CCEP CCEP Radiology & Imaging for Extremities 1 — Questions and Answers
Question 1: Which specialized radiographic view best visualizes the bony borders of the carpal tunnel?
- PA wrist
- Lateral wrist
- Carpal tunnel (tangential) view (Correct answer)
- Oblique wrist
Correct answer: Carpal tunnel (tangential) view
The carpal tunnel view is taken with the wrist in dorsiflexion and the beam directed along the tunnel, profiling the hook of hamate and pisiform.
Question 2: Which radiographic finding on an AP knee view is most consistent with osteoarthritis?
- Increased joint space
- Joint space narrowing (Correct answer)
- Periosteal reaction
- Cortical thinning
Correct answer: Joint space narrowing
Osteoarthritis on radiograph classically shows joint space narrowing along with osteophytes, subchondral sclerosis, and subchondral cysts.
Question 3: The Ottawa Ankle Rules recommend radiographs based on which clinical findings?
- Patient age and mechanism only
- Bone tenderness at specific sites and inability to weight bear (Correct answer)
- Swelling and ecchymosis pattern
- Soft tissue pain with palpation only
Correct answer: Bone tenderness at specific sites and inability to weight bear
Ottawa Ankle Rules require X-rays when there is bone tenderness at the posterior fibula or tibia malleoli, or inability to bear weight immediately after injury and in the ED.
Question 4: Which MRI sequence is most sensitive for detecting soft tissue edema and ligament tears in the extremities?
- T1-weighted
- T2-weighted or STIR (Correct answer)
- Proton density fat-saturated
- Gradient echo
Correct answer: T2-weighted or STIR
T2-weighted and STIR sequences display fluid as bright (hyperintense) signal, making them ideal for detecting edema, ligament tears, and joint effusions.
Question 5: A Hill-Sachs lesion of the posterolateral humeral head is best visualized on which shoulder X-ray view?
- True AP in neutral rotation
- Axillary view
- Internal rotation AP (Correct answer)
- Y-scapular view
Correct answer: Internal rotation AP
The Hill-Sachs compression fracture is best seen on the AP shoulder view with the arm in internal rotation, which brings the posterolateral head into profile.
Question 6: Which imaging modality is preferred for detecting stress fractures not yet visible on plain radiographs?
- Ultrasound
- CT scan
- MRI (Correct answer)
- Repeat plain X-ray in 2 weeks
Correct answer: MRI
MRI is the gold standard for early stress fracture detection, revealing bone marrow edema before cortical changes appear on radiographs.
CCEP CCEP Radiology & Imaging for Extremities 1
Which specialized radiographic view best visualizes the bony borders of the carpal tunnel?