Radiographic Anatomy of Extremities — MCQs
What condition is primarily diagnosed using Von Rosen's view?
In a case of recurrent anterior dislocation of the shoulder, posterolateral lesions were found on radiological examination. What are these lesions?
The commonly injured carpal bone next to the scaphoid is:
A 40-year-old presents with chronic shoulder pain and restricted ROM. X-ray shows decreased joint space. Most likely diagnosis?
The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?
Which Salter-Harris fracture type involves a metaphyseal fragment?
A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
The best view to visualize zygomatic arches is
The following X-ray is used to evaluate \qquad sinus?
Radiographic Anatomy of Extremities Indian Medical PG Practice Questions and MCQs
Question 1: What condition is primarily diagnosed using Von Rosen's view?
- A. Congenital dislocation of the hip (CDH) (Correct Answer)
- B. Perthes disease
- C. Congenital Talipes Equinovarus (CTEV)
- D. None of the options
Explanation: ***Congenital dislocation of the hip (CDH)*** - **Von Rosen's view** is a specialized X-ray projection used specifically to assess for **developmental dysplasia of the hip (DDH)**, also known as CDH, in infants. - This view helps visualize the relationship between the **femoral head** and the **acetabulum** by positioning the infant's hips in extension, abduction, and internal rotation. *Perthes disease* - **Perthes disease** is an avascular necrosis of the femoral head, typically diagnosed with standard **frog-leg lateral** and **AP pelvic X-rays**. - While it affects the hip, Von Rosen's view is not the primary diagnostic imaging for this condition, which usually presents later in childhood. *Congenital Talipes Equinovarus (CTEV)* - **CTEV**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It is primarily diagnosed clinically and then confirmed with **AP and lateral X-rays of the foot** to assess bone alignment. *None of the options* - This option is incorrect because **Congenital dislocation of the hip (CDH)** is indeed primarily diagnosed using Von Rosen's view, among other methods.
Question 2: In a case of recurrent anterior dislocation of the shoulder, posterolateral lesions were found on radiological examination. What are these lesions?
- A. Bankart's lesion
- B. Hill-Sachs lesion (Correct Answer)
- C. Reverse Hill Sachs lesion
- D. Putti-Platt lesion
Explanation: ***Hill-Sachs lesion*** - A Hill-Sachs lesion is an **impaction fracture** of the posterolateral aspect of the **humeral head** caused by its collision with the anterior glenoid rim during anterior shoulder dislocation. - Its presence is a common finding in **recurrent anterior shoulder dislocations**, as described in the case. *Bankart's lesion* - A Bankart's lesion is an injury to the **anterior-inferior labrum** of the glenoid, often involving an avulsion of the capsule attached to the labrum. - This lesion is typically located on the **glenoid side**, not the humeral head, and is caused by the humeral head forcing against the glenoid rim during dislocation. *Putti-Platt lesion* - A Putti-Platt lesion describes a tear or avulsion of the **subscapularis tendon** and capsule from the anterior aspect of the glenoid. - This lesion is less commonly encountered as a distinct radiographic finding in the same way as a Hill-Sachs or Bankart, and refers more to surgical repair. *Reverse Hill Sachs lesion* - A reverse Hill-Sachs lesion is an impaction fracture on the **anteromedial aspect** of the humeral head. - This lesion is characteristic of a **posterior shoulder dislocation**, which is not the case described in the question.
Question 3: The commonly injured carpal bone next to the scaphoid is:
- A. Trapezoid
- B. Capitate
- C. Triquetrum (Correct Answer)
- D. Lunate
Explanation: ***Triquetrum*** - The **scaphoid** is the most commonly fractured carpal bone [1]. After the scaphoid, the **triquetrum** is the next most frequently injured carpal bone. - Injuries to the triquetrum often occur due to **hyperextension of the wrist** with ulnar deviation, typically resulting from falls onto an outstretched hand (FOOSH). *Trapezoid* - The trapezoid is a carpal bone in the **distal row** of the wrist, located medial to the trapezium and lateral to the capitate. - While it can be injured, it is **much less commonly fractured** than the scaphoid or triquetrum due to its protected position and strong ligamentous attachments. *Capitate* - The capitate is the **largest carpal bone** and the central bone in the distal row of the carpus. - Fractures of the capitate are **relatively rare**, often occurring in conjunction with other carpal injuries or dislocations, and are less frequent than triquetral fractures. *Lunate* - The lunate bone is located in the **proximal row** of carpal bones, articulating with the radius and contributing to wrist stability. - While the lunate is crucial in wrist mechanics, it is more commonly associated with **dislocations** or **Kienböck's disease** (avascular necrosis) rather than simple fractures, and is not the next most common fracture after the scaphoid.
Question 4: A 40-year-old presents with chronic shoulder pain and restricted ROM. X-ray shows decreased joint space. Most likely diagnosis?
- A. Osteoarthritis (Correct Answer)
- B. Adhesive Capsulitis
- C. Impingement Syndrome
- D. Rotator Cuff Tear
Explanation: ***Osteoarthritis*** - **Chronic shoulder pain** and **restricted range of motion (ROM)**, coupled with **decreased joint space** on X-ray, are classic signs of osteoarthritis. - This condition involves the **degeneration of articular cartilage**, leading to bone-on-bone friction and joint space narrowing. *Adhesive Capsulitis* - While it causes significant **restricted ROM** and pain, X-rays typically show a **normal joint space** in the early stages, as it primarily affects the joint capsule. - The primary pathology is **fibrosis and thickening of the joint capsule**, not cartilage loss. *Impingement Syndrome* - Characterized by pain, especially with overhead activities, due to the **compression of tendons** (often the rotator cuff) under the acromion. - X-rays usually do not show **decreased joint space** but may reveal spurs or acromial morphology predisposing to impingement. *Rotator Cuff Tear* - Causes pain and weakness, particularly during arm elevation or rotation, and can lead to restricted ROM due to pain or structural damage. - X-rays are typically **normal** or show secondary changes like **humeral head elevation** in chronic, massive tears, but not primary loss of joint space.
Question 5: The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?
- A. Gartland 3
- B. Salter Harris 3 (Correct Answer)
- C. Gartland 2
- D. Salter Harris 2
Explanation: ***Salter Harris 3*** - The image shows a **fracture extending from the epiphyseal surface down through the growth plate (physis) and exiting through the epiphysis** into the joint. This configuration is characteristic of a Salter-Harris type III fracture. - Salter-Harris Type III fractures disrupt the **articular cartilage** and can have a poorer prognosis due to potential joint incongruity and growth disturbance if not properly reduced. *Gartland 3* - The **Gartland classification** is specifically used for **supracondylar fractures of the humerus** in children, which is a different type of fracture involving the distal humerus metaphysis, not typically the growth plate itself in this manner. - Gartland type 3 refers to a **completely displaced supracondylar fracture** with no cortical contact, involving the metaphysis proximal to the growth plate. *Gartland 2* - **Gartland type 2** describes a **displaced supracondylar fracture** with an intact posterior cortex, also referring to a fracture of the distal humerus metaphysis, not a trans-growth plate fracture. - This classification is not applicable to the image which clearly depicts a fracture involving the epiphysis and physis. *Salter Harris 2* - A **Salter-Harris type II fracture** involves the **physis and extends into the metaphysis**, creating a triangular fragment known as the "Thurston Holland sign." - In the provided image, the fracture line clearly extends into the **epiphysis**, not just the metaphysis, distinguishing it from a Salter-Harris type II.
Question 6: Which Salter-Harris fracture type involves a metaphyseal fragment?
- A. Type I
- B. Type II (Correct Answer)
- C. Type III
- D. Type IV
Explanation: **Type II** - **Type II Salter-Harris fractures** involve a fracture line that extends through the growth plate (physis) and then exits through the metaphysis, carrying a portion of the metaphysis with it. - This is the most common type of Salter-Harris fracture, characterized by the presence of a **metaphyseal fragment** attached to the epiphysis. *Type I* - **Type I Salter-Harris fractures** involve a complete separation of the epiphysis from the metaphysis through the physis, without any bone fracture. - There is no involvement of the metaphysis or epiphysis in the fracture line itself, making it difficult to detect on X-ray unless displacement is significant. *Type III* - **Type III Salter-Harris fractures** involve a fracture line that extends through the growth plate and then exits through the epiphysis, extending into the joint. - This type does not involve a metaphyseal fragment; instead, a portion of the **epiphysis is fractured**. *Type IV* - **Type IV Salter-Harris fractures** involve a fracture line that passes through the epiphysis, across the growth plate, and then through the metaphysis. - This type extends through all three components (epiphysis, physis, and metaphysis) as a single fracture line, but it does not specifically involve a detached metaphyseal fragment in the way Type II does.
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 patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
- A. 1st metacarpal fracture
- B. Scaphoid fracture (Correct Answer)
- C. Trapezoid fracture
- D. Lower end of radius fracture
Explanation: ***Scaphoid fracture*** - Tenderness in the **anatomical snuffbox**, which is the area between the **extensor pollicis longus** and **extensor pollicis brevis** tendons, is a classic sign of a scaphoid fracture. - A fall on an **outstretched hand** is a common mechanism of injury for scaphoid fractures. *1st metacarpal fracture* - This type of fracture would typically present with tenderness and swelling over the **base of the thumb** or the body of the first metacarpal bone, not specifically the anatomical snuffbox. - While a fall can cause it, the precise location of tenderness points away from the first metacarpal. *Trapezoid fracture* - Fractures of the trapezoid bone are **rare** and often occur in conjunction with other carpal injuries. - Tenderness would be located more proximally and centrally in the wrist, not primarily in the anatomical snuffbox. *Lower end of radius fracture* - This injury, often a **Colles' fracture**, presents with pain, swelling, and deformity (dinner fork deformity) near the **wrist joint**, proximal to the carpal bones. - The tenderness would be more widespread and not confined to the anatomical snuffbox.
Question 9: The best view to visualize zygomatic arches is
- A. Skull PA view
- B. Jug Handle view (Correct Answer)
- C. Orthopantamogram
- D. Occipito mental view
Explanation: ***Jug Handle view*** - The **Jug Handle view**, also known as the **submentovertex (SMV) view**, is optimal for visualizing the entire course of both **zygomatic arches**, projecting them free from superimposition by other facial bones. - This projection requires the patient's head to be tilted back so that the central ray passes through the neck and enters the skull vertically, allowing for a clear, unobstructed image of the arches. *Skull PA view* - A **PA (posteroanterior) skull view** primarily demonstrates the frontal bone, orbits, and nasal cavity. - While it shows portions of the zygoma, the **zygomatic arches are often superimposed** by other cranial structures, making detailed assessment difficult. *Orthopantamogram* - An **Orthopantamogram (OPG)** is a panoramic dental X-ray that provides a broad view of the maxilla, mandible, and temporomandibular joints. - It offers a **limited or distorted view of the zygomatic arches**, as its primary purpose is dental assessment, not detailed facial bone evaluation. *Occipito mental view* - The **occipitomental view**, also known as the **Waters' view**, is excellent for visualizing the **maxillary sinuses**, orbits, and nasal bones. - While it shows the **zygomaticomaxillary complex**, it does not provide a true tangential projection of the entire zygomatic arch, which is often partially obscured by other structures.
Question 10: The following X-ray is used to evaluate \qquad sinus?
- A. Frontal
- B. Maxillary (Correct Answer)
- C. Ethmoidal
- D. Sphenoidal
Explanation: ***Maxillary*** - The image provided is a **Waters' view** (occipitomental view) X-ray of the paranasal sinuses, which is primarily used to visualize the **maxillary sinuses**. - In a Waters' view, the **petrous ridges** (dense bone at the base of the skull) are projected below the maxillary sinuses, allowing for a clear view of these sinuses. *Frontal* - While the **frontal sinuses** are visible in a Waters' view, they are generally better visualized in a **Caldwell view** (occipitofrontal view) or lateral view. - In this projection, their visualization can be obscured by other bony structures, and they are not the primary focus. *Ethmoidal* - The **ethmoidal sinuses** are typically comprised of multiple small air cells located between the orbits and are best seen on a **Caldwell view** or specialized oblique views. - In a Waters' view, their evaluation is limited due to superimposition of other facial bones. *Sphenoidal* - The **sphenoidal sinuses** are located deep within the skull, inferior to the sella turcica, and are quite difficult to visualize on standard plain radiographs like the Waters' view. - They are best assessed using a **lateral view of the skull** or advanced imaging like **CT scans**.
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