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year 2 > radiology lectures 2-4 > Flashcards

radiology lectures 2-4 Flashcards

1
Q

when to use MRI (4) vs CT (1)

A

CT- good for boney fragments & spatial resolution (fractures)

MRI
soft tissue tears/injury
occult fxs not picked up on xray/CT
edema/fluid
structural abnormalities
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2
Q

MRI sequences… how do we see fat and fluid in

T1 vs. T2 vs. STIR

A

T1- fat bright, fluid dark
T2- fat bright, fluid bright, can do fat saturation
STIR- fat dark, fluid bright

T2 & STIR are fluid sensitive => good for seeing edema

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3
Q 
standard views for:
 long bones
 joints
 shoulder
pelvis & hips
A

long bones: 2 orthogonal view; 90 degrees from eachother
AP/laterl (for arm, forearm, thigh, leg)

joints: 3 views; AP, lateral, oblique

shoulder: 3 views; AP, y-scap & axillary
AP in IR and ER

pelvis & hips: 2 AP & frog-leg lateral

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4
Q

how to read an x-ray (8)

A
  1. identify normal bones
  2. look for cortical continuity
  3. look at alignment
  4. look for any extra densities or lucencies w/i or outside bone
  5. look at soft tissue for swelling or joint effusion
  6. look at adjacent joints
  7. compare with prior studies
  8. if still concerned get CT or MRI
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5
Q

3 hand arcs

A

arc I = proximal surface of: scaphoid, lunate, triquetrium
arc II = distal surface of: scaphoid, lunate, triquetrium
arc III = proximal surface of: capitate & hamate

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6
Q

alignment of wrist/ hand in lateral view

A

radius, lunate, capitate & 3rd MC line up

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7
Q

various ways fx show up on x-ray (6)

A
  1. cortical discontinuity or deformity
  2. radiolucent fx lines
  3. abnormally white or dense areas = overlapping fragments
  4. extra or unexplained bone fragments
  5. soft tissue swelling or jt effusion
  6. callus formation in healing fxs
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8
Q

gamekeepers thumb
a.k.a.
what is it
complication

A

a.k.a. skiers thumb

diruption of UCL at 1st MCP joint (falling on outstretched hand with aBducted thumb

stener lesion-displacement; UCL can’t heal properly because aponeurosis blocks insertion

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9
Q

posterior fat pad sign
normal anatomy on radiograph (2)
sign (1)

A

normal anatomy:

  1. anterior fat pad is normally a faint line more radiolucent than adjacent muscles & runs parallel to distal humerus
  2. posterior fat pad is normally pressed deep into olecranon fossa by tricep tendons and is invisible

posterior fat pad sign:
elevated anterior lucency and/or visible posterior lucency at true lat radiograph of elbow flexed at 90 deg

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10
Q

hill scahs lesion
what is it/ when do we see it?
how do we best view it

bankart lesion
what is it/ when do we see it?

A

hill sachs

  1. flattening of supero-lateral (posteriolateral) aspect of humeral head seen after forceful anterior shoulder dislocation
  2. best seen on AP IR plain film

bankart
inferior/ anterior aspect of glenoid injured during anterior dislocation

these two are commonly seen together

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11
Q

posterior shoulder dislocation
biomechanics (2)
cause
dx

A
  1. humerus forced posteriorly and IR
  2. anterior humeral head isimpacting posterior glenoid
  3. usually caused by convulsions, rarely by trauma
  4. difficult to dx by radiograph and often mis-dx as frozen shoulder or adhesive capsulitis * get CT or MR
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12
Q

shoulder dislocation rates
anterior
posterior
luxatio

A

anterior- 95-97%
posterior- 2-4%
luxatio (inferior) - 0.5%

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13
Q

clinical findings for RC tears
signs (3)
symptoms (2)
dx

A

signs

  1. supraspinatus weakness
  2. ER weakness
  3. impingement

symptoms

  1. over >60 yo
  2. night pain

if all 3 signs are positive or 2/3 and pt > 60; chance of tear is 98%

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14
Q 
RC cuff tears
 most commonly affected
 where they begin
 full length extend to...
 subscap affects...
A
  1. supraspin is primarily involved in most instances
  2. tears usually begin at site of insertion
  3. tears can extend posteriorly to infraspin & teres minor
  4. subscap tendon may have isolated tear & associated with dislocation of bicep tendon
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15
Q

what is subscap tendon tear associated with?
anatomy
which location

A

dislocation of bicep tendon (usually medially)

subscap tendon continues across bicipital groove as transverse humeral ligament which helps stabilize bicep tendon.

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16
Q

radiographic findings of RC tears (3)

look at slides

A
  1. high riding humerus
  2. faceting & sclerosis in inferolateral acromion & superior aspect of greater tuberosity
  3. secondary osteophytes in GH joint to maintain joint congruity
17
Q

full thickness tears of supraspinatus (4)

A
  1. fully extend from bursal to articular surface
  2. nonvisualization of tendon
  3. fluid in expected location of tendon
  4. measure AP width
18
Q 
calcific tendinosis
 most common place
 what we see on radiograph
 symptoms
 radiograph we need to find it
 tx
A
  1. most comon in supraspin tendon
  2. tendon is thickened and heterogenous w/o discrete defects
  3. subclinical -> painful
  4. can be seen as low signal intensity on all MR sequences
  5. treated by saline lavage
19
Q 
infection
 looking for... laundry list
 when its the joint its called...
 when its the bone its called...
 how to look for it (radiologic testing)
A

looking for… soft tissue swelling, ulcers, subcutaneous air, skin thickening, cellulitis, abscess, fistulas

joint => septic arthritis
bone => osteomyelitis

MRI is most sensitive to edema or do nuclear bone scan

20
Q

approach to arthritis (ABCDES)

A 
a= alignment
b= bone mineralization
c= cartilage loss
d= distribution
e= erosions?
s= soft tissue masses
21
Q

classifications of arthritis (3)

A
  1. OA; primary or secondary
  2. RA
  3. crystal; gout
22
Q

degenerative arthritis
aka
radiologic findings
where do we commonly see DJD? where do we rarely see DJD?
does if affect more prox or distal in hands?

A

aka- OA

radiologic findings

  1. loss of articular cartilage
  2. joint space narrowing
  3. osteophyte formation
  4. sclerosis
  5. subchondral cysts

occurs in WB joints (hips knees), rarely in hands or shoulders

generally more distal in hands (than RA which is proximal)

23
Q 
RA
 what is it
 characterized by...
 what type of inflammation
 does it affect prox or distal more?
A
  1. chronic autoimmune inflammatory disease
  2. characterized by joint swelling, pain and destruction
  3. synovial inflammation - synovium becomes thickened and causes erosion in bones
  4. affects hands more proximally (vs. OA which is distal)
24
Q

criteria for being dx with RA (4)

score needed

A
  1. based on # of jts
  2. blood tests for rheumatoid factor
  3. acute phase reactants (CPR &ESR)
  4. duration of symptoms

score 6/10 => dx

25
Q

RA radiographic findings (5)

A
  1. soft tissue swelling
  2. osteoporosis
  3. joint space narrowing
  4. marginal erosions
  5. in hands; bilateral, proximal process
27
Q

GOUT radiolgraphic features (4)

A
  1. eccentric soft tissue swelling (TOPHI)
  2. erosions with overhanging edges (reactive bone around tophus)
  3. jt space preserved
  4. erosions can be far away from joint
28
Q

bisphosphonate-related atypical femoral fx
pathophysiology (2)
radiologic signs (3)

A
  1. med that inhibits bone resorption by supressing osteoclasts => increased bone mineral density
  2. this suppresses bone turnover & remodeling & healing of microinjury

radiologic signs

  1. lateral cortical thickening (transverse fx)
  2. lack of comminution
  3. medial femoral spike; sharp medial cortical projection, typically arising from distal femoral fragment
29
Q 
muscle attachments on pelvis
 iliac crest
 ASIS (2)
 AIIS 
 greater trochanter
 lesser trochanter
 ischial tuberosity
 body of pubis & inferior pubic ramus
A 
iliac crest- abs
 ASIS (2)- sartorius & TFL
 AIIS - rec fem
 greater trochanter - ERs
 lesser trochanter - iliopsosas
 ischial tuberosity- hamstrings
 body of pubis & inferior pubic ramus- adductors, gracilis
30
Q 
stress fx
 class appearance
 2 types
A

classic appearance = condensation of cancellous bone - perpendicular to long axis

2 types:
fatigue= normal bone, abnormal stress
insufficiency = abnormal bone, normal stress

31
Q

femoral neck stress fx
who it affects most
why its important
imaging

A
  1. commonly occurs in runners and military trainees
  2. blood supply to femoral head runs thru femoral neck => AVN of head
  3. need MRI or bone scan
32
Q

hip fx precautions

A

if there is a hx of trauma & high clinical concern for fx keep pt NWB until MRI (even if xray is negative)

34
Q 
GOUT
 what it is
 primary gout
 secondary
 acute
 chronic 
 places it commonly affects
A

due to hyperuricemia =>deposition of monosodium urate crystals

primary gout = inborn error of metabolism

secondary gout = disorders affecting urate metabolism (eg alcoholism)

acute= swelling and pain mimicking septic arthritis

chronic = tophi erode into bone, resulting in bony changes

places it commonly affects= 1st MTP jt =90%
olecranon bursitis

year 2 (24 decks)

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