2.5.D Extremities Flashcards

Question

Conditions in which there is a lack of normal bone calcification include 1. rickets. 2. osteomalacia. 3. osteoarthritis. A - 1 only B - 1 and 2 only C - 2 and 3 only D - 1, 2, and 3

Answer 1

B - 1 and 2 only Rickets and osteomalacia are disorders in which there is softening of bone. Rickets results from a deficiency of vitamin D and usually is found affecting the growing bones of young children. The body's weight on the soft bones of the legs results in bowed and misshapen legs. Osteomalacia is an adult condition in which new bone fails to calcify. It is a painful condition and can result in easily fractured bones, especially in the lower extremities. Osteoarthritis is seen often in the elderly and is characterized by degeneration of articular cartilage in adjacent bones. The resulting rubbing of bone against bone results in pain and deterioration.

Answer 2

C - Medial A lateral projection of the fourth digit/finger is best obtained if the finger is positioned so that there is as little OID as possible. Therefore, with only the fourth digit extended in the lateral position, the arm is positioned on the ulnar (medial) surface. This places the digit closer to the IR than if it were positioned radial side down. Excessive magnification distortion is avoided, and better spatial resolution is obtained.

Answer 3

B - lateral projection. A frontal projection (AP or PA) demonstrates the medial and lateral relationship of structures. A lateral projection demonstrates the anterior and posterior relationship of structures. Two views, at right angles to each other, are generally taken of most structures.

Answer 4

C - AP erect Arthritic changes in the knee result in changes in the joint bony relationships. These bony relationships are best evaluated in the AP position. Narrowing of the joint spaces is readily detected more on AP weight-bearing projections than on recumbent projections.

Answer 5

B - 1 and 2 only The axial trauma lateral (Coyle) position is described. If routine elbow projections in extension are not possible because of limited part movement, this position can be used to demonstrate the coronoid process and/or radial head. With the elbow flexed 90 degrees, the epicondyles perpendicular to the IR, and the CR directed to the elbow joint at an angle of 45 degrees medially (i.e., toward the shoulder), the joint space between the radial head and capitulum should be revealed. With the elbow flexed 80 degrees and the CR directed to the elbow joint at an angle of 45 degrees laterally (i.e., from the shoulder toward the elbow), the elongated coronoid process will be visualized.

Answer 6

C - Plane The sternoclavicular joint is a plane or gliding joint marked by a sliding/gliding motion between the sternum and clavicle (C). This type of joint does not allow for much movement. Spherical or ball-and-socket joints are freely movable and are found in the hip and shoulder joints (A). Ginglymus or hinge joints are found in the interphalangeal and elbow joints (B). Trochoid or pivot joints are found between C1 and C2 and between the radius and ulna (proximal and distal) (D).

Answer 7

D - Transthoracic lateral The transthoracic (Lawrence) method is used when trauma exists, and the arm cannot be rotated or abducted because of an injury. This method results in a projection 90 degrees from the AP projection and shows the relationship between the proximal humerus and the scapula.

Answer 8

D - Number 11 An anterior view of the forearm is pictured. The proximal anterior surface of the ulna (number 8) presents a rather large pointed process at the anterior margin of the semilunar (trochlear) notch (5) called the coronoid process (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.

Answer 9

D - 1, 2, and 3 The greater and lesser tubercles are prominences on the proximal humerus separated by the intertubercular (bicipital) groove. The AP projection of the humerus/shoulder places the epicondyles parallel to the IR and the shoulder in external rotation, and demonstrates the greater tubercle in profile. The lateral projection of the humerus places the shoulder in extreme internal rotation with the epicondyles perpendicular to the IR and demonstrates the lesser tubercle in profile.

Answer 10

B - 45 degrees oblique, affected side adjacent to IR. When viewing the glenoid cavity/fossa from the anterior, it is seen to angle posteriorly and laterally approximately 45 degrees. To view it in profile, then, it must be placed so that its surface is perpendicular to the IR. The patient is positioned in a 45-degree oblique, affected side adjacent to IR, which places the glenoid fossa approximately perpendicular to the IR. The arm is abducted slightly, the elbow is flexed, and the hand and forearm are placed over the abdomen. The CR is directed perpendicular to the glenohumeral joint.

Answer 11

B - 1 and 2 only The carpal scaphoid is a curved, boat-shaped, bone, and is therefore superimposed on itself ("self-superimposition") in a routine PA projection. Since the scaphoid is the most frequently fractured carpal, special projections have been developed to help overcome self-superimposition. Stecher (in 1937) recommended elevating the hand and wrist 20° and using a perpendicular CR directed to the scaphoid. Effective variations of this position include employing ulnar deviation and angling the CR 20° proximally (toward the elbow). The 20° tube angulation would be used in place of the elevated hand/wrist.

Answer 12

C - tangential ("sunrise") projection. The tangential ("sunrise") projection is used to demonstrate the articular surfaces of the femur and patella. It is also used to demonstrate vertical fractures of the patella. The AP, PA, and oblique projections of the knee are used primarily to evaluate the joint space and articulating structures. The tunnel view is used to demonstrate the intercondyloid fossa.

Answer 13

A - 1 only The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly and presents a long, narrow ridge posteriorly called the linea aspera. The proximal femur consists of a head that is received by the pelvic acetabulum. The femoral neck, which joins the head and shaft, normally angles upward about 120 degrees and forward (in anteversion) about 15 degrees. The greater and lesser trochanters are large processes on the posterior proximal femur. The intertrochanteric crest runs obliquely between the posterior trochanters; the intertrochanteric line parallels the intertrochanteric crest on the anterior femoral surface. The intercondyloid fossa, a deep notch, is found on the distal posteri

Answer 14

D - PA hand A PA projection of the left hand and wrist is obtained most often to evaluate skeletal maturation. These images are compared with standard normal images for the age and sex of the child. Additional supplemental images may be requested.

Answer 15

D - 1, 2, and 3 X-ray arthrography requires the use of local anesthesia; sterile technique must be observed to avoid introducing infection into the joint. Fluoroscopy is used for proper placement of the needle and to obtain images immediately after the introduction of contrast medium. Arthrogram is frequently followed up with magnetic resonance (MR) arthrogram to visualize additional soft tissue structures. Arthrography is performed to detect compromised knee capsule structures, meniscal damage, ligament tears, and Baker cysts.

Answer 16

B - Plantodorsal projection of the calcaneus The talocalcaneal, or subtalar, joint is a three-faceted articulation formed by the talus and the os calcis (calcaneus). The plantodorsal and dorsoplantar projections of the os calcis should exhibit sufficient receptor exposure to visualize the talocalcaneal joint. This is the only "routine" projection that will demonstrate the articular surfaces of the talocalcaneal joint. The lateral projection demonstrates the calcaneocuboid joint but does not demonstrate the entirety of the talocalcaneal joint, demonstrating all its articular surfaces. If evaluation of the talocalcaneal joint is desired, special views (such as the Broden and Isherwood methods) are required.

Answer 17

C - epiphysis. Bones are classified as long, short, flat, and irregular. Many of the bones making up the extremities are long bones. Long bones have a shaft and two extremities (ends). The shaft (or diaphysis) of long bones is the primary ossification center during bone development. It is composed of compact tissue and covered with a membrane called periosteum. Within the shaft is the medullary cavity, which contains bone marrow and is lined by the membrane called endosteum. In the adult, yellow marrow occupies the shaft, and red marrow is found within the proximal and distal extremities of long bones. The secondary ossification center, the epiphysis, is separated from the diaphysis

Answer 18

C - Lateral weight-bearing The bones of the foot are arranged to form a number of longitudinal and transverse arches. The longitudinal arch facilitates walking and is evaluated radiographically in lateral weight-bearing (erect) projections. Recumbent laterals would not demonstrate any structural change that occurs when the individual is weight-bearing erect.

Answer 19

A - Tangential, Neer method The Neer method is an LAO or RAO position used to demonstrate the coracoacromial arch/outlet for demonstration of shoulder impingement. The patient is rotated, with affected side toward IR, enough to place scapular body perpendicular to the IR. The central ray is directed 10 to 15° caudally to the anterior aspect of the humeral head. This position demonstrates the superior border of the coracoacromial arch/outlet formed by the posterior surface of the acromion process and the acromioclavicular joint. The iinferosuperior West Point method will demonstrate abnormalities of the glenoid rim and Hill-Sacks defects of the humeral head.

Answer 20

D - acromion process 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).

Answer 21

C - 1 and 3 only The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, that articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. Just proximal to the capitulum and the trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. The coronoid fossa is found on the anterior distal humerus and functions to accommodate the coronoid process with the elbow in flexion. The intertubercular (bicipital) groove is located on the proximal humerus.

Answer 22

A - 1 and 2 only Knee arthrography may be performed to demonstrate torn meniscus (cartilage), Baker's cyst, loose bodies, and ligament damage. A torn rotator cuff would be demonstrated on a shoulder, not a knee arthrogram.

Answer 23

C - the arm should be in internal rotation. The inferosuperior axial (nontrauma, Lawrence method) projection of the shoulder demonstrates the glenohumeral joint and adjacent structures. The patient is supine with arm abducted 90°, and in external rotation. The (horizontal) CR is directed medially 25° to 30° through the axilla. The coracoid process and lesser tubercle are seen in profile.

Answer 24

A - head. The distal radius presents a styloid process laterally; its ulnar notch is located medially, helping to form the distal radioulnar articulation. The distal surface of the radius (carpal articular surface) is smooth for accommodating the scaphoid and lunate to form the radiocarpal (wrist) joint. The proximal radius has a cylindrical head with a medial surface that participates in the proximal radioulnar joint; its superior surface articulates with the capitulum of the humerus. Fracture of the distal radius is one of the most common skeletal fractures. Fractures of the radial head and neck frequently result from a fall onto an outstretched hand with the elbow partially flexed. Severe fractures often are accompanied by posterior dislocation of the elbow joint. Colles' fractures of the distal radius usually result from a fall onto an outstretched hand with the arm extended.

Answer 25

D - Trochlea The distal humerus articulates with the proximal radius and ulna to form the elbow joint. Specifically, the semilunar/trochlear notch of the proximal ulna articulates with the trochlea of the distal medial humerus. The capitulum is lateral to the trochlea and articulates with the radial head (see figures below).

Answer 26

B - Lateral border 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.

Answer 27

A - 1 only In the AP projection of the normal knee, the space between the tibial plateau and the femoral condyles is equal bilaterally. It is, therefore, important that there be no pelvic rotation that could change the appearance of an otherwise normal relationship. The AP projection of the knee superimposes the patella and femur. The CR should enter at the knee joint, located ½ in. distal to the patellar apex.

Answer 28

D - Cuboid The bones of the foot include the seven tarsal bones, five metatarsal bones, and 14 phalanges. The calcaneus (os calcis) serves as the attachment for the Achilles tendon and articulates anteriorly with the cuboid bone. Articulating anteriorly with the navicular are the three cuneiform bones: medial/first, intermediate/second, and lateral/third. The navicular articulates laterally with the cuboid. The bases of the fourth and fifth metatarsals articulate with the cuboid. The fifth (most lateral) metatarsal projects laterally and presents a large tuberosity at its base making it very susceptible to fracture.

Answer 29

C - 1 and 3 only 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.

2.5.D Extremities Flashcards

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