Final

Question 1

Your 26 yo patient presents after attending a wellness talk that you gave 2 days before. They have no significant history of previous low back pain. Upon inspection the patient has what you estimate to be at least 30 degree lumbar scoliosis. The exam is unremarkable. Are x-rays of the lumbar spine indicated

Answer 1

No

Question 2

You have been treating an acute disc herniation patient for 3 weeks and the patient is concerned that they are not improving as quickly as they had hoped. They are wondering if they should continue with care in your office. As discussed in class, which one of the following would be best person to send to for a second opinion regarding your care

Answer 2

Neurologist

Question 3

You have a 41 yo female patient who comes in with a 2 week history of low back pain which began 4 days after the funeral of their mother who died from spinal metastasis secondary to breast carcinoma. Your patient is convinced that she also has cancer and has barely been able to sleep for the last week because of this fear. Your exam is unremarkable. Are lumbar x-rays indicated

Answer 3

Yes

Question 4

When viewing digital x-rays, the viewing area should be as bright as possible

Answer 4

False

Question 5

All of the following are signs of suspected lumbar neoplasm except

Answer 5

Vomiting (intractable pain, ESR>50 mm/hr, and unexplained weight loss are)

Question 6

Regarding x-ray fees, which one of the following satisfies the professional component

Answer 6

Creating a typed ABCS report

Question 7

Your 25 yo patient enters 4 days after a motor vehicle accident. She back into a guard rail pulling out of a parking space with an estimated speed of 5-7 miles per hour. She had no pain that day but upon waking she had neck pain 8-9/10. Palpation revealed significatnt discomfort in both SCM’s but nowhere else. Flexion/extension is limited to 10 degrees in each direction but all other ROM’s are within normal limits. Compression and distraction both produce considerable neck pain. Neurologic exam is unremarkable. Are x-rays of teh cervical spine indicated

Answer 7

No

Question 8

According to y/r failure to have a written report when using the global fee constitutes fraud

Answer 8

True

Question 9

You have a 24 yo male who presents with a 6 week history of pain and stiffness in the pelvis/lumbosacral region which is present each morning he wakes up and lasts for about an hour until he is up and around at which time things seem to loosen up. Gaenslen’s test and the belt test are positive. Both of his siblings have been diagnosed with isthmic spondylolisthesis. Which one of the following is most likely

Answer 9

Possible AS/lumbopelvic X-rays indicated

Question 10

According to GA law and x-ray interpretation, a DC is only held responsible to the same standard of care as a local DC with the same degree of education. T/F

Answer 10

False

Question 11

A 43 yo overweight female comes in complaining primarily of leg pain and secondarily of low back pain 3 days after lifting heavy boxes while helping a friend move into a new apartment. She rates the pain 9/10. The leg pain starts int eh buttock, goes down the side of the thigh, crosses over the knee and heads to the great toe. SLR and Bowstring’s reproduce the leg pain. Sensation to the pinwheel is decreased in the same leg pain distriubtion adn the foot/great toe dorsiflexors are weak. Are x-rays indicated

Answer 11

No

Question 12

With regard to x-ray interpretation and GA law, the local defense represents the standard of care. T/F

Answer 12

False

Question 13

You have a 21 yo male who presents with a 6 week history of insidious neck pain. He really hasn’t done anythign for it treatment wise thinking that it would go away as quickly as it started. Your exam is rather unremarkable. Are x-rays of the c-spine indicated

Answer 13

No

Question 14

Malpractice cases always result in board of examiner action

Answer 14

False

Question 15

A 32 yo female presents with low back and leg pain of 1 week duration. The leg pain seems worse than the low back pain. Straight leg raise and Kemp’s produce significant low back pain. She states that sitting seems to reduce the symptoms. Are x-rays indicated of the lumbar spine

Answer 15

No

Question 16

Punitive actions by the board of examiners can occur from inaccurate diagnosis of an x-ray without a malpractice case being filed

Answer 16

True

Question 17

A patient presents the same day they suffered a direct trauma to the posterior ribs. Your exam indicates possible posterior rib fractures in the mid thorax. X-rays are indicated. Which one of the following best identifies the views you should take

Answer 17

AP and 10 degree and 30 degree posterior oblique and 10 and 30 degree anterior oblique

Question 18

As discussed in class, the oblique views in the cervical spine are very accurate regarding degree of IVF stenosis that is present

Answer 18

False

Question 19

A 20 yo female presents with a 3 day history of neck pain and stiffness. Your exam is unremarkable other than some suboccipital tenderness. She says this has occurred every 3-4 months since she turned 16. Are x-rays indicated

Answer 19

Yes

Question 20

You have a 42 yo patient who presents with a 2 week history of an insidious onset of neck pain. Other than palpable midline tenderness the exam is unremarkable. There is no real history of neck pain other than a whiplash from a motor vehicle accident 5 years ago which was treated with pain killers, muscle relaxants and anti-inflammatories. Are x-rays indicated

Answer 20

No

Question 21

Which one of the following would not be appropriate to put in the body of an x-ray report

Answer 21

A grade II spondylolisthesis is noted at L5

Question 22

A 48 yo female presents with neck and arm pain/paresthesia of 1 week duration. The exam is for the most part unremarkable. Are x-rays indicated

Answer 22

Yes

Question 23

It is considered acceptable and is legal to take a digital photo of an x-ray and email it to a radiologist for interpretation

Answer 23

False

Question 24

On examining a new patient you palpate a nodule in teh thyroid. An endocrinologist would be an excellent person to refer to for further assessment since they frequently treat thyroid issues

Answer 24

True

Question 25

You take x-rays on a 65 yo and see a 5cm abdominal aortic aneurysm which is confirmed by a DACBR. Which one of the following providers should you send this patient to

Answer 25

Cardiologist

Question 26

A 49 yo female presents 2 days after a motor vehicle accident. In the history she says she had her ovaries removed 8 years earlier and her erecent DEXA shows she is osteoporotic. She had delayed onset of neck pain but now her traps and lateral neck musculature are very tender and she ahs a tension type headache. The lateral musculature and traps are tender to palpation. The remainder of the exam is basically normal. Are x-rays indicated

Answer 26

Yes

Question 27

A 58 yo male comes in for wellness care following a back talk you gave 1 week earlier. He has never had neck pain. On exam the swallowing test is positive and on further questioning he does have some discomfort when he swallows. His cervical exam is otherwise completely unremarkable. Which one fo the following would represent the next best step

Answer 27

X-ray the cervical spine

Question 28

A patient presents with a known history of RA. She is seeking care from you for neck pain that had an insidious onset 6 days ago. Your neck exam is unremarkable. Which x-rays of the cervical spine should you take, if indicated

Answer 28

Apom, AP lower cervical, AP lateral

Question 29

A 29 yo male presents with low back pain 4 months after helping a friend move. Other than decreased range of motion, generalized low back tenderness and spasm, the exam and history are unremarkable. Are x-rays indicated

Answer 29

Yes

Question 30

A patient presents with a 1 week history of low back pain after cleaning out a garage. They have some palpable pain and spasm but the exam is otherwise unremarkable. Although they had a lot of back pain years ago, they have had little to no problems since having a lumbar surgical fusion with the use of metal screws 6 years ago. Are x-rays indicated

Answer 30

Yes

Question 31

A long time 32 yo patient comes in for a normally scheduled appointment. You notice they are quite flustered and on questioning they say they just slipped and fell on the ice in the parking lot. They have 1/10 pain around L2 but little to no tenderness or spasm. Are x-rays indicated

Answer 31

No

Question 32

You are leasing space in an office that does not have an x-ray machine but is adjacent to a lab. A 68 yo male you have been treating complains of worsening low back/SI pain and asks if you can order some lab work. The ESR comes back at 58 mm/hr. Are x0rays indicated

Answer 32

Yes

Question 33

Given the results which is the msot likely diagnosis - 58mm/hr

Answer 33

Skeletal metastasis

Question 34

On an AP lumbar you see a calcification to the right of L2. You are not sure if it is in teh kidney or gallbladder. You take a posterior oblique and it moves closer to the spine. Therefore it is most likely in the gallbladder

Answer 34

True

Question 35

Your patient has been diagnosed with prostate carcinoma and wants a surgical opinion. Which would you refer to

Answer 35

Urologist

Question 36

In which portion of the report should the following be placed

Increased density is noted withint the entire vertebral body of L2 without a change in size or shape to the segment

Answer 36

B

Question 37

In which portion

Anterolisthesis is noted at C3

Answer 37

A

Question 38

In which portion

Vacuum phenomenon is seen in the L4/L5 disc space

Answer 38

C

Question 39

In which portion

Scattered vascular calcification is noted without evidence of aneurysm formation

Answer 39

S

Question 40

In which portion

Bilateral fusion of the SI joints is noted

Answer 40

C