Musculoskeletal Trauma Imaging — MCQs
Regarding Hangman's fracture, which of the following statements are correct? 1) Fracture of either pedicles or lamina of C2 cervical vertebra 2) Bilateral in nature
Ultrasound is the investigation of choice for
What is the investigation of choice for diagnosing a stress fracture?
Which of the following statement(s) is/are true?
Which of the following classifications is used to assess the fracture shown in the provided image?
Earliest investigation for diagnosis of Ankylosing spondylitis:
A patient presents with a forefinger injury from glass, with suspicion of a retained foreign body. What is the initial investigation of choice?
For the evaluation of blunt abdominal trauma, which of the following imaging modalities is ideal?
What is the full form of FAST?
Which of the following is the investigation of choice for evaluation of acute head injury?
Musculoskeletal Trauma Imaging Indian Medical PG Practice Questions and MCQs
Question 1: Regarding Hangman's fracture, which of the following statements are correct? 1) Fracture of either pedicles or lamina of C2 cervical vertebra 2) Bilateral in nature
- A. Both are false
- B. 2 is true, 1 is false
- C. 1 is true, 2 is false
- D. Both are true (Correct Answer)
Explanation: ***Both are true*** - A **Hangman's fracture** is specifically a fracture through the **pedicles** (or pars interarticularis) of the **C2 vertebra**, which can also involve the lamina. - This fracture is inherently **bilateral** across both pedicles, classifying it as a spondylolisthesis of C2 on C3. *Both are false* - This option is incorrect because both presented statements are accurate descriptions of a Hangman's fracture. - The definition and typical presentation of this fracture align with both points. *1 is true, 2 is false* - This is incorrect because the fracture of the C2 pedicles/lamina is indeed the hallmark (statement 1), but the bilateral nature across the pedicles is also a defining characteristic, making statement 2 true as well. - A Hangman's fracture is a **traumatic spondylolisthesis** of C2 on C3 due to bilateral pedicle fractures. *2 is true, 1 is false* - This is incorrect because statement 1 accurately defines the location of the fracture at the **C2 pedicles/lamina**. - While it is **bilateral**, the primary anatomical location in C2 is foundational to the diagnosis.
Question 2: Ultrasound is the investigation of choice for
- A. Somatostatinoma
- B. Intraductal Pancreatic calculi
- C. Urethral stricture
- D. Blunt abdominal trauma (Correct Answer)
Explanation: ***Blunt abdominal trauma*** - **Focused Assessment with Sonography for Trauma (FAST) exam** is the initial imaging modality of choice for rapidly detecting **intra-abdominal free fluid** (hemoperitoneum) in hemodynamically unstable patients with blunt abdominal trauma due to its speed, portability, and non-invasiveness. - It helps guide the need for further imaging or surgical intervention, making it critical in the acute setting. *Somatostatinoma* - Diagnosed primarily through biochemical tests (elevated **somatostatin levels**) and imaging like **CT, MRI, or somatostatin receptor scintigraphy (SRS)**, which are superior for localizing these rare neuroendocrine tumors. - Although ultrasound can sometimes detect pancreatic masses, it is not the **investigation of choice** for definitive diagnosis or staging of somatostatinomas. *Intraductal Pancreatic calculi* - Often best visualized with **Endoscopic Retrograde Cholangiopancreatography (ERCP)** or **Magnetic Resonance Cholangiopancreatography (MRCP)**, which provide detailed imaging of the pancreatic and bile ducts. - While transabdominal ultrasound can sometimes detect dilated ducts or large calculi, **Endoscopic Ultrasound (EUS)** is more sensitive and specific for intraductal pathologies, making routine transabdominal ultrasound not the primary choice. *Urethral stricture* - The gold standard for diagnosing urethral strictures is **urethrography** (retrograde urethrogram), which directly visualizes the stricture and its extent. - While ultrasound can sometimes be used to assess the urethra, it is less effective than urethrography for defining the length and severity of a stricture.
Question 3: What is the investigation of choice for diagnosing a stress fracture?
- A. X-ray
- B. CT scan
- C. MRI (Correct Answer)
- D. Bone scan
Explanation: ***MRI*** - **Magnetic Resonance Imaging (MRI)** is the most sensitive and specific imaging modality for diagnosing **stress fractures**, especially in their early stages. - It can detect **bone marrow edema** and **periosteal reactions** indicative of stress injury before cortical changes are visible on plain radiographs. *X-ray* - **X-rays** are often the initial investigation, but they have low sensitivity for **stress fractures** in the early stages as bone changes may not be apparent for several weeks. - A positive X-ray for stress fracture typically shows a **sclerotic line** or **periosteal reaction**, but this indicates a more advanced injury. *CT scan* - **CT scans** provide excellent detail of **cortical bone** and can detect subtle fractures not seen on X-rays. - While more sensitive than X-rays, CT has **higher radiation exposure** and is generally less sensitive than MRI for early detection of **bone marrow edema** associated with stress injuries. *Bone scan* - **Bone scans** (scintigraphy) are highly sensitive for detecting increased **osteoblastic activity** associated with stress fractures. - However, they are **less specific** as various conditions can cause increased uptake, and they do not provide detailed anatomical information, making MRI superior for definitive diagnosis and staging.
Question 4: Which of the following statement(s) is/are true?
- A. Normally the radial styloid is 1/2 lower than the ulnar
- B. Dinner fork deformity is characteristic of Colles' fracture (Correct Answer)
- C. All of the options
- D. Oedema & tenderness over the anatomical snuffbox is the characteristic features of Fracture of the scaphoid
Explanation: **Dinner fork deformity is characteristic of Colles' fracture** - **Colles' fracture** involves a **dorsal displacement** and angulation of the distal radius, creating a characteristic **"dinner fork" or "bayonet" deformity** of the wrist. - This specific deformity is a classic clinical sign that aids in the diagnosis of a Colles' fracture, which is an **extra-articular fracture** of the distal radius with dorsal angulation. *Normally the radial styloid is 1/2 lower than the ulnar* - The **radial styloid** normally extends approximately **1-1.5 cm (or about 1/2 inch)** *distal* to the ulnar styloid, not lower than. - This difference in length is crucial for normal wrist kinematics, and its reversal can indicate conditions like **ulnar positive variance**. *All of the options* - This option is incorrect because the statement regarding the radial styloid being lower than the ulnar is **false**. - Since one of the options provided is factually incorrect, this choice cannot be true. *Oedema & tenderness over the anatomical snuffbox is the characteristic features of Fracture of the scaphoid* - While **oedema and tenderness in the anatomical snuffbox** are hallmark signs of a **scaphoid fracture**, this statement alone does not encompass all the truth presented in the options. - This specific physical finding is highly indicative of a scaphoid fracture, necessitating further imaging to confirm the diagnosis due to **poor vascular supply** to the scaphoid and risk of **avascular necrosis**.
Question 5: Which of the following classifications is used to assess the fracture shown in the provided image?
- A. Gustilo classification
- B. Garden classification (Correct Answer)
- C. Weber classification
- D. Salter and Harris classification
Explanation: ***Garden classification*** - The Garden classification is specifically used to classify **femoral neck fractures** based on displacement, which is a common and important fracture type to categorize. - While the provided image depicts an **elbow fracture**, the question asks to identify a classification system for fractures in general. Among the given options, Garden classification is correctly associated with a specific type of fracture (femoral neck) and is a well-known system. The image is a distracter on its own and isn't relevant to the question. *Gustilo classification* - The Gustilo-Anderson classification is used for **open fractures** to assess the severity of soft tissue damage and contamination. - It does not apply to the type of fracture shown in the image, nor is it a general classification for all fractures. *Weber classification* - The Weber classification is used for **ankle fractures**, specifically evaluating the level of the fibular fracture in relation to the syndesmosis. - This classification is not applicable to fractures at other anatomical sites, such as the elbow or femoral neck. *Salter and Harris classification* - The Salter-Harris classification is used for **growth plate (physeal) fractures** in children. - It is crucial for predicting growth disturbances but is not relevant for adult fractures or the specific fracture shown in the image.
Question 6: Earliest investigation for diagnosis of Ankylosing spondylitis:
- A. CT scan
- B. Bone scan
- C. X-ray
- D. MRI STIR sequence (Correct Answer)
Explanation: ***MRI STIR sequence*** - An **MRI STIR (Short Tau Inversion Recovery) sequence** is highly sensitive for detecting early inflammatory changes in the **sacroiliac joints** and spine, such as **bone marrow edema**, which is a hallmark of early ankylosing spondylitis. - It can identify disease activity and structural changes *before* they are visible on conventional X-rays, making it the earliest diagnostic tool. *CT scan* - While a **CT scan** provides excellent detailed images of bone, it is not as sensitive as MRI for detecting early inflammatory changes like **bone marrow edema** in the sacroiliac joints. - It involves significant **radiation exposure** and is typically used for more advanced structural assessment rather than early diagnosis. *Bone scan* - A **bone scan** (scintigraphy) shows areas of increased bone turnover but is **not specific** for ankylosing spondylitis and has lower spatial resolution compared to MRI. - It can indicate inflammation or increased metabolic activity but cannot differentiate specific causes or provide detailed anatomical information as effectively as MRI. *X-ray* - **X-rays** are often the initial imaging modality due to their accessibility, but they only show **structural changes** (like erosions, sclerosis, or fusion) in the sacroiliac joints and spine at a later stage of the disease. - Early inflammatory changes, such as **bone marrow edema**, are typically not visible on plain radiographs, leading to a delay in diagnosis compared to MRI.
Question 7: A patient presents with a forefinger injury from glass, with suspicion of a retained foreign body. What is the initial investigation of choice?
- A. MRI
- B. CT scan
- C. Plain radiograph (Correct Answer)
- D. Ultrasonography
Explanation: **Explanation:** The initial investigation of choice for a suspected retained foreign body (FB) in the extremities is a **Plain Radiograph (X-ray)**. 1. **Why Plain Radiograph is Correct:** Most foreign bodies encountered in trauma, such as glass, metal, and stone, are **radiopaque**. Glass, regardless of its lead content, is visible on X-rays in over 90% of cases if it is at least 2mm in size. X-rays are inexpensive, widely available, and highly effective at screening for these materials. Two orthogonal views (Anteroposterior and Lateral) are mandatory to localize the object accurately. 2. **Why other options are incorrect:** * **Ultrasonography (USG):** This is the investigation of choice for **radiolucent** foreign bodies (e.g., wood, thorns, plastic) that do not show up on X-ray. It is also excellent for guiding removal but is usually the second step after a negative X-ray. * **CT Scan:** While highly sensitive, it is not the "initial" choice due to higher radiation dose and cost. It is reserved for deep-seated foreign bodies in complex anatomical areas. * **MRI:** This is generally **contraindicated** as an initial step because if the foreign body is metallic, the magnetic field can cause it to migrate, leading to further tissue or neurovascular injury. **High-Yield Clinical Pearls for NEET-PG:** * **Radiopaque FBs (Visible on X-ray):** Metal, Glass, Stone, Pencil lead (graphite). * **Radiolucent FBs (Invisible on X-ray):** Wood, Thorns, Plastic, Cactus spines. * **Gold Standard for Wood/Organic matter:** Ultrasonography. * **Rule of Thumb:** If the history suggests glass or metal, start with an **X-ray**. If the history suggests wood or the X-ray is negative but clinical suspicion remains high, proceed to **USG**.
Question 8: For the evaluation of blunt abdominal trauma, which of the following imaging modalities is ideal?
- A. Ultrasonography
- B. Computed tomography (Correct Answer)
- C. Nuclear scintigraphy
- D. Magnetic resonance imaging
Explanation: In blunt abdominal trauma (BAT), **Computed Tomography (CT) with IV contrast** is the gold standard and the imaging modality of choice for hemodynamically stable patients. ### Why CT is the Correct Answer: * **Superior Sensitivity and Specificity:** CT is highly accurate in identifying and grading solid organ injuries (liver, spleen, kidneys) and detecting hemoperitoneum. * **Retroperitoneal Evaluation:** Unlike ultrasound, CT can reliably visualize the retroperitoneum, including the pancreas, duodenum, and major vessels. * **Hollow Viscus Injury:** It is the most sensitive tool for detecting signs of bowel injury (e.g., wall thickening, free air, or mesenteric hematoma). * **Whole-Body Imaging:** In polytrauma, CT allows for a "Pan-scan" to evaluate the head, chest, and pelvis simultaneously. ### Why Other Options are Incorrect: * **A. Ultrasonography:** While **FAST (Focused Assessment with Sonography for Trauma)** is the initial screening tool for hemodynamically unstable patients, it cannot grade organ injuries or reliably detect retroperitoneal pathology. * **C. Nuclear Scintigraphy:** This is too time-consuming and lacks the anatomical detail required for acute trauma management. * **D. Magnetic Resonance Imaging:** MRI is contraindicated in emergency settings due to long scan times, difficulty in monitoring unstable patients, and incompatibility with metallic life-support equipment. ### High-Yield Clinical Pearls for NEET-PG: * **Hemodynamically Unstable + Positive FAST:** Proceed directly to **Laparotomy**. * **Hemodynamically Stable:** **CECT (Contrast-Enhanced CT)** is the investigation of choice. * **CT "Shock Bowel":** Look for diffuse small bowel wall thickening and hyper-enhancement, indicating hypovolemic shock. * **Splenic Injury:** The spleen is the most commonly injured organ in blunt abdominal trauma.
Question 9: What is the full form of FAST?
- A. Focused abdominal sonography for trauma
- B. Focused assessment by sonography for trauma (Correct Answer)
- C. Focussed assessment by sonography and tomography
- D. Fast assessment by sonography and trauma
Explanation: **Explanation:** **1. Why Option B is Correct:** FAST stands for **Focused Assessment with Sonography for Trauma**. It is a rapid bedside ultrasound examination performed by surgeons or emergency physicians as a primary screening tool in the evaluation of blunt or penetrating abdominal trauma. The goal is not to image every organ, but to identify the presence of **free intraperitoneal or pericardial fluid** (hemoperitoneum or hemopericardium), which appears anechoic (black) on ultrasound. **2. Analysis of Incorrect Options:** * **Option A:** While the abdomen is a major focus, this is a common misnomer. The term "Assessment" is broader and more accurate as it includes the pericardial view. * **Option C:** FAST does not involve "Tomography" (CT scans). It is strictly an ultrasound-based modality. * **Option D:** "Fast" is an adjective, not the formal medical expansion of the acronym. **3. Clinical Pearls for NEET-PG:** * **The Four Standard Views:** 1. **RUQ (Morison’s Pouch):** Between the liver and right kidney (most sensitive site for free fluid). 2. **LUQ (Splenorenal space):** Between the spleen and left kidney. 3. **Pelvic (Suprapubic):** Posterior to the bladder (Pouch of Douglas in females). 4. **Subxiphoid (Pericardial):** To rule out cardiac tamponade. * **E-FAST (Extended FAST):** Includes the **pleural spaces** to detect pneumothorax (absence of lung sliding) and hemothorax. * **Indication:** Primarily used in **hemodynamically unstable** patients. If a FAST is positive in an unstable patient, they usually proceed directly to laparotomy. * **Limitation:** FAST cannot reliably detect retroperitoneal bleeds or hollow viscus injuries. CT remains the gold standard for stable patients.
Question 10: Which of the following is the investigation of choice for evaluation of acute head injury?
- A. NCCT Head (Correct Answer)
- B. CECT Head
- C. MRI Brain
- D. PET scan
Explanation: **Explanation:** **Non-Contrast Computed Tomography (NCCT) Head** is the investigation of choice (IOC) for acute head injury due to its high sensitivity in detecting acute intracranial hemorrhage (which appears hyperdense/white) and skull fractures. In an emergency setting, NCCT is preferred because it is rapid, widely available, and allows for the monitoring of unstable patients. It is excellent for identifying life-threatening conditions like epidural hematomas, subdural hematomas, and subarachnoid hemorrhages. **Why other options are incorrect:** * **CECT Head:** Contrast is generally avoided in acute trauma because intravenous contrast can mimic the appearance of acute blood (both appear white/hyperdense), making it difficult to diagnose a hemorrhage. * **MRI Brain:** While MRI is more sensitive for diffuse axonal injury (DAI) and posterior fossa lesions, it is not the initial IOC because it is time-consuming, expensive, and incompatible with metallic life-support equipment (ventilators/monitors). * **PET Scan:** This is a functional imaging modality used primarily in oncology and dementia workups; it has no role in the acute management of trauma. **Clinical Pearls for NEET-PG:** * **Windowing:** In head trauma, always evaluate both **Brain Windows** (for parenchyma/blood) and **Bone Windows** (for fractures). * **GCS:** CT is indicated if GCS <15 two hours after injury or if there is any sign of basal skull fracture (e.g., Battle sign, Raccoon eyes). * **Hyperacute Blood:** On CT, acute blood has an attenuation value of **+50 to +100 Hounsfield Units (HU)**. * **IOC for Diffuse Axonal Injury (DAI):** MRI (specifically GRE or SWI sequences).
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free