Chapter 4: Upper Limb- Self Test

How many bones make up the phalanges of the hand?

14

How many bones make up the carpal region?

8

What is the total number of bones that make up the hand and wrist?

27

Which carpal contains a "hooklike" process?

Hamate

Which carpal articulates with the base of the thumb?

Trapezium

Which carpal is most commonly fractured?

Scaphoid

Which two carpal bones are located most anteriorly as seen on a lateral wrist radiograph? (hint; they are on the radial side of the wrist)

Scaphoid and trapezium

True/False: To visualize fat pads surrounding the elbow, exposure factors must be adjusted to see both bony and soft tissue structures.

True

True/False: Anterior and posterior fat pads of the elbow are best seen on correctly positioned and correctly exposed AP elbow projections.

False

Why should a forearm never be taken as a PA projection?

Causes the proximal radius to cross over the ulna

In what position should the hand be for an AP elbow projection?

Supinated (palm up)

In what position should the hand be for an AP medial rotation oblique elbow position?

Pronated (palm down)

True/False: Placing multiple images on the same digital IP is recommended as long as close collimation is applied for each projection.

False

The long axis of the anatomic part being imaged should be placed:

Parallel to long axis of the IR

Arthrography is a radiographic study of:

Soft-tissue structures within certain synovial joints

Which of the following clinical indications requires a decrease in manual exposure factors?

Advanced osteoporosis

Where is the central ray centered for a PA projection of the second digit?

Affected PIP joint

Why is it important to keep the long axis of the digit parallel to the IR?

A. Reduce distortion of the phalanges

B. To visualize joints properly

C. To demonstrate small fractures

All of the above

Where is the central ray centered for a PA projection of the hand?

Third MCP joint

What is the major disadvantage of performing a PA projection of the thumb rather than an AP?

Increased OID

What type of fracture is best demonstrated with a modified Robert's method?

Bennett fracture

True/False: the Brewerton method requires a CR angle of 15 degrees proximal

True

True/False: The hand(s) is(are) placed in a true PA position when using the Brewerton methon

False

Choose the best set of exposure factors for upper limb radiography.

64 kVp, 200 mA, 1/20 second, small focal spot, and 40-inch SID

A radiograph of a PA oblique of the hand shows that the third, fourth and fifth metacarpals are superimposed. What must be done to correct this positioning problem on the repeat exposure?

Decrease obliquity of hand

A radiography of an AP elbow projection demonstrates total separation between the proximal radius and ulna. What must be done to correct this positioning error on the repeat exposure?

Rotate upper limb medially

A radiography of the carpal canal (inferosuperior) projection shows that the pisiform and the hamulus are superimposed. What can be done to correct this problem on the repeat exposure?

Rotate wrist laterally 5-10 degrees

A radiograph of an AP oblique-medial rotation show that the coronoid process is not in profile and the radial head is not superimposed over the ulna. What specific positioning error was involved?

Insufficient medial rotation

A radiograph of a lateral projection of the elbow shows that the epicondyles are not superimposed and the trochlear notch in not clearly seen. What must be done to correct this positioning error during the repeat exposure?

Place humerus/forearm in the same horizontal plane

Situation: A patient with a possible Barton fracture enters the emergency room. Which positioning routine should be performed to confirm the diagnosis?

Wrist

Situation: A patient with a possible Smith fracture enters the emergency room. Which positioning routine should be performed to confirm the diagnosis?

Wrist/Forearm

Situation: A patient has a Colles fracture reduced, and a large plaster cast in placed on the upper limb. the orthopedic surgeon orders a postreduction study. The original technique, used before the cast placement, involved 60 kVp and 5 mAs. How should the exposure factors be altered with a large plaster cast?

68 to 70 kVp

Situation: A pediatric patient with a possible radial head fracture is brought into the emergency room. It is too painful for the patient to extend the elbow beyond 90 degrees or to rotate the hand. What type of special projection could be performed on this patient to confirm the diagnosis without causing further discomfort?

Coyle method