Radiology of the Pelvis and Lower Limb

Question 1

What is ordered as an initial examination of the pelvis

Answer 1

flat upright film PA radiograph

Question 2

What skeletal landmarks should be recognized on a pa radiograph (10)

Answer 2

sacroiliac joints
sacrum
iliac wings
pubic symphysis
ASIS
AIIS
Obturator foramen
superior pubic rami
Inferior pubic rami
Ischium

SSSIIIAAPO

Question 3

What skeletal landmarks should be identified on CT (7)

Answer 3

sacroiliac joints 
sacral neural foramina
sacral wings
iliac wings
acetabulum
superior pubic rami
inferior pubic rami

AIISSSS

Question 4

What soft tissues structures should be identified on a CT scan of the pelvis

Answer 4

Urinary bladder
prostate/seminal vesicles in males
uterus in females

Question 5

what gives the rectum a bubbly appearance

Answer 5

presence of stool and as such small gas pockets

Question 6

What is the type of plane film used to visualize the uterine cavity and the uterine tubes

Answer 6

hysterosalpingograph

contrast introduced into vagina and uterus

Question 7

What would be used to evaluate the uterus for masses and congenital anatomic variations (bicornuate uterus affecting fertility)

Answer 7

MRI

Question 8

What would be used to asses the prostate gland in the setting of prostate cancer

Answer 8

MRI

Question 9

What would be used to image suspected ovarian or uterine pathology

Answer 9

Utrasound

Question 10

What would be used for obstetrical evaluation of the fetus

Answer 10

Ultrasound

Question 11

What imaging method would be used to visualize the testis

Answer 11

Ultrasound

Question 12

What is “the window” to visualize structure in pelvis with ulrasound and why

Answer 12

Urinary bladder

because sound travels well through liquid

Question 13

How are suspected ovarian masses best evaluated

Answer 13

ultrasound

Question 14

What can be placed near the uterus and ovaries allowing for better images

Answer 14

endovaginal ultrasound probes

Question 15

What are the typical views of the hip that are obtained

Answer 15

AP and “frog leg” lateral views

Question 16

What is the “frog leg” lateral view

Answer 16

frontal view obtained with leg abducted and externally rotated

Question 17

What does the “frog leg” lateral view allow for best visualization of

Answer 17

anatomic neck of proximal femur (common site of femur fractures)

Question 18

What is the relation of the posterior acetabular lip to the anterior acetabular lip on a frontal film and why

Answer 18

it is sloped so

posterior is seen inferior to anterior

Question 19

What three bones make up the acetabulum

Answer 19

illium
ischium
pubis

Question 20

What covers the femoral head

Answer 20

hyaline cartilage

Question 21

Where is the femoral head not covered by cartilage

Answer 21

fovea (site of ligament attachment)

Question 22

What is the best imaging for avascualr necrosis

Answer 22

MRI

Question 23

What is a frequent site of fracture especially in elderly

Answer 23

femoral neck

Question 24

What film has issues identifying femoral neck factures , what is used in addition then

Answer 24

plain films

MRI or CT is often perforemd

Question 25

What has the greatest sensitivity in iding nondisplaced femoral neck fractures

Answer 25

MRI

Question 26

What is the most common direction for femoral disslocation and what normally associates with it

Answer 26

Posterior Associated fracture of posterior acetabulum

Question 27

What actions usually cause posterior dislcoations of the femur

Answer 27

Motor vehicle accident (dashboard drives femur posteriorly)

Question 28

What actions usually cause anter dislcoations of the femur? how are anterior dislocations different from posterior

Answer 28

abduction and external rotation of the hip Not associated with fractures

Question 29

What are the typical views obtained of the knee

Answer 29

Lateral AP Tunnel Sunrise LATS

Question 30

What is the knee a frequent site of

Answer 30

fracture and ligamentous inury

Question 31

What can plain films reveal and not reveal about a knee

Answer 31

Can reveal prescence of fracture or effusion Cant: ligamentous and meniscal injury (due to radioleucency)

Question 32

What is the largest sesamoid bone in the body

Answer 32

Patella

Question 33

What does the patella articulate with

Answer 33

distal anterior femur at patellar groove

Question 34

How is the patella best assessed when using plain films

Answer 34

using lateral and sunrise views

Question 35

What is the main imaging for identifying ligamentous and meniscal injuries preoperatively

Answer 35

MRI

Question 36

What is the best imaging for diagnosing cruciate ligament tears

Answer 36

MRI

Question 37

What are the standard vies for the ankle

Answer 37

AP Lateral Oblique

Question 38

What should be observed onthe oblique view

Answer 38

entirety of ankle joint space should be symmetric

Question 39

What is a site of fequent fracture with ankle injuries and which view should be used to evaluate it

Answer 39

base of 5th metatarsal lateral view

Question 40

What bones are located directly inferior to the head of the 1st metatarsal

Answer 40

2 sesamoid bones

Question 41

What are 4 ways to nonivasively study the vessels of the pelvis and lower extremity

Answer 41

Doppler Ultrasound Nuclear medicine techniques Magnetic resonance Angiography (MRA)

Question 42

How is the arterial system generally studied

Answer 42

injection of radio opaque contrast directly into target vessels

Question 43

What is the point of entry for arteriograms Why?

Answer 43

femoral artery in femoral triangle can be readily accessed for catheterization and then pushed against the femur to induce clotting once the procedure is concluded

Question 44

When does the femoral bifurcate into the deep femoral (profunda)

Answer 44

2 inches beyond the inguinal ligament

Question 45

Which is the larger of the branches of the tibial artery? what does it give off

Answer 45

posterior tibial fibular

Question 46

What is the most frequent indication for studying veins

Answer 46

to determine presence of blood clots | venous thrombosis

Question 47

Why is accurate assessment of the venous system essential?

Answer 47

clots can break up and pass to the lungs with sometime fatal consequences

Question 48

What is the most common non invasive method for studying veins

Answer 48

Doppler ultrasound

Question 49

For which area is the doppler ultrasound effective

Answer 49

effective in studying the veins from the lower external iliac system down to the popliteal area some patients, the veins of the calf can also be seen

Question 50

Why are dopler studies often all that is required for clot adequate care assesment, even with their limited area of effectiveness?

Answer 50

clots arising from popliteal and femoral veins are much more prone to break off and pass to the lungs than those in the calf

Question 51

What are the superficial veins frequently used as

Answer 51

bypass vessels for coronaries and leg arteries