chapter 4 evolve mt
wrist and forearm
a patient enters the ED with a Smith fracture. which region of the upper limb must be radiographed to demonstrate this injury?
thumb
a patient enters the ED with a possible Bennett's fracture. which of the following routines should be performed to confirm this diagnosis?
modified stecher
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?
coyle method with 80 degree flexion, CR angled 45 degrees away from the shoulder
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 cornoid process?
63 kV
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
gaynor hart method
a patient with a history of carpal tunnel syndrome comes to radiology. the physician wants to rule out abnormal calcifications in the capral sulcus. which of the following projections would best demonstrate this region?
excessive rotation of the hand and/or wrist laterally
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?
repeat the PA projection to include all of the carpals and about 1 inch of the distal radius and ulna
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 tech do to correct the problem?
rotate the wrist and hand 10 degrees internally
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?
true
carpal tunnel syndrome is more common in middle-aged women than in middle-aged men
10
grids are generally not required unless the anatomy measures greater than ________ cm in thickness
true
nuclear medicine is generally more sensitive that radiography for assessing bones of the upper limb for either metastatic bone lesions or stress fractures
humeral epicondyles
what two bony landmarks are palpated for positioning of the AP elbow?
at the third metacarpophalangeal joint
where is the CR centered for a PA projection of the hand?
at the proximal interphalangeal joint
where is the CR placed for a PA projection of the third digit?
lateral
which basic projection of the elbow best demonstrates the trochlear notch in profile?
hamate
which carpal articulates with both the fourth and fifth metacarpals?
pisiform
which carpal bone is the smallest?
scaphoid
which is the most commonly fractured carpal bone?
capitate
which of the carpal bones is considered to be the largest?
pronation of the hand
which of the following actions will lead to the proximal radius crossing over the ulna?
elbow flexed 90 degrres, CR angled 45 degrees toward shoulder
which of the following best demonstrates the radial head using the trauma lateral Coyle's method routine?
head
which of the following bony structures is found on the distal aspect of the ulna?
scaphoid
which of the following carpals articulates with the radius?
multiple myeloma
which of the following is the most common type of primary cancerous bone tumor?
ap
which of the following projections of the wrist will best demonstrate the wrist joint and intercarpal spaces
70 kV, 300 mA, 1/30 sec, small focal spot
which of the following sets of exposure factors would be best for an adult hand study using a digital imaging system?
styloid processes
which of the following structures is considered to be most distal? -radial head -styloid processes -radial tuberosity -capitulum
capitulum
which of the following structures is considered to be most lateral? -capitulum -head of ulna -trochlea -coronoid tubercle
olecranon process
which of the following structures is considered to be most posterior? -coronoid process -radial tuberosity -trochlea -olecranon process
olecranon process
which of the following structures is considered to be most proximal? -head of ulna -radial styloid process -olecranon process -radial tuberosity
ulnar notch
which one of the following structures is NOT part of the ulna? -styloid process -radial notch -ulnar notch -coronoid tubercle
ap axial (modified robert's method)
which projecting best demonstrates pathology involving the first carpomeacarpal joint and trapezium?
AP oblique with external rotation
which routine projection of the elbow best demonstrates the radial head and tuberosity free of superimposition?
true lateral with 90 degree flexion
which routine projection of the elbow will best demonstrate an elevated or visible posterior fat pad?
lateral
which routine projjection of the elbow best demonstrates the olecranon process in profile?
carpal bridge
which special projection of the wrist is ideal for demonstrating possible calcification in the dorsal aspect of the carpals?
radial deviation
which special projection of the wrist will open up the interspaces on the ulnar side of the wrist?
phalanges
which specific anatomy is better visualized with a fan lateral as compared with other lateral projections of the hand?
ulnar notch and head of ulna
which two structures form the distal radioulnar joint?
trochlea and olecranon process
which two structures primarily form the hinge-like structure and movement of the elbow joint?
ulnar collateral ligament
which wrist ligament is attached to the styloid process of the ulna and continues to the triquetrum and pisiform?
prevents foreshortening of phalanges and obscuring of interphalangeal joints
why is it important to keep the phalanges parallel to the IR for a PA oblique projection of the hand?
minimize object IR distance (OID)
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?
45 degrees internally
why type of rotation of the hands is required for the AP oblique bilateral (Norgaard method) hand projection?
the position of the hand and/or wrist
with the radial head lateromedial projections, what is the only difference between the four projections?
bennet'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
osteogenic sacoma
the second most common type of primary cancerous bone tumor is:
sulcus
the smooth, depressed, center portion of the trochlea used for evaluating rotation on a lateral elbow is termed the trochlear:
pronator
the two fat stripes of the wrist demonstrated radiographically are known as the scaphoid fat stripe and the __________ fat stripe
partially flexed AP and limited lateral 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 degrees. which of the following routines should be performed to confirm diagnosis?
parallel
a general positioning rule is to place the long axis of the part ______ to the long axis of the IR
hinge
a ginglymus joint can also be referred to as a ___________ joint
no positioning errors occurred
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 negative study for injury
a nonvisible posterior fat pad on a well-exposed, correctly positioned lateral elbow radiograph generally suggests:
PA and lateral in extension projections
a patient arrives in radiology with a metal foreign body in the palm f the hand. which of the following hand routines should be performed on this patient to confirm the location of the foreign body?
folio method
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 don't 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?
excessive medial rotation
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?
excessive lateral rotation
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?
insufficient ulnar deviation
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?
medial (internal) rotation oblique
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?
ulnar collateral ligament
a skier's thumb is an injury of the:
four
an ellipsoidal joint allows movement in _________ directions
barton fracture
fracture and dislocation of posterior lip of distal radius
45 degree lateral rotation
from a pronated position, which of the following is required for a PA oblique projection of the fourth digit of the hand?
increase
how do you change the technique for advance paget's disease?
decrease
how do you change the technique for advanced osteoporosis
decrease
how do you change the technique for advanced rheumatoid arthritis
no change
how do you change the technique for bone tumors
no change
how do you change the technique for bursitis
no change
how do you change the technique for carpal tunnel syndrome
no change
how do you change the technique for otseomyelitis
no change
how do you change the technique for small joint effusion
8
how many carpal bones are found in the wrist?
two
how many projections are required for an AP acute flexion study of the elbow?
25-30 degrees
how much CR angulation to the long axis of the hand is required for the tangential inferosuperior projection to demonstrate the carpal sulcus (canal)?
45 degrees
how much rotation of the humeral epicondyles is required for the AP medial oblique projection of the elbow?
perpendicular to the IR
how should the humeral epicondyles be aligned fr a lateral projection of the elbow?
increase 3 to 4 kV
how should the original analog kV range be changed with a fiberglass cast applied for a wrist or forearm radiographic procedure?
ginglymus
interphalangeal joints have a(n) ________ type of movement
osteomyelitis
local or generalized infection of bone or bone marrow caused by bacteria introduced by trauma or surgery is a condition termed:
true
one of the early signs of rheumatoid arthritis is soft tissue swelling near the ulnar styloid process
false
rheumatoid arthritis is three times more common in men than women
rheumatoid arthritis
the AP oblique bilateral hands projection (ball-catcher's position) is performed to evaluate for early signs of:
first carpometacarpal joint
the CR placement for an AP axial projection (modified Robert's method) of the thumb is at the:
ulnar deviation
the bending or forcing of the hand outward with the hand pronated in a PA projection is known as:
saddle
the first carpometacarpal joint is classified as a ________ joint
ellipsoidal
the first metacarpophalangeal joint has a(n) _______________ type of joint movement
false
the folio method is performed to rule out a displaced fracture of the thumb (first metacarpal)
true
the folio method requires a bilateral projection of the thumbs to be taken with one single exposure
carpometacarpal
the joint found between the base of the third metacarpal and carpal bone is the :
ellipsoidal
the radiocarpal (wrist) joint possesses a(n) _________ type of joint movement.
true
the radiographic criteria for a true lateral finger indicate equal concavity of the anterior and posterior aspects of the phalanges
gaynor-hart method
this projection is performed to rule out median nerve impingement, calcification in carpal sulcus, and carpal tunnel syndrome
boxer's fracture
transverse fracture through fifth metacarpal neck
15 degrees proximally (toward the wrist)
what CR angle is required with the modified Robert's method?
radial and coronoid fossa
what are the names of the two small depressions found on the anterior aspect of the distal humerus?
3 to 4 inches (8 to 10 cm)
what is the approximate distance between the tabletop and the bucky tray on most floating tabletop types of tables?
interphalangeal
what is the name of the joint found between the proximal and distal phalanges of the first digit?
to provide n AP perspective if the patient can't full extend the elbow
what is the purpose of performing the AP partially flexed projections of the elbow?
coyle method with 45 degree CR angled away from shoulder
young child comes to radiology with an elbow injjury. the basic elbow projections demonstrate a possible nondiscplaced fracture of the coronoid process. beyond the medial oblique projection, what additional projection(s) can be performed to demonstrate the coronoid process in profile?
