Radiology of Arthritis and Bone Pathologies

Question 1

What is meant by a ‘distracted’ fracture?

Answer 1

Bone pieces are pulled apart in the fracture

Question 2

What is meant by a ‘comminuted’ fracture?

Answer 2

Bone is broken up into lots of small pieces

Question 3

What is meant by a ‘compound’ fracture?

Answer 3

Open to the skin, more likely to be infection

Question 4

What is meant by a ‘overriding’ fracture?

Answer 4

Dense, sclerotic lesion due to overriding bits of bone

Question 5

Extra-articular fractures are at higher risk for development of arthritis than intra-articular fractures. t/f?

Answer 5

False - the opposite is true

Question 6

Why do intracapsular fractures of the femoral head require surgical intervention?

Answer 6

These fractures are at high risk of avascular necrosis.

Question 7

What sign on x-ray is specific for Paget’s disease?

Answer 7

Blade of grass sign

Question 8

What type of joint changes are seen in degenerative arthritis?

Answer 8

Increased bone production - osteophytes

Question 9

What type of joint changes are seen in inflammatory arthritis?

Answer 9

Periarticular erosions

Question 10

What type of joint changes are seen in depositional arthritis?

Answer 10

Periarticular soft tissue masses

Question 11

Active erosions are likely to appear well-defined on x-ray. T/F?

Answer 11

False - active erosions are ill-defined, old erosions are well-defined

Question 12

What is primary degenerative arthritis?

Answer 12

Intrinsic degeneration of the articular cartilage caused by excessive wear and tear

Question 13

What joints are commonly affected by primary degenerative arthritis?

Answer 13

Hips

Knees

Question 14

What signs of primary degenerative arthritis are seen on x-ray?

Answer 14

Narrowed joint spaces
Osteophytes
Subchondral sclerosis/cysts

Question 15

What is secondary degenerative arthritis?

Answer 15

Arthritis caused by another process which destroys the articular cartilage

Question 16

What are the common causes of secondary degenerative arthritis?

Answer 16

Trauma
Infection
Avascular necrosis
CPPD
RA
Haemophilia

Question 17

What are the uncommon causes of secondary degenerative arthritis?

Answer 17

Haemachromatosis
Acromegaly
Ochronosis
Wilson’s disease

Question 18

Any type of arthritis can end up as degenerative arthritis. T/F?

Answer 18

True

Question 19

What is CPPD caused by?

Answer 19

Hyperparathyroidism

Haemachromatosis

Question 20

What changes are seen in CPPD?

Answer 20

Similar to OA but symmetrical and unusual distribution
Chonedrocalcinosis - calcification of the articular cartilage
Triangular fibrocartilage of the wrist, knee, hip, shoulder an symphysis pubis

Question 21

What is the acute presentation of CPPD?

Answer 21

Sudden onset of pain or fever
Joint appears tender, swollen and red
May mimic septic arthritis

Question 22

What are the possible causes of inflammatory arthritis?

Answer 22

Infection
RA
Seronegative arthropathies
Other connective tissue diseases

Question 23

What are the possible causes of seronegative arthropathies?

Answer 23

Psoriatic arthritis
Reactive arthritis
Ankylosing spondylitis
Inflammatory bowel disease

Question 24

What systemic connective tissue diseases can cause inflammatory arthritis?

Answer 24

Scleroderma

SLE

Question 25

In what age group is infectious arthritis most common?

Answer 25

Adults

Question 26

When does infectious arthritis commonly occur?

Answer 26

After local injury or surgery

Question 27

Which joints are typically affected in infectious arthritis?

Answer 27

Fingers due to bites Feet due to diabetes Hip due to hip replacement Usually only one joint affected

Question 28

Which organisms commonly cause infectious arthritis?

Answer 28

Staph Step TB

Question 29

What are the signs (clinical and on x-ray) of infectious arthritis?

Answer 29

``` Soft tissue swelling Destruction of cartilage and bone Rapid loss of joint soace Possible periosteal reaction Osteoporosis Subluxation OA Fusion ```

Question 30

What signs will be seen on imaging in discitis?

Answer 30

``` End-plate erosion Disc space narrowing Bone destruction Paravertebral masses Sclerosis Anklyosis ```

Question 31

What are the signs (clinical and on x-ray) of RA?

Answer 31

``` Hyperaemia Soft tissue swelling Synovitis Effusion Bone marrow oedema Erosions Cysts Joint space narrowing Secondary degenerative changes Loose bodies ```

Question 32

Which gene is particularly associated with serous-negative inflammatory arthropathies?

Answer 32

HLA-B27

Question 33

What classical deformity can be seen on x-ray in patients with psoriatic arthritis?

Answer 33

Pencil and cup deformity

Question 34

What is retire syndrome?

Answer 34

Triad of urethritis, arthritis and conjunctivitis

Question 35

Describe the epidemiology of renter's syndrome

Answer 35

Male>female White>black 20-40 years

Question 36

How long after infection does renter's syndrome occur?

Answer 36

1-3 weeks

Question 37

What joints are commonly affected by renter's syndrome?

Answer 37

Sacro-iliac | Lower limb joints

Question 38

What are the presenting complaints of a patient with ankylosing spondylitis?

Answer 38

Low back pain and stiffness

Question 39

Which joints are usually affected by ankylosing spondylitis?

Answer 39

Sacro-iliac

Question 40

In which cause of inflammatory arthritis would you see a 'bamboo spine' on imaging in late disease?

Answer 40

Ankylosing spondyltiis

Question 41

What condition is characterised by urate crystal deposition?

Answer 41

Gout

Question 42

What is the epidemiology of gout?

Answer 42

Common in elderly men | Often hereditary

Question 43

What joints are commonly affected by gout?

Answer 43

Foot, knee, hand, elbow