Radiology

Question 1

What is the average width of small bowel?

Answer 1

<3cm

Question 2

What is the average width of large bowel?

Answer 2

<6cm

Question 3

What might thumb printing indicate on an abdo x-ray?

Answer 3

Inflammation
Crohn disease
ulcerative colitis
pseudomembranous colitis
ischaemic colitis

Question 4

In which condition may you see a lead pipe colon?

Answer 4

UC

Question 5

What is a complication of UC which is very obvious on an abdo x-ray?

Answer 5

Toxic megacolon

Question 6

Which 3 places do kidney stones normally get stuck?

Answer 6

Pelvic ureteric junction, pelvic brim at iliac vessel crossing and vesico ureteric junction

Question 7

What might an apple core stricture indicate on xray?

Answer 7

Obstruction, cancer, diverticular disease and IBD

Question 8

What do you see on a lumbar spine xray of a patient with ank spond?

Answer 8

Syndesmophyes- bony growth originating inside a ligament.

Question 9

If you seen air fluid levels in bowel on an abdo xray, what is it?

Answer 9

SBO

Question 10

Causes of SBO?

Answer 10

Indirect inguinal hernias (most common type of hernia), adhesions (most common cause). Gall stone ileus, chrons causing strictures, intussception from a meckels/ileus.

Question 11

Analgesia in SBO?

Answer 11

Opioids- morphine

Question 12

What is cushings sign?

Answer 12

Bradycardia + HTN + reducing GCS

Question 13

What to do if you spot cushings sign?

Answer 13

Sit patient up, O2, IV dex and Mannitol.

Question 14

What is a pathological fracture?

Answer 14

A stress fracture through an abnormal bone (usually the edges aren’t ragged like in a traumatic fracture.
Think about pathological fractures when an atypical fracture occurs in a bone.

Question 15

What are the causes of pathological fractures?

Answer 15

Malignancy ( most common)

Metabolic bone disease/infection also cause but less commonly

Question 16

What is the difference between stress fractures and pathological fractures?

Answer 16

Stress fractures occur in otherwise normal bone but are just due to a repeated force rather than a sudden one like in a traumatic fracture.

Question 17

How might you recognise a stress fracture?

Answer 17

These occur in gymnasts over time, and there will be chronic periosteal reaction (new bone growth/it looks like white and fluffy) around where the fracture is.

Question 18

Example

Answer 18

A transverse fracture of the distal tibia with lateral periosteal reaction.

Question 19

What is the classification used for knee OA?

Answer 19

Ahlbock classification system
Grades according to degree of joint space narrowing and bone attrition (the process of reducing something’s strength or effectiveness through sustained attack or pressure)

Question 20

How is the loss of joint space usually in OA?

Answer 20

It is usually uneven due to the nature of destruction. So mention where you see increased narrowing when describing a radiograph.

Question 21

Where does the auto-inflammation primarily target in seropositive arthritis (aka rheumatoid)?

Answer 21

The synovium

Question 22

Where does the auto-inflammation primarily target in seronegative arthritis?

Answer 22

The enthesis- where the capsule, ligaments & tendon attach to the bone.

Question 23

What can you see on plain film in inflammatory arthritis?

Answer 23

Soft tissue swelling due to synovial hyperplasia.
Also bone erosion + osteopenic change adjacent to the eroded joint (increase in osteoclast activity).
If RA continues to progress, subluxation of the joint may occur.

Question 24

Hallmarks of inflammatory arthritis?

Answer 24

Joint swelling, bone erosions, periarticular osteoporosis & subluxations.

Question 25

Radiological differences between RA and OA?

Answer 25

OA- sub chondral sclerosis, so there are more areas of dense whitening below the joint space.
RA- the loss if joint space is symmetrical in contrast to OA where it is asymmetrical.

Question 26

Other features in RA?

Answer 26

Tenosynovitis & tendon formation

Question 27

What is the most common pulmonary manifestation of RA?

Answer 27

Pleural thickening

You also get reticular shadowing

Question 28

When do you see bone erosions? (OA or RA)

Answer 28

RA

Question 29

When do you see osteoporosis ?(OA or RA)

Answer 29

RA

Question 30

What is reactive arthritis?

Answer 30

This is an autoimmune response to a reaction somewhere else in the body- classic triad of non-gonococcal urethritis, asymmetrical oligoarthritis and conjunctivitis

Question 31

Inspection of a sacro-iliac joint in AS

Answer 31

More ill-defined when compared to the other joint Narrowed joint space
Irregular cortex
Bone erosion in upper ilium
Sclerosis around the joint surfaces of both bones

Question 32

Cod-fish spine on X-ray?

Answer 32

This indicates osteoporosis, most common in post-meopausal women. Next request a DEX scan and start patient on bisphosphonate- remember to take sat up at least 30 minutes before food. Also encourage patients to have a dental check before and they will be on these tablets for at least 5 years.

Question 33

HLA B27 associations?

Answer 33

AS, Psoriasis, reiters, IBD, uveitis

Question 34

Causes of cavitating lesions in lungs?

Answer 34

Carcinoma (SCC)
Autoimmune (lupus, RA)
Vascular (PE)
Infection (TB, Klebsiella, staph aureus)
Trauma