🩻 Radiology · Part 4 revision hub

Musculoskeletal Imaging

Everything you need to revise this Part in one place — the one‑page note for every concept, a rapid‑revision sheet, exam‑style questions that point you back to the right concept, flashcards, staged cases and viva practice.

16 concepts20 MCQs20 flashcards4 cases15 viva questions

📝 The plate wall

Every concept in this Part as a one‑page handwritten note. Open one to read it in full and zoom.

⚡ Rapid revision

The whole Part on one screen — read it the night before.

Fractures and arthritis

Two orthogonal views, joint above and below; ABCS (alignment, bone, cartilage, soft tissue). Describe the distal fragment relative to the proximal. Lipohaemarthrosis = intra‑articular fracture.
OA = LOSS (non‑uniform loss, osteophytes, sclerosis, cysts); medial knee earliest. Inflammatory = uniform loss, periarticular osteopenia, marginal erosions.
RA: symmetric MCP/PIP/wrist, DIP spared, ulnar styloid and 5th MTP erosions; swan neck, boutonnière, Z‑thumb, ulnar deviation; atlantoaxial subluxation. Felty = RA + spleen + neutropenia; Caplan = RA + pneumoconiosis nodules.
AS: bilateral symmetric sacroiliitis (MRI earliest), Romanus shiny corner, squaring, syndesmophytes → bamboo spine; dagger, trolley‑track; carrot‑stick fracture.
Psoriatic: DIP, sausage digit, pencil‑in‑cup, ivory phalanx, no osteopenia, parasyndesmophytes.
Gout: 1st MTP, punched‑out erosions with overhanging edges (Martel), joint space preserved, no osteopenia; DECT. CPPD: meniscal chondrocalcinosis, isolated patellofemoral OA; 4 Hs. Ochronosis: multilevel disc calcification.
Charcot 6 Ds: diabetes → foot (Lisfranc), syringomyelia → shoulder, tabes → knee. DISH ≥ 4 vertebrae, candle wax, discs and SIJ normal. OPLL cervical, MRI for cord.

Infection and metabolic disease

Osteomyelitis: radiograph lags ~10–14 days; bone scan 24–48 h; MRI IOC. Sequestrum (dead), involucrum (new shell), cloaca (hole); Marjolin ulcer. Brodie abscess: subacute metaphyseal lucency with sclerotic rim, penumbra sign.
Septic arthritis: US effusion → aspirate; early widening → rapid narrowing; Tom Smith (infant hip). TB arthritis: Phemister triad; spina ventosa; Pott's spine (paradiscal, disc preserved early, large cold abscess).
Diabetic foot osteomyelitis: MRI (low T1 marrow contiguous with ulcer).
Rickets: widened physis, cupping, splaying, fraying (wrist, knee); healing dense band. Osteomalacia: Looser zones. Osteoporosis: DEXA T ≤ −2.5. Scurvy: Wimberger ring, Frankel line, Trümmerfeld zone, Pelkan spur, subperiosteal haemorrhage.
HPT: radial middle phalanges (2nd/3rd) subperiosteal resorption, salt‑and‑pepper skull, brown tumours. Renal: rugger‑jersey. Paget's: enlarged bone, cotton‑wool skull, picture‑frame vertebra, blade of grass. Thalassaemia: hair‑on‑end, Erlenmeyer flask; sickle: H vertebra, AVN.
AVN: steroids/alcohol; femoral head; MRI (double line sign); crescent sign = collapse. Hawkins sign = viable talus. Perthes 4–8 yr boys, Waldenström sign earliest. Kienböck lunate, Freiberg 2nd MT head, Köhler navicular, Osgood–Schlatter tibial tuberosity.

Tumours and dysplasias

ALTA: Age (most useful), Location, Transition zone, Appearance (matrix, periosteum). Epiphysis: chondroblastoma (immature), GCT (mature). Diaphysis: Ewing. Metaphysis: osteosarcoma.
Periosteal reactions: solid (benign) → lamellated (Ewing, infection) → sunburst (osteosarcoma) → Codman triangle (aggressive).
Polyostotic: FEEMMHI. "Don't touch": NOF, bone island, cortical desmoid.
Osteochondroma (commonest benign; points away from joint; cap > 1.5–2 cm = worry). Osteoid osteoma (nidus < 1.5 cm, night pain, NSAIDs, CT, RFA). SBC (proximal humerus, fallen fragment). ABC (fluid–fluid levels). FD (ground glass, shepherd's crook, McCune–Albright). Chondroblastoma (epiphyseal, chicken wire). Haemangioma (corduroy, polka dot).
Osteosarcoma (10–25, distal femur, sunburst, Codman, lung mets). Parosteal (posterior distal femur, string sign). Ewing (5–20, diaphysis, onion skin, soft‑tissue mass). Chondrosarcoma (> 40, pelvis, rings and arcs). GCT (20–40, epimetaphyseal to subchondral, soap bubble, no sclerotic rim). Chordoma (sacrum > clivus).
Metastasis = commonest malignant bone lesion; prostate sclerotic; renal/thyroid blow‑out; winking owl. Myeloma: raindrop skull, cold bone scan, WB‑LDCT/MRI. LCH: bevelled edge, vertebra plana (child).
Achondroplasia: champagne‑glass pelvis, trident hand, narrowing interpedicular distance. OI: fractures, Wormian bones, blue sclera. Osteopetrosis: bone‑within‑bone, sandwich. Cleidocranial: absent clavicles. Morquio central beak; Hurler inferior beak.

🎯 Single‑best‑answer MCQs

Pick an answer to see the explanation — and the concept to revisit if you missed it. Your answers are saved on this device.

Score 0 / 00 of 20 answered

Question 1
A horizontal‑beam lateral knee radiograph after trauma shows a fat–fluid level in the suprapatellar bursa. This indicates:
Question 2
Which feature favours osteoarthritis over rheumatoid arthritis?
Question 3
Which joints are characteristically spared in rheumatoid arthritis?
Question 4
The earliest imaging finding of ankylosing spondylitis is best shown by:
Question 5
Punched‑out juxta‑articular erosions with overhanging edges and preserved joint space at the first MTP joint suggest:
Question 6
A neuropathic shoulder joint is most characteristically associated with:
Question 7
Flowing ossification along the anterolateral aspect of at least four contiguous thoracic vertebrae with preserved disc heights and normal SI joints is:
Question 8
The investigation of choice for early acute osteomyelitis is:
Question 9
In chronic osteomyelitis, the dead fragment of bone acting as a nidus of infection is the:
Question 10
TB dactylitis of the short tubular bones of a child's hand is called:
Question 11
Looser zones are characteristic of:
Question 12
The radiographic hallmark of rickets at the wrist is:
Question 13
The earliest and most specific radiographic sign of hyperparathyroidism is subperiosteal resorption of:
Question 14
H‑shaped vertebrae are characteristic of:
Question 15
The most sensitive imaging test for early avascular necrosis of the femoral head is:
Question 16
Which tumour classically produces an onion‑skin periosteal reaction in the diaphysis of a child's long bone?
Question 17
A "fallen fragment" sign is pathognomonic of:
Question 18
A lytic, eccentric, expansile lesion extending to the subchondral bone of the distal femur in a 28‑year‑old, with a narrow zone of transition and no sclerotic rim, is most likely:
Question 19
A bone scan is often normal despite extensive disease in:
Question 20
A "champagne‑glass" pelvic inlet and trident hand are features of:

🃏 Flashcards

Say the answer out loud before you flip. Shuffle once you know the order.

Card 1 of 20

🩺 Staged clinical cases

Read the presentation, decide what is going on and what you would do — then reveal the reasoning.

Case 1 — The limping 6‑year‑old

Stage A: A 6‑year‑old boy has had a painless limp for 3 weeks and intermittent knee pain. He is afebrile with normal inflammatory markers. AP pelvis: subtle widening of the left medial hip joint space and a slightly smaller, denser left femoral epiphysis.

Linked concepts: 53. Bone That Dies, 50. Infected Joints, TB Bones and the Diabetic Foot

Case 2 — The teenager's night pain

Stage A: A 15‑year‑old has 2 months of left knee pain waking him at night, not relieved by NSAIDs, and a firm swelling above the knee. Radiograph: ill‑defined mixed lytic–sclerotic distal femoral metaphyseal lesion with spiculated periosteal reaction and a Codman triangle.

Linked concepts: 54. Reading a Bone Lump, 56. Dangerous Bone Tumours

Case 3 — The diabetic's swollen foot

Stage A: A 58‑year‑old with long‑standing diabetes and peripheral neuropathy has a warm, swollen, minimally painful midfoot. No ulcer. Radiograph: fragmentation and subluxation at the tarsometatarsal joints with sclerosis.

Linked concepts: 48. Joints That Cannot Feel and Spines That Ossify, 50. Infected Joints, TB Bones and the Diabetic Foot

Case 4 — The old man with back pain and anaemia

Stage A: A 68‑year‑old has back pain, anaemia, raised creatinine and calcium. Spine radiograph: diffuse osteopenia with an L2 compression fracture. A bone scan done elsewhere was "normal".

Linked concepts: 57. Cancer That Spreads to Bone, 22. Concept 22

🎤 Viva practice

Answer aloud as if an examiner asked you — then check the model points.

Viva 1

How do you describe a fracture?

Viva 2

Distinguish OA from RA radiographically.

Viva 3

What is the significance of atlantoaxial subluxation in RA?

Viva 4

Describe the spinal changes of AS.

Viva 5

What are the radiological features of chronic gout?

Viva 6

List the 6 Ds of a Charcot joint and causes by site.

Viva 7

Why are radiographs normal in early osteomyelitis?

Viva 8

Define sequestrum, involucrum and cloaca.

Viva 9

How do you differentiate osteoporosis from osteomalacia?

Viva 10

What are the radiological signs of scurvy?

Viva 11

Describe the MRI features of AVN.

Viva 12

What does ALTA stand for in bone tumour assessment?

Viva 13

Name four "don't touch" bone lesions.

Viva 14

Compare osteosarcoma and Ewing sarcoma.

Viva 15

Why is a bone scan unreliable in myeloma?

Keep going

📘 Foundation contents 🩺 Clinical Reasoning contents 🎯 More practice

Educational only — not a substitute for clinical judgement, supervision, or local guidelines.

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