Session One

Question 1

Describe what Radio dense/Radiopaque is?

Answer 1

Light/white area on the radiograph due to presence of dense objects in paths of photons that are strong absorbers e.g., metal replacement

Question 2

Describe what Radiolucent is?

Answer 2

dark/black area on the radiograph due to maximum number of photons passing through the object e.g., air

Question 3

What is contrast?

Answer 3

The degree of difference between adjacent densities

Question 4

What is Density?

Answer 4

Radiographic density is dependent on amount of radiation received and refers to the degree of darkening of an exposed radiograph e.g.,
- white areas = no density
- black areas = maximum density

Question 5

What condition could have Uniform joint space loss?

Answer 5

Rheumatoid Arthritis

Question 6

What condition could have Non - Uniform joint space loss?

Answer 6

Osteoarthritis

Question 7

What are the 3 types of arthritis?

Answer 7

Inflammatory
Degenerative
Metabolic

Question 8

What is an example of a local congenital segmental defect?

Answer 8

Block vertebrae

Question 9

What is an example of a generalised congenital skeletal anomoly?

Answer 9

Achondroplasia

Question 10

Name 2 examples of trauma

Answer 10

Fracture / Dislocation

Question 11

What different types of fractures are there when looking on an x-ray?

Answer 11

complete/incomplete; spiral; oblique; transverse; comminuted ( more than 3 separate pieces)

Question 12

Name 2 bone marrow disorders

Answer 12

Anaemia
Leukaemia

Question 13

What is a condition associated with lack of blood supply?

Answer 13

Avascular necrosis

Question 14

Name a bone infection

Answer 14

Osteomyelitis

Question 15

Name a joint infection

Answer 15

Septic arthritis

Question 16

What are the main two types of tumours?

Answer 16

Malignant or benign

Question 17

What conditions can be as a result of Endocrine, Nutritional, Metabolic?

Answer 17

Osteoporosis / Osteomalacia / Rickets / Scurvy / Hyperparathyroidism / Steroids use

Question 18

Name 2 conditions that calcifications indicate in pathology?

Answer 18

Lupus or scleroderma

Question 19

What could swelling on a radiograph indicate?

Answer 19

Inflammation / bleeding

Question 20

What is the pneumonic - CATBITES?

Answer 20

C – Congenital
A – Arthritis
T – Trauma
B – Blood
I – Infection
T – Tumours
E – Endocrine, Nutritional, Metabolic
S – Soft Tissue

Question 21

What is the pneumonic - VINDICATE?

Answer 21

V – Vascular
I – Infection / Inflammatory
N – Neoplastic
D – Degenerative / Deficiency / Drugs
I – Idiopathic / Intoxication / Iatrogenic
C – Congenital
A – Autoimmune / Allergic / Anatomic
T – Traumatic
E – Endocrine / Metabolic

Question 22

What condition is most common inflammatory arthritis?

Answer 22

Rheumatoid Arthritis

Question 23

Name a degenerative arthritis?

Answer 23

Osteoarthritis

Question 24

Do patients with Osteoporosis have a high or low bone density?

Answer 24

Low

Question 25

Do people with Osteoporosis have more brittle bones compared to those without the condition?

Answer 25

Yes

Question 26

If people with osteoporosis have brittle bones, is the first point of treatment to be doing manipulation?

Answer 26

No

Question 27

What are the ABCDS?

Answer 27

A - Anatomy, Alignment & Articular B - Bone C - Cartilage D - Deformity, Density &Distribution S - Soft Tissue

Question 28

Is the radiolucent area on the radiograph light or dark?

Answer 28

Dark

Question 29

Is the radiodense area on the radiograph light or dark?

Answer 29

Light

Question 30

Is the radiopaque area on the radiograph light or dark?

Answer 30

Light

Question 31

What are the 5 areas/shades for density?

Answer 31

Air Fat Water Bone Metal

Question 32

On an x-ray, which material is darkest?

Answer 32

Air

Question 33

On an x-ray, which material is lightest?

Answer 33

Metal

Question 34

What are the 4 important things to write in a report?

Answer 34

- Location - Side - R/L - Severity - Mild, Moderate, Severe - Diagnosis

Question 35

When assessing a radiograph, what should you NOT do first?

Answer 35

Do not think of a diagnosis first - look at the signs and see where the evidence leads

Question 36

What are you looking for with Articular in an x-ray?

Answer 36

Erosions. Localisation: marginal - bare area or subchondral

Question 37

What are you looking for when looking at Bones on an X-ray?

Answer 37

Any Productive changes i.e osteophyte formation, scelrosis subchondral, enthesophyte or spur formation, syndesmophytes and chondrocalcinosis Diminished bone density - osteoporosis (non-focal), osteomyelitis (focal), cyst formation

Question 38

What are you looking for when looking at Cartilage on an X-ray?

Answer 38

Joint space narrowing

Question 39

What are you looking for in distribution on an x-ray?

Answer 39

Symmetric v asymmetric Proximal vs peripheral (small or large joints) Monarticular, polyarticular

Question 40

What are the E - Extra Findings?

Answer 40

Demographics (age and sex) Systemic symptoms or laboratory data

Question 41

What are you looking for under soft tissue on an x-ray?

Answer 41

Deformity, swelling massing (nodules, calcifications, urate crystals)

Question 42

What are marginal erosions?

Answer 42

They occur at the bare area of the joint, where the bone is not covered by articular cartilage. They are typically seen in rheumatoid arthritis (MCP-joints) and psoriatic arthritis (DIP). They present with small, round erosions.

Question 43

What are subchondral erosions?

Answer 43

They occur at the subchondral bone plate of the articular surfaces. They are a typical feature of erosive osteoarthritis. They present like jagged edges

Question 44

What is a gullwing deformity?

Answer 44

In erosive osteoarthritis the combination of central erosions and osteophytes results in a gullwing deformity

Question 45

What is pencil in cup deformity?

Answer 45

In psoriatic arthritis the combination of marginal erosions and bone proliferation can result in a pencil-in-cup deformity

Question 46

What are Peri- or juxtaarticular erosions?

Answer 46

Gout erosions are a bit more eccentric juxta-articular located, where the joint capsule attaches to the bone. They are most often seen in the MTP1-joint.

Question 47

What is the typical erosion pattern of RA?

Answer 47

Typical marginal erosions in MCP-joints.

Question 48

What is the typical erosion pattern of Erosive Osteoarthritis?

Answer 48

Subchondral erosions in DIP- and PIP-joints. The concurrent formation of osteophytes results in a gull-wing deformity.

Question 49

What is the typical erosion pattern of Gout?

Answer 49

Eccentric erosion with an overhanging edge.

Question 50

What is the typical erosion pattern of Infection?

Answer 50

Destructive changes with cartilage loss and erosions.

Question 51

What is the typical erosion pattern of Psoriatic arthritis?

Answer 51

Bony erosions narrowed the end of the proximal phalange as a “pencil”, which rests in the “cup” formed by the expanded base of the distal phalanx as a result of bony proliferations.

Question 52

What is the typical erosion pattern of Scleroderma?

Answer 52

And other multisystem disorders can produce erosions at the distal tufts, this is called acro-osteolysis.

Question 53

How do you tell the difference between RA and OA?

Answer 53

Osteophytes are only present in OA, no erosions. Most often in weight bearing joints. OA=Non uniform joint loss RA = Uniform joint loss. Marginal erosions predominantly in MCP-joints and the carpus, not in DIP-joints. No bone proliferation.