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Clinical Med I > MSK/Rheumatolgy - Radiology - Exam 3 > Flashcards

MSK/Rheumatolgy - Radiology - Exam 3 Flashcards

1
Q

What is the first line choice of imaging for all MSK complains?

A

Plain radiography (x-ray)

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2
Q

On a radiograph, what appears black and what appears white?

A

Black - air

White - bone

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3
Q

What are indications for radiography?

A

First line and usually order before advanced imaging
Fractures
Dislocations

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4
Q

What are radiograph contraindications?

A

Exclusively soft tissue injuries

Caution with excessive repeat images and unnecessary radiation

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5
Q

What are advantages for radiography?

A 
Readily available
Reproducible
Inexpensive 
Patient ease
Technical training not required
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6
Q

What are limitations for radiography?

A

Superimposed structures (3D data on a 2D image)
Radiation exposure
Low sensitivity for subtly fractures and soft tissue injuries

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7
Q

What imaging technique produces tomographic images to put data into sections to create a 3D image?

A

Computed Tomography (CT)

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8
Q

What are indications for a CT?

A 
Combined with contrast to image joints
Stereotactic frame (biopsies, surgical planning)
Angiography 
Small intraarticular fragments
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9
Q

What are CT limitations?

A 
Unnecessary imaging 
Significant metal in area to be imaged
Allergy to contrast dye
Pregnancy 
Claustrophobia
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10
Q

What are advantages to CT imaging?

A

Tomography
Best bone assessment modality
Higher contrast resolution (iodine based)

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11
Q

What are limitations to CT imaging?

A 
Artifacts (blurring from pt movement, beam hardening)
Limited use for soft tissue
Weight limitations, 300-400lbs
Cost (higher than X-ray lower than MRI)
Radiation exposure
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12
Q

How do you interpret a CT image?

A

R side of pt is on the L side of the screen
Axial images: looking from the pts feet toward the head
Coronal: patient is facing you
Sagittarius: looking from the side

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13
Q

What plane divides superior and inferior?

A

Axial

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14
Q

What plane divides anterior and posterior planes?

A

Coronal

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15
Q

What divides right and left planes?

A

Sagittal

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16
Q

What type of imagining utilized a strong magnetic field with radio frequency pluses and collects differences in tissue signal intensities?

A

Magnetic Resonance Imaging (MRI)

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17
Q

What are advantages to MRIs?

A

Superior contrast resolution
Ideal for soft tissue pathology while still good for bone pathology
Highly sensitive
Contrast compounds generally safer than CT contrast medium (gadolinium based)

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18
Q

What are MRI limitations?

A 
Magnetic field
Large shielded imaging site
Claustrophobia 
Expensive
One exam = one body part
Takes an average of 45min
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19
Q

What are indications for an MRI?

A

Intraarticular soft tissue structures
MR arthrography
Superior sensitivity in the diagnosis of early detection of bone marrow conditions, stress fractures, osteomyelitis, and malignancy
Problem solver tool instead of initial screening tool

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20
Q

What test has the most radiation?

A

CT

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21
Q

What test has the least radiation?

A

MRI and ultra sound

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22
Q

What are contraindications of MRIs?

A

Pacemakers
Mechanical pumps
Electronic stimulators
Metal products

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23
Q

What type of MRI is better for anatomical assessment? And how does it present?

A

T1

Fat is bright and typically fluid is dark (gadolinium)

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24
Q

What type of MRI is better for fluid assessment? And how does it present?

A

T2
Fat/fluid are both bright (adding fat saturation a,lows for fat to be dark)
Highlights soft tissue injuries

25
Q

What type of imaging transmits sound waves and detects reflected sound waves to produce a tomographic image?

A

Ultrasound

26
Q

What is echogenicity?

A

Frequency of sound waves
Low- cystic
High- solid mass

27
Q

What does a Doppler measure?

A

Motion

28
Q

What are advantages to ultrasound?

A 
Beneficial for soft tissues (tendons and muscles)
Low cost
No known harmful effects
Highly portable
Unossified epiphyses
29
Q

What are limitations to ultrasound?

A

Artifacts
Limited skills by provider
Minimal use in evaluating bone

30
Q

What are indications of ultrasound?

A

Common study of choice for infants
Soft tissue conditions
Guided assistance for joint injections, biopsies, soft tissue drainage

31
Q

What are contraindications of ultrasound?

A

None

32
Q

What is a bone scintigraphy?

A

Nuclear medicine imaging bone scan
IV injection of radioisotope bound to phosphate (tracer)
Imaging may be completed at different phases between 1min and 24 hours following injections
Tracer distributes in metabolically active bone at 2-4 hrs
Produces single or cross sectional projection

33
Q

What are advantages to bone scans?

A

Very sensitive for skeletal pathology
Negative = negative
Mildly sensitive for soft tissues

34
Q

What are limitations to bone scans?

A

Non specific
Lack detail
Lower sensitivity in early fractures with slow healing potential
Radiation exposure

35
Q

What are the 3 types of complete fractures?

A

Transverse
Oblique
Spiral

36
Q

What are the 3 types of incomplete fractures?

A

Greenstick
Torus
Bowing

37
Q

What is a comminuated fracture?

A

Fracture resulting in many bone pieces

38
Q

What is an avulsion fracture?

A

Injury to the bone where a tendon or ligament attaches

39
Q

What is an impact fracture?

A

Occurs when the broken ends of the bone are jammed together by the force of the injury

40
Q

What is a fissure fracture?

A

Only the outer layer of the bone is broken

41
Q

What is a greenstick fracture?

A

Fracture in which one side of the bone is broken and the other only bent (break doesn’t go all the way through)

42
Q

What is a torus fracture?

A

Occurs when a bone slightly crushes in on itself

43
Q

Why do pediatric fractures typically heal faster?

A

The periosteum covering the bones is more metabolically active, thicker, and more durable

44
Q

What are apophyseal injuries?

A

Fracture occurring in adolescents that separates the growth plate (apophysis) of a bone from the main osseous tissue at a point of strong tendinous or ligamentous attachment

45
Q

What is the Salter-Harris Classification system?

A

Severity classification of fractures involving the physeal (growth plate)

46
Q

What is a type I Salter-Harris fracture?

A

Physis only

least severe

47
Q

What is a type II Salter-Harris fracture?

A

Metaphysis and physis

48
Q

What is a type III Salter-Harris fracture?

A

Physis and epiphysis

49
Q

What is a type IV Salter-Harris fracture?

A

Metaphysis, physis, and epiphysis

50
Q

What is a type V Salter-Harris fracture?

A

Physis only; crushing injury

most severe

51
Q

What type of physis fracture is most common?

A

Type II (metaphysis and physis)

52
Q

Are are concerning features of bone tumors and lesions?

A 
Indistinct margins
Abnormal periosteal reaction
Soft tissue mass
Rapid growth
Pathologic fracture
53
Q

What are the 5 types of displacements?

A 
Translation
Angulation
Rotation
Shortening
Distraction
54
Q

What is a translation displacement?

A

Sideways motion of the fracture, usually described as a percentage of movement

55
Q

What is an angulation displacement?

A

The normal axis of the bone has been altered such that the distal portion of the bone points off in a different direction, usually measured in degrees

56
Q

What is a rotational displacement?

A

Rotation of the distal fracture fragment in relation to the proximal portion

57
Q

What is a shortening displacement?

A

Shortening is the amount a fracture is collapsed, measured in cm of overlap. Also called a bayonete apposition

58
Q

What is a distraction displacement?

A

Fracture resulting in increased bone length due to widening of the compartment between the broken bones (basically the opposite of an impaction/compression)

59
Q

What is an occult fracture?

A

Does not appear well on an X-ray “hidden”

Clinical Med I (24 decks)

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