Fracture
Positioning
Anatomy
Critique/ criteria
Image acquisition
100
Medial displacement of a tibial fracture would be best demonstrated in the
A/ AP projection
B/lateral projection
C/ medial oblique projection
D/ lateral oblique projection
The Correct Answer is: A
A frontal projection (AP or PA) demonstrates the medial and lateral relationships of structures. A lateral projection demonstrates the anterior and posterior relationships of structures.
100
:
An axial projection of the clavicle is often helpful in demonstrating a fracture that is not visualized using a perpendicular CR. When examining the clavicle in the PA axial projection, how should the Central Ray directed?
A Cephalad
B Caudad
C Medially
D Laterally
The correct answer is (B).
With the patient positioned AP erect or supine, the CR is directed cephalad 25 to 30°. This serves to project the clavicle away from the pulmonary apices and ribs, projecting most of the clavicle above the thorax. The reverse is true when the patient is examined for the PA axial projection, i.e. the CR is directed caudally. The PA and PA axial projections can be useful for better resolution because of the reduced OID.
100
Which of the following correctly identifies the head of the ulna in the illustration in the Figure ?
A Number 3
B Number 4
C Number 5
D Number 9
The Correct Answer is: D
An anterior view of the forearm is shown. The proximal anterior surface of the ulna (number 8) presents a rather large pointed process at the anterior margin of the semilunar (trochlear) notch (number 5) called the coronoid process (number 6). The olecranon process is identified as number 4, and the radial notch of the ulna is number 7. Distally, the ulnar head is number 9, and the styloid process is labeled 10. The radius (number 12) is the lateral bone of the forearm. The radial head is number 3, the radial neck is number 2, and the radial tuberosity is number 1. Distally, the radial styloid process is labeled 11
100
Which of the following is (are) valid criteria for a lateral projection of the forearm?
1.The radius and ulna should be superimposed proximally and distally.
2.The coronoid process and radial head should be superimposed.
3.The radial tuberosity should face anteriorly.
A 1 only
B 1 and 2 only
C 2 and 3 only
D 1, 2, and 3
The Correct Answer is: C
To accurately position a lateral forearm, the elbow must form a 90° angle with the humeral epicondyles superimposed. The radius and ulna are superimposed only distally. Proximally, the coronoid process and radial head are superimposed, and the radial head faces anteriorly. Failure of the elbow to form a 90° angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm.
100
How can OID be reduced for a PA projection of the wrist?
A Extend the fingers.
B Flex the metacarpophalangeal joints.
C Extend the forearm.
D Oblique the metacarpals 45 degrees.
The Correct Answer is: B
When the hand is pronated and the fingers are extended for a PA projection of the wrist, the wrist arches, and an OID is introduced between the wrist and the cassette. To reduce this OID, the metacarpophalangeal joints should be flexed slightly. This maneuver will bring the anterior surface of the wrist into contact with the cassette.
200
Which of the following fracture classifications describes a small bony fragment pulled from a bony process?
A /Avulsion fracture
B /Torus fracture
C /Comminuted fracture
D /Compound fracture
The Correct Answer is: A
An avulsion fracture is a small bony fragment pulled from a bony process as a result of a forceful pull of the attached ligament or tendon.
A comminuted fracture is one in which the bone is broken or splintered into pieces.
A torus fracture is a greenstick fracture with one cortex buckled and the other intact.
A compound fracture is an open fracture in which the fractured ends have perforated the skin.
200
For the AP projection of the scapula, the
1-patient's arm is abducted at right angles to the body.
2-patient's elbow is flexed.
3-exposure is made during quiet breathing.
A 1 and 2 only
B 1 and 3 only
C 3 only
D 1, 2, and 3
The Correct Answer is: D
With the patient in the AP position, the scapula and upper thorax are normally superimposed. With the arm abducted, the elbow flexed, and the hand usually supinated, much of the scapula is drawn away from the ribs. The patient should not be rotated toward the affected side because this causes superimposition of ribs on the scapula. The exposure is made during quiet breathing to obliterate pulmonary vascular markings
200
Which of the following indicates the scapular costal surface seen in the figure below?
A D
B H
C K
D M
The correct answer is: (C)
The radiograph illustrates an AP projection of the scapula; abduction of the arm moves the scapula away from the rib cage, revealing a greater portion of the scapula than would be visualized with the arm at the side. A number of bony structures are identified: the acromion process (A), the humeral head (B), glenoid fossa (C), scapular spine (D), clavicle (E), supraspinatus fossa (F), acromioclavicular joint (G), scapular notch (H), coracoid process (I), inferior angle/apex (j), body/costal surface (K), lateral/axillary border (L), axillary part upper rib (M).
200
Which of the following statements regarding the radiograph in Figure is (are) true?
1.The tibial eminences are well visualized.
2.The intercondyloid fossa is demonstrated between the femoral condyles.
3.The femorotibial articulation is well demonstrated.
A 1 only
B 1 and 2 only
C 1 and 3 only
D 2 and 3 only
The Correct Answer is: C
The pictured radiograph is an AP projection of the knee with the knee extended. The tibial intercondylar eminences are well demonstrated on the tibial plateau, and the femorotibial joint is well visualized. The intercondyloid fossa is not demonstrated here. A "tunnel" view of the knee is required to demonstrate the intercondyloid fossa
200
Which of the following projections will best demonstrate the carpal scaphoid?
A Lateral wrist
B Ulnar deviation
C Radial deviation
D Carpal tunnel
The Correct Answer is: B
The carpal scaphoid is somewhat curved and consequently foreshortened radiographically in the PA projection/position. To better separate it from the adjacent carpals, the ulnar deviation maneuver is frequently employed. In addition to correcting foreshortening of the scaphoid, ulnar deviation opens the interspaces between adjacent lateral carpals. Radial deviation is used to better demonstrate medial
300
The relationship between the ends of fractured long bones is referred to as
A angulation
B apposition
c luxation
D sprain
The Correct Answer is: B
Various terms are used to describe the position of fractured ends of long bones. The term apposition is used to describe the alignment, or misalignment, between the ends of fractured long bones.
The term angulation describes the direction of misalignment.
The term luxation refers to a dislocation.
A sprain refers to a wrenched articulation with ligament injury.
300
With the patient positioned as shown in the Figure , how should the CR be directed to best demonstrate the intercondyloid fossa?
A Perpendicular to the popliteal depression
B 40 degrees caudad to the popliteal depression
C Perpendicular to the long axis of the femur
D 40 degrees cephalad to the popliteal depression
The Correct Answer is: B
To demonstrate the intercondyloid fossa, the CR must be directed perpendicular to the long axis of the tibia.Because the knee is flexed so that the tibia forms a 40-degree angle with the IR, the CR must be directed 40 degrees caudad to place the CR perpendicular to the long axis of the tibia. Directing the CR to the popliteal depression aligns the CR parallel with the knee joint space
300
The bone labeled number 3 in Figure is the
Courtesy of Stamford Hospital, Department of Radiology.
A talus
B cuboid
C navicular
D lateral cuneiform
The Correct Answer is: B
The bones of the foot include the 7 tarsal bones, 5 metatarsal bones, and 14 phalanges. The calcaneus (os calsis), or heel bone, is the largest tarsal (numbers 6 and 7). It serves as attachment for the Achilles tendon posteriorly, articulates anteriorly with the cuboid bone (number 3), presents three articular surfaces superiorly for its articulation with the talus (number 1), and has a prominent shelf on its anteromedial edge called the sustentaculum tali. The inferior surface of the talus (astragalus) articulates with the superior calcaneus to form the three-faceted subtalar joint. The talus also articulates anteriorly with the navicular (number 2). Articulating anteriorly with the navicular are the three cuneiform bones—medial/first, intermediate/second, and lateral/third. The navicular articulates laterally with the cuboid.
300
Which of the following is (are) valid evaluation criteria for a lateral projection of the forearm?
The radius and the ulna should be superimposed distally.
The coronoid process and the radial head should be partially superimposed.
The humeral epicondyles should be superimposed.
A 1 only
B 1 and 2 only
C 2 and 3 only
D 1, 2, and 3
The Correct Answer is: D
To accurately position a lateral forearm, the elbow must form a 90-degree angle with the humeral epicondyles superimposed. The radius and ulna are superimposed distally. Proximally, the coronoid process and radial head are partially superimposed. Failure of the elbow to form a 90-degree angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm.
300
In which of the following projections is the talofibular joint best demonstrated?
A AP
B Lateral oblique
C Medial oblique
D Lateral
The Correct Answer is: C
The AP projection demonstrates superimposition of the distal fibula on the talus; the joint space is not well seen. The 15- to 20-degree medial oblique position shows the entire mortise joint; the talofibular joint is well visualized, as well as the talotibial joint. There is considerable superimposition of the talus and fibula in the lateral and lateral oblique projections.
400
What is this Fracture ?
Bimalleolar Fracture
•Fracture of both malleoli
•One side is usually spiral or oblique and the other transverse
400
ich of the following should be demonstrated in a true AP projection of the clavicle?
- Clavicular body
- Acromioclavicular joint
- Sternocostal joint
A 1 only
B 1 and 2 only
C 2 and 3 only
D 1, 2, and 3
The correct answer is: (B)
The AP projection of the clavicle should demonstrate the clavicular body/shaft and its two extremities: the sternal extremity and its associated sternoclavicular articulation, and the acromial extremity and its associated acromioclavicular articulation. The sternocostal joint is the articulation between the sternum and rib and is not delineated in the AP clavicle image.
400
What is the anatomic structure indicated by the number 7 in the Figure ?
A Coracoid process
B Coronoid process
C Trochlear notch
D Radial notch
Correct answer is D Radial notch
An anterior view of the forearm is shown. The proximal anterior surface of the ulna (number 8) presents a rather large pointed process at the anterior margin of the semilunar (trochlear) notch (number 5) called the coronoid process (number 6). The olecranon process is identified as number 4, and the radial notch of the ulna is number 7. Distally, the ulnar head is number 9, and the styloid process is labeled 10. The radius (number 12) is the lateral bone of the forearm. The radial head is number 3, the radial neck is number 2, and the radial tuberosity is number 1. Distally, the radial styloid process is labeled 11.
400
A lateral projection of the hand in extension is often recommended to evaluate
- a fracture
- a foreign body
- soft tissue
A 1 only
B 2 only
C 2 and 3 only
D 1 and 3 only
The correct answer is: (C)
The lateral hand in extension, with appropriate technique adjustment, is recommended to evaluate foreign-body location in soft tissue. A small lead marker frequently is taped to the spot thought to be the point of entry. The physician then uses this external marker and the radiograph to determine the exact foreign-body location. Extension of the hand in the presence of a fracture would cause additional and unnecessary pain and possibly additional injury.
400
Which position of the shoulder demonstrates the lesser tubercle in profile medially?
A. AP
B External rotation
C Internal rotation
D Neutral position
The Correct Answer is: C
The external rotation position is the true AP position and places the greater tubercle in profile laterally and places the lesser tubercle anteriorly. The internal rotation position demonstrates the lesser tubercle in profile medially and places the humerus in a true lateral position; the greater tubercle is seen superimposed on the humeral head. The epicondyles should be superimposed and perpendicular to the IR. The neutral position places the epicondyles about 45 degrees to the IR and places the greater tubercle anteriorly but still lateral to the lesser tubercle
500
What is the fracture
Boxer’s Fracture
•Transverse fracture of the neck of the 5th metacarpal with palmar angulation of the distal fragment
•Often caused by hitting an object with a closed fist
500
Which of the following projections require(s) that the humeral epicondyles be perpendicular to the IR?
- AP humerus
- Lateral forearm
- Internal rotation shoulder
A 1 only
B 1 and 2 only
C 2 and 3 only
D 1, 2, and 3
The Correct Answer is: C
When the arm is placed in the AP position, the epicondyles are parallel to the plane of the IR, and the shoulder is placed in external rotation. In this position, an AP projection of the humerus, elbow, and forearm can be obtained; it places the greater tubercle of the humerus in profile. For the lateral projection of the humerus and the internal rotation projection of the shoulder, the arm is internally rotated, elbow somewhat flexed, with the back of the hand against the thigh, and the epicondyles are superimposed and perpendicular to the IR. The lateral projections of the humerus, elbow, and forearm all require that the epicondyles be perpendicular to the plane of the cassette.
500
In the Figure, which of the following is represented by the number 3?
A Acromion process
B Scapular spine
C Coracoid process
D Acromioclavicular joint
The Correct Answer is: A
Figure 2–29 depicts a posterior view of the right scapula and its articulation with the humerus (number 4). The scapula presents two borders—the lateral or axillary border (number 7) and the medial or vertebral border (number 9). It also presents three angles—the inferior angle (number 8), the superior angle (number 12), and the lateral angle (number 6). The processes of the scapula are the coracoid (number 2), the acromion (number 3), and the scapular spine (number 13). The scapula has a (supra) scapular notch (number 1), a supraspinatus fossa (number 11), and an infraspinatus fossa (number 10). Number 5 identifies the glenoid fossa—the articular surface for the humeral head, forming the glenohumeral articulation
500
To better visualize the knee-joint space in the radiograph in the Figure , the radiographer should
A flex the knee more acutely
B flex the knee less acutely
C angle the CR 5 to 7 degrees cephalad
Dangle the CR 5 to 7 degrees caudad
The Correct Answer is: C
In the lateral projection of the knee, the joint space is obscured by the magnified medial femoral condyle unless the CR is angled 5 to 7 degrees cephalad. The degree of flexion of the knee is important when evaluating the knee for possible transverse patellar fracture. In such a case, the knee should not be flexed more than 10 degrees. The knee normally should be flexed 20 to 30 degrees in the lateral position.
500
What projection was used to obtain the image seen in Figure ?
A AP, internal rotation
BAP, external rotation
C AP, neutral position
D AP axial
The Correct Answer is: B
An AP, external rotation, projection of the shoulder is pictured. The hand is supinated, and the arm is in the anatomical position. Therefore, the greater tubercle (number 3) is well visualized. The greater portion of the clavicle is seen, the acromioclavicular joint (number 1), the acromion process (number 2), the coracoid process (number 4), and the glenohumeral joint (number 5). The coronoid process is located on the ulna