should you get?

A
  • AP: good for AC jt
  • axillary: can see lesser tuberosity, glenohumeral jt
  • Y: indication is if pt can’t give axillary view, trying to see dislocation
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13
Q

How many X-ray views of humerus are done?

A
  • AP and lateral
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14
Q

Elbow xrays: how many views?

A
  • AP (looking for avulsion fx) and lateral (have 90 degrees flexion)
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15
Q

What dictates if it is a true forearm xray?

A
  • need full forearm in X-ray including wrist and elbow

- get AP and lateral

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16
Q

Wrist xrays?

A
  • AP, lateral and oblique
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17
Q

Hand xray positions?

A
  • AP, lateral, oblique
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18
Q

Lumbar spine xrays? what are we looking for?

A
  • AP and lateral
  • can get oblique: looking for pars fx (scotty dog)
  • spinous processes
  • kyphosis, lordosis
  • arthritis
  • SI jts: arthritis
  • ankylosing spondylitis: see in SI jts first b/f bamboo spine
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19
Q

Pelvis xray?

A

want entire ring

  • can see rami fx, want to see L5-S1
  • get CT for pelvic fx (don’t want to miss anything)
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20
Q

What are we looking for on Hip AP?

A
  • at acetabulum, femoral head (want it to be concave not convex - acetbaular femoral impingement)
  • looking for crescent sign: AVN
    RFs for AVN:
    corticosteroids
    previous fx, hip dislocation
    ETOH
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21
Q

Xray views of knee?

A

AP, lateral, sunrise (can see patella)

- make sure wt bearing films are ordered (arthritis)

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22
Q

Xray views of ankle?

A
  • mortis, lateral and AP

- AP: can’t see lateral jt like mortis (wan to make sure jt space is even - if not may have fx higher up)

23
Q

xray views of foot?

A
  • AP, lateral, oblique

- want to see tibial-talar jt, tarsals

24
Q

Characteristics of clavicle fx? Dx?

A
  • MC fx bone in kids and adolescents
  • males more than females
  • 80% middle third
  • 15% distal
  • 5% proximal
  • dx:
    H and P
    XRs: AP - see both SC and AC jts, zanca view (30-45 degree cephalic tilt - helps to eval displacement and comminution)
25
Q

MC dislocation of humerus? Why is this?

A
  • anterior b/c of pec muscle
26
Q

Characteristics of humeral head fxs? Dx?

A
  • 2nd MC UE fx
  • older than 65 3rd MC fx (1: radius, 2: hip)
  • usually in adults older than 65
  • females more than males
  • surgical neck more common than anatomical neck

-dx:
XRs: AP, lateral, and scap Y
CT: if articular involvement of glenoid and humeral head

27
Q

Tx of humeral head fxs?

A

tx comorbidities that may increase risk of nonunion:

  • osteoporosis
  • alcoholism
  • tobacco use
  • mental illness
  • steroid use
  • rheum diseases
28
Q

Humeral shaft fx characteristics? Dx?

A
  • usually occr from high impact injury (fall)
  • worried about radial nerve
  • dx:
    XRs - AP and lateral, get shoulder and elbow in views
29
Q

Presentation of anterior dislocation of humerus? Posterior?

A
  • on xray: looks like humeral head is depressed

- posterior: almost looks normal, may look elevated

30
Q

What muscle may pull on ulna if there is olecranon fx?

A
  • triceps may pull up olecranon
31
Q

Diff midforeram fx? Tx?

A
  • radius and ulna: midshaft are unstable - refer to ortho
  • isolated ulnar fx: if displaced less than 50% bone diameter and less than 10 degrees of angulation.
    Short arm cast 2 wks then fxnl splint 2-6 wks
32
Q

MC radial fx?

A
  • distal radial
  • FOOSH
  • 1/6 of all fx tx
  • xrays:
    radial inclination, radial ht: 1 cm, volar tilt: normal is 10 degrees
33
Q

Presentation of scaphoid fx?

A
  • snuffbox tenderness

- worried about AVN of proximal end (retrograde blood flow)

34
Q

Dx scaphoid fx?

A
  • xrays of wrist: PA, lateral and scaphoid view (AP w/ 30 degrees of supination and ulnar deviation)
  • look for widening of scapholunate distance (greater than 3 mm)
  • high risk of nonunion: greatest at proximal pole
  • xrays may be normal initially: if snuffbox tenderness and xrays negative be very suspicious - tx?
  • repeat xray in 101-4 days
  • bone scan: more cost effective than MRI, can show uptake in 72 hrs
  • MRI: sensitivity same as bone scan, better specificity, but spendy
  • CT: helps see fx line and displacement
35
Q

Diff metacarpal fxs? Tx?

A

thumb:

  • bennet’s: fx combined w/ subluxation or dislocation of metacarpal jt
  • rolando fx: T or Y shaped fx involving jt space
  • if extra articular fx: can consider closed reduction and thumb spica cast for 4-6 wks (less than 25 degrees angulation and rotation are acceptable limits for thumb)
  • boxer’s fx: 5th metacarpal 1st time, if rotates while making a first - needs to be fixed
36
Q

Tx of proximal phalanx fx that is transverse?

A
  • splint
37
Q

What heals faster: spiral or transverse fx?

A
  • spiral: more bone to bone surface area
38
Q

What fxs of fingers reqr further referral to ortho?

A
  • anything that involves articulating surfaces
39
Q

Tx of distal phalanx fx? When does this occur?

A
  • usually from slamming finger in a door (tuft fx)
  • tx if closed w/ minimal to no displacement-tuft or shaft:
    stable, Al splint over tip of finger for 3-4 wks, leave PIP free
40
Q

Pistol grip deformity is a sign of what?

A
  • femoroacetabular impingement (some portion of the soft tissue around hip socket is getting pinched or compressed) - present w/ deep groin pain w/ activities that stress hip motion, may be clicking, catching
41
Q

Tx for patellar transverse fx?

A
  • straight leg knee immobilizer
42
Q

Medial or lateral arthritis more common in knee?

A
  • medial
43
Q

What type of imaging should you get for tibial plateau fx?

A
  • CT
44
Q

MC etiology of isolated fibular shaft fx?

A
  • direct trauma
45
Q

What should you be concerned about if you see distal fibular fx on xray?

A
  • ankle fx

- or vice versa: get ankle xray to look for widening of syndesmosis - means there is a fx more proximally

46
Q

If you see medial malleolar fx what else will most likely be present?

A
  • lateral fx
47
Q

What is a Jones fx?

A
  • proximal shaft of 5th metatarsal aka dancer’s fx
  • type 1: nondisplaced or displaced (less than 2 mm)
    tx: short leg cast w/ strict non-wt bearing for 6-8 wks (may take longer)
  • all types (I-III) consider surgical fixation
  • run risk of nonunion (proximal area)
48
Q

Tx for plantar fasciatis?

A
  • stretching
49
Q

How will osteosarcoma present?

A
  • will be warm to the touch on palpation (high metabolism)
50
Q

MC benign bone tumor?

A
  • osteochondroma
51
Q

Axillary view of XR looks at what?

A
  • glenoid-humeral jt
52
Q

What is a buckle fx? MC in what pop?

A
  • MC in kids
  • forearm fx
  • compression fx on one side of bone to bend or buckle toward damaged side (stable fx)
53
Q

Nursemaid’s elbow?

A
  • child’s arm pulled = leads to subluxation of radial head, slips anteriorly out of annular ligament
  • usually under 4
  • present w/ extremity full pronated, flexed and held tightly to side
  • AP and lateral films usually done
  • tx: supinate and flex forearm and applly posteriorly directed pressure
54
Q

What is SCFE?

A
  • weakneing of epiphyseal plate of femur, resulting in displacement of femoral head, may be bilateral
  • typicall presents: 10-16yo
  • boys more than girls, obese, athletically inclined, african americans
  • most cases are idiopathic but in younger child consider metabolic cause (hypothyroidism, or hypopituitarism)
  • presentation: insidious hip, thigh, or knee pain assoc w/ painful limp
  • imaging: lateral xrays will show post and medial displacement of epiphysis, best assessed when in frog leg or lateral hip view
  • tx: pinning in situ is definitive
  • should be on crutches and non-wt bearing

Ortho (24 decks)

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