Radiographic Anatomy of Bones and Joints — MCQs
Epiphyseal tumor before fusion of epiphysis:
CT numbers of water and bone are respectively:
The image shows a highlighted region on the dorsal aspect of the hand (anatomical snuffbox). Which of the following anatomical structures form the boundaries or floor of this region?
Osteoarthritis is associated with all of the following except -
In which of the following conditions is joint erosion NOT a primary feature?
Which of the following is not a feature of ankylosing spondylitis?
A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
A 7-year-old child presents with a lesion in upper tibia. X-ray shows radiolucent area with Codman's triangle and sunray appearance. Diagnosis is
Holdsworth classification of thoracolumbar spine fracture is based on how many columns of spine?
Radiographically, the lesion shown in the image could be:
Radiographic Anatomy of Bones and Joints Indian Medical PG Practice Questions and MCQs
Question 1: Epiphyseal tumor before fusion of epiphysis:
- A. Chondrosarcoma
- B. Chondroblastoma (Correct Answer)
- C. Giant cell tumor
- D. Ewing's sarcoma
Explanation: ***Chondroblastoma*** - This is primarily an **epiphyseal tumor** that occurs predominantly in adolescents and young adults **before epiphyseal fusion**. - It is a **benign cartilaginous tumor** that typically presents with pain and swelling around the affected joint. *Chondrosarcoma* - This is a **malignant cartilaginous tumor** that typically occurs in older adults, usually after epiphyseal fusion. - While it can occur in various bones, it is generally found in the **metaphysis or diaphysis**, not primarily the epiphysis before fusion. *Giant cell tumor* - This tumor is typically found in the **epiphysis/metaphysis** but primarily occurs in skeletally mature individuals **after epiphyseal closure**. - It is characterized by its aggressive nature and high recurrence rate, but is less common before epiphyseal fusion. *Ewing's sarcoma* - This is a highly **malignant bone tumor** that primarily affects the **diaphysis** of long bones and flat bones. - It is common in children and young adults but is not characteristically an epiphyseal tumor before fusion.
Question 2: CT numbers of water and bone are respectively:
- A. 100,0
- B. +1000,-100
- C. 0, + 1000 (Correct Answer)
- D. 0,-1000
Explanation: ***0, + 1000*** - The **CT number (Hounsfield Unit)** for **water** is defined as **0**, serving as a reference point for all other tissues in CT imaging. - **Bone**, particularly **cortical bone**, has a high density and thus corresponds to a CT number of approximately **+1000 HU**. *100,0* - This option incorrectly assigns a CT number of **100 to water**, which is fundamentally incorrect as water is defined as **0 HU**. - It also assigns **0** to **bone**, which is the CT number for water, not bone. *+1000,-100* - This option correctly identifies **+1000 HU** for dense bone but incorrectly assigns **-100 HU to water**, which is the CT number typically associated with fat, not water. *0,-1000* - While **0 HU** is correct for water, **-1000 HU** is the CT number for **air**, not bone. - Bone has a high positive CT number due to its high density, whereas air has a very low negative CT number.
Question 3: The image shows a highlighted region on the dorsal aspect of the hand (anatomical snuffbox). Which of the following anatomical structures form the boundaries or floor of this region?
- A. Abductor pollicis longus muscle.
- B. Styloid process of the radius.
- C. Extensor pollicis longus muscle.
- D. All of the above anatomical structures. (Correct Answer)
Explanation: ***All of the above anatomical structures.*** - The image highlights the **anatomical snuffbox**, a triangular depression on the radial dorsal aspect of the hand. Its boundaries are formed by the tendons of the **extensor pollicis longus muscle** (ulnar side), and the **abductor pollicis longus** and **extensor pollicis brevis muscles** (radial side). - The **styloid process of the radius** forms the floor of the anatomical snuffbox along with the scaphoid and trapezium bones. All the options listed are key anatomical features associated with this region. *Extensor pollicis longus muscle.* - This muscle forms the **ulnar (medial) border** of the anatomical snuffbox. - Its tendon can be palpated during **thumb extension** and contributes to the overall structure of the highlighted area. *Abductor pollicis longus muscle.* - This muscle, along with the extensor pollicis brevis, forms the **radial (lateral) border** of the anatomical snuffbox. - Its tendon is visible and palpable on the radial side of the highlighted region when the thumb is abducted. *Styloid process of the radius.* - This bony prominence is located at the **distal end of the radius** on the radial side of the wrist. - It forms part of the **proximal floor** of the anatomical snuffbox, contributing to its definition.
Question 4: Osteoarthritis is associated with all of the following except -
- A. Subchondral sclerosis
- B. Ca++deposition in joint space (Correct Answer)
- C. Osteophyte formation
- D. Decreased joint space
Explanation: ***Ca++deposition in joint space*** - **Calcium pyrophosphate dihydrate (CPPD) crystal deposition** in the joint space is characteristic of **pseudogout**, not osteoarthritis [1]. - While some **calcification** may occur in osteophytes, direct **calcium crystal deposition** in the synovial fluid is not a primary feature of osteoarthritis [1]. *Subchondral sclerosis* - **Subchondral sclerosis** refers to the increased bone density that occurs beneath the cartilage in areas of stress in osteoarthritis. - This is a common radiological finding in osteoarthritis, reflecting the bone's response to increased mechanical load. *Osteophyte formation* - **Osteophytes** (bone spurs) are bony projections that form along the joint margins in osteoarthritis [2]. - They are a hallmark feature of the disease, resulting from the body's attempt to repair and stabilize the damaged joint [2]. *Decreased joint space* - **Decreased joint space** on radiographs is a classic sign of osteoarthritis, indicating loss of articular cartilage thickness [2]. - As the cartilage erodes, the distance between the bones within the joint decreases. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 683-684. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1210-1212.
Question 5: In which of the following conditions is joint erosion NOT a primary feature?
- A. Psoriatic arthropathy
- B. Rheumatoid arthritis
- C. Osteoarthritis
- D. SLE (Correct Answer)
Explanation: ***SLE*** - While arthritis is common in **Systemic Lupus Erythematosus (SLE)**, it is typically **non-erosive**, meaning it does not cause damage to the **cartilage** or **bone** [1]. - Joint involvement in SLE is often characterized by **arthralgias** or a **reversible inflammatory arthritis**. *Osteoarthritis* - **Osteoarthritis** is definitively characterized by the **progressive erosion of articular cartilage**, leading to **bone-on-bone friction** and structural changes. - This condition involves **wear-and-tear** that directly causes damage to the joint surfaces. *Psoriatic arthropathy* - **Psoriatic arthropathy** (Psoriatic Arthritis) is an inflammatory condition that can lead to significant **joint erosion** and **destruction**, particularly in the small joints of the hands and feet [1]. - It often features characteristic radiographic changes such as **"pencil-in-cup" deformities** due to bone resorption and erosion [1]. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a classic example of an inflammatory arthritis where **joint erosion** is a primary and hallmark feature, driven by **synovial inflammation** and pannus formation. - Persistent inflammation in RA leads to **cartilage destruction** and **subchondral bone erosion**.
Question 6: Which of the following is not a feature of ankylosing spondylitis?
- A. Morning stiffness is a feature of ankylosing spondylitis.
- B. Improvement with exercise is a feature of ankylosing spondylitis.
- C. Asymmetric joint involvement (Correct Answer)
- D. Pain relief with NSAIDs is a feature of ankylosing spondylitis.
Explanation: ***Asymmetric joint involvement*** - While ankylosing spondylitis can involve peripheral joints, the axial skeletal involvement (sacroiliac joints and spine) is typically **symmetric** [1]. - **Asymmetric joint involvement** is more characteristic of other spondyloarthropathies, such as **psoriatic arthritis** or **reactive arthritis** [1]. *Morning stiffness is a feature of ankylosing spondylitis* - Patients with ankylosing spondylitis frequently experience significant **morning stiffness**, often lasting more than 30 minutes, which is a classic symptom of inflammatory back pain [2]. - This stiffness is due to the characteristic **inflammation** of the axial skeleton, particularly the sacroiliac joints and spine. *Improvement with exercise is a feature of ankylosing spondylitis* - The back pain and stiffness associated with ankylosing spondylitis typically **improve with activity and exercise**, distinguishing it from mechanical back pain which often worsens with movement [2]. - Regular physical activity helps to reduce the **stiffness and discomfort** by promoting joint mobility. *Pain relief with NSAIDs is a feature of ankylosing spondylitis* - Nonsteroidal anti-inflammatory drugs (**NSAIDs**) are often very effective in providing **significant pain relief** for patients with ankylosing spondylitis, especially early in the disease course [3]. - Their effectiveness in reducing pain and inflammation is a key diagnostic clue and a cornerstone of initial symptomatic treatment.
Question 7: A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
- A. Bohler's Angle
- B. Ferguson's Angle
- C. Cobb's Angle (Correct Answer)
- D. Pauwels' Angle
Explanation: **Cobb's Angle** - **Cobb's angle** is the primary method for measuring the severity of **scoliosis** on radiographs. - It is measured by drawing lines parallel to the superior endplate of the most tilted superior vertebra and the inferior endplate of the most tilted inferior vertebra of the curve; the angle between these two lines (or their perpendiculars) is the Cobb angle. *Bohler's Angle* - **Bohler's angle** is used in the assessment of **calcaneus fractures** and is measured on a lateral foot radiograph. - A decrease in this angle is indicative of a calcaneal fracture. *Ferguson's Angle* - **Ferguson's angle**, also known as the lumbosacral angle, measures the inclination of the sacrum relative to the horizontal in the standing position. - It is primarily used in the assessment of **spondylolisthesis** and other lumbosacral conditions. *Pauwels' Angle* - **Pauwels' angle** is used to classify **femoral neck fractures** based on the angle of the fracture line relative to the horizontal. - It helps determine the severity and stability of femoral neck fractures, guiding treatment decisions.
Question 8: A 7-year-old child presents with a lesion in upper tibia. X-ray shows radiolucent area with Codman's triangle and sunray appearance. Diagnosis is
- A. Osteosarcoma (Correct Answer)
- B. Osteoid Osteoma
- C. Ewing sarcoma
- D. Chondrosarcoma
Explanation: ***Osteosarcoma*** - The classic radiographic features of **Codman's triangle** (periosteal elevation) and **sunray appearance** (spiculated periosteal reaction) are highly characteristic of osteosarcoma. - This tumor commonly affects the **metaphysis of long bones** in children and young adults, with the distal femur and proximal tibia being frequent sites. *Osteoid Osteoma* - This is a **benign bone tumor** characterized radiographically by a small radiolucent **nidus** surrounded by a rim of dense sclerosis. - It does not present with Codman's triangle or sunray appearance and typically causes **nocturnal pain relieved by NSAIDs**. *Ewing sarcoma* - Ewing sarcoma often presents with an **"onion skin" periosteal reaction** (layers of new bone formation) due to its aggressive nature. - While it can be destructive and radiolucent, it typically does not classically exhibit the sunray appearance or a distinct Codman's triangle as prominently as osteosarcoma. *Chondrosarcoma* - Chondrosarcoma is a **malignant cartilaginous tumor** that usually affects older adults more commonly than children. - Radiographically, it often shows a **lobulated appearance** with **punctate or ring-and-arc calcifications** within the lesion, not the sunray or Codman's triangle findings.
Question 9: Holdsworth classification of thoracolumbar spine fracture is based on how many columns of spine?
- A. Two (Correct Answer)
- B. Three
- C. Four
- D. Five
Explanation: ***Two*** - The **Holdsworth classification** focuses on the **biomechanical stability** of the spine and divides the vertebral column into two main columns: the **anterior column** and the **posterior column**. - This classification was foundational for understanding spinal instability, particularly related to **flexion-rotation injuries**. *Three* - The **Denis classification** is based on a **three-column model** (anterior, middle, and posterior columns) and is more commonly used in current practice for describing thoracolumbar spine fractures. - While Denis expanded upon Holdsworth's ideas, Holdsworth himself only described two columns. *Four* - There is no widely recognized or primary classification system for thoracolumbar spine fractures that uses a **four-column model**. - Spinal fracture classifications primarily revolve around two- or three-column models, or more recently, morphological and neurological injury patterns (e.g., AO Spine classification). *Five* - A **five-column model** is not standard for classifying thoracolumbar spine fractures in medical literature. - Comprehensive classifications usually incorporate factors beyond just column numbers, such as injury morphology, neurological status, and integrity of the disc and ligaments.
Question 10: Radiographically, the lesion shown in the image could be:
- A. Cherubism
- B. Garre's osteomyelitis (Correct Answer)
- C. Fibrous dysplasia
- D. Osteosarcoma
Explanation: ***Garre's osteomyelitis*** - The radiographs show **periosteal new bone formation** resembling an **"onion skin"** appearance, which is characteristic of **Garre's osteomyelitis** (chronic osteomyelitis with proliferative periostitis). - This condition is typically a **reaction to low-grade chronic infection** or irritation, often seen in the periosteum of the mandible. *Cherubism* - Cherubism is a **fibro-osseous lesion** characterized by bilateral, symmetric enlargement of the jaws, giving a "cherubic" appearance. - Radiographically, it presents as **multilocular radiolucencies** with poorly defined borders, usually in children. *Fibrous dysplasia* - Fibrous dysplasia is a developmental anomaly where normal bone is replaced by **fibrous tissue and immature bone**. - Radiographically, it often has a **"ground glass" appearance** or a "peau d'orange" texture, differentiating it from the periosteal reaction seen in the image. *Osteosarcoma* - Osteosarcoma is a **malignant bone tumor** that typically shows a mix of osteolytic and osteoblastic areas, often with a **"sunburst" or "spiculated" periosteal reaction**. - While it involves periosteal reaction, the pattern and typical aggressive nature differ from the more layered and milder appearance of Garre's osteomyelitis.
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