Term 3 mock exam

Question 1

1. A patient arrives for a CXR.

a. Name TWO (2) ways to ensure full inspiration is achieved on a CXR.

Answer 1

Discuss the instructions with the patient first, letting them know it is important

• Practice the breath in with the patient
• Watch the patient so you expose at the correct time

Question 2

Identify TWO (2) ways to check whether a patient is rotated on a PA CXR image.

Answer 2

• The ribs should appear symmetrical
• The medial end of the clavicles should be equidistant from the midline
• The distance from the lateral border of the vertebral column to the costal margin should be equal

Question 3

The request form states ‘CXR – PA AND LATERAL VIEWs please’. Provide a clinical indication that would be expected to be written on the request form (.5) and explain the reason why a lateral view is justified to be performed

Answer 3

Oncology reasons – see mets. behind the lungs

Mass on a particular lung (R/L)– close to ID

Question 4

. You are looking at a lateral chest image. List THREE (3) ways to judge whether the positioning of the lateral was acceptable:

Answer 4

For a true lateral projection the ribs should appear superimposed posteriorly

- The apices and bases should be included (lean the patient forward to include posterior bases) 
- The humeri should be elevated so that there is no soft tissue overlap from the arms.
- the midsagittal plane should parallel to the IR, no cupping seen of the thoracic vertebra

Question 5

What is COAD?

Answer 5

Chronic obstructive airways disease

Question 6

What is LVF?

Answer 6

Left ventricular failure

Question 7

What is PE?

Answer 7

Pulmonary embolism or pleural effusion

Question 8

What is CABG?

Answer 8

Coronary artery bypass graft

Question 9

On a patient’s request form the Doctor has requested an Abdomen X-ray.

a. State TWO (2) clinical reasons which justify this projection

Answer 9

? Obstruction

Pain ? cause

Question 10

Suggest an average adult exposure for a KUB X-ray, a kVp (.5) and a mAs (.5) value.

Answer 10

70 - 85 kV, and 20 - 35 mAs

Question 11

Your next patient has arrived on a bed for a knee X-ray after their surgery. On the referral form the clinical indications states ‘Post op TKR’

a. Define the abbreviation TKR

Answer 11

Total Knee replacement

Question 12

When positioning the patient for an AP Knee projection, suggest ONE (1) positioning consideration you will apply when you are manoeuvring the man’s leg to ensure that the knee is in a true AP position?

Answer 12

The condyles of the knee should be equidistant from the table top.
The patella should be centralised.

Question 13

You are working in the Orthopaedic department and your next patient is an adult for an Elbow X-ray. The clinical indications states the following ‘Fell onto R elbow. Pain over olecranon’

a. Justify your choice of which X-ray projection would you perform first

Answer 13

Lateral first. More comfortable for patient to begin with as painful over the olecranon

Question 14

Describe the key points of positioning for an elbow lateral view, including the centre point (.5) and central ray (.5)

Answer 14

Sit the patient alongside the table, with the table raised so that the elbow is level with the shoulder (.5) and the elbow is flexed 90deg (.5). Position the film under the elbow and turn the wrist true lateral (if patient able to) and ensure the epicondyles of the humerus are superimposed (.5). CR should be perpendicular centred to the elbow joint (.5) which is 4cm medial to the olecranon process (.5)

Question 15

Briefly discuss why is it important to include both the ankle and knee joints when the request card suggests ?# tibia.

Answer 15

With some fractures of the distal tibia there may also be a fracture of the proximal fibula as these bones articulate in a ring formation

Question 16

You are imaging the tibia and fibula of a tall patient. Suggest two methods that would increase your chances of including both joints on one image.

Answer 16

Increase the FFD

Turn the cassette on a diagonal

Question 17

You are working in ED when an 80 year old male arrives in the department. The request form states “Fall. Valgus deformity L Hip ?# NOF”

Name TWO (2) views you would take on this patient (2 x .5) and how will a valgus deformity affect your positioning?

Answer 17

AP Pelvis ASIS down
Cross table lateral hip

This means you will not alter the position of the affected leg to risk further damaging the hip and blood vessels (.5). This is of particular importance for the AP pelvis as you will not medially rotate the leg (.5)

Question 18

What is valgus deformity (.5) and write in full what the pathology is likely to be demonstrated on the images

Answer 18

Valgus deformity: The hip and foot will be turn out laterally.
This is a classic sign of hip fracture - Neck of Femur #

Question 19

Suggest ONE (1) method you would use to check that the correct exposure was used for producing diagnostic images of a hip fracture.

Answer 19

EI – within range
Cortical outline of femoral shaft and soft tissue
Bony trabecular pattern

Question 20

A 18 year old female presents to the Radiology Department with an injury to base of thumb. Her GP has requested for her to have routine thumb X-rays with the clinical indications stating ‘Injured thumb yesterday. ++++ swelling ? Base of thumb #’.

a. Name a pathology that involves a fracture at the base of the thumb that would be likely to be demonstrated on the images taken

Answer 20

Bennett’s fracture

Question 21

. As well as checking the patient’s name, DOB and that the correct anatomy has been requested to be X-rayed, what should you also check with the patient?

Answer 21

Pregnancy check / LMP

Question 22

With the swelling around base of thumb, name the views that you take to complete the examination (2 x .5) and justify why you would chose to perform these to complete the examination answering the clinical indications

Answer 22

PA and lateral views (1 mark)
PA and too sore for AP (plus swelling – hard on patient to bring dorsal aspect of hand on ID)
Lateral – to show base of thumb in 2 planes – more information of base of thumb fracture if present

Question 23

A young man arrives in the Radiology department for imaging of his left shoulder from a sporting injury with querying a dislocation.

a. Explain the differences in positioning and image appearance of an AP Shoulder to the Grashey’s method.

Answer 23

The most commonly employed AP method requires a 15 degree rotation towards the affected side so that the body of the scapula is parallel to the cassette and there is a 1/3rd overlap of humeral head on the glenoid fossa

The Grashey’s method, however, uses a 45 degree posterior oblique rotation so that the Glenohumeral joint is open (glenoid rim in profile)

Will accept true AP description with half overlap of humeral head on glenoid.

Question 24

Describe the key points of positioning for a shoulder Lateral Y view, including the patient positioning technique (2 x .5), central ray (.5) and centre point (.5)

Answer 24

Erect in an anterior oblique position in front of the upright bucky
MSP 45-60degrees in relation to the IR- medial border of scapula and acromion process should align
CR perpendicular to the midpoint of the medial scapula

Question 25

On the shoulder Lateral Y view image the scapula is not demonstrated in true lateral position and the coracoid process is projected over the rib cage. Explain how this would be corrected for a repeat projection.

Answer 25

The patient must have been over rotated (e.g. greater than 60 degrees) so for the repeat image the patient should be angled less steeply such as 45 degree RAO

Question 26

The report states ‘Anterior dislocation’. Identify TWO (2) image appearances that would demonstrate this pathology on both an AP and lateral Y view images of the shoulder

Answer 26

On the Y view the humeral head no longer aligns over the glenoid fossa and is demonstrated under the coracoid process

On the AP view the humeral head is low in comparison to the glenoid fossa and is positioned more over the ribs

Question 27

A 70 year old patient is referred to have routine Thoracic spine X-rays due to complaining of worsening pain between the shoulder blades

a. Justify why you will ask the patient to take a deep breath in and hold their breath for both Thoracic spine X-ray images

Answer 27

Lungs are black – length provides better contrast of the spine

Question 28

When viewing a Lateral Thoracic spine X-ray image, discuss how you will assess the image appearances for rotation

Answer 28

Perfect square vertebrae

No double borders

Question 29

Identify a pathology that may be demonstrated on a Lateral Thoracic spine X-ray image

Answer 29

OA: Osteophytic lipping in the upper thoracic spine

Question 30

. A 35 year old woman is requiring a Lumbar spine X-ray due to falling off her horse.

a. Outline the benefits of PA Erect position for images of the Lumbar spine.

Answer 30

• Erect views of the spine are weight bearing and therefore demonstrate the natural curve or posture for the patient
• PA provides good radiation protection as the gonads sit anteriorly and receive less dose
  OR The diverging rays are also more likely to open up the SI joints and the intervertebral disc spaces with the patient in a PA position
• Will also accept ease of positioning as you can palpate the spine in PA position.

Question 31

Discuss TWO (2) key points of advice for gaining an optimal lateral lumbar spine image. Your points may relate to positioning or exposure.

Answer 31

Any two:

• Ensure the MSP is parallel to the table top, by placing a sponge under the waistline (esp. for women)
• Use lead strips behind the spine to absorb scatter
• For true lateral ensure shoulders and hips superimpose, so the plain of the back is perpendicular to the table top
• Any other answer that relates well to the question
• Take the lateral lumbar image on expiration to ensure that the lung fields are well clear of the upper lumbar vertebrae.

Question 32

You are rostered to the Emergency Dept, while the CT machine is down for maintenance. An elderly gentleman is referred for a skull bones series after falling down a staircase. He has a large haematoma over base of skull.

a. Name the X-ray projections used within your clinical centre to complete the examination

Answer 32

Occipital Frontal
Townes
Lateral skull

Question 33

On the lateral skull view fluid is seen within the sphenoid sinus. What could this be indicative of?

Answer 33

Base of skull fracture

Question 34

Describe the key points of positioning for the following supplementary views, including the patient positioning technique (2 x .5), central ray (.5) and centre point

a. Sternoclavicular obliques

Answer 34

Patient stands PA erect. The oblique with the affected side in contact with the IR is demonstrated best although both obliques are done, 10-15 degrees anterior oblique with CR perpendicular to the sternal notch

Question 35

b. Describe the key points of positioning for the following supplementary views, including the patient positioning technique (2 x .5), central ray (.5) and centre point

AP Lower Ribs

Answer 35

Supine, true AP with shoulders and hips equidistant. CR15-20 degrees cephalid. Centre with iliac crests at the bottom of the IR to show ribs 8-12

Question 36

Describe the key points of positioning for the following supplementary views, including the patient positioning technique (2 x .5), central ray (.5) and centre point
c. Oblique Sacroiliac Joints

Answer 36

Supine posterior oblique, rotate the patient 15-25 degrees. CR perpendicular to a point 2.5cm medial to the ASIS on the raised side, which is of interest.

Question 37

A patient arrives in the department for C spine X-ray imaging.

a. Describe THREE (3) key positioning criteria for when positioning the patient for an AP C. spine (3 x .5). Also add the Centre point (.5) and Central Ray

Answer 37

CP: C4
CR: Direct 15 degrees to 20 degrees cephalic level of the lower margin of the thyroid cartilage

Positioning: 
Patient Erect or supine
Align MSP to CR and midline of IR
Chin raised – mandible and occiput aligned with CR
No rotation

Question 38

You are positioning the patient for a lateral cervical spine projection. Provide TWO (2) methods that you will incorporate for improving the visualisation of the C7-T1 junction

Answer 38

Ask the patient to relax their shoulders as far down as possible
Give the patient weights (if they have not had a traumatic injury)
Expose on expiration

Question 39

A patient arrives in the department for C spine X-ray imaging.
c. Provide a clinical indication that is a valid justification for flexion and extension views

Answer 39

Whiplash

Ligament disruption