Lower Limb Imaging

Question 1

When examining images in MSK, we use AABCSS, which 2 of the following are the As?

1 - A = adequacy
2 - A = autonomy
3 - A = alignment
4 - A = asymmetry

Answer 1

1 - A = adequacy
- cover area required, correct patient position

3 - A = alignment
- are bones aligned the correct way

Question 2

When examining images in MSK, we use AABCSS, what does the B stand for?

1 - B = bilateral symmetry
2 - B = bony landmarks included
3 - B = bones
4 - B = both limbs imaged

Answer 2

3 - B = bones
- draw around cortical bone looking for break
- look inside trabecular bone for tumours or breaks

Question 3

When examining images in MSK, we use AABCSS, what does the C stand for?

1 - C = cartilage or joint
2 - C = contrast
3 - C = complete image
4 - C = correct patient

Answer 3

1 - C = cartilage or joint
- narrowing of the joint
- aligned and even throughout

Question 4

When examining images in MSK, we use AABCSS, which 2 of the following do the SS stand for?

1 - S = superior and inferior views
2 - S = satisfaction of search
3 - S = swelling and oedema
4 - S = soft tissue

Answer 4

2 - S = satisfaction of search
- double check everything, even if there is a very obvious fracture

4 - S = soft tissue
- swellings
- tissue damage that indicate bone damage

Question 5

In the image below, is the left or right an child’s bone?

Answer 5

• right
• you can see the epiphyseal plate (growth plates)
• gaps may appear in bones, but this is cartilage that has not become bone yet

Question 6

Which of the following is the mnemonic used to identify joint changes on radiography in patients with osteoarthritis?

1 - LOAD
2 - LOSS
3 - LOSE
4 - LEAN

Answer 6

2 - LOSS

L = loss of joint space
O = osteophytes
S = subchondral sclerosis (thickening of the bone)
S = subchondral cyst

Question 7

If we were to image both knees of a patient with osteoarthritis, would we see loss of joint space bilaterally?

Answer 7

• unlikely to happen

Question 8

What is the most likely diagnosis of the image below?

1 - osteoarthritis
2 - RA
3 - gout
4 - SLE

Answer 8

3 - gout
- erosion of the joint
- swelling around the joint

Question 9

What is the most likely diagnosis of the image below?

1 - osteoarthritis
2 - osteomyelitis
3 - gout
4 - charcot foot

Answer 9

4 - charcot foot
- common in diabetes
- progressive degenerative/destructive joint disorder
- abnormal pain and proprioception
- deformity but no pain or raised temperature

Question 10

What is the most likely diagnosis of the image below, where the bone has been eroded away?

1 - osteoarthritis
2 - osteomyelitis
3 - gout
4 - charcot foot

Answer 10

2 - osteomyelitis
- common in diabetes and foot ulcers
- only seen after 10-14 days

Question 11

What is the most likely diagnosis of the image below?

1 - osteoarthritis
2 - osteomyelitis
3 - dislocation
4 - lytic bony metastases

Answer 11

4 - lytic bony metastases

Question 12

What is the most likely diagnosis of the image below?

1 - osteoarthritis
2 - osteomyelitis
3 - enchondroma
4 - lytic bony metastases

Answer 12

3 - enchondroma
- benign tumour from cartilage, no treatment needed
- typically found incidentally
- carpals, metacarpals or phalanges
- more prone to fracture

Question 13

Is the left or right image an adult image?

Answer 13

• right

Question 14

What type of fracture can we see in the image below?

1 - colles fracture
2 - greenstick fracture
3 - scaphoid fracture
4 - torus fracture

Answer 14

1 - colles fracture
- fracture of the distal forearm in which the broken end of the radius is bent backwards.

Question 15

What type of fracture can we see in the image below, that occurred following a fall on an outstretched hand (FOOSH)?

1 - colles fracture
2 - greenstick fracture
3 - scaphoid fracture
4 - torus fracture

Answer 15

3 - scaphoid fracture
- line across the scaphoid bone
- can press on snuffbox to elicit pain