A Complete Guide to the Final FRCR 2B

Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison

• Publisher: CRC Press
• Year: 2022
• eBook ISBN: 9781000605051
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This book aims to help candidates preparing for the Final FRCR 2B examinations held by the Royal College of Radiologists of the UK, and the Joint Final FRCR/FHKCR Part B Examination for the Fellowship of the Royal College of Radiologists and Hong Kong College of Radiologists. This book provides advice on preparation techniques, followed by dozens of practice cases and images relevant to all three sections of the examination: reporting session, rapid reporting session and oral examination/viva voce. The richly-illustrated book contains images of plain X-rays, CT, MR, US and radionuclide scans, making it particularly useful for candidates who have limited access to teaching or film libraries. A selection of both common and uncommon cases is included, giving candidates a realistic idea of the level of preparation and the breadth and depth of knowledge needed for success. Although primarily focused on the FRCR 2B examination, radiology trainees across the world facing viva and reporting sessions and candidates for American Board Examinations will find this a useful and informative book.

Section II

Chapter 1

Reporting session

Case bag 1

CASE 1.1

Age: 72 years	Gender: Male
Clinical problem: Back pain following a fall
Images in exam case: Plain radiograph (4), CT (2)

Figure 1a

Figure 1b

Figure 1c

Figure 1d

Figure 1e

Figure 1f

FINDINGS

• 1. X-ray thoracolumbar spine:

• a. Marginal syndesmophytes
• b. Ossification of the interspinous ligament – ‘dagger’ sign
• c. Ossification of the anterior longitudinal ligament
• d. Fusion of both sacroiliac joints
• e. Fracture through mid-thoracic intervertebral disc with retrolisthesis of superior vertebra.

• 2. CT whole spine:

• a. Ossification of anterior longitudinal ligament
• b. Fusion of multiple facet joints
• c. Severe cervicothoracic kyphosis
• d. Fracture line starting at D5/6 intervertebral disc and extending into the posterosuperior body of D6 and D6/7 facet joints
• e. Mild retrolisthesis of D5 over D6
• f. Widened lucent line through D10/11 disc space and facet joints with adjacent reactive sclerosis
• g. Distended urinary bladder.

DIAGNOSIS

• 1. Ankylosing spondylitis, acute fracture through D5/6 extending through the posterior elements. This is an unstable fracture as all three vertebral columns are disrupted.
• 2. Pseudoarthrosis D10/11, most likely secondary to non-union of an old fracture.

FURTHER INVESTIGATIONS AND MANAGEMENT

• 1. Urgent neurosurgical referral, as the fracture is unstable.
• 2. If there are signs of cord compression, MRI may be necessary to look for cord injury or spinal extra-axial haematoma.

FURTHER INFORMATION

Ankylosing spondylitis is a regular feature of the FRCR 2B examination, either as a written case or in the viva. The scenarios involved could be bilateral symmetrical sacroiliac joint erosion, sclerosis or fusion, erosion of the anterosuperior corner of the vertebra on lateral radiograph (Romanus sign), sclerosis of the anterosuperior corner and periostitis of the waist giving rise to vertebral ‘squaring’, syndesmophyte formation leading to ‘bamboo spine’, intervertebral disc calcification, ossification of the anterior longitudinal, posterior longitudinal, interspinous and supraspinous ligaments, kyphosis and facet joint fusion. Other skeletal features include erosions of the symphysis pubis and ischial tuberosities, asymmetrical erosive oligoarthritis, atlanto-axial dislocation and osteoporosis. In a traumatic setting, the fracture line may run through the intervertebral disc space right through into the posterior elements, and may be missed if one is not vigilant. Clinically occult fractures can also occur, leading to mobile non-union (pseudoarthrosis) – the so-called Anderson lesion.

CASE 1.2

Age: 63 years	Gender: Male
Clinical problem: Histo...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• List of image contributors
• Dedication
• Section I
• Section II
• Further reading
• Index