when to order imaging

Question 1

True/False

In general, imaging should confirm a suspicion.

Answer 1

True

Question 2

Good or bad consult

18 year old male with cough, please advise

Answer 2

Bad

Question 3

Good or bad consult
18 year old male non-smoker with fever, cough, dullness to percussion at left lower lobe, course crackles. Please evaluate for pneumonia.

Answer 3

Good

Question 4

Ottawa Rules ankle

Answer 4

Ankle series is indicated if:
(a) Has pain in the “malleolar” zone AND
(b) Has bone tenderness at the posterior edge (6cm) of the lateral or medial malleolus
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.
1) If the patient can transfer weight twice to each foot, the patient can bear weight.
2) If the patient limps, the patient can bear weight.

Question 5

under Ottawa rules should you order an Xray for a limping patient

Answer 5

If the patient limps, the patient can bear weight.

Question 6

Xray yes or no

Inability to bear weight both immediately after the injury and for four steps in the evaluation room.

Answer 6

YES

Question 7

Ankle series is indicated if

Answer 7

(a) Has pain in the “malleolar” zone AND
(b) Has bone tenderness at the posterior edge (6cm) of the lateral or medial malleolus
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.

Question 8

True/false

the patient can transfer weight twice to each foot, the patient can’t bear weight

Answer 8

False

the patient can bear weight

Question 9

Foot series is indicated if:

Answer 9

(a) Has pain in the “midfoot” region
AND
(b) Has bone tenderness at the base of the 5th metatarsal or the navicular
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.

Question 10

For suspicion of stress fractures if X-rays are normal initially

Answer 10

Bone scan can show abnormalities before X-ray findings

Consider CT or MRI

Question 10

If plain radiographs are negative and you still suspect bony fracture what should you do?

Answer 10

Consider CT

Question 11

Knee series is indicated if:

Answer 11

(a) Age >55 year old
(b) Isolated tenderness of the patella (with no other bony tenderness to the knee).
(c) Tenderness at the head of the fibula.
(d) Inability to flex the knee to 90 degrees.
(e) Inability to bear weight both immediately after the injury and for four steps in the evaluation room (limping is allowed).

Question 12

If you suspect ligamentous injury, what is the preferred imaging

Answer 12

MRI

Question 13

True/False

You should Immobilize a knee while awaiting further evaluation

Answer 13

True

Question 13

When is shoulder imaging warranted?

Answer 13

1) Traumatic cause
(2) Presence of pain
(3) Loss of range of motion

Question 14

Shoulder plain films will be able to identify what?

Answer 14

Fractures
Dislocations
Arthritis
Acromioclavicular (AC) joint or 
Sternoclavicular (SC) joint injuries.

Question 15

Shoulder

What is preferred for labral, ligamentous or rotator cuff injuries?

Answer 15

MRI

Question 16

True/ False
A radiograph of the injured part of the hand should be obtained. The type of radiograph depends on the clinical assessment and suspected injuries, based on the physical examination and mechanism of injury. Consultation with a radiologist is often helpful.

Answer 16

True

Question 17

If a fracture of the phalanx is suspected, an anteroposterior (AP) and true lateral views are obtained of what?

Answer 17

The individual digit

Question 18

When the fracture involves or is close to the joint, what view is helpful?

Answer 18

Oblique view

Question 19

Finger Xray
If the fracture cannot be delineated because of superimposed digits, such as the base of the proximal phalanx what is done?

Answer 19

radiograph of the entire hand must be obtained

Question 20

All metacarpal fractures require what views?

Answer 20

AP, lateral, and oblique views

Question 21

A suspected scaphoid fracture should be evaluated with a ______

Answer 21

scaphoid series…………………………

Question 22

True/False

Special views may be required for assessment of specific injuries.

Answer 22

True

Question 23

Intra-articular fractures refer to fractures involving what?

Answer 23

the joint

Question 24

Tuft fractures refer specifically to fractures involving what?

Answer 24

head of the distal phalanx.

Question 25

True lateral views show the pisiform projected over the scaphoid tubercle.
scapholunate angle greater than 60 degrees suggests _________________
An angle of less than 30 degrees suggests __________

Answer 25

• A scapholunate angle greater than 60 degrees suggests possible scapholunate instability.
• An angle of less than 30 degrees suggests ulnar-sided wrist instability.

Question 26

In the PA wrist view, the wrist is held in neutral, with _____ of rotation to evaluate the relative lengths of the radius and ulna.

Answer 26

0 degrees

Question 27

Scaphoid view (wrist in ulnar deviation) to check for _____

Answer 27

scaphoid fractures……………..

Question 28

Clenched fist view to check for ___________ seen with ligament disruptions.

Answer 28

scapholunate joint space widening

Question 29

_______ view is used to check for hook of the hamate fractures.

Answer 29

Hook view….

Question 30

_____________________ of the radiocarpal joint is characterized by narrowing of the joint space and sclerosis of the articular surfaces.

Answer 30

Osteoarthritis

Question 31

Imaging is not indicated in the first 4-6 weeks unless back pain is present with:

Answer 31

(a) Progressive neurological findings or cauda equina symptoms
(b) Constitutional findings (fever, weight loss)
(c) Traumatic cause
(d) Current or history of malignancy
(e) Elderly
(f) Infectious risk (IV drug use, immunosuppression)
(g) Chronic steroid use
(h) Failed conservative management with signs of nerve root irritation
(i) At risk for osteoporosis

Question 32

For back pain
______ is helpful for fractures or joint degeneration
______ is preferred for serious trauma
______ is imaging of choice for back pain with prior surgery, suspected infection, spinal cord injury, tumor, or cord compression.

Answer 32

1. X-ray
2. CT
3. MRI

Question 33

headache

____ is preferred for trauma, to rule out hemorrhage, bone abnormalities, or prior to lumbar punctures.

Answer 33

CT

Question 34

For headache

____ is preferred for soft tissue causes such as tumors, or vascular.

Answer 34

MRI

Question 35

For a headache with one or more of these issues what should you consider?

(a) Associated with head/neck trauma
(b) New, worse or new features, or abrupt onset headache
(c) Focal neurologic signs or symptoms
(d) Thunderclap headache (sudden, severe)
(e) Headache radiating to the neck
(f) Persistent positional headache
(g) Temporal headache in older than 55 years of age
(h) Suspect infection
1) Associated with cough, exertion, or sexual activity

Answer 35

imaging…..