chapter 4 upper extremity eval

What is the projection for the PA finger?

Phalanges demonstrate equal concavity

What is the projection for the PA oblique finger?

Phalanges demonstrate more concavity on one side than on the other

To take advantage of the anode heel effect when imaging a forearm,

the wrist is positioned at the anode end of the x-ray tube

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is unable to ulnar-deviate the wrist?

20 degrees

An IR that is large enough to extend at least 1 inch (2.5 cm) beyond the elbow and wrist joints for a forearm projection is

needed to record the elbow and wrist on the image

An optimal internally rotated AP oblique elbow projection will demonstrate all of the following except the

radioulnar articulation as an open space

A less than optimal lateral humerus projection demonstrating the capitulum positioned posterior to the medial trochlea

will be obtained when the distal forearm is not brought close enough to the torso.

PA wrist projection obtained in radial deviation demonstrates 1. the lunate positioned distal to the ulna. 2. a foreshortened scaphoid. 3. closed CM joints. 4. an elongated scaphoid

1 and 2 only

A lateral forearm projection obtained in a patient with the proximal humerus elevated and the wrist internally rotated demonstrates the 1. radial head posterior to the coronoid process. 2. pisiform anterior to the distal scaphoid. 3. capitulum distal to the medial trochlea. 4. pisiform distal to the distal scaphoid.

1 and 3 only

Sharply recorded details are demonstrated on extremity images when 1. motion is controlled. 2. a large focal spot is used. 3. a small IR is used for computed radiography images. 4. a large OID is used.

1 and 3 only

A lateral elbow projection demonstrates the radial head situated anterior and proximal to the coronoid process. How was the patient positioned for such an image to be obtained? 1. The distal forearm was too high. 2. The distal forearm was too low. 3. The proximal humerus was too high. 4. The proximal humerus was too low.

1 and 4 only

A lateral elbow projection obtained with the distal forearm positioned too low and the proximal humerus positioned too high demonstrates the 1. radial head distal and posterior to the coronoid process. 2. radial head proximal and anterior to the coronoid process. 3. capitulum posterior and proximal to the medial trochlea. 4. capitulum anterior and distal to the medial trochlea.

1 and 4 only

A lateral wrist projection obtained with the wrist in slight internal rotation demonstrates the 1. distal scaphoid anterior to the pisiform. 2. radius posterior to the ulna. 3. distal scaphoid distal to the pisiform. 4. radius anterior to the ulna.

1 and 4 only

The IP joint spaces on finger projections are open and demonstrated without distortion when the 1. central ray is aligned parallel with the IP joint spaces. 2. central ray is aligned perpendicular to the IP joint spaces. 3. IP joints are aligned parallel with the IR. 4. IP joints are aligned perpendicular to the IR.

1 and 4 only

A PA hand projection obtained with the hand flexed demonstrates 1. foreshortened phalanges. 2. the thumb in a lateral projection. 3. closed IP joint spaces. 4. foreshortened metacarpals.

1, 2, 3, and 4

A PA wrist projection with accurate positioning demonstrates 1. an open radioulnar articulation. 2. the radial styloid in profile. 3. the long axes of the third metacarpal aligned with the midforearm. 4. open second through fifth MC joint spaces.

1, 2, 3, and 4

For a carpal canal wrist image, the 1. wrist is hyperextended until the long axes of the metacarpals are vertical. 2. hand is rotated 10 degrees internally until the fifth metacarpal is perpendicular to the IR. 3. central ray is angled proximally until the CR is 15 degrees from the MCs. 4. central ray is centered to the palm of the hand.

1, 2, 3, and 4

A lateral forearm projection with accurate positioning demonstrates 1. the distal scaphoid slightly distal to the pisiform. 2. the ulnar styloid in profile. 3. an open elbow joint space. 4. the radial tuberosity in profile.

1, 2, and 3 only

A lateral hand projection obtained with the hand in slight external rotation demonstrates the 1. shortest of the second through fourth metacarpals anteriorly situated. 2. radius posterior to the ulna. 3. second metacarpal posterior to the other metacarpals. 4. pisiform posterior to the distal scaphoid.

1, 2, and 3 only

An AP elbow projection with accurate positioning demonstrates 1. the medial and lateral humeral epicondyles in profile. 2. the radial tuberosity in profile medially. 3. an open capitulum-radial joint. 4. the ulna free of radial head and radial tuberosity superimposition.

1, 2, and 3 only

A PA wrist projection obtained with the wrist in a neutral position demonstrates 1. the scaphoid in partial foreshortening. 2. the center of the lunate positioned distal to the radioulnar articulation. 3. closed CM joints. 4. alignment of the long axis of the third metacarpal and radius.

1, 2, and 4 only

A properly positioned tangential projection of the wrist will demonstrate which of the following? 1. Flexor retinaculum anteriorly and the capitate posteriorly 2. Scaphoid and trapezium laterally 3. Scaphoid and trapezoid medially 4. Pisiform and hamate medially 5. Flexor retinaculum posteriorly and the capitate anteriorly 6. Pisiform and hamate laterally

1, 2, and 4 only

An AP forearm projection with accurate positioning demonstrates the 1. radial styloid in profile laterally. 2. radial head superimposing the ulna by 0.25 inch (0.6 cm). 3. ulnar styloid in profile laterally. 4. humeral epicondyles in profile.

1, 2, and 4 only

For an externally rotated AP oblique elbow projection with accurate positioning, the 1. capitulum is in profile. 2. capitulum-radial joint space is open. 3. coronoid process is in profile. 4. ulna is demonstrated without radial head superimposition.

1, 2, and 4 only

Which of the following are in profile on an optimally positioned AP humerus projection? 1. Lateral epicondyle 2. Medial epicondyle 3. Lesser tubercle 4. Greater tubercle

1, 2, and 4 only

A lateral elbow projection with accurate positioning demonstrates 1. an open elbow joint space. 2. the radial head distal to the coronoid process. 3. the radius superimposing the radial tuberosity. 4. the anterior fat pad.

1, 3, and 4 only

An externally rotated PA oblique wrist projection with accurate positioning demonstrates 1. the trapezoid and trapezium without superimposition. 2. an open radioulnar articulation. 3. the ulnar styloid in profile. 4. superimposition of the medially located carpals.

1, 3, and 4 only

When the patient ulnar-deviates for a PA axial, ulnar-deviated wrist projection, the 1. first metacarpal and radius are aligned. 2. distal scaphoid shifts anteriorly. 3. lunate is demonstrated distal to the radius. 4. distal scaphoid shifts posteriorly.

1, 3, and 4 only

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned?

15 degrees

A lateral finger projection obtained with the finger in a 45-degree PA oblique projection demonstrates 1. equal soft tissue width on both sides of the phalanges. 2. more midshaft concavity on one side of the phalanges than on the opposite side. 3. twice as much soft tissue on one side of the phalanges as on the opposite side. 4. convexity on one side of the phalanges and concavity on the opposite side.

2 and 3 only

A properly positioned AP thumb projection will demonstrate which of the following? 1. Twice as much soft tissue is present on the side of the next to the fingers than the opposite side. 2. Phalanges are not foreshortened. 3. Minimal superimposition of the medial palm soft tissue over the proximal first MC and the CM 4. Hand fully extended.

2 and 3 only

An AP elbow projection obtained with the elbow internally rotated demonstrates 1. the radial tuberosity in profile. 2. an open capitulum-radial joint space. 3. more than 0.25 inch (0.6 cm) of radial head and ulnar superimposition. 4. less than 0.25 inch (0.6 cm) of radial head and ulnar superimposition.

2 and 3 only

PA wrist projection obtained in slight external rotation demonstrates 1. superimposition of the laterally located carpal bones. 2. a closed radioulnar articulation. 3. open lateral carpal joint spaces. 4. the radial styloid in profile.

2 and 3 only

An internally rotated AP oblique elbow projection with accurate positioning demonstrates which of the following structures in profile? 1. Capitulum 2. Radial head 3. Medial trochlea 4. Coronoid process

3 and 4 only

A PA wrist projection obtained with the hand flexed and the metacarpals at a 45-degree angle with the IR demonstrates 1. a closed radioulnar articulation. 2. foreshortened metacarpals. 3. a decrease in scaphoid foreshortening. 4. closed second through fifth carpometacarpal joint spaces.

2, 3, and 4 only

A lateral wrist projection obtained with the elbow flexed 90 degrees and the humerus placed parallel with the IR demonstrates 1. the ulnar styloid distal to the midline of the ulnar head. 2. superimposition of the radius and ulna. 3. superimposition of the distal scaphoid and pisiform. 4. the ulnar styloid in profile.

2, 3, and 4 only

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a distal scaphoid fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned?

20 to 25 degrees

A lateral elbow projection obtained with the wrist and hand pronated demonstrates 1. the radial head anterior to the coronoid. 2. the radial tuberosity in profile anteriorly. 3. an open elbow joint. 4. the radial tuberosity in profile posteriorly.

3 and 4 only

An AP forearm projection obtained with the wrist and elbow in lateral rotation demonstrates 1. superimposed first and second metacarpal bases. 2. the proximal radius superimposed over the ulna by more than 0.25 inch (0.6 cm). 3. superimposed fourth and fifth metacarpal bases. 4. the proximal radius and ulna without superimposition

3 and 4 only

A right lateral fourth finger projection obtained with the hand internally rotated to 20 degrees demonstrates 1. equal soft tissue width on both sides of the phalanges. 2. more phalangeal midshaft concavity on the side facing the fifth finger. 3. convexity on one side of the phalanges and concavity on the opposite side. 4. greater phalangeal midshaft concavity on the side facing the third finger.

4 only

Which of the following is not true about an optimal lateral thumb projection? 1. Central ray is aligned parallel with the IP joint spaces. 2. The fingers and hand are flexed until the thumbnail is in profile. 3. Long axes of the thumb are aligned with the collimator light field. 4. Equal soft tissue width on each side of the phalanges.

4 only

Which of the following technical factors should be chosen when 20 mAs is desired and the patient being imaged has difficulty remaining still? A. 200 mA at 0.1 sec B. 400 mA at 0.05 sec C. 100 mA at 0.4 sec D. 100 mA at 0.2 sec

400 mA at 0.05 sec

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a proximal scaphoid fracture is suspected, and the patient is to ulnar-deviate the wrist?

5 to 10 degrees

Which of the following projections is used to prevent crossing of the forearm bones?

AP projection

Where are the soft tissue structures that can be used to indicate joint effusion located on the lateral wrist projection?

Anteriorly

A poorly positioned PA oblique wrist projection demonstrates superimposition of the trapezoid and trapezium, and the capitate is superimposed by the trapezoid. How should the positioning setup be adjusted to obtain an optimal projection?

Decrease the degree of medial wrist rotation

A less than optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates closed scaphotrapezium, scaphotrapezoidal, and CM joint spaces. How should the positioning setup be adjusted to obtain an optimal projection?

Extend the hand, positioning it flat against the IR

Which side of the arm is positioned against the IR for the lateral second finger projection?

Radial

Which of the following is not true about an optimal axiolateral elbow projection (Coyle method)?

The capitulum and medial trochlea demonstrate slight superimposition.

A less than optimal PA wrist projection demonstrates an elongated scaphoid and the second through fourth metacarpals superimposing the CM joint spaces. Which of the following is true about this projection?

The hand was overflexed

Which side of the arm is positioned against the IR for the lateral fourth finger projection?

Ulnar

What is the degree of central ray angulation that should be used for an ulnar-deviated PA axial (scaphoid) wrist projection being obtained to demonstrate a proximal scaphoid fracture?

Use a 10-degree angle if the first metacarpal and ulna are aligned

Which of the follow statements is true as demonstrated on a lateral elbow projection?

When the wrist is in a lateral projection, the radial tuberosity is superimposed by the radius

An optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates all of the following except

a closed radioscaphoid joint space

To properly position an AP humerus, place the elbow at the _____ end of the tube, _____ the hand and wrist, and align the humeral condyles _____ with the IR.

anode; supinate; parallel

A less than optimal lateral elbow projection demonstrating the capitulum posterior to the medial trochlea will

be obtained when the distal forearm is elevated.

A PA axial, ulnar-deviated wrist projection with poor positioning demonstrates a closed scapholunate joint and hamate and capitate show some superimposition. How should the positioning setup be adjusted for an optimal image to be obtained?

decrease the degree of external wrist rotation

An optimal AP elbow projection is obtained when

the radial head superimposes the lateral aspect of the proximal ulna by 0.25 inch (0.6 cm)

How is a patient positioned for a PA wrist projection to superimpose the anterior and posterior margins of the distal radius and obtain open radioscaphoid and radiolunate joint spaces?

depress the proximal forearm

The trapezium is demonstrated without superimposition of other anatomy on a lateral wrist projection when the patient

depresses the distal first metacarpal

A tangential, inferosuperior carpal canal wrist projection with poor positioning demonstrates superimposition of the pisiform and hamulus of the hamate. How should the positioning setup be adjusted for an optimal image to be obtained?

internally rotate the hand

A PA oblique wrist projection with poor positioning demonstrates an obscured trapeziotrapezoidal joint space and excessive trapezoid and capitate superimposition. How should the positioning setup be adjusted for an optimal image to be obtained?

internally rotate the wrist

Where are the soft tissue structures that can be used to indicate joint effusion located on the PA wrist projection?

laterally

Where are the soft tissue structures that can be used to indicate joint effusion located on the ulnar-deviated PA axial wrist projection?

laterally

What is the projection for the lateral finger?

phalanges demonstrate concavity on one side and convexity on the other

A less than optimal PA finger projection demonstrates unequal soft tissue width and midshaft concavity on each side of the phalanges. The side of the phalanges with the greatest midshaft concavity is facing the shortest finger metacarpal. All of the following are true about this projection except that the

projection will demonstrate more soft tissue width on the lateral surface.

A tangential, inferosuperior carpal canal wrist projection with accurate positioning demonstrates

the carpal canal

An optimally positioned PA wrist projection demonstrates all of the following except

the pronator fat stripe

A less than optimal AP elbow projection demonstrating the ulna without radial head superimposition

was obtained with the elbow in external rotation

A less than optimal lateral hand projection demonstrating the longest of the second through fifth metacarpal midshafts situated anterior to the others

was obtained with the hand internally rotated

A less than optimal lateral wrist projection demonstrating the distal scaphoid anterior to the pisiform

was obtained with the wrist internally rotated

A less than optimal lateral elbow projection demonstrating the radial head positioned posterior to the coronoid process

will also demonstrate the capitulum distal to the trochlea