Bontrager Chapter 4 Workbook

Identify the number of bones: Phalanges (fingers and thumb)

14

Identify the number of bones: Metacarpals (palm)

5

Identify the number of bones: Carpals (wrist)

8

Identify the number of bones: Total

27

The two portions of the thumb (first digit) are the:

A. Proximal phalanx

B. Distal phalanx

The three portions of each finger (second through fifth) are the:

A. Proximal phalanx

B. Middle phalanx

C. Distal phalanx

The three parts of each phalanx, starting distally, are the:

A. Head

B. Body (shaft)

C. Base

List the three parts of each metacarpal, starting proximally:

A. Base

B. Body (shaft)

C. Head

The name of the joint between the proximal and distal phalanges of the first digit is the ___________.

Interphalangeal joint

The joints between the metacarpals and the phalanges are the _____________________.

Metacarpophalangeal (MCP) joints

What is the largest of the carpal bones?

Capitate

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

Hamulus/Hamular process

Which is the most commonly fractured carpal bone?

Scaphoid

List two of the mnemonics given in the textbook that uses the first letter of each of the preferred terms of the eight carpal bones.

Either of these two mnemonics is acceptable:

1.) Send Letter To Peter To Tell'im (to) Come Home 2.) Steve Left The Party To Take Carol Home

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

Indicate whether the following structures are part of the radius, ulna, or distal humerus:

Trochlear notch

Ulnar

Indicate whether the following structures are part of the Radius, Ulna, or Distal Humerus:

Radial notch

Ulnar

Indicate whether the following structures are part of the radius, ulna, or distal humerus:

Olecranon fossa

Distal Humerus

Indicate whether the following structures are part of the radius, ulna, or distal humerus:

Trochlea

Distal Humerus

Indicate whether the following structures are part of the radius, ulna, or distal humerus:

Coronoid tubercle

Ulnar

Indicate whether the following structures are part of the radius, ulna, or distal humerus:

Coronoid process

Ulnar

Indicate whether the following structures are part of the radius, ulna, or distal humerus:

Olecranon process

Ulnar

Indicate whether the following structures are part of the radius, ulna, or distal humerus:

Coronoid fossa

Distal Humerus

Which joint permits the forearm to rotate during pronation?

Proximal radioulnar joint

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

B. Capitulum

The deep depression located on the posterior aspect of the distal humerus is the __________.

Olecranon fossa

The criteria for evaluating a true lateral position of the elbow are the appearance of three concentric arcs:

A. The first and smallest of the arcs

B. The intermediate double arc, consisting of the outer ridges of:

(a) The smaller arc

(b) The larger arc

C. The third arc, which is part of the Ulna

A. Trochlear sulcus (groove)

B. (a) Capitulum

(b) Trochlea

C. Trochlear notch

Joint movement type:

Interphalangeal

Ginglymus

Joint movement type:

Carpometacarpal of first digit

Saddle

Joint movement type:

Elbow joint (humeroulnar and humeroradial)

Ginglymus

Joint movement type:

Metacarpophalangeal of second to fifth digits

Ellipsoidal

Joint movement type:

Radiocarpal

Ellipsoidal

Joint movement type:

Intercarpal

Plane

Joint movement type:

Elbow joint

Ginglymus

Joint movement type:

Proximal radioulnar joint

Pivot

Ellipsoidal joints are classified as freely movable, or ____________, and allow movement in __________ directions.

diarthrodial; 4

True/False: In addition to the ulnar and radial collateral ligaments, the following five additional ligaments are also important in stabilizing the wrist joint.

A. Dorsal radiocarpal

B. Palmar radiocarpal

C. Triangular fibrocartilage complex (TFCC)

D. Scapulolunate

E. Lunotriquetral

True

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

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

B. Radial Deviation

Of the two positions listed in the previous question, which is most commonly performed to detect a fracture of the scaphoid bone?

Ulnar Deviation

How does the forearm appear radiographically if pronated for a PA projection?

The proximal radius crosses over the ulna

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

A. Scaphoid fat stripe

B. Pronator fat stripe

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

A. Elbow flexed 90 degrees

B. Optimal exposure factors used

C. In a true lateral position.

True/False: If the posterior fat pad of the elbow is not visible radiographically, it suggests that a non-obvious radial head or neck fracture is present.

False

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

True

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

False

Which routine projections best demonstrate the scaphoid fat pad?

PA and Oblique wrist

Which routine projection best demonstrates the pronator fat stripe?

Lateral wrist

Identify the technical factors most commonly used for upper limb radiography:

kV range

60-80 kV

Identify the technical factors most commonly used for upper limb radiography:

Long or short exposure time

Short exposure time

Identify the technical factors most commonly used for upper limb radiography:

Large or small focal spot

Small focal spot

Identify the technical factors most commonly used for upper limb radiography:

Most common minimum SID

40" (102 cm)

Identify the technical factors most commonly used for upper limb radiography:

Grids are used if the body part measures greater than ___________ cm

10 cm

Identify the technical factors most commonly used for upper limb radiography:

Small-to-medium dry plaster casts, increase

5-7 kV

Identify the technical factors most commonly used for upper limb radiography:

Large plaster casts, increase

8-10 kV

Identify the technical factors most commonly used for upper limb radiography:

Fiberglass casts, increase

3-4 kV

Identify the technical factors most commonly used for upper limb radiography:

Correctly exposed radiographs:

Visualize ___________ margins and ___________ markings of all bones

soft tissue; trabecular

The general rule for collimation for upper limb radiography states:

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

What are the pertinent factors that help reduce image distortion during upper limb radiography?

A. 40 to 44" SID

B. Minimal OID

C. Correct CR centering and angulation

D. Small focal spot

True/False: Lead (protective) shielding is only required for upper limb studies performed on patients who are of childbearing age.

False (a good practice is to provide shielding for all patients)

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

True - ensure adults are given a lead apron to wear during exposures

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

Arthrography

What is the positioning routine for the second through fifth digits of the hand?

PA, PA oblique, and lateral

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

Distal aspect of metacarpals

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

Identify which positioning modification(s) 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 the medial oblique rather than lateral oblique to decrease OID

B. Perform a thumb-down lateral (mediolateral projection) to decrease OID

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

Proximal Interphalangeal (PIP) joint

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

A. To prevent distortion of the phalanx

B. To prevent distortion of the joints

C. To demonstrate small, non-displaced fractures near the joint

D. All of the above

D. All of the above

Why is the AP projection of the thumb recommended instead of the PA?

The AP position produces a decrease in OID and increased resolution.

Which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the IR?

PA oblique

Which IR size should be used for a thumb projection?

8 x 10"

A sesamoid bone is frequently found adjacent to the ____________________ joint of the thumb.

MCP - metacarpophalangeal

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

True

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

A. First interphalangeal (IP) joint

B. Mid-aspect of proximal phalanx

C. First metacarpophalangeal (MCP) joint

D. First proximal interphalangeal (PIP) joint

C. First metacarpophalangeal (MCP) joint

A Bennett's fracture involves:

A. Base of first metacarpal

B. Trapezium bone

C. Scaphoid bone

D. Fracture extending through first IP joint

A. Base of first metacarpal

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

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

A. Third MCP joint

B. Mid-aspect of third metacarpal

C. Second MCP joint

D. Third PIP joint

A. Third MCP joint

A minimum of _______ inches of the forearm should be included radiographically for a PA projection of the hand.

1"

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

True

Which preferred lateral position of the hand best demonstrates the phalanges without excessive superimposition?

Fan lateral

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

Lateral in extension

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

Norgaard method

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

A. Osteoporosis

B. Osteomyelitis

C. Osteopetrosis

D. Rheumatoid arthritis

D. Rheumatoid arthritis

The elbow generally should be flexed _______ degrees for the routine positions of the wrist.

90

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

45 degrees

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

AP projection (with the hand slightly arched)

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

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

During the PA axial scaphoid projection with CR angle and ulnar flexion, the CR must be angled ________ degrees _______ (proximally or distally).

10 to 15, proximally

How much are the hand and wrist elevated from the IR for the modified Stecher method?

A. None

B. 10 degrees

C. 20 degrees

D. 15 degrees

C. 20 degrees

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

25 to 30 degrees

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

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

Tangential inferosuperior or Gaynor-Hart projection

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

45 degrees

The hand and wrist form a _________ degrees angle to the forearm with the carpal bridge (tangential) projection.

90 degrees

Pathology term for this description:

Fracture and dislocation of the posterior lip of the distal radius

Barton's fracture

Pathology term for this description:

Most common type of primary malignant tumor occurring in bone

Multiple Myeloma

Pathology term for this description:

Reduction in the quantity of bone or atrophy of skeletal tissue

Osteoporosis

Pathology term for this description:

Sprain or tear of the ulnar collateral ligament

Skier's thumb

Pathology term for this description:

An abnormality of the cartilage affecting long bones

Achondroplasia