Upper limbs

Boxer's fracture

Transverse fracture through fifth metacarpal neck

Carpal tunnel syndrome is more common in middle-aged women than in middle-aged men. TRUE or FALSE

true

Nuclear medicine is generally more sensitive than radiography for assessing bones of the upper limb for either metastatic bone lesions or stress fractures. TRUE or FALSE

true

One of the early signs of rheumatoid arthritis is soft tissue swelling near the ulnar styloid process. TRUE or FALSE

true

The Folio method requires a bilateral projection of the thumbs be taken with one single exposure. TRUE or FALSE

true

The radiographic criteria for a true lateral finger indicate equal concavity of the anterior and posterior aspects of the phalanges. TRUE or FALSE

true

Rheumatoid arthritis is three times more common in men than women. TRUE or FALSE

false

The Folio method is performed to rule out a displaced fracture of the thumb (first metacarpal). TRUE or FALSE

false

Select the correct manual exposure adjustment for each disease or condition. a. Increase (+) b. Decrease (−) c. No change (0) 1.Advanced Paget's disease 2. Bursitis 3. Advanced osteoporosis 4. Bone tumors 5. Osteomyelitis 6. Carpal tunnel syndrome 7. Small joint effusion 8. Advanced rheumatoid arthritis

1. A 2. C 3. B 4. C 5. C 6. C 7. C 8. B

Barton fracture

Fracture and dislocation of posterior lip of distal radius

Bennett's fracture

Fracture of base of first metacarpal

Smith fracture

Fracture of distal radius with anterior displacement

Colles' fracture

Fracture of distal radius with posterior displacement

55. What type of rotation of the hands is required for the AP oblique-bilateral (Norgaard method) hand projection? a. 45° internally b. 30° to 35° externally c. 5° to 10° internally d. None

a. 45° internally

A patient with a fractured forearm had the fracture reduced and a fiberglass cast placed on the extremity. The orthopedic surgeon orders a postreduction study. The original (analog) kV was 60 kV. Which one of the following kV factors should be selected for the postreduction study? a. 63 kV b. 67 kV c. 70 kV d. 75 kV

a. 63 kV

Which of the following projections of the wrist will best demonstrate the wrist joint and intercarpal spaces? a. AP b. PA c. Gaynor-Hart d. 30° PA oblique

a. AP

Which projection best demonstrates pathology involving the first carpometacarpal joint and trapezium? a. AP axial (modified Robert's method) b. PA oblique thumb c. Norgaard method d. PA scaphoid, ulnar deviation wrist projection

a. AP axial (modified Robert's method)

Which special projection of the wrist is ideal for demonstrating possible calcification in the dorsal aspect of the carpals? a. Carpal bridge b. Carpal canal c. Ulnar deviation d. Lateral wrist

a. Carpal bridge

A radiograph of an AP oblique elbow with medial rotation reveals that the radial head is superimposed over part of the coronoid process. What positioning error has been committed? a. Excessive medial rotation b. Flexion of the elbow c. Excessive lateral rotation d. Incorrect CR angulation

a. Excessive medial rotation

A radiograph of a PA oblique of the hand reveals that the midshaft of the fourth and fifth metacarpals is superimposed. What specific positioning error has been committed? a. Excessive rotation of the hand and/or wrist laterally b. Insufficient rotation of the hand and/or wrist laterally c. Incorrect CR angulation d. Fingers of the hand are not parallel to IR

a. Excessive rotation of the hand and/or wrist laterally

Which one of the following is the most common primary cancerous bone tumor? a. Multiple myeloma b. Osteochondroma c. Osteosarcoma d. Osteocarcinoma

a. Multiple myeloma

A patient arrives in radiology with a metal foreign body in the palm of the hand. Which of the following hand routines should be performed on this patient to confirm the location of the foreign body? a. PA and lateral in extension projections b. PA and lateral in flexion projections c. PA and fan lateral projections d. PA and Gaynor-Hart method

a. PA and lateral in extension projections

A patient enters the ED in severe pain with a possible dislocation of the elbow. The patient has the elbow flexed more than 90°. Which one of the following routines should be performed to confirm the diagnosis? a. Partially flexed AP and limited lateral projections b. Jones method and limited lateral projection c. Coyle method and limited lateral projection d. Lateral elbow only

a. Partially flexed AP and limited lateral projections

Why is it important to keep the phalanges parallel to the IR for a PA oblique projection of the hand? a. Prevents foreshortening of phalanges and obscuring of interphalangeal joints. b. Prevents foreshortening of radiocarpal joint. c. Opens up the carpometacarpal joints. d. Demonstrates the sesamoid bones near the first interphalangeal joint.

a. Prevents foreshortening of phalanges and obscuring of interphalangeal joints.

Which special projection of the wrist will open up the interspaces on the ulnar side of the wrist? a. Radial deviation b. Ulnar deviation c. Carpal canal d. Carpal bridge

a. Radial deviation

A radiograph of a tangential, inferosuperior projection of the carpal canal reveals that the hamular process is superimposed over the pisiform. Which of the following measures will correct this problem? a. Rotate the wrist and hand 10° internally. b. Increase the CR angle. c. Decrease the CR angle. d. Increase the extension of the hand and/or wrist.

a. Rotate the wrist and hand 10° internally.

With the radial head-lateromedial projections, what is the only difference between the four projections? a. The position of the hand and/or wrist b. The CR angulation c. The amount of flexion of the elbow d. The SID used for each projection

a. The position of the hand and/or wrist

which of the following structures is considered to be most lateral? a. capitulum b. head of ulna c. trochlea d. coronoid tubercle

a. capitulum

The radiocarpal (wrist) joint possesses a(n) ____ type of joint movement. a. ellipsoidal b. ginglymus c. plane d. pivot

a. ellipsoidal

The CR placement for an AP axial projection (modified Robert's method) of the thumb is at the: a. first carpometacarpal joint. b. first proximal interphalangeal joint. c. first distal interphalangeal joint. d. midproximal phalanx of the first digit.

a. first carpometacarpal joint.

A nonvisible posterior fat pad on a well-exposed, correctly positioned lateral elbow radiograph generally suggests: a. negative study for injury. b. fracture of one of the bones of the elbow. c. injury to the synovial joint. d. a congenital defect.

a. negative study for injury.

Local or generalized infection of bone or bone marrow caused by bacteria introduced by trauma or surgery is a condition termed: a. osteomyelitis. b. Paget's disease. c. osteoarthritis. d. cellulitis.

a. osteomyelitis.

The two fat stripes of the wrist demonstrated radiographically are known as the scaphoid fat stripe and the _____ fat stripe. a. pronator b. pisiform c. abductor d.anterior

a. pronator

The first carpometacarpal joint is classified as a ____ joint. a. saddle b. ginglymus c. plane d. trochoidal

a. saddle

which carpal bone is 4? a. scaphoid b. trapezoid c. hamate d. lunate

a. scaphoid

which carpal bone is 5? a. trapezium b. trapezoid c. hamate d. scaphoid

a. trapezium

which two structures primarily form the hinge-like structure and movement of the elbow joint? a. trochlea and olecranon process b. capitulum and trochlea c. coronoid process and coronoid fossa d. coronoid fossa and trochlea

a. trochlea and olecranon process

Grids are generally not required unless the anatomy measures greater than _____ cm in thickness. a. 8 b. 10 c. 14 d. 5

b. 10

How much CR angulation to the long axis of the hand is required for the tangential, inferosuperior projection to demonstrate the carpal sulcus (canal)? a. 10° to 15° b. 25° to 30° c. 35° to 45° d. 5° to 10°

b. 25° to 30°

Where is the CR centered for a PA projection of the hand? a. At the third proximal interphalangeal joint b. At the third metacarpophalangeal joint c. At the base of the third metacarpal d. At the third distal interphalangeal joint

b. At the third metacarpophalangeal joint

A patient enters the ED with an elbow injury. The partially flexed AP and lateral positions reveal a possible fracture of the coronoid process. The patient's elbow is partially flexed and he refuses to extend it farther. Which one of the following positions/projections should be performed to confirm the fracture of the coronoid process? a. AP-acute flexion b. Coyle method with 80° flexion, CR angled 45° away from shoulder c. Coyle method with 90° flexion, CR angled 45° toward the shoulder d. Gaynor-Hart method

b. Coyle method with 80° flexion, CR angled 45° away from shoulder

What two bony landmarks are palpated for positioning of the AP elbow? a. Ulnar and radial heads b. Humeral epicondyles c. Humeral condyles d. Trochlea and capitulum

b. Humeral epicondyles

How should the original analog kV range be changed with a fiberglass cast applied for a wrist or forearm radiographic procedure? a. No change b. Increase 3 to 4 kV c. Increase 5 to 7 kV d. Increase 8 to 10 kV

b. Increase 3 to 4 kV

How many carpal bones are found in the wrist? a.14 b.8 c.5 d.7

b.8

A radiograph of the PA scaphoid projection reveals extensive superimposition of the scaphoid and adjacent carpals. Which of the following factors can lead to this problem? a. Elevation of the hand and wrist b. Insufficient ulnar deviation c. Insufficient CR angle distally d. Slight flexion of the phalanges

b. Insufficient ulnar deviation

Which basic projection of the elbow best demonstrates the trochlear notch in profile? a. AP b. Lateral c. Medial rotation oblique d. Lateral rotation oblique

b. Lateral

Which routine projection of the elbow best demonstrates the olecranon process in profile? a. AP b. Lateral c. Medial rotation oblique d. Lateral rotation oblique

b. Lateral

How should the humeral epicondyles be aligned for a lateral projection of the elbow? a. Parallel to image receptor b. Perpendicular to image receptor c. 45° to image receptor d. 30° to image receptor

b. Perpendicular to image receptor

Which routine projection of the elbow will best demonstrate an elevated or visible posterior fat pad? a. True AP with no rotation b. True lateral with 90° flexion c. Lateral rotation oblique d. Coyle method

b. True lateral with 90° flexion

How many projections are required for the AP-acute flexion study of the elbow? a. One b. Two c. Three d. Four

b. Two

Which two structures form the distal radioulnar joint? a. Radial notch and radial head b. Ulnar notch and head of ulna c. Radial tuberosity and ulnar notch d. Coronoid tubercle and radial notch

b. Ulnar notch and head of ulna

which of the following bony structures is found on the distal aspect of the ulna? a. coronoid process b. head c. olecranon process d. all of the above

b. head

which carpal bone is the smallest? a. scaphoid b. pisiform c. hamate d. capitate

b. pisiform

Which of the following carpals articulates with the radius? a. trapezium b. scaphoid c. pisiform d. hamate

b. scaphoid

which of the following structures is considered to be most distal? a. radial head b. styloid processes c. radial tuberosity d. capitulum

b. styloid processes

The bending or forcing of the hand outward with the hand pronated in a posteroanterior (PA) projection is known as: a. radial deviation. b. ulnar deviation. c. radial abduction. d. ulnar extension.

b. ulnar deviation.

What CR angle is required with the modified Robert's method? a. 5° proximally (toward the wrist) b. 10° distally (away from the wrist) c. 15° proximally (toward the wrist) d. 20° distally (away from the wrist)

c. 15° proximally (toward the wrist)

How much rotation of the humeral epicondyles is required for the AP medial oblique projection of the elbow? a. 30° b. 90° c. 45° d. 20°

c. 45°

A young child comes to radiology with an elbow injury. The basic elbow projections demonstrate a possible nondisplaced fracture of the coronoid process. Beyond the medial oblique projection, what additional projection(s) can be performed to demonstrate the coronoid process in profile? a. Coyle method with 45° CR angle toward shoulder b. Radial head lateral projections c. Coyle method with 45° CR angle away from shoulder d. Acute flexion projection

c. Coyle method with 45° CR angle away from shoulder

Which of the following best demonstrates the radial head using the trauma lateral Coyle method routine? a. Elbow flexed 80°, CR angled 45° away from shoulder b. Elbow flexed 90°, CR angled 30° toward shoulder c. Elbow flexed 90°, CR angled 45° toward shoulder d. Elbow flexed 90°, CR perpendicular to image receptor

c. Elbow flexed 90°, CR angled 45° toward shoulder

A radiograph of an AP projection of the elbow reveals that there is complete separation of the proximal radius and ulna. What positioning error has been committed? a. Excessive medial rotation b. Partial flexion of the joint c. Excessive lateral rotation d. Incorrect CR location and angle

c. Excessive lateral rotation

A patient enters the ED with a possible scaphoid fracture. The patient is unable to assume the ulnar deviation position. Which of the following positions should be performed to confirm the diagnosis? a. Gaynor-Hart b. Jones c. Modified Stecher d. Coyle

c. Modified Stecher

Which specific anatomy is better visualized with a fan lateral as compared with the other lateral projections of the hand? a. Sesamoid bones b. Carpals c. Phalanges d. Carpometacarpal joints

c. Phalanges

Which of the following actions will lead to the proximal radius crossing over the ulna? a. Supination of the hand b. Placing epicondyles parallel to the image receptor c. Pronation of the hand d. External rotation of the elbow

c. Pronation of the hand

what are the names of the two small depression found on the anterior aspect of the distal humerus? a. Trochlea and capitulum b. Olecranon and coronoid fossa c. Radial and coronoid fossa d. Olecranon and radial fossa

c. Radial and coronoid fossa

What is the purpose of performing the AP partially flexed projections of the elbow? a. To provide a view of the radial head and capitulum b. To separate the radial head from the ulna c. To provide an AP perspective if the patient cannot fully extend the elbow d. To demonstrate any possible elevated fat pads

c. To provide an AP perspective if the patient cannot fully extend the elbow

A patient enters the emergency department (ED) with a Smith fracture. Which region of the upper limb must be radiographed to demonstrate this injury? a. Trapezium b. Elbow c. Wrist and forearm d.Hand

c. Wrist and forearm

The joint found between the base of the third metacarpal and carpal bone is the: a. intercarpal b. interphalangeal c. carpometacarpal d. proximal metacarpophalangeal

c. carpometacarpal

An ellipsoidal joint allows movement in ____ directions. a. two b. all c. four d. six

c. four

Which carpal articulates with both the fourth and fifth metacarpals? a. triquetrum b. capitate c. hamate d. trapezoid

c. hamate

A ginglymus joint can also be referred to as a _____ joint. a. trochoid b. saddle c. hinge d. pivot

c. hinge

which of the following structures is considered to be most proximal? a. head of ulna b. radial styloid process c. olecranon process d. radial tuberosity

c. olecranon process

The AP oblique-bilateral hands projection ("ball-catcher's position") is performed to evaluate for early signs of: a. gout. b. osteoporosis. c. rheumatoid arthritis. d. bursitis.

c. rheumatoid arthritis.

which is the most commonly fractured carpal bone? a. lunate b. trapezium c. scaphoid d. hamate

c. scaphoid

A "skier's thumb" is an injury of the: a. scaphoid. b. pronator fat stripe. c. ulnar collateral ligament. d. median nerve

c. ulnar collateral ligament.

which one of the following structures is NOT part of the ulna? a. styloid process b. radial notch c. ulnar notch d. coronoid tubercle

c. ulnar notch

What is the approximate distance between the tabletop and Bucky tray on most floating tabletop types of tables? a. 1/2 to 1 inch (1.3 to 2.5 cm) b. 1 to 2 inches (2.5 to 5.1 cm) c. 2 to 3 inches (5 to 7.6 cm) d. 3 to 4 inches (8 to 10 cm)

d. 3 to 4 inches (8 to 10 cm)

From a pronated position, which of the following is required for a PA oblique projection of the fourth digit of the hand? a. 45° medial rotation b. 30° to 35° lateral rotation c. 30° to 35° medial rotation d. 45° lateral rotation

d. 45° lateral rotation

Which of the following sets of exposure factors would be best for an adult hand study using a digital imaging system? a. 80 kV, 600 mA, 1/60 seconds, large focal spot b. 64 kV, 200 mA, 1/20 seconds, large focal spot c. 78 kV, 600 mA, 1/60 seconds, large focal spot d. 70 kV, 300 mA, 1/30 seconds, small focal spot

d. 70 kV, 300 mA, 1/30 seconds, small focal spot

Which routine projection of the elbow best demonstrates the radial head and tuberosity free of superimposition? a. AP b. Lateral c. AP oblique with internal rotation d. AP oblique with external rotation

d. AP oblique with external rotation

Where is the central ray (CR) placed for a PA projection of the third digit? a. At the distal interphalangeal joint b. At the metacarpophalangeal joint c. At the head of the third metacarpal d. At the proximal interphalangeal joint

d. At the proximal interphalangeal joint

A patient comes to radiology with a possible tear of the ulnar collateral ligament of the wrist. The patient complains of discomfort near the thumb region. Basic thumb projections do not demonstrate any type of fracture or dislocation. Which one of the following projections can be performed to confirm an injury to the ulnar collateral ligament? a. Norgaard method b. Modified Robert's method c. Gaynor-Hart method d. Folio method

d. Folio method

A patient with a history of carpal tunnel syndrome comes to radiology. The physician wants to rule out abnormal calcifications in the carpal sulcus. Which of the following projections would best demonstrate this region? a. Coyle method b. Jones method c. Carpal bridge d. Gaynor-Hart method

d. Gaynor-Hart method

A radiograph of the elbow demonstrates the radius directly superimposed over the ulna and the coronoid process in profile. Which projection of the elbow has been performed? a. AP b. Lateral c. Lateral (external) rotation oblique d. Medial (internal) rotation oblique

d. Medial (internal) rotation oblique

Why is it recommended that the PA oblique (with medial rotation) projection be performed rather than the PA oblique (with lateral rotation) for the second digit of the hand? a. Minimizes optimal immunomodulating dose (OID). b. Is more comfortable for the patient. c. Opens up joints better. d. Minimizes object image-receptor distance (OID).

d. Minimizes object image-receptor distance (OID).

A lateral elbow radiograph demonstrates about half of the radial head superimposed by the coronoid process of the ulna. Which of the following occurred? a. The hand was pronated rather than in a true lateral position. b. The hand and wrist were rotated laterally and not in a true lateral position. c. The shoulder was not dropped sufficiently to the tabletop level. d. No positioning errors occurred.

d. No positioning errors occurred.

A radiograph of a PA projection of the hand reveals that the distal radius and ulna and the carpals were cut off. What should the technologist do to correct this problem? a. Accept the radiograph. Carpals and distal radius and ulna are not part of a hand study. b. Make sure the carpals, distal radius, and ulna are included on the lateral projection. c. If the injury to the patient did not involve the carpal region and distal forearm, do not repeat it. d. Repeat the PA projection to include all the carpals and about 1 inch (2.5 cm) of the distal radius and ulna.

d. Repeat the PA projection to include all the carpals and about 1 inch (2.5 cm) of the distal radius and ulna.

A patient enters the ED with a possible Bennett's fracture. Which of the following routines should be performed to confirm this diagnosis? a. Finger b. Wrist c. Forearm d. Thumb

d. Thumb

Which wrist ligament is attached to the styloid process of the ulna and continues to the triquetrum and pisiform? a. Radial collateral ligament b. Dorsal radiocarpal ligament c. Palmar radiocarpal ligament d. Ulnar collateral ligament

d. Ulnar collateral ligament

this projection is correctly referred to as: a. carpal canal, inferosuperior projection b. carpal tunnel, inferosuperior projection c. Gaynor-hart method d. all of the above

d. all of the above

this projection is performed to rule out: a. median nerve impingement b. calcification in carpal sulcus c. carpal tunnel syndrome d. all the above

d. all the above

Which of the carpal bones is considered to be the largest? a. hamate b. triquetrum c. trapezium d. capitate

d. capitate

The first metacarpophalangeal joint has a(n) ____ type of joint movement. a. plane b. pivot c. saddle d. ellipsoidal

d. ellipsoidal

The interphalangeal joints have a(n) ____ type of joint movement. a. plane b. saddle c. ellipsoidal d. ginglymus

d. ginglymus

what is the name of the joint found between the proximal and distal phalanges of the first digit? a. proximal interphalangeal b. distal interphalangeal c. metacarpophalangeal d. interphalangeal

d. interphalangeal

which of the following structures is considered to be most posterior? a. coronoid process b. radial tuberosity c. trochlea d. olecranon process

d. olecranon process

The second most common type of primary cancerous bone tumor is: a. multiple myeloma. b. chondrosarcoma. c. Ewing's sarcoma. d. osteogenic sarcoma.

d. osteogenic sarcoma.

A general positioning rule is to place the long axis of the part ____ to the long axis of the image receptor. a. perpendicular b. adjacent c. axial d. parallel

d. parallel

which carpal bone is 1? a. scaphoid b. trapezium c. hamate d. pisiform

d. pisiform

The smooth, depressed, center portion of the trochlea used for evaluating rotation on a lateral elbow is termed the trochlear: a. process. b. fossa. c. depression. d. sulcus.

d. sulcus.