Procedures - Extremity

Question 1

Which of the following projections provides the best view of the trochlear groove of the femur?

AP projection of the knee
Lateral projection of the knee
Tangential projection of the knee
AP oblique projection of the knee

Answer 1

Tangential projection of the knee

A tangential projection provides the best view of the trochlear groove of the femur.
The AP, lateral, and AP oblique projection are not optimized to visualize this structure.

Question 2

For this tangential projection of the toes, the foot should be dorsiflexed so the
plantar surface is at what angle?

5-10 degrees from vertical
15-20 degrees from vertical
30-45 degrees from vertical
90 degrees from vertical

Answer 2

15-20 degrees from vertical

For the tangential projection of the toes to visualize the sesamoid bones, the patient should be placed in a prone position with the foot dorsiflexed until the plantar surface
of the foot forms a 15-20 degree angle from vertical. Less or more angulation will not clearly demonstrate the sesamoid bones.

Question 3

What is the primary purpose of using a 10-degree cephalad angle for the central ray in an AP axial
projection of the foot?

To elongate the phalanges
To visualize the tarsal bones
To open the interphalangeal joint spaces
To reduce foreshortening of the metatarsals

Answer 3

To reduce foreshortening of the metatarsals

Using a 10-degree cephalad angle helps to reduce foreshortening of the metatarsals, providing a clearer image. Elongating the phalanges and visualizing the tarsal bones are not the primary goals. Opening the interphalangeal joint spaces is incorrect as the
angulation primarily impacts the metatarsals

Question 4

What is the proper central ray angle for a trauma axial projection Coyle method) of the elbow to
visualize the radial head?

5 degrees cephalad
30 degrees caudad
45 degrees cephalad
Perpendicular to the mid-elbow

Answer 4

45 degrees cephalad

A 45-degree cephalad angle for the central ray in an axial projection of the elbow
ensures optimal visualization of the radial head. Other angles or a perpendicular ray
would not provide the necessary view for diagnosing issues with the radial head.

Question 5

Which bone contains the radial notch?

Ulna
Radius
Humerus
Scapula

Answer 5

Ulna

The radial notch is a depression on the ulna that articulates with the head of the
radius. The radius has the ulnar notch, the humerus has the radial fossa, and the
scapula does not have a radial notch.

Question 6

Which of the following projections is best for visualizing the sinus tarsi of the foot?

AP projection
Medial oblique projection
Lateral projection
Lateral oblique projection

Answer 6

Medial oblique projection

A medial oblique projection best visualizes the sinus tarsi. This view also demonstrates the third through fifth metatarsals free of superimposition, the tuberosity at the base of the fifth metatarsal in profile, and the joint spaces around the cuboid. AP, lateral, and lateral oblique projections are not suitable for visualizing this structure

Question 7

What degree of knee flexion is recommended for the lateral projection of the distal femur?

15 degrees
25 degrees
35 degrees
45 degrees

Answer 7

45 degrees

Flexing the knee 45 degrees ensures optimal visualization of the distal femur in a lateral projection without causing overlap of structures. Less or more flexion can obscure the image.

Question 8

Which projection is best for visualizing the scaphoid bone in the wrist?

PA with ulnar deviation
PA with radial deviation
PA oblique
Tangential Gaynor-Hart)

Answer 8

PA with ulnar deviation

FEEDBACK
A PA projection with ulnar deviation is best for visualizing the scaphoid bone. Ulnar deviation opens the joint spaces around the scaphoid, providing a clearer image.
Radial deviation is typically used for visualizing the lunate, triquetrum, pisiform, and hamate. A PA oblique does not demonstrate the scaphoid free of superimposition.
The tangential (Gaynor-Hart) projection is used to visualize the carpal canal, not the scaphoid.

Question 9

For the AP projection of the toes, how should the central ray be directed?

Perpendicular to the third metatarsophalangeal joint
Perpendicular to the third distal phalanx
Angled 10-15 degrees caudad
Angled 10-15 degrees cephalad

Answer 9

Angled 10-15 degrees cephalad

Angling the central ray 1015 degrees cephalad helps to open the joint spaces and reduce foreshortening of the phalanges. A perpendicular or caudad angle can close
off the joint spaces and foreshorten the phalanges.

Question 10

The proximal radioulnar joint is classified as what type of articulation?

Amphiarthroidial, slightly movable
Diarthroidial, gliding
Synarthroidial, fibrous
Synovial, pivo

Answer 10

Synovial, pivo

The proximal radioulnar joint is classified as a synovial, pivot type of articulation. The proximal and distal radioulnar joints are freely movable, synovial pivot (trochoidal)
joints.

Question 11

For an AP projection of the clavicle, how should the central ray be directed?

Perpendicular to the midshaft of the clavicle
Perpendicular to the acromioclavicular joint
15-30 degrees cephalad to the midshaft of the clavicle
15-30 degrees caudad to the midshaft of the clavicle

Answer 11

Perpendicular to the midshaft of the clavicle

For an AP projection of the clavicle, the central ray should be directed perpendicular to the midshaft of the clavicle. Directing the ray to the acromioclavicular joint focuses
on a different anatomical area. A 15-30 degree cephalad angle would be appropriate for an AP axial projection. A caudad angle would superimpose the clavicle over the
ribs and other thoracic anatomy instead of separating it.

Question 12

Which bony structure is found at the proximal end of the tibia and serves as an attachment for the
patellar ligament?

Medial condyle
Tibial tuberosity
Lateral condyle
Intercondylar eminence

Answer 12

Tibial tuberosity

The tibial tuberosity is a prominent bony structure at the proximal end of the tibia where the patellar ligament attaches. The medial and lateral condyles are part of the
tibia’s proximal end, forming the knee joint, and the intercondylar eminence is a raised area between the condyles.

Question 13

Which bone articulates with the distal end of the ulna?

Scaphoid
Lunate
Radius
Humerus

Answer 13

Radius

The radius articulates with the distal end of the ulna at the distal radioulnar joint. The humerus articulates with the ulna at the elbow joint, while the scaphoid and lunate
are carpal bones that articulate with the radius and not the ulna.

Question 14

Which artery is the primary blood supply to the hand?

Radial artery
Ulnar artery
Brachial artery
Axillary artery

Answer 14

Ulnar artery

The ulnar artery is the primary blood supply to the hand, particularly to the superficial palmar arch. The radial artery also contributes to the blood supply, particularly to the
deep palmar arch. The brachial and axillary arteries are located more proximally in the upper extremity

Question 15

Which two (2) of the following positioning guidelines are crucial for a true lateral projection of the
lower leg? -Select two

Affected leg should be flexed at the knee and the foot dorsiflexed

Supine with the affected leg extended

Lateral recumbent position with the affected leg against the IR

Affected leg should be extended and externally rotated

Answer 15

Affected leg should be flexed at the knee and the foot dorsiflexed

Lateral recumbent position with the affected leg against the IR

Positioning the patient in a lateral recumbent position with the affected leg against the IR with the knee flexed and the foot dorsiflexed will help place the lower leg in a true lateral position. The other choices would not place the lower leg in a true lateral position.

Question 16

Which of the following bones is the smallest tarsal bone in the foot?

Talus
Navicular
Cuboid
Lateral cuneiform

Answer 16

Lateral cuneiform

The lateral cuneiform is the smallest tarsal bone in the foot. The talus, navicular, and
cuboid are larger tarsal bones

Question 17

For an accurate oblique projection of the elbow, what degree of rotation should be used?

15 degrees
30 degrees
45 degrees
60 degrees

Answer 17

45 degrees

A 45-degree oblique projection of the elbow provides optimal visualization of the radial head, neck, and tuberosity. Smaller or larger degrees of rotation would not
adequately separate these structures and might obscure important anatomical details.

Question 18

Which nerve is commonly compressed in carpal tunnel syndrome?

Ulnar nerve
Median nerve
Radial nerve
Axillary nerve

Answer 18

Median nerve

The median nerve is commonly compressed in carpal tunnel syndrome, leading to symptoms such as numbness and tingling in the hand. The ulnar, radial, and axillary
nerves are not typically involved in this condition.

Question 19

A Bankart lesion is associated with what anatomy?

Glenoid cavity
Knee
Scaphoid bone
Tuberosity of the 5th metatarsal

Answer 19

Glenoid cavity

A Bankart lesion is associated with the glenoid cavity and is an injury to the anterior and inferior labrum of the glenoid cavity. It is generally caused by anterior dislocations of the humerus.

Question 20

In a PA axial projection Holmblad method) of the knee, how should the patient be positioned?

Prone with 40-50 degrees of knee flexion

Kneeling or partially standing with 60-70 degrees of knee flexion

Standing with 45 degrees of knee flexion

Supine with 40-45 degrees of knee flexion

Answer 20

Kneeling or partially standing with 60-70 degrees of knee flexion

The Holmblad method involves positioning the patient in a kneeling or partially standing position with 6070 degrees of knee flexion. Positioning the patient prone
with 4050 degrees of flexion is the Camp Coventry method. Standing with 45 degrees of flexion is the Rosenberg method. Supine with 4045 degrees of flexion is
the Béclere method. All methods demonstrate the intercondylar fossa.