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CQR RAD with 100- sure answers.
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CQR RAD with 100% sure answersWhat is the Salter-Harris Classification? Most common Salter-Harris fracture? - Correct
Answers:The Salter-Harris Classification of Fractures is for the prognosis of the fracture.
Type I offers the best prognosis and Type V the worst.
Type II - Most common fracture. Through the epiphyseal plate and extends into the
metaphysis.
The most common type of shoulder dislocation is? - Correct Answers:Anterior is the
most common type of shoulder dislocation.
The shoulder is the most common joint in the body to dislocate and most of the
dislocations are anterior. The humeral head dislocates anterior and inferior to the
glenoid fossa and commonly is located beneath the coracoid process.
Lateral radiograph -- look down the spine, looks more lucent. If it looks more dense? -
Correct Answers:Pleural effusion or something
The CP angles should be sharp, blunting may indicate pleural effusion
Pleural effusion is first seen int he posterior costophrenic gutters on the lateral view.
Positive fat pad sign? - Correct Answers:Falls down on their elbow, fat pad sign --
elevation of the fat pad along the anterior aspect of the humerus, visualization of the
posterior fat pad, strongly suggestive of a fracture w/in the elbow.
Posterior and anterior fat pads - Correct Answers:
Colles Fracture? - Correct Answers:Colles' Fracture - this is a fracture of the distal
radius, which is usually within one inch of the articular surface with posterior
displacement of the distal fragment. Frequently there is accompanying fracture of the
ulnar styloid.
What is the most common bone in the wrist to fracture? - Correct Answers:Scaphoid -
pain at the anatomical snuff box with scaphoid fracture
a. Most commonly Fx carpal bone
b. Proximal pole has no blood supply :: usually can see aseptic necrosis of the proximal
fragment = increased density of the proximal fragment
Wrist bones - Correct Answers:
Elderly patient can't bear wait on pelvis? - Correct Answers:Fracture unless proven
otherwise. plain film may not show the fracture.
,Which of the following isn't associated w/ child abuse? (1) Spiral fractures of the femur
(2) Posterior Rib Fractures (3) Metaphyseal corner fractures (4) Spiral fractures of the
tibia (5) All of these - Correct Answers:Spiral fracture of the tibia = Toddler's fracture.
Toddler's Fracture - A fracture of the tibia in young children beginning to walk. Most
commonly a spiral type fracture involving the distal shaft of the tibia. Buckle type
fracture involving the metaphyseal portion of the proximal tibia is also common.
Maissoneuve Fx? - Correct Answers:
What is a DEXA Scan? - Correct Answers:The preferred method for determining bone
mass is the Dual Energy X-Ray Absorptiometry Scan or DEXA. This utilizes two X-Ray
energy sources to determine the bone mineral content or bone mass. The DEXA scan
defines osteoporosis as a bone mineral density (T Score) that is 2.5 SD below the mean
peak value in younger adults. The Z Score is also determined and is a comparison with
the mean value in normal subjects the same age and sex.
The severity of osteoporosis is determined by the bone values.
* -1.0 to -2.0 mild
* -2.0 to -3.0 moderate
* -3.0 to -4.0 marked
* -4.0 to -5.0 severe
Hyperparathyroidism - Hallmark? - Correct Answers:The hallmark of
hyperparathyroidism in the skeleton is **subperiosteal resorption of bone,** which is
particularly pronounced on the **radial side of the middle phalanx, middle finger.**
Views of the hand are very important in demonstrating subperiosteal resorption. There
is also penciling of the tufts of the distal phalanges and penciling of the distal aspects of
the clavicles. Subperiosteal resorption may occur along the medial aspects of the neck
of the humerus and femur as well as in the hand. There is loss of the lamina dura about
the teeth and there is a generalized lucency of the skeleton. As finer trabecula
disappear, the cortex also thins. Localized destructive areas may occur and are known
as brown tumors.
Paget's disease -- what is it? What is markedly elevated? - Correct Answers:This
disease is due to the imbalance of osteoclastic and osteoblastic activity. It is very rare in
patients under 50. Paget's disease may be monosteal or generalized. Pathologically,
there is increased resorption with disorganization of bone in a characteristic mosaic
appearance. The resorption is rapidly followed by new bone formation. Usually in pelvis
and bowing of long bones. Large lytic areas in skull.
The alkaline phosphatase is markedly elevated in most patients with active Paget's
disease.
Paget's disease radiographic features? - Correct Answers:Course, too dense often the
pelvis
,Radiographic findings:
a. There is actual expansion of involved bone.
b. There is thickening of the cortex, particularly in the pelvis.
c. Deformities may occur with bowing of long bones and intrapelvic
protrusion of the aceabulae of the hips.
d. There is an abnormal trabecular pattern in Paget's disease with patchy areas of
radiolucency and sclerosis. The trabeculae appear very large and irregular.
e. A "candle flame" lytic process may be seen in the early stages of Paget's disease,
particularly in the long bones and is particularly
common in the femur and midshaft of the tibia.
f. Large lytic areas in the skull may be seen initially followed by irregular sclerotic
lesions. The **lytic (NOT SCLEROTIC)** process is known as **osteoporosis
circumscripta.**
Osteoporosis circumscriptia - Correct Answers:Paget's Disease: Large lytic areas in the
skull may be seen initially followed by
irregular sclerotic lesions. The lytic process is known as osteoporosis circumscripta.
What are the radiographic characteristic of osteoarthritis or degenerative arthritis? -
Correct Answers:Radiographically, the characteristic changes are **narrowing of the
joint space with associated hypertrophic spurring, subchonral cyst formation, and
sclerosis about the joint.**
Sendesmophytes and bamboo spine? - Correct Answers:Ankylosing spondylitis
Why order plain film? - Correct Answers:Trauma, pain, instability, impingement,
suspected abuse, metabolic diseases, benign and malignant neoplasm, arthropathies,
infections, preop/postop, congenital syndromes, vascular lesions, eval of soft tissues in
extremities, corr abnormal skeletal findings on other images
Plain film views - PA - Correct Answers:Posterior anterior. This view is usually obtained
at a 6 foot target to film distance in order to reduce magnification. With tis view, the film
is against the anterior aspect of the patient and the x-ray beam is directed towards the
posterior aspect of the patient.
Plain film views - AP - Correct Answers:anterior posterior. The film is against the
posterior aspects of the patient and the x-ray beam is directed toward the anterior
aspect of the chest. This is the view commonly obtained with portable technique and the
target to film distance is usually 40 inches. The cardiac silhouette is magnified in this
projection.
Hallmark of airspace disease? - Correct Answers:Air bronchograms (air spaces and
distal bronchial structures w/in an area of consoldation, which still contain air rather than
fluid)
, What is air space disease? - Correct Answers:Fluid (exudates, transudate, blood)
replaces the air in the pulmonary acinus. The pulmonary acinus represents that portion
of lung to a terminal bronchiole and consists of respiratory bronchioles, alveolar ducts,
alveolar sacs, and alveoli.
Pneumonia looks like what? - Correct Answers:Pneumonia lokos patchy. Most
pneumonias are manifest as air space disease. It is helpful to look for the distribution in
the lung, pneumatoceles, pleural effusion, and other associated findings, which may
help identify the specific type of pneumonia. Determination of a specific causative agent
for pneumonia is usually not possible by x-ray.
Five basic radiographic densities? - Correct Answers:There are five basic radiographic
densities:
1. Air
2. Fat
3. Water-Soft tissue
4. Bone
5. Metal
Pulmonary Edema manifests as? - Correct Answers:Pulmonary edema from any cause
such as heart failure, azotemia, inhalation of noxious agents, etc. are manifest as air
space disease in a perihilar or bat-wing distribution. Pulmonary hemorrhage may also
have the same perihilar distribution.
CHF - look for what? what happens to the pulmonary venous pressure? - Correct
Answers:Get chest xray and look for central radiation
Because of the variability of heart size, radiographic signs of increased pulmonary
venous pressure, no cardiomegaly, are the primary diagnostic criteria.
Atelectasis - Correct Answers:Atelectasis = volume loss
A. Local increased density
B. Displacement of interlobar fissures
C. Elevation of hemidiaphragm
D. Displacement of mediastinum
E. Compensatory overinflation
F. Displacement of hila
G. Approximation of ribs
H. Absence of air bronchograms in obstructive atelectasis
Displacement of fissures is one of the most important of the signs of atelectasis. The
fissures always appear as sharp straight lines bordering on an area of increased
density.
What view is helpful to determine pneumothorax? - Correct Answers:Film in expiration.
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