QUESTION 5
(6 MARKS). NOTE: This question has TWO (2) parts. Make sure that you attempt each part of the question.
Clinical history: A 61-year old male presents with memory problems. You are provided with a T1-weighted FLAIR sequence (top row); axial FDG-PET (2nd row) which evaluates the regional cerebral metabolic rate for glucose and gives information about the entity of neuronal loss or synapse dysfunction; 3D smoothed cortical surface projection (3rd row, SPM); and a cortical projection of a Z-score statistical map (4th row, PET Z-score) of the patient’s FDG uptake pattern relative to a normal comparison, with coloured areas indicating hypometabolism
PART A: Summarise the key radiographic features evident on the 2D and 3D PET scans (2 marks)
PART B: The FDG-PET results indicate possible Alzheimers disease (AD). Detail the progression of AD anatomically (e.g. regions and/or structures) and functionally (e.g. affected abilities) (4 marks)
QUESTION 6
(19 MARKS). NOTE: This question has SIX (5) parts. Make sure that you attempt each part of the question.
Case Synopsis:A 15-year-old female athlete presents with recurrent back pain (>18 months). The original onset was in playing basketball, and when she stopped playing, it improved. She re-injured her back 3 months ago. She is very active, and participates in dance, hurdles and horseback riding. She notes that her pain is worse with extension, jumping, and bending.
PART A: Detail the most likely radiological finding indicated by the black arrow in Figure 6.1. (2 marks)
PART B: In the square above, draw or sketch an axial view of the vertebrae indicated. Include the following:
(i) label all osteological and ligamentous components
(ii) shade/highlight/mark the area of bone affected by the abnormality noted in PART A (4 marks)
PART C: The junior radiographer complains that it is too hard to see the area of trauma. He suggests a repeat scan with an increased KvP. Briefly detail the effects of this decision on the patient and image quality. (3 marks)
PART D: The 15-year-old patient returns to the doctor 6 weeks later with bilateral leg pain, movement restriction and lower back pain. She reports being unable to sit for more than 10 minutes.
Have the radiological findings in this patient changed since her initial visit, based on the radiograph in Figure 6.2?
Justify your answer using your anatomical knowledge. (3 marks)
Fig 6.2: Lateral, right lumbar spine radiograph.
PART E: The patient exhibits weakness when asked to flex her knees and point her toes to the sky (dorsiflex). She is unable to plantarflex the ankle and has no sensory response to pinprick tests over the lateral margin of the foot and little toe or posteromedial strip of the leg and thigh. Sensation on the medial malleolus and the sole of the foot is still preserved. Which nerve root/s have been compressed in this patient? (2 marks)
PART F: The junior radiographer cannot wrap his head around how the x-ray machine works and how x-rays are produced. Using a drawing, sketch or flowchart, detail the main components of the x-ray rube and the basic physics behind x-ray production, in the space below. (5 marks)
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