MSK radiology

Question 1

What are the 4 patterns of arthritis?

Answer 1

Degenerative, inflammatory, depositional, infection

Question 2

What are some characteristic features of degenerative arthritis?

Answer 2

• loss of articular cartilage in the joint space in an irregular fashion
• subchondral sclerosis
• osteophyte at joint margins
• subchondral cysts

Question 3

Where does OA typically affect?

Answer 3

the hip, the knee, the first metacarpal joint of the thumb, DIP

Question 4

What are some hallmarks of inflammatory arthritis?

Answer 4

1.inflammation of synovium or pannus formation
2.focal osteoporosis
3.Erosions at margins of joint and then articular cartilage 4.loss
5.subluxation and deformity
Occurs at the wrist, MCP, PIP, MTP, IP in feet

Question 5

What might you find on X-ray in a person who has had many episodes of gout?

Answer 5

periarticular erosions at the margins of joints, or calcific deposits in soft tissues (tophi)

Question 6

When do X-rays changes become apparent in septic arthritis?

Answer 6

2-3 weeks after onset of clinical symptoms

Question 7

What are benign features of a bone lesion?

Answer 7

well defined border, sclerotic border, linear periosteal patten, stable over time, absent soft tissue mass

Question 8

What some malignant features of a bone lesion?

Answer 8

ill defined border, cortical destruction, sunburst/codman triangle periosteum. Presence of soft tissue mass. Increase in size over time

Question 9

what are the rule of 2s for MSK fractures?

Answer 9

2 views, 2 joints, 2 times

Question 10

what sort of things are you looking for on imaging for RA?

Answer 10

erosions, periarticular osteopenia, synovitis (seen on MRI). loss of joint space

Question 11

19 year old woman in MVA. Midline rear passenger wearing seat belt. What injuries is she susceptible of?

Answer 11

(proximal) Bowel injury- bowel ischaemia can result
Liver injury, pancreas injury
Fracture of the spine

Question 12

what do you think if you saw a widened mediastinum on CXR for a MVA trauma patient?

Answer 12

aortic rupture

Question 13

what is the look on a lateral X-ray of a colles fracture?

Answer 13

dinner fork deformity. Distal radial fracture

Question 14

what sort of fractures do we commonly with anterior shoulder dislocations?

Answer 14

Hill-Sachs lesions are a posterolateral humeral head compression fracture, typically secondary to recurrent anterior shoulder dislocations, as the humeral head comes to rest against the anteroinferior part of the glenoid.

Question 15

what are some radiological characteristics of septic arthritis?

Answer 15

Demineralisation and rapid articular cartilage loss is diagnostic of untreated septic arthritis

Question 16

what do we worry about for subcapitalar neck of femur fractures?

Answer 16

avascular necrosis due to disruption of the retinacular arteries

Question 17

how can we classify neck of femur fractures?

Answer 17

subcapitular or intratrochanteric

Question 18

what are some features of pagets disease on X-ray?

Answer 18

Paget’s disease of the bone

• lytic lesions and sclerotic lesions
• disorganised trabeculae
• expanded bone
• bowed legs

Question 19

tell me about stress fractures and X-rays?

Answer 19

stress fracture due to repetitive abnormal stresses on normal bones
- usually see the healing response on X-ray (e.g. formation of new callus)

Question 20

what imaging do we use to look at marrow oedema?

Answer 20

STIR- T2 weighted MRI with fat suppression

Question 21

what sorts of fracture classification do we have for ankle fractures?

Answer 21

Webers classification:
A- fracture is below the syndesmosis
B- at the level of the syndesmosis
C- syndesmosis is disrupted.

Question 22

4 features of OA on X-ray?

Answer 22

osteophytes
subchondral sclerosis
subchondral cysts
reduced joint space

Question 23

signs of RA on Xray?

Answer 23

periarticular erosions usually PIP, soft tissue swelling, loss of joint space, deformity

Question 24

D’s for Charcott’s foot?

Answer 24

Debris
destruction
dislocation
deformity

Question 25

what can cause diffuse osteopenia

Answer 25

renal osteodystrophy
osteomalacia
myeloma

Question 26

Paget’s disease of the bone characteristics on XRAY?

Answer 26

bowing deformity, trabeculae loss, hyper expansion (osseous expansion)

Question 27

Complications of paget’s disease of the bone

Answer 27

osteosarcoma
cranial neuropathies
pathological fracture
malignant fibrosarcoma
high output cardiac failure

Question 28

What other bones can paget’s affect?

Answer 28

tibia, skull, pelvis

Question 29

What sort of tumour is often found in the finger?

Answer 29

enchondroma (lytic lesion of the bone)

Question 30

what are the cancers that metastasise to the bone?

Answer 30

1. breast
2. prostate
3. lung
4. thyroid

Question 31

what is the mercedes benz sign?

Answer 31

sign on Lateral shoulder X-ray to look for anterior or posterior shoulder dislocation

Question 32

what is the drumstick sign?

Answer 32

indicates internal rotation of the humeral head of the shoulder joint. Seen on a AP projection

Question 33

features of psoriatic arthritis on X-ray?

Answer 33

The hallmark of PsA is the combination of erosive change with bone proliferation, in a predominantly distal distribution (i.e. interphalangeal more than MCP joints). The disease most commonly involves the hands, followed by feet. It can also affect sacroiliac joints and spine.