Procedures - Thorax and abdomen procedures

Question 1

The outermost layer of the esophagus is the:
a. smooth muscle layer
b. mucosa layer
c. longitudinal muscular layer
d. fibrous layer

Answer 1

D fibrous layer

Question 2

Which organ has mucosal folds that are referred to as haustra?

Colon
Small intestine
Liver
Stomach

Answer 2

Colon

The colon has mucosal folds that are referred to as haustra. The muscular layer of the
large intestine contains three longitudinal muscular bands, or taeniae coli, that pull
the intestine into pouches.

Question 3

The esophagus originates:

At the back of the mouth
At the hyoid bone
At the inferior border of the cricoid cartilage (C6)
At the inferior margin of the oropharynx

Answer 3

At the inferior border of the cricoid cartilage (C6)

at approximately C6 as a continuation of the laryngopharynx

Question 4

The esophagus is a continuation of what structure

Laryngopharynx
Oropharynx
Thyroid cartilage
Trachea

Answer 4

Laryngopharynx

The esophagus is a continuation of the laryngopharynx. The esophagus begins at the
lower border of the cricoid cartilage (approximately C6.

Question 5

What type of joint is the second sternocostal joint?

Immovable

Slightly movable

Synovial condyloid

Synovial gliding

Answer 5

Synovial gliding

The second sternocostal joint is a synovial gliding type of joint. The second through
seventh sternocostal joints are synovial joints that allow gliding movement. The
sternocostal joints are found between the costal cartilage of the true ribs and the
sternum. Immovable joints are joints in which two or more bones are in close contact
but no movement can occur as in skull sutures. An example of slightly movable joints
are vertebral joints; two or more bones are held together tightly that only limited
movement is permitted. A synovial condyloid type of joint is a modified ball and
socket joint that allows for flexion, extension, abduction, and adduction movements.

Question 6

What type of joint is a costovertebral joint?

Immovable
Slightly movable
Synovial condyloid
Synovial gliding

Answer 6

Synovial gliding

FEEDBACK
Costovertebral joints are synovial gliding joints. Costovertebral joints are found
between the head of a rib and the body of a thoracic vertebra. These are synovial
joints that allow gliding movement.

Question 7

Which of the following describes the sternoclavicular joint?

Amphiarthrodial
Synarthrodial
Synovial, condylar
Synovial, gliding

Answer 7

Synovial, gliding

FEEDBACK
Synovial, gliding describes the sternoclavicular joint. Sternoclavicular joints are freely
movable, gliding joints that allow elevation and depression of the shoulders along
with other movements. Synarthrodial joints are immovable joints and amphiarthrodial joints are slightly movable joints.

Question 8

What is the term for the opening of the esophagus into the stomach

Esophageal hiatus
Cardiac orifice
Pyloric antrum
Cardiac incisure

Answer 8

Cardiac orifice

FEEDBACK
The opening of the esophagus into the stomach is called the cardiac orifice. The
esophagus empties into the stomach through an opening called the cardiac orifice or
the esophagogastric EG junction.

Question 9

In which clinical scenario is performing a lateral chest projection with suspended expiration particularly useful?

Evaluating the lung apices
Assessing diaphragmatic movement
Visualizing the trachea
Examining a suspected pneumothorax

Answer 9

Examining a suspected pneumothorax

FEEDBACK
Suspended expiration helps reduce lung volume, making a pneumothorax more visible by enhancing the contrast between the collapsed lung and the pleural air. Evaluating the lung apices and visualizing the trachea do not specifically benefit from suspended expiration. Assessing diaphragmatic movement requires multiple phases of breathing, not just expiration.

Question 10

Which position is best for demonstrating the right colic (hepatic) flexure of the colon in a barium enema study?

RAO
LAO
Right lateral decubitus
Left lateral decubitus

Answer 10

RAO

FEEDBACK
The RAO position opens up and demonstrates the right colic (hepatic) flexure of the
colon. The LAO is used for the left colic (splenic) flexure. Right lateral decubitus and
left lateral decubitus do not specifically target this flexure.

Question 11

In which clinical scenario is performing a lateral chest projection with suspended expiration particularly useful?

Evaluating the lung apices

Assessing diaphragmatic movement

Visualizing the trachea

Examining a suspected pneumothorax

Answer 11

Examining a suspected pneumothorax

Suspended expiration helps reduce lung volume, making a pneumothorax more visible
by enhancing the contrast between the collapsed lung and the pleural air. Evaluating
the lung apices and visualizing the trachea do not specifically benefit from suspended
expiration. Assessing diaphragmatic movement requires multiple phases of breathing,
not just expiration.

Question 12

Which of the following is the most common cause of esophageal varices?

Cardiovascular disease
Eating spicy food
Long term gastritis
Portal hypertension

Answer 12

Portal hypertension

Portal hypertension is the most common cause of esophageal varices. A condition of
dilated and tortuous veins in the middle and distal esophagus is called varices, which
is secondary to long term portal hypertension where blood does not easily circulate
through the liver and must find an alternate path to return to the heart.

Question 13

Which of the following describes the sternoclavicular joint?

Amphiarthrodial
Synarthrodial
Synovial, condylar
Synovial, gliding

Answer 13

Synovial, gliding

Synovial, gliding describes the sternoclavicular joint. Sternoclavicular joints are freely
movable, gliding joints that allow elevation and depression of the shoulders along
with other movements. Synarthrodial joints are immovable joints and amphiarthrodial
joints are slightly movable joints.

Question 14

What is the term for the opening of the esophagus into the stomach?

Cardiac incisura
Cardiac orifice
Esophageal hiatus
Pyloric antrum

Answer 14

Cardiac orifice

The opening of the esophagus into the stomach is called the cardiac orifice. The
esophagus empties into the stomach through an opening called the cardiac orifice or
the esophagogastric EG junction

Question 15

Which part of the rib articulates with the transverse process of the thoracic vertebra?

Head
Neck
Shaft
Tubercle

Answer 15

Tubercle

The tubercle part of the rib articulates with the transverse process of the thoracic
vertebra. There are two types of articulations between the ribs and the thoracic
vertebrae: costovertebral—between the heads of the ribs and the bodies of the
vertebrae and costotransverse—between the tubercles of the ribs and the transverse
processes of the vertebrae.

Question 16

Which three of the following structures are found in the left lung? Select three)

Horizontal Fissure
Lingula
Oblique Fissure
Short and wide primary bronchus
Superior lobe

Answer 16

Lingula
Oblique Fissure
Superior lobe

The following structures are found in the left lung: lingula, oblique fissure, and
superior lobe. The left lung has only two lobes and is divided into a superior and
inferior lobe by the oblique fissure. The portion of the left lung that would correspond
to the right middle lobe is called the lingula. The left main bronchus is more
horizontal, narrower, and much longer than the right main bronchus.

Question 17

Which of the following conditions is a complication of gastroesophageal reflux disease (GERD)?

Achalasia
Barrett’s esophagus
Gastritis
Varices

Answer 17

Barrett’s esophagus

Barrett’s esophagus is a complication of gastroesophageal reflux disease (GERD).
Gastroesophageal reflux allows stomach contents and acid to pass retrograde from the stomach through an incompetent cardiac sphincter. Because of the constant
irritation, the internal lining of the distal esophagus may undergo metaplasia. Normal esophageal tissue is replaced with tissue that more closely resembles other parts of
the digestive system which is called Barrett’s esophagus.

Question 18

For an AP oblique projection of the ribs, how should the patient be positioned to best visualize the left axillary ribs?

45 Degree RPO
45 Degree LPO
45 Degree RAO
45 Degree LAO

Answer 18

45 Degree LPO

To best visualize the left axillary ribs in an AP oblique projection of the ribs, the patient should be placed in a 45 degree obliquity with the affected left side closest to
the IR, LPO position. For AP oblique projections, the posterior aspect of the patient is closest to the IR, and the axillary ribs of the side closest to the IR will be seen in
profile. The RAO and LAO positions are used for PA oblique projections.

Question 19

The trachea bifurcates at what vertebral level?

C6
T1-T2
T4-T5
T9

Answer 19

T4-T5

The trachea bifurcates at the level of T4-T5.

Question 20

The esophagus is a continuation of what structure?

Laryngopharynx
Oropharynx
Thyroid cartilage
Trachea

Answer 20

Laryngopharynx

The esophagus is a continuation of the laryngopharynx. The esophagus begins at the
lower border of the cricoid cartilage (approximately C6.

Question 21

In a patient with severe emphysema, what adjustment should be made to optimize the chest radiograph?

Increase the exposure time
Use a lower kVp
Use a higher kVp
Perform the radiograph in expiration

Answer 21

Use a lower kVp

Patients with severe emphysema have hyperinflated lungs, which require less kVp for adequate penetration and visualization. Increasing the exposure time is not beneficial as it may lead to motion artifacts. Higher kVp would over-penetrate the lungs.
Performing the radiograph in expiration is generally not recommended for patients with emphysema as it does not allow for proper evaluation of lung fields.

Question 22

For an AP oblique projection of the ribs, how should the patient be positioned to best visualize the left axillary ribs?

45 degree RPO position
45 degree RAO position
45 degree LPO position
45 degree LAO position

Answer 22

45 degree LPO position

To best visualize the left axillary ribs in an AP oblique projection of the ribs, the patient should be placed in a 45 degree obliquity with the affected left side closest to the IR, LPO position. For AP oblique projections, the posterior aspect of the patient is closest to the IR, and the axillary ribs of the side closest to the IR will be seen in
profile. The RAO and LAO positions are used for PA oblique projections.

Question 23

A patient is to be scheduled for a barium enema (BE), an abdominal sonogram (US), and an upper GI (UGI). The proper sequence for performing these procedures is:

BE, US, UGI
UGI, BE, US
UGI, US, BE
US, BE, UGI

Answer 23

US, BE, UGI

The proper sequence for performing these procedures is US, BE, UGI. Because barium and intestinal gas interfere with the transmission of sound waves, the abdominal sonogram should be performed prior to either of the contrast studies. Upper and lower GI studies are performed on consecutive days; barium remaining in
the lower intestine from a barium enema will not interfere with an upper GI, however, barium remaining in the abdomen from an upper GI will interfere with visualization of the large intestine.

Question 24

What degree of patient rotation is typically used to achieve this
radiograph?

A 15-20 degree rotation in the RAO position is used to project the sternum over the heart shadow, providing better contrast and avoiding superimposition of the spine. Rotations greater than 20 degrees are unnecessary and may distort the image.

Question 25

What type of joint is the first sternocostal joint?

Immovable
Slightly movable
Synovial condyloid
Synovial gliding

Answer 25

Immovable

The first sternocostal joint is an immovable type of joint. The first sternocostal joint is a cartilaginous synchondrosis that allows no movement. The sternocostal joints are found between the costal cartilage of the true ribs and the sternum. Synovial gliding
joints allow gliding movement. An example of slightly movable joints are vertebral joints; two or more bones are held together tightly that only limited movement is permitted. A synovial condyloid type of joint is a modified ball and socket joint that
allows for flexion, extension, abduction, and adduction movements.

Question 26

Why is the RAO position preferred for a sternum projection?

To move the sternum away from the heart shadow
To minimize distortion of the ribs
To prevent superimposition of the spine
To maximize exposure of the manubrium

Answer 26

To prevent superimposition of the spine

The RAO position places the sternum over the heart shadow, avoiding superimposition of the spine, which provides a clearer image of the sternum. Minimizing distortion of the ribs and maximizing exposure of the manubrium are not the primary reasons.

Question 27

What is the appropriate position for demonstrating the anterior surface of the stomach and the retrogastric space in an upper GI series?

Right lateral
Left lateral
AP supine
PA prone

Answer 27

Right lateral

The right lateral position demonstrates the anterior surface of the stomach and the retrogastric space. The left lateral, AP supine, and PA prone positions do not provide the same view of these structures.

Question 28

For a female patient undergoing a VCUG, which central ray direction is used for imaging the urethra during voiding?

At the level of the pubic symphysis
2 inches above the pubic symphysis
At the level of the iliac crests
2 inches above the ASIS

Answer 28

At the level of the pubic symphysis

The CR should be perpendicular at the level of the pubic symphysis for imaging the urethra during voiding in a female patient undergoing a VCUG. This positioning ensures the urethra is properly visualized. The other CR directions are incorrect for
this specific purpose.

Question 29

During an IVU, which central ray alignment is used for an oblique projection to visualize the renal pelvis of the right kidney?

2 inches above the iliac crests in a 30-degree LPO position
2 inches above the iliac crests in a 30-degree RPO position
At the level of the iliac crests in a 30-degree LPO position
At the level of the iliac crests in a 30-degree RPO position

Answer 29

At the level of the iliac crests in a 30-degree LPO position

The CR should be perpendicular at the level of the iliac crests in a 30-degree LPO position to visualize the renal pelvis of the right kidney during an IVU. This position ensures optimal visualization and reduces superimposition of structures. The other options do not provide the correct CR direction for this specific projection.

Question 30

What adaptation to technical factors should be made for a patient with known empyema?

Increase mA
Decrease exposure time
Increase kVp
Decrease kVp

Answer 30

Increase kVp

A patient with known empyema (accumulation of pus in the pleural cavity) will require an increase in kVp to penetrate the dense fluid that is not typically present. Increasing mA will not help penetrate the pathology and will increase patient dose. Decreasing exposure time is not necessary and could cause a decrease in image quality. Similarly, decreasing kVp will likely compromise image quality because it will have even less penetrability than what is needed.

Question 31

Which positioning technique is recommended when performing a chest AP projection on an infant?

Using a positioning aid to hold the infant
Having the infant sit upright
Laying the infant supine on the imaging table
Holding the infant’s arms above their head

Answer 31

Using a positioning aid to hold the infant

Using a positioning aid helps to secure the infant and maintain the correct position while minimizing motion, ensuring high-quality images. Having the infant sit upright or laying them supine can be challenging without immobilization. Holding the infant’s
arms above their head can be difficult to maintain without a positioning aid and causes unnecessary radiation exposure to the person holding the patient.

Question 32

Which central ray angulation is used for an AP axial projection of the urinary bladder during a cystogram?

10-15 degrees cephalad
10-15 degrees caudad
15-20 degrees cephalad
15-20 degrees caudad

Answer 32

10-15 degrees caudad

A CR angulation of 1015 degrees caudad is used for an AP axial projection of the urinary bladder during a cystogram to project the bladder free of superimposition by the pubic bones. The other options are incorrect for this specific projection.

Question 33

What type of joint is a costotransverse joint?

Immovable
Slightly movable
Synovial condyloid
Synovial gliding

Answer 33

Synovial gliding

The costotransverse joint is a synovial gliding type of joint. Costotransverse joints are found between the tubercle of a rib and the transverse process of a thoracic vertebra. These are synovial joints that allow gliding movement. Immovable joints are
joints in which two or more bones are in close contact but no movement can occur as in skull sutures. An example of slightly movable joints are vertebral joints; two or more bones are held together tightly that only limited movement is permitted. A synovial
condyloid type of joint is a modified ball and socket joint that allows for flexion, extension, abduction, and adduction movements.

Question 34

The jugular notch lies at what level on a sthenic patient?

C7
T1
T2-T3 interspace
T4-T5 interspace

Answer 34

T2-T3 interspace

The jugular notch is at the level of T2T3 on a sthenic patient. The jugular notch is the most superior anatomic landmark associated with the manubrium or uppermost portion of the sternum.

Question 35

The suspensory muscle of the duodenum or ligament of Treitz is an anatomic landmark used to identify:

The caudate lobe of the liver
The duodenal bulb
The duodenojejunal flexure
The pyloric sphincter

Answer 35

The duodenojejunal flexure

The suspensory muscle of the duodenum or ligament of Treitz is an anatomic landmark used to identify the duodenojejunal flexure. The junction of the duodenum with the jejunum is called the duodenojejunal flexure and is located at the ligament of
Treitz, the suspensory muscle of the duodenum

Question 36

In what position is the fundus of the stomach filled with Barium

supine
prone
lpo
rao

Answer 36

LPO