Exam 4- Upper limb

102) Osteopetrosis

(+) increase manual exposure factors

99) Advanced Paget's diseases

(+) increase manual exposure factors

101) Osteoporosis

(-) decrease manual exposure factors

103) Advanced rheumatoid arthritis

(-) decrease manual exposure factors

104) Bursitis

(0) exposure factors remain the same

100) Joint effusion

(0) manual exposure factors remain the same

62) Why is it important to keep the affected digit parallel to the IR for the PA oblique and lateral projections?

- To prevent distortion of the joints - To prevent distortion of the phalanx - to demonstrate small, nondisplaced fractures near the joint

64) A minimum of __________ inch(es) (____________cm) of the forearm should be included radiographically for a PA projection of the hand.

1 inch; 2.5 cm

149) Grids are generally not required unless the anatomy measures greater than______cm in thickness.

10

47) Grids are used if the body part measures greater than __________ cm.

10

80) During the PA axial scaphoid projection with CR angle and ulnar flexion, the CR must be angled _____________° ______________ (distally or proximally)

10 to 15, proximally

81) How much CR angulation to the axis of the hand is required for the carpal canal (tunnel) projection?

25-30°

4) How many bones are their total in one hand?

27

49) Fiberglass casts: Increase _____________ kV.

3-4

46) Most common source image receptor distance(SID) for upper limb radiography

40" SID for all projections

76) How much rotation is required for an oblique projection of the wrist?

45 degrees

84) How much CR angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection?

45 degrees

115) How much and in which direction should the CR be angled for the trauma axial lateral projection (Coyle method) involving the coronoid process?

45° away from shoulder

113) How much is the upper limb rotated for a lateral oblique projection of the elbow?

45° laterally

114) How much and in which direction should the CR be angled for the trauma axial lateral projection (Coyle method) involving the radial head?

45° toward shoulder

2) How many metacarpal (palm) bones are in one hand?

5

48) small-to-medium dry plaster casts: Increase _______________ kV.

5-7

137) 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 kV was 60 kV. Which kV factor should be selected for the postreduction study?

63 kV

3) How many carpal (wrist) bones are in one hand?

8

11) which IR should be used for a thumb projection?

8 x 10 inch (18 x 24 cm)

50) Large plaster casts: Increase ___________ kV.

8-10

116) What is the amount of elbow flexion required for the trauma lateral projection (Coyle method) to demonstrate the coronoid process

80° of flexion

85) The hand and wrist form a ______________° angle to the forearm with the carpal bridge (tangential) projection.

90

75) The elbow generally should be flexed how many degrees for the routine positions of the wrist?

90°

1) A) How many phalanges (fingers & thumb) are in one hand? B) in both hands?

A) 14 B) 28

37) The fat pads around the elbow joint are valuable diagnostic indicators of the following three technical/positioning requirements are met with the lateral position

A) Elbow flexed 90° B) Optimal exposure factors used C) In a true lateral position

28) A) Which special positioning method can be performed to demonstrate a Bennett's fracture? B) what degree of CR angulation is required for this projection?

A) Modified Robert's method B) 15 degrees proximal

36) The two important fat stripes or bands around the wrist joint are the:

A) Scaphoid fat stripe (visualized on a PA & OBL) B) Pronator fat stripe (visualized 1 cm from the anterior surface of the radius)

23) A) The articular portion of the medial aspect of the distal humerus is called the? B) the similar structure found on the lateral aspect of the distal humerus is called the?

A) Trochlea (medial) B) Capitulum (lateral)

33) What is the name of the two special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region?

A) Ulnar Deviation (Scaphoid deviation); shows lateral aspect (opens up opposite side) B) Radial Deviation; shows medial aspect (opens up opposite side)

60) Identify which positioning modifications should be used for a study of the second digit to reduce distortion for each of the following: A) PA oblique projection B) Lateral position

A) perform medial OBL rather than lateral OBL to decrease OID B) perform a thumb-down lateral (mediolateral projection) to decrease OID

20) A) In the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side? B) which is on the medial side

A) radius B) Ulna

59) List the two radiographic criteria used to determine whether rotation is present on the PA projection of the digits

A) symmetric appearance of both sides of the shafts of phalanges and distal metacarpals B) Equal amounts of tissue on each side of the phalanges

29) Match the following articulations with the correct joint movement types: A. Interphalangeal B. Carpometacarpal of first digit C. Elbow joint (humeroulnar or humeroradial) D. Metacarpophalangeal of second to fifth digits E. Radiocarpal F. Intercarpal G. Elbow joint H. Proximal radioulnar joint

A. Ginglymus (Hinge) B. Saddle (Sellar) C. Ginglymus (Hinge) D. Ellipsoidal (Condyloid) E. Ellipsoidal (Condyloid) F. Plane (Gliding) G. Ginglymus (Hinge) H. Ellipsoidal (Condyloid)

21) Indicate whether the following structures are part of the ulna (U), radius (R), or distal humerus (H) by listing the appropriate letter next to the structure. A. Trochlear notch B. Radial notch C. Olecranon fossa D. Trochlea E. Coronoid tubercle F. Coronoid process G. Olecranon process H. Coronoid fossa

A. U B. U C. H D. H E. U F. U G. U H. H

105) What projections are required for a routine study of the forearm?

AP & Lateral

74) A patient with a trauma injury enters the ER with an evident Colles' fracture. Which positioning routine should be used to determine the extent of the injury?

AP and Lateral Forearm

109) Which routine projection of the elbow best demonstrates the radial head, neck, and tuberosity with slight (if any) superimposition of the ulna?

AP oblique with 45° lateral rotation

111) Which projection of the elbow best demonstrates the coronoid process in profile?

AP oblique with 45° medial rotation

145) Which routine projection of the elbow best demonstrates the radial head and tuberosity free of superimposition?

AP oblique with lateral rotation

77) Which alternative projection to the routine PA wrist best demonstrates the intercarpal joint spaces and wrist joint?

AP projection (with the hand slightly arched)

90) An abnormality of the cartilage affecting long bones

Achrondoplasia

56) ______________ is a radiographic procedure that uses contrast media injected into the joint capsule to visualize soft tissue pathology of thewrist, elbow, and shoulder joints.

Arthrography

79) Which of the following fractures is not demonstrated in a wrist routine? A. Barton's B. Pott's C. Smith's D. Colles'

B) Pott's

86) Fracture and dislocation of the posterior lip of the distal radius

Barton's fracture

8) List three parts of each metacarpal, starting proximally?

Base, Body (shaft), Head

91) Transverse fracture extending through the distal aspect of the metacarpal neck, most often the fifth metacarpal

Boxer's fracture

15) Which is the largest of the carpal bones?

Capitate

155) Which of the carpal bones is considered to be the largest?

Capitate

126) A patient with a history of carpal tunnel syndrome comes to the radiology dept. The orthopedic physician suspects that bony changes in the carpal sulcus may be causing compression of the median nerve. Which special projection best demonstrates this region of the wrist?

Carpal canal position (Gaynor-Hart method)

144) The joint found between the base of the 3rd metacarpal and carpal bone is the:

Carpometacarpal

153) The joint found between the base of the third metacarpal and carpal bone is the:

Carpometacarpal

93) Transverse fracture of the distal radius with posterior displacement of the distal fragment

Colles' fracture

52) The general rule for collimation for upper limb radiography states:

Collimation borders should be visible on all four sides if the image receptor (IR) is large enough to allow this without cutting off essential anatomy

72) A patient with a possible fracture of the radial head enters the ER. When the technologist attempts to place the arm in the AP oblique-lateral rotation position, the patient is unable to extend or rotate the elbow laterally. Which other positions can be used to demonstrate the radial head and neck without superimposition on the proximal ulna?

Coyle method for radial head (lateral elbow, CR 45° toward shoulder)

30) Ellipsoidal joints are classified as freely moveable, or _____________, and allow movement in _______________ directions

Diarthrodial; 4 (four directions)

78) Which positioning error is involved if a majority of the carpal bones are superimposed in a PA oblique wrist projection?

Excessive lateral rotation from PA

(169) The trapezoid is more proximal than the pisiform?

False

110) True/False: Lead shielding is not required for upper limb radiographs if the patient can sit upright for these exams

False

40) True/False: Trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph

False

38) True/False: if the posterior fat pad of the elbow is not visible radiographically, it suggests that a nonobvious radial head or neck fracture is present

False (A nonvisible fat pad suggests a negative exam)

54) True/False: Lead shielding is only requires for upper limb studies performed on patients who are of childbearing age or younger?

False; good practice is to provide shielding for all patients

106) True/False: for a forearm study, the technologist needs to include only the joint closest to the site of the injury.

False; study of long bones between joints must include both joints

66) Which preffered lateral position of the hand best demonstrates the phalanges without excessive superimposition?

Fan lateral

25) Where is the CR centered for an AP projection of the thumb?

First metacarpophalangeal (MCP) joint

156) Which carpal articulates with both the 4th and 5th metacarpals?

Hamate

16) What is the name of the hooklike process extending anteriorly from the hamate?

Hamulus

45) Identify the parts labeled:

I. Olecranon process J. Superimposed humeral epicondyles K. Radial head L. Radial neck M. Radial tuberosity N. Outer ridges of Capitulum and Trochlea O. Trochlear Sulcus P. Trochlear notch

140) How should the original kV range be changed with a large plaster cast applied for a wrist or forearm radiographic procedure?

Increase 8 to 10 kV

123) A routine radiograph of an AP oblique elbow with lateral rotation shows that the radial tuberosity is superimposed over the ulna. In what way must this position be modified during the repeat exposure?

Increase lateral rotation of the elbow to separate the radius from the ulna

159) What is the name of the joint found between the proximal and distal phalanges of the first digit?

Interphalangeal (IP)

9) The name of the joint between the proximal and distal phalanges of the first digit is the?

Interphalangeal joint (IP)

67) Which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand?

Lateral in extension

43) Which routine projections best demonstrates the pronator fat stripe?

Lateral wrist

70) Is the hamate on the medial or lateral side of the wrist?

Mediam

13) A sesamoid bone is frequently found adjacent to the ______________ joint of the thumb

Metacarpophalangeal (MCP)

10) The joints between the metacarpals and the phalanges are the?

Metacarpophalangeal joints (MCP)

125) A patient with a possible fracture of the trapezium enters the ER. The routine projections do not clearly demonstrate a possible fracture. Which other special projection can be taken?

Modified Robert's method

87) Most common type of primary malignant tumor occurring in bone

Multiple myeloma

68) What is the proper name for the position referred to as the "ball-catcher's position"?

Norgaard method

127) A patient comes to the radiology dept for a hand series to evaluate early evidence of rheumatoid Arthritis. Which specific position can be used in addition to the routine hand projections to evaluate this patient?

Norgaard method- ball catcher's position

24) The deep depression located on the posterior aspect of the distal humerus is the?

Olecranon fossa

94) Narrowing of joint spaces with periosteal growths on the joint

Osteoarthritis

92) Hereditary condition marked by abnormally dense bone

Osteopetrosis

97) Mixed areas of sclerotic and cortical thickening along with radiolucent lesions

Osteopetrosis

73) A patient with a metallic foreign body in the palm of the hand enters the ER. Which specific positions should be used to locate the foreign body?

PA and lateral-in-extension projection

41) Which routine best demonstrates the scaphoid fat pad?

PA and oblique wrist

120) In a radiographic study of the forearm, the proximal radius crossed over the ulna in the frontal projection. which specific positioning error led to this radiographic outcome?

PA forearm projection was performed rather than AP

83) Which special projection of the wrist best demonstrates the interspaces on the ulnar side of the wrist between the lunate, triquetrum, pisiform, and hamate bones?

PA projection with radial deviation

128) A patient is referred to radiology with a possible injury to the ulnar collateral ligament. The patient complains of pain near the first MCP joint. Initial radiographs of the hand do not indicate any fracture or dislocation. Which special projection can be performed to rule out an injury to the UCL?

PA stress (Folio method) projection

57) What is the position routine for the second through fifth digits of the digits?

PA, PA OBL, and Lat

61) Where is the CR centered for a PA oblique projection of the second digit?

PIP joint

107) To position the patient properly for an AP projection of the elbow, the epicondyle must be _______________ to the IR.

Parallel

131) A general positioning rule is to place the long axis of the part ___________ to the long axis of the image receptor.

Parallel

136) The two fat stripes of the wrist demonstrated radiographically are known as the scaphoid fat stripe and the ______________ fat stripe.

Pronator

35) How does the forearm appear radiographically if pronated for a posteroanterior (PA) projection?

Proximal Radius crosses over the Ulna

32) Which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones?

Radial Collateral Ligament

138) What is the name of the two small depressions on the anterior aspect of the distal humerus?

Radial and coronoid fossa

148) The bending or forcing of the hand towards the lateral side of the wrist with the hand pronated in a PA projection is known as:

Radial deviation

151) Which special position of the wrist will open up the interspaces of the carpals on the ulnar side of the wrist?

Radial deviation

69) The "ball-catcher's position" is commonly used to evaluate for early signs of:

Rheumatoid arthritis

118) A radiograph of a PA projection of the second digit shows that the phalanges are not symmetric on both sides of the bony shafts. Which specific positioning errors has occurred?

Rotation

Mnemonic for carpal bones

Sally Left The Party To Take Cathy Home

154) Which of the following carpals articulates with the radius?

Scaphoid

157) Which is the most commonly fractured carpal bone?

Scaphoid

17) Which is the most commonly fractured carpal bone?

Scaphoid

135) first carpometacarpal joint is classified as a __________joint.

Sellar (saddle)

89) Sprain or tear of the ulnar collateral ligament

Skier's thumb

132) The smooth, depressed, center portion of the trochlea used for evaluating rotation on a lateral elbow is termed the trochlear:

Sulcus

150) Which of the following actions will lead to the radius and ulna being parallel to each other?

Supination of the hand

82) Which special projection of the wrist helps rule out abnormal calcifications in the carpal sulcus?

Tangential inferosuperior or Gaynor-Hart projection

129) A patient enters the ER with a possible foreign body in the dorsal aspect of the wrist. Initial wrist radiographs are inconclusive in demonstrating the location of the foreign body. What additional projection can be performed to demonstrate this region of the wrist?

Tangential projection- carpal bridge projection

121) A PA axial scaphoid projection of the wrist using a 15-degree distal CR angle and ulnar flexion was performed. The resulting radiograph shows that the scaphoid bone is foreshortened. How must this projection be modified to produce a more diagnostic image of the scaphoid?

The CR needs to be angled 15° proximally, toward the elbow

122) A radiograph of an AP elbow projection shows considerable superimposition between the proximal radius and ulna. What specific positioning error has occcured?

The elbow is rotated medially

71) A radiograph of a lateral projection of the elbow shows that the humeral epicondyle are not superimposed and the trochlear notch is not clearly demonstrated. Which specific type of positioning error is involved?

The forearm and humerus are not on the same horizontal plane

117) What is the only difference among the four radial head lateral projections of the elbow?

The rotation position of the hand and wrist

44) Where is the CR centered for a PA projection of the hand?

Third MCP joint

130) A patient has a routine elbow series performed. The AP projection indicates a possible deformity or fracture of the coronoid process. However, the patient is unable to pronate the upper limb for the AP oblique-medial rotation projection because of an arthritic condition. What other projection could be performed to demonstrate the coronoid process?

Trauma axial lateral projection ---Coyle method for coronoid process

143) Which two structures primarily form the hinge-like structure and movement of the elbow joint?

Trochlea and olecranon process

167) The radius is considered the lateral bone in the forearm?

True

18) True/False: The entire metacarpal and trapezium must be demonstrated on all projections of the thumb.

True

31) True/False: In addition to the ulnar and radial collateral ligaments, the following five additional ligaments are also important in stabilizing the wrist joint: Dorsal radiocarpal, Palmar radiocarpal, Triangular fibrocartilage complex (TFCC), Scapulolunate, and Lunotriquetral

True

39) True/False: Excessive kV may obscure the visibility of a fat pad

True

65) True/False: Slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well positioned PA OBL projection of the hand.

True

142) Which routine projection of the elbow will best demonstrate an elevated or visible posterior fat pad?

True lateral with 90° flexion

55) True/False: Guardians of young pediatric patients who are undergoing upper limb studies can be asked to hold their child during the radiographic study?

True; Ensure that adults are given lead shielding to wear during exposure

34) Which position is most commonly performed to detect a fracture of the scaphoid bone?

Ulnar (Scaphoid) Deviation

134) Which wrist ligament is attached to the styloid process of the ulna and continues to the triquetrum and pisiform?

Ulnar collateral ligament

165) which two structures form the distal radioulnar joint?

Ulnar notch and head of ulna

27) A Bennett's fracture involves:

base of first metacarpal

95) Fluid-filled joint space with possible calcification

bursitis

98) Possible calcification in the carpal sulcus

carpal tunnel syndrome

58) How much of the metacarpals should be included for PA projection of the digits?

distal aspect of metacarpals

133) The first metacarpophalangeal joint has a(n)_______ type of joint movement.

ellipsoidal (condyloid)

147) The radiocarpal (wrist) joint possesses a(n)_________ type of joint movement.

ellipsoidal (condyloid)

119) A radiograph of a PA oblique projection of the hand shows that the fourth and fifth metacarpals are superimposed. When specific positioning errors has occured?

excessive lateral rotation

139) The interphalangeal joints have a(n) _________ type of joint movement.

ginglymus (hinge)

160) Which of the following bony structures is found on the distal aspect of the ulna?

head

7) The three parts of each phalanx, starting distally are the?

head, body, base

146) A ginglymus joint can also be referred to as a ____________ joint.

hinge

152) What bony landmarks are palpated for positioning of the elbow?

humeral epicondyles

141) A nonvisible posterior fat pad on a well-exposed, correctly positioned lateral elbow radiograph generally suggests:

negative study for injury

162) which of the following structures is considered to be most proximal?

olecranon process

163) Which of the following structures is considered to be the most posterior?

olecranon process

96) Soft tissue swelling and loss of fat-pad detail visibility

osteomyelitis

88) Reduction in the quantity of bone or atrophy of skeletal tissue

osteoporosis

158) Which carpal bone is the smallest?

pisiform

166) Which of the following actions will lead to the proximal radius crossing over the ulna

pronation of the hand

5) The two portions of the thumb (first digit) are?

proximal and distal phalanx

22) Which joint permits the forearm to rotate during pronation?

proximal radioulnar joint

6) The three portions of each finger (second through fifth digits) are the?

proximal, middle, and distal phalanx

63) Why is the anteroposterior projection of the thumb recommended instead of the PA?

reduces OID between thumb and IR, therefore, increasing resolution

51) Correctly exposed radiographs: Visualize _________________ margins and ___________________ markings of all bones.

soft tissue, trabecular

164) Which of the following structures is considered to be most distal?

styloid process

168) Which carpal bone articulates with the first metacarpal?

trapezium

108) If the patient cannot fully extend the elbow for the AP projection, what alternative projection(s) should be performed?

two AP projections (partially flexed), one with humerus parallel to IR and one with forearm parallel to IR

124) A patient with a dislocated elbow enters the ER. The patient has the elbow tightly flexed and is careful not to move it. Which specific positioning routine can be used to determine the extent of the injury?

two AP projectionswith acute flexion and a lateral projection

112) Which special projection(s) of the elbow should be performed instead of the routine AP if the patient's elbow is tightly flexed and cannot extend at all?

two projections-- CR perpendicular to humerus and CR perpendicular to forearm (acute flexion projections)

161) which one of the following structures is NOT part of the ulna?

ulnar notch

53) what pertinent factors help reduce image distortion during upper limb radiography?

• 40-44 inches (102-113 cm) SID • Minimal OID • Correct CR placement and angulation • Use of small focal spot