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Year 2 - Musculoskeletal (DP) > Radiology > Flashcards

Radiology Flashcards

1
Q

In a spinal x-ray what can we see?

A

Bony outlines

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2
Q

What do spinal CT scans allow us to see?

A

Bony outlines in more detail

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3
Q

What do spinal MRI scans allow us to see?

A

Soft tissue structures:

 - Bone marrow
 - Discs
 - Ligaments
 - Spinal cord and nerves
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4
Q

What lies inferior to the pedicle of a vertebra?

A

Neural/Intervertebral foramen

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5
Q

When do we use a spinal CT?

A 
If x-ray shows fracture but:
     - More detail needed
     - Any more fractures suspected
If x-ray normal but:
     - High clinical suspicion of fracture
               > High impact
               > Neurological symptoms
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6
Q

What does abnormal vertebral alignment on x-ray or CT suggest?

A

Ligament damage -> Unstable spine

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7
Q

How do ligaments appear on MRI?

A

Normal - Black

Damaged - Light (White)

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8
Q

When is a spinal MRI used?

A

If neurological deficit is not explained by x-ray/CT:

 - Acute prolapsed IV disc
 - Epidural haematoma
 - Spinal cord injury
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9
Q

What features of bony tumours can be seen on spinal c-ray and CT?

A

Bone destruction -> Reduced density -> Dark spots
Vertebral collapse
Bone sclerosis -> Increased density

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10
Q

What MRI findings may indicate a spinal bony tumour?

A 
Early:
     - Bone marrow inflitrate
Late:
     - Extradural mass
     - Spinal cord compression
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11
Q

What are some causes of spinal cord disease?

A

Trauma
Demyelination
Tumour
Ischaemia

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12
Q

What causes the loss of joint space in osteoarthritis?

A

Asymmetric cartilage wear -> Space reduction

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13
Q

What causes subchondral sclerosis in OA?

A

Increased bone cellularity and vascularity

Excitation of bone turnover

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14
Q

What causes subchondral cysts in OA?

A

Synovial fluid dissecting into bone

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15
Q

What causes osteophyte formation in OA?

A

Periosteal stimulation

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16
Q

What x-ray feature of OA may not be visible in a spinal x-ray and why?

A

Cysts

No synovial fluid -> Fibrocartilage

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17
Q

What causes soft tissue swelling in RA?

A

Synovial proliferation

Reactive joint effusion

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18
Q

What causes periarticular osteopaenia in RA?

A

Hyperaemia leading to bone demineralisation

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19
Q

What results in periarticular erosions in RA?

A

Inflammatory pannus:

- Inflamed, thickened synovium

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20
Q

Why do joints sublux and deform in RA?

A

Capsular and ligamentous softening due to inflammation

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21
Q

How do the sacro-iliac joints appear on x-ray?

A

Uniform lucencies

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22
Q

What are radiographic features of seronegative arthritidies?

A

Sacro-iliac and spine involvement:
- Syndesmophyte formation
Ill-defined periarticular bone formation
Joint ankylosis

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23
Q

What is an isotope bone scan used for?

A

To look for increased vascularity around joints, such as in RA

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24
Q

What other scan can show synovium thickening and increased blood flow in a RA joint?

A

Colour Doppler USS

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25
Q

What MRI feature of RA often precedes significant joint damage?

A

Periarticular bone marrow oedema

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26
Q

How can we guide x-ray interpretation?

A 
Injury mechanism:
     - High/Low velocity
     - Impaction/Rotation/Distraction
Site of bone tenderness
Deformity
Patient age
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27
Q

In what bones are more than two x-ray views required?

A 
Cervical spine:
     - AP
     - Lateral
     - Odontoid peg view
Scaphoid:
     - AP
     - Lateral
     - Two oblique views
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28
Q

How can a fracture appear on x-ray?

A 
Lucency
Cortical expasion
Spiral/Transverse
Comminution
Joint involvement
Angulation
Displacement
Impaction
Avulsion
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29
Q

How do avulsion fracture fragments appear?

A

Incompletely corticated:

- ie. Cortex doesn’t completely surround it

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30
Q

What bony entities may mimic an avulsion fracture?

A

Sesamoid bones:
- Bone embedded in ligament/tendon (eg Patella)
Accessory ossification centres
Old non-united fracture

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31
Q

What fat pad is normally seen on an elbow x-ray and how does it appear?

A

Anterior:
- Anterior to distal humerus
Darker region

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32
Q

What causes the posterior fat pad sign and is it always abnormal?

A

Elbow effusion -> Displacement of fat pad

Yes

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33
Q

What type of fractures are seen in children?

A 
Bending/Bowing fractures:
     - Buckle fracture
     - Plastic bowing
Incomplete fractures:
     - Greenstick fracture
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34
Q

How does a growth plate appear on x-ray?

A

Lucency between epiphysis and metaphysis

35
Q

What features suggest a non-accidental injury?

A 
Tiny baby:
     - Not moving around yet
Fractures of different ages:
     - Suggest multiple injuries
Distal femoral fractures:
     - Suggests twisting force
36
Q

Bulging of the bony cortex is a feature of what type of fracture and what people is it seen in?

A

Buckle fracture

Children

37
Q

What foreign bodies may be invisible on x-ray?

A

Wood

Plastic

38
Q

When should we suspect a pathological fracture?

A

Bone abnormality out of proportion to injury mechanism

39
Q

When would skeletal weakening be:

  1. Focal?
  2. Diffuse?
A
  1. Metastatic deposit

2. Osteoporosis

40
Q

An elderly woman has fallen onto her outstretched hand. She is known to have osteoporosis. On x-ray you see a distal radius fracture that is dorsally angulated. There is an associated ulnar styloid fracture

A

Colles fracture

41
Q

A 4 year old girl presents to A&E having fallen off the swing onto an outstretched hand. On x-ray there is cortical expansion of her distal radius. You note a lucency between the metaphysis and epiphysis of her radius and there are only 4 carpal bones.

A 
Radial buckle fractire
Lucency:
     - Growth plate
4 carpal bones:
     - Other 4 haven't ossified yet
42
Q

An 11 year old boy presents after falling onto an outstretched hand while playing football. On palpation there is tenderness over the anatomical snuff box.

A

Scaphoid fracture

43
Q

A 53 year old woman has fallen onto an outstretched hand. She has noticed some shoulder pain and is finding it difficult to move her shoulder, not because of pain but because it feels weak.

A

Surgical neck of humerus fracture:
- Often comminuted
This patient’s fracture has also damaged the axillary nerve:
- Deltoid and teres minor weakness
- Weak shoulder abduction and flexion/extension

44
Q

How can we see a posterior shoulder dislocation on x-ray?

A

Obtain an oblique view:

- Humeral head will lie posterior to glenoid

45
Q

What is a complication of a supracondylar fracture?

A

Brachial artery damage

Malunion -> Lifelong disability

46
Q

What are some complications of a scaphoid fracture and how do these occur?

A

Non-union
AVN
Both leading to early OA
Due to retrograde blood supply being disrupted

47
Q

What is a Bennett’s fracture?

A

Fracture of the articular surface of the first metacarpal base

48
Q

What can a Bennett’s fracture result in if not treated?

A

Tendons pull thumb distal to fracture:

 - Displacement
 - Deformity -> Dysfunction -> Early OA
49
Q

What can immobility due to lower limb injury result in?

A

Dehydration
DVT/PE
Pneumonia

50
Q

What are ultrasound scans good for imaging?

A

Tendons

51
Q

Where are typical locations of impacted lower limb fractures?

A

Femoral neck
Tibial plateau
Calcaneus

52
Q

What tends to cause a pelvic ring fracture?

A

High energy incidents:

 - RTA
 - Fall from height
53
Q

True or false; Pelvic ring fractures usually only involve one single fracture?

A 
False
Bony ring disruption usually involves 2 or more sites:
     - Bones
     - Pubic symphysis
     - SIJs
54
Q

What is the primary imaging modality for polytrauma patients?

A

CT

55
Q

What patients can be seen with low energy pelvic ring fractures?

A

Elderly patients with osteoporosis:
- Minor falls
Often affecting sacrum and pubic rami

56
Q

What is the imaging modality of choice in a suspected low energy pelvis fracture?

A

MRI

57
Q

What injury mechanisms tend to result in hip dislocations?

A

RTA

Contact sports were hip is flexed

58
Q

What features are typically present in a hip dislocation?

A

Posterior

Acetabular rim fracture

59
Q

What can intra-capsular hip fractures interfere with and cause?

A

Blood supply to femoral head:

 - AVN
 - Non-union
60
Q

How do we treat an intra-capsular fracture?

A

Hip hemiarthroplasty
If undisplaced/young patient:
- Reduction and screw fixation

61
Q

How do we treat an extra-capsular fracture?

A

Internal fixation with DHS

62
Q

If an undisplaced proximal femoral fracture is suspected but there is no x-ray evidence what should be done?

A

Repeat x-ray 10 days later
OR
Immediate MRI

63
Q

What can small avulsed bone fragments on a knee x-ray suggest?

A

Significant soft tissue injury

64
Q

How can we examine the soft tissue knee structures on knee x-ray and what will we be able to see?

A

Lateral view:

 - Patellar and quadriceps tendon
 - Suprapatellar fat space
65
Q

What may be seen on an x-ray if there is significant soft tissue injury to the knee?

A

Effusion in the suprapatellar space

66
Q

What are the standard trauma x-rays of the knee?

A 
AP
Lateral to show these in suprapatellar recess:
     - Lipohaemarthrosis
     - Blood
     - Fat
67
Q

What must we check for in an x-ray of a dislocated knee?

A

Bony alignment

68
Q

What injury mechanism often results in a tibial plateau fracture? What part of the plateau is often most affected?

A

Valgus force with foot planted:
- ‘Bumper’ injury
Lateral condyle (80%)

69
Q

How do we guide treatment of a tibial plateau fracture?

A

Area on condylar involvement
Depth of depression
(shown on CT)

70
Q

What imaging modality can identify extensor mechanism injuries?

A

USS

71
Q

What injuries can an MRI of the knee show?

A

Meniscal tears
Ligamentous injurys (LCL/MCL/ACL/PCL)
Hyaline cartilage injuries
Subtle fracture

72
Q

What is a Maisonneuve fracture?

A

Remote disruptions in the tibia and fibula

73
Q

What is the common injury mechanism for an ankle injury?

A

Inversion or Eversion

74
Q

What can cause a talar dome fracture?

A

Excessive inversion/eversion

75
Q

How dose the Bohler’s angle help us diagnose a calcaneal fracture?

A

Compression fracture results in loss of calcaneal peak and increased bone density

76
Q

True or false; Calcaneal fractures are rarely comminuted?

A

False

77
Q

What is a normal accessory ossification centre seen in the foot?

A

In adolescents:

- 5th metatarsal base

78
Q

What is the fabella?

A

Sesamoid bone:

 - In lateral head of gastrocnemius
 - Posterior to distal femur
79
Q

What is the os trigonum?

A

An accessory ossification centre:

- Posterior to talus

80
Q

Where is a common site in the foot for rounded sesamoid bones?

A

1st metatarsal head:

 - Medial plantar aspect
 - Lateral plantar aspect
81
Q

What can predispose to an achilles tendon rupture?

A

DM
RA
Steroids

82
Q

What is a Lisfranc injury and how is it assessed?

A

TMT joint injury
Assess 1st and 2nd TMTJs on AP view
Assess 3rd to 5th TMTJs on oblique view

83
Q

What do Lisfranc injuries tend to involve?

A

Several TMTJs

Multiple ligamentous avulsion fractures

84
Q

What is the best way to diagnose a Lisfranc injury?

A

CT

Year 2 - Musculoskeletal (DP) (16 decks)

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