Musculoskeletal Radiology Practice Questions

Q: Radiological findings of scurvy are A/E:

Metaphyseal infarction. ***Metaphyseal infarction*** - **Metaphyseal infarction** (bone infarcts) is NOT a feature of scurvy and is typically associated with conditions like **sickle cell anemia**, **Gaucher disease**, or following trauma/infection. - Scurvy primarily affects collagen synthesis, leading to issues with bone matrix and subperiosteal hemorrhages rather than ischemic necrosis. *Pelkan spur* - **Pelkan spur** (also known as the "corner sign" or "spur formation") is a **characteristic radiological finding in scurvy**, not rickets. - It results from metaphyseal corner fractures due to subperiosteal hemorrhages and weakened bone matrix at the metaphyseal edges. *Epiphyseal widening* - This is not a classic or characteristic finding of scurvy. - While scurvy affects the growth plate with features like **Wimberger ring sign** (dense calcification around epiphysis) and **epiphyseal separation**, generalized epiphyseal widening is not typically described. *Metaphyseal porosis* - **Ground glass osteopenia/porosis** is a recognized feature of scurvy due to impaired osteoid formation. - This results from defective collagen synthesis leading to decreased bone density, particularly evident in the metaphyseal regions.

Q: Beheaded Scottish terrier sign is seen in:

Spondylolysis. ***Spondylolysis*** - The \"Beheaded Scottish terrier sign\" is **pathognomonic for spondylolysis**, which is a **fracture of the pars interarticularis**. - On oblique lumbar spine radiographs, the normal vertebra resembles a \"Scotty dog\" where the pars interarticularis forms the \"neck\"; when fractured, it appears \"beheaded\". - This defect occurs most commonly at **L5**, often due to repetitive stress in athletes (gymnasts, football players). - **Key distinction**: Spondylolysis is the pars fracture itself; if it progresses to anterior vertebral slippage, it becomes spondylolisthesis. *Spondylolisthesis* - This refers to **anterior displacement of one vertebra over another**, which can occur as a complication of spondylolysis. - While related to spondylolysis, the \"Beheaded Scottish terrier sign\" specifically indicates the **pars fracture** (spondylolysis), not the vertebral slippage. - Diagnosed on lateral radiographs showing vertebral step-off, not the oblique view Scotty dog sign. *Spondylosis* - Refers to **degenerative changes of the spine** including disc degeneration, osteophyte formation, and facet joint arthritis. - This is an **age-related process** and does not involve pars interarticularis fractures. - Not associated with the \"Beheaded Scottish terrier sign\". *Osteoporosis* - A systemic condition of **decreased bone mineral density** predisposing to fractures. - Does not produce the specific \"Beheaded Scottish terrier sign\" which is unique to pars interarticularis defects. *Osteogenesis imperfecta* - A **genetic collagen disorder** causing brittle bones and multiple fractures. - While it causes pathological fractures, it does not specifically manifest as the \"Beheaded Scottish terrier sign\".

Q: Cod-fish vertebrae are seen in:

Osteoporosis. ***Osteoporosis*** - **Cod-fish vertebrae**, or biconcave vertebral bodies, are characteristic of **osteoporosis**, resulting from the weakened vertebral body collapsing under the pressure of the intervertebral discs. - This specific vertebral deformity occurs due to the **loss of bone mineral density**, making the central portions of the vertebrae more susceptible to compression. *Osteomalacia* - While osteomalacia also leads to generalized bone softening, it typically presents with **Looser zones (pseudofractures)** and diffuse skeletal pain, rather than classic cod-fish vertebrae. - The primary defect in osteomalacia is **impaired mineralization of osteoid**, leading to softer bones that deform but do not typically collapse in the characteristic biconcave shape. *Fractures* - Fractures describe a break in the bone and do not inherently cause the typical **cod-fish deformity** unless it is a specific type of vertebral compression fracture in an already weakened osteoporotic bone. - While vertebral compression fractures can occur in severe osteoporosis, the term "fractures" alone is too broad and does not specifically lead to the characteristic biconcave shape of cod-fish vertebrae. *Spinal tumors* - Spinal tumors can cause bone destruction or compression, but they typically lead to **lytic lesions**, new bone formation, or more irregular vertebral deformities, often with neurological symptoms. - They do not typically result in the **symmetrical biconcave indentation** of the vertebral endplates seen in cod-fish vertebrae.

Q: Looser's zones are seen in:

Osteomalacia. ***Osteomalacia*** - **Looser's zones** (also called **pseudofractures** or **Milkman's fractures**) are **pathognomonic** radiological findings of **osteomalacia**. - These appear as **radiolucent bands perpendicular to the cortex**, typically bilateral and symmetrical, commonly seen in the **pubic rami, femoral necks, ribs, and scapulae**. - They represent **stress fractures with unmineralized osteoid seams** that fail to heal due to defective mineralization from **vitamin D deficiency** or **phosphate depletion**. *Paget's disease* - Characterized by **disorganized bone remodeling** with a "**cotton wool**" appearance on skull X-rays, **cortical thickening**, and **bone expansion**. - Shows increased bone density and deformities, **not** radiolucent pseudofractures. - Does not feature Looser's zones. *Renal osteodystrophy* - This is a **spectrum of bone disorders** in chronic kidney disease, which can include osteitis fibrosa cystica, osteomalacia, adynamic bone disease, and mixed patterns. - While the **osteomalacic component** of renal osteodystrophy could theoretically show Looser's zones, they are **not a characteristic or common finding** of renal osteodystrophy as a whole. - The question asks for the **classic association**, which is **primary osteomalacia**. *All of the above* - Incorrect because Looser's zones are **specifically pathognomonic for osteomalacia**, not for Paget's disease or the general spectrum of renal osteodystrophy.

Q: A 2-year-old boy suffering from leukemia. Which of the following is the most characteristic X-ray finding?

Transverse line of dark band below the growth plate. ***Transverse line of dark band below the growth plate*** - This finding, often called a **leukemic line** or **lucent metaphyseal band**, is highly characteristic of childhood leukemia. - It represents accumulation of **leukemic cells** in the metaphysis, causing osteopenia and a lucent band. *Osteolytic lesion in flat bones* - While **osteolytic lesions** can occur in leukemia, they are more commonly seen in advanced stages or with specific subtypes. - They are not as characteristic or early a finding as metaphyseal lucencies in childhood leukemia. *Osteosclerosis of long bones* - **Osteosclerosis** (increased bone density) is generally not a feature of leukemia; rather, bone marrow infiltration typically leads to osteopenia. - This finding is more associated with conditions like myelofibrosis or certain metastatic cancers. *Periosteal new bone formation* - **Periosteal new bone formation** can be seen in leukemia due to direct periosteal infiltration or hemorrhage, but it is less specific. - It is also a feature of osteomyelitis, trauma, or other bone tumors, making it less characteristic compared to metaphyseal lines.

Q: Earliest and characteristic radiological finding of leukemia in children

Translucent transverse metaphyseal bands. ***Translucent transverse metaphyseal bands*** - These **translucent transverse metaphyseal bands**, also known as **leukemic lines**, represent areas of **decreased bone density** due to **leukemic infiltration** and impaired osteogenesis. - They are the **earliest and most characteristic radiological finding** in children with acute leukemia, particularly **acute lymphoblastic leukemia (ALL)**. *Metaphyseal Osteosclerosis* - This refers to increased bone density in the metaphysis, which is generally not an early or characteristic finding of leukemia. - While osteosclerosis can occur in some hematologic conditions, it is not primary to the initial presentation of leukemia. *Metaphyseal cortical erosions* - **Cortical erosions** indicate bone destruction but are typically seen in more advanced stages or in aggressive forms of leukemia, not as the earliest characteristic sign. - They are often associated with larger masses of leukemic cells eroding the bone cortex. *Periosteal reaction* - **Periosteal reaction** (new bone formation on the surface of the bone) can occur in leukemia due to **periosteal irritation** from expanding leukemic infiltrates. - However, it is a **less specific finding** and usually appears later than metaphyseal bands, or in response to gross bone involvement.

Q: A 35-year-old lady with chronic backache. On X-ray she had a D12 collapse. But intervertebral disk space is maintained. All are possible except:

Tuberculosis. ***Tuberculosis*** - **Tuberculosis of the spine (Pott's disease)** characteristically causes destruction of the **intervertebral disc space** in addition to vertebral body collapse. - The disease often begins in the vertebral body and spreads to the adjacent disc and vertebrae, leading to a **gibbus deformity** and eventual fusion. *Multiple myeloma* - This condition is a **plasma cell malignancy** that frequently causes **osteolytic lesions** and vertebral collapse without typically affecting the intervertebral disc spaces primarily. - Myeloma cells infiltrate the bone marrow, leading to osteoclast activation and bone destruction. *Metastasis* - **Metastatic disease** to the spine commonly causes **vertebral body collapse** while **preserving the intervertebral disc space** because malignancies typically spread through the blood to the bone rather than directly invading the cartilaginous disc. - Common primary sites for spinal metastases include breast, lung, prostate, kidney, and thyroid. *Osteoporosis* - Severe **osteoporosis** can lead to **vertebral compression fractures (collapse)**, especially in the thoracic and lumbar spine, but usually **spares the intervertebral disc space**. - The bone loss weakens the vertebral body, making it susceptible to collapse with minimal trauma or even spontaneously.

Q: Radiological features in rickets?

All of the options. ***All of the options*** - **All three findings are classic radiological features of rickets**, reflecting defective mineralization and abnormal bone growth at the growth plates. **Widening of distal end of metaphysis** - This is a **hallmark sign** of rickets, best seen at the wrist (distal radius and ulna) - Results from accumulation of **unmineralized osteoid** and cartilage at the growth plate - The growth plate appears widened, irregular, and has increased distance between epiphysis and metaphysis **Cupping of distal end of radius** - **Cupping and fraying** of the metaphysis are characteristic findings - The metaphyseal margin becomes **concave** (cup-shaped) instead of straight - Associated with irregular, frayed appearance due to defective mineralization - Most prominent at sites of rapid growth (wrist, knee) **Delayed ossification of epiphyses** - Epiphyseal ossification centers appear **later than normal** or are poorly mineralized - Results in **decreased bone density** and delayed skeletal maturation - Part of the generalized growth disturbance in rickets **Other radiological features** of rickets include: loss of sharp zone of provisional calcification, osteopenia, bowing deformities, pathological fractures (Looser zones), and rachitic rosary.

Q: X-ray views of fracture of nasal bone include all except:

Submental view. ***Submental view*** - The **submental view** (or basal view) is primarily used to visualize the **zygomatic arches** and the base of the skull, not the nasal bones. - This projection involves aiming the X-ray beam from beneath the chin, making it unsuitable for detailed assessment of nasal bone fractures. *Waters view* - The **Waters view** (occipitomental view) is commonly used to assess the **maxillary sinuses**, orbits, and zygomatic bones, which can provide some indirect information about nasal structures. - While not a primary view for nasal bones, it can show displacement of parts of the nasal skeleton if the fracture extends to adjacent structures. *Lateral view* - The **lateral view** of the nasal bones is considered the **gold standard** for detecting nasal bone fractures. - It clearly shows the **contour and integrity of the nasal bones**, helping to identify fracture lines and displacement. *Occlusal view* - The **occlusal view** is primarily used for visualizing the **hard palate**, floor of the mouth, or anterior portions of the maxilla and mandible. - While it's not a standard view for nasal bone fractures, it may be used in specific cases to assess involvement of the palatal or alveolar processes if the fracture extends inferiorly.

Q: Blumensaat line is used to radiologically diagnose an anatomical condition called patella alta. It is

Drawn through the roof of the intercondylar notch of femur. ***Drawn through the roof of the intercondylar notch of femur*** - The **Blumensaat line** is a radiologic landmark defined by the **roof of the intercondylar notch** of the femur on a lateral knee X-ray. - It is used in the diagnosis of **patella alta** or **patella baja** by assessing the position of the patella relative to this line; the inferior pole of the patella should ideally be at or slightly below the Blumensaat line in a flexed knee. *The line joining the greater trochanter and the centre of the patella* - This description does not correspond to the **Blumensaat line** or any standard anatomical measurement for patellar position. - The greater trochanter is part of the proximal femur, far removed from the knee joint for this specific radiological evaluation. *Drawn through the superior pole of patella.* - While lines can be drawn in relation to the patella, the **Blumensaat line** is specifically defined by the **femoral intercondylar notch**, not the superior pole of the patella. - Other indices like the **Insall-Salvati ratio** use the patellar pole, but in relation to the patellar tendon length, not as the Blumensaat line itself. *The line joining the ASIS with the centre of patella* - This line is not the **Blumensaat line** and does not have a standard application in diagnosing **patella alta** or baja. - The **anterior superior iliac spine (ASIS)** is part of the pelvis and would not be used in a direct measurement of patellar height on a knee X-ray.

Question 1

Radiological findings of scurvy are A/E:

Accepted Answer

Metaphyseal infarction

Answer

Pelkan spur

Answer

Epiphyseal widening

Answer

Metaphyseal porosis

Question 2

Beheaded Scottish terrier sign is seen in:

Accepted Answer

Spondylolysis

Answer

Osteoporosis

Answer

Spondylosis

Answer

Osteogenesis imperfecta

Question 3

Cod-fish vertebrae are seen in:

Accepted Answer

Osteoporosis

Answer

Osteomalacia

Answer

Fractures

Answer

Spinal tumors

Question 4

Looser's zones are seen in:

Accepted Answer

Osteomalacia

Answer

All of the above

Answer

Paget's disease

Answer

Renal osteodystrophy

Question 5

A 2-year-old boy suffering from leukemia. Which of the following is the most characteristic X-ray finding?

Accepted Answer

Transverse line of dark band below the growth plate

Answer

Osteolytic lesion in flat bones

Answer

Osteosclerosis of long bones

Answer

Periosteal new bone formation

Question 6

Earliest and characteristic radiological finding of leukemia in children

Accepted Answer

Translucent transverse metaphyseal bands

Answer

Metaphyseal Osteosclerosis

Answer

Metaphyseal cortical erosions

Answer

Periosteal reaction

Question 7

A 35-year-old lady with chronic backache. On X-ray she had a D12 collapse. But intervertebral disk space is maintained. All are possible except:

Accepted Answer

Tuberculosis

Answer

Multiple myeloma

Answer

Metastasis

Answer

Osteoporosis

Question 8

Radiological features in rickets?

Accepted Answer

All of the options

Answer

Delayed ossification of epiphyses

Answer

Widening of distal end of metaphysis

Answer

Cupping of distal end of radius

Question 9

X-ray views of fracture of nasal bone include all except:

Accepted Answer

Submental view

Answer

Waters view

Answer

Occlusal view

Answer

Lateral view

Question 10

Blumensaat line is used to radiologically diagnose an anatomical condition called patella alta. It is

Accepted Answer

Drawn through the roof of the intercondylar notch of femur

Answer

The line joining the greater trochanter and the centre of the patella

Answer

Drawn through the superior pole of patella.

Answer

The line joining the ASIS with the centre of patella

Musculoskeletal Radiology — MCQs

Musculoskeletal Radiology — MCQs

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