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Radiology > Common Primary Complaints > Flashcards

Common Primary Complaints Flashcards

1
Q

When should you order imaging?

A
  • To confirm a suspicion
  • Should impact your treatment
  • Should include relevant and brief Pt Hx with purpose of evaluation*
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2
Q

Why should you not order imaging?

A
  • Should not be a “fishing expedition”

- Avoid imaging “just in case”

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3
Q

What are common issues within primary care for x-rays?

A
  • Acute foot pain
  • Acute ankle pain
  • Acute knee pain
  • Elbow pain
  • Wrist pain
  • Shoulder pain
  • Low back pain
  • Headache
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4
Q

When is an X-ray indicated for acute ankle series?

A

Ottowa Rules:
- Pain in the malleolar zone
- Bone tenderness at the posterior edge (6cm) at the medial/lateral malleolus
OR
- Inability to bear weight both immediately after injury and four steps in the evaluation room

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5
Q

The Pt can bear weight on their ankle/foot if:

A
  • If Pt can transfer weight twice to each foot

- If Pt can limp

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6
Q

When is an X-ray indicated for acute foot pain?

A

Ottowa Rules:
- Pain in the “midfoot” region
AND
- Bone tenderness at the base of the 5th metatarsal or navicular
OR
- Inability to bear weight both immediately after injury and four steps in the evaluation room

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7
Q

Considerations for stress fractures in association with acute foot pain?

A
  • X-rays may be normal initially
  • Bone scan can show abnormalities before X-ray
  • Consider CT or MRI
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8
Q

When is an X-ray indicated for acute knee pain?

A

Ottowa Rules:

  • Age >55
  • Isolated tenderness of patella (no other bony tenderness)
  • Tenderness at head of fibula
  • Inability to flex to 90
  • Inability to bear weight both immediately after injury and four steps in the evaluation room
  • *Ottowa knee rules are for bony injuries
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9
Q

When should you schedule additional imaging for knee injuries (non-bony)?

A
  • MRI is preferred if ligamentous injury suspected
  • Immobilize while awaiting further eval
  • If plain radiographs are negative and you still suspect bony fracture, consider CT
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10
Q

When is an X-ray indicated for shoulder pain?

A
  • Traumatic cause
  • Presence of pain
  • Loss of range of motion
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11
Q

What problems will you be able to identify on shoulder x-rays?

A
  • Fractures
  • Dislocations
  • Arthritis
  • Acromioclavicular (AC) or Sternoclavicular (SC) joint injuries
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12
Q

When is MRI preferred for shoulder pain?

A
  • Labral
  • Ligamentous
  • Rotator Cuff
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13
Q

When is an X-ray indicated for the hand?

A 
Depends on:
- Clinical assessment
- Suspected injuries
Based on:
- Physical exam
- MOI

Consultation with Radiologist is often helpful

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14
Q

X-ray views for suspected phalanx (hand)?

A
  • AP

- True Lateral

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15
Q

X-ray views for close to or involving joint (hand)?

A
  • Oblique
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16
Q

X-ray views for inability to delineate because of superimposed digits (i.e. base of proximal phalanx)?

A

Obtain radiograph of entire hand

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17
Q

All metacarpal fractures require what views?

A
  • AP
  • Lateral
  • Oblique
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18
Q

X-ray for suspected scaphoid fracture?

A

Scaphoid series

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19
Q

Hand fracture description to guide radiological exam and management?

A

Described radiologically by:

  • Location
  • Geometry
  • Whether commutation is present
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20
Q

How to describe fracture location for radiological exams of the hand?

A
  • Name broken bone and finger involved

then further anatomic details of exact location of fracture

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21
Q

Location descriptions for phalanges and metacarpals?

A
  • Head
  • Neck
  • Shaft
  • Base
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22
Q

Location descriptions for scaphoid fracture?

A
  • Tubercle
  • Waist
  • Proximal pole
  • Distal pole
23
Q

Tuft fractures refer to fractures involving what?

A

Head of the distal phalanx

24
Q

Intra-articular fractures refer to what?

A

Fractures involving the joint

25
Q

What views are obtained for a patient with chronic wrist pain?

A
  • PA
  • Oblique
  • Lateral
  • Ensure correct positioning for proper examination
26
Q

How is the wrist positioned for a PA view?

A

Wrist held in neutral with 0 degrees of rotation

- to evaluate relative lengths of radius/ulna

27
Q

How is the wrist positioned for a lateral view?

A
  • Wrist in 0 degrees of rotation

- Radial shaft and third metacarpal long axis collinear

28
Q

What do true lateral views of the wrist show?

A
  • Pisiform projected over the scaphoid tubercle

- A scapholunate angle >60 degrees suggests possible scapholunate instability

29
Q

What does an angle of <30 degrees suggest on wrist X-ray?

A

Ulnar- sided wrist instability

30
Q

What is a scaphoid view (wrist in ulnar deviation) used for?

A

Scaphoid fractures

31
Q

Clenched fist view is used for?

A

Check for scapholunate joint space widening seen with ligament disruptions

32
Q

Carpal tunnel view?

A

Carpal tunnel duh

33
Q

Osteoarthritis of the radiocarpal joint is characterized by?

A

Narrowing of the joint space and sclerosis of the articular surfaces

34
Q

What type of joint is the elbow?

A

Complex synovial joint formed by articulations of:

  • humerus
  • radius
  • ulna
35
Q

What are the three articulations of the elbow?

A
  • Radiohumeral
  • Ulnohumeral
  • Radioulnar
36
Q

What is Radiohumeral articulation?

A

Capitellum of humerus with radial head

37
Q

What is Ulnohumeral articulation?

A

Trochlea of the humerus with the trochlear notch of the ulna

38
Q

What is Radioulnar articulation?

A

Radial head with the radial notch of the ulna (proximal radioulnar joint)

39
Q

How can fractures of the elbow occur and what are the most common fractures?

A
  • When falling directly on the elbow or falling on outstretched arm/hand
  • Distal humerus or radial head
40
Q

How is the elbow view typically performed?

A
  • AP and Lateral projections
  • OBL can be done to visualize radial head
  • Coyle’s view for fracture not seen, but clinical suspicion present
41
Q

If a fracture cannot be identified, the presence of what should be treated as a fracture?

A
  • Joint effusion

- Treated as a non-displaced radial head fracture

42
Q

Elbow effusions are best seen on what projection?

A

Lateral projection where fluid in the joint capsule elevates the pericapsular fat

43
Q

How are dislocations of the elbow named?

A

For the direction of the radius and ulna dislocate relative to the humerus

44
Q

What is the most obvious soft tissue injury seen on elbow x-ray?

A

Biceps tendon tear

- as seen by obvious bulge of retracted muscle

45
Q

What is best for assessing tendons and ligaments of the elbow?

A

MRI (can see):

  • Ulnar collateral ligament (baseball pitchers)
  • Lateral Epicondylitis (tennis elbow)
46
Q

When is an X-ray not indicated for back pain?

A

Within 4-6 weeks

47
Q

What conditions must be present to obtain x-ray for back pain within 4-6 weeks?

A
  • Progressive neurological findings/cuada equina symptoms
  • Constitutional findings
  • Traumatic cause
  • Current/history of malignancy(cancer)
  • Elderly
  • Infectious risk (IV drug use, immunosuppression)
  • Chronic steroid use
  • Failed conservative management with signs of nerve root irritation
  • At risk for osteoporosis
48
Q

What are X-rays able to identify with back pain?

A

Helpful for fractures and joint degeneration

49
Q

When would you elect to perform CT for back pain?

A

Preferred for serious trauma

50
Q

What are considerations for MRI for back pain?

A
  • Imaging of choice for back pain with prior surgery
  • Suspected infection
  • Spinal cord injury
  • Tumor
  • Cord compression
51
Q

When do you consider imaging for Headache?

A
  • Associated with head/neck trauma
  • New, worse, or new features or abrupt onset
  • Focal neurological signs/symptoms
  • Thunderclap HA (sudden, severe)
  • HA radiating to neck
  • Persistent positional HA
  • Temporal HA >55
  • Suspect infection (associated with cough, exertion, sexual activity)
52
Q

When is CT preferred in association with HA?

A
  • Trauma
  • Rule out hemorrhage
  • Bone abnormalities
  • Prior to lumbar punctures
53
Q

When is MRI preferred in association with HA?

A

Soft tissue causes such as tumors or vascular

Radiology (4 decks)

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