Radiology - Musculoskeletal

Question 1

What are the indications for extremity radiography?

Answer 1

• Pain
• Trauma
• Redness/swelling/infection or inflammation
• Foreign body
• Arthritis/degenerative change
• Post-operative

Question 2

What are some advantages of Xraying extremities?

Answer 2

• excellent evaluation of bones!
• Quick and cheap
• Low radiation

Question 3

Disadvantages of Xray

Answer 3

• soft tissues seen but hard to evaluate
• radiation :(
• challenging in large uncooperative patients
• requires experience

Question 4

What color are areas with more radiation?

Answer 4

black

Question 5

What color are areas where radiation is absorbed?

Answer 5

white

Question 6

Which is denser on xray: fat or soft tissue?

Answer 6

soft tissue is denser than fat.

Air/lung
Fat
Soft tissue
Bone
Metal

Question 7

What word describes how many parts a fracture is in?

Answer 7

comminution

• simple
• comminuted (degree of comminution)

Question 8

What word describes how far apart opposing bone fractures are?

Answer 8

non displaced vs. displaced

Question 9

What are the pediatric subtypes of fractures?

Answer 9

• Bowing/plastic
• buckle/torus
• Greenstick

Question 10

What is a diaphysis?

Answer 10

shaft of a long bone

Question 11

What is a metaphysis?

Answer 11

between diaphysis and epiphysis.

Location of the growth plate

Question 12

What is a lipohemarthrosis?

Answer 12

(results from an intra-articular fracture)

-escape of fat and blood from the bone marrow into the joint,

side note: most frequently seen in the knee, associated with a tibial plateau fracture or distal femoral fracture.

Question 13

What is a “sunrise” view?

Answer 13

Looking down the shaft of the femor to visualize position of patella in femoral trochlea

Question 14

What does DJD stand for?

Answer 14

degenerative joint disease

Question 15

What fracture is common in a child with a fall on an outstretched arm?

Answer 15

supracondylar fracture

*associated with lipohemarthrosis

Question 16

Adult with fall and elbow pain and limited ROM?

Answer 16

impacted radial head and neck fracture (proximal)

*associated with lipohemarthrosis

Question 17

What produces lipohemarthrosis?

Answer 17

intra-articular fracture

Question 18

Fracture of supracondylar humerus is associated with what population?

Answer 18

pediatrics

Question 19

What do adults tend to fracture in their elbows?

Answer 19

proximal radius (head, neck, or both)

Question 20

Which bone in the wrist has high risk of complication?

Answer 20

Scaphoid

Question 21

What are some complications of scaphoid fracture?

Answer 21

• Non-union
• avascular necrosis of the distal pole
• Chronic pain

Question 22

What is the appropriate treatment for “anatomic snuff box tenderness”?

Answer 22

Orthopedic referral and close follow-up (due to risk of complications)

Question 23

Name the bones of the wrist?

Answer 23

Carpal bones:

• Scaphoid
• Lunate
• Triquetrum
• Pisiform
• Hamate
• Capitate
• Triquetrum
• Trapezium

Question 24

What is the name for a distal radius fracture (usually mildly impacted)?

Answer 24

Colles Fracture

Question 25

What are 3 common features of a Colles fracture?

Answer 25

1. Extra-articular (doesn't involve joint) 2. Dorsal angulation 3. *Very common: most often from FOOSH*

Question 26

What fracture of the radius has volar angulation?

Answer 26

Smith fracture

Question 27

What bone is commonly broken when a fist punches a wall?

Answer 27

5th metacarpal. *Boxer Fracture

Question 28

What is commonly referred to as a "hip" fracture?

Answer 28

fracture of the femur

Question 29

What are 4 subtypes of femoral fracture?

Answer 29

1. Subcaptial (just below head) 2. Transcervical (middle of neck) 3. Intertrochanteric (base of neck and trochanters) 4. Subtrochanteric (below trochanters)

Question 30

What is the name for infection of the bone=bone destruction?

Answer 30

osteomyelitis

Question 31

What is cellulitis?

Answer 31

infection of subcutaneous soft tissues - swelling - edema * can be seen on Xray

Question 32

What do you do if patient has bone infection and the Xray is negative?

Answer 32

MRI (can be done with contrast but not necessary) Bone scan or CT in people who can't have MRI

Question 33

What blood tests can be helpful in assessing bone infection?

Answer 33

ESR (SED rate) CRP (c-reactive protein) -can also "probe down to bone" on physical exam

Question 34

For who is MRI contrast contraindicated?

Answer 34

patients with renal failure (GFR < 30)

Question 35

What is nephrogenic systemic fibrosis?

Answer 35

Nephrogenic systemic fibrosis (NSF): a disease of fibrosis of the skin and internal organs caused by gadolinium exposure used in imaging in patients who have renal insufficiency.

Question 36

What is known as "degenerative change" of a joint

Answer 36

osteoarthritis

Question 37

What are 4 characteristics of osteoarthritis?

Answer 37

1. Joint space loss 2. Osteophyte formation 3. Subchondral sclerosis 4. Subchondral cyst formation

Question 38

What is the name for pediatric fractures involving the growth plate?

Answer 38

Salter-Harris classification ``` S-traight across A-bove L-ower or below ("L" shaped) T-hrough ER-asure of growth plate (crushed) ```

Question 39

Differential Diagnosis for Anything?

Answer 39

*VITAMIN C,D, E* ``` V-ascular I-nfection T-raumatic A-utoimmune M-etabolic I-nflammatory N-eoplastic ``` C-ongenital D-rug-related E-xposure (toxic)

Question 40

Monteggia

Answer 40

- middle - ulnar fracture - Radial head dislocation FOOSH

Question 41

Galeazzi

Answer 41

- distal - radial fracture - ulnar dislocation FOOSH